Community HealthChoices (CHC) Program Overview
Community HealthChoices (CHC) is a Medicaid managed care program offering physical health benefits and long-term services and supports for individuals aged 21 and older who are dually eligible for Medicare and Medicaid or need nursing facility-level care. This program excludes certain groups like those in state-operated nursing facilities. The statewide population and goals of CHC are outlined, emphasizing its focus on enhancing care delivery and outcomes.
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CHC Updates CHC Updates July 17, 2019 July 17, 2019 Kevin Hancock/Deputy Secretary Office of Long-Term Living Department of Human Services 1
WHAT IS COMMUNITY HEALTHCHOICES (CHC)? WHAT IS COMMUNITY HEALTHCHOICES (CHC)? A Medicaid managed care program that will include physical health benefits and long A Medicaid managed care program that will include physical health benefits and long- -term services and supports (LTSS). The program is referenced to nationally as a managed long supports (LTSS). The program is referenced to nationally as a managed long- -term services and supports program (MLTSS). program (MLTSS). term services and term services and supports WHO IS PART OF CHC? WHO IS PART OF CHC? Individuals who are 21 years of age or older and dually eligible for Medicare and Medicaid. Individuals who are 21 years of age or older and eligible for Medicaid (LTSS) because they need the level of care provided by a nursing facility. This care may be provided in the home, community, or nursing facility. Individuals currently enrolled in the LIFE Program will not be enrolled in CHC unless they expressly select to transition from LIFE to a CHC managed care organization (MCO). 2
WHO IS NOT PART OF CHC? WHO IS NOT PART OF CHC? People receiving long-term services & supports in the OBRA waiver & are not nursing facility clinically eligible (NFCE) A person with an intellectual or developmental disability receiving services beyond supports coordination through the Department of Human Services Office of Developmental Programs A resident in a state-operated nursing facility, including the state veterans homes 3
CHC STATEWIDE POPULATION CHC STATEWIDE POPULATION 15% 15% 66,561 Duals in Waivers 69,036 Duals in Nursing Facilities 454,045 454,045 CHC POPULATION CHC POPULATION 93 93% DUAL DUAL- -ELIGIBLE ELIGIBLE 63% 285,018 NFI Duals 6% 26,293 Non-duals in Waivers % 20 20% IN WAIVERS IN WAIVERS 17 17% IN NURSING FACILITIES IN NURSING FACILITIES % 2% 7,137 Non-duals in Nursing Facilities % 4
WHAT ARE THE GOALS OF CHC? WHAT ARE THE GOALS OF CHC? 5
WHERE WHERE IS IT NOW? IS IT NOW? 6
SOUTHWEST AND SOUTHEAST IMPLEMENTATION SOUTHWEST AND SOUTHEAST IMPLEMENTATION Successfully implemented CHC in the Southwest on January 1, 2018 and the Southeast on January 1, 2019 Approximately 79,000 Participants in the Southwest and 131,000 Participants in the Southeast have been transitioned to the CHC program Lessons Learned Enhanced communication materials and training regarding Medicare vs. CHC More education and communication on continuity-of-care MCO Provider Training and outreach to occur earlier and more often Earlier pre-transition notices Increased focus on transportation Schedule additional provider workshops in the fall of 2019 Identify additional locations for participant information sessions 8
SOUTHEAST CONTINUITY OF CARE SOUTHEAST CONTINUITY OF CARE Continuity of Care period ended in the Southeast zone of CHC on June 30th. What can participants expect at the end of the continuity of care period? A comprehensive needs assessment Person-centered service planning A revised person-centered service plan 9
PHASE 3 PHASE 3 IMPLEMENTATION IMPLEMENTATION 10
CHC PHASE 3 POPULATION CHC PHASE 3 POPULATION 16% 10% 14,609 Duals in Waivers 23,323 Duals in Nursing Facilities 143,004 143,004 CHC POPULATION CHC POPULATION 96 96% DUAL DUAL- -ELIGIBLE ELIGIBLE 70% 99,887 NFI Duals 3% 4,089 Non-duals in Waivers % 13% 13% IN WAIVERS IN WAIVERS 17% 17% IN NURSING FACILITIES IN NURSING FACILITIES 1% 1,096 Non-duals in Nursing Facilities 11
PHASE 3 ZONES: LEHIGH/CAPITAL PHASE 3 ZONES: LEHIGH/CAPITAL 16% 10,861 Duals in Nursing Facilities 10% 6,269 Duals in Waivers 70% 46,411 NFI Duals 66,044 66,044 CHC POPULATION CHC POPULATION 96 96% DUAL DUAL- -ELIGIBLE ELIGIBLE 3% 1,996 Non-duals in Waivers LEHIGH/CAPITAL COUNTIES: Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry, York % 1% 507 Non-Duals in Nursing Facilities 12
