Physical Disabilities & Aging

The Pennsylvania Departments of Aging and Human Services recently announced an agreement with Aging Well (a subsidiary of the Pennsylvania Association of Area Agencies on Aging or P4A that represents all Area Agencies on Aging) to partner on the implementation of Community HealthChoices (CHC).

Under this new agreement, Aging Well will have the following responsibilities:

  • Complete the Functional Eligibility Determinations (FEDs) (via subcontracts with AAAs). Aging Well will conduct the FEDs for participants seeking eligibility for long-term services and supports. Aging Well will also perform the annual in-person re-determinations for people over the age of 60. While FEDs currently need to be completed for individuals applying for the Office of Long-Term Living (OLTL) waivers, ACT 150 program, Living Independence for the Elderly (LIFE), and nursing facility coverage, as the commonwealth begins its implementation of Community HealthChoices, Aging Well will continue to fulfill this role. In addition, as the commonwealth transitions from the existing assessment tool (the Level of Care Determination) to the FED, Aging Well will continue to actively support and facilitate this conversion.
  • Conduct Pennsylvania Preadmission Screening Resident Review Evaluation (PASRR-EV Level II Tool) (via subcontracts with AAAs). Aging Well will conduct the screening for individuals with a mental illness, intellectual disability or related condition, who are seeking admission to Medicaid certified nursing facilities regardless of payer source. These individuals must have the PASRR process completed prior to admission to the nursing facility.
  • Annual re-determinations (via subcontracts with AAAs). Prior to the implementation of CHC, Aging Well will conduct an annual in-person re-assessment within 10 business days of request by a service coordinating entity for all Aging Waiver participants. After the implementation of CHC, Aging Well will review FED assessment data collected by the managed care organizations for all CHC waiver participants in order to confirm annual redeterminations of level of care have been properly conducted. This will be completed as a desk review.
  • Conduct CHC outreach and education activities statewide (via partnerships with AAAs, nursing facilities, and community-based organizations). Aging Well will begin outreach and education activities in July 2017 for the rollout of Phase 1. These activities include 20 public information sessions and training of service coordinators and nursing facility staff.

On Thursday, June 29, 2017, the Centers for Medicare and Medicaid Services (CMS) and the Office of Medicare Hearings and Appeals (OMHA) will host a call from 1:00 pm to 3:00 pm that will focus on the recent regulatory changes to the Medicare claims appeals process. There will also be discussion surrounding the Medicare Appeals Final Rule that was published in the January 17, 2017 Federal Register, as well as the changes that are intended to streamline the administrative appeals processes, reduce the backlog of pending appeals, and increase the consistency in decision making across appeal levels.

To participate in the call, registration is required by 12:00 pm on June 29, or until the event is full. Following the presentation, time will be allocated to a session for questions and answers.

In this year of challenging state-level budget negotiations, RCPA is working with a coalition of community foundations, United Way organizations, Labor Unions, religious and advocacy groups, and other key stakeholders in the #FamilyFirstPA Coalition. The growing list of coalition members can be viewed on the #FamilyFirstPA#FamilyFirstPA website. The main goal of the #FamilyFirstPA Campaign is to ensure that there are no cuts to human services in upcoming 2017/2018 state budget. Cuts to human services not only cause irreparable damage to Pennsylvania families, but they also have adverse impacts on organizations that our families rely on. Sharing family stories via social media was the first phase of this campaign. Now, we need your support to push our efforts to the next level. As a coalition partner, RCPA is encouraging our members to amplify the work of the coalition by making use of the social media resources created by this initiative for the coalition. Engage with #FamilyFirstPA on social media; “Like” us on Facebook and “follow us” on Twitter. The initiative is now sharing family stories from across Pennsylvania and engaging legislators through our posts and tweets. Encourage your staff, families, other organizations, county and state level stakeholders, to like and follow the campaign as well.

Any questions about the work of the #FamilyFirstPA Coalition can be directed to Connell O’Brien, who is serving as liaison between RCPA and the #FamilyFirstPA initiative.

The Office of Long-Term Living (OLTL) recently announced an upcoming stakeholder meeting regarding the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home and Community-based Services (HCBS) survey. This meeting, scheduled for Wednesday, June 7, 2017, at 1:30 pm, will include representatives from the State of Connecticut (CT) who will share their experiences during the testing of the tool. Members are invited to participate in person (Honor’s Suite 333 Market Street Tower, Harrisburg, PA) or via webinar by registering prior to the meeting. After registering, you will receive a confirmation email containing information about the webinar. Members are encouraged to submit any questions for the representatives from CT in advance of the call to Melissa Dehoff by 12:00 pm on Tuesday, June 6.

