Enrollment Updates

Reinstated 90-day application process for HCBS Waiver Enrollment, added a Special Needs Unit, Aging Waiver Enrollment volumes comparison, and technical improvements for IEB.

• Enrollment
• Updates
• Data Review
• HCBS Waiver
• Aging Waiver

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1. Enrollment Updates and Data Review LTSS Sub-MAAC August 8, 2017 Updates 2/23/2025 1

2. HCBS Waiver Enrollment HCBS Waiver Enrollment What are the changes to HCBS Waiver Enrollment? Reinstated 90 day application process to prevent the need for re-applications except for nursing facility transitions, waiver transfers and EPSDT which must be complete within 180 days Requires follow-up with referrals 4 attempts to contact with at least one personal call If unable to contact after 2nd attempt, contact referral source to verify information If no contact after 4 attempts, a letter to contact IEB and application is issued within 30 days requesting contact within 30 days

3. HCBS Waiver Enrollment HCBS Waiver Enrollment What are the changes to HCBS Waiver Enrollment? Enter all applications directly into COMPASS, Electronic processing of 1768s and Notices of Determination to eliminate delays in document processing. Added a Special Needs Unit to assist with expediting cases related to APS/PS, coordinate the enrollment from EPSDT to LTSS services, from inpatient or other facilities to HCBS, and/or an immediate need for services to prevent hospitalization or nursing facility placement. For transitions from nursing facilities, contact participant or NHT coordinator at least every 30 days to confirm status. Additionally, Maximus implemented a new software system at the end of May which allows for the automation of many of the processes that Maximus was completing manually.

4. Aging Waiver Enrollment Volumes Aging Waiver Enrollment Volumes Aging Waiver Enrollment Volumes 2014 2015 346 256 589 573 389 526 484 498 611 594 409 483 Month January February March April May June July August September October November December 2016 2017 474 463 628 533 402 545 644 873 749 654 492 556 477 681 946 856 814 857 285 495 538 730 867 1207 774 882 1003 942 893 742 789 Aging Waiver Enrollment Year-by-Year Comparison 1400 1200 1000 800 600 400 200 0 2014 2015 2016 2017 2/23/2025 4

5. Technical Improvements for IEB Technical Improvements for IEB Deloitte Interface Automated the 1768 process Electronic receipt of the waiver code daily Electronic receipt of 162 daily Compass Data Entry Implementation of New Platform Includes: Modifications to support a revised workflow A distinct complaint management module and enhanced complaints reporting capabilities Enhanced case management capabilities that provide the ability to view the entire history of a case, including calls, application events, documents, appeals, and complaints Enhanced reporting platform to facilitate quicker generation of ad hoc reports 2/23/2025 5

6. Length of Time for Enrollment Status Length of Time for Enrollment Status Average Length of time for each Status 1/1/17 thru 5/31/17 1768 Approval Issued to CAO : 25 days Pending review by OLTL : 2 days Waiting for In Home Visit to be Scheduled : 6 days In Home Visit Scheduled : 10 days PC Pending/LCD Received : 14 days PC Received/LCD Pending : 14 days PC & LCD Pending : 14 days 2/23/2025 6

7. ADRC Involvement in the Application Process ADRC Involvement in the Application Process 2/23/2025 7

8. ADRC Involvement in the Application Process ADRC Involvement in the Application Process 2/23/2025 8

9. ADRC Involvement in the Application Process ADRC Involvement in the Application Process 2/23/2025 9

10. MMDI Project Overview To assist OLTL, CMS offered OLTL technical assistance support from a CMS contractor, FEi Systems. Using both on-site staff and staff based at their Maryland office, FEi has been performing several tasks: Developing and documenting a Final Action process for Part D, Pharmaceutical Medicare claims (complete). Developing and documenting a Final Action process for Medicare Parts A and B FFS claims (In Process) Developing and documenting a Client Cross Reference Table that will enable efficient and comprehensive merging of data from Medicare, Medicaid and other sources, such as the Minimum Data Set (MDS) (In Process). Assistance with the development of the infrastructure to receive and store the Enhanced COBA FFS Claims data Developing a Use Case demonstrating the power of bringing Medicare and Medicaid data to better understand a selected population; in this case the Pennsylvania dual eligible residents who would have been eligible for CHC as of December 2014 (Target 9/5/2017). All of the programs, including the analytic programs for the Use Case, will become the property of OLTL. 2/23/2025 10

