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Tags Posts tagged with "PA Office of Long-Term Living"

PA Office of Long-Term Living

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In an effort to become more aware of, and knowledgeable about, specific measures to consider improving the quality, consistency, and effectiveness of the Office of Long-Term Living’s (OLTL) application and enrollment procedure, the Department of Human Services (DHS) has issued a Request for Information (RFI). The RFI will be used to gather information and input concerning the application and enrollment services for the beneficiaries of two Medical Assistance (MA) managed care programs, four 1915(c) MA home and community-based services (HCBS) waiver programs, and a state-funded program, all administered by OLTL.

 

Specifically, the RFI seeks information to assist DHS in determining how it may improve its LTSS application and enrollment process, including services provided by the OLTL Independent Enrollment Broker (IEB) to individuals who apply for and enroll in the Community HealthChoices (CHC) Program, the Pennsylvania Living Independence for the Elderly Program (LIFE), the Aging Waiver, the Attendant Care Waiver, the Independence Waiver and the OBRA Waiver, and the state-funded Act 150 Attendant Care Program.

DHS is requesting that all responses to the RFI be submitted by 12:00 pm on April 22, 2019. Responses must be submitted electronically to this email account with “OLTL Application and Enrollment Services RFI” in the email subject line. RCPA will establish a work group to review the RFI and compile comments to be submitted by the required deadline.

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The Office of Long-Term Living (OLTL) released the following provider update on electronic visit verification (EVV).

How will Electronic Visit Verification (EVV) impact providers who serve participants in OLTL programs?
As a reminder, EVV is a technology solution which electronically verifies the delivery dates and times of home and community-based services to the individuals needing those services. EVV is intended to require submission of information that will help electronically validate services and prevent fraudulent claims.  Federal law (the 21st  Century Cures Act) requires all state Medicaid agencies implement an EVV solution to manage their personal care services by January 1, 2020, and home health care services by January 1, 2023. The Department of Human Services (DHS) is moving forward with a soft implementation in September of 2019 and DHS will continue to provide you with guidance and updates as we move through this process.  Updated information will be sent to you and will also be included on the DHS website.

Providers Serving Participants Enrolled in the OBRA Waiver or Act 150 Program
Providers serving participants in the OBRA waiver or Act 150 program must adhere to all timelines and guidance issued by DHS in order to comply with EVV requirements in the fee-for-service system. DHS is working with vendors (DXC and Sandata) to develop an EVV system that will integrate with PROMISe, our existing Medicaid Management Information System.  Providers with their own internal EVV system must work with DHS to ensure their EVV system can interface with the DHS EVV aggregator system. Providers without an EVV system may secure their own EVV solution; if they choose to do so, they must follow all guidance issued by DHS to ensure training and implementation requirements are completed in order to implement EVV by September 2019. DHS will issue additional implementation details as they become available.

Providers Serving Participants in an Active Community HealthChoices (CHC) Zone (Southwest or Southeast)
Providers serving participants who are already enrolled in one of the CHC Managed Care Organizations (MCOs) will have the option to use the MCO’s EVV system, HHAeXchange.  A CHC-participating provider with their own internal EVV system must work with each contracted MCO to ensure the provider’s system is able to send information to HHAeXchange. Providers should begin discussing training and system options with their contracted MCO(s) in order to implement EVV by September 2019.

Providers Serving Participants in the Phase 3 Region of CHC
Providers in Phase 3 of CHC, which includes Lehigh/Capital, Northeast, and Northwest Zones, must coordinate the use of EVV with MCOs when Phase 3 is implemented on January 1, 2020. This includes providers currently serving participants in Aging, Attendant Care, and Independence waivers. Providers who will be participating in CHC will have the option to use the MCO’s EVV system, HHAeXchange.  A CHC-participating provider with their own internal EVV system must work with each contracted MCO to ensure the provider’s system is able to send information to HHAeXchange. Providers currently serving participants in the Phase 3 region of CHC should begin discussing training and system options with the three MCOs to ensure that they will be able to use EVV when they transition to CHC on January 1, 2020.

Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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On February 11, 2019, the Office of Long-Term Living (OLTL) released Bulletin 59-19-03, Hearings and Appeals. The bulletin provides the responsibilities of Service Coordination Entities (SCEs) with respect to the notice and fair hearing requirements. Also included with the bulletin are the following attachments:

  1. MA 561 – Notice of Service Determination and the Right to Appeal
  2. MA 562 – Decision to Withdraw an Appeal Request
  3. MS 561 – MA 561 Form Instructions for Service Coordinators
  4. Bureau of Hearings and Appeals Agency Appeal Cover Sheet
  5. Bureau of Hearings and Appeals Agency Appeal Cover Sheet Instructions
  6. OHA 147 – Bureau of Hearings and Appeals Agency Expedited Information Sheet
  7. BHA Regions Chart

The bulletin is updated to reflect expedited appeals requirements that were established by the Medicaid Eligibility Final Rule and can be found in 42 CFR Part 431.224. The SCEs are responsible to understand the rights and procedures set forth in the state regulations and federal regulations. The bulletin highlights the many requirements of the SCEs.

