Physical Disabilities & Aging

The Wolf Administration is committed to serving more people in the community while giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. CHC rolled out in the Southwest region on January 1, 2018.

CHC was developed to: (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. Long-term services and supports help eligible individuals to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.

Please see this online document that describes how CHC works in coordination with Medicare.

The document is available in alternate format upon request by contacting the Office of Long-Term Living, Bureau of Policy and Regulatory Management, at 717-857-3280. If you have any questions, please visit the HealthChoices web page or submit comments via email.

The Office of Long-Term Living issued guidance to Service Coordinators and Direct Service Providers  regarding the reporting of critical incidents for the Southwest Pennsylvania Counties. Please note the two texts below.

FOR SERVICE COORDINATION ENTITIES
This communication is to service coordinators of Office of Long-Term Living (OLTL) participants in the 14 Southwest Community HealthChoices (CHC) counties. Service coordinators are required to submit critical incidents according to OLTL’s critical incident management bulletin; however, OLTL is making a time-limited change in the incident submission process in order to ensure all service coordinators in these 14 Southwest CHC counties receive necessary Enterprise Incident Management (EIM) user IDs for each CHC-MCO.

Do not submit incidents for CHC-MCO participants using your fee-for-service user IDs in EIM. Instead, please work with the CHC-MCOs and submit incidents to them directly until you receive your user IDs that will allow you to submit an incident in EIM which will be directed to the relevant CHC-MCO.

If you have not already received a user ID from UPMC or PA Health and Wellness, please contact them directly to receive more information on how they want you to submit incidents to them in this interim period.

At this time, AmeriHealth Caritas will be utilizing this RA email box for service coordinator submission of critical incidents. If you have questions about this information, please contact OLTL at 717-787-8091.

FOR ALL DIRECT SERVICE PROVIDERS
This communication is to Direct Service Providers of Office of Long-Term Living (OLTL) participants in the 14 Southwest Community HealthChoices (CHC) counties. Direct Service Providers are required to submit critical incidents according to OLTL’s critical incident management bulletin. Currently, providers serving participants in the ‘under-60’ waivers submit incidents into the EIM System, and Aging Waiver Direct Service Providers submit critical incidents into an RA-incident email box.

With the implementation of CHC on January 1, 2018, in 14 Southwest counties, all OLTL Direct Service Providers will now submit critical incidents into EIM for participants enrolled in CHC. Aging Waiver providers will no longer submit critical incidents to an RA email box if the participant is enrolled in CHC.

Please work with the CHC-MCOs to receive training to use the EIM system. Please note: Direct Service Providers will need to select the “search for CHC participants” checkbox when creating incidents in EIM for CHC participants.

Direct Service Providers serving participants that are NOT in the current 14 Southwest CHC counties (listed below), and NOT enrolled in CHC, must continue to submit critical incidents into EIM for the ‘under 60’ waivers, and Aging Waiver providers must continue to submit critical incidents to the RA incident email box until further notice.

CHC counties — Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington, and Westmoreland. If you have questions about this information, please contact OLTL at 717-787-8091.

The Social Security Advisory Board (SSAB) has released a report this month outlining recommendations on how to strengthen the Representative Payee Program of the Social Security Administration (SSA). This report is the result of a two-year study of the current Representative Payee Program serving more than 8 million vulnerable beneficiaries/recipients, including children and adults.

The five section report includes short-term recommendations to SSA and Congress, and also advocates for the Office of Management and Budget to pursue long-term structural changes which will involve comprehensive government-wide coordination efforts and cross-agency reforms. More information, as well as a link to the full report, is available on the SSAB website.

In February 2017, RCPA launched the Physical Disabilities and Aging Division to provide members with information, networking, and opportunities to access Pennsylvania Legislators and Administration. This division advocates for all HCBS services funded by the Office of Long-Term Living (OLTL) and Department of Aging, including service coordination, personal assistance, brain injury, community integration, and employment and vocational services to name a few. It has been a year of significant action and with your support, RCPA is now considered one of the leading associations in the services you provide. Here are some highlights of the past year and why you want to engage even more:

  • The Secretaries of the Department of Human Services and Department of Aging, as well as the Deputy Secretaries from the Office of Long-Term Living and Office of Medical Assistance Programs, presented at the RCPA Conference, providing members the opportunity to get to know the leadership at the state level and to network with them on a one-on-one basis.
  • Quarterly meetings have included leadership from the Community HealthChoices (CHC) Managed Care Organizations (MCOs), with two of them providing in-depth presentations on policies and rollout of this program.
  • RCPA has established monthly meetings with the leadership of OLTL, providing an opportunity to represent our members’ challenges and to advocate for regulatory changes.
  • RCPA facilitated and continues to provide access to trainings to meet the regulations for newly announced OLTL employment services.
  • A new track was added to the annual conference, offering members sessions addressing changes in regulations, nursing home transition, and value-based payments, with the opportunity to earn continuing education credits.
  • RCPA leadership participates in weekly calls with OLTL as CHC is being rolled out to bring forth key issues to be addressed by OLTL and the MCOs.