11. Other Projects using MMDI OLTL is currently collaborating with FEi Systems on an additional project: A study examining the process whereby MA and dual eligible recipients transition from the community to the hospital and then either to a nursing facility or back to the community. 2/23/2025 11

12. Consumer and Churn Reports Snap Shot Chart for 4th Quarter SFY 2016-17 Waiver/Act 150 Program Descriptions A Active Consumers authorized for services at the end of the period Act 150 Aging Attendant Care COMMCARE Independence OBRA LIFE Total Active Authorized Consumers 66,608 67,188 67,402 67,491 B Consumers added Act 150 Aging Attendant Care COMMCARE Independence OBRA LIFE Total Consumers added C Consumers that left Act 150 Aging Attendant Care COMMCARE Independence OBRA LIFE Total Consumers that left D Transfers from ACW to Independence Jun-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 as a % Budget 1,747 29,838 29,442 29,410 29,194 13,385 13,847 13,964 14,093 909 923 13,911 14,405 14,529 14,658 1,423 1,446 5,395 5,417 1,708 1,707 1,705 1,687 30,305 14,131 937 14,673 1,458 5,468 68,659 1,680 30,366 14,296 942 14,799 1,465 5,485 69,033 1,671 30,099 14,577 952 15,038 1,470 5,492 69,299 1,651 33,347 14,693 929 15,073 1,469 5,574 72,736 1,643 33,546 14,908 938 15,245 1,479 5603 73,362 1,631 33,206 15,131 944 15,401 1,482 5,473 73,268 2% 45% 21% 1% 21% 2% 7% 1,705 36,421 12,892 884 13,309 1,694 934 928 1,456 5,451 1,452 5,412 66,905 11 692 125 9 9 6 6 7 2 5 6 1 0.1% 32% 30% 1% 21% 1% 16% 312 220 577 261 11 207 10 133 1,205 609 251 326 383 13 280 820 334 727 293 12 213 11 130 1,392 291 273 528 234 10 238 11 138 1,168 529 207 7 9 8 7 8 8 173 188 12 137 1,213 278 14 175 1,634 187 156 187 8 6 8 9 7 138 133 858 139 1,151 141 906 14 1,014 1,087 5 3 1 3 14 549 86 11 592 104 7 3 14 626 48 6 1% 84% 3% 0% 2% 0.1% 10% 687 45 831 79 519 84 13 45 984 33 571 57 554 95 531 91 10 45 0 5 2 1 1 - 9 8 13 1 96 845 34 64 6 117 841 53 43 3 119 874 57 18 29 3 100 821 26 23 1 119 1,166 61 4 124 831 62 2 103 827 47 - 1 4 141 823 44 135 1,071 136 801 57 47 15 2/23/2025 12

13. Employment Note: This is the total number of waiver/program participants employed (Source: CIS employment data) 2016 Jun 2016 Oct 2017 Jan Waiver/Employment Nov Dec Feb Mar Apr May Jun ACT 150 Full Time Employment Part Time Employment Self Employment 10 17 12 19 11 15 12 19 12 18 12 17 11 18 12 16 13 18 13 19 7 8 8 9 8 9 9 9 9 9 Total 34 39 34 40 38 38 38 37 40 41 Attendant Care Full Time Employment Part Time Employment Self Employment 22 29 34 33 34 33 36 36 34 35 129 53 204 142 57 228 144 53 231 154 57 244 158 58 250 152 57 242 150 61 247 151 53 240 159 57 250 152 57 244 Total COMMCARE Full Time Employment Part Time Employment Self Employment 3 2 2 2 3 3 3 2 2 2 49 56 54 57 57 57 59 57 58 57 2 4 4 4 6 5 5 5 4 4 Total 54 62 60 63 66 65 67 64 64 63 Independence Full Time Employment Part Time Employment Self Employment 44 38 38 41 47 48 53 44 42 41 167 55 266 188 61 287 186 60 284 192 59 292 199 61 307 197 59 304 193 61 307 195 64 303 203 62 307 206 58 305 Total OBRA Full Time Employment Part Time Employment Self Employment 14 89 15 94 16 93 16 15 16 16 17 17 16 101 102 106 108 110 110 108 2 5 3 5 5 4 4 3 3 3 Total 105 663 114 730 112 721 122 761 122 783 126 775 128 787 130 774 130 791 127 780 All Waivers 2/23/2025 13