Webinar and FAQ Available on Home and Community-Based Settings (HCBS) Requirements

On March 7, 2017 and March 9, 2017, the Office of Long Term Living (OLTL) held webinar presentations on the Home and Community-Based Settings (HCBS) Requirements as described in OLTL Bulletin 59-16-14. This training was to provide guidance on the HCBS Final Rule and provide steps providers of waiver services must take in order to comply with the rule. A recording of this training, the powerpoint presentation, and an FAQ from these training sessions are now available on the DHS website.

Questions on the HCBS Final Rule should be sent via emailFor questions, call 717-783-8412.

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page to update or register your email address.

Join MITC and RCPA on Thursday, June 1, 2017, 10:30 am–12:00 pm, at Penn Grant Centre (RCPA) for a special presentation on Workforce Management Priorities for Physical Disabilities and Aging (PD&A) Division members. This registration was previously an in-person meeting, but is now also available by webcast. We look forward to your participation. Register now to join in on this educational and networking event.

Following this presentation, the Physical Disabilities & Aging Division will meet at 1:00 pm. Deputy Secretary Jen Burnett and other Office of Long-Term Living (OLTL) representatives will be in attendance to discuss Community HealthChoices (CHC) and provide other OLTL updates. Also attending will be Josh Sloop, President, Government Programs, PA Health and Wellness, presenting on rebalancing strategies and the importance to CHC success. Register here for the PD&A Division meeting.

Join MITC and RCPA on Thursday, June 1, 2017, 10:30 am, at Penn Grant Centre (RCPA) for a special presentation on Workforce Management Priorities for Physical Disabilities and Aging (PD&A) Division members.

MITC has over 25 years of experience working with agencies that serve individuals with disabilities and seniors. MITC has created solutions designed to help agencies operate more efficiently, including:

  • Time and Attendance
  • Staff & Client Scheduling
  • HR Solutions
  • Service Documentation
  • EVV compliance and more!

MITC is pleased to be presenting on the morning of the upcoming PD&A Division meeting on how Pennsylvania providers can benefit from effective and efficient workforce management throughout their organizations. Learn about workforce management best practices for Home and Community-Based Services, how new regulations could impact your agency, and how to prepare for Community HealthChoices.

This presentation is also an opportunity for your organization to provide input to MITC about your workforce management challenges as you prepare for the transition to Managed Long-Term Services and Supports in Pennsylvania. We look forward to hearing from you!

Register now to join in on this educational and networking event. There will be a break for lunch on your own prior to the PD&A Division meeting at 1:00 pm. Register here for the PD&A Division meeting.

In the May 13, 2017 PA Bulletin, the Department of Human Services (Department) made available for public review and comment the Medical Assistance Quality Strategy for Pennsylvania.

The Department is complying with Centers for Medicare and Medicaid Services’ (CMS) requirement that states draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by managed care organizations that have a contract with the Department. As a result, the Department has developed the Medical Assistance Quality Strategy for Pennsylvania, which discusses the various quality improvement initiatives the Department has implemented to increase the quality of care for individuals receiving services through its managed care programs. The Medical Assistance Quality Strategy for Pennsylvania is not intended to comprehensively describe all the activities that the Department undertakes to assure the quality of care rendered to individuals who are receiving services through managed care programs.

The Department’s quality strategy will be used to assure that the contractors that are implementing the Department’s managed care programs are in compliance with the terms of their agreements with the Department and have committed resources to meet the following: to perform monitoring and ongoing quality improvement; to contribute to the improvement of health for the populations they serve; and to incorporate new programmatic changes to assure that the individuals they serve have timely access to high-quality care.

The Medical Assistance Quality Strategy for Pennsylvania will include programs and initiatives within the following:

  • The Office of Medical Assistance Programs, Bureau of Managed Care Operations;
  • The Office of Mental Health and Substance Abuse Services;
  • The Office of Long-Term Living Community HealthChoices;
  • CHIP; and
  • Adult Community Autism Program (ACAP).

The Medical Assistance Quality Strategy for Pennsylvania can be viewed here and interested persons are invited to submit comments regarding the Medical Assistance Quality Strategy for Pennsylvania to the Department via email. Comments received within 30 days must be reviewed and considered before the Quality Strategy is submitted to CMS for review.

Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at 800-654-5984 (TDD users) or 800-654-5988 (voice users).

Today Governor Wolf announced that the departments of Human Services (DHS) and Community and Economic Development (DCED) are now accepting applications for the Home and Community-Based Services (HCBS) loan program.

The loans are intended to support long-term care providers as they position themselves to successfully transition to managed care in Community HealthChoices, Governor Tom Wolf’s plan to improve the quality of care for seniors and individuals with disabilities through managed long-term services and supports.

“HCBS will allow seniors and individuals living with disabilities to transition from living in long-term care facilities to residing in the community, ensuring that people have choices about where they live and receive services,” Governor Wolf said. “My administration is committed to serving more people in the community – where they want to live.”

It’s expected that loans – for startups, reconfiguration, or expansion – will range from $50,000 to $200,000.

“These loans will support projects that help the Commonwealth to improve the quality of care for seniors and people with disabilities by building infrastructure so individuals will have more choices available to them,” DHS Secretary Ted Dallas said. “Through these funds, individuals will be served in the right setting with the proper amount of services and supports to help all Pennsylvanians live full, independent lives on their own terms.”

DHS can receive loan applications at any time of the year and will process them on a first-come, first-served basis. DCED will then work with DHS to process the loans.

“The collaborative effort necessary to launch this program is a demonstration of our commitment to Governor Wolf’s government that works initiative for a common goal of creating a better Pennsylvania,” said DCED Secretary Dennis Davin, “DCED is proud to be a part of such an important program.”

Visit here for more information on the HCBS loan program, or here (PDF) for the loan application.

The Department of Human Services has released a timeline for transitions to Community HealthChoices (CHC), which is a managed care program that will better coordinate the way participants receive their physical health services and long-term services and supports (LTSS). The goal is to serve more people in their homes and their communities. CHC will serve Medicaid participants 21 years of age or older who also receive Medicare, need LTSS in their home or community, or are in nursing facilities. Today, there are five waivers in which participants receive LTSS. In the future there will be two waivers.

CHC: will serve participants currently in the Aging, Attendant Care, Independence, and COMMCARE waivers. OBRA participants who are nursing facility clinically eligible will also move to CHC.

OBRA Waiver: will continue to serve participants 18 years of age and older who have a severe developmental disability requiring the level of care provided in an intermediate care facility/other related conditions (often referred to as ICF/ORC).

What will happen?

  • Since CHC only serves participants 21 years of age and older, participants in the Attendant Care and Independence waivers who are between 18 to 20 years of age will be enrolled in the OBRA Waiver to receive LTSS services.
  • The OBRA Waiver will provide the same services available in Attendant Care and Independence waivers.
  • It is DHS’ priority to ensure that participants’ services are not impacted in any way.

When will this happen?
Southwest Zone: August 2017 to October 2017
Southeast Zone: February 2018 to May 2018
Remaining Zones: August 2018 to October 2018

What will happen?

  • The COMMCARE Waiver will end December 31, 2017. Any new applicants who would have been eligible for the COMMCARE Waiver after September 1, 2017, will be eligible for and enrolled in the Independence Waiver.
  • This means that participants who are receiving services in the COMMCARE Waiver who do not live in the Southwest Zone will be enrolled in the Independence Waiver before December 31, 2017.
  • It is DHS’ priority to ensure that participants’ services are not impacted in any way.

When will this happen?
COMMCARE Waiver participants residing outside of the Southwest Zone will be enrolled in the Independence Waiver by their service coordinators between July 2017 and November 2017.

COMMCARE participants in the Southwest Zone will transition to CHC on January 1, 2018.

What will happen?

  • OBRA Waiver participants whose level of care determination was completed before November 18, 2016, will get an assessment to determine their eligibility for CHC. Those determined ineligible for CHC will remain in OBRA.
  • DHS is working with the Area Agencies on Aging, service coordinators, and providers to ensure assessments are completed in a timely manner. Participants will be contacted by their Area Agency on Aging to schedule a time for the assessor to meet with them to go through the assessment process. 

When will this happen?
Southwest Zone: May 2017 to August 2017
Southeast Zone: October 2017 to February 2018
Remaining Zones: April 2018 to August 2018

*There are no additional transitions for Aging Waiver participants. Aging Waiver participants will simply transition to CHC when CHC begins in their zones.