Tags Posts tagged with "community healthchoices"

community healthchoices

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.

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 Office of Long-Term Living (OLTL) implemented Community HealthChoices (CHC) effective January 1, 2018, in the counties identified as the CHC Southwest Region. With the roll-out of CHC, the process for referring individuals for nursing home transition (NHT) has changed for anyone who is enrolled in CHC.

For CHC participants in the following counties, referrals for NHT must be made to the participant’s Managed Care Organization (MCO).  For the purposes of making referrals according to MDS Section Q guidelines, the MCO is to be considered the local contact agency for individuals who are enrolled in CHC. The counties affected as of January 1 are:

  • Allegheny
  • Armstrong
  • Beaver
  • Bedford
  • Blair
  • Butler
  • Cambria
  • Fayette
  • Greene
  • Indiana
  • Lawrence
  • Somerset
  • Washington
  • Westmoreland

Please see contact information for the CHC MCOs below:

For all other questions regarding this notification, please contact the OLTL NHT staff at:

  • Rachel Sink 717-783-7378
  • Brandy Staub 717-783-7219
  • Janel Maple 717-857-3149
  • Mariah Henry 717-772-2542
  • or via email

Today the Office of Long-Term Living (OLTL) issued a communication to the Home and Community-Based Service Providers that will be enrolling into the provider networks of the Managed Care Organizations (MCOs) through Community HealthChoices (CHC).

With the onset of CHC, Pennsylvania’s three Managed Care Organizations are in the process of establishing strong provider networks to support the program. In order to ensure network adequacy, the department is gathering information to establish a baseline of the number of full time equivalent (FTE) workers that are potentially needed to continue to provide services and meet the needs of the participants. Due to this requirement, the CHC MCOs will be asking providers for this information during a provider’s initial enrollment with an MCO and on an ongoing basis. The OLTL appreciates the continued cooperation of providers in ensuring a smooth transition for participants into the CHC program. If you have questions, please contact the OLTL Bureau of Quality and Provider Management, Enrollment and Certification Section at 717-772-2570.

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.

RCPA is partnering with PA Health & Wellness to provide a free webinar on contracting overview and training. We are preparing to ensure continued access of care for participants of the Community HealthChoices program. This webinar will review the PA Health & Wellness contract and the process to become a partner in their network.

This free webinar will be held on Tuesday, June 27, 1:00 pm – 2:00 pm EDT. Please register here. Please download the orientation file.

If you have any questions, please call Melissa J. Siwiec from PA Health & Wellness at 717-551-8020.

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.

Webinar and FAQ Available on Home and Community-Based Settings (HCBS) Requirements

On March 7, 2017 and March 9, 2017, the Office of Long Term Living (OLTL) held webinar presentations on the Home and Community-Based Settings (HCBS) Requirements as described in OLTL Bulletin 59-16-14. This training was to provide guidance on the HCBS Final Rule and provide steps providers of waiver services must take in order to comply with the rule. A recording of this training, the powerpoint presentation, and an FAQ from these training sessions are now available on the DHS website.

Questions on the HCBS Final Rule should be sent via emailFor questions, call 717-783-8412.

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