Step 6: Implementation

Step 6: Implementation

The consideration and planning in Steps 4 and 5 should have helped you identify some of the steps you need to take to implement your chosen LTSS model in your community. This implementation checklist can help you get a clearer view of certain aspects of your program.

Implementation Checklist

Based on your unique plan, you may wish to add action items to this list or break items down into smaller steps.


  • Ensure that your program can bill for its services
    • Review and update billing codes
    • Determine whether a tribal resolution is required for these changes
  • Discuss funding opportunities with your tribe
    • Does your tribe plan to fund or help fund your program?
    • If so, does the tribal budget set aside money for this type of program?
  • Discuss reimbursement rates with state Medicaid officials


  • Work with your tribe to find a space where you can build, renovate, or lease


  • Meet requirements of accrediting agencies
    • Which accreditation agency do you need to work with? (This is based on the type of facility you have.)
    • What steps do you need to take to meet the requirements of your accreditation agency?
  • Submit application to gain or renew accreditation


  • Recruit, hire, and train staff
    • Do your staff members need certain trainings or certifications for your program to meet its accreditation requirements?
  • Contact any outside providers that you would like to contract with

Program Development Resources

The following national organizations can assist with tribal LTSS programs. Some national programs may have initiatives geared toward working with tribes.

Certification for Medicare and Medicaid

There are many kinds of certification that facilities and programs can apply for. Certification through CMS for Medicare and Medicaid is an important step in developing an LTSS program.

Accreditation is often a lengthy process. Be sure to plan on spending plenty of time on this certification and other types of accreditation.

Learn more about Medicare and Medicaid certification—after following the link, check the list on the left for information on different types of services and facilities.

Create a Work Plan

Develop a work plan that shows the activities you need to accomplish and when they should take place.

Sample Work Plan

Strategies for Success

Because the following approaches tend to be ongoing and always changing, they may not be on your checklist, but they are important strategies:

  • Take advantage of existing resources
    • Streamline LTSS services with existing tribal health services
    • Collaborate with other tribes that have similar programs and services
    • Create or improve an elder safety code
    • Start an elder taskforce
  • Communicate often with key stakeholders
  • Build and use partnerships
    • Contract with other tribal and nontribal providers

After implementing an LTSS program, it is important to evaluate how well it works, whether it meets the goals you set for it, and how it benefits community members. Proceed to Step 7.

Page Last Modified:
09/06/2023 04:57 PM