OLTL Updates Summary October 10, 2023
OLTL provides updates including LTSS membership, IEB enrollment data, State Transition Plan approval, and federal funding information. They also enhance their Data Dash report and highlight National Disability Employment Awareness Month. No pause on disenrollments despite recent federal requirements.
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OLTL Updates LTSS Sub MAAC October 10, 2023 1
Agenda OLTL Updates Independent Enrollment Broker (IEB) Enrollment Data Living Independence for the Elderly (LIFE) Enrollments 2
OLTL Updates LTSS Membership New seats available for the January 1, 2024 through December 31, 2025 year. Nominations should be forwarded to c-gmagloir@pa.gov . CHC Request for Application (RFA) No updates as of today s meeting but any timelines will be shared accordingly. Statewide Listen and Learn Tour Full summary of the sessions is currently in the internal review process and will be disseminated soon. Updates will continue to be provided at the various stakeholder meetings. 4
OLTL Updates State Transition Plan - Home and Community-Based Services (HCBS) Rule CMS approved PA s Statewide Transition Plan on 8/24/23 The approved plan and CMS approval letter are available at https://www.dhs.pa.gov/Services/Assistance/Pages/HCBS- Statewide-Transition-Plan.aspx 5
OLTL Updates Federal Shut Down Short Term funding Bill passed providing funding streams for an additional 45 days. Medicaid is a mandatory spending program, meaning that funds do not need to be appropriated by Congress each year. This means that, in the event of a shutdown, federal match (FMAP) would not be impacted. CMS staff and operations would be impacted by a shutdown. The National Association of Medical Directors (NAMD) current understanding is that most Medicaid operations including unwinding operations would continue during a shutdown. PHE Unwinding In response to the recent U.S. Department of Health and Human Services article about pausing disenrollment for 30 states, DHS wants you to know that CMS guidance requires mitigation or pause of disenrollment for the effected population. DHS implemented mitigations and will not be pausing disenrollments at this time. 6
OLTL Updates OLTL Data Dash Enhancements OLTL's Data Dash is a collection of documents regarding current OLTL enrollment data, market share between CHC-MCO's and other frequently requested information. Enhancements have been made to the report to include race, ethnicity and participant self-direction data. Revisions will be reflected in the September report. Current Report: Data Brief - August 2023 National Disability Employment Awareness Month Observed each October, National Disability Employment Awareness Month (NDEAM) celebrates the contributions of America s workers with disabilities past and present and showcases supportive, inclusive employment policies and practices that benefit employers and employees. Additional resources can be found at: https://www.dol.gov/agencies/odep/initiatives/ndeam. 7
OLTL Updates Workforce Plan Listening Sessions The PA Workforce Board is hosting 3 in-person sessions from October 11th through the 13th, and one virtual session on October 17th. The sessions are for the public to provide input on Pennsylvania s 2024-2028 workforce development strategies for the Workforce Innovation and Opportunity Act (WIOA) state plan. The plan focuses on: Apprenticeship and Career & Technical Education Industry Partnerships and Employer Engagement Youth Continuous Improvement of the One-Stop System Barrier Remediation Worker Shortages in Critical Industries To RSVP, email RA-LI-PAWDB@pa.gov. Walk-in space may be limited. Feedback may also be submitted via the email above. 8
IEB Enrollment Data Average Days in Status Status 3/31/2023 4/27/2023 5/30/2023 6/30/2023 7/31/2023 8/30/2023 9/29/2023 Description IEB has received a referral from a third party, the IEB is outreaching to the Applicant/Representative to schedule Visit. READY_ASSESSMENT 8 8 12 10 10 10 9 SCHEDULED 6 6 8 6 8 6 5In Home Visit has been scheduled In Home Visit completed and the IEB is reviewing completeness of intake documents required. IEB is waiting for the PA 600 or the PA 600 received and IEB to enter in COMPASS PC sent to the identified Physician and FED Reques sent to Aging Well ASSESSMENT_INPROCESS 1 1 4 1 3 1 1 MA_PA_600_REVIEW 9 10 8 6 7 5 4 PC & FEDPending 5 5 8 5 7 7 6 PC Pending/FED Received 36 38 39 36 38 36 35Completed FED received from Aging Well/ PC is pending PC Received/FED Pending 6 7 9 7 7 8 8Completed PC received/ FED pending with Aging Well APP_REVIEW 0 0 3 1 2 1 1Medical Director Review Pending OLTL_READY 13 14 27 16 24 19 22Program Eligibility under review by OLTL Functionally eligible, Applicant is pending nursing facility discharge READY_TRANSITION 54 52 59 60 62 62 60 APPROVED 1768_DENIAL 13 13 15 14 14 14 14Functionally Eligible, 1768 sent to CAO 1Functionally ineligible, HCBS Denial notice pending Financial Approval Received, enrollment in Process of being finalized 1 1 4 1 3 1 FINANCIAL_APPROVAL 2 2 3 1 2 2 3 MMS_READY FINANCIAL_DENIAL Financial Approval Mismatch 2 0 1 0 0 4 0 1 0 0 1 4 0 0 5 0 0 4Pending acceptance by OBRA or Act 150 Service Coordinator 0Financial Denial Received, application in process of completion 4Incorrect Waiver code in CIS, action needed by the CAO. 13 10
