Managed Long-Term Services and Supports: Assessing Provider Network Adequacy

The decentralized nature of Home and Community-Based Services, and the fact that many HCBS providers travel to an individual’s home rather than service recipients traveling to provider facilities, have presented real difficulties for policymakers and advocates seeking to determine the most appropriate means of measuring network adequacy for LTSS providers. This report outlines multiple options that are available to state policymakers seeking to evaluate network adequacy for HCBS providers under MLTSS programs. It makes the case that not all types of HCBS can be measured by the same types of provider network adequacy standards. In particular, while the bulk of existing LTSS provider network adequacy standards focus on agency providers, self-directed services – which generally rely on an independent provider network – may require new, more innovative approaches to assessing network adequacy. Similarly, there is a marked difference between HCBS providers that come to a member’s home and those that deliver services at a fixed site.