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The Long-Term Services and Supports (LTSS) Subcommittee has released its agenda for the February 5 virtual meeting. The meeting will have no onsite options for attendance and will be held via webinar at 10:00 am – 1:00 pm. You can view the agenda, which includes the webinar link, here.

The key agenda items are:

  • Office of Long-Term Living (OLTL) Updates
  • Assisted Living Residences — In Lieu of Services Policy Updates
  • Assisted Living Residences and Personal Care Homes — MCO Updates

The Office of Long-Term Living (OLTL) Critical Incident Management Unit monitors provider compliance in the application of guidance specific to critical incident management. OLTL has identified compliance concerns and is issuing the following clarification.

This communication focuses on required critical incident notification by provider agencies to the participant’s assigned service coordinator and the documentation of such notification in the Enterprise Incident Management (EIM) entry. The OLTL Critical Incident Management Bulletin, which is also available on OLTL’s website, indicates the following:

  • Within 48 hours, the Managed Care Organization (MCO), Service Coordinator (SC), provider agency that discovers or has independent knowledge of the critical incident is to submit the First Section of the critical incident report to OLTL using OLTL’s critical incident management system. If the critical incident was discovered on a weekend or holiday, the 48 hours begin at 12:00 am on the first business day after discovery of the critical incident.
  • Providers must inform the participant’s SC within 24 hours of discovering or first learning of a critical incident.

Notification to the participant’s SC that a critical incident was discovered must not be made using the HHAeXchange system. The required notification to the participant’s SC must be made by telephone call, electronic mail communication, or any other method that is agreed upon by all parties involved, excluding the HHAeXchange system.

In addition, the notification by the provider to the participant’s SC that a critical incident was discovered must be clearly documented in the EIM incident report, specifically within the “Agencies Contacted” page. Instructions are below:

  1. Enter the first name of the SC in the Person Contacted (First Name) Field.
  2. Enter the SC’s last name in the Person Contacted (Last Name) Field.
  3. Enter the contact phone number. Note that the email address field is not mandatory; however, it should be completed when notification to the SC was made via email.
  4. Click the SAVE button when all information has been entered.

See an example of page completion below.

Providers who are experiencing difficulty meeting the Critical Incident Management Bulletin requirements may email concerns to the resource account. Additionally, questions related to critical incidents may be emailed to the Critical Incident Management team member identified in any case-specific communication.

The Office of Long-Term Living (OLTL) issued a Critical Incident Management Bulletin, with indications that they and the Managed Care Organizations (MCO) will be enforcing these regulations. Per OLTL:

Investigation of critical incidents and its documentation is an integral part of a Service Coordinator’s (SC) responsibilities, not a stand-alone function. During the course of quality reviews, Office of Long-Term Living’s (OLTL) Incident Management staff has found that critical incident investigations are not consistently following the established policy and procedure. OLTL wants to reinforce the following requirements found in various OLTL policy and procedure documents, which remain unchanged. Non-compliance with these requirements is subject to corrective action by OLTL.

1. Investigation of Critical Incidents

a. According to the Critical Incident Management Bulletin dated 2/23/2023, Community HealthChoices (CHC) managed care organizations (MCO) and SC must begin investigating a critical incident within 24 hours of discovery or of learning of the incident. This requirement was also indicated in the 2015 version of the document. The bulletin reinforces the onsite visit requirement for fact finding. The critical incident facts, sequence of events, interview of witnesses, and observation of the participant and/or environment is required. The onsite investigation is not the same as a comprehensive needs reassessment or assessment of need, and it must be completed regardless of participant choice. The participant reserves the right to refuse involvement in the critical incident investigation. However, the onsite visit must be completed. The Telephone Investigation referenced in the Bulletin does not replace the onsite investigation requirement, and is meant for instances when more information is necessary to complete the incident report. For example, when a protective services investigation is occurring and the SC needs to gather details to ensure mitigation measures are in place. Please note that while required to cooperate in the investigation, SCs are not required to investigate reported allegations of abuse, neglect, or exploitation, which are referred to a protective services agency. However, SCs remain responsible for ensuring participants health, safety, and welfare by means of risk mitigation and appropriate service implementation.

