Kevin HancockChief of Staff

Office of Long-Term LivingDepartment of Human Services

Third Thursday Webinar

August 17, 2017

Welcome to the Third Thursday MLTSS Webinar

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Third Thursday Webinar Agenda

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• CHC Implementation Updates• Third Party Liability in CHC• Functional Eligibility Determination• Aging Well Background and Update• Questions

CHC-Southwest Educational Conference Follow-up

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• Held A Four-Day Educational Conference for Providers in the Southwest Region July 24 - Cranberry Township July 25 - Pittsburgh July 26 - Altoona July 27 – Cranberry Township

• 1,200 Providers and Participants in Attendance Over Four Days

• Five Daily Breakout Sessions: Behavioral Health Physical Health Home- and Community-Based Services Nursing Facilities Service Coordination/Area Agency on Aging

• 581 Community HealthChoices (CHC) Provider Questions Raised over Four Days Provider Questions and Answers (FAQs)will be updated on the Community HealthChoices website in

the near future www.healthchoices.pa.gov/providers/resources/publications/community/

Communications Updates

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CHC Participant Communications Update Notification was sent to CommCare Waiver Participants and their Service

Coordinators explaining CHC and the transition process in the second week of July. The initial touchpoint flyer went out to participants in the Southwest during the first

week of August. The flyer says that CHC is coming and participants should expect to be contacted by Aging Well in the near future to assist them with their transition.

OBRA LCD-Assessment Notifications (NFI & NFCE)to be sent out last week of August. Attendant Care & Independence Waiver letters to be sent out first week of

September. The first of three pre-transition notifications for LTC Dual/Non-Dual and Dual/Non

Dual HCBS will be sent out in September.

Communications Updates Cont’d

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CHC Provider Communications Update Provider fact sheet explaining CHC for Service Coordinators and Nursing Facilities

sent out first week in August. Mailer (postcard) for Direct Care Workers of PPL sent out second week of August. Provider fact sheet on continuity of care to go in the next few weeks. Training for Service Coordinators and Nursing Facilities will be scheduled in the

September timeframe. Distribution of bi-weekly fact sheets will continue and will outlining CHC related

topics i.e., nursing homes, Options, continuity of care, TPL, service coordination, billing etc.

Attendant Care

Waiver Notice

18-20 year old Attendant Care Waiver Participant

Name

Address City, State, Zip

Dear [Participant Name]:

As a participant in the Attendant Care Waiver, it is important for you to know that some changes are

happening that will improve the way that you receive services. The Pennsylvania Department of

Human Services is rolling out managed long-term services and supports, which will be called

Community HealthChoices, and the Attendant Care Waiver is included in this change. Individuals are

eligible for Community HealthChoices if they are 21 years old or over. The Community HealthChoices

phase-in schedule is included at the end of this document.

Why is this change happening?

The Pennsylvania Department of Human Services is rolling out managed long-term services and

supports, which will be called Community HealthChoices, and the Independence Waiver is included in

this change. Individuals are eligible for Community HealthChoices if they are 21 years old or over.

Because you are under the age of 21, you will receive services in the OBRA Waiver until you become

eligible for Community HealthChoices.

Do I need to do anything?

No. We will work with your service coordinator to complete your transition to the OBRA Waiver. You

do not need to do anything. You will receive a notice from the County Assistance Office with your

transition date.

Will my services change?

No. You will continue to receive the same services you do today.

What is Community HealthChoices?

Community HealthChoices is a program that will provide physical healthcare and Medicaid waiver

services to eligible adults 21 and older through a managed care plan of your choice. Enclosed with

this letter is more information about Community HealthChoices.

Letter to be sent out to participants first week of September 2017

Independence

Waiver Notice

18-20 year old Attendant Care Waiver Participant

Name

Address City, State, Zip

Dear [Participant Name]:

As a participant in the Independence Waiver, it is important for you to know that some changes are

happening. You will be transitioned to the OBRA Waiver in October 2017, to continue receiving your

Medicaid waiver services.. Your services and providers will remain the same.

Do I need to do anything?

