Brain Injury

This week the Pennsylvania Department of Human Services (DHS) announced several new initiatives to reduce the use of psychotropic medication among our state’s most vulnerable children. Speaking at The Children’s Hospital of Philadelphia, DHS Secretary Ted Dallas reported on the partnership of DHS with the Pennsylvania Chapter of the American Academy of Pediatrics and the Pennsylvania Psychiatric Society. A state-commissioned PolicyLab study that found that in 2012 in Pennsylvania, the use of psychotropic medications was nearly three times higher among 6-18 year olds in foster care than among youth in Medicaid overall. Based on this study and the collaborative effort mentioned above, Pennsylvania has initiated the following:

  • Best practice guidelines are being developed for clinicians regarding comprehensive assessments of behavior and treatment interventions;
  • Managed care organizations will be required to give prior authorization for antipsychotic medications for children;
  • A new electronic dashboard will make it easier for DHS to monitor what medications children are taking and improve care coordination;
  • In April, DHS will open a telephonic child psychiatric consultative service to help prescribing physicians, physician assistants, and nurse practitioners appropriately prescribe psychotropic medication for children; and
  • In July, the department will begin training child welfare caseworkers and caregivers on the appropriate use of psychotropic medication.

“The inappropriate use of these powerful medications for children in the foster care system compounds the trauma experienced by children who have been the victim of abuse and neglect and is simply unacceptable,” Dallas said, “The recommendations and analysis from PolicyLab provide Pennsylvania with an invaluable roadmap to improve the safety and quality of life for foster children served by the Medicaid system.”

The Office of Long-Term Living (OLTL) has announced changes that are being made to the enrollment process for Home and Community-based Services (HCBS), including the Aging Waiver, Attendance Care Waiver, CommCare Waiver, Independence Waiver, OBRA Waiver, and Act 150 Program. Effective Tuesday, March 1, 2016, OLTL will enter into a new contract with MAXIMUS, the PA Independent Enrollment Broker (IEB). According to OLTL, the adjustments being made and expectations regarding this new contract will streamline the enrollment process, as well as ensure consistency across all home and community-based programs, in anticipation of the roll-out of Community HealthChoices (CHC), a Managed Long-Term Services and Supports program for older Pennsylvanians and adults with physical disabilities. CHC will move the Commonwealth’s home and community-based waiver system from fee-for service to a capitated Medicaid managed long-term services and supports delivery system. The changes OLTL is making to the enrollment process support the Commonwealth’s efforts to ensure that the enrollment process is conflict free, strengthening necessary firewalls between enrollment in services and the provision of ongoing service coordination and other services.

Changes made to improve the IEB process:

  • The enrollment timeframe requirement has been reduced from 90 days to 60 days. This change is effective March 1, 2016.
  • The IEB will assume the Aging Waiver enrollment process effective April 1, 2016.
  • Enrollments that are already in process before April 1 will remain the responsibility of the Area Agency on Aging. Aging Waiver applications initiated prior to April 1 must be completed by the AAA prior to June 30. Applications still pending on June 30 will revert to Maximus for completion. OLTL will provide additional information on this process in an upcoming webinar.
  • These changes, which affect all OLTL Home- and Community-Based Programs – Aging, Attendant Care, CommCare, Independence, OBRA and the Act 150 program administered through the Office of Long-Term Living – will be completed by the PA Independent Enrollment Broker (IEB), Maximus.

The tasks completed by the IEB (Maximus) include the following:

  • Coordinate with the County Assistance Office to ensure timely completion of the PA 600L Medical Assistance Applications.
  • Coordinate with the Area Agency on Aging to ensure timely completion of the Clinical Eligibility Determination (formerly known as the Level of Care Determination). Complete in-home visit with applicant to gather information for enrollment.
  • Complete the Program Eligibility Determination.
  • Provide applicant with choice of Service Coordination provider.
  • Enroll applicant in waiver upon receipt of PA 162.
  • Transfer record and enrollment documentation to the selected Service Coordination agency.

If you have any questions, please contact Amy High, Office of Long-Term Living, Bureau of Participant Operations, at 717-787-8091.

On January 27, 2016, a letter was sent to Department of Human Services (DHS) Secretary Ted Dallas, requesting reconsideration of DHS’ decision to raise the minimum age of eligibility for Community HealthChoices (CHC). RCPA was one of more than 35 organizations and individuals that signed this letter of support.

