Physical Disabilities & Aging

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.

In order to promote improved coordination between Medicare and Medicaid as the rollout of Community HealthChoices (CHC) in the Southeast portion of the state gets closer, the Office of Long-Term Living (OLTL) released a CHC Medicaid/Medicare billing fact sheet. The fact sheet includes information and answers to frequently asked questions (FAQs) regarding coverage and how billing works under CHC.

Contact Melissa Dehoff with questions.

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.

November 15 is Pressure Injury Prevention Day. ODP Medical Director Dr. Gregory Cherpes, MD released a Health Alert with important information for those who provide care to individuals at risk of developing pressure injuries.

The skin is the largest organ of the body. Skin protects the body by creating a barrier to the environment, regulates the body’s temperature, supports peripheral circulation, and helps maintain fluid balance. Skin also is a reservoir for the formation of Vitamin D. The nerves in the skin provide sensations that detect changes in the environment such as heat, cold, touch, and pain. The skin is made of two layers, the epidermis and dermis, which cover the underlying tissues, muscles, and bones. “Skin integrity” refers to the intact, unbroken nature of healthy skin. Open wounds to the skin, such as those that occur with pressure injuries, make an individual more vulnerable to infection, sickness, and death.

This document provides information defining pressure injuries, why prevention is important, who is at risk of developing pressure injuries, signs and stages, treatment, and prevention of these injuries.

Due to the serious nature of pressure injuries, the pain associated with these injuries, and the additional conditions that may result from pressure injuries, prevention and immediate action at the first sign of pressure injuries are of utmost importance. In addition to skin, muscle, and bone loss, bacteria entering the sore can cause infection. In some cases, infection in the tissue can lead to bone infection, also called osteomyelitis. Infections can worsen and result in sepsis (when infection enters the blood), which can lead to shock and even death.

IMPORTANT: Notify the health care practitioner (HCP) if there are concerns for a pressure wound. Because pressure injuries can have many different appearances, the HCP should be alerted to any skin changes that are noted, particularly in areas at risk for pressure injury. Notify the HCP at the first sign of redness that does not resolve within 15 minutes after relieving the pressure.

ODP issued Communication Number 099-18: Requesting an Enhanced Communication Rate for Services for Individuals Who Use Sign Language. This communication provides a process for providers to request an enhanced communication rate for Consolidated, Person/Family-Directed Support (P/FDS), and Community Living Waiver services for individuals who use Sign Language to communicate. The Harry M settlement agreement was approved by a federal court judge on August 20, 2013 to ensure Pennsylvanians are provided with necessary communication assistance services based on their assessed needs. The enhanced communication rate is available for services for individuals who are enrolled in the Consolidated, P/FDS, and Community Living waiver from providers who have signing staff to serve individuals who use Sign Language to communicate.

An enhanced communication rate is available for the following services:

  • Companion Services
  • In-Home and Community Supports
  • Older Adult Daily Living Centers
  • Community Participant Support (CPS)
  • Small Group Employment
  • Benefits Counseling
  • Supported Employment to include: Career Assessment, Job Finding and Development, Job Coaching and Support
  • Advanced Supported Employment to include: Discovery Profile Outcome, Job Acquisition Outcome, Job Retention Outcome
  • Respite
  • Supports Broker Services
  • Housing Transition and Tenancy Sustaining
  • Residential Habilitation
  • Shift Nursing RN
  • Shift Nursing LPN
  • Behavioral Supports
  • Communication Specialist
  • Therapies to include: Physical, Occupational, Speech/Language, Orientation, Mobility, and Vision
  • Music Therapy
  • Art Therapy
  • Equine Assisted Therapy
  • Consultative Nutritional Services
  • Family Caregiver Support Counseling (with participant present)
  • Supplemental Habilitation
  • Supported Living
  • Life Sharing

Providers who wish to request an enhanced communication rate must complete the Enhanced Communication Rate Request Form and submit the completed form to: ODP’s Deaf Services Mailbox. The Enhanced Communication Rate Request Form can be accessed at MyODP.

The following documentation must be provided in addition to the form:

  • Certificates of completion for the Harry M web-based training
  • Quiz on Harry M training (sent to the provider once the request for the enhanced rate is made)
  • Video of signing skills (sent to the provider once the request for the enhanced rate is made)

Following receipt of a provider’s request, ODP will review the information submitted and determine whether the provider is eligible for the enhanced communication rate. The provider will be notified of ODP’s decision following the review. If additional information or discussion concerning the request is required, ODP will reach out to the contact persons identified on the Enhanced Communication Rate Request Form.

Questions about the contents of this communication may be directed to the ODP Deaf Services Mailbox. This communication obsoletes ODP Announcement 002-17, Requesting Enhanced Communication Residential Habilitation Rates for Harry M Class Members.

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.