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UPDATE: Community HealthChoices Delayed for Phase 2 and 3

November 07, 2017
Reimbursement By Jennifer Matoushek, Senior Consultant

Phase 2 and 3 of Community HealthChoices delayed. Community HealthChoices (CHC) is Pennsylvania's mandatory managed care program for eligible individuals and persons with physical disabilities. CHC was developed to enhance access to and improve the coordination of care and long-term services and supports (LTSS). The program creates a person-centered, long-term support system where individuals have choice over the medical services they receive.

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CHC is set to be implemented in three phases. Notices have previously been mailed out to participants within 14 counties located within Pennsylvania's southwest region. Participants in phase 1 of the implementation have until November 13, 2017 to select a Managed Care Organization (MCO). As cited in a recent member alert, released by LeadingAge PA, The Department of Health and Human Services states,

We are confident that the southwest is ready for Phase 1, but in order to allow for the deliberate and purposeful implementation of CHC in the southeast region [Phase 2] and the remainder of the state [Phase 3], we need to have the flexibility of learning from that roll out with proper time to make any needed adjustments.

Phase 2 will be implemented on January 1, 2019, instead of July 1, 2018.

Phase 3 will be implemented on January 1, 2020, instead of January 1, 2019.

What the Delay Means for Providers

If you are provider located within the southeast region of the state, or any of the state's remaining regions, there is still time to improve your CMI. The average of the last four Pennsylvania Medicaid facililty-level Case Mix Indexes will be used to set the floor rate per diem for the first 36 months following the implementation date of each phase. The floor rate will not be adjusted during the 36 months like it is today. Therefore, it is imperative that facilities appropriately capture the care provided that will affect reimbursement.

If your facility is struggling to capture appropriate reimbursement, LW Consulting, Inc. has consultants that specialize in Pennsylvania's Medicaid Case-Mix and have successfully assisted facilities in appropriately improving CMI and capturing reimbursement. Contact us today while there is still time to improve your Case Mix.


Download a case study to learn more about how LW Consulting, Inc. has successfully helped facilities improve their case  mix.

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