Who are Eligible for CHC Transition/who enrolls in CHC?
- Dual Eligibible – cons who have both Medicare and Medicaid
- Currently in a facility paid for by Medicaid
- Waiver Recepients: through Attendant Care, Independence, COMMCARE and or Aging, who are not enrolled in the LIFE (Living Independence for the Elderly) Program
- those who get services through the OBRA waiver and are NFCE (Nursing Facility Clinically Eligible)
- those who are 55 years old and older may also choose to enroll in CHC
What is the goal of CHC?
- enhance opportunities for community-based services
- strengthen healthcare and long-term, service and support delivery systems
- allow for new innovations
- promote health, safety, and well-beng of participants
- ensure transparency, accountability, effectiveness, and efficiency
MCOs or MANAGED CARE ORGANIZATIONS are central points of ADMINISTRATION, COORDINATION and ACCOUNTABILITY.
3 MCOs in the STATE of PA:
- Amerihealth Caritas of PA – Keystone First CHC for Southeast only
- PA Health and Wellness
- UPMC Community Healthchoices
There is a 180-day transition period to ensure the participants (our consumers) continuity of care, this allows the consumers to keep their current coordinators and providers and let them know they need to be contracted with their MCO of choice.
WHEN and HOW DOES ONE START WITH THE CHC ENROLLMENT PROCESS?
To start the CHC enrollment process with participants, our consumers will receive a letter from the DHS within 90 days of implemention in each zone. This letter will outline the transition process.
Participants will be contacted by PA’s Independent Enrollment Brokers and will guide them through the process of selecting an MCO.
If the consumer is not able to select an MCO within a given timeframe, an MCO will be selected for them based on their current needs, providers, and services. PARTICIPANTS may change their MCO at any time.
WHAT IS MSI’s ROLE in the TRANSITION PROCESS?
Our role as a provider is:
- To educate participants about the program asnd the processes
- answer questions
- encourage the participants make an informed choice of MCOs
WHAT DO WE DISCUSS WITH OUR CONSUMERS?
- You can let them know when CHC will begin in their area. PHASE 3 begins is January 2020.
- We can tell our customers that they should expect a letter from DHS regarding CHC
- We can help them understand what the IEB (Independent Enrollment Brokers) will discuss to them and their role in the CHC process.
- We should be able to give them a compelling reason why choosing an MCO is important
- What are the new services that will be available to them
- And that everyone is committed to the continuity of care.
WHAT IS THE TARGET AREA of CHC PHASE 3?
The Northwest, Northeast and Lehigh Capital Zones belong to Phase 3.
IMPLEMENTATION TIMELINE of CHC
The Department of Human Services (DHS) will provide training and outreach to educate participants before transition.
PART 1. AWARENESS FLYER:
Flyers are sent to participants. They include contact information for a dedicated CHC partipicant hotline.
PART 2. LOCAL EVENTS:
Local events are scheduled 2-3 months prior to implementation to educate participants.
PART 3. PRE-TRANSITION NOTICE & PRE-ENROLLMENT PACKAGE:
DHS will send a pre-transition notice to inform participants that they will transition to CHC and that the independent enrollment broker (IEB) will send them a pre-enrollment package.
PART 4. MCO SELECTION:
The IEB will work with the participant to identify the MCO that best meets their needs.
PART 5. MCO PARTICIPANT MATERIALS:
Once the participant selects an MCO, the MCO will send the participant a package with their participant identifcation card and information about next steps
PRIORITY OF DHS BEFORE and AFTER CHC:
- No interruption is participant services
- No interruption is provider payments
** DHS will monitor closely for continuity of services and payments.
ROLE of MCOs DURING TRANSITION
MCOs are required to:
- Perform participant assessments
- Contract with all willing an qualified providers
- provide training to providers on billing and monitoring systems
- report ot DHS on continuity of care and provider payments
- keep its network providers informed and updated
- develop and maintain a provider manual
- train their providers on various aspects and areas
REFER CONSUMERS WHO DON’T HAVE ACCESS TO INTERNET OR A COMPUTER TO THIS NUMBER: 8337354416