b. The 24-hour requirement to initiate an investigation is not to be interpreted as one business day. The only time business days apply is when submitting a critical incident report in Enterprise Incident Management (EIM), which is required within 48 hours excluding weekends and holidays. Please note that while the investigation must be initiated within 24 hours of incident discovery/learning of the incident, the CHC-MCO and SC will still have 30 calendar days to complete the investigation. It is also important to note that the onsite visit does not necessarily have to occur within 24 hours of incident discovery as long as it occurs at a time that enables ensuring the health and welfare of the participant, and within the allotted 30 calendar days or extended due date in the case where a timely EIM report extension was requested.

c. The Critical Incident Management bulletin also indicates the following:
No further action is required when the critical incident report meets all three of the following conditions:

  1. The facts and sequences of events are outlined with sufficient detail; and
  2. Preventative action through the service plan is either not required or is implemented and documented; and
  3. The participant is not placed at any additional risk.

Therefore, CHC-MCOs and SCs must ensure that, prior to submitting the Final Section of the incident report in EIM, the participant is aware of the critical incident, its resolution, and the measures taken to prevent recurrence. This includes determining whether a comprehensive needs reassessment or assessment of need must be conducted, based on the requirements outlined in OLTL’s policy and procedure documents. The SC must also ensure thorough documentation in the critical incident report of all actions taken to ensure participants health and welfare.

2. Notice to Participant

The Critical Incident Management Bulletin indicates that:

  1. The agency staff that discovered or first became aware of the critical incident is to notify the participant (and representative if requested by the participant) that a critical incident report has been filed. This notice must be provided to the participant within 24 hours and in a cognitively and linguistically accessible format. If the participant’s representative is suspected to be involved in the critical incident, the representative should not be notified.
  2. Within 48 hours of the conclusion of the critical incident investigation, the SC must inform the participant of the resolution and measures implemented to prevent recurrence.

CHC-MCOs and SCs must ensure the required notifications are made to the participant, and document completion within the Referrals and Notifications page in the EIM critical incident report.

OLTL encourages all CHC-MCOs and SCs to review the Critical Incident Management Bulletin to ensure all requirements are met.

If you have any questions, please contact Fady Sahhar.

The Office of Long-Term Living (OLTL) has announced an upcoming transportation summit planned for December 11, 2023, from 1:00 pm – 4:00 pm.

The purpose of this meeting is to have a full and robust discussion about transportation issues and needs. There will be staff from various programs on the call, including the Managed Care Organizations (MCO) and transportation brokers, Medical Assistance Transportation Program (MATP), and the Pennsylvania Department of Transportation (PennDOT). They will be discussing their programs and will be available to answer any questions.

Attendees are encouraged to send questions in advance of the meeting and should be sent to Cortney Alvord via email. Attendees can also ask questions during the webinar by either raising their hand, at which point they will be unmuted, or by asking their question in the chat box.

This meeting is open to the public, transportation providers, and anyone interested in transportation issues in the Community HealthChoices (CHC) Program.

To participate in the meeting, the call information is provided below:

Microsoft Teams meeting

Join on your computer, mobile app or room device
Visit here to join the meeting
Meeting ID: 244 282 417 805
Passcode: T7xSky
Download Teams | Join on the web

Or call in (audio only)
+1 267-332-8737,,693312806#   United States, Philadelphia
Phone Conference ID: 693 312 806#
Find a local number | Reset PIN

Photo by Markus Winkler from Pexels

On May 1, Beacon Health Options of Pennsylvania, Inc., the behavioral health Medicaid managed care organization serving members in Western Pennsylvania, is becoming Carelon Health of Pennsylvania, Inc.

