Functional Status & Cognitive Impairment Key Predictive Factors Tied To More Accurate LTSS Capitation Rates

Variation in functional status and cognitive impairment among Massachusetts Medicaid beneficiaries needing long-term services and supports (LTSS) are the most influential among 13 predictive factors tied to more accurate capitation rates for Medicaid managed LTSS programs. Functional status encompasses activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Historically MassHealth (the state’s Medicaid program) has paid a fixed per-person capitation rate to its Senior Care Options (SCO) Medicaid managed LTSS organizations. The rate for SCO community-dwelling “nursing-home certifiable” participants is not adjusted to account for varying levels of need and service use . . .