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Policy Areas

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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.”

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The Department of Human Services, under Secretary Ted Dallas, has established an IDD Fiscal Work Group over the last several months. This has been led by the Office of Developmental Programs Deputy Secretary Nancy Thaler and includes several RCPA members. The focus of this work group has been on the IDD residential rate methodology.

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The Centers for Medicare and Medicaid Services had originally scheduled a webinar on February 11, 2016 on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. However, the webinar had to be canceled due to technical difficulties. The webinar has now been rescheduled for Tuesday, February 23, 2016 from 1:00 – 2:30 pm.

The IMPACT Act requires the reporting of standardized patient assessment data in the following areas, to better coordinate care and improve outcomes for people with Medicare:

  • Quality measures;
  • Resource use; and
  • Other measures in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies.

To participate in this webinar, registration is required.

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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.

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On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) posted this update to the “Therapy Cap” page on their website, regarding manual medical review (MMR) of therapy claims above the $3,700 threshold. The guidance is vague and additional information is needed for clarification. Members that provide outpatient therapy services should be cognizant that MMR will resume in the near future and should comply with medical record requests issued by Strategic Health Solutions.

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Licensing Free Trainings
The Department of Human Services Bureau of Human Services Licensing is offering free statewide trainings for community homes for individuals with intellectual disabilities, family living homes, adult training facilities, and vocational facilities for persons with intellectual disabilities. These trainings are being conducted by Northampton Community College in four regions across the state on multiple dates with multiple topics.

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