Authors Posts by Fady Sahhar

Fady Sahhar

Fady Sahhar, PhD, is the Acting COO for ProVantaCare. He is responsible for managing the operations of the company, leading the contract development and negotiations with the Managed Care Organizations on behalf of owner providers. Fady works directly on the business development opportunities for ProVantaCare and is engaged in the advocacy of the RCPA Physical Disabilities and Aging Division.

Message from the Department of Human Services (DHS):

Pennsylvania’s Department of Human Services (DHS) is changing which Physical Health Managed Care Organizations (PH Plans) are available for Medical Assistance (MA) consumers. This is an opportunity for DHS to be sure that the program and our partners are continuing to strive towards improved access to care and superior quality of care and support provided by the PH Plans to MA consumers.

The PH plans available in your county may change. In some counties, your current MCO will no longer be available, and in others, you may have new options to pick from. If you have to select a new plan, DHS is committed to helping you find a plan that meets your individual needs, while also allowing you to keep your current health care providers. It’s important for you to consider what doctors, hospitals, or other health care providers are in a PH plan’s network.

This enrollment period is your opportunity to compare the health plan options in your region and choose the best plan for you.

Please note that the above information means that your agency needs to alert your consumers to the change so they can make an informed decision. Otherwise, they will be auto-assigned. Visit here for more details regarding which plans are available by county.

The Pennsylvania Health Law Project (PHLP) will host a virtual information session on Wednesday, August 10 at 2:00 pm to review upcoming changes to the Physical HealthChoices program. Representatives from the PA Department of Human Services (DHS), PA Enrollment Services, and the Pennsylvania Health Access Network (PHAN) will be available to answer questions during the session. Space is limited, and registration is required.

Examples of the communications that DHS sent to plan participants are here (individuals who are required to change plans) and here (individuals who may but are not required to change plans).

Message from the Office of Long-Term Living (OLTL):

The Pennsylvania Department of Human Services is offering a webinar on the topic of the Social Security Administration’s Ticket to Work Benefits Counseling, which provides individuals, their families, friends, and caregivers information relative to their benefits/services and competitive integrated employment. This overview will be presented by Ms. Joy Smith, AHEDD Work Incentive Planning and Assistance, Certified Work Incentive Coordinator, Regional Manager.

Office of Long-Term Living Service Coordinators, Direct Service Providers, CHC-MCO staff, and any individuals that work on employment are strongly encouraged to participate in this webinar on an overview of Benefits Counseling as it relates to the participants you serve.

The Overview of Benefits Counseling webinar is on April 21, 2022, from 10:00 am–11:00 am.

Please register using this register link. After registering, you will receive a confirmation email containing information about joining the webinar.

If you have questions, please contact Edward M. Butler or call 717-214-3718.

The Electronic Visit Verification (EVV) public meeting originally scheduled for Friday, March 18, 2022, has been rescheduled to Friday, April 8, 2022, from 1:00 pm–2:00 pm. Topics include updates related to DHS’s implementation of EVV.

Please register using this registration link. After registering, you will receive a confirmation email containing information about joining the webinar.

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Almost half of the states are operating Medicaid managed long-term services and supports (MLTSS) programs, but there has historically been limited evidence of their value. To help fill this gap, this report presents updated results from states responding to ADvancing States’ survey, as well as new research on states with MLTSS programs. The 12 states responding to the surveys — Arizona, Florida, Iowa, Kansas, Massachusetts, Minnesota, New Jersey, New Mexico, Tennessee, Texas, Virginia, and Wisconsin — account for more than half of the states who are operating MLTSS programs. States were asked about their goals in implementing MLTSS programs, what progress they had made in attaining those goals, and if they faced any challenges collecting data to document progress. In addition, new research has documented additional value from MLTSS programs in the following areas:

