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Sandata Webinar on Provider Integrity in Medicaid Home Personal Care Services — March 7
Tuesday, March 7, 2023
1:00 pm – 1:30 pm ET
Join the Provider Integrity in Medicaid Home Personal Care Services webinar with Kirit Pandit, VP, Data and Analytics. Preventing fraud, waste, and abuse (FWA) in the Medicaid market is an on-going effort, with many providers, payers, and vendors involved in the effort to improve the health care system.
During this session, you can expect to:
- Learn about the analytics dashboards developed to mine data and identify these cases;
- See our vision for application of analytics for program integrity in home personal care services; and
- Understand how the development of the dashboards can lead to further insights and actions to support the efforts of state and compliance programs.
Reserve your spot today, and stay tuned for information about more upcoming Empower webinars!
DHS Provides Update on the End of the PA PHE, Medicaid, and CHIP
Pennsylvania is preparing for a major change in renewal processes for Medicaid and Children’s Health Insurance Program (CHIP) recipients.
Starting April 1, 2023, Pennsylvania is required by federal law to review Medicaid and CHIP recipients’ eligibility every year, which means that recipients must submit a renewal. While the Department of Human Services (DHS) still sent renewals during the height of the COVID-19 pandemic, most people were not disenrolled from Medicaid or CHIP because of a change in eligibility.
DHS encourages everyone to share the following information with Medicaid and CHIP recipients to help them stay informed about renewals.
What Should I Do Right Now?
The best thing that Medicaid and CHIP recipients can do right now to prepare for their renewal is to make sure that their contact information is up-to-date with DHS. By making sure that their information is current, recipients can receive timely updates about their renewal. They also can opt-in to receiving text and email alerts about their benefits.
- Visit COMPASS and log into their My COMPASS Account.
- Use the free myCOMPASS PA mobile app.
- Call 877-395-8930 or 215-560-7226 (Philadelphia), Monday – Friday from 8:00 am – 4:30 pm.
What Else Do I Need to Know?
Completing Medicaid and CHIP Renewals
Renewals should be completed when they are received, even if recipients receive them before April 1, 2023. Recipients will receive a renewal packet in the mail when it is time to renew their coverage. Information about their renewal will start to arrive 90 days before it is due. It is very important that renewal forms are completed and returned even if nothing has changed. Completing a renewal allows DHS to determine eligibility for MA or CHIP coverage. Coverage will continue for recipients who are still eligible.
There are a few ways for recipients to complete a renewal:
- Complete the forms DHS sends and mail them back in the envelope included in the packet.
- Drop completed forms off at the local county assistance office (CAO).
- Complete the renewal online.
- Complete the renewal over the phone by calling 866-550-4355.
What is Continuous Coverage?
Under the continuous coverage requirement, individuals covered by Medicaid and/or CHIP have been able to keep their health coverage even if they would have otherwise become ineligible for the program based on other factors.
Evaluating Eligibility
Once the continuous Medicaid and CHIP coverage requirement ends, recipients will have to complete a renewal to maintain their coverage as long as they are eligible.
Are You Ineligible for Coverage?
DHS will provide instructions on how to re-enroll or share options for coverage if individuals are no longer eligible. Options for free or low-cost health coverage are available online.
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House Republican Appropriations Chair to Lead Discussion With MA MCOs on Feb. 7
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.
Medicaid Continuous Coverage Requirement Set to Expire on April 1: Stakeholder Toolkit Available From DHS
Because of the continuous coverage requirement, states were able to use additional money from the federal government during the federal public health emergency (PHE) for health care programs like Medicaid if they kept people covered. Therefore, Pennsylvanians did not lose their Medicaid/Medical Assistance (MA) or CHIP coverage if their income changed or they did not complete a renewal during the PHE.
However, starting April 1, 2023, Pennsylvania and other states will have to start disenrolling people if households are ineligible for MA at the time of their renewal or do not complete their renewal. The Pennsylvania Department of Human Services (DHS) will have to return to normal renewal processing procedures for Pennsylvanians enrolled in MA and the CHIP. Renewals will be completed over 12 months. Everyone with MA or CHIP coverage will need to submit a renewal to see if they are still eligible.
In Pennsylvania, approximately 3.5 million people rely on Medicaid. Last year, it was estimated that about 500,000 of those would lose coverage when the continuous coverage requirement ended, creating access issues for individuals and exacerbating financial challenges for providers.
The Pennsylvania Department of Human Services has created an online resource, including a stakeholder toolkit as well as a guide on how to become a helper, that provides resources for groups like providers to communicate ways for Pennsylvanians who receive MA or CHIP coverage to continue their coverage.
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