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The decision for Pennsylvania to postpone the implementation of Community HealthChoices (CHC) was announced today. This decision was made as a result of the delays associated with the resolution of several bid protests.

Following the announcement of the selection of the managed care organizations (MCOs) that would deliver health care coverage in Community HealthChoices, several protests were filed. As a result, the progress of major components of CHC implementation was delayed, resulting in the Department of Human Services (DHS) feeling uncertain with moving forward with their established start dates. Some of the impacted activities associated with this decision include:

  • Developing an adequate network: DHS has not been able to engage with the selected offerors. The agreement and rate negotiations and finalization typically take six weeks, and the agreements need to be finalized before the MCOs are able to engage in network development activities. The current delays mean the MCOs will not have enough time to meet the network adequacy requirements by July 1, 2017.
  • Completing a readiness review: Readiness review is a requirement for the MCOs before they are certified to be able to go live and provide services. Protests prohibit MCO engagement for readiness review and the window to complete the certification continuously shrinks. New programs require a minimum of six months to complete a readiness review.
  • Communicating: Communication about selected MCOs and their available networks is a critical component to CHC education and outreach. Individuals who will be enrolling in CHC need to have complete information about the MCO provider network in order to be able to make an informed provider choice. That communication will not be able to take place until the agreements are largely finalized and the MCOs are in a position to provide network information.

Important dates to note include:

  • Phase 1 will now begin in January 2018 in the Southwest region of the state.
  • Phase 2 will now begin in July 2018 in the Southeast region of the state.
  • The January 2019 start date for the rest of the state remains unchanged.

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Yesterday, a Texas federal judge issued a temporary injunction to the Department of Labor’s (DOL) overtime rule. In granting the preliminary injunction, the federal judge said the DOL’s overtime rule exceeds the authority the agency was granted by Congress.

As you may recall, the DOL’s overtime rule was announced in May, and it has been opposed by many businesses and nonprofits. The rule was to take effect on December 1 of this year. Now with yesterday’s ruling, it is likely that President-elect Trump’s administration, which opposed the rule, will have time to review it and make changes and/or roll back various provisions contained in the current rule.

The DOL could appeal the Tuesday ruling, but with the Obama administration only having approximately two months in office, an appeal is unlikely. With many RCPA members already implementing and announcing changes to comply with the DOL’s overtime rule, it might be difficult for those members to roll back these changes, because it may impact employee morale. As further information is released, RCPA will provide additional guidance to members. Please contact Jack Phillips, RCPA Director of Government Affairs with any questions.

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The Centers for Medicare and Medicaid Services (CMS) recently approved five new employment-related services in the Office of Long-Term Living’s (OLTLs) CommCare and Independence waivers. The services offer providers an opportunity to expand their profiles, particularly those who have been providing prevocational services and supported employment. Listed below are the new services, their credentialing and certification requirements, and rates that will be paid for the services.

  • Benefits Counselors must hold a Certified Work Incentives Counselor (CWIC) certification that is accepted by the Social Security Administration for its Work Incentives Planning and Assistance program. To learn more about CWIC, visit this web page.
  • Employment Skills Development (replaces Prevocational Services), Job Coaching (replaces Supported Employment), Job Finding, and Career Assessment workers must hold one of the following:
  1. A Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE); and
  2. A Basic Employment Services Certificate of Achievement or Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has ACRE-approved training. Individuals without one of these certifications must be supervised by an individual holding the above certification until certification is achieved. Certification must be achieved within 18 months of employment.

Information on APSE credentialing can be found here.
Information on how to receive a certificate of achievement from ACRE can be found here.

(NOTE: Employment Skills Development services that are provided in vocational rehabilitation facilities that fall under 55 PA Code Chapter 2390 are not required to have the above credential or certification. Employment Skills Development services provided in the community do require the above credential or certification.)

A complete description of these services and provider qualifications can be found in the CommCare and Independence waivers here.

NOTE: OLTL has scheduled a webinar on Friday, November 18, 2016 at 1:00 pm to review and discuss these new services. Registration is required to participate.

Listed below are the rates for the new employment services:

 
Service PT/Spec CC IW Procedure Code Modifier Region 1 Region 2 Region 3 Region 4 Unit
Benefits Counseling 59/502 X X W1740 $9.78 $10.21 $10.54 10.87 15 mins
Career Assessment 59/503 X X W1732 $11.12 $12.12 $12.39 12.67 15 mins
Employment Skills Development (1:1) 59/505 X X W1728 $9.44 $11.22 $10.07 10.12 15 mins
Employment Skills Development (1:2 to 1:3) 59/505 X X W1729 $3.77 $4.49 $4.03 4.05 15 mins
Employment Skills Development (1:15) 59/505 X X W1741 $6.29 $6.50 $6.96 6.54 15 mins
Job Coaching 1:1 (Follow-Along) 59/504 X X W1733 U5 $9.78 $10.21 $10.54 10.87 15 mins
Job Coaching 1:2 to 1:4 (Follow-Along) 59/504 X X W1734 U5 $3.26 $3.40 $3.51 3.62 15 mins
Job Coaching 1:1 (Intensive) 59/504 X X W1733 U4 $9.78 $10.21 $10.54 10.87 15 mins
Job Coaching 1:2 to 1:4 (Intensive) 59/504 X X W1734 U4 $3.26 $3.40 $3.51 3.62 15 mins
Job Finding 59/530 X X W1735 $11.15 $12.11 $11.98 12.34 15 mins