14. NHT and MFP Transitions % NHT Transitions who also had MFP NHT02 Service Deliveries Count Number of those who were also MFP* Participants who were MFP only** Month 2016 September October November December 2017 January February March April May June TOTAL for Period 133 121 94 94 18 28 15 13 41 27 24 16 13.5% 23.1% 16.0% 13.8% 91 109 139 98 120 126 21 21 21 12 19 8 19 12 8 26 11 9 23.1% 19.3% 15.1% 12.2% 15.8% 6.3% 1125 193 176 15.6% 2/23/2025 14

15. Updated Participant Data Flow Chart by System *There is not always a referral 1A. IEB receives referral (IEB System)* Facility Begin Date (CIS) 1B. IEB sends PA600 (non-MA) and Freedom of Choice (already MA and non-MA) 2. AAA conducts LCD (SAMS) 5. Participant entered into HCSIS (under 60) and file to SC 5. Participant entered into SAMS (over 60) and file to SC 4. Financial Eligibility approved and 162 Issued(CIS) Eligibility Run (Data Load Date) 3. IEB sends 1768 & 600L to CAO with Waiver Program 6. SC starts plan in HCSIS 6. SC starts plan in SAMS 7. Service Plan Approved HCSIS 7. SP Approved SAMS 8. Service Performed / Billed (PROMISe) 2/23/2025 15

16. Current IEB Report Under 60 2017 QTR 2 2015 QTR1 2015QTR 2 2015 QTR3 2015 QTR4 2016 QTR1 2016 QTR2 2016 QTR3 2016 QTR4 2017 QTR1 Grand Total 5041 5407 5577 5719 6677 8231 8399 9179 7925 9393 Complete 2867 2944 3020 3254 3215 5872 4452 6149 5066 5083 Complete in 90 Days 2351 2714 2767 2878 2864 4969 4094 5504 4212 4519 Complete > 90 Days With Excuse Compliance Percentage 161 88% 116 96% 129 96% 120 96% 169 94% 193 88% 112 94% 126 92% 129 86% 115 91% Average Days To Complete 73 62 66 71 66 55 41 45 54 50 1. All unduplicated applications in process this quarter 2. Total unduplicated applications completed this quarter 3. Total unduplicated applications completed during the quarter in 90 days 4. Total unduplicated applications completed during the quarter and over 90 days, but with excuse 5. Using the above fields = (row 3 + row 4)/ row 2 6. Average to complete excluding excused applications Note: 2016 QTR 2 was revised to remove Aging waiver applications. Note: Reapplications removed 2/23/2025 16

17. Current IEB Report Over 60 2016 QTR 4 2017 QTR 1 2017 QTR 2 Grand Total 12624 10705 10464 All unduplicated applications in process this quarter Total unduplicated applications completed this quarter Total unduplicated applications completed during the quarter in 90 days Total unduplicated applications completed during the quarter and over 90 days, but with excuse 89% Complete 8358 6409 6295 Complete in 90 Days 5907 4824 5431 Complete > 90 Days With Excuse Compliance Percentage 146 72% 145 78% 168 Average Days To Complete 67 64 57 Average to complete excluding excused applications 2/23/2025 17