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Tags Posts tagged with "community healthchoices"

community healthchoices

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The Department of Human Services (DHS) today announced applicants selected through a Request for Applications (RFA) process to administer Pennsylvania’s Community HealthChoices (CHC) program, the Medicaid managed care program that covers adults who are dually eligible for Medicare and Medicaid or who qualify to receive Medicaid long-term services and supports due to a need for the level of care provided in a nursing facility.

Selected applicants will now move to a readiness review period before the agreements are fully executed.

The five selected plans will be available statewide. They include the three current incumbents and two plans new to Community HealthChoices:

  • Aetna Better Health of Pennsylvania
  • Health Partners Plans
  • PA Health and Wellness
  • UPMC For You
  • Vista Health Plan (AmeriHealth Caritas/Keystone First)

RCPA will be reaching out to the selected applicants to be at the upcoming PD&A meeting in September. If you have any questions, please contact Fady Sahhar or Melissa Dehoff.

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver renewal. The renewal became effective on January 1, 2020.

Key changes in the approved waiver include:

  • Revised the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to a minimum of 8 hours.
  • To the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment and Benefits Counseling, added language that Office of Vocational Rehabilitation (OVR) services are considered to not be available if OVR has not made an eligibility determination within 120 days; and added language to address when employment services through the CHC waiver can be provided should OVR close the order of selection, thereby creating a waiting list for OVR services.
  • Modified the qualifications for Service Coordinators and Service Coordinator supervisors.
  • Clarified that if a CHC Managed Care Organization (MCO) identifies that a participant has not been receiving services for 5 or more days, and if the suspension of services was not pre-planned, then the CHC-MCO must communicate with the participant to determine the reason for the service suspension within 24 hours. If the participant’s health status or needs have changed, the CHC-MCO must conduct a comprehensive needs reassessment of the participant’s needs within fourteen (14) days of identifying the issue.
  • Added that an emergency back-up plan must be included in the Person-Centered Service Plan.
  • Modified language to reflect that the CHC waiver will be fully operational statewide as of January 1, 2020.
  • Updated language to reflect that the Department utilizes IDEMIA as the data system to process fingerprint-based Federal Bureau of Investigation (FBI) criminal record checks.
  • Updated the OLTL bureau names and responsibilities.

Questions surrounding the CHC Waiver Renewal should be directed to the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

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In preparation for the roll-out of Phase III of Community HealthChoices (CHC), it was announced today that registration is now open for the upcoming Fall Educational Provider Sessions for the regions in Phase III. The locations for each region are included on the registration form.

The agenda for each session includes:

  • Registration: 8:30 am – 9:30 am
  • CHC Overview Presentation: 9:30 am – 12:00 pm
  • Lunch/MCO Meet and Greet: 12:00 pm – 1:30 pm
  • Breakout sessions: 1:30 pm – 3:30 pm

Leading up to the summits, emails will be sent to attendees regarding schedule, parking, and event location on each campus. If you encounter problems with registering, please notify this email with your necessary information, and they can register on your behalf.

Questions about CHC? The CHC Questions and Answers Document can be found on both the Participant and Provider sections of the CHC website.

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The Department of Human Services (DHS) has released the Office of Long-Term Living’s (OLTL’s) proposed Community HealthChoices (CHC) waiver renewal for public review and comment in the August 17, 2019 Pennsylvania Bulletin.  DHS proposes to renew the CHC waiver with an effective date of January 1, 2020 in order to be aligned with the calendar year.

Some of the proposed changes to the CHC waiver include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to a minimum of 8 hours.
  • To the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment and Benefits Counseling, add language that Office of Vocational Rehabilitation (OVR) services are considered to not be available if OVR has not made an eligibility determination within 120 days; and add language to address when employment services through the CHC waiver can be provided should OVR close the order of selection, thereby creating a waiting list for OVR services.
  • Modify the qualifications for Service Coordinators and Service Coordinator supervisors.
  • Clarify that, if a CHC Managed Care Organization (MCO) identifies that a participant has not been receiving services for 5 or more days, and if the suspension of services was not pre-planned, then the CHC-MCO must communicate with the participant to determine the reason for the service suspension within 24 hours. If the participant’s health status or needs have changed, then the CHC-MCO must conduct a comprehensive needs reassessment of the participant’s needs within 14 days of identifying the issue.
  • Add that an emergency back-up plan must be included in the Person-Centered Service Plan.
  • Remove and modify language to reflect that the CHC waiver will be fully operational Statewide as of January 1, 2020.
  • Update language to reflect that the Department utilizes IDEMIA as the data system to process fingerprint-based Federal Bureau of Investigation criminal record checks.
  • Update the OLTL bureau names and responsibilities.

The proposed CHC waiver renewal and a summary of all revisions are available for review here. Written comments regarding these proposed revisions will be accepted through close of business on September 16, 2019 and should be sent to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: CHC Waiver Renewal, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments may also be submitted to the Department at [email protected].

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On June 30, 2019, the continuity of care period for long-term services and supports (LTSS) for Phase II (southeast region) ended. As a result, Community HealthChoices (CHC) is now live in this region of the state. Providers should be aware of questions this may generate from CHC participants, such as a change to their service coordinator or a change they may experience with the services they receive (amount, duration, or frequency).

