Wolf Administration Launches Revisions to Early Learning Provider Program
DHS
Electronic Visit Verification
The Department of Human Services (Department) is soliciting public input on the use of electronic visit verification (EVV) systems for Medicaid-funded personal care and home health care services in Pennsylvania. See announcement below and here.
DHS Quality Strategy for Managed Care
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).
HealthChoices Effective Date Adjustment
The Department of Human Services (DHS) is announcing two changes to the planned effective dates of the new Physical HealthChoices agreements originally planned for June 2017. View the full release for details.
DHS Provides Grants Aimed at Improving Coordination of Care for Medicaid Patients
On February 8, the Department of Human Services (DHS) Secretary Ted Dallas announced the availability of onboarding grant funds to help connect hospitals and ambulatory practices to the Authority’s Pennsylvania Patient & Provider Network, or P3N.
The P3N enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N.
“These grants will assist providers in the efficient delivery of quality services to the individuals we serve across the commonwealth,” said DHS Secretary Ted Dallas. “As more providers participate, individuals will experience better coordination of care and a better quality of health care.”
The grant program, available to Pennsylvania HIOs to enable the connection of inpatient hospital/facilities and outpatient practice or other outpatient provider organizations participating in the Medicaid Electronic Health Records (EHR) Incentive Program, includes:
- Up to $75,000 to connect each eligible inpatient hospital or other inpatient facility to an HIO;
- Up to $35,000 to connect each eligible outpatient practice or other outpatient provider organization to an HIO; and
- Up to $5,000 to enable other eligible providers that do not fit into the two categories above, but want to enable HIE participation and connect to an HIO via a portal.
Each eligible provider will connect via an HIO to the P3N.
Only a single award is permitted to any one hospital/facility or outpatient practice. The anticipated performance period for this grant runs through September 30, 2017.
The grant will:
- Help providers deliver higher quality and more efficient care, particularly through better care coordination for patients covered by Medicaid;
- Support provider participation in private-sector HIOs by offsetting connection costs;
- Incentivize HIOs to join the P3N, a precondition for receiving funding;
- Support rapid movement toward the participation in eHIE, and support various care reform efforts currently underway across the Commonwealth; and
- Defray up-front costs for individual providers to join an HIO, thus helping to achieve meaningful use and satisfy obligations under the Medicaid EHR Incentive Program.
This program will be made possible through an $8.125 million grant from the federal Centers of Medicare & Medicaid Services (CMS). Under the terms of the federal grant, CMS will provide 90 percent of the onboarding grant, with the remaining 10 percent funded by the Commonwealth. The grant applications and supporting materials are available online here.
(Information courtesy of DHS)
Approved OBRA Waiver Amendments
The Department of Human Services (DHS) has announced the recent changes to the OBRA Waiver that have been approved by the Centers for Medicare and Medicaid Services (CMS). Some of the waiver amendments include:
- Adds five new employment-related service definitions that are replacing two existing employment service definitions. Five employment services have been added (benefits counseling, career assessment, employment skills development, job coaching, and job finding) (C-1/C-3).
- Corrects the regulatory citation for an Outpatient or Community-Based Rehabilitation Agency provider type in the Occupational Therapy (OT), Physical Therapy (PT), Speech and Language Therapy (SLP) service definitions (C-1/C-3).
- Clarifies that Personal Assistance Services (PAS) are only available to individuals in the waiver 21 years of age and over. All medically necessary Personal Assistance Services for children under age 21 are covered in the state plan pursuant to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit (C-1/C-3).
The complete service definitions and requirements are now included in an updated OBRA Waiver document. The effective date of these changes is February 1, 2017.
The OBRA Waiver PROPOSED rates for the new Employment Services have also been released. Questions regarding these rates should be directed to (717) 783-8412.