As we look forward to the year ahead, the need will continue to broaden the horizons of what we share. This begins with the meeting on February 22, 2018, when we will facilitate networking and a focus on aging during lunch. Teresa Osborne, Secretary of the Department of Aging and Rebecca May-Cole, Executive Director of the Association of Area Agencies on Aging (P4A), will present updates and their perspectives on the single largest group served in the Commonwealth. We will also discuss the leadership structure and future meetings of this division.

Your involvement and engagement is vital to meeting the needs you have in these services. We look forward to seeing you at the meeting on February 22. Please Register Here.

The Department of Defense (DoD) published the final rule, TRICARE; Reimbursement of Long Term Care Hospitals and Inpatient Rehabilitation Facilities, in the December 29, 2017 Federal Register. This final rule finalizes the changes in the inpatient rehabilitation facility (IRF) payments from the proposed rule that was published back in 2016 and establishes TRICARE inpatient care reimbursement methodologies and rates similar to Medicare. Currently, IRFs are exempted from the TRICARE diagnosis related group (DRG) based payment system and paid by TRICARE at the lower of a negotiated rate or billed charges.

 

To reduce the burden from sudden significant reductions on the IRFs, the final rule includes a gradual transition from TRICARE’s current policy of allowing 100 percent of allowable charges (either the billed charge or voluntary negotiated rate), by phasing-in the Medicare IRF prospective payment system (PPS) rates as follows:

  • Allowing 135 percent of Medicare IRF PPS amounts in the first 12-month period after implementation (estimated reduction of $24M);
  • 115 percent in the second 12-month period after implementation (an estimated reduction of $41M); and
  • 100 percent in the third 12-month period after implementation (an estimated $57M).

The DoD will apply the FY 2019 IRF PPS for purposes of the 12-month period beginning on October 1, 2018, and follow any changes adopted by the Medicare IRF PPS for subsequent years. The provisions in the final rule become effective on March 5, 2018.

The Office of Long-Term Living (OLTL) is offering a webinar on the topic of the Pennsylvania ABLE Savings Program. A PA ABLE account gives individuals with qualifying disabilities (eligible individuals), and their families and friends, a tax-free way to save for disability-related expenses while maintaining government benefits. Federal and state law authorized the creation of PA ABLE accounts. Please join Ryan Buxton, Program Representative from the Pennsylvania Treasury Department, who will conduct the webinar.

OLTL Service Coordinators and Direct Service Providers are strongly encouraged to participate in this webinar that will help you understand the ABLE Program and how it can benefit the OLTL participants you serve.

The webinar on PA ABLE is scheduled as follows:
Wednesday, January 17, 2018, from 1:00 pm – 2:00 pm.

Please register online here. After registering, you will receive a confirmation email containing information about joining the webinar.

If you have questions regarding this email please contact Edward M. Butler, OLTL, at 717-214-3718 or via email.

Today the Office of Long-Term Living (OLTL) issued guidance to service coordinators providing services to waiver participants residing in the Community HealthChoices (CHC) Southwest Zone (Zone 1) in their caseloads. The information was copied to providers of waiver services in Zone 1 as well.

The frequently asked questions includes the following statement: The current Service Authorization Form (SAF) that is in place remains effective through the continuity of care period.

OLTL has made available SCE update and resource documents regarding continuity of care, and HCSIS and SAMS service plan updates, for waiver participants in the Southwest Zone who are transitioning to CHC on January 1, 2018.

The following information is available:

  • Letters describing actions that SCs can take to address service plan changes in HCSIS and SAMS.
  • Flow-charts that illustrate the HCSIS or SAMS service plan changes.
  • An EVS resource

OLTL notes that participants residing in Zones 2 through 5 enrolled in any other waiver (Attendant Care, Independence, or OBRA) will not have enrollments, services, or plans automatically end-dated at this time.

If you have any questions, or to request the attachments in alternate format, please call the OLTL Participant Helpline at 800-757-5042 or send an email.

The Department of Human Services has been working in collaboration with Managed Care Organizations (MCOs), county oversight organizations, and RCPA regarding the concerns and challenges with implementing federal Ordering, Referring and Prescribing (ORP) requirements by the January 1, 2018 deadline. The Department of Human Services has informed RCPA of the following:

  • The ORP requirements for Fee-for-Service continue to apply; i.e., allORP practitioners must be enrolled in the Pennsylvania Medical Assistance (MA) Program or the rendering provider will not be paid.
  • In the HealthChoices managed care delivery system, if a rendering network provider submits a claim to an MCO with the National Provider Identifier (NPI) information that results in edits identifying that the non-networkORP is not enrolled in MA, the claim can be paid. However, if the non-MA enrolled ORP has a high volume of claims, the MCO will work with the network provider and non-MA enrolled ORP to have them enroll in MA or work to transition the member to an enrolled MA provider.

Contact your contracting BH-MCO for additional information.