OLTL has scheduled a webinar for Monday, February 25, 2019 at 2:00 pm to answer questions SCEs may have in relation to this bulletin. Please register here. After registering, you will receive a confirmation email containing information about joining the webinar. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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Background
In administering the Office of Long-Term Living (OLTL) Home and Community-Based Services (HCBS) Waivers, OLTL requires service coordinators to monitor that waiver participants receive all HCBS services authorized in their service plans and to develop a backup plan in case a service could not be provided. If a provider is unable to provide an authorized service, the service coordinator must work with the participant to secure another provider to provide the service as specified in the participant’s backup plan. In addition, service coordinators and providers must report critical incidents, including any occurring as a result of the participant’s failure to receive services which placed the participant’s health or safety at risk, in accordance with OLTL’s Critical Incident Management Bulletin.

Policy
With the implementation of Community HealthChoices (CHC), OLTL is adopting a different reporting process for HCBS similar to the process currently implemented in the HealthChoices program. Since CHC-MCOs cover all authorized home health skilled care, home health aide, and personal assistance services, OLTL is expanding the current HealthChoices operations report to identify all missed services for participants who utilize these services.

Providers of CHC-covered home health skilled care, home health aide services, and personal assistance services must submit information on missed services to the CHC-MCOs. CHC-MCOs must submit a missed services operations report to OLTL on a monthly basis that includes detailed information on missed services, such as the date of the missed service, the reason for the missed service, and actions taken to address the missed service in both the short and long term.

In its CHC oversight role, OLTL will review these monthly reports along with complaint and grievance, CHC-MCO inquiry, and EIM data to monitor the health and welfare of CHC participants. Providers who do not submit the required information to the CHC-MCO may face corrective actions.

CHC-MCOs will notify their home health and home care network providers of their reporting requirements. Please direct any questions about these reporting requirements to the CHC-MCOs.

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The Office of Long-Term Living issued guidance to Service Coordinators and Direct Service Providers  regarding the reporting of critical incidents for the Southwest Pennsylvania Counties. Please note the two texts below.

FOR SERVICE COORDINATION ENTITIES
This communication is to service coordinators of Office of Long-Term Living (OLTL) participants in the 14 Southwest Community HealthChoices (CHC) counties. Service coordinators are required to submit critical incidents according to OLTL’s critical incident management bulletin; however, OLTL is making a time-limited change in the incident submission process in order to ensure all service coordinators in these 14 Southwest CHC counties receive necessary Enterprise Incident Management (EIM) user IDs for each CHC-MCO.

Do not submit incidents for CHC-MCO participants using your fee-for-service user IDs in EIM. Instead, please work with the CHC-MCOs and submit incidents to them directly until you receive your user IDs that will allow you to submit an incident in EIM which will be directed to the relevant CHC-MCO.

If you have not already received a user ID from UPMC or PA Health and Wellness, please contact them directly to receive more information on how they want you to submit incidents to them in this interim period.

At this time, AmeriHealth Caritas will be utilizing this RA email box for service coordinator submission of critical incidents. If you have questions about this information, please contact OLTL at 717-787-8091.

FOR ALL DIRECT SERVICE PROVIDERS
This communication is to Direct Service Providers of Office of Long-Term Living (OLTL) participants in the 14 Southwest Community HealthChoices (CHC) counties. Direct Service Providers are required to submit critical incidents according to OLTL’s critical incident management bulletin. Currently, providers serving participants in the ‘under-60’ waivers submit incidents into the EIM System, and Aging Waiver Direct Service Providers submit critical incidents into an RA-incident email box.

With the implementation of CHC on January 1, 2018, in 14 Southwest counties, all OLTL Direct Service Providers will now submit critical incidents into EIM for participants enrolled in CHC. Aging Waiver providers will no longer submit critical incidents to an RA email box if the participant is enrolled in CHC.

Please work with the CHC-MCOs to receive training to use the EIM system. Please note: Direct Service Providers will need to select the “search for CHC participants” checkbox when creating incidents in EIM for CHC participants.

Direct Service Providers serving participants that are NOT in the current 14 Southwest CHC counties (listed below), and NOT enrolled in CHC, must continue to submit critical incidents into EIM for the ‘under 60’ waivers, and Aging Waiver providers must continue to submit critical incidents to the RA incident email box until further notice.

CHC counties — Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington, and Westmoreland. If you have questions about this information, please contact OLTL at 717-787-8091.

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The Office of Long-Term Living (OLTL) is offering a webinar on the topic of the Pennsylvania ABLE Savings Program. A PA ABLE account gives individuals with qualifying disabilities (eligible individuals), and their families and friends, a tax-free way to save for disability-related expenses while maintaining government benefits. Federal and state law authorized the creation of PA ABLE accounts. Please join Ryan Buxton, Program Representative from the Pennsylvania Treasury Department, who will conduct the webinar.

OLTL Service Coordinators and Direct Service Providers are strongly encouraged to participate in this webinar that will help you understand the ABLE Program and how it can benefit the OLTL participants you serve.

The webinar on PA ABLE is scheduled as follows:
Wednesday, January 17, 2018, from 1:00 pm – 2:00 pm.

Please register online here. After registering, you will receive a confirmation email containing information about joining the webinar.

If you have questions regarding this email please contact Edward M. Butler, OLTL, at 717-214-3718 or via email.

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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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