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OLTL

The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver renewal. The renewal became effective on January 1, 2020.

Key changes in the approved waiver include:

  • Revised the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to a minimum of 8 hours.
  • To the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment and Benefits Counseling, added language that Office of Vocational Rehabilitation (OVR) services are considered to not be available if OVR has not made an eligibility determination within 120 days; and added language to address when employment services through the CHC waiver can be provided should OVR close the order of selection, thereby creating a waiting list for OVR services.
  • Modified the qualifications for Service Coordinators and Service Coordinator supervisors.
  • Clarified that if a CHC Managed Care Organization (MCO) identifies that a participant has not been receiving services for 5 or more days, and if the suspension of services was not pre-planned, then the CHC-MCO must communicate with the participant to determine the reason for the service suspension within 24 hours. If the participant’s health status or needs have changed, the CHC-MCO must conduct a comprehensive needs reassessment of the participant’s needs within fourteen (14) days of identifying the issue.
  • Added that an emergency back-up plan must be included in the Person-Centered Service Plan.
  • Modified language to reflect that the CHC waiver will be fully operational statewide as of January 1, 2020.
  • Updated language to reflect that the Department utilizes IDEMIA as the data system to process fingerprint-based Federal Bureau of Investigation (FBI) criminal record checks.
  • Updated the OLTL bureau names and responsibilities.

Questions surrounding the CHC Waiver Renewal should be directed to the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

As a reminder, section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services. EVV must be implemented for personal care services by January 1, 2020, and for home health care services by January 1, 2023.

OLTL waiver services included in the initial implementation of EVV:

  • Personal Assistance Services (Agency and Participant-Directed Model)
  • Participant-Directed Community Supports
  • Respite (unlicensed settings only)

As part of the soft launch period, claims submitted to PROMISeTM for services subjected to EVV will be validated against EVV visits submitted through the Department of Human Services (DHS) Sandata system or DHS Aggregator. During claims processing in PROMISeTM, EVV validation against the DHS Aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment. The ESCs for EVV will become active on December 13, 2019, for claims submissions with dates of service on or after November 1, 2019. Providers are expected to review when the EVV edit(s) set and actively make corrections either to the data stored in the DHS Aggregator or the claim itself to ensure errors do not repeat.

Please see this chart of EVV-specific ESCs for reference. If you have questions about EVV, please refer to the Frequently Asked Questions document on the DHS EVV website or contact the EVV Resource Account.

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The Office of Long-Term Living (OLTL) will be conducting the next Community HealthChoices (CHC) Third Thursday webinar on December 19, 2019 from 1:30 pm – 3:00 pm. During this webinar, Deputy Secretary Kevin Hancock will provide updates on the CHC program. To participate in the webinar, please register here. Once registered, you will receive a confirmation email that contains the information about joining the webinar. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

The Department of Human Services (DHS), Office of Long-Term Living (OLTL) will conduct the next Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting on Tuesday, December 3, 2019, in the Honor’s Suite at 333 Market Street Tower in Harrisburg from 10:00 am – 1:00 pm. Those who cannot attend in person may participate by dialing: 213-929-4212; Access Code: 524-290-985, or by webinar. If you plan to participate via webinar, registration is required.

Public comments will be accepted during presentations instead of just being heard at the end of the meeting; however, there will be an additional 15-minute period at the end of the meeting for any additional public comments.

If you have any questions about registering for the webinar or require a toll-free number to dial in, please contact the Office of Long-Term Living.

The Office of Long-Term Living (OLTL) will conduct the next Community HealthChoices (CHC) Third Thursday webinar on September 19, 2019 at 1:30 pm. During this webinar, OLTL’s Deputy Secretary, Kevin Hancock, will provide updates on the CHC program. Registration is required to participate in the webinar. Once registered, you will receive a confirmation email containing information about joining the webinar.

Reminder: All CHC related information can be found here. Comments can be submitted electronically via email. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

The Department of Human Services (DHS) has released the Office of Long-Term Living’s (OLTL’s) proposed OBRA waiver amendments for public review and comment in the August 24, 2019 Pennsylvania Bulletin.

DHS proposes the following substantive changes to the OBRA waiver effective January 1, 2020:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • To the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling, add language that Office of Vocational Rehabilitation (OVR) services are considered not to be available if OVR has not made an eligibility determination within 120 days; and add language to address when employment services through the OBRA waiver can be provided should OVR close the order of selection, thereby creating a waiting list for OVR services.

In addition, DHS proposes to make the following technical edits:

  • Update Appendix C-2.b., Abuse Registry Screening, to reflect that the Department utilizes IDEMIA as the data system to process fingerprint-based Federal Bureau of Investigation (FBI) criminal record checks as well as other minor editorial changes to the section.

The proposed amendments and a summary of all of the revisions are available for review here.

Written comments regarding these proposed waiver amendments will be accepted through close of business on Monday, September 23, 2019 and should be sent to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: OBRA Waiver Amendments, PO Box 8025, Harrisburg, PA 17105-8025. Comments may also be submitted to the Department via email. Please use OBRA Waiver Amendments as the subject line.

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On July 20, 2019, the Office of Long-Term Living (OLTL) will begin implementing changes to the Enterprise Incident Management (EIM) system. The changes include adding additional screens and information surrounding deaths and greater detail in the review of incidents. An overview of all of the changes and additions, which includes screenshots and explanations of each change, is available here.

Questions regarding these changes should be directed to the OLTL EIM resource account.

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On June 30, 2019, the continuity of care period for long-term services and supports (LTSS) for Phase II (southeast region) ended. As a result, Community HealthChoices (CHC) is now live in this region of the state. Providers should be aware of questions this may generate from CHC participants, such as a change to their service coordinator or a change they may experience with the services they receive (amount, duration, or frequency).

A CHC Managed Care Organization (MCO) must notify the Office of Long-Term Living (OLTL) in writing of its intent to terminate contracts with a provider, and services that a provider offers, 90 days before the termination’s effective date. Procedures to address the termination’s impact on participants should be in place and participants must be notified in writing 45 days before the effective date.

OLTL will continue to monitor notification requirements, service plan changes, service denial notices, complaints, and grievances despite the continuity of care period ending. CHC-MCOs will be held accountable for meeting notification requirements to ensure participants are properly informed and continue to receive necessary services without unexpected disruption.

Participants with questions or concerns about changes to services or service delivery should contact their CHC-MCO. If questions remain after talking with their CHC-MCO, participants can contact OLTL at 800-757-5042.

There are resources available to answer questions, etc. including a fact sheet, a question and answer document, and online training.

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The next Community HealthChoices (CHC) Third Thursday webinar has been scheduled for January 17, 2019, 1:30 pm – 3:00 pm. Some of the agenda topics to be included during this webinar include updates from Deputy Secretary Kevin Hancock on the initial CHC implementation efforts in the Southeast; and Randy Nolen will lead a discussion on launch indicators and Operations Reports data. In addition, the Office of Long-Term Living (OLTL) Chief Medical Officer, Dr. Lawrence Appel, will present on quality activities and performance measures in the Southwest from the first year of CHC.

To participate in the webinar, participants need to register. After participants register, a confirmation email will be sent containing information about joining the webinar.

Questions should be directed to the OLTL Bureau of Policy and Regulatory Management at 717-857-3280.