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Physical Disabilities & Aging

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The Centers for Medicare and Medicaid Services (CMS) has approved the renewal of the Community HealthChoices (CHC) 1915(b) waiver effective January 1, 2023, for a 5-year period. Under the 1915(b) waiver, Pennsylvania operates the CHC managed care program.

As part of the CHC 1915(b) waiver renewal, the Office of Long-Term Living (OLTL) was required to obtain an independent evaluation or assessment of its CHC waiver program and submit the findings when renewing the CHC 1915(b) waiver.

The CHC 1915(b) waiver renewal and the Independent Assessment of the 1915(b) waiver are posted to the CHC-Supporting Documents website. Questions about the CHC 1915(b) waiver amendment or Independent Assessment can be submitted electronically.

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The Office of Long-Term Living’s (OLTL) Bureau of Coordinated and Integrated Services (BCIS) has announced the dates and times of the mandatory upcoming Critical Incident Reporting Training webinars. The purpose of the webinar is to provide guidance to Home and Community-Based Services (HCBS) Direct Service Providers and Service Coordinators regarding timely reporting of critical incidents using the Enterprise Incident Management (EIM) system and to review:

  • Who is responsible for reporting critical incidents?
  • When should a critical incident be reported in EIM?
  • What sections of the EIM Critical Incident Report must be completed?

The webinar dates and times are below. The requirement is to attend one of the sessions.

March 7, 2023: 9:30 am – 11:30 am
Register by March 1, 2023
Registration for March 7, 2023, Morning Session

March 7, 2023: 1:30 pm – 3:30 pm
Register by March 1, 2023
Registration for March 7, 2023, Afternoon Session

March 9, 2023: 9:30 am – 11:30 am
Register by March 3, 2023
Registration for the March 9, 2023, Morning Session

March 15, 2023: 9:30 am – 11:30 am
Register by March 8, 2023
Registration for the March 15, 2023, Morning Session

Within a few days after registering, you will receive a confirmation email containing information about joining the webinar. Please email OLTL should you have any questions or concerns.

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On February 15, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed National Coverage Determination (NCD) that power seat elevation equipment on Group 3 power wheelchairs falls within the benefit category for durable medical equipment (DME).

CMS is proposing that the evidence is sufficient to determine that power seat elevation equipment is reasonable and necessary for individuals using power wheelchairs when all of the following conditions are met:

  • The individual performs weight bearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit to stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g. sliding board, cane, crutch, walker); and,
  • The individual has undergone a specialty evaluation by a practitioner who has specific training and experience in rehabilitation wheelchair evaluations, such as a physical therapist (PT) or occupational therapist (OT), that assesses the individual’s ability to safely use the seat elevation equipment in the home.

The proposed NCD is open for public comment for 30 days. The 30-day comment period will close on March 17, 2023.

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The monthly Long-Term Services and Supports (LTSS) Subcommittee convened on February 14, 2023. The meeting handouts included the agenda and a PowerPoint presentation from the Office of Long-Term Living (OLTL). Some of the topics in their presentation included:

  • COVID-19 Vaccination Rates From the Community HealthChoices Managed Care Organizations (CHC-MCOs);
  • CHC Request for Information (RFI) Update;
  • Electronic Visit Verification (EVV);
  • Independent Enrollment Broker (IEB) Enrollment Data;
  • LIFE Enrollments;
  • Medical Assistance (MA) Unwinding;
  • Appendix K Waiver; and
  • Home and Community-Based Services (HCBS) Settings Rule.

The next LTSS Subcommittee meeting is scheduled for April 11, 2023.

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Tuesday, March 7, 2023
1:00 pm – 1:30 pm ET
Join the Provider Integrity in Medicaid Home Personal Care Services webinar with Kirit Pandit, VP, Data and Analytics. Preventing fraud, waste, and abuse (FWA) in the Medicaid market is an on-going effort, with many providers, payers, and vendors involved in the effort to improve the health care system.

During this session, you can expect to:

  • Learn about the analytics dashboards developed to mine data and identify these cases;
  • See our vision for application of analytics for program integrity in home personal care services; and
  • Understand how the development of the dashboards can lead to further insights and actions to support the efforts of state and compliance programs.

Reserve your spot today, and stay tuned for information about more upcoming Empower webinars!

Reserve Your Spot!

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Pennsylvania is preparing for a major change in renewal processes for Medicaid and Children’s Health Insurance Program (CHIP) recipients.

Starting April 1, 2023, Pennsylvania is required by federal law to review Medicaid and CHIP recipients’ eligibility every year, which means that recipients must submit a renewal. While the Department of Human Services (DHS) still sent renewals during the height of the COVID-19 pandemic, most people were not disenrolled from Medicaid or CHIP because of a change in eligibility.

DHS encourages everyone to share the following information with Medicaid and CHIP recipients to help them stay informed about renewals.

What Should I Do Right Now?

The best thing that Medicaid and CHIP recipients can do right now to prepare for their renewal is to make sure that their contact information is up-to-date with DHS. By making sure that their information is current, recipients can receive timely updates about their renewal. They also can opt-in to receiving text and email alerts about their benefits.

  • Visit COMPASS and log into their My COMPASS Account.
  • Use the free myCOMPASS PA mobile app.
  • Call 877-395-8930 or 215-560-7226 (Philadelphia), Monday – Friday from 8:00 am – 4:30 pm.

What Else Do I Need to Know?

Completing Medicaid and CHIP Renewals
Renewals should be completed when they are received, even if recipients receive them before April 1, 2023. Recipients will receive a renewal packet in the mail when it is time to renew their coverage. Information about their renewal will start to arrive 90 days before it is due. It is very important that renewal forms are completed and returned even if nothing has changed. Completing a renewal allows DHS to determine eligibility for MA or CHIP coverage. Coverage will continue for recipients who are still eligible.
There are a few ways for recipients to complete a renewal:

  • Complete the forms DHS sends and mail them back in the envelope included in the packet.
  • Drop completed forms off at the local county assistance office (CAO).
  • Complete the renewal online.
  • Complete the renewal over the phone by calling 866-550-4355.

What is Continuous Coverage?

Under the continuous coverage requirement, individuals covered by Medicaid and/or CHIP have been able to keep their health coverage even if they would have otherwise become ineligible for the program based on other factors.

Evaluating Eligibility

Once the continuous Medicaid and CHIP coverage requirement ends, recipients will have to complete a renewal to maintain their coverage as long as they are eligible.

Are You Ineligible for Coverage?

DHS will provide instructions on how to re-enroll or share options for coverage if individuals are no longer eligible. Options for free or low-cost health coverage are available online.

Get more information and resources at DHS’s website.

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