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Physical Disabilities & Aging

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The Department of Health and Human Services (HHS) has committed to improving the Medicare claims appeals process. This commitment includes the internal implementation of an expanded Settlement Conference Facilitation (SCF) program by the Office of Medicare Hearings and Appeals (OMHA). SCF is an alternative dispute resolution process at OMHA that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals.

 

In order to educate all Medicare Part A and Medicare Part B providers and suppliers who have OMHA or Medicare Appeals Council appeals pending, an SCF Expansion Open Door Call will be held on Tuesday, May 22, 2018 at 1:30 pm. The call will focus on the logistics of the SCF process and SCF eligibility criteria. Providers that plan to join the call are encouraged to submit their questions in advance via email and include “SCF May 22 Call” in the subject line. To participate, registration is required. Additionally, providers are encouraged to read the updated SCF expansion materials, including an SCF Expansion Frequently Asked Questions document, on the website.

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Due to the Southeast Community HealthChoices (CHC) provider meetings being held in Philadelphia on June 4 – June 8, 2018, the Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting scheduled for June 6, 2018 has been rescheduled for Wednesday, May 30, 2018. The May 30 MLTSS Subcommittee meeting will be held at the Pennsylvania Department of Education, Honor’s Suite, 1st Floor, 333 Market Street Tower, Harrisburg, PA 17126 from 10:00 am to 1:00 pm.

If you have any questions, please contact the Office of Long-Term Living via email or call 717-857-3280.

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Community HealthChoices (CHC) is coming in January 2019 to Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

Here is what you need to know:

  • Find CHC information online for providers or participants. The website will be updated as events are scheduled, so check back often.
  • Click here to take our online trainings and read CHC fact sheets.
  • Contact a CHC managed care organization (CHC-MCO) to become part of their provider network:
    • Keystone First Community HealthChoices
      Phone: 1-800-521-6007 // Email
    • Pennsylvania Health & Wellness
      Phone: 1-844-626-6813 // Email
    • UPMC Community HealthChoices
      Phone: 1-844-860-9303 // Email
  • Sign up and encourage your peers to subscribe to CHC emails here. By signing up, you will receive regular communications regarding CHC distributed from the Office of Long-Term Living.

Here’s a schedule of what’s coming up:

Late Spring/Early Summer 2018

Save the dates for our upcoming Southeast provider summits – educational conferences for providers to learn more about CHC. More information regarding time and location coming soon!

  • Philadelphia: June 4–8
  • Chester County: June 18
  • Delaware County: June 19
  • Montgomery County: June 20
  • Bucks County: June 21

Summer 2018

An introductory flyer will be sent to participants identified within the CHC population.

Fall 2018

  • Notices and enrollment packets will be mailed to participants.
  • Information on the LIFE Program will be sent to potentially eligible participants.
  • Informational sessions will be held for participants to learn about CHC and how to select a CHC-MCO.
  • For a full look at the CHC implementation timeline, use this link.
  • To learn the differences between CHC vs HealthChoices, use this link.

If you have any questions, please contact the Office of Long-Term Living’s provider line at 1-800-932-0939 or visit the HealthChoices website.

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On January 24, the Office of Long-Term Living (OLTL) sent an email to Community HealthChoices (CHC) providers stating “All OLTL Direct Service Providers will now submit critical incidents into EIM for participants enrolled in CHC.” Pennsylvania Health and Wellness is offering two webinars on March 28 to train providers on using the system.

The webinar will cover:

  • Critical Incident Reporting Requirements
  • Definition of Critical Incidents
  • How to obtain access to EIM
  • EIM System Training

10:00 am – 11:30 am session – Click here to register
1:00 pm – 2:30 pm session – Click here to register

If an agency has previously attended this training provided by UPMC or AmeriHealth Caritas, it is not necessary to attend this session.

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Background
In administering the Office of Long-Term Living (OLTL) Home and Community-Based Services (HCBS) Waivers, OLTL requires service coordinators to monitor that waiver participants receive all HCBS services authorized in their service plans and to develop a backup plan in case a service could not be provided. If a provider is unable to provide an authorized service, the service coordinator must work with the participant to secure another provider to provide the service as specified in the participant’s backup plan. In addition, service coordinators and providers must report critical incidents, including any occurring as a result of the participant’s failure to receive services which placed the participant’s health or safety at risk, in accordance with OLTL’s Critical Incident Management Bulletin.

