2-15-18 Third Thursday Webinar (Slides)...INDEPENDENT ENROLLMENT BROKER: 1-844-824-3655 OR (TTY...
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Third Thursday Webinar February 15, 2018 Kevin Hancock Acting Deputy Secretary OFFICE OF LONG - TERM LIVING DEPARTMENT OF HUMAN SERVICES
Transcript of 2-15-18 Third Thursday Webinar (Slides)...INDEPENDENT ENROLLMENT BROKER: 1-844-824-3655 OR (TTY...
Third Thursday Webinar
February 15, 2018
Kevin HancockActing Deputy SecretaryOFFICE OF LONG-TERM LIVINGDEPARTMENT OF HUMAN SERVICES
CHC LAUNCH UPDATE
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2018 Community HealthChoices SW GOALS
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• ASSURING NO PARTICIPANT SERVICE INTERRUPTIONS
• ASSURING NO INTERRUPTION IN PROVIDER PAYMENT
• SUCCESSFUL LAUNCH FIRST PHASE
CHC SOUTHWEST JANUARY (Population Distribution)
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NFI Duals73%
HCBS Duals10%
HCBS Non Duals3%
LTC Duals13%
LTC Non-Duals1%
PA CHC Total Enrollments by Population
NFI Duals HCBS Duals HCBS Non Duals LTC Duals LTC Non-Duals
CHC SOUTHWEST JANUARY (Age Distribution)
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Population Over 60 Under 60NFI Duals 51.2% 48.8%HCBS Duals 69.4% 30.6%HCBS Non Duals 33.3% 66.7%NF Duals 94.7% 5.3%NF Non-Duals 45.0% 55.0%Total Population 57.9% 42.1%
CHC SOUTHWEST JANUARY (Plan Distribution)
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DistributionAmerihealth
Caritas
Pennsylvania Health and Wellness
UPMC COMMUNITY
HEALTHCHOICES
Percentage 20% 28% 52%
CHC SOUTHWEST JANUARY: Plan Selection Method
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D-SNP ALIGNMENT
PARTICIPANT PLAN SELECTION
AUTO ASSIGNED
PLAN SELECTION
FORM PHONE WEB
11% 19% 20% 2% 48%
CHC SOUTHWEST POPULATION (BY WEEK ENROLLED)
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o EFFECTIVE 2/2/18
56
62
67
0 10 20 30 40 50 60 70 80 90 100
AmeriHealth
PA Health and Wellness
UPMC
LI1 - Weekly New Enrollment of Participants into CHC
Week Ending Jan 5 Week Ending Jan 12 Week Ending Jan 19 Week Ending Jan 26Source: EDW Report
CHC SOUTHWEST (BY AGE AND POPULATION GROUP)
9
3 3 1
14 5
18
5 1
8
41 12 31
14
28
1 -
10
20
30
40
50
60
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
Jan5
Jan12
Jan19
Jan26
HCBS LTC NFI HCBS LTC NFI HCBS LTC NFI
AmeriHealth Caritas PA Health and Wellness UPMC
LI1b - Weekly New Enrollment by Age and Population Group
Under 60 60 and OverSource: EDW Report
CHC SOUTHWEST Weekly Plan Transfers
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-63 -51
114
-200
-150
-100
-50
0
50
100
150
200
250
300
Jan 5 Jan 12 Jan 19 Jan 26 Jan 5 Jan 12 Jan 19 Jan 26 Jan 5 Jan 12 Jan 19 Jan 26
AmeriHealth Caritas PA Health and Wellness UPMC
LI 2 - Weekly Plan Transfers Captured
Transfer In Transfer Out NetSource: OMAP Report
CHC SOUTHWEST Weekly Plan Transfers
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Reasons for Plan Transfers:• Prefers another MCO’s Benefits• Doctor Left Plan• Continuation of care concerns - unable to stay with current nonparticipating
doctor for treatment• PCP Recommendation
CHC SOUTHWEST HCBS Outreach
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2,000 2,550
6,317
834
-
5,796
87.5%1,749 53.2%
1,357
56.9%3,596
0.0%-
0.6%8
0.5%18
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
AmeriHealth Caritas PA Health and Wellness UPMC
LI5 - HCBS Participants receive HCBS without Interruption(Enrollment Data includes January 1, 2018 Begin Date Only)
Total Population Unsuccessful contact attempts Successful Contacts Reported InterruptionsSource: MCO
For Week Ending: 1/26/2018
* Reported Interruptions identified on this indicatorwere reported by the participants who were successfully contacted during the reporting period.
CHC SOUTHWEST Critical Incidents
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21
4
7
0123456789
10111213
AmeriHealthCaritas
PA Healthand
Wellness
UPMC AmeriHealthCaritas
PA Healthand
Wellness
UPMC AmeriHealthCaritas
PA Healthand
Wellness
UPMC
Abuse Neglect Service Interuption
LI6 - Weekly Participant Critical Incidents
Week Ending Jan 5 