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CHAPTER 4 Functional Assessments for Long-Term Services ...

CHAPTER 4 Functional Assessments for Long-Term Services and Supports June 201668 CHAPTER 4: Functional Assessments for Long-Term Services and SupportsFunctional Assessments for Long-Term Services and Supports Key Points Functional assessment tools are sets of questions about an applicant s health conditions and Functional needs that state Medicaid programs use to determine Functional eligibility for Long-Term Services and supports (LTSS) and to create specific care plans for eligible individuals. The federal government does not require states to use a particular assessment tool to determine eligibility or to develop a care plan. MACPAC s analysis of states Functional assessment tools shows that there are at least 124 tools currently in use. On average, states are using three different tools each, as they generally use separate tools for different populations. States that use managed care plans to deliver LTSS either require plans to use a certain tool or allow them to use a tool of their choosing.

plan. In states with managed long-term services and supports (MLTSS) programs, care plans are developed using either a state-selected tool or— depending on state requirements—a tool chosen by the managed care plan into which a beneficiary is enrolled.2 MACPAC’s inventory of assessment tools shows that there are, at a minimum, 124 tools

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