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Long-Term Services and Supports (LTSS)

The principles of choice, personal autonomy, and community integration are at the core of our model of care.

For reading on the go or to share with a colleague, download our printable LTSS brochure (PDF).

AmeriHealth Caritas is committed to helping people with disabilities and people who are aging to live in, participate in, and contribute to their communities. This aligns with our mission to help people get care, stay well, and build healthy communities.

We believe that everyone — regardless of age, income, or ability — has the right to make choices that affect all aspects of their lives.

What is LTSS?

LTSS help qualifying individuals who have functional limitations receive help in state approved settings with certain activities of daily living, such as:

  • Bathing.
  • Eating.
  • Dressing.
  • Using the bathroom.
  • Doing laundry.
  • Shopping.
  • Getting to appointments.
  • Taking medication.

What is a waiver?

A waiver is an option that allows state Medicaid agencies some flexibility in the delivery and payment of certain health care services under federal guidelines. One type of waiver — home and community-based waivers — allows for the provision of LTSS in home and community-based settings.

The services, commonly known as home and community-based services (HCBS), are covered by Medicaid for eligible persons under the waiver. HCBS address the social needs of individuals by supplementing and supporting their medical treatment received through the health plan. HCBS also address the functional limitations of individuals to help provide for their health and welfare, and to support their quality of life.

HCBS may include:

  • Adult day health.
  • Personal care services.
  • Personal emergency response services.
  • Respite care.
  • Transition services.

How to identify a member who might need LTSS

If you recognize a member with a special, chronic, or complex condition, who may need assistance with activities of daily living, or who:

  • Had a recent or has frequent hospitalizations or emergency room visits.
  • Is unable to access health services because of physical or behavioral health concerns.
  • Received or is currently receiving in home:
    • Physical therapy.
    • Oxygen.
    • Occupational therapy.
    • Nursing services.

You can refer the member by contacting us directly and our Care Coordinators can help you.

Integrated health care management model

Care coordination is integral to helping navigate the process for individuals who require LTSS. Coordinating care can be complicated, but we understand the importance of ensuring that appropriate services are in place to meet the individual's needs and preferences.

A service coordinator is assigned to work with the individual, and the individual's family, guardian, and/or caregiver and key LTSS providers to determine the appropriate services. Needed medical and social services are identified, coordinated, and monitored through a person-centered plan of care, developed in collaboration with the individual.

Member care team

In addition to a care team offered through the individual's Medicare and Medicaid managed care plan, he or she will also be assigned:

  • A service coordinator who will work with the individual, family, and the medical care teams to coordinate services.
  • A resource coordinator who will work with the individual’s care team to access identified LTSS services and furnish assistance in identifying providers, accessing services, working through issues or concerns, and helping to ensure the individual receives quality services.
  • A Care Connector who will provide telephonic support, including appointment scheduling.

Care plan

Our model incorporates an individual-based decision support system that drives both communication and care plan development. The care plan is developed by the individual, with the support of the individual's family or guardian, service coordinators, caregivers, and key LTSS providers.