Gov. Wolf Announces Plan to Create Dept of Health and Human Services
This just in from the governor’s office:
FOR IMMEDIATE RELEASE
January 30, 2017
View Online
Governor Wolf Announces Plan to Create Department of Health and Human Services
Seeks to Improve Services and Benefits for Seniors, People with Intellectual and Physical Disabilities, and Those Suffering From Substance Use Disorder
Harrisburg, PA – Today, Governor Wolf announced his plan to create a Department of Health and Human Services (HHS) in his 2017-2018 budget in order to promote more effective collaboration and service delivery, enhance program effectiveness, and eliminate duplicative processes.
“This new department will streamline government and allow the commonwealth to deliver more effective services to seniors, individuals with intellectual and physical disabilities, and those suffering from a substance use disorder as well as promote the health and well-being of all Pennsylvanians,” said Governor Tom Wolf. “Over the past several months, I have worked closely with these four departments to break down silos and reimagine how we deliver critical services that will provide treatment to those suffering from substance use disorder, ensure children are receiving high quality services, and expand community-based opportunities for seniors. The creation of a new, unified Department of Health and Human Services will not result in any program cuts for Pennsylvanians, but will dramatically improve our ability to deliver services that will improve lives. “
The Departments of Aging (PDA), Drug and Alcohol Programs (DDAP), Health (DOH), and Human Services (DHS) have the same core mission: to improve public health and quality of life for all residents of the commonwealth. These four separate state agencies currently serve similar, and sometimes overlapping, populations.
Fighting Opioid Epidemic to Remain a Top Priority for New Integrated Agency
Governor Wolf has led the battle against the opioid and heroin epidemic and each of these agencies has been critical to this effort. Among many other initiatives, DOH launched a prescription drug monitoring program and has been raising awareness of the naloxone standing order, DDAP has led the effort to increase the availability of naloxone and drug take back boxes, DHS has created 45 centers of excellence to coordinate treatment for those suffering from substance use disorders, and PDA has led prescription drug take back efforts among the senior population encouraging proper use, storage, and disposal of unused prescription medications.
By creating an organization that is structurally better able to support and coordinate these efforts, individuals in desperate need of substance use disorder treatment will be able to access services through one agency with an integrated data and delivery system. The new HHS will serve as the single state authority for Medicaid, substance use, and mental health purposes enabling the commonwealth to maximize available federal dollars and offset state costs for staff and services. There will continue to be a cabinet-level position in Governor Wolf’s administration that will be dedicated to battling the opioid and heroin epidemic.
Delivering better services to those suffering from substance use disorder is just one example of the benefits realized through the creation of a new, unified department.
Senior Benefits and Programs Will Be Bolstered By Ease, Focus of Single Agency
Seniors will also have a single agency as their point of contact within state government to receive health and human services. Instead of receiving prescription assistance from PACE through PDA, applying for an aging waiver through DHS while seeking home and community-based services from PDA, finding where to dispose of unwanted or expired prescription drugs through DDAP, or searching for information on the quality of nursing homes through DOH, seniors would find the services they need through the Department of Health and Human Services. Furthermore, the creation of this department will have no impact on how lottery fund monies are used to support senior programs.
Reducing Complexity and Confusion for Seniors and Individuals with Disabilities
Currently, at least 21 separate services across the departments provide care for seniors and individuals with physical disabilities. The creation of the Department of Health and Human Services will eliminate the unnecessary duplication of effort and confusion among consumers and their families. The Wolf Administration is dedicated to continuing to provide the same quality services for seniors and individuals with disabilities and will dramatically improve the delivery of services like health screenings, programs to allow individuals to remain in their homes and communities, adult protective services, and home health care and housing supports, though the creation of this new department.
Reducing Red-Tape for Providers and Non-Profits Subject to Regulation
Currently, providers ranging from hospitals and child care centers to substance use treatment facilities and nursing homes are licensed by multiple agencies, many times for the provision of the exact same services. Requiring these businesses to subject themselves to multiple, duplicative inspections and audits costs them money. By centralizing facility licensure in one agency we will improve coordination, increase transparency, and promote uniformity for the health and human services field. The state and providers will be able to better focus our resources on our mission to improve the health and quality of life for citizens rather than back office functions.
