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Educational Provider Sessions are now scheduled in the Southeast Region to learn about Community HealthChoices (CHC). Several sessions have been scheduled throughout June in various locations.  Targeted provider groups include: home and community-based services, service coordinators and area agencies on aging (AAAs), behavioral health, physical health services, nursing facilities, and transportation providers.

JUNE 4–8 • PHILADELPHIA COUNTY
Temple University, Ritter Hall
1301 Cecil B. Moore Ave., Philadelphia, PA 19122

JUNE 18 • CHESTER COUNTY
West Chester University, Sykes Student Union
700 S High St, West Chester, PA 19382

JUNE 19 • DELAWARE COUNTY
Stay tuned for updates regarding the Delaware location

JUNE 20 • MONTGOMERY COUNTY
Montgomery County Community College, Central Campus
340 DeKalb Pike, Blue Bell, PA 19422

JUNE 21 • BUCKS COUNTY
Bucks County Community College, Newtown Campus
275 Swamp Rd, Newtown, PA 18940

Follow this link for more information and to register.

Background
In administering the Office of Long-Term Living (OLTL) Home and Community-Based Services (HCBS) Waivers, OLTL requires service coordinators to monitor that waiver participants receive all HCBS services authorized in their service plans and to develop a backup plan in case a service could not be provided. If a provider is unable to provide an authorized service, the service coordinator must work with the participant to secure another provider to provide the service as specified in the participant’s backup plan. In addition, service coordinators and providers must report critical incidents, including any occurring as a result of the participant’s failure to receive services which placed the participant’s health or safety at risk, in accordance with OLTL’s Critical Incident Management Bulletin.

Policy
With the implementation of Community HealthChoices (CHC), OLTL is adopting a different reporting process for HCBS similar to the process currently implemented in the HealthChoices program. Since CHC-MCOs cover all authorized home health skilled care, home health aide, and personal assistance services, OLTL is expanding the current HealthChoices operations report to identify all missed services for participants who utilize these services.

Providers of CHC-covered home health skilled care, home health aide services, and personal assistance services must submit information on missed services to the CHC-MCOs. CHC-MCOs must submit a missed services operations report to OLTL on a monthly basis that includes detailed information on missed services, such as the date of the missed service, the reason for the missed service, and actions taken to address the missed service in both the short and long term.

In its CHC oversight role, OLTL will review these monthly reports along with complaint and grievance, CHC-MCO inquiry, and EIM data to monitor the health and welfare of CHC participants. Providers who do not submit the required information to the CHC-MCO may face corrective actions.

CHC-MCOs will notify their home health and home care network providers of their reporting requirements. Please direct any questions about these reporting requirements to the CHC-MCOs.

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 (OLTL) has released two documents for direct service providers that serve COMMCARE Waiver participants. The documents outline the activities that will occur in the coming months as the COMMCARE Waiver participants transition to either the Community HealthChoices (CHC) program or the Independence Waiver. These documents include a detailed overview and timeline of the transition and a fact sheet about CHC. The COMMCARE Waiver will end statewide on December 31, 2017.

OLTL Service Coordination Entities (SCEs) and participants will be notified of these changes in a separate communication in mid-July.

The Pennsylvania Departments of Aging and Human Services recently announced an agreement with Aging Well (a subsidiary of the Pennsylvania Association of Area Agencies on Aging or P4A that represents all Area Agencies on Aging) to partner on the implementation of Community HealthChoices (CHC).

Under this new agreement, Aging Well will have the following responsibilities:

