Roll Out

Priorities Through Implementation

Essential Priorities

  • No interruption in participant services
  • No interruption in provider payment

How will we ensure no interruptions?

  • The Department is engaged with the MCOs in a rigorous readiness review process that looks at provider network adequacy and IT systems.
  • The Department of Health must also review and approve the MCOs to ensure they have adequate networks.

  • Known nationally as the Program of All-inclusive Care of the Elderly (PACE)

    • Integrated managed care program for individuals age 55 and over, needing the level of care provided in a nursing facility
    • Provides long-term care, acute care and behavioral health services to its older citizens through an interdisciplinary approach
  • Currently LIFE programs are available in 39 countries across the commonwealth.
  • The LIFE Program will continue to operate as an option for eligible individuals in geographic areas in which LIFE is available.
  • Here is a link for more information about LIFE Program: PA DHS – LIFE (Living Independence for the Elderly).

Communications Goals

  • Educate participants, providers, family members, and stakeholders on changes coming.
  • Eliminate confusion regarding transition plans.
  • Align HealthChoices with Community HealthChoices events and communications whenever appropriate and possible.

Communication Activity

  • Ongoing

    • Social Media
    • Third Thursday Webinars

  • Current

    • Strategy meetings to discuss interconnectivity of programs
    • Website redesign
    • Creation of deliverables
    • Outreach event planning
      • 20 events in the SW for CHC
      • Provider education summit in the SW (July 24 – 26)
    • Provider and staff training development
    • Provider education material development (bi-weekly one pagers)

CHC Website

CHC Provider Communications

Provider Resources:

Communication Strategies

  • Phase 1 participants will hear from the Commonwealth in July 2017 (flyer).
    • Pre-transition notices will go in September 2017 to Phase 1
  • Aging Well will:
    • Host community forums for duals
    • Train SC and nursing facility staff
  • Provider communication going out on a regular basis

Aging Well

CHC Protests and Appeals

  • Protests were filed by unsuccessful bidders
    • Protests filed with DHS
    • Appeals filed with Commonwealth Court
    • Status of Injunction

CHC Initial Flyer for Southwest Region

Evaluation Plan by Medicaid Research Center

Research Team continues to conduct Key Informant Interviews (KII) with various providers.

  • Individuals living in an Assisted Living
  • Meal Provider
  • Service Coordination agencies
  • Area Agencies on Aging
  • CHC-MCOs scheduled for late July/early August

Participant Interview Tool (pilot testing)

  • Conducted 46 Telephone Interviews
  • Goal is to complete 15 in-person interviews before going live.

Note: Working on ways to streamline the interview process in order to decrease the time it takes to complete an interview and decrease the burden on the participant.

More details will be available at an upcoming MLTSS
Subcommittee Meeting

CHC Readiness Review (RR) Update

  • Ongoing weekly Readiness Review check-in meetings with each CHC-MCO and the contract monitor teams.
  • MCOs are currently working on Readiness Review Deliverables.
  • MCOs continue to reach out to and recruit providers for their networks.
  • OLTL, DOH, PA Health Law Project (PHLP), and participants to continue to meet and discuss LTSS Provider Network standards.
  • Future Technical Assistance Sessions have been identified and schedule for the CHC-MCOs: Quality, Pharmacy, Encounter/Claims.

Functional Eligibility Determination (FED) Tool

  • New FED tool beginning late Fall 2017 as part of the participant eligibility determination for LTSS.
  • New FED tool will be more consistent and less subjective, and provide for a more valid gateway to Medicaid-funded services.
  • Training of testing Assessors was completed in April and testing of the FED tool began on May 15th.