PHASE 3 ZONES: NORTHWEST PHASE 3 ZONES: NORTHWEST 15% 4,053 Duals in Nursing Facilities 13% 3,671 Duals in Waivers 68% 18,737 NFI Duals 27,730 27,730 CHC POPULATION CHC POPULATION 95 95% DUAL DUAL- -ELIGIBLE ELIGIBLE 4% 1,080 Non-duals in Waivers % NORTHWEST COUNTIES: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango, Warren <1% 189 Non-Duals in Nursing Facilities 13
PHASE 3 ZONES: NORTHEAST PHASE 3 ZONES: NORTHEAST 17% 8,397 Duals in Nursing Facilities 9% 4,664 Duals in Waivers 49,195 49,195 CHC POPULATION CHC POPULATION 97 97% DUAL DUAL- -ELIGIBLE ELIGIBLE 71% 34,727 NFI Duals 2% 1,007 Non-Duals in Waivers NORTHEAST COUNTIES: Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming % 1% 400 Non-Duals in Nursing Facilities 14
PHASE THREE IMPLEMENTATION PHASE THREE IMPLEMENTATION OBJECTIVES Comprehensive participant communication Robust readiness review Provider communication and training Pre-transition and plan selection for phase three participants Incorporation of southwest, southeast implementation and launch lessons learned CHALLENGES Transportation Geography Participant Outreach Electronic Visit Verification (EVV) Implementation 15
PHASE 3 PROVIDER SESSIONS (MAY PHASE 3 PROVIDER SESSIONS (MAY- -JUNE) JUNE) Lehigh/Capital Zone: OLTL conducted Provider Workshops in Harrisburg, Shippensburg, and Kutztown. A Transportation Summit was also held in Kutztown. Approximately 600 people attended. Northwest Zone: OLTL conducted Provider Workshops in Edinboro, Lock Haven, and Bradford. A Transportation Summit was also held in Bradford. Approximately 420 people attended. Northeast Zone OLTL conducted Provider Workshops in East Stroudsburg, Scranton, and Bloomsburg. A Transportation Summit was also held in Bloomsburg. Approximately 520 people attended. 16
TRANSPORTATION SUMMITS TRANSPORTATION SUMMITS Key Takeaways Evaluate potential areas for innovation to support the informal transportation supports currently being provided by direct care workers. Continue to facilitate discussion to ensure MCOs, providers, and other stakeholders understand the various transportation resources offered through Commonwealth programs. Increase communication to service coordinators regarding the role of the transportation brokers in CHC. 17
UPCOMING PHASE 3 ACTIVITIES UPCOMING PHASE 3 ACTIVITIES July July- -August August July 15: Initial Participant Touchpoint Flyer and LIFE Program Flyer August 1: Aging Well Participant Information Session Mailer August 19-30: First Round of Pre-Transition Notices Meaningful Contact Activities Begin September-October Participant Information Sessions Provider Sessions Multiple Rounds of Pre-Transition Notices and Enrollment Packets Ongoing Meaningful Contact Activities November November- -December November 13 Last Day for Plan Selection Before Auto-Assignment December 20 Last Day for Plan Selection Effective January 1 December 18
MANAGED CARE ORGANIZATIONS MANAGED CARE ORGANIZATIONS The selected offerors were announced on August 30, 2016. www.AmerihealthCaritasCHC.com www.PAHealthWellness.com www.upmchealthplan.com/chc 19
ENROLLMENT ENROLLMENT SERVICES SERVICES 20
ENROLLMENT SERVICES TIMELINE ENROLLMENT SERVICES TIMELINE Concept Paper Released for Public Comment Released March 22, 2019 for a 30 day comment period. Draft RFA Released for Public Comment Released June 28, 2019 for a 30 day comment period RFA Publication 45 day response period 21
KEY ELEMENTS KEY ELEMENTS Key elements: Conflict-free enrollment and choice counseling A regional presence One in-home visit at the onset of the process (navigation) Assistance with completing the LTSS application (navigation) Efficient and effective operations Consistency Improved communications and follow-up Better customer service and improved applicant experience Enhanced accountability and quality control 22
ELECTRONIC VISIT ELECTRONIC VISIT VERIFICATION (EVV) VERIFICATION (EVV) 23
EVV REQUIREMENTS EVV REQUIREMENTS Section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services. EVV must be implemented for personal care services by January 1, 2020 and for home health care services by January 1, 2023. The Cures Act requires that the EVV system verify: Type of service provided Individual receiving the service Individual providing the service Date of the service Location of the service delivery Time the service begins and ends OLTL waiver services included in the initial implementation of EVV include: Personal Assistance Services (Agency and Participant-Directed Model) Participant-Directed Community Supports Respite (unlicensed settings only) 24
