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DHS

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Licensing, Certification, and Incident Management Conducted by the Departments of Human Services, Health, Drug and Alcohol Programs, and Aging

The Departments of Human Services, Health, Drug and Alcohol Programs, and Aging regulate a variety of health and human services providers in order to protect the health and safety of Pennsylvanians. Among the regulatory activities, they license or certify providers and conduct incident management, as required by state and federal law. The departments are currently reexamining processes to identify opportunities for coordinating efforts in order to streamline the licensing, certification, and incident management process and increase efficiencies for providers and the commonwealth, while maintaining and enhancing the quality of licensing and certification activities of the providers they regulate. As part of this process, they are seeking input from stakeholders of the Departments of Human Services, Health, Drug and Alcohol Programs, and/or Aging on the following questions. These questions are focused on providers, but feedback is welcome from advocates and other stakeholders. Please send responses via email by Monday, April 30, 2018.

  1. Which of the following commonwealth agencies do you interact with for licensing and certification: the Departments of Human Services, Health, Drug and Alcohol Programs, and/or Aging? Please identify the specific license or certificate types you have.
  2. Which of the following commonwealth agencies do you interact with when you must report an incident that took place at your facility/agency: the Departments of Human Services, Health, Drug and Alcohol Programs, and/or Aging? This could include incidents required to be reported per licensing regulations, or home and community based (waiver) programs.
  3. What works well in interacting with multiple commonwealth agencies on licensing, certification, and incident management activities?
  4. What challenges do you experience in interacting with multiple commonwealth agencies on licensing, certification, and incident management activities? If possible, please identify whether the challenges are caused by statutory or regulatory requirements, policy or operational guidance, or agency processes or technology.
  5. What opportunities do you see for the commonwealth to streamline your experience interacting with multiple commonwealth agencies on licensing, certification, and incident management activities?

This is a major opportunity that can’t be missed. The work being done by the departments is what RCPA and its members have been advocating for over many years. We currently have an administration willing and able to make significant changes. Members are asked to provide as much detail as possible in your responses.

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The Department of Human Services’ (DHS) Office of Long-Term Living (OLTL) has updated the list of Frequently Asked Questions (FAQ) related to Community HealthChoices (CHC). Many of the FAQs have been generated through their Third Thursday CHC webinars, as well as questions received at the Southwest Participant Education meetings. The FAQs are separated by Provider FAQs and Participant FAQs.

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The Department of Human Services has been working in collaboration with Managed Care Organizations (MCOs), county oversight organizations, and RCPA regarding the concerns and challenges with implementing federal Ordering, Referring and Prescribing (ORP) requirements by the January 1, 2018 deadline. The Department of Human Services has informed RCPA of the following:

  • The ORP requirements for Fee-for-Service continue to apply; i.e., allORP practitioners must be enrolled in the Pennsylvania Medical Assistance (MA) Program or the rendering provider will not be paid.
  • In the HealthChoices managed care delivery system, if a rendering network provider submits a claim to an MCO with the National Provider Identifier (NPI) information that results in edits identifying that the non-networkORP is not enrolled in MA, the claim can be paid. However, if the non-MA enrolled ORP has a high volume of claims, the MCO will work with the network provider and non-MA enrolled ORP to have them enroll in MA or work to transition the member to an enrolled MA provider.

Contact your contracting BH-MCO for additional information.

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The Wolf Administration has launched the Pennsylvania Link to Community Care website, which connects older Pennsylvanians and individuals with a disability or behavioral health need to services and supports available in their community.

The website provides users with a wide variety of resources, including a home care directory and an information referral tool. It is a collaboration of the departments of Aging (PDA) and Human Services (DHS), and is an extension of PDA’s Aging and Disability Resource call center. By providing assistance online, the initiative further enhances the Commonwealth’s efforts to help Pennsylvanians locate and best utilize services at the local level.

The site features 12 service and support categories: Advocacy, Behavioral Health, Employment, Finance, Health Care, Housing, In-Home Services, Legal, Meals, Protection from Abuse, Support Groups, and Transportation.

Users can find information about organizations, services, and programs within these categories. A major component to the site is the home care directory, which connects individuals to in-home services available in their counties. In-home service providers appearing on the searchable directory may offer personal care, assistance with activities of daily living, companionship services, respite care, and/or habilitation services.

If you are an in-home service provider licensed by the Pennsylvania Department of Health, and would like to appear on the home care directory, you may submit your information by navigating to the footer of the site and selecting “Apply.”

In addition to the home care directory, another major feature of the website is the information referral tool. This tool guides users through a series of questions and then provides a list of resources based on their specific needs.

