CurrentAnthemPolicy N/A

Long Term Services and Supports (LTSS)

Describes Anthem's role providing Long Term Services and Supports (LTSS) for Medi-Cal managed care members in specified California counties and summarizes the LTSS program categories (IHSS, CBAS, MSSP, LTC/SNF), services included, and where to find more information or to apply as a provider.

Policy Summary

PayerAnthem

PolicyLong Term Services and Supports (LTSS)

Policy CodePolicy N/A

Change TypeInformational (no material change)

Effective DateN/A

Next Review DateN/A

Key ActionProviders interested in participating with Anthem as an LTSS provider should send a request with contact information to LTSSProviders@anthem.com.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes — brief indicates has_material_change = false.

4LTSS Program Categories Described

3California Counties Mentioned

NoHas material change

Policy summary: Long Term Services and Supports (LTSS)

Anthem was selected by the California Department of Health Care Services (DHCS) and the California Department of Public Health (DPH) to provide Long Term Services and Supports (LTSS) for Medi‑Cal managed care members in Los Angeles, Santa Clara, and Alameda counties. LTSS assist elderly individuals and/or individuals with disabilities with activities of daily living and community supports and may be provided in home, community, or facility‑based settings. LTSS may include programs such as In Home Support Services (IHSS), Community‑Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP), and Long Term Care/Skilled Nursing Facility (LTC/SNF).

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Key terms

In Home Support Services (IHSS): IHSS is a federal, state, and locally-funded program that provides in‑home assistance to low‑income adults who are over 65, blind, or disabled, and to children who are blind or disabled; under the CCI IHSS services will become a managed care benefit in Demonstration counties and individuals will maintain current participant rights.

Community‑Based Adult Services (CBAS): CBAS is an outpatient, facility‑based program that delivers skilled nursing, social services, therapies, personal care, caregiver training and support, meals, and transportation to older persons and younger adults with chronic conditions and/or disabilities who are at risk of needing institutional care.

Multipurpose Senior Services Program (MSSP): MSSP is a 1915(c) home‑ and community‑based Medi‑Cal waiver program that provides care management and the ability to coordinate and/or purchase services such as adult care, housing assistance, personal care, protective supervision, respite, transportation, meals, social services and communication services for Medi‑Cal eligible individuals over age 65 who meet clinical qualifications for nursing facility admission.

Long Term Care (LTC)/Skilled Nursing Facility (SNF): LTC is the provision of medical, social, and personal care services (above room and board) that are needed regularly due to a mental or physical condition and are generally provided in facility‑based settings such as Skilled Nursing Facilities.

Actions for providers

Documentation Required

Provider enrollment interest

Providers interested in participating with Anthem as an LTSS provider should send a request with contact information to LTSSProviders@anthem.com.

Note

County rollout information

For information on the rollout timeline for the counties, providers and members should refer to the program website (WWW_calduals.org) and DHCS website (www.dhcs.ca.gov).

Who and where this applies

Scope and Affected Population

PopulationMedi‑Cal managed care members (elderly and individuals with disabilities)

Counties MentionedLos Angeles; Santa Clara; Alameda

Program CategoriesIHSS, CBAS, MSSP, LTC/SNF

Scope SummaryDescribes Anthem's role providing Long Term Services and Supports (LTSS) for Medi-Cal managed care members in specified California counties and summarizes the LTSS program categories (IHSS, CBAS, MSSP, LTC/SNF), services included, and where to find more information or to apply as a provider.

OpenPayer

Long Term Services and Supports (LTSS)

Policy summary: Long Term Services and Supports (LTSS)

Key terms

Actions for providers

Who and where this applies

Codes and billing

Document history