No. We will work with your service coordinator to complete your transition to the OBRA Waiver. You

do not need to do anything. You will receive a notice from the County Assistance Office with your

transition date.

Will my services change?

No. You will continue to receive the same services you do today.

Why is this change happening?

The Pennsylvania Department of Human Services is rolling out managed long-term services and

supports, which will be called Community HealthChoices, and the Independence Waiver is included in

this change. Individuals are eligible for Community HealthChoices if they are 21 years old or over.

Because you are under the age of 21, you will receive services in the OBRA Waiver until you become

eligible for Community HealthChoices.

What is Community HealthChoices?

Community HealthChoices is a program that will provide physical healthcare and Medicaid waiver

services to eligible adults 21 and older through a managed care plan of their choice. Enclosed with

this letter is more information about Community HealthChoices.

Letter to be sent out to participants first week of September 2017

1915 (b) and 1915 (c) Waiver Approvals

• CMS approved the 1915(b) and 1915(c) waivers on July 24, 2017. The 1915(b) authority allows OLTL to

implement a mandatory managed care delivery system for eligible beneficiaries, and the 1915(c) authority

allows for the provision of home and community-based services. These services will be delivered through

the managed care organizations.

• In addition, CMS approved the Independence Waiver amendment that adds Residential Habilitation

Services and Structured Day Habilitation Services to that waiver. This allows CommCare Waiver

participants to transition to the Independence Waiver. As we prepare for CHC implementation, we are on

track for having the waivers in place and transitioning participants prior to January 1, 2018.

• Next Steps in the Process

Contracts sent to the three MCO’s.

Certified rates have been submitted to CMS for approval.

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Readiness Review Update

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• OLTL conducts weekly Readiness Review check-in meetings with each CHC-MCO and the contract monitor

teams.

• MCOs have submitted and continue to submit policies and procedures for readiness review.

• OLTL, DOH, PA Health Law Project (PHLP), and participants continue to refine LTSS Provider Network

Standards. As part of these standards, historical claims data is used to develop parameters around the

number of LTSS related staff that will be needed for network adequacy.

• All three MCOs continue to reach out to and recruit providers for their networks.

• Technical Assistance sessions with MCOs continue.

• Biweekly meetings with each MCO have been set up to answer their systems and testing related questions.

An encounter data file processing technical assistance session was held on August 8th. Testing is

scheduled for late August.

Third Party Liability

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• Third Party Liability in CHC

Functional Eligibility Determination Tool Update (FED)

AgiFng Well Summary

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Functional Eligibility Determination Tool Update

• Testing on the new tool took place from May 15th through June 30, 2017 under the direction of the

University of Pittsburgh.

• Testing was conducted by assessors at 10 Area Agencies on Aging and represented both rural and urban

settings as well as over and under 60 participants.

• Following June 30th, there were several assessments that were submitted to the University of Pittsburgh

well after the due date placed on the assessing AAA’s.

• The materials were checked by University of Pittsburgh staff and it was found that several needed to be

returned to the assessors due to illegibility issues, incomplete data, etc.

• University of Pittsburgh is currently reviewing and performing the analysis on the information received. A

new timetable for completion of the analysis has yet to be determined.

• We are anticipating an update on the testing by the beginning of September.

Aging Well Background Summary

Background

• Aging Well Pa, LLC, has been selected to assist DHS in providing CHC Outreach and education to HCBS participants in

the 14 counties comprising the first phase of CHC rollout. DHS is currently finalizing contract language with Aging Well

Pa.

• Included in this effort will be 20 education sessions in the Southwest region specifically geared toward current HCBS

participants and topics that will include what they can expect over the next several months regarding the transition to

CHC.

• Aging Well Pa will also be responsible for the coordination of level of care assessments, one of two eligibility steps for

HCBS waivers, statewide, beginning in the fall of 2017

• Aging Well will supervise the Pennsylvania Preadmission Screening Resident Review Evaluation (PASRR-EV level II

Tool).

