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Community HealthChoices: Recap Third Thursday Webinar (November 21, 2019)

December 12, 2019
Reimbursement By Fidel Mercado, Analyst

On November 21, 2019, during the Department of Human Services’ (DHS) “Third Thursday Webinar,” DHS discussed the participation results from the Informational Sessions, and how facilities can ensure a smooth transition into the Phase 3 Community HealthChoices (CHC) Implementation.

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The Phase 3 CHC Implementation is ahead of schedule relative to Phase 1 and 2. To date, there have been 72 Aging Well Participant Information Sessions across 43 different sites with 3,000 participants. All of the participants were listed as first-time attendees. There were 11 additional Information Sessions offered in partnership with the PA Centers for Independent Living with over 600 attendees.  

To date, provider networks are as follows: for nursing facilities—AmeriHealth has 256 contracts, PA Health & Wellness has 241 contracts, and UPMC has 268 contracts; and for Hospitals—AmeriHealth Caritas has 85 contracts, PA Health & Wellness has 60 contracts, and UPMC has 59. Managed Care Organizations (MCOs) are continuing to submit weekly updates for network accuracy.

With regard to provider training, three workshops were offered to supplement the 12 workshops held in May and June. The workshops were held at Clarion University on October 8, Marywood University on October 21st, and Kutztown University on October 28. Approximately 1,950 providers participated in the spring and fall.

 

Provider Participation - Zone 3

(Northwest, Northeast and Lehigh/Capital)

Time Period Total Participants
Spring 600
420
520
Fall 415

 

Several messages have been sent to Service Coordination Entities (SCEs) regarding the Social Assistance Management System (SAMS) Aging Waiver Data Clean-Up to support CHC. To ensure a smooth transition, it is crucial that all SCEs review and make the necessary corrections to affected plans. If the CHC Managed Care Organizations are unable to successfully transition service authorizations due to inaccurate data elements or continuity of care, provider payment could be impacted. We have seen some improvement in the number of errors, but there are still plan errors in SAMS that require attention as soon as possible.

If providers are electing to use the HHAeXchange Electronic Visit Verification (EVV) System offered by the MCOs, providers must work with the MCOs to complete training and other onboarding requirements. Providers using alternate EVV systems in CHC will need to send their EVV data to the CHC-MCOs. Providers should contact HHAeXchange at EDIsupport@hhaexchange.com to complete third party system integration activities for CHC.

The DHS Sandata System training is available for providers electing to use the DHS Sandata System for the Omnibus Budget Reconciliation Act (OBRA) waiver, Act 150 program, and ODP waiver programs. This training is needed to set up agency accounts and security permissions. This service will only be available for fee-for-service providers.  Fee-for-service providers that elect to use an alternative system will need to contact Sandata at 1-855-705-2407. 

Q&A Session

Below are a few of the questions from the "Third Thursday Webinar" Q&A session. 

Q: Can a Skilled Nursing Facility (SNF) look up their residents in Environmental Services (EVS) to determine which MCO the resident chose? (memo 017_6.57)
A: Yes, EVS is the ‘go-to’ when it comes to eligibility and/or MCO assignment, but the MCO plan assignments will not be visible until January 1-since the participant can continue to change the plans through December 20.

Q: If a participant wants their worker to meet them somewhere (outside the participant home) will EVV allow that? (memo 016_2.31)
A: Yes. You can start or end a shift using a mobile application or you can use a landline outside of the participant home, you will just need to associate the participant address. 

Q: Can we continue to provide services without a valid Service Authorization Form (SAF) after December 31, 2019? (memo 016_4.46)
A: As of January 1, 2020, you will be under the continuity of care period with the MCO. You should be providing services as you were prior to January 1, 2020 through the continuity of care period, but from there on, you will need to make sure that you are using the HHAeXchange system to obtain your authorization. You will no longer receive an SAF.

Q: Will persons enrolled in the OBRA waiver have to change systems?
A: No, the case management system will still be the Hospital Incident Command System (HICS). Individuals providing services through OBRA will still be billing PROMISE, and the PROMISE services will still be authorized via HICS. OBRA will continue to be a fee-for-service waiver. 

 

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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