Current IEB Report All Waivers 2020QRT3 2020 QRT4 2021QTR1 2021QTR2 2021QTR3 2021QTR4 2022QTR1 2022QTR2 2022QTR3 2022QTR4 2023QTR1 2023QTR2 25106 25118 29365 29082 31328 16081 16153 18783 18953 20171 15491 15569 17985 18233 19326 379 300 403 345 329 99% 98% 98% 98% 97% 40 40 37 39 40 Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 26398 16180 14918 648 96% 26213 18098 17428 408 99% 33482 22372 21776 316 99% 31563 22070 21584 318 99% 30012 21399 20705 347 98% 31490 21383 20767 576 99% 34883 23501 22974 471 99% 45 41 34 35 34 33 33 Grand Total - All unduplicated applications in process this quarter Complete - 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 of a delayed enrollment Using the above fields = (row 3 + row 4)/ row 2 Average to complete excluding excused applications Note: Reapplications removed 1. 2. 3. 4. 5. Data Source: Maximus IEB 11
Current IEB Report Under/Over 60 Over 60 Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 2020QRT3 2020 QRT4 2021QTR1 2021QTR2 2021QTR3 2021QTR4 2022QTR1 2022QTR2 2022QTR3 2022QTR4 2023QTR1 2023QTR2 16848 16775 16161 17383 20414 18991 10282 11658 10189 11069 13204 12349 9500 11233 9828 10696 12673 11909 392 267 239 194 263 200 96% 99% 99% 98% 98% 98% 45 40 40 39 37 39 21116 13602 13025 238 98% 22098 14699 14333 207 99% 21104 14853 14537 221 99% 20123 14393 13969 218 99% 20740 14141 13760 377 99% 22946 15459 15138 304 99% 40 34 34 33 33 33 Under 60 Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 2020QRT3 2020 QRT4 2021QTR1 2021QTR2 2021QTR3 2021QTR4 2022QTR1 2022QTR2 2022QTR3 2022QTR4 2023QTR1 2023QTR2 9335 9438 8964 7735 8951 10092 5898 6439 5893 5084 5579 6604 5418 6195 5663 4873 5312 6324 256 141 140 106 140 145 96% 98% 98% 98% 98% 98% 47 41 41 41 38 39 10208 6566 6302 11384 7673 7443 109 98% 10459 7217 7047 9889 7006 6736 129 98% 36 10750 7242 7007 199 99% 11937 8042 7836 167 99% 81 97 97% 40 99% 35 35 34 33 1. 2. 3. 4. Grand Total - All unduplicated applications in process this quarter Complete - 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 of a delayed enrollment Using the above fields = (row 3 + row 4)/ row 2 Average to complete excluding excused applications Note: Reapplications removed 5. Data Source: Maximus IEB 12
Q4 2022 Closure Reasons Closed Reason Enrolled Description of Closure 5785 Applicant enrolled in HCBS. Failure to provide info-CAO 7388 CAO issued denial due to applicant not providing financial verification timely Unable to Reach Client 1878 IEB unable to reach applicant from third party referral. incomplete 2430 Closed at day 86 of application due to incomplete or missing information Example: MA 570 not returned Clinically Ineligible 1966 HCBS Denial Notice issued - Applicant determined NFI as a result of the FED and PC or Medical Director Review Not Interested in Services Voluntary Withdrawal reApped Financially Ineligible Already Receiving Services Applicant Not Discharged DECEASED 845 Applicant is contact after referral is received and notifies the IEB that they are not interested in receiving HCBS services 1396 Applicant contacts the IEB and requests to withdraw the application. 523 System corrected application and the status needs revised. The originl application start date is used. 355 CAO issued denial notice due to the applicant being determined financially ineligible. 325 Upon referral IEB identifies that applicant is already enrolled in HCBS and is receiving services. 117 NHT applicant that does not discharge within 180 days of the application start date. 179 IEB is notified or identifies that the applicant is deceased before application is finalized. Duplicate Application Functionally Ineligible Does not meet 5 year bar 165 Applicant has more than one open application. This is used for system correction when application is in an incorrect status. 64 Applicant is reviewed for OBRA or Act 150 and Denial notice issued due to Applicant not meeting Program Requirements. 30 CAO issued notice indicating the applicant does not meet the 5 year residency requirement to receive MA HCBS services. IVA was completed and the individual requested to submit the 600L at a later time and did not return within 30 days. MA Application Not Received Insufficient Information Expired Documents Grand Total 27 11 Referral received that does not include enough information to follow up with individual begin an application. 17 Application closed due to application documents (FED/PC) over 12 months 23501 13