• Aging Well, through its subcontractors, will conduct the Preadmission Screening using the approved level II tool for

individuals who are seeking admission to MA certified nursing facilities, and who have Mental Illness (MI), Intellectual

Disability (ID/DD) or an Other Related Condition regardless of payer source. These individuals must have the PASRR

process completed prior to admission to the nursing facility.

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Aging Well Background Summary Cont’d

• Aging Well, through its subcontractors, will conduct the Preadmission Screening using the approved level II

tool for individuals who are seeking admission to MA certified nursing facilities, and who have Mental

Illness (MI), Intellectual Disability (ID/DD) or an Other Related Condition regardless of payer source. These

individuals must have the PASRR process completed prior to admission to the nursing facility.

• Aging Well will be contracting with agencies who have the capability to complete these assessments and

then monitor the completion of assessments in conjunction with the IEB and DHS.

• Ongoing oversight of Aging Well Pa activities will remain the responsibility of OLTL with regular reporting

being the expectation.

• Assessors supervised by Aging Well Pa. will be trained on the new Functional Eligibility Determination tool

(FED) as it becomes active late summer/early fall of 2017.

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Aging Well

LCD/FED Assessments

In the sole source agreement with Aging Well they will be responsible to sub-contract and oversee entities who will be

capable of performing the following:

• Complete the Functional Eligibility Determinations (FEDs) and annual in-person re-determinations for over 60

populations.

• Complete FEDs for OLTL Medical Assistance (MA) waivers (Aging, Attendant Care, CommCare, Independence, and

OBRA waivers), the state-funded ACT 150 program, and Living Independence for the Elderly (LIFE)

• Nursing facility residents seeking and continuing to receive Medicaid services to meet functional eligibility standards.

• Aging Well will complete initial and annual FEDs, Level of Care Determinations/Clinical Eligibility Determinations

(LCD/FED) in accordance with Nursing Facility Clinical Eligibility (NFCE) standards.

• Conduct Pennsylvania Preadmission Screening Resident Review Evaluation (PASRR-EV Level II Tool).

• Annual Re-Determinations –

Prior to the implementation of CHC

After the implementation of CHC

• Aging Well will also support and facilitate the transition from the existing tool (the LCD) to the new version (the FED).

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Aging Well

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Oversight of Aging Well By OLTL

The following monthly reports will be submitted to OLTL:

• A report of the number of LTSS applicants who have been referred for an FED,

and number of completed FEDs

• A report measuring Length of Time (Days) for FED Completed for Applicant by

each Subcontractor.

• Length of Time (Days) for “in person” Annual Re-determinations for Participants

Completed for Applicant by each Subcontractor.

• Length of Time (Days) for Annual Re-determinations New FED Tool Data

Integrity Report.

• FED Comparison Results Report.

Aging Well

Outreach and Education

• In addition to the assessments and re-assessments, Aging Well will conduct CHC specific outreach and

education activities in each CHC zone beginning with the anticipated implementation of CHC in the

Southwest zone in January 2018, and continuing to the Southeast zone in July 2018 and in the remainder of

the Commonwealth zones in January 2019.

• For the first phase of implementation, Aging Well will begin preparation for outreach and education activities

beginning when the agreement is signed. Actual Outreach and Education activities have begun in July of

2017 for the roll-out of Phase 1.

• Aging Well will also provide training to all personnel, including subcontractors, conducting CHC Outreach

and Education activities

Outreach and Education activities will be overseen by the DHS Communication Department staff in conjunction with any other outreach activities associated with CHC rollout.

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Third Thursday Webinars

Aging Well

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We will host an informational webinar on the third Thursday of each month throughout the

implementation of CHC. An invite and registration link will be sent out on the ListServe. To ensure you

receive email communications distributed from the Office of Long-Term Living, please visit the

ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

The next webinar will be held: September 21, 2017 @ 1:30 PM

General HealthChoices Web Page that includes Community HealthChoices:

http://www.healthchoices.pa.gov/index.htm

Webinar participants will also find this presentation at

http://www.healthchoices.pa.gov/info/resources/publications/community/third-thursday-webinars/

QUESTIONS

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