Policy
With the implementation of Community HealthChoices (CHC), OLTL is adopting a different reporting process for HCBS similar to the process currently implemented in the HealthChoices program. Since CHC-MCOs cover all authorized home health skilled care, home health aide, and personal assistance services, OLTL is expanding the current HealthChoices operations report to identify all missed services for participants who utilize these services.

Providers of CHC-covered home health skilled care, home health aide services, and personal assistance services must submit information on missed services to the CHC-MCOs. CHC-MCOs must submit a missed services operations report to OLTL on a monthly basis that includes detailed information on missed services, such as the date of the missed service, the reason for the missed service, and actions taken to address the missed service in both the short and long term.

In its CHC oversight role, OLTL will review these monthly reports along with complaint and grievance, CHC-MCO inquiry, and EIM data to monitor the health and welfare of CHC participants. Providers who do not submit the required information to the CHC-MCO may face corrective actions.

CHC-MCOs will notify their home health and home care network providers of their reporting requirements. Please direct any questions about these reporting requirements to the CHC-MCOs.

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The Office of Long-Term Living (OLTL) is offering a webinar on Tuesday, April 10, 2018, at 9:00 am that will focus on the topic of Pennsylvania Resources for Funding Assistive Technology. Assistive technology devices help make it possible for individuals with disabilities to work, live independently in their own homes, go to school, and participate in the community. Mrs. Susan Tachau, Chief Executive Officer (CEO) of the Pennsylvania Assistive Technology Foundation (PATF), will conduct the webinar.

Registration is required to participate in the webinar. Registrants will receive a confirmation email containing information about joining the webinar. Questions should be directed to Edward Butler, OLTL, at 717-214-3718.

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On March 9, 2018, Representative Tina Pickett introduced House Resolution 741 designating the month of March 2018 as “Brain Injury Awareness Month” in Pennsylvania. The resolution was adopted (188–0) on March 14, 2018. A similar co-sponsorship memo was introduced in the Senate by Senator Schwank and will be voted on in the near future. March is nationally recognized as Brain Injury Awareness Month as well.

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Due to cancellation of the March 7 Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting, the meeting has been rescheduled for Monday, March 19, from 10:00 am to 1:00 pm in the Honor’s Suite at 333 Market Street Tower in Harrisburg.

Attendance via phone/webinar:
If you wish to participate in the MLTSS Subcommittee meeting on March 19, but can’t attend in person, the option to participate via webinar is being offered. Provided below is the webinar link and dial-in information for the meeting.

Technology:
The Department of Human Services, Office of Long-Term Living is using technology similar to that used at Third Thursday webinars for MLTSS Subcommittee meetings. This technology allows individuals to participate in the webinar and listen in through computer speakers instead of participating by webinar and dial in. Dial in will still be available if you do not participate by webinar only, but the number is no longer toll free.

To participate in the meeting via webinar, please register by clicking on the link below. Members participating via webinar are encouraged to register early. When registering, please verify that you entered your email address correctly. You will receive a confirmation email containing information about joining the webinar if you registered correctly.

Webinar Registration Link:
https://attendee.gotowebinar.com/register/1406232880227054595

Dial-In Number:
The dial in number is: 1-415-655-0052; Access Code: 722-088-701

If you have any questions about registering for the webinar or require a toll free number to dial in, please contact the Office of Long-Term Living. For questions regarding this email, call 717-857-3280.

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The Alliance of Community Service Providers has opened online registration for their 16th Annual Conference for Direct Support Professionals (DSP). The event will be held Friday, April 20, 2018, from 8:00 am to 4:00 pm at the Philadelphia Hilton on City Avenue. The conference is open to all direct support professional staff who provide services to individuals with intellectual disabilities, behavioral health needs, and/or substance use disorders.

Several workshops are scheduled throughout the day focusing on adult mental health, children and families, addictions, intellectual disabilities, advocacy, and professional development. For more information and to register, use this link.

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