May 31, 2017

Community HealthChoices

Updates

Jen Burnett

Deputy Secretary

Office of Long-term Living

Department of Human Services

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.

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

Covered Services

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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

CHC Roll Out

6/1/2017 6

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

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

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.

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CHC Program Evaluation Information

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.

CHC Readiness Review Process

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• 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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