 

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Late on Friday, October 28, the Office of Long-Term Living (OLTL) released a draft Request for Proposal (RFP) for an Independent Enrollment Broker (IEB) to manage the enrollment processes for all OLTL programs. The RFP includes enrollments for Community Health Choices when implemented, Home and Community-based Services Waivers, the Act 150 program, and the LIFE program. Comments are due no later than 5:00 pm on Monday, November 21, 2016, and should be submitted via email by using the drop down menus within the comment template.

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Today, the Office of Long-Term Living (OLTL) issued communication on changes to four OLTL home and community-based services waivers that were recently approved by the Centers for Medicare and Medicaid Services (CMS).

The changes include:

Aging Waiver amendments (effective 10/1/16)

  • Introduces the department’s intent to transition individuals from the Aging waiver into a managed care delivery system;
  • Revises language to reflect the current practice under the new child abuse clearance laws;
  • Breaks out the home health and therapeutic and counseling service definition into five discreet service definitions; and
  • Adds a new entity to perform waiver enrollments.

Attendant Care Waiver amendments (effective 10/1/16)

  • Introduces the department’s intent to transition individuals from the Attendant Care waiver into a managed care delivery system; and
  • Revises language to reflect the current practice under the new child abuse clearance laws.

Independence Waiver amendments (effective 10/1/16)

  • Adds five new employment-related service definitions* which are replacing one existing employment service definition;
  • Breaks out the Home Health and Therapeutic and Counseling service definition into eight discreet service definitions;
  • Introduces the Department’s intent to transition individuals from the Independence waiver into a managed care delivery system; and
  • Revises language to reflect the current practice under the new child abuse clearance laws.

CommCare Waiver amendments (effective 10/1/16)

  • Adds five new employment-related service definitions* which are replacing two existing employment service definitions;
  • Breaks out the home health and therapeutic and counseling service definition into eight discreet service definitions;
  • Introduces the department’s intent to transition of individuals from the Independence waiver into a managed care delivery system; and
  • Revises language to reflect the current practice under the new child abuse clearance laws.

OBRA Waiver renewal (effective 7/1/16)

  • Renewal of the waiver for an additional five years;
  • Introduces the department’s intent to transition individuals from the OBRA waiver into a managed care delivery system;
  • Breaks out the home health and therapeutic and counseling service definition into eight discreet service definitions; and
  • Revises language to reflect the current practice under the new child abuse clearance laws.

*New employment-related services are benefits counseling, career assessment, employment skills development (replaces prevocational services), job coaching (replaces supported employment), and job finding. For complete service definitions, provider qualifications, and requirements of each waiver, please refer to the approved waiver documents.

Providers of these new services will be paid at the proposed rates. Information on implementation of the new employment services, including transition from current employment services and billing procedures, is forthcoming.

In addition to the above changes, CMS has required OLTL to add limitations to any waiver services that are state plan services and are available to individuals under the age of 21. These services include: assistive technology, counseling, nursing services, nutritional consultation services, occupational therapy, personal assistance services, physical therapy, specialized medical equipment and supplies, and speech and language therapy. These services are only to be provided to individuals aged 21 and over. All medically necessary services for children under age 21 are to be covered in the state plan pursuant to the EPSDT benefit.

Questions on this information may be referred to either OLTL’s Bureau of Quality and Provider Management at 800-932-0939 or Bureau of Policy and Regulatory Management at 717-783-8412.

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The Centers for Medicare and Medicaid Services (CMS) published a final rule in the September 16, 2016 Federal Register that establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It will also assist providers and suppliers to adequately prepare to meet the needs of patients, residents, clients, and participants during disasters and emergency situations. The effective date of the regulations are effective on November 15, 2016.

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Robena Web Edited

RCPA is pleased to announce the hiring of Robena Spangler as the new director for its Children’s Division. Robena has worked for NHS Human Services for many years in several key positions, including operations resource specialist, regional director – children’s services, director of out of home services and gender responsive services, and children and youth program specialist. In addition to her bachelor’s degree in sociology/human services, she holds an MS degree in leadership and professional advancement from Duquesne University.

Robena will begin in this position on September 26 – just in time for the RCPA Annual Conference. As many of you know, Connell O’Brien serves as the current children’s services director and will be retiring. Connell will remain with RCPA to assist in the transition and to continue with select initiatives. Please join us in welcoming Robena to RCPA!

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