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May 31, 2017
Community HealthChoices
Updates
Jen Burnett
Deputy Secretary
Office of Long-term Living
Department of Human Services
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The Basics
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What is Community HealthChoices (CHC)?
CHC is a Medicaid managed care program that will include
physical health benefits and long-term services and supports.
The program is referenced nationally as a Managed Long-term
Services and Supports Program or MLTSS.
Who is part of CHC?
• Individuals who are dually eligible for Medicare and
Medicaid
• Individuals who are eligible for Medicaid long-term services
and supports (LTSS) because they need the level of care
provided by a 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-
MCO.
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Community HealthChoices Goals
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CHC Population
6/1/2017 4
Duals in Waivers 49,759
Non-Duals in Waivers 15,821
Duals in Nursing Facilities 77,610
Non-Duals in Nursing Facilities 7,314
Non-LTSS Duals 270,114
TOTAL 420,618
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Covered Services
6/1/2017 5
For all participants:Physical health services such as, but not limited to:
• Primary Care Physician
• Specialist Services
For participants who qualify for LTSS:– Long-term services and supports in a nursing facility
– Home and community-based long-term services and
supports including
• Employment related services
• Pest eradication
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CHC Roll Out
6/1/2017 6
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CHC Current Status
• Implementation Phase as of 3/30/2017:
– Readiness Review
– Participant and Provider Outreach
– CMS Waiver Submission
– Program Evaluation and Launch Preparation
– Finalizing Agreement with CHC MCOs
• Selected offerors:
– UPMC for You
– Amerihealth Caritas
– Pennsylvania Health and Wellness
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Priorities Through Implementation
• Information Systems
• Network Adequacy
• Member materials and services
Readiness Review
• Participants and caregivers
• Providers
• Public
Stakeholder Communication
• General Information
• Training
• Coordination between offices
• Launch Indicators
DHS Preparedness
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Priorities Through Implementation
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Essential Priorities
• No interruption in participant services
• No interruption in provider payment
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CHC Implementation Timeline
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4/1/2017 1/1/20197/1/2017 10/1/2017 1/1/2018 4/1/2018 7/1/2018 10/1/2018
4/1/2017 - 10/31/2017
SW Readiness Review
11/20/2017
SW Participant Conversion to CHC
11/1/2017 - 5/1/2018
SE Readiness Review
5/20/2018
SE Participant Conversion to CHC
5/1/2018 - 11/1/2018
Phase 3 Readiness Review
11/20/2018
Phase 3 Participant Conversion to CHC
1/1/2018 - 6/30/2018
SW Continuity of Care Period
7/1/2018 - 12/31/2018
SE Continuity of Care Period
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CHC Communication Goals
• Educate and inform participants, providers, family members, and stakeholders on CHC and managed care.
• Eliminate confusion regarding transition plans.
• Minimize auto-enrollment through education
• Align HealthChoices with Community HealthChoices events and communications whenever appropriate and possible.
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Communications Strategies and Timelines
• Phase 1 participants will hear from the commonwealth in July 2017.– Pre-transition notices will go in September 2017 to Phase 1
• Aging Well will:
– Host community forums for well duals
– Train SC and nursing facility staff
• The Jewish Healthcare Foundation will continue to be integral in coordinating community forums and providing feedback to the commonwealth on documents and processes throughout the CHC implementation.
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CHC and HC Communication Coordination
• We heard from advocates, consumers, and providers concerning the HealthChoices implementation timeframe –including the CHC interaction.
• Adjusted the timeline accordingly and included a phased-in approach:
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• Conducted by the Health Policy Institute, Medicaid Research Center at the University of Pittsburgh
• Report of Year 1 Activities Reported at the March 1, 2017, MLTSS SubMAAC
• For more information visit the evaluation tab under the Community HealthChoices page.
6/1/2017 14
CHC Program Evaluation Information
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CHC Waivers
6/1/2017 15
Concurrent1915 (b) and 1915 (c) Waivers
• 1915 (b) waiver allows for the use of managed care in the Medicaid program through MCOs and makes the program mandatory for eligible participants to receive services.
• 1915 (c) waiver allows the provision of home and community-based services to people who would otherwise need institutional care. Waiver services compliment and/or supplement services that are available through the Medicaid State plan and other Federal, state, and local resources, as well as supports that families provide to individuals.
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CHC Readiness Review Process
6/1/2017 16
• Measures readiness of MCO prior to CHC going-live
• Readiness review criteria and benchmarks are set by the Department
• Completed as desk review and on-site
• Readiness Review Teams: • One team will be assigned to each MCO
• Average team consists of 3-4 staff from the Department
• Each team will have up to 10 subject matter experts (SME)
• CHC readiness review will review all LTSS components. Physical health will be reviewed in conjunction with HealthChoices.
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1915
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