> > Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare DPW Overview & Healthy PA Presented by: Secretary Beverly Mackereth

>www.dpw.state.pa.us >Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare

DPW Overview& Healthy PA

Presented by: Secretary Beverly

Mackereth

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>www.dpw.state.pa.us >

DPW is the largest Human Services Agency in the Country:

• Staff complement as of July 2014: • 15,617 full-time filled complement• 96 part-time• 845 wage• 134 annuitants

• Total DPW budget for FY 2014-15: $31.5 Billion• $11.2 billion in state (general fund)• $17.6 billion in federal• $ 3.0 billion in other funds• DPW is 39% of the General Fund Budget

• Approximately 22.7% (2.89 million) of all Pennsylvanians were enrolled in a DPW benefit program as of May 31, 2014

(Based on the US Census Bureau 2012 Pennsylvania population estimate of 12,763,536).

DPW Quick Facts

2Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare


Facilities Operated by DPW:

• 94 County Assistance Offices

• 6 Youth Development Centers/Youth Forestry Camps that served around 777 children in FY 2013-14

• 5 State Centers for Persons with Intellectual Disabilities that were serving 996 individuals as of June 30, 2014

• 7 State Mental Health Hospitals that were serving 1,522 individuals as of July 2014

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DPW Quick Facts

Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare


Program Office Service Delivery

67 County/Joinders

52 Area Agencies on

Aging

~100 Service Coordination Organizations10 Managed Care

Organizations

94 CAOs

42 CCIS

500 School Districts

29 Intermediate

Units

Other DPW Central Office

67,000 Providers

DPW Regional Offices

OIMOLTL

OMAP

OMHSASODP

OCYF

OCDEL OA

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• Conducts administrative hearings on appeals received from recipients and DPW funded agencies services

Hearings and Appeals

• Detects and deters fraud waste and abuse in the Medicaid program and administers third party recoveries in the Medicaid program

Program Integrity

• Organizes and conducts audits, guides procurement process, evaluates RFP’s, and executes and monitors contracts

Financial Operations

• Administers DPW’s HR systems including labor relations, employee training, recruitment, classification, and placement

Human Resources

• Supports all information technology needs for Departments of Welfare, Aging and Insurance

Information Systems

• Ensures nondiscrimination and equal opportunity in all activities

Equal Opportunity

• Services include: forms and publications, printing, automotive fleet operations, guardianship programs, facilities and property management, and emergency operations

AdministrativeServices

The Bureau of Human Services Licensing ensures safe living conditions for over 100,000 adults and children with mental illnesses, intellectual disabilities, physical disabilities, and behavioral and/or cognitive disorders.

Office of Administration (OA)


• Licenses, inspects, and regulates more than 8,500 out-of-home care settings.

Human Services Licensing


• Child Care CertificationCertification

Services

• Keystone STARS

• Keystone Babies

• Pennsylvania Pre-K Counts

• Full Day Kindergarten

• Head Start State Supplemental Assistance Program

• Early Head Start

• Parent-Child Home Program

• Nurse-Family Partnership

• Children’s Trust Fund

Early

Learning

Services

• Early Intervention Infant/Toddler

• Early Intervention Preschool

Early

Intervention

Services

• Child Care WorksSubsidy Services

As of December 2013, nearly 112,423 children were provided monthly subsidies through Child Care Works.

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Office of Child Development and Early Learning (OCDEL)



• Youth Development Centers

• Youth Forestry Camps• County Juvenile Probation

Offices• Private Agency

Delinquency Services

Juvenile Justice Services

• Foster Family Service• Community Residential

Service and Group Home Service

• Supervised Independent Living Service

• Residential Service • Secure Residential

Service• Emergency Shelter

Service

Placement

• Homemaker/Caretaker Service

• Life Skills Education

AdultEducation

• Protective Services (Child Abuse)

• Protective Services (General)

• Counseling/Intervention Services

Protective

Services

• Adoption Services

• Adoption AssistanceAdoption

• Day Care Service

• Day Treatment Service Day Services

• Information and Referral Services

• Service Planning

Administration & Oversight

From Sept. 30, 2009 to March 31, 2014, out-of-home placements of children have decreased by 19% in PA.

Office of Children, Youth and Families (OCYF)



• HealthChoices Behavioral Health (HC-BH) Program

• Fee-for-Service

• Behavioral Health Services Initiative (BHSI)

• Base

• Act 152

Behavioral

Health & Substance

Abuse Services

• CHIPPIntegration Programs

• State Hospitals and Restoration Center

• Other Initiatives

State

Facilities

• Special Pharmacy Benefits Program for Mental Health (SPBP-MH)

Pharmacy

1,952,895 of MA covered Pennsylvanians were covered by HealthChoices Behavioral Health as of March 2014.

Office of Mental Health and Substance Abuse Services (OMHSAS)



• Consolidated Waiver

• P/FDS Waiver

• Base Services

Intellectual Disabilities:

HCBS

• Adult Autism Waiver (AAW)

• Adult Community Autism Program (ACAP)

Autism: HCBS

• State Centers

• Private Facilities

Intermediate Care Facilities

Office of Developmental Programs (ODP)


Over 28,000 individuals were served by ODP waivers as of May 2014.