In 2015, the administration transferred the Children’s Health Insurance Program (CHIP) from the Department of Insurance to DHS. Through this consolidation, the administration has increased the number of kids covered by 10 percent, shortened the average processing time for applications from 40 days to only one day, and saved taxpayers $8 million annually. Additionally, this consolidation resulted in an improved customer experience as many families move between the two programs on a regular basis due to income guidelines. In the same way, combining the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants and Children (WIC) program will result in improved outcomes, shortened application timelines and cost savings to taxpayers.
“Responding to the diverse and sometimes complex needs of older Pennsylvanians often requires interaction with multiple state agencies which can be confusing and incredibly frustrating,” said PDA Secretary Osborne. “The opportunity to create a single, unified, Department of Health and Human Services will reduce fragmentation, eliminate silos, promote accountability, and create a culture of shared responsibility that puts Pennsylvanians first.”
“By working together under Governor Wolf’s leadership, this administration has saved lives by expanding access to naloxone, combatted the stigma of the disease of addiction, and has raised awareness of the severity of this crisis. However, our work is not done,” said Department of Drug and Alcohol Acting Secretary Jennifer Smith. “The creation of the Department of Health and Human Services will help us continue this fight in a collaborative, coordinated manner.”
“The health of all Pennsylvanians is first and foremost to the Wolf Administration,” said Secretary of Health Dr. Karen Murphy. “Consolidating state agencies into one new agency while improving services for Pennsylvanians is not only fiscally responsible, but will ensure that we can continue to meet their needs. The Department of Health team looks forward to working with our sister agencies on the consolidation plan to ensure that Pennsylvanians continue to receive needed services.”
“Consolidation puts the focus where it always should be — on the consumer,” said Secretary of Human Services Ted Dallas. “The Governor’s plan to create HHS will result in a more streamlined and cost-effective agency that delivers better services for Pennsylvania.”
The goal of the Department of Health and Human Services will be to deliver services that will improve the health and quality of life for all Pennsylvanians in an efficient, transparent, and uniform manner.
MEDIA CONTACT: J.J. Abbott, 717.783.1116
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Direct Care Workers Policy Clarification
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.
DHS Bulletin on Revised Autism Diagnostic and Procedure Codes for BH and Rehab
The Department of Human Services (DHS) has just issued a Medical Assistance (MA) Bulletin for providers relating to Act 62 titled, Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder (ASD). The purpose of this bulletin is to remind providers enrolled in the MA Program, both fee-for-service (FFS) and HealthChoices, of the requirement to bill a child’s or adolescent’s private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD. It is also to inform providers of the diagnosis codes and procedure codes which will be included in the MA FFS cost avoidance process, effective Friday, September 30. HealthChoices managed care organizations will provide guidance and information to contracted practitioners and providers in the Medicaid managed care system with regard to implementation by September 30.
The DHS clinical staff has identified behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62. The procedure codes that are on the MA Program fee schedule will be subject to the cost avoidance process for MA FFS claims beginning September 30.
Registration is open now for two webinar sessions on Thursday, August 25 that are being held by DHS in collaboration with RCPA:
- Session 1, 12:00–1:00 pm: The target audience for this webinar session is BH-MCOs, counties, and county oversight organizations.
- Session 2, 1:00–2:00 pm: The target audience for this webinar session is behavioral health and pediatric rehabilitation provider organizations.
DHS Changes Start Date of Community HealthChoices to July 2017
The Department of Human Services (DHS) just announced their decision to lengthen the transition time for the start of the Community HealthChoices (CHC) program. The first phase (southwest part of the state) was originally scheduled to be implemented on January 1, 2017. The implementation date of phase one has now been changed to begin July 1, 2017.
The decision to extend the start date allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved.
All other established CHC timeframes will remain the same. The selection of managed care companies, changes in the Commonwealth’s information technology systems, and other changes are still proceeding on the same timeframe. The implementation of phases two and three (the southeast and remainder of the Commonwealth) also remain on the previously announced timelines of 2018 and 2019, respectively.
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