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Authors Posts by Richard Edley

Richard Edley

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Dr. Richard Edley is the lead executive for RCPA and is responsible for all aspects of operations and direction for the association. His professional career began in 1988 and most recently he was president and CEO of PerformCare/Community Behavioral HealthCare Network of Pennsylvania, Inc., a national, full-service, behavioral health managed care organization.

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In the May 13, 2017 PA Bulletin, the Department of Human Services (Department) made available for public review and comment the Medical Assistance Quality Strategy for Pennsylvania.

The Department is complying with Centers for Medicare and Medicaid Services’ (CMS) requirement that states draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by managed care organizations that have a contract with the Department. As a result, the Department has developed the Medical Assistance Quality Strategy for Pennsylvania, which discusses the various quality improvement initiatives the Department has implemented to increase the quality of care for individuals receiving services through its managed care programs. The Medical Assistance Quality Strategy for Pennsylvania is not intended to comprehensively describe all the activities that the Department undertakes to assure the quality of care rendered to individuals who are receiving services through managed care programs.

The Department’s quality strategy will be used to assure that the contractors that are implementing the Department’s managed care programs are in compliance with the terms of their agreements with the Department and have committed resources to meet the following: to perform monitoring and ongoing quality improvement; to contribute to the improvement of health for the populations they serve; and to incorporate new programmatic changes to assure that the individuals they serve have timely access to high-quality care.

The Medical Assistance Quality Strategy for Pennsylvania will include programs and initiatives within the following:

  • The Office of Medical Assistance Programs, Bureau of Managed Care Operations;
  • The Office of Mental Health and Substance Abuse Services;
  • The Office of Long-Term Living Community HealthChoices;
  • CHIP; and
  • Adult Community Autism Program (ACAP).

The Medical Assistance Quality Strategy for Pennsylvania can be viewed here and interested persons are invited to submit comments regarding the Medical Assistance Quality Strategy for Pennsylvania to the Department via email. Comments received within 30 days must be reviewed and considered before the Quality Strategy is submitted to CMS for review.

Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at 800-654-5984 (TDD users) or 800-654-5988 (voice users).

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Today Governor Wolf announced that the departments of Human Services (DHS) and Community and Economic Development (DCED) are now accepting applications for the Home and Community-Based Services (HCBS) loan program.

The loans are intended to support long-term care providers as they position themselves to successfully transition to managed care in Community HealthChoices, Governor Tom Wolf’s plan to improve the quality of care for seniors and individuals with disabilities through managed long-term services and supports.

“HCBS will allow seniors and individuals living with disabilities to transition from living in long-term care facilities to residing in the community, ensuring that people have choices about where they live and receive services,” Governor Wolf said. “My administration is committed to serving more people in the community – where they want to live.”

It’s expected that loans – for startups, reconfiguration, or expansion – will range from $50,000 to $200,000.

“These loans will support projects that help the Commonwealth to improve the quality of care for seniors and people with disabilities by building infrastructure so individuals will have more choices available to them,” DHS Secretary Ted Dallas said. “Through these funds, individuals will be served in the right setting with the proper amount of services and supports to help all Pennsylvanians live full, independent lives on their own terms.”

DHS can receive loan applications at any time of the year and will process them on a first-come, first-served basis. DCED will then work with DHS to process the loans.

“The collaborative effort necessary to launch this program is a demonstration of our commitment to Governor Wolf’s government that works initiative for a common goal of creating a better Pennsylvania,” said DCED Secretary Dennis Davin, “DCED is proud to be a part of such an important program.”

Visit here for more information on the HCBS loan program, or here (PDF) for the loan application.

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The Department of Human Services has released a timeline for transitions to Community HealthChoices (CHC), which is a managed care program that will better coordinate the way participants receive their physical health services and long-term services and supports (LTSS). The goal is to serve more people in their homes and their communities. CHC will serve Medicaid participants 21 years of age or older who also receive Medicare, need LTSS in their home or community, or are in nursing facilities. Today, there are five waivers in which participants receive LTSS. In the future there will be two waivers.

