Healthcare worker holding the shoulders of an older man looking out a window

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The COVID-19 pandemic shed light on home- and community-based services needs for older adults, leading to the introduction of several federal proposals for significant policy changes and funding. But addressing gaps in HCBS access and quality is imperative to realizing a vision for a managed Medicaid long-term services and supports model, according to a framework from the National MLTSS Health Plans Association. Expanding services through assisted living is one way to realize that vision, authors say.

The MLTSS Health Plans Association created a framework for states with managed LTSS  programs to ensure that state HCBS systems have a quality provider network and a direct care workforce to meet the needs of older adults and individuals with disabilities in need of services. The framework builds on the association’s initial 2017 recommendations.

Among the recommendations from the group are to ensure that network adequacy is aligned with quality, including requiring state Medicaid agencies to increase standards required of providers to be licensed and credentialed to provide HCBS. This recommendation includes allowing health plans to incorporate additional requirements for provider enrollment and participation in plan networks beyond state licensing requirements.

Promoting quality and building a sufficient supply of HCBS providers, the report states, can be accomplished through state partnerships with health plans, and allowing those plans some latitude in developing new provider options. Indiana and Illinois, for example, apply a “tiered standards” approach to any category of HCBS, introducing new provider options in the areas of assisted living.

“States should allow health plans committed to implementing higher quality metrics / standards for providers to build or increase their network over time in a more methodical way that focuses on the evolving and expanded development of a higher quality provider network and direct care workforce,” the report reads. 

The framework also highlights new models for addressing network inadequacy in rural, frontier and tribal areas. Models for rural HCBS, the report reads, should include compliance standards focused on access, stabilization of providers, and quality outcomes.

The reports spotlights an assisted living pay for performance partnership that managed care organization Inclusa has with Wisconsin’s Residential Quality Program and other ways to recognize providers meeting and exceeding quality standards. 

Wisconsin-based Inclusa focuses on incorporating provider quality, adequacy and capacity measures as part of upgrades. This approach includes feedback opportunities to improve communication, recognition, quality reports and best practice reviews for providers.

The framework also includes recommendations to support the development and capacity of the direct care workforce and to encourage solutions to meet increased demand.