A CHC Managed Care Organization (MCO) must notify the Office of Long-Term Living (OLTL) in writing of its intent to terminate contracts with a provider, and services that a provider offers, 90 days before the termination’s effective date. Procedures to address the termination’s impact on participants should be in place and participants must be notified in writing 45 days before the effective date.

OLTL will continue to monitor notification requirements, service plan changes, service denial notices, complaints, and grievances despite the continuity of care period ending. CHC-MCOs will be held accountable for meeting notification requirements to ensure participants are properly informed and continue to receive necessary services without unexpected disruption.

Participants with questions or concerns about changes to services or service delivery should contact their CHC-MCO. If questions remain after talking with their CHC-MCO, participants can contact OLTL at 800-757-5042.

There are resources available to answer questions, etc. including a fact sheet, a question and answer document, and online training.

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The Office of Long-Term Living (OLTL) has scheduled and will be presenting webinars to Service Coordinators (SCs) to provide information about how the implementation of Community HealthChoices (CHC) will impact Attendant Care and Independence Waiver participants under the age of 21.

The implementation of CHC will change the way that Attendant Care and Independence Waiver participants who are under 21 years of age receive their Medicaid waiver services. All Attendant and Independence Waiver participants who live in Phase 3, and are not yet eligible for CHC because they are under 21 years of age, will transition to the OBRA Waiver until they become eligible for CHC.

All Phase 3 (Lehigh/Capital, Northwest, and Northeast counties) SCs serving participants who are under 21 years of age should plan to participate in this webinar.

Please register for one of the following dates:

After registering, you will receive a confirmation email containing information about joining the webinar.

If you have any questions regarding this communication, please contact the OLTL Participant Helpline Monday through Friday at 800-757-5042 from 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm or via email at any time.

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The next Community HealthChoices (CHC) Third Thursday webinar has been scheduled for April 18, 2019 at 1:30 pm.

The agenda for this webinar will include Office of Long-Term Living (OLTL) Deputy Secretary Kevin Hancock providing updates on the CHC launch, with a special focus on monitoring report data from both the Southwest and Southeast regions.

If you wish to participate in the webinar, you must register using this link. After registering, you will receive a confirmation email containing information about joining the webinar.

If you require captioning services, please use this link and use the following login information:
Username: OLL  Password: OLL

Reminder: All CHC related information can be found online here. Comments can be submitted electronically via email.

If you have any questions, please contact the OLTL Bureau of Policy and Regulatory Management at 717-857-3280.

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Registration is now open for the upcoming Community HealthChoices (CHC) Educational Provider Sessions for Phase three regions of the state. The locations for each region are available on the RSVP pages through the links below.

Additionally, one day-long transportation summit will be held in each region. RSVP for this summit here.

The agenda for each summit is as follows:

  • Registration: 8:30 am – 9:30 am
  • CHC Overview Presentation: 9:30 am – 12:00 pm
  • Lunch/MCO Meet and Greet: 12:00 pm – 1:30 pm
  • Breakout sessions: 1:30 pm – 3:30 pm

Prior to the summit meetings, emails will be sent to attendees regarding schedule, parking, and event location on each campus. Additionally, there is a CHC Questions and Answers (Q&A) document on the CHC website as a resource for additional questions.

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The Department of Human Services (DHS) has published a Q&A Fact Sheet regarding Community HealthChoices (CHC) and ODP Providers. This fact sheet provides basic information such as enrollment in CHC, dates for rollout in various regions in Pennsylvania, services available through CHC, how to become a CHC provider, and transition between CHC and ODP.

What is Community HealthChoices?
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for dually eligible (Medicare and Medicaid) individuals and individuals 21 years of age or older with physical disabilities. The goal of the program is to improve services for hundreds of thousands of Pennsylvania residents.

CHC has been developed to enhance access to and improve coordination of medical care and create a person-centered long-term support system in which people have choice, control, and access to a full array of services that provide independence, health, and quality of life. Long-term services and supports (LTSS) help eligible individuals to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.

Will participants receiving services from ODP be in CHC?
Individuals with an intellectual disability or autism who are receiving services beyond supports coordination through ODP will not be enrolled in CHC. However, if an individual needs the level of care provided in a nursing facility, and they would be better served by the services available in CHC, they may choose to transition from ODP into CHC.

Individuals will be enrolled in CHC if they are age 21 or over and are:

  • Receiving both Medicare and Medicaid;
  • Receiving LTSS in the Attendant Care, Independence, or Aging waivers;
  • Receiving services in the OBRA waiver and determined nursing facility clinically eligible;
  • Receiving care in a nursing home paid for by Medicaid; or
  • Determined to meet nursing facility level of care.

Individuals who already participate in the Living Independence for the Elderly (LIFE) program can remain in their LIFE program and will not be moved into CHC unless they specifically ask to change. Anyone who is enrolled in CHC who would prefer to participate in the LIFE program and qualifies to participate in LIFE may do so.

CHC is now live in the Southeast region. Make sure you and your coworkers have the information you need about CHC. Take our 30-minute online training here.

If you have other questions about CHC, view our comprehensive question and answer document.

If you have any additional questions, please visit the HealthChoices website or submit via email.

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