Authors Posts by Richard Edley

Richard Edley

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Dr. Richard Edley is the lead executive for RCPA and is responsible for all aspects of operations and direction for the association. His professional career began in 1988 and most recently he was president and CEO of PerformCare/Community Behavioral HealthCare Network of Pennsylvania, Inc., a national, full-service, behavioral health managed care organization.

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RCPA will be holding an Open Board/General membership meeting on Wednesday, December 12, 2018, 10:00 am – 12:00 pm. This meeting is also available by webcast if you are unable to attend in person. If you were considering attending, please review the agenda and register here.

We look forward to your participation. If you have any questions, please contact Tina Miletic.

All Community HealthChoices (CHC) participants have access to emergency and non-emergency medical transportation.  Emergency medical transportation is provided by an ambulance in the event of a medical emergency. Non-emergency medical transportation can help participants travel to and from a medical facility, doctor’s office, hospital, clinic, pharmacy, or medical equipment vendors.

The attached fact sheet outlines transportation options and how transportation is billed and coordinated for CHC participants based on where the participant resides and the type of transportation needed.

CHC goes live January 1, 2019 in the Southeast. To learn more about CHC, take the 30 minute online training. If you have any questions, please visit www.HealthChoices.pa.gov or email RA-PWCHC@pa.gov.

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

OLTL outlines the requirements for Electronic Visit Verification (EVV) roll out and the services impacted by it. EVV is required by Managed Care Organizations (MCOs) in the Community HealthChoices SW and SE roll out zones, effective January 1, 2019.

Electronic Visit Verification (EVV) Implementation Update:

The 21st Century Cures Act requires implementation of EVV for personal care services (PCS) and home health services.  For Office of Long-Term Living (OLTL) waivers, including agency and participant-directed services, PCS includes:

  • Personal Assistance Services
  • Respite (unlicensed settings only)

As shared previously, the Department of Human Services (Department) will utilize an open system for EVV.  This means that providers who already have an EVV system will be able to use their existing systems to submit information to the Department’s EVV vendor.  The Department is using the existing PROMISe™ fiscal agent contract with DXC for EVV.

Providers who do not have their own EVV system will be able to utilize the Department’s system for compliance. Providers participating in Community HealthChoices (CHC) can also reach out to the CHC-MCOs they are contracted with to discuss potential opportunities to meet compliance requirements with the CHC-MCO- contracted EVV system, HHAeXchange.

For participant-directed programs in the OLTL waivers, the vendor fiscal agent, Public Partnerships, LLC (PPL), will be utilizing their EVV system, Time4Care, to satisfy EVV requirements.

EVV Implementation Timeline Reminder:

The 21st Century Cures Act requires implementation of EVV by January 1, 2019 for personal care services (PCS).  On July 30, 2018, the President signed a law delaying penalties for implementation to January 1, 2020 for PCS.  The requirement for implementation of EVV for home health services by January 1, 2023 has not changed.

This delay will allow Pennsylvania an opportunity to extend implementation activities and training, to make sure that providers are fully ready for the implementation of EVV.  The tentative plan for Pennsylvania’s implementation of EVV is:

  • January 2019 – PA guidance will be distributed
  • Spring 2019 – provider training will be offered with phased-in system use
  • Summer 2019 – full implementation of system

Additional information will be shared when it becomes available.  You may also look for information on our website.

For further questions regarding EVV, please email RA-PWEVVNotice@pa.gov.

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With sincere gratitude from all of us at RCPA

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At this point, you’ve probably heard about the move toward value-based payment (VBP) models.

The promise – better quality care at a lower cost. But, what does this mean for behavioral health providers? With all the uncertainty around if, when and how VBP will be implemented, what is the best way to proceed? And, what can you do to influence the policy decisions being made in your state?

Join the National Council on Thursday, November 15 from 2 to 3 p.m. ET for VBP: Adoption Rates, Policy Pitfalls and Provider Readiness to get the answers to these questions and more. During this webinar, speakers will discuss trends and current approaches in adopting VBP models, lessons learned from a state’s past and what behavioral health organizations can do to adopt a culture of value amid uncertainty.

Speakers:

  • Nina Marshall, Assistant Vice President of Healthcare Finance, National Council for Behavioral Health
  • Richard Edley, President and CEO, Rehabilitation and Community Providers Association (RCPA)
  • Echo Shumaker-Pruitt, Vice President of Quality Improvement and Data Analytics, The Mental Health Association of Westchester

Register today and walk away with concrete actions you can take to shape the policy discussions in your state and prepare for VBP.

The PROMISe Eligibility Verification System (EVS) enables providers to determine a participant’s Medical Assistance eligibility and scope of coverage. It is vital for providers to check EVS to verify a participant’s eligibility each time services are provided because a participant’s eligibility is subject to change. EVS methods, inquiries, and response formats will not change with the implementation of Community HealthChoices (CHC).

The attached fact sheet illustrates EVS return codes for participants enrolled in each of the CHC-MCOs and provides examples of the CHC-MCO participant identification cards. If you have any questions, please visit www.HealthChoices.pa.gov or email RA-PWCHC@pa.gov.

To:  Service Coordinators (SC) who serve participants in the Southeast Region
Subject:  SC Training Materials:  Community HealthChoices (CHC) Implementation for Participant-Directed Services

Below are materials from the August 21, 2018 SC training, CHC Implementation and Participant-Directed Services. The purpose of this presentation was to provide information and process updates to SCs on the implementation of CHC for participants who utilize participant-directed services in the Southeast Region, including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

Public Partnerships LLC (PPL) will also complete the following items to assist SCs:

  • Update the PPL Service Coordination Entity (SCE) Training Manual, post it to the PPL website and send it out via the PPL Enrollment Managers.
  • Re-record the training (to eliminate the end-of-presentation Q&A issues) and post it to the PPL website. PPL will notify SCEs that the training is posted to the website when PPL sends out the SCE Training Manual.
  • If PPL receives input from SCEs via the Enrollment Managers, PPL will review comments with the Office of Long-Term Living and CHC Managed Care Organizations to determine a follow-up format for an FAQ document, as applicable. If PPL does create an FAQ, PPL will similarly distribute through the Enrollment Managers and post to the PPL website.

If you have any questions, please contact your PPL Regional Enrollment Manager.

The Office of Long-Term Living (OLTL) is pleased to announce that Public Partnerships, LLC, has been selected as the new statewide Vendor Fiscal/Employer Agent (VF/EA) for Financial Management Services (FMS) for OLTL-administered programs. The VF/EA performs fiscal-related functions for the successful operation of participant direction for multiple home and community-based waivers managed by OLTL. FMS reduce the employer-related burden for participants while making sure Medicaid and Commonwealth funds used to pay for services and supports are managed and disbursed appropriately as authorized. The new contract will begin on October 1, 2018.

If you have any questions regarding this email, please contact the OLTL provider helpline at 1-800-932-0939.

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.