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Community HealthChoices: Recap Third Thursday Webinar (August 15, 2019)

August 23, 2019
Reimbursement By Fidel Mercado, Analyst

On August 15, 2019, during the Department of Human Services' (DHS) "Third Thursday Webinar," DHS discussed the Community HealthChoices (CHC) Phase 3 Implementation and efforts to prepare participants and providers. The webinar also discussed the CHC Waiver renewal process and Electronic Visit Verification (EVV).

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Phase 3 Implementation

The third and final implementation phase of PA Community HealthChoices (CHC) is quickly approaching and will include the following counties:

  • Lehigh/Capital Counties-Adams, Berks Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York.
  • Northwest Counties- Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren
  • Northeast Counties-Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming

In an effort to foster a robust readiness review, with comprehensive participant and provider communication, CHC has sent out a series of mailings. The Initial Participant Touchpoint Flyer and LIFE Program Flyer was dispersed on July 15, 2019. The Aging Well Participant Information Session Mailer was sent on August 1, 2019.

On August 19, 2019, CHC will begin sending pre-transition notices. If a response is not received, multiple rounds of pre-transition notices will continue to go out through September and October. Copies of the pre-transition notice, flyers  or any other standard mailings can be found at here.

If needed, plan changes can be made throughout the year. If the change is made before the second Thursday of the month, the change will take effect at the beginning of the following month. If the change is made after the second Thursday of the month, then the change will go into effect at the beginning of the second month after the selection is made. For example, if participants want a plan selection with effective date of January 1, 2020, they will need to make a selection before December 20, 2019.

CHC Waiver Renewal

The current CHC 1915(c) waiver will renew early-January 1, 2020 as opposed to June 30, 2020, in hopes of aligning the waiver with CHC rates which are currently updated by calendar year.

The waiver will renew with minimal changes, to facilitate the early waiver renewal. A more comprehensive amendment will be completed by the effective date of January 1, 2021.

The most notable changes are:

  • Service Coordinators are no longer required to have a bachelor’s degree IF they have at least 3 or more years of experience in a social service or healthcare setting.
  • Service Coordinator Supervisors are no longer required to have a bachelor’s degree IF they have at least (3) or more years relative experience with a commitment to obtain either a PA social work or mental health professional license within one year of hire.
  • Emergency Back-Up Plans are now required to be included in the Person-Centered Service Plan
  • Office of Vocational Rehabilitation (OVR) can now be considered ‘unavailable’ IF an eligibility determination is not made within 120 days. In addition, language that explains when CHC-employment related services will be available to participants if the OVR is operating with a waiting list.
  • A day of Residential Habilitation will be a minimum of 8 hours as opposed to 12 hours.
  • A Comprehensive Needs Reassessment must now be completed within 14 days, if a CHC-MCO identifies that a participant has not been receiving services for 5 or more days, and the participant’s health status or needs have changed. NOTE: the CHC-MCO is responsible for contacting the participant to determine if the cessation of care was related to a health status change.

Electronic Visit Verification (EVV)

Providers can use 3rd party EVV systems, as long as the system(s) capture the 6 required items under Section 12006 of the 21st Century Cures Act. These 6 required items include:

  • Type of service provided;
  • Individual receiving the service;
  • Individual providing the service;
  • Date of service;
  • Location of the service delivery, and;
  • Time service begins and ends.

The 3rd party system also needs to meet the Department of Human Services’ (DHS) system data requirements outlined in the technical specifications documents.

EVV must be implemented for personal care services by January 1, 2020, and for home health services by January 1, 2023.

The PA DHS EVV (Sandata) system training will be available for providers beginning in September 2019. Providers using the Sandata EVV system are required to complete this training in order to begin setting up their agency accounts and security permissions. 

 

Does your facility need help with Community HealthChoices implementation? Contact Jennifer Matoushek, Senior Consultant, by calling 717-213-3130 or email JMatoushek@LW-Consult.com.

 

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