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How States Measure MLTSS Performance: Quality, Oversight, and Accountability
MLTSS is expected to do more than simply move long-term services and supports (LTSS) into managed care. States also use these models to improve coordination, strengthen accountability, and support care in home and community-based settings.
June 4, 2026 – Once a state decides to use managed long-term services and supports (MLTSS), determining who the program will serve and how it will be structured, the next question is how the state will know whether the program is actually working. That question matters because MLTSS is expected to do more than simply move long-term services and supports (LTSS) into managed care. States also use these models to improve coordination, strengthen accountability, and support care in home and community-based settings.
That is why measuring MLTSS performance looks different from measuring traditional medical care. A strong program doesn’t just controls costs or processes enrollment efficiently, it also needs to assess members on time, build person-centered care plans, coordinate services across settings, and help people remain safely in their homes and communities whenever possible. But how is that measured and how are plans held accountable? That is what we are going to explore in this blog.
What Good MLTSS Measurement Looks Like
Measuring performance in MLTSS is different from measuring performance in traditional medical care. MLTSS is not designed around short-term episodes alone. It is meant to support people with ongoing functional needs, often across home care, personal assistance, behavioral health, hospital transitions, and other long-term supports. Because of that, states cannot rely only on familiar medical utilization metrics if they want to understand whether a program is actually working.
CMS developed a Long-Term Services and Supports quality measure set that groups measures into areas such as assessment and care planning, falls risk assessment, and rebalancing and utilization. CMS also identifies a core set of MLTSS-focused measures on its managed long-term services and supports page, including Comprehensive Assessment and Update, Comprehensive Person-Centered Plan and Update, Shared Person-Centered Plan with Primary Care Provider, and Reassessment and Person-Centered Plan after Inpatient Discharge.
Those measures are useful because they focus on the practical functions that make or break an MLTSS program. A state can claim that its program coordinates care, but that promise means very little if members are not assessed promptly, if person-centered care plans are missing or outdated, or if those plans are not shared with the providers responsible for day-to-day care. CMS’s technical specifications for the MLTSS measures make that operational focus even clearer.
This kind of framework matters because MLTSS success needs to be able to assess whether people can remain safely in the community, whether transitions after hospitalization are handled well, and whether care feels coordinated instead of fragmented. This is not an easy task, and evaluation and oversight in these types of programs have historically been limited by inconsistent baseline data and a lack of standardized quality measures. A strong MLTSS performance strategy needs to begin with metrics that reflect real member experience rather than treating long-term supports like any other managed care benefit.
States should also pair these process and utilization measures with validated consumer experience tools such as CAHPS, because administrative data can show whether an assessment or care plan exists, but member experience surveys are often better at showing whether care actually felt coordinated, respectful, and useful from the consumer’s point of view.
Why Oversight Matters as Much as Metrics
Performance measurement in MLTSS is also about whether states have the oversight tools to act on what those measures show. Oversight becomes especially important in MLTSS because long-term services and supports are harder to evaluate through claims data alone. States need to know not only whether assessments and care plans are completed, but whether members can actually access services on time, whether provider networks are adequate, and whether plans are responding when care breaks down.
It’s also important to note that data gathering and performance measurement matter only if states use the results to actually improve programs and care. Tennessee is one example, with continuous Quality Strategy updates. In addition, the 2025 TennCare Quality Assessment and Performance Improvement Strategy Report, details how managed care organizations must conduct non-clinical performance improvement projects in long-term care focused on LTSS measures or person-centered planning.
Pennsylvania offers another example. The state’s Community HealthChoices Evaluation Plan includes a seven-year evaluation examining access to long-term care, care coordination, and quality of life, while Pennsylvania also publicly posts a managed care quality strategy and external quality review reports for the program. Together, those efforts show that oversight is most useful when states treat performance data as a tool for ongoing monitoring and improvement rather than simple reporting. Pennsylvania’s approach is often cited as strong because it combines public quality strategy materials, external quality review, and a multi-year CHC evaluation conducted by the University of Pittsburgh. At the same time, advocates may still ask how independent that oversight feels when the evaluation is commissioned by the state itself, which is a reminder that credibility matters just as much as methodology in MLTSS accountability.
Where States Still Struggle and Why That Matters Now
Even with a more standardized measure set, MLTSS performance is still difficult to evaluate in a consistent way. CMS’s FAQ on MLTSS measures explains that the measures are not federally required, although states may choose to require plans to report them. The same document also notes practical challenges with documentation and data collection, especially when assessment and care plan information is recorded inconsistently or spread across multiple systems. CMS recommends that plans map their existing tools to standardized data elements, train staff on consistent documentation, and consolidate data into a central system, which makes clear that having measures on paper does not automatically mean states have clean, comparable information to work with.
There are also limits to what states can measure depending on how their programs are structured. Many MLTSS measures rely on inpatient claims data, which may not be available when an MLTSS plan does not also cover the member’s medical benefit. That matters because it shows how closely performance measurement is tied to program design. A state may want to know whether members are being reassessed after a hospital stay or whether institutional use is declining, but those outcomes are harder to track when data is fragmented across separate delivery systems.
Applying the Model to LTSS
In LTSS, performance measurement should reflect what matters most to the people who depend on these services every day. That means states need to know whether members are being assessed in a timely way, whether person-centered care plans are actually developed and updated, whether services are coordinated across providers and settings, and whether people are able to remain safely in their homes and communities when that is their preference. CMS’s LTSS quality framework points in that direction by emphasizing assessment, care planning, and rebalancing measures that go beyond traditional medical care metrics.
At the same time, good accountability in MLTSS requires states to measure more than what is easiest to count. They need oversight systems that can identify when networks are inadequate, when care coordination is failing, and when members are cycling through hospitals or institutions because community-based supports are not working. That is what makes performance measurement so important to the future of MLTSS. Before states can tie payment incentives to outcomes or claim that managed care is improving LTSS, they first have to show that their programs are delivering timely, coordinated, person-centered support in the places where people want to live.
That is also why consumer experience should not be treated as secondary to operational metrics. Validated tools like CAHPS can help states understand whether people feel heard, whether services are easy to navigate, and whether care coordination is working in practice rather than only on paper.
Advocate’s Perspective
The most important question is not whether a state can capture and report on MLTSS data, but whether it is measuring the things that actually shape a person’s daily life, as well as what consumers actually experience. A high-performing program should do more than meet administrative benchmarks. It should help people get services on time, avoid unnecessary institutional care, remain in their communities, and understand who is responsible for coordinating their support. As states continue expanding oversight and quality reporting, advocates have an opportunity to push for accountability measures that reflect real consumer experience rather than just what is easiest for plans and agencies to count. And while Administrative measures and quality dashboards matter, they do not fully capture whether people can get help when they need it, whether care feels coordinated, or whether they are treated with dignity and respect. That is why validated consumer experience tools like CAHPS are so important.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.
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