OPEN VENDOR MODEL OPEN VENDOR MODEL DHS is working with DXC and Sandata to develop an EVV system that will integrate with PROMISe, our existing Medicaid Management Information System. Providers may use other EVV vendors/systems (Alternate EVV). Alternate EVV systems will need to capture the six required items under the Cures Act and will need to meet DHS system data requirements. The DHS Aggregator will receive information from Alternate EVV systems being used by providers. Providers who choose to use their own internal system must allow at least 60 days to complete certification and testing with the DHS Aggregator system. 25
EVV IMPLEMENTATION UPDATES EVV IMPLEMENTATION UPDATES July July- -August 2019 August 2019 Providers using a third party EVV system will need to review and comply with the technical specifications that are available on the DHS EVV website. Providers who are currently using or plan to use a third party EVV solution should contact Sandata and any MCOs they may be contracted with to ensure data interfaces align. September 2019 September 2019 The PA DHS EVV system training will be available for providers. Providers using the DHS system must complete this training in order to begin setting up their agency accounts and security permissions. Three types of training will be available: in-person, class-room style training offered at regional locations instructor-led webinars self-paced on-line training This mandatory provider training will be a train the trainer style training. Provider agencies are expected to send representatives to the face-to-face training sessions who in turn will train other agency personnel and direct care staff at their home agency. October 2019 October 2019 DHS will expect provider agencies, Agencies with Choice (AWC), and Vendor Fiscal (VF) agents to use EVV for the capture and verification of visits. 26
EVV RESOURCES EVV RESOURCES DHS EVV Resources DHS EVV Resources EVV Frequently Asked Questions document was recently posted to the DHS EVV Website Providers using a third party EVV system will need to review and comply with the technical specifications that are available on the PA DHS website. Website: http://www.dhs.pa.gov/provider/billinginformation/electronicvisitverification/ For specific questions regarding EVV and to subscribe to the EVV listserv, please contact RA-PWEVVNotice@pa.gov Upcoming EVV Public Meetings: Tuesday August 13, 2019 from 1:00 to 3:30PM Tuesday September 17, 2019 from 1:00 to 3:30PM Tuesday October 22, 2019 from 1:00 to 3:30PM Additional meeting information is included on the DHS EVV website. 27
CHC RESOURCE INFORMATION CHC RESOURCE INFORMATION CHC LISTSERV // STAY INFORMED: CHC LISTSERV // STAY INFORMED: http://listserv.dpw.state.pa.us/oltl http://listserv.dpw.state.pa.us/oltl- -community community- -healthchoices.html healthchoices.html COMMUNITY HEALTHCHOICES WEBSITE: COMMUNITY HEALTHCHOICES WEBSITE: www.healthchoices.pa.gov www.healthchoices.pa.gov MLTSS SUBMAAC WEBSITE: MLTSS SUBMAAC WEBSITE: www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss EMAIL COMMENTS TO EMAIL COMMENTS TO: : RA RA- -PWCHC@pa.gov PWCHC@pa.gov OLTL PROVIDER LINE: OLTL PROVIDER LINE: 1 1- -800 800- -932 932- -0939 0939 OLTL PARTICIPANT LINE: OLTL PARTICIPANT LINE: 1 1- -800 800- -757 757- -5042 5042 INDEPENDENT ENROLLMENT BROKER: INDEPENDENT ENROLLMENT BROKER: 1 1- -844 824- -3655 or (TTY 1 3655 or (TTY 1- -833 or visit 844- -824 or visit www.enrollchc.com www.enrollchc.com 833- -254 254- -0690) 0690) 28
CHC MCO CONTACT INFORMATION CHC MCO CONTACT INFORMATION AmeriHealth AmeriHealth Caritas/Keystone Caritas/Keystone First www www. .amerihealthcaritaschc amerihealthcaritaschc. .com First | | CHCProviders@amerihealthcaritas CHCProviders@amerihealthcaritas. .com com - - 1 1- -800 800- -521 521- -6007 6007 (TTY (TTY 1 1- -855 com 855- -235 235- -5112 5112) ) Pennsylvania Health and Wellness (Centene) | Pennsylvania Health and Wellness (Centene) | information@pahealthwellness.com www.PAHealthWellness.com www.PAHealthWellness.com 1 1- -844 844- -626 626- -6813 (TTY 1 information@pahealthwellness.com 6813 (TTY 1- -844 844- -349 349- -8916) 8916) UPMC Community HealthChoices | UPMC Community HealthChoices | CHCProviders@UPMC.edu www.upmchealthplan.com/chc www.upmchealthplan.com/chc - - 1 1- -844 CHCProviders@UPMC.edu 844- -860 860- -9303 (TTY 1 9303 (TTY 1- -866 866- -407 407- -8762) 8762) 29
QUESTIONS 30