In June 2022, Beacon’s parent company Elevance Health announced the launch of Carelon, a new healthcare services brand. The name Carelon is derived from the word “care” and suffix “-lon,” which means full and complete. Beacon is joining with other businesses across the nation under the Carelon brand to provide ongoing healthcare services to support whole-person health.

Provider contracts, reimbursement, policies, and points of contact will all remain the same. All existing phone numbers, emails, websites, and portals will redirect to the Carelon-branded locations with no action required from providers.

Providers with questions can call 877-615-8503.

House Republican Appropriations Chairman Seth Grove will lead a roundtable discussion with Medicaid (MA) Managed Care Organizations (MCOs) on February 7, 2023, at 10:00 am.

Committee Chairman Grove will be joined by House members and the following testifiers:

  • Emily Katz, Executive Director of PAMCO;
  • Joanne McFall, Market President of Keystone First;
  • Matthew Hurford, President/CEO of Community Care Behavioral Health;
  • James Schuster, Chief Medical Officer of UPMC Insurance Services Division;
  • Jack Carroll, Executive Director of Cumberland-Perry Drug & Alcohol Commission;
  • John Koehn, Market President of Community HealthChoices, AmeriHealth Caritas;
  • Justin Davis, Plan President/CEO of PA Health & Wellness; and
  • Brendan Harris, Vice President of Community HealthChoices, UPMC Health Plan.

The hearing will be held in Room 60 East Wing, Main Capitol, State Capitol Complex in Harrisburg. The hearing will also be streamed live.

A Financial Management Services (FMS) stakeholder meeting has been scheduled for January 6, 2023, from 1:00 pm – 2:30 pm. During this public meeting, there be a discussion on the administration of FMS under the Community HealthChoices (CHC), OBRA Waiver, and Act 150 programs. Representatives from the Office of Long-Term Living (OLTL) and CHC Managed Care Organizations (MCOs) will be in attendance to discuss the FMS program.

Please register using this registration link. After registering, you will receive a confirmation email containing information about joining the webinar.

If you choose to use your phone to call in, please use the numbers below:
Dial in: (631) 992-3221
Access Code: 335417876#
Audio PIN: shown after joining the webinar

ODP Announcement 22-087 issues an important reminder that major changes are being made to the HealthChoices Physical Health Managed Care Organizations (MCOs) offering Medical Assistance benefits on September 1, 2022. A large number of Medical Assistance consumers must select a new MCO by August 16, 2022. If they do not make a selection, a new MCO will be automatically chosen for them.

If Medical Assistance consumers are unsure if they need to select a new MCO, or haven’t received selection materials, they should contact Pennsylvania Enrollment Services at the following:

800-440-3989
TTY: 800-618-4225 | Monday – Friday | 8:00 am – 6:00 pm
Home | PA Enrollment Services

The Office of Long-Term Living (OLTL) implemented Community HealthChoices (CHC) effective January 1, 2018, in the counties identified as the CHC Southwest Region. With the roll-out of CHC, the process for referring individuals for nursing home transition (NHT) has changed for anyone who is enrolled in CHC.

For CHC participants in the following counties, referrals for NHT must be made to the participant’s Managed Care Organization (MCO).  For the purposes of making referrals according to MDS Section Q guidelines, the MCO is to be considered the local contact agency for individuals who are enrolled in CHC. The counties affected as of January 1 are:

  • Allegheny
  • Armstrong
  • Beaver
  • Bedford
  • Blair
  • Butler
  • Cambria
  • Fayette
  • Greene
  • Indiana
  • Lawrence
  • Somerset
  • Washington
  • Westmoreland

Please see contact information for the CHC MCOs below:

For all other questions regarding this notification, please contact the OLTL NHT staff at:

  • Rachel Sink 717-783-7378
  • Brandy Staub 717-783-7219
  • Janel Maple 717-857-3149
  • Mariah Henry 717-772-2542
  • or via email