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Tags Posts tagged with "HealthChoices"

HealthChoices

As the state’s primary contractor for Medicaid-funded behavioral health (BH) care services (HealthChoices), Allegheny County DHS is responsible for $420M in state-managed care funding to deliver behavioral health services to approximately 260,000 county residents through its contracted partnership with Community Care Behavioral Health.

Historically, as the primary contractor to the state for the HealthChoices program, DHS has delegated its oversight and monitoring functions for this program to Allegheny Health Choices, Inc. (AHCI), and AHCI has done tremendous work helping the county to meet state obligations over the years. Increasingly however, the county has determined that making a structural change to bring monitoring and oversight in-house can streamline those functions and further strengthen the HC program for Allegheny County.

For this reason, the county, together with DHS, has made the decision to transition HealthChoices oversight and monitoring functions from AHCI to DHS, with expected changes to occur in the first quarter of 2023.

See below for further information:

Rep. Seth Grove, chair of the House State Government Committee, has reintroduced legislation that would eliminate Pennsylvania’s HealthChoices behavioral health carve-out and instead integrate physical and behavioral health care into one managed care program. On Thursday, his bill (HB 1940) was referred to the House Health Committee.

In 2018, RCPA wrote a position paper in support of continuing the behavioral health carve-out. In 2019, RCPA signed onto a letter from the Coalition to Preserve Behavioral HealthChoices opposing what was then HB 335.

Read Rep. Grove’s co-sponsorship memo.

Read HB 1940.

During the past few years, the state Medicaid program, HealthChoices, has begun to implement and expand the use of Value-Based Purchasing models in procurement contracts with all Physical Health Managed Care Organizations (PH-MCOs). With a goal of increasing clinical outcomes, patient satisfaction, and cost management, the PH-MCOs have called for increased use of such Value-Based Purchasing models as Pay for Performance, Patient Centered Medical Homes, and Bundled Payments. On May 25, the leadership of the Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) conducted a webcast to review the implementation process used in HealthChoices by the PH-MCOs and their provider networks, and to introduce the process of expanding Value-Based Purchasing to the Behavioral Health Managed Care Organizations and their provider networks. The OMHSAS target for introducing this expansion is January, 2018 with a focus on integrated and collaborative behavioral and physical health and care coordination.

Today the Wolf Administration issued a document entitled Understanding Community HealthChoices vs HealthChoices to explain the similarities and differences between the two programs.

Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. HealthChoices is Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants.

CHC was developed to: (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. Long-Term Services and Supports help eligible individuals to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.

The document describes eligibility, timelines for implementation, and the CHC managed care organizations that will operate in each zone beginning in January, 2018.

From: “HS, Secretary’s Office”
Date: January 5, 2017 at 1:01:56 PM EST
To:[email protected]
Subject: [DHS-STAKEHOLDERS] DHS Awards Medicaid Agreements

Department of Human Services (DHS) Secretary Ted Dallas announced that DHS has agreed to move forward and negotiate agreements with six managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements will be the most significant changes to Pennsylvania’s Medicaid program since we moved to managed care two decades ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee.”

The $12 billion, three-year contracts include a 30 percent target for payments based on value received or outcomes, rather than on the quantity of services provided.

The MCOs were selected based on several criteria, including their current performance, the level of customer service delivered, member satisfaction, and their value-based performance plan. Performance criteria measured, among other things, management of chronic conditions such as high blood pressure, diabetes, and asthma; frequency of prenatal and post-partum care; and access to preventive services.

“The average performance ratings of the selected organizations are consistently higher than the current averages in every region. This transition will result in higher levels of quality care for the 2.2 million Pennsylvanians served by Medicaid,” said Dallas.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS. The result will be that billions in funds that would have otherwise been spent on traditional payment arrangements will instead be invested in outcome or value-based options such as:

  • Accountable care organizations (voluntary networks of hospitals, doctors, and other providers that work together to provide coordinated care to patients);
  • Bundled payments (increases value-based purchasing);
  • Patient-centered medical homes; and
  • Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services. You get what you pay for so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity of care they give patients,” said Dallas. “In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

HealthChoices delivers quality medical care and timely access to all appropriate services to 2.2 million children, individuals with disabilities, pregnant women, and low-income Pennsylvanians.

For more information, visit www.HealthChoicesPA.com or www.dhs.pa.gov.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in June 2017. The agreements are awarded in five geographic regions:

Southeast Region Gateway Health
Health Partners Plans
PA Health and Wellness
UPMC for You
Vista–Keystone First Health Plan
Southwest Region Gateway Health
PA Health and Wellness
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Lehigh/Capital Region Gateway Health
Geisinger Health Plan
Health Partners Plans
PA Health and Wellness
Northeast Region Gateway Health
Geisinger Health Plan
UPMC for You
Northwest Region Gateway Health
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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Pennsylvania Continues Shift to Outcome and Value-based Payment Structure

On April 27, Department of Human Services (DHS) Secretary Ted Dallas announced that the state has agreed to move forward and negotiate contracts with eight managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements mark the most significant change in Pennsylvania’s Medicaid program since we moved to managed care 18 years ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee. The result will be higher levels of quality care for the 2.1 million Pennsylvanians served by Medicaid.”

HealthChoices delivers quality medical care and timely access to all appropriate services to children, individuals with disabilities, pregnant women, and low-income Pennsylvanians. For more information, visit the HealthChoices website or DHS website.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in 2017. The agreements are awarded in five geographic regions:

Southeast Region

 

Centene (Pennsylvania Health and Wellness)
Health Partners Plans
United Healthcare of Pennsylvania, Inc.
UPMC for You, Inc.
Vista–Keystone First Health Plan
Lehigh/Capital Region Centene (Pennsylvania Health and Wellness)
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Southwest Region

 

Centene (Pennsylvania Health and Wellness)
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Northwest Region Aetna Better Health of Pennsylvania
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Northeast Region Geisinger Health Plan
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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On September 15, 2015, an Info was issued regarding a webinar the Office of Long-Term Living (OLTL) will be holding on provider credentialing for Community HealthChoices. The registration link for this webinar sent by OLTL was incorrect. Please use the corrected link below to register for the webinar.

The Office of Long-Term Living (OLTL) will be holding a webinar on Wednesday, September 30, 2015, from 8:30 – 10:00 am for Home and Community Based Services providers and Service Coordination Entities interested in participating in Pennsylvania’s planned Managed Long Term Services and Supports (MLTSS) program, now known as Community HealthChoices. The purpose of the webinar is to provide a high level overview of OLTL’s current provider credentialing process, to obtain input on credentialing MLTSS providers, and to discuss how the provider credentialing process may look for Community HealthChoices. Information on how to access the webinar can be found below.

  1. Please join my Webinar.
    https://global.gotowebinar.com/register/152791275
  2. You will be connected to audio using your computer’s microphone and speakers (VoIP).  A headset is recommended. Or, you may select “Use Telephone” after joining the webinar.

Dial +1 (631) 992-3221
Access Code: 787-398-715
Audio PIN: Shown after joining the webinar
Webinar ID: 103-329-483

For questions regarding this email, please contact the OLTL Provider Inquiry Line at (800) 932-0939.