> For the complete documentation index, see [llms.txt](https://wiki.medicaiddatalearningnetwork.org/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://wiki.medicaiddatalearningnetwork.org/basics/long-term-services-and-supports.md). # Long-Term Services and Supports {% hint style="info" icon="pen-to-square" %} Contributed by [Hyunjee Kim](https://www.ohsu.edu/people/hyunjee-kim-phd) () {% endhint %} ## **Background** About 10% of Medicaid enrollees use long-term services and supports (LTSS), and LTSS accounts for roughly 34% of Medicaid spending. LTSS includes (1) nursing facility (NF) care for long-stay residents and (2) home- and community-based services (HCBS), such as personal care/home-based services, adult day services, assisted living services, and home-delivered meals. All state Medicaid programs are required to cover NF care for long-stay residents. In contrast, HCBS is generally optional and is offered through a mix of authorities and financing mechanisms (for example, 1915(c) waivers, 1115 waivers, state plan benefits, and “money follows the person” demonstrations). Because states use different benefit structures and coding practices, identifying LTSS claims consistently in TAF can be challenging. ## How can we identify HCBS in Medicaid TAF data? There are multiple ways to identify home- and community-based services (HCBS) in Medicaid TAF. For a clear, standardized approach, use [CMS’s TAF Methodology Brief #7061: “Identifying HCBS and the Enrollees Who Use Them in the TAF.](https://www.medicaid.gov/dq-atlas/downloads/supplemental/7061-Identifying-HCBS-in-TAF.pdf) You can start with Table 3 in CMS brief, which outlines a step-by-step (hierarchical) process for flagging HCBS claims, generally beginning with procedure codes and then using other fields (for example, type of service codes, benefit type codes, and FASC codes).
**Note:** In Step 3, the CMS guidance does not specify which `TOS_CD` values to use. As an additional resource, you may consider the `TOS_CD` list provided in the appendix of [this paper](https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.14643):
This study ([Comparing Outcomes Among Medicaid Home and Community-Based Service Users: Private Homes vs. Assisted Living Facilities](https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.14643)) distinguishes HCBS delivered in private homes versus assisted living facilities, which may be helpful if you want to classify HCBS by setting (or identify different types of HCBS). ## How can we identify long-stay nursing facility use in Medicaid TAF? Many studies use the Minimum Data Set (MDS) to examine nursing facility (NF) use. You *can* also use Medicaid TAF - long-term care file when you specifically want NF stays **paid by Medicaid**, and you are comfortable working with claims-based definitions. **Step 1. Identify nursing facility services** Using type of service code (TOS\_CD): 009, 045-047, 059 Apply the algorithm in CMS Methodology Brief #5241, Appendix A, FASC category 6 (Nursing Facility). () **Step 2. Construct NF stays and require at least 100 days** This helps avoid inadvertently capturing short-term/post-acute stays (often referred to as “SNF-like” stays). * Step 2a: Create enrollee NF stays by grouping claims with consecutive or overlapping dates of service (identified in Step 1) by enrollee. * Step 2b: Calculate the length of each enrollee NF stay by subtracting the most recent `SRVC_END_DT` from the earliest `SRVC_BGN_DT`. Select stays that lasted at least 100 days. **Things to consider** * **Validation is limited:** To our knowledge, the completeness of NF claims in TAF has not been formally validated (as of March 5, 2026). This is one practical approach for identifying long-stay NF use in TAF. * **State variation:** How `SRVC_BGN_DT` and `SRVC_END_DT` are coded can vary across states. It is worth doing basic checks across states. --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation dynamically by asking a question. Perform an HTTP GET request on the current page URL with the `ask` query parameter, and the optional `goal` query parameter: ``` GET https://wiki.medicaiddatalearningnetwork.org/basics/long-term-services-and-supports.md?ask=&goal= ``` `ask` is the immediate question: it should be specific, self-contained, and written in natural language. `goal` is optional and describes the broader end goal you are ultimately trying to accomplish on behalf of the user. GitBook uses it to tailor the answer towards what is most useful for that goal. The response will contain a direct answer to the question and relevant excerpts and sources from the documentation. Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.