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Physical Disabilities & Aging

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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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From the Department of Human Services:

The Wolf Administration is committed to serving more people in the community whenever possible, and we believe that the work performed by direct care workers (DCWs), including personal attendants and other household aides, enables individuals with disabilities to live a more independent life. We have heard from many people asking for a policy clarification on the types of non-skilled, home care services and activities that DCWs can perform in home- and community-based settings.

Last week, the Wolf Administration issued a policy clarification surrounding the role of DCWs.

The non-skilled activities provided in the consumer’s place of residence or other independent living environment are specialized care, a type of home care service unique to the consumer’s care needs that are exempt from the licensure requirements under the Professional Nursing Law and Practical Nurse Law.

DCWs may perform these non-skilled services/activities, with evidence of competency or training, provided they do not represent or hold themselves out as being licensed nurses, licensed registered nurses, or registered nurses; or use in connection with their names, any designation tending to imply they are licensed to practice nursing.

Individuals with disabilities will have a greater chance of remaining in their homes and community when they are able to receive assistance with long-term supports and services from DCWs. These non-skilled, routine activities/services include:

  • assistance with bowel and bladder routines;
  • assistance with medication;
  • ostomy care;
  • clean intermittent catheterization;
  • assistance with skin care; and
  • wound care.

DHS appreciates the partnership with the departments of Health and State and the collaboration with ADAPT and Disability Rights Pennsylvania in issuing this important policy clarification. Further guidance will be issued as appropriate to ensure successful implementation.

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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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