Network adequacy standards for home and community-based services (HCBS)—where providers often travel to beneficiaries—must address different issues than acute care network adequacy standards where beneficiaries travel to the provider. Moreover, HCBS, unlike short-term acute care services, may be needed for months and even years. Although in its April 2016 Medicaid managed care rule the Centers for Medicare & Medicaid Services (CMS) directed states to use standards other than time and distance for providers that travel to beneficiaries, CMS did not specify any particular standards states must use.
In June 2016, MACPAC contracted with Health Management Associates to provide a snapshot of the current status of states’ HCBS network adequacy standards. This slide set presents findings from this effort—drawn from reviews of managed care contracts, and interviews with state officials and organizations representing health plans, providers, and beneficiaries—to catalog existing HCBS network adequacy standards and understand how these standards are evolving.