Currently, the minimum age of eligibility for the Attendant Care, Independence, and OBRA waivers is 18. However, the CHC Request for Proposal (RFP) states, “CHC will serve adults age 21 or older who require Medicaid Long-Term Services and Supports (MLTSS) (whether in the community or in private or county nursing facilities)…. and current participants in DHS’ (Office of Long-Term Living) waiver programs who are 18-to 21 years old.” This would change the minimum age for home and community-based services administered by OLTL to age 21.

Concern was noted in the letter of how raising the minimum age of eligibility for CHC will create large gaps in services. Many examples were elaborated on the services that keep young adults in their homes and communities and out of institutional care, including home modifications, vehicle modifications, assistive technology, respite, and residential habilitation. The letter urges DHS to fix this critical problem before the CHC RFP is finalized.

In an effort to promote “Government that Works,” the Office of Child Development and Early Learning (OCDEL) has made it a priority to integrate early childhood education services, so that providers can offer multiple OCDEL services to families without duplicating paperwork, and families can more easily access the services they need. To lead and promote this approach to improving and streamlining bureaucratic and operational challenges faced by providers and families, OCDEL has produced a short video overview with Deputy Secretary Michelle Figlar.

Providers are also being asked to share their experiences with OCDEL programs to help shape this work. It is critical for the RCPA Children’s Steering Committee and work groups to hear how OCDEL programs work for providers and families. Input from providers of early childhood care will significantly inform and influence this work. For RCPA members, it will be vital that providers of early childhood mental health, behavioral consultation, autism, and pediatric rehabilitation services, that need to be delivered in a coordinated and collaborative manner, help to inform this process. RCPA members who serve young children are encouraged to complete a short survey by Monday, February 8. The survey includes five pages of questions and should take an average of five minutes to complete. For more information, visit the PA Keys website.

OCDEL has made stakeholder engagement one of its priorities to assure high quality services for children and families. For a listing of all open stakeholder engagement opportunities, please visit the PA Keys website.

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The RCPA Brain Injury Committee meeting, scheduled for January 13 from 10:00 am to 2:00 pm, will have a different focus from the regularly scheduled bi-monthly committee meetings.

Due to the timing of Community HealthChoices and all that has transpired, including the Managed Care Organization (MCO) Meet and Greet session for Brain Injury Providers planned for January 14, and the advancement of the RCP-SO for Community HealthChoices, the meeting will focus on these key important topics that will impact the brain injury providers.

Dr. Richard Edley, RCPA President/CEO, will be in attendance to provide everyone with updates on the one-to-one meetings that have been held with Managed Care Organizations regarding brain injury services, as well as updates regarding the RCO-SO offering. He will also answer any questions you may have on these issues.

Due to the importance of this meeting, members are encouraged to either attend or participate via webcast. If you have not registered yet, please do so as soon as possible.

DHS and PDA Invite Brain Injury Providers to Meet With MCOs Interested in Community HealthChoices

The Departments of Human Services (DHS) and Aging are continuing to develop Community HealthChoices (CHC), Pennsylvania’s plan for managed long-term services and supports. The success of CHC will be determined by a number of factors, including the relationships between future managed care organizations (MCOs) and existing providers. It is extremely important to continue the conversation with MCOs and Pennsylvania’s experienced providers, to successfully transform the fee-for-service system to managed care.

An invitation has been extended to RCPA’s Brain Injury Committee members to participate in an upcoming MCO meet and greet session, exclusively for brain injury providers. As a part of this invitation, we were asked to establish a panel and presentation, as well as participate in a facilitated discussion with the MCOs. Because of the importance of this meeting, please plan on sending at least one representative from your organization to this event. We have also been asked to submit questions we may have for the MCOs prior to the meeting date.

The meeting is scheduled for Thursday, January 14 from 11:30 am to 2:30 pm at the Hilton Harrisburg, 1 North 2nd Street. This will be a working lunch meeting (boxed lunches will be provided to registered attendees). Registration/RSVP is required.

Please respond to Melissa Dehoff if you will be attending. Responses are due no later than Monday, January 11, so the list of attendees can be provided prior to the meeting and the appropriate number of lunches ordered.

Time is running out; the deadline for revalidating is Thursday, March 24, 2016. Numerous RCPA members have already gone through this process, but it appears that large numbers of providers have not yet done so. A special provider revalidation webinar will be held by RCPA on Wednesday, January 6 at 10:00 am. Jamie Buchenauer, from the Department of Human Services, will be presenting the webcast.