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Community HealthChoices: Recap Third Thursday Webinar (June 20, 2019)

July 29, 2019
Reimbursement By Jennifer Matoushek, Senior Consultant

On June 20, 2019, during the Department of Human Services' (DHS) "Third Thursday Webinar," DHS discussed the Community HealthChoices (CHC) Phase 3 Implementation Updates and Functional Eligibility Determination (FED) Updates. Below is an overview of the discussion.

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Southwest and Southeast Operation Updates

  • The continuity of care period ended in the Southeast zone of CHC on June 30th. 
  • At the end of the continuity of care period participants can expect a comprehensive needs assessment, person-centered service planning and a revised person-centered service plan. 

Phase 3 Implementation

  • Phase 3 includes the Northwest, Northeast and Lehigh/Capital Zones.
  • Phase 3 population includes 143, 004 individuals. 
    • 96% dual-eligible.
    • 17%  in nursing facilities.
    • 13% in waivers.
    • 23, 323  or 16% duals in nursing facilities.
    • 14, 609 or 10% duals in waivers.
    • 99,887 or 70% NFI duals.
    • 1,096 or 3%  non-duals.
    • 4,089 or 3 % non-duals in waivers.

Lehigh/Capital Zone

  • Has the largest population out of the three zones. 
  • Includes Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties.
  • Lehigh/Captial Zone population is 66,044 individuals.
    • 10,861 or 16 % duals in nursing facilities.
    • 6,269 or 10% duals in waivers.
    • 46,411 or 70% NFI duals.
    • 1,996 or 3% non-duals in waivers.
    • 507 or 1% non-duals in nursing facilities.

Northwest

  • Includes Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren Counties. 
  • Northwest Zone population is 27,730 individuals. 
    • 4,053 or 15% duals in nursing facilities.
    • 3,671 or 13% duals in waivers. 
    • 18,737 or 68% NFI duals.
    • 1,080 or 4 % non-duals in waivers.
    • 189 or <1& non-duals in nursing facilities.

Northeast

  • Out of the three Phase 3 zones, Northeast contains the most counties.
  • Includes Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming Counties.
  • Northeast Zone  population of 49, 195 individuals. 
  • 8,397 duals in nursing facilities.
  • 4,664 or 9% duals in waivers.
  • 34,727 or  71% NFI duals.
  • 1,007 non-duals in waivers.
  • 400 or 1% non-duals in nursing facilities. 

Phase 3 Timeline

  • July- August
    • Flyers, mailers and Round 1 pre-transition notices will be distributed. 
  •  September -October
    • Participant information session and provider sessions will be held. There will also enrollment packets and round 2 and 3 of the pre-transition notices being distributed. 
  • November-December
    • November 13 is the last day for plan selection before auto-assignment
    • December 20 is the last day for plan selection that will go into effective January 1, 2020.
  • January 1, 2020 CHC Phase 3 Implementation will be completed.

Phase 3 Provider Sessions/Transportation Summits

During the Phase 3 Provider Sessions, The Office of Long-Term Living (OLTL)  conducted provider workshops and a transportation summits in all three of the Phase 3 zones. Approximately, 1,540 individuals attended these workshops.

Below are some key takeaways that were discussed during the Transportation Summits. 

Transportation Summits Key Takeaways

  • Evaluate potential areas for innovation to support the informal transportation supports that are currently being provided by direct care workers. 
  • Continue to facilitate discussions to ensure MCOs, providers, and other stakeholders hold an understanding on the various transportation resources offered through Commonwealth programs . 
  • Increase communication to service coordinators regarding the role of the transportation brokers in CHC.

Functional Eligibility Determination (FED) Updates

  • There have been 20,597 FED assessments completed between April 1 and May 28, 2019.
  • 15,613 or 77% had an initial recommendation of NFCE.
  • 4,495 or 23% had an initial recommendation of NFI.
  • 1,157 of the FED assessments had a medical review requested. 

For more information on training, Direct Service Providers or other CHC news, click here. Download our infographic "Your Guide to Medicare and Medicaid Dual Eligibility" for more information changes that are resulting from dual eligibility. 


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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