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Managed Long Term Services and Supports (mLTSS) Update

Posted Aug 3, 20211 min Read

Payment & Reimbursement

IHCA continues to actively participate in the three mLTSS Finance workstreams:  Nursing Facility Base Rate, Upper Payment Limit (UPL) and Value Based Purchasing (VBP).   Please find a summary of the most recent meetings below.  You can find more details and the meeting presentations on our website at this link:


  • Base rate: The second Nursing Facility Base Rate Workstream meeting took place on July 15, 2021.  The meeting focused on the Direct Care component of the reimbursement rate, Case Mix Adjustment of Direct Care, and four alternative models for rate setting that could be considered. The main alternative to the current system that was discussed was a modified price based system that includes a Case Mix Adjusted Direct Care component that would be rebased every 3-5 years, with an annual inflation index.
  • UPL: During the second Nursing Facility UPL Workstream meeting on July 8, 2021, Milliman presented options on how supplemental payments, such as the UPL, can be paid to providers under a managed care program.  It appears likely that a directed payment system will be used in the initial contract years with the managed care entities.
  • VBP: At the VBP Workstream meeting on July 22, 2021, Milliman presented a deep dive analysis of nursing facility performance for the current VPB components and identified options for potential changes to the program.  The goals would be to reward for improvement over time, as well as actual performance measures; add measures that more broadly reflect quality of care; account for the impact of serving residents with behavioral and more complex needs; and more closely align the payment timing to the measurement period.

About the Author

Elizabeth Eichorn