Requirements for Home and Community-Based Services

Under managed long-term services and supports (LTSS) programs, contracts commonly require managed care organizations (MCOs) to provide an array of home and community-based services (HCBS).  Some states have procedures meant to incentivize home-based services as an alternative to institutional care (such as nursing facility services).  Services provided in an assisted living facility may be considered home and community-based services, but in some states there is a corresponding requirement that facility services be provided in a way that supports consumers’ dignity and privacy.

Contents – To access the full text, please click each sub-topic.

  • Community LTSS is beneficial by preventing more expensive hospitalizations or nursing facility stays, and by maintaining consumers’ level of functioning: Texas a
  • Consumers cannot be required to enter an alternative residential setting because it is more cost-effective than living at home: Florida b
  • Ensuring no gaps in services: Arizona c
  • Focus on allowing consumers, when appropriate, to reside or return to home versus moving into institutional or alternative residential setting: Arizona d
  • If percentage of HCBS consumers in assisted living exceeds 20%, MCO must take steps to reduce percentage: Arizona e
  • Services to encourage living in community, rather than institution: Massachusetts f
  • Nursing facility disincentive to prevent inappropriate admissions: Texas g
  • HCBS cost generally limited to 202% of nursing facility cost; limit sometimes can be exceeded with excess covered by state general fund monies: Texas h
  • Reducing waiting lists: Hawaii i
  • MCO must submit data indicating status in use of HCBS as alternative to nursing facility care: Hawaii j, Tennessee k
  • MCO must submit data indicating use of HCBS and nursing facilities by members with dementia: Massachusetts l
  • MCO must submit data indicating use of nursing facilities: Massachusetts m

  • MCO must have LTSS team that includes persons responsible for care coordination, network development, provider claims, and quality improvement: Tennessee n

  • Choice of private room, choice of roommate in semi-private room, ability to lock door to living unit, access to telephone, control over daily schedule, unlimited visitation, and snacks as desired: Florida o
  • Personalized quality care, dignity and respect, promotion of individuality, involvement of family and friends in care planning, protection of privacy, and choices in care and life style: New Mexico p

  • MCO must have electronic visit verification system for services provided in consumer’s home: Kansas q, Tennessee r
  1. Tex. Contract, p. 8-125.  (back)
  2. Fla. Contract, Atch II, Exh. 5, p. 35-42.  (back)
  3. Ariz. Contract, 62.  (back)
  4. Ariz. Contract, p. 59-60.  (back)
  5. Ariz. Contract, p. 61.  (back)
  6. Mass. Contract, p. 56.  (back)
  7. Tex. Contract, p. 6-7.  (back)
  8. Tex. Contract, p. 8-137.  (back)
  9. Haw. RFP, p. 143-47.  (back)
  10. Haw. RFP, p. 255.  (back)
  11. Tenn. Contract, pp. 376-77.  (back)
  12. Mass. Contract, pp. 75-76.  (back)
  13. Mass. Contract, pp. 77-79.  (back)
  14. Tenn. Contract, p. 369.  (back)
  15. Fla. Contract, Atch. II, Exh. 7, p. 58.  (back)
  16. N.M. Contract, pp. 65-66.  (back)
  17. Kan. RFP, p. 56.  (back)
  18. Tenn. Contract, pp. 8, 158-59.  (back)

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