Long term services and supports (LTSS) clinical guidelines are the foundation of a successful LTSS utilization management program. Strong guidelines help health plans drive LTSS programs toward positive outcomes such as consistency in decision making, clinically appropriate services, contained costs and program integrity. The goal is ensuring individuals receive the right service, in the right setting, and at the right time. As the independent living movement continues to advance, more individuals with disabilities are seeking to live in their own homes or within a community setting. As such, there has been an increased demand for LTSS. Increased demand combined with service supports of varying costs and inconsistencies in service delivery across provider types can lead to challenges in LTSS delivery, including inappropriate utilization of services.