• For Families with Children

• For the Aged and Disabled

• Long Term Care

• Select Plan for Women

Medical Assistance

• Temporary Assistance for Needy Families (TANF)

• SSI State Supplement

Cash Assistance

• Nutritional support for low-income families

Supplemental Nutrition

Assistance Program (SNAP)

• Assistance to low-income families in need of assistance with their heating and cooling bill

Low Income Home Energy Assistance

Program (LIHEAP)

• Establishes paternity and support orders and provides medical support and employment services for non-custodial parents

Child Support Enforcement

• A suite of programs that provide job readiness, placement, retention training, and supportive services

Employment and Training

Programs

• Provides services to families and children in immediate need of shelter and to those in imminent danger of becoming homeless

Homeless

Assistance

• Provides free services to assist clients to resolve civil legal problems

Legal Assistance

As of July 2014, CAOs helped more than 397,000 households to stay safe and warm in their homes.

Office of Income Maintenance (OIM)



• Managed Care

• Fee for Service

Medical

Assistance

What is Medical Assistance?

• Medicaid is an entitlement program jointly funded by the federal and state governments that provides health care coverage to low income children and adults, the elderly, and disabled. The Pennsylvania Medicaid Program is known as Medical Assistance (MA) because it includes both the federal Medicaid Program as well as state funded only programs, i.e., General Assistance and State Blind Pension recipients

How are services delivered?

• Fee for service administered through the federally-approved Medicaid State Plan

• Mandatory Medicaid managed care program known as HealthChoices administered through a federally-approved 1915(b) waiver

Pennsylvania Medicaid Facts

• 17.8% of Pennsylvanians are currently covered by some form of MA• Over 81,000 MA providers• 58,136,763 claims processed for FY13

Office of Medical Assistance Programs (OMAP)



• Attendant Care Waiver

• Act 150

AttendantCare

• Independence Waiver

• COMMCARE Waiver

• OBRA Waiver

Community Service Programs for People with

Physical Disabilities (CSPPPD)

• Aging WaiverAging• MA Nursing FacilitiesNursingFacilities

• AIDS WaiverAIDS • Living Independence for the Elderly (LIFE)LIFE

Over 47,000 individuals were served by OLTL waivers as of May 2014.

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Office of Long-Term Living (OLTL)



Our mission is to improve the quality of life for Pennsylvania’s individuals and families. We promote opportunities for independence through services and supports while demonstrating accountability for taxpayer resources.

Mission Statement

Our vision is to see Pennsylvanians living safe, healthy and independent lives.

Vision Statement

Strategic Focus Areas

Communications

Accountabilit

y

Back to

Basics

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Strategic Planning for the Department



DPW Budget Priorities

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Expanding Services for Older Pennsylvanians and Individuals with Physical Disabilities:

Increase of $25.3 million in General and Lottery funds to serve:

• An additional 1,764 older Pennsylvanians through the Medicaid Home and Community-Based Aging Waiver ($11.6 million);

• An expansion in the LIFE program ($4.7 million);

• An additional 1,599 individuals with physical disabilities in community settings ($9 million).

Expanding Services for Individuals with Intellectual Disabilities and Autism:

Additional $13.1 million to provide home and community-based options for:

• 700 young adults who are graduating from the special education system to continue to live independently in the community;

• 400 individuals who are on the emergency waiting list to access crucial services to keep them in their homes and communities; and

• 100 adults with autism spectrum disorders.




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Moving Individuals from Institutional Care to Community-Based Care:

An additional $2.8 million to increase community placement for individuals currently in state mental hospitals and state intellectual disability facilities. This enables the transition of clients from state mental hospitals to progressive mental health treatment in home-like settings as well as clients from state intellectual disability facilities to home and community-based settings. Act 150:

Funding was allocated to serve individuals currently on the Act 150 waiting list who are determined eligible. Child Care Assistance:

Increase of $15 million in federal funds to allow an additional 2,895 children currently waiting for services to receive child care assistance. Child Advocacy Centers:

$2 million for the support and expansion of Child Advocacy Centers in Pennsylvania, supporting a recommendation from the Task Force on Child Protection.




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Balancing Incentive Program - $94 million ($75m in FY 2014-2015)

• Enhanced federal funds (2% increase in federal matching funds, or FMAP) on community-based long-term services and supports

• Available to states that spend less than 50% of their long term supports on community based services

• The increase in FMAP is time limited and expires September 2015

• Requirements to receive the increase include:

• No wrong door approach

• Core elements required by CMS and consistency between assessment tools

• Conflict free

• Provide utilization and outcome data

• Application approved by the federal government on June 18, 2014

• BIP funding began July 1, 2014



Long-Term Care Commission

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• Commission Responsibilities– Identify and examine the critical issues and trends in Pennsylvania’s

long-term care services and supports delivery system – Study existing long-term care resources available for individuals with

physical disabilities, older adults, their families and caregivers – Consult with various commonwealth departments and agencies on:

• Regulations • Licensure • Financing • Other responsibilities relating to long-term care

– Review current and proposed state and federal legislation and regulations relating to long-term care

– Make written recommendations to the Governor on findings




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• Areas of Focus for Work Groups

– Prevention

– Accessibility

– Provision of Service

– Quality Outcomes and Measurements




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• Held 7 public sessions across the state

• More than 200 individuals provided input at the public meetings or submitted comments

• Report due to the Governor no later than December 31, 2014

• The Executive Order expires on December 31, 2014


Healthy PAOverview

Healthy Pennsylvania at a Glance

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Increased health care access for 600,000 Pennsylvanians

Improve health outcomes

Benefits match health care needs

Increased personal responsibility

Reformed Medicaid program

Introduction

This session provides an overview of the Healthy PA Program and the components being introduced in January 2015.

• Newly Eligible Adult Group• Health Screening• Healthy Behaviors

New Components

• Low Risk• High Risk

Simplified Benefit Plan Structure

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Healthy PA Components


Healthy PA Timeline

Overview Topics

Healthy PA Newly Eligible

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Ages 19-64

Income ≤ 133% FPL

Not eligible for Medicaid

Healthy PA Newly Eligible

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Ages 19-64

Income ≤ 133% FPL

Not eligible for Medicaid

Up to approximately $15,500 for an individual and

$20,900 for a family of two.

Applying for Benefits

There is ‘no wrong door’ when applying for

health care!

COMPASSPaper

Application

ConsumerServiceCenter

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Health Screening

Health Screening

• Aligns health care needs to the appropriate benefit package• Basic information about a person’s health conditions, similar

to what you may provide when first visiting a doctor’s office• Completion of the tool is not required for eligibility• Questions may be skipped• Information is confidential• If not completed, individuals will be placed in either the low

risk plan or the Private Coverage Option.27

Health Screening

Who will need to complete the screening tool?

• Adults between the ages of 21 through 64 applying for Medicaid or the Private Option Coverage

• The following individuals will not complete the screening tool:• Children up to the age of 21• Adults 65 years of age and older• Pregnant woman• Individuals on SSI (or in a SSI related eligibility category),• Those applying for or receiving MA home and community

base (waiver) services• Individuals residing in institutional settings (nursing homes,

intermediate care facilities)

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Healthy Behaviors

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Annual Wellness Visit

Meet Cost-Sharing Obligations• Continue to pay as assigned• Providers can deny services if:

• Individual refuses to pay copay; • Current practice is to deny services with refusal to pay copay; and • Household income is >100% of the applicable FPL

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Healthy PA Timeline

Overview Topics

New Medicaid Benefit Plans

High Risk

• Adults who have complex health care needs, either medical or behavioral health, including pregnant women

• Administered by current HealthChoices managed care plans

• Screened High• Includes adults 65 and over

Low Risk

• Adults, ages 21 through 64, who do not have complex health care needs, either medical or behavioral, and are eligible for Traditional MA.

• Administered by current HealthChoices managed care plans

• Not screened high• Opted out of how risk plan

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No changes have been made to the children’s benefit plan.

Both the high risk and low risk plans meet the

federal standards for essential health benefits, mental health and drug &

alcohol parity.

Benefit Categories Covered

Physician services, including primary care

Outpatient services

Emergency room services and emergency transportation (ambulance)

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services and treatments

Lab services, x-rays, imaging (MRI, CT, etc.)

Rehabilitation and habilitation services and devices

Preventive and wellness services

Prescription drugs

Dental services

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High Risk and Low Risk Plans

Private Coverage Option

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Private market health insurance plan for individuals up to 133% of FPL who do not qualify for Medicaid

Pennsylvania Enrollment Services will assist in enrolling individuals in a health insurance plan

Cost sharing obligations identical to current MA plans

Covers cost sharing for in-network services

Medically Frail

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Medical Frail includes individuals who have a:• Disabling mental disorder• Chronic substance abuse disorder• Serious and complex medical condition• Physical disability that significantly impairs his or her

functioning• Intellectual or developmental disability• Disability determination designation by the Social Security

Administration

Individuals who are screened as medically frail will be placed in the Medicaid high risk benefit plan.

A Pennsylvania-specific Plan

Medical Assistance (Vulnerable Pennsylvanians)

• Low income parents/ caretaker relatives with incomes up to 44% FPL

• Children

• Medically frail/Individuals with disabilities

• Seniors

Private Coverage Option (January 1, 2015)

• Childless adults

• Adult parents/caretaker relatives

• Incomes up to 133% FPL

• Working poor

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Simplified Benefit Package Structure

Healthy PA Timeline

Overview Topics

Implementation Timeline

November 2014

December 2014

January 2015

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• Letter sent to recipients changing packages

• If transitioning to low risk or PCO plan, includes invitation to complete health screening

• Notices of transition mailed

• Effective date of new MA and PCO plans

• PCO enrollment begins

Documents

> > Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare DPW Overview & Healthy PA Presented by: Secretary Beverly Mackereth