  • Rebalancing Medicaid LTSS Spending. Rebalancing Medicaid long-term services and supports spending toward home- and community-based settings and providing more options for people to live in and receive services in the community was a key goal for all states. Many states have specific rebalancing targets, as well as financial incentives for MLTSS plans to meet them.
  • Improving Member Experience, Quality of Life, and Health Outcomes. All states wanted to improve consumer health and satisfaction/quality of life. While it can be challenging to attribute improvements in health outcomes solely to MLTSS programs, seven states reported improved consumer health. Eleven states said that they collect data on the quality of life; from those reporting outcomes, MLTSS consumers had improved quality of life and high levels of satisfaction compared to fee-for-service programs. One challenge highlighted by states was that the fielding the surveys used to collect these data is time and labor-intensive.
  • Reducing Waiver Waiting Lists and Increasing Access to Services. MLTSS programs may reduce or eliminate waiting lists for waiver services. Seven states said they wanted to reduce waiting lists, while others focused on increasing access to services. Some states successfully eliminated waiting lists, while other states addressed waiting lists through prioritizing applicants by level of need. Some states reinvested savings achieved through implementing MLTSS to decrease the number of people on waiting lists.
  • Increasing Budget Predictability and Managing Costs. MLTSS programs’ use of capitated payments can help improve budget predictability. The programs also have the potential to achieve savings by: rebalancing LTSS spending, managing service use, and avoiding unnecessary hospitalizations or institutional placements. While states report they are “bending the cost curve,” inadequate data are a barrier to states’ ability to demonstrate these outcomes. The state surveys and recent research provide compelling examples demonstrating that states are meeting their MLTSS program goals. It also underscores the importance of expanding the scope and amount of data collected on program impacts. Health plan contracts with strong data reporting and performance monitoring requirements are important tools for states to build stakeholder support and demonstrate program viability over time.

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Photo by Mikael Blomkvist from Pexels

About 73% of the American “Baby Boomer Generation” (between the ages of 57 and 75) hope to receive long-term care (LTC) in their current home. Another 17% want to receive LTC in an assisted living facility, and 2% would prefer to receive LTC in a nursing facility.

About 47% of non-retired Americans and 33% of retired Americans say they are concerned that it will not be safe for them to remain in their home when they need LTC. As a result, only 56% of Baby Boomers believe that their home is the most likely place for them to receive LTC, 23% believe receiving LTC in an assisted living facility is most likely, and 6% believe they are most likely to need nursing home care.

A full 50% of adult Americans feel it is the responsibility of their family to care for them if they need LTC; this equates to 69% of Millennials, 52% of those in Generation X, and 33% of Baby Boomers. About 70% of adult Americans would like to have the option of relying on a family member if they need LTC; however, 70% also would not expect a family member to provide LTC without compensation. A total of 66% are worried that they will become a burden to their family as they get older.

More than half of respondents consider themselves at least somewhat knowledgeable about the options available in LTC. For Baby Boomers, approximately 49% said they were very or somewhat knowledgeable about their options. About 63% of Millennials said they were very or somewhat knowledgeable about their options, and 55% of those in Generation X said they are familiar with their options.

More than 60% of respondents said they were uncertain about costs related to specific LTC options. When asked about the costs for assisted living communities, 63% of Baby Boomers said they were unsure about annual costs, compared with 61% of those in Generation X and 59% of Millennials.

In 2020, the estimated annual median costs of US assisted living communities was $51,600. When asked what they thought this number was, Baby Boomers estimated the cost to be $65,000. Those in Generation X estimated this cost to be $41,379; and Millennials estimated the cost to be $23,467.

About 88% of Americans believe it’s very important for people to have a plan for LTC insurance. A total of 86% said that it is very important to have LTC insurance. However just 25% of those surveyed said they currently own LTC insurance for themselves. Millennials (39%) are more likely than those in Generation X (26%) and those of Baby Boomer age or older (19%) to claim they currently own LTC insurance for themselves.

These findings were presented in the 2021 Nationwide Long-Term Care Consumer Survey, conducted by The Harris Poll for The Nationwide Retirement Institute® in October 2021. Researchers at The Harris Poll surveyed 1,812 US adults aged 24 or over, and 706 caregivers. The goal was to determine trends in consumer opinions, expectations, and planning related to long-term care.

The full text of the 2021 Long-Term Care Consumer Survey results was published December 8, 2021, by Nationwide.

Message from the Office of Long-Term Living: 

As a reminder, the January EVV Public Meeting will be occurring on January 21, 2022, at 1:00 pm.  Topics to be covered include EVV system updates, a Home Health Care Services implementation update, general reminders, and a Personal Care Services data update, as well as others.

Please register for the January 21, 2022 EVV Public Meeting. Questions on this topic can be directed via email.