In-person vs. Virtual IVA 2022 Visit Type Phone Count 4939 5454 6472 5645 5603 5568 4669 5892 5395 5127 4883 4523 64170 In Home Count 1422 1522 2021 1969 1977 1986 2531 3228 2645 2632 2577 2541 27051 Total Count Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Grand Total 2023 Percentage 77.65% 78.18% 76.20% 74.14% 73.92% 73.71% 64.85% 64.61% 67.10% 66.08% 65.46% 64.03% 70.35% Percentage 22.35% 21.82% 23.80% 25.86% 26.08% 26.29% 35.15% 35.39% 32.90% 33.92% 34.54% 35.97% 29.65% 6361 6976 8493 7614 7580 7554 7200 9120 8040 7759 7460 7064 91221 Visit Type Phone Count 2859 2108 2349 1393 345 0 0 0 0 9054 In Home Count 2029 2710 3461 3619 5350 5291 5306 6495 5450 39711 Total Count Month Jan Feb Mar Apr May Jun Jul Aug Sep Grand Total Percentage 58.49% 43.75% 40.43% 27.79% 6.06% 0.00% 0.00% 0.00% 0.00% 18.57% Percentage 41.51% 56.25% 59.57% 72.21% 93.94% 100.00% 100.00% 100.00% 100.00% 81.43% 4888 4818 5810 5012 5695 5291 5306 6495 5450 48765 Data Source: Maximus IEB 14
FED Appeals Data Jan Feb Mar Apr May Jun Jul Aug Sep Grand Total MEDICAL DIRECTOR REVIEW - NFI 19 22 3 MEDICAL DIRECTOR REVIEW - NFI 23 17 3 2 MEDICAL DIRECTOR REVIEW - NFI 16 14 2 NFI - FED AND PC NFI MEDICAL DIRECTOR REVIEW - NFI 19 42 2 MEDICAL DIRECTOR REVIEW - NFI 44 65 4 MEDICAL DIRECTOR REVIEW - NFI 20 76 5 MEDICAL DIRECTOR REVIEW - NFI 7 19 3 MEDICAL DIRECTOR REVIEW - NFI 13 37 4 MEDICAL DIRECTOR REVIEW - NFI 9 51 7 1 1 Status APPEAL_HEARING_SCHEDULED APPEAL_INITIATED APPEAL_WITHDRAWN APPEAL_WAITING_JUDGE_DECISION APPEAL_SETTLED APPEAL_STIPULATED_SETTLEMENT Grand Total 1 1 171 344 33 3 2 1 554 1 1 54 44 45 32 2 63 114 69 102 29 APPEAL_WITHDRAWN - Following Pre-Hearing Appellant Withdrew APPEAL_INITIATED - Appeal Received - Hearing Date has not yet been scheduled APPEAL_HEARING_SCHEDULED - Hearing Date Scheduled APPEAL_DISMISSED - ALJ Dismissed Appeal ( example Appellant cannot be reached) APPEAL_WAITING_JUDGE_DECISION - Pending decision by the ALJ APPEAL_SETTLED - Hearing outcome was a stipulated settlement (example - new FED or Applicant to submit additional information to be considered) APPEAL_STIPULATED_SETTLEMENT - Hearing outcome was a stipulated settlement (example - new FED or Applicant to submit additional information to be considered) Appeal Settlement Denied - Appeal Denied following outcome of the Stipulated Settlement Appeal Approved - ALJ found in favor of Appellant Applicant moved forward for Financial Eligibility Determination 16
MCO Plan Change Reasons Reason Transferring from Auto-Assigned MCO Current Provider no longer working with MCO Dissatisfied with Medical MCO Services Would not give reason Dissatisfied with Service Coordinator Prefers another MCOs benefits PCP Recommendation Doctor left plan Not Applicable - Not Disenrolling from Another Plan Family Friend Recommendation Prefers nonparticipating doctor or hospital Out of plan services wanted Dissatisfied with MCOs services marketing rep Location of doctors inconvenient Dissatisfied with dental program provider Moved Moving Out of Area Cant stay with current nonparticipating doctor for treatment Dissatisfied with Doctor PCP Someone other than those listed above recommendation MCO has denied reduced my services Language Problem Dissatisfied with range or length of services - too limited Dissatisfied with family planning services Receives bills for services Dissatisfied with vision program provider Mail Plan Change - No reason given Dislikes Making Appointments Dissatisfied with hospital Dislikes using referrals Dissatisfied with Drug Alcohol or Mental Health Services Pharmacist recommendation Pas agency does not accept current plan Grand Total Count 230 162 98 73 38 28 25 25 20 17 10 10 8 8 7 5 4 4 3 3 3 2 2 2 2 2 1 1 1 1 1 1 797 17
LIFE Enrollments LIFE Census July 2019 through September 2023 8,500 8,000 7,500 7,000 6,500 6,000 As of July the LIFE Program has 7,824 participants. Since statewide LIFE IEB implementation, the overall LIFE Program census has increased by 424 individuals (from May 2021 through September 2023). During the 12 months prior to statewide implementation (May 2020 through April 2021), the program grew by 86 individuals. IEB referrals are directly attributable to a 7% increase in LIFE enrollments. 19
Questions? 20