Moving forward, the departments of Aging and Human Services will continue to enhance the website using data and feedback from users, and expand the resources and information provided through the site. This includes working with your organization and other stakeholders to increase the number of options appearing within each category. Read the press release here.

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The Office of Long-Term Living (OLTL) recently announced that the waiver amendments effective as of October 1, 2017 have been posted to the Department of Human Services (DHS) website. The waivers and links to each one include:

Questions related to this communication may be directed to the OLTL Bureau of Policy and Regulatory Management at 717-783-8412.

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As the implementation of Community HealthChoices (CHC) approaches the January 1, 2018 launch in the Southwest Region, the Department of Human Services (DHS) has developed informational materials for those individuals who will be covered by the new program. The documents, including notices and the pre-enrollment packet, are posted on the DHS website, where you will also find their most recent participant document, “CHC: Here’s What You Need to Know” (available for download in English and Spanish).

In addition, a document designed to clarify eligibility for CHC is available here. It includes the following information:

Individuals are NOT eligible for CHC if they are a person with an intellectual or developmental disability who is eligible for services through the Department of Human Services’ Office of Developmental Programs (ODP), OR are a resident in a state-operated nursing facility, including state veterans homes.

Please visit the CHC website or call the CHC Provider Hotline at 833-735-4417 with any questions.

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The Department of Human Services (DHS) recently issued the following information and resources in preparation for the roll-out of Community HealthChoices (CHC) beginning January 2018 in the Southwest zone of the state.

Coming to the Southwest Zone in January 2018

The Department of Human Services (DHS) is committed to open and frequent communication to educate and inform individuals who will move to Community HealthChoices (CHC). It is critical that they are aware of the upcoming changes and are able to make an informed decision on their plan selection. We are using multiple channels to get the message out, and want to ensure that you are aware of upcoming information that potential participants will receive.

  • INFORMATIONAL FLYER

Participants in the Southwest Zone received this flyer (also available in Spanish) in August 2017 to inform them that CHC was coming to their county in January 2018.

  • CHC Community Meetings for Participants

Participants in the Southwest will receive an invitation to community meetings in late September.

There will be more than 40 events in the Southwest Zone, with at least one in each of the 14 impacted counties. The meetings will give more information about CHC, the LIFE program, and answer questions participants may have.

To register for a community meeting, participants can go to www.healthchoices.pa.gov or call 1-833-735-4416. A copy of the invitation is available here.

  • Notices

DHS will mail notices to potential participants beginning today. The notice will inform participants that they will transition to CHC in January and will need to select a health plan, also called a managed care organization (MCO).

The notice also tells potentially eligible participants that they may be eligible for the LIFE program.

Copies of the notices are be available here.

  • Pre-Enrollment Packets

Beginning on October 2, 2017, pre-enrollment packets will be mailed to participants. This packet will contain information about each of the health plans and the benefits offered by each plan, and tell participants how to enroll in a health plan. There will be a toll-free number and website for participants to use to make their selection. A day after the packets are mailed, automated calls will be made to let participants know that the packets are coming.

If participants do not select a health plan, they will get a follow-up call.

Individuals who do not select a plan by November 13, 2017, will be assigned to a plan. Individuals can change their plan at any time.

  • Social Media

DHS’ Facebook, Twitter, and YouTube accounts make CHC information readily available. If you are not following us yet, please click the provided links to make sure you are receiving all up-to-date information on CHC and all department priorities.

chc-phases-map

(Map, Community HealthChoices Phases)

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The Department of Human Services (DHS) published a notice that will appear in tomorrow’s Pennsylvania Bulletin that they intend to make a supplemental payment in fiscal year (FY) 2017/2018 to certain special rehabilitation facilities (SRFs) that have high Medical Assistance (MA) and total facility occupancy levels. An SRF is one that specializes in providing services and care to adults who have a neurological/neuromuscular diagnosis and condition, as well as severe functional limitations. Because of the complex needs of these individuals, SRF’s typically incur staffing and specialized medical equipment costs that are very high. Additionally, SRF’s with high MA and total facility occupancy levels are dependent on MA payments to continue to operate. To help offset the higher costs incurred by these SRFs while they reconfigure to home and community-based services, DHS intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.

To qualify for an MA dependency payment the following requirements must be met:

  • Be classified as an SRF as of the cost report end date.
  • Have MA occupancy greater than or equal to 94% as reported on Schedule A, Column A, Line 5 of the cost report.
  • Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A, Line 4 of the cost report.
  • Have at least 200 MA certified nursing facility beds as of the cost report end date.

DHS will accept comments on this notice for thirty days following publication. Comments should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, PO Box 8025, Harrisburg, PA 17105-8025.

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