CHC: will serve participants currently in the Aging, Attendant Care, Independence, and COMMCARE waivers. OBRA participants who are nursing facility clinically eligible will also move to CHC.

OBRA Waiver: will continue to serve participants 18 years of age and older who have a severe developmental disability requiring the level of care provided in an intermediate care facility/other related conditions (often referred to as ICF/ORC).

ATTENDANT CARE AND INDEPENDENCE WAIVERS
What will happen?

  • Since CHC only serves participants 21 years of age and older, participants in the Attendant Care and Independence waivers who are between 18 to 20 years of age will be enrolled in the OBRA Waiver to receive LTSS services.
  • The OBRA Waiver will provide the same services available in Attendant Care and Independence waivers.
  • It is DHS’ priority to ensure that participants’ services are not impacted in any way.

When will this happen?
Southwest Zone: August 2017 to October 2017
Southeast Zone: February 2018 to May 2018
Remaining Zones: August 2018 to October 2018

COMMCARE WAIVER
What will happen?

  • The COMMCARE Waiver will end December 31, 2017. Any new applicants who would have been eligible for the COMMCARE Waiver after September 1, 2017, will be eligible for and enrolled in the Independence Waiver.
  • This means that participants who are receiving services in the COMMCARE Waiver who do not live in the Southwest Zone will be enrolled in the Independence Waiver before December 31, 2017.
  • It is DHS’ priority to ensure that participants’ services are not impacted in any way.

When will this happen?
COMMCARE Waiver participants residing outside of the Southwest Zone will be enrolled in the Independence Waiver by their service coordinators between July 2017 and November 2017.

COMMCARE participants in the Southwest Zone will transition to CHC on January 1, 2018.

OBRA WAIVER
What will happen?

  • OBRA Waiver participants whose level of care determination was completed before November 18, 2016, will get an assessment to determine their eligibility for CHC. Those determined ineligible for CHC will remain in OBRA.
  • DHS is working with the Area Agencies on Aging, service coordinators, and providers to ensure assessments are completed in a timely manner. Participants will be contacted by their Area Agency on Aging to schedule a time for the assessor to meet with them to go through the assessment process. 

When will this happen?
Southwest Zone: May 2017 to August 2017
Southeast Zone: October 2017 to February 2018
Remaining Zones: April 2018 to August 2018

*There are no additional transitions for Aging Waiver participants. Aging Waiver participants will simply transition to CHC when CHC begins in their zones.

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RCPA has signed on to a multi-association letter being sent to the PA congressional delegation in Washington, DC urging legislators to carefully evaluate any effort to repeal and replace the Affordable Care Act (ACA), given the critical need to maintain funding for the current Pennsylvania Medicaid program and to protect the vulnerable citizens who rely on Medicaid for critical and necessary care.

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RCPA will host its annual conference at the Hershey Lodge on October 10–13, 2017. At this large-scale, statewide event, the RCPA board of directors wants to continue the important tradition of recognizing individuals and organizations/facilities for their dedication and commitment to service. The following award categories have been created for this event and recognition:

  • RCPA Innovation Award. Presented to an individual or organization in recognition of significant innovation. Examples include cross-systems integration, physical/behavioral health integration, and implementation of new technologies.
  • Exemplary Service to RCPA Award. Presented to an individual or organization/facility that has shown a strong commitment and dedication in service to the association, its members, and related issues.
  • Legislative Leadership Award. Presented to an individual who has shown significant leadership and commitment to government affairs and legislative issues, on behalf of RCPA and its members.
  • Community Leadership Award. Presented to an individual in recognition of extending service and knowledge to the community at large, and efforts in helping the community understand the needs of individuals served by RCPA members. This can be for specific or short-term significant acts, or to recognize a career-long body of work.
  • Lifetime Achievement Award. Presented to an individual in honor of his/her significant, consistent, and enduring contribution throughout his/her career in support and furthering of the field.

