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Authors Posts by Fady Sahhar

Fady Sahhar

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Fady is responsible for policy and regulatory matters related to Physical Disabilities and Aging, with primary focus on personal assistance, employment services, and service coordination. Emphasis is placed on engaging the Office of Long-Term Living and the Community HealthChoices Managed Care Organizations, coordination of care with Behavioral HealthChoices MCOs, and collaborations with other advocacy and provider associations. Fady is also the President / CEO of ProVantaCare, an RCPA-affiliated company focused on contracting with MCOs, and is the President of XtraGlobex, a consulting firm focused on Value-Based Payment contracting. He brings extensive experience in the advocacy and operations of human services providers in physical disabilities and aging, from his role at Liberty Resources, Inc., and his service with a number of nonprofit services providers. He earned an MBA in Marketing from The University of Tennessee and a PhD in Organizational Leadership from Capella University.

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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.

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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.

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This email is to provide notice of an FMS Stakeholder meeting scheduled for Friday, February 4, from 1:00 pm–2:30 pm. This public meeting will be to discuss upcoming changes for the administration of FMS under the Community HealthChoices (CHC), OBRA Waiver, and Act 150 Programs. Representatives from the Office of Long-Term Living and CHC Managed Care Organizations will be in attendance to discuss upcoming changes. Meeting details are below:

Friday, February 4, 2022
1:00 PM | (UTC-05:00) Eastern Time (US & Canada) | 1 hour 30 minutes

Join meeting

More ways to join:

Join from the meeting link:
https://pa-hhs.webex.com/pa-hhs/j.php?MTID=m875f603c23c0d55929713197aaab9643

Join by meeting number
Meeting number (access code): 2631 989 4527
Meeting password: Stakeholder

Tap to join from a mobile device (attendees only)
+1-408-418-9388,,26319894527## United States Toll
+1-202-860-2110,,26319894527## United States Toll (Washington D.C.)

Join by phone
+1-408-418-9388 United States Toll
+1-202-860-2110 United States Toll (Washington D.C.)
Global call-in numbers

Join from a video system or application
Dial [email protected]

You can also dial 173.243.2.68 and enter your meeting number.

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On December 8, the Health and Human Services Administration and the Department of Housing and Urban Development launched a Housing and Services Resource Center, to help older adults and people with disabilities access federal resources and guidance on both housing and services that support community living, including Medicaid-funded home and community-based services, vouchers, and other programs.

You can see more information on the services available here.

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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 as follows:
April 21, 2022 from 10:00 am–11:00 am

Please register to attend this event. After registering, you will receive a confirmation email containing information about joining the webinar.

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

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The Office of Long-Term Living (OLTL) has issued additional guidance on the Enterprise Incident Management (EIM) Enhancements.

As stated in the communication sent on December 10, 2021, Critical Incident Report Extensions changes were implemented in the EIM system on December 11, 2021. With these changes, once the maximum number of allowed extensions is reached, providers and service coordinators (SC) will need to contact OLTL if additional extensions are needed.

The December 10, 2021, communication indicated that OLTL had drafted a form to use in the near future, and once approved, you would be notified. The OLTL EIM Critical Incident Report Extension Request form has been approved and is here for your use.

When requesting incident report extensions, please follow these instructions:

  • Request forms must be submitted to OLTL at least 5 business days prior to incident report due date, via email.
  • Reasons for prior extensions must be clearly documented in the incident report.
  • The reason for an extension request must be detailed, valid, and clearly documented in the incident report as well as in the Home and Community Services Information System (HCSIS) notes.
  • Incident report extensions will be approved for 30 days from previous report due date.

OLTL staff will respond to extension requests within 3 business days by replying to the requestor to let them know if the request was approved or rejected. If rejected, the reason for the rejection will be included in the response. If approved, OLTL staff will enter the extension in EIM.

Any questions regarding the information in this email should be directed here.

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