Q18. What is the term (length) of the agreement with CHC-MCOs and when will be the next bidding be held for new CHC-MCO providers?
A. The term of the Southwest Zone agreements will commence on 1/1/18 and will have a five-year term.
The term of the Southeast Zone agreement will commence on 7/1/18 or a later date selected by DHS and will have a four-year term.
The term of the Lehigh-Capital, Northwest, and Northeast Zone agreements will commence on 1/1/19 or a later date selected by DHS and will have a three-year term.
DHS may, at its discretion, choose to extend the term of the agreements for one additional period of two years.
Q19. How can we access a CHC-MCO’s agreement with the state?
A. The fully-executed CHC agreements will be available on the Pennsylvania Department of Treasury’s website; however, the rate information will be redacted.
Q20. Is the version of the CHC waivers that were submitted to the center for medicare and medicaid services (CMS) publicly available?
A. The approved CHC related waiver are available on the CHC website.
Q21. Will the three CHC-MCOs over all of Pennsylvania or will certain ones be available only in certain areas?
A. All three CHC-MCOs will cover all CHC zones throughout the state.
Q22. If a participant is currently enrolled in a health choices plan that is not offered under CHC, does the participant need to change plans?
A. A CHC participant must select one of the three CHC-MCOs. If a participant is enrolled in an MCO that is not affiliated with one of the three selected CHC-MCOs, the CHC participant will need to select another CHC-MCO.
Q23. Will be able to choose from among one of the three CHC-MCOs and a pick a provider such as an attendant?
A. Yes, a participant has the freedom to choose both the CHC-MCO and their service providers from the CHC-MCO’s provider network. In addition, all CHC-MCOs must offer participants receiving home and community-based services the opportunity to self-direct Personal Assistance Services and employ their own personal assistance provider, who can be a family member, a friend, a neighbor, or any their personal assistance worker as determined by the Department of Human Services.
Q24. Is PA health and wellness known by another name?
A. PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).
Q25. What’s difference between the state Hotline’s – 1-800-757-5042, 1-800-932-0939, 1-833-735-4416, and 1-833-735-4417?
A. DHS has established a call center to specifically assist providers and participants with CHC. 1-833-735-4416 is the CHC Participant Call Center and 1-833-735-4417 is thge CHC Provider Call Center. The Office of Long-term Living (OLTL) also has call centers to assist participants and providers with fee-for-service questions. 1-833-757-5042 is the OLTL Participant Line and 1-800-932-0939 is the OLTL Provider Line.
Q26. How do you get on the list serve?
A. A list serve has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES. Please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
Q27. Has the office of the long-term living approved the CHC-MCO contracts that are being presented to providers? Not all providers have the resources to pay for an independent review of each contract?
A. The Department of Human Service’s agreement with the CHC-MCOs requires that the CHC-MCOs include certain provisions in their provider agreements and that CHC-MCOs submit their provider contracts agreements OLTL for approval. OLTL’s review, which only focuses on whether the provider agreements include the required content, is not a substitute for the provider’s own review. Providers should consult with their own legal counsel regarding any contracting questions or concerns.
Q28. What guidance/instruction will be given to the CHC-MCO from the Department of Human Services?
A. The CHC Agreement establishes requirements, which the CHC-MCOs must meet. DHS has provided technical assistance on various topics such as housing, home and community-based services and reimbursement , service and coordination, nursing facility services and reimbursement, third party liability, information technology systems and behavioral health. DHS is also providing written documentation on various programmatic topics.
Q29. What is the office of long-term living’s role under the new CHC-MCO arrangement?
A. Under CCH, OLTL will be responsible for the administration of CHC and will have full, ongoing oversight and monitoring functions of the CHC-MCOs. OLTL will review and approve processes, policies, manuals, and procedures of each CHC-MCO.
Q30. Will the current bed transfer process continue under CHC?
A. In accordance with state and federal regulations, the Department of Human Services (DHS) and the CHC-MCOs must ensure participants have adequate access to nursing facility services. DHS will continue to monitor access and will continue the bed request and bed transfer request processes in accordance with §1187 sub-chapter L unless other regulations related to this process are promulgated.
Q31. Will reimbursement be backed by the state if the CHC-MCO is failing to make payment?
A. The Department of Human Services (DHS) will not make payments directly to providers once CHC is implemented in a CHC zone. However, DHS established several mechanism to help ensure providers receive timely payments from CHC-MCOs, including requirements to ensure CHC-MCOs’ financial viability and readiness to pay claims, and claims processing timeliness.
The CHC-MCOs must required to meet equity and solvency requirements and other financial protections to ensure they have the financial resources to pay providers.
The CHC-MCOs must demonstrate during readiness review that they have the ability to provide services as required by the agreement prior to implementation of CHC in a given zone. This includes demonstrating their claims processing system.
If DHS determines that a CHC-MCO has not complied with the claims processing timeliness standards, DHS may impose sanctions on the CHC-MCO.
Q32. How is the Department of Human Services reaching consumers who are not online or have limited English proficiency (LEP)?
A. In an effort to relay information through various formats, DHS is mailing about CHC to all individuals impacted by CHC, working with the stakeholders to help relay information about CHC, and holding in-person meetings. CHC-MCOs must mail notices to participants and provide hard copies of important documents, including its provider directory, to participants upon request.
DHS is taking steps to provide meaningful access for individuals with LEP.
DHS is sending information to consumers by mail which will include tag lines, CHC-MCOs must include tag lines in the top 15 prevalent languages in Pennsylvania, in addition to an English Tag lines in large print, on all significant publications and communications. CHC-MCOs must also provide oral interpretation in all languages and written translations in prevalent languages determined by thie DHS. CHC-MCOs must revise and update their policies, procedures, and materials to integrate templates and taglines in accordance with the requirements.
Q34. Are the certain zip codes in the HEZ (Health Enterprise Zone) involved in the CHC program?
A. Yes, when CHC is implemented in the Southeast zone effective July 1, 2018 all participants residing in a zip code covered by the HEZ will be enrolled in CHC. The goals of CHC and HEZ are consistent – improving coordination of services, achieving better health outcomes, and developing a more sustainable system.
Q35. Will the CHC-MCOs have a local office in each region?
A. Will the CHC-MCO must have an administrative office within each CHC zone. In its discretion, The Department of Human Services may grant exceptions if the CHC-MCO has administrative offices offices located elsewhere in Pennsylvania and the CHC-MCO is in compliance with all standards set forth by the Pennsylvania Department of Health (DOH) and Pennsylvania Insurance Department (PID).