At this time, RCPA is accepting nominations through an open solicitation of members (e.g., designated contact person, CEOs/executive directors, staff) and RCPA committees. Members may nominate one or more individuals/organizations in one or more categories. Nominations will be reviewed by a sub-group of the board of directors to make recommendations for final selection and approval by the full board.

Include the name/organization (if applicable) of the nominee, the award category, and a statement about why you believe the individual/organization should be honored. Nominations should be made by Friday, June 2, 2017. Please send nominations to Cindy Lloyd.

Award recipients are not limited to RCPA members and every award may not be presented annually. Please join the association in continuing this tradition and in offering nominations for those who deserve recognition for their significant contributions.

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“RCPA is a member of the National Council and we received this urgent request regarding the ACA.  Whether or not your agency is part of the National Council, we ask that you seriously consider joining this effort.” – Richard S. Edley, RCPA President/CEO
*ACTION ALERT FROM THE NATIONAL COUNCIL FOR BEHAVIORAL HEALTH*

Last night, an amendment to the American Health Care Act was released, providing a concrete sign that Congress is again working on legislation that would gut federal investment in Medicaid and devastate Americans’ mental health and addiction coverage and care.

In addition to restructuring Medicaid and shifting over $800 billion in costs to states, the revised version of the American Health Care Act directly targets provisions that are important to mental health and addiction advocates, including: rolling back essential health benefits, eliminating protections for individuals with pre-existing conditions and widening the gap in primary and behavioral health parity. For millions of individuals, these provisions would mean restricted access to Medicaid, restricted access to affordable coverage and restricted access to lifesaving mental health and addictions treatment.

Please take 2 minutes today and urge your legislators to oppose the revised American Health Care Act. Click here to get started!

Thank you to all National Council advocates who have engaged with us this year. We are asking that you continue to join us in uniting for behavioral health and ensuring that every American has the mental health and addiction care they need.

Sincerely,

Chuck Ingoglia
Senior Vice President, Public Policy and Practice Improvement
National Council for Behavioral Health

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RCPA is a proud contributor of this event:

Jewish Family Service of Greater Harrisburg presents:
Mental Illness and the Role of the Faith Community
FREE to the entire community
Thursday, May 11, 2017, 7:00 pm at the Jewish Community Center in Harrisburg

https://paproviders.org/wp-content/uploads/2017/04/Fried-event-revised-electronic-version-4-19-17.pdf

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Today the Wolf Administration issued a document entitled Understanding Community HealthChoices vs HealthChoices to explain the similarities and differences between the two programs.

Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. HealthChoices is Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants.

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.

The document describes eligibility, timelines for implementation, and the CHC managed care organizations that will operate in each zone beginning in January, 2018.

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(From OMHSAS)

From: DHS STAKEHOLDERS
On Behalf Of: HS, Secretary’s Office
Sent: Monday, April 10, 2017 2:41 PM
To: DHS Stakeholders
Subject: OMHSAS Leadership

Today I am announcing that Dr. Dale Adair will serve as the Acting Deputy Secretary for the Office of Mental Health and Substance Abuse Services (OMHSAS). For those of you who have not yet met him, Dale currently serves with distinction as the Chief Medical Officer at OMHSAS and is an essential member of the OMHSAS executive team.

Dale’s nearly 30 years of experience in all levels of state government and his leadership experience will be invaluable as we move forward during this difficult time and begin the process of selecting our next Deputy Secretary. I have complete confidence that Dale will make the transition to a new Deputy Secretary as smooth as possible and that the critical work that OMHSAS does every day continues without interruption.

I would personally like to thank Dale for stepping up into this role, your leadership is needed now more than ever at DHS.

Please join me in welcoming Dale to this new role and working with him so that we can ensure that services continue for the vulnerable Pennsylvanians that OMHSAS serves.

Ted

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