; and (v) a description of barriers to accessing home and community-based services identified by eligible individuals and families of such individuals. (C) Utilization An assessment of the utilization of home and community-based services in the State. (D) Service delivery structures A description of the service delivery structures for providing home and community-based services in the State, including with respect to the use and models of self-direction, the provision of services by agencies, the ownership of service provider agencies, the use of managed care versus fee-for-service to provide such services, and the supports provided for family caregivers. (E) Workforce A description of the characteristics of the direct care workforce that provides home and community-based services, including the number of full- and part-time direct care workers, the average and range of direct care worker wages, the benefits provided to direct care workers, the turnover and vacancy rates of direct care worker positions, the membership of direct care workers in labor organizations or professional organizations, and the race, ethnicity, and gender of such workforce. (F) Payment rates A description of the payment rates for home and community-based services, including when such rates were last updated, an assessment of the extent to which authorized services are not delivered as a result of such rates being insufficient, and the extent to which payment rates are passed through to direct care worker wages. (G) Quality A description of how the quality of home and community-based services is measured and monitored, including how the State uses beneficiary and family caregiver experience of care surveys to assess the quality of home and community-based services provided by the State. (H) Long-term services and supports provided in institutional settings A description of— (i) the extent to which eligible individuals receive long-term services and supports in institutional settings in the State