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medical assistance

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.

**Does NOT affect current Behavioral HealthChoices or
Community HealthChoices participants.**

ODP Announcement 22-087 issues an important reminder that major changes are being made to the HealthChoices Physical Health Managed Care Organizations (MCOs) offering Medical Assistance benefits on September 1, 2022. A large number of Medical Assistance consumers must select a new MCO by August 16, 2022. If they do not make a selection, a new MCO will be automatically chosen for them.

If Medical Assistance consumers are unsure if they need to select a new MCO, or haven’t received selection materials, they should contact Pennsylvania Enrollment Services at the following:

TTY: 800-618-4225 | Monday – Friday | 8:00 am – 6:00 pm
Home | PA Enrollment Services

ODP Announcement 22-073 announces that the Department of Human Services (DHS) is preparing for the eventual end of the Public Health Emergency. Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has continued Medical Assistance (MA) coverage for most people unless they moved out-of-state, passed away, or asked to end their MA.

When the federal PHE ends, the Department of Human Services must determine if people are still eligible for MA. MA recipients will have to complete a renewal to maintain their MA coverage.

DHS is seeking trusted partners to assist in this PHE unwinding process through means of connection to individuals that will need to renew MA benefits. Today, an email newsletter called the DHS Helper Portal is being launched.

Sign up to become a helper today!

  1. Fill out the simple online form.
  2. The form will generate an email to the email address given.
  3. Confirm the address by walking through the prompts in the email.
  4. Congratulations! You are a helper!

Photo by Markus Winkler on Unsplash

The Medical Assistance (MA) Bulletin posted on 10-22-2021 applies to all providers that render personal care services (PCS) to beneficiaries in the fee-for-service (FFS) delivery system, including Agency with Choice and Vendor Fiscal/Employer Agent financial management services organizations that provide PCS to MA participants who are enrolled in an Office of Developmental Program or Office of Long-Term Living waiver, the Act 150 Program, or a Community HealthChoices managed care organization.

The purpose of the bulletin is to:

  • Advise providers of updates to certain error status codes (ESC) for PCS subject to electronic visit verification (EVV), effective for claims received on and after October 22, 2021; and
  • Advise providers of an updated Provider Assistance Center (PAC) contact e-mail for their use.

Providers rendering PCS in the managed care delivery system should address any questions regarding ESCs for PCS subject to EVV with the applicable managed care organization.

The Department of Human Services (DHS) has released a Request for Information (RFI) to gather input from vendors and other stakeholders on the specific measures it may undertake to improve the quality, consistency and effectiveness of the Office of Long-Term Living’s (OLTL’s) Independent Enrollment Broker’s (IEB’s) services.

This RFI will gather input and information concerning the application and enrollment services and support services for the beneficiaries of two Medical Assistance (MA) managed care programs, one 1915(c) MA home and community-based services (HCBS) waiver program and a state-funded program, all administered by the DHS OLTL. Through these programs, eligible beneficiaries receive long-term services and supports (LTSS) and other benefits, depending on the particular program.

Specifically, DHS issued this RFI to solicit input on its potential strategies and solutions to improve the LTSS application and enrollment services and beneficiary support services provided by the OLTL’s IEB to individuals who apply for and enroll in the Community HealthChoices (CHC) Program, the Pennsylvania Living Independence for the Elderly Program (LIFE), the OBRA Waiver and the state-funded Act 150 Attendant Care Program.

DHS is requesting that all responses to the RFI be submitted by 12:00 p.m. on July 29, 2019. Responses must be submitted electronically to the following email account with “OLTL Application and Enrollment Services RFI” in the email subject line: RA-PWRFICOMMENTS@PA.GOV.

DHS does not intend to respond to questions or clarifications during the RFI response period; however, respondents may submit questions related to the RFI electronically to: RA-PWRFICOMMENTS@PA.GOV using “OLTL Application and Enrollment Services RFI question” in the email subject line. DHS may or may not respond based on the nature of the question.

If you have any questions regarding this email please contact Michael Hale, Bureau Director, Fee for Service Programs at mhale@pa.gov.

RCPA will be scheduling teleconference calls in the coming weeks to review this RFI and obtain feedback from members.

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The Department of Human Services (DHS) published a notice that will appear in tomorrow’s Pennsylvania Bulletin that they intend to make a supplemental payment in fiscal year (FY) 2017/2018 to certain special rehabilitation facilities (SRFs) that have high Medical Assistance (MA) and total facility occupancy levels. An SRF is one that specializes in providing services and care to adults who have a neurological/neuromuscular diagnosis and condition, as well as severe functional limitations. Because of the complex needs of these individuals, SRF’s typically incur staffing and specialized medical equipment costs that are very high. Additionally, SRF’s with high MA and total facility occupancy levels are dependent on MA payments to continue to operate. To help offset the higher costs incurred by these SRFs while they reconfigure to home and community-based services, DHS intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.

To qualify for an MA dependency payment the following requirements must be met:

  • Be classified as an SRF as of the cost report end date.
  • Have MA occupancy greater than or equal to 94% as reported on Schedule A, Column A, Line 5 of the cost report.
  • Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A, Line 4 of the cost report.
  • Have at least 200 MA certified nursing facility beds as of the cost report end date.

DHS will accept comments on this notice for thirty days following publication. Comments should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, PO Box 8025, Harrisburg, PA 17105-8025.