  • Complete the Functional Eligibility Determinations (FEDs) (via subcontracts with AAAs). Aging Well will conduct the FEDs for participants seeking eligibility for long-term services and supports. Aging Well will also perform the annual in-person re-determinations for people over the age of 60. While FEDs currently need to be completed for individuals applying for the Office of Long-Term Living (OLTL) waivers, ACT 150 program, Living Independence for the Elderly (LIFE), and nursing facility coverage, as the commonwealth begins its implementation of Community HealthChoices, Aging Well will continue to fulfill this role. In addition, as the commonwealth transitions from the existing assessment tool (the Level of Care Determination) to the FED, Aging Well will continue to actively support and facilitate this conversion.
  • Conduct Pennsylvania Preadmission Screening Resident Review Evaluation (PASRR-EV Level II Tool) (via subcontracts with AAAs). Aging Well will conduct the screening for individuals with a mental illness, intellectual disability or related condition, who are seeking admission to Medicaid certified nursing facilities regardless of payer source. These individuals must have the PASRR process completed prior to admission to the nursing facility.
  • Annual re-determinations (via subcontracts with AAAs). Prior to the implementation of CHC, Aging Well will conduct an annual in-person re-assessment within 10 business days of request by a service coordinating entity for all Aging Waiver participants. After the implementation of CHC, Aging Well will review FED assessment data collected by the managed care organizations for all CHC waiver participants in order to confirm annual redeterminations of level of care have been properly conducted. This will be completed as a desk review.
  • Conduct CHC outreach and education activities statewide (via partnerships with AAAs, nursing facilities, and community-based organizations). Aging Well will begin outreach and education activities in July 2017 for the rollout of Phase 1. These activities include 20 public information sessions and training of service coordinators and nursing facility staff.

Join MITC and RCPA on Thursday, June 1, 2017, 10:30 am–12:00 pm, at Penn Grant Centre (RCPA) for a special presentation on Workforce Management Priorities for Physical Disabilities and Aging (PD&A) Division members. This registration was previously an in-person meeting, but is now also available by webcast. We look forward to your participation. Register now to join in on this educational and networking event.

Following this presentation, the Physical Disabilities & Aging Division will meet at 1:00 pm. Deputy Secretary Jen Burnett and other Office of Long-Term Living (OLTL) representatives will be in attendance to discuss Community HealthChoices (CHC) and provide other OLTL updates. Also attending will be Josh Sloop, President, Government Programs, PA Health and Wellness, presenting on rebalancing strategies and the importance to CHC success. Register here for the PD&A Division meeting.

(From OMHSAS)

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 will use managed care organizations (MCOs) to coordinate physical health care and long-term services and supports (LTSS).

The Commonwealth of Pennsylvania is committed to improving service coordination and health outcomes for older residents and adults with disabilities. In order to meet this commitment,

Community HealthChoices (CHC) joins with Physical HealthChoices and Behavioral HealthChoices to ensure a complete system of coordinated managed care. Behavioral HealthChoices provides a range of mental health and substance use disorder treatment services.

What does CHC mean for Behavioral HealthChoices?
Behavioral health services will continue to be offered through the existing network of behavioral health managed care organizations (BH-MCOs). Behavioral health providers will not be required to contract with a CHC-MCO to provide behavioral health services. CHC-MCOs and BH-MCOs will work together to coordinate the services that each participant needs.

Will CHC increase behavioral health services recipients?
CHC will enable individuals previously excluded from the Behavioral HealthChoices program to be eligible for BH-MCO coverage. The majority of new enrollees will include individuals in the Aging Waiver and residents of nursing facilities. Behavioral health providers serving these individuals can ensure continuity of care by enrolling to provide services through Behavioral HealthChoices. Providers should continue to check the Eligibility Verification System (EVS) daily to confirm BH-MCO enrollment.

Who are the Community HealthChoices managed care organizations?
Through a request for proposals, the commonwealth has selected the following MCOs to proceed with negotiations to deliver services on a statewide basis:

  • AmeriHealth Caritas
    • Pennsylvania Health and Wellness (Centene)
    • UPMC for You

When does the CHC program begin?
Pennsylvania is undertaking a regionally based, three phase implementation of CHC, beginning with the Southwest region. Prior to the implementation of CHC in each region, DHS will hold an in-person regional event for providers, which will include a session addressing BH-MCOs and behavioral health providers. Southwest region providers will receive an event announcement soon.

Please visit the DHS website for detailed information on CHC including helpful FAQs. If you have any specific questions or comments about the CHC program, please email RA-PWCHC@pa.gov.

Late on Friday, October 28, the Office of Long-Term Living (OLTL) released a draft Request for Proposal (RFP) for an Independent Enrollment Broker (IEB) to manage the enrollment processes for all OLTL programs. The RFP includes enrollments for Community Health Choices when implemented, Home and Community-based Services Waivers, the Act 150 program, and the LIFE program. Comments are due no later than 5:00 pm on Monday, November 21, 2016, and should be submitted via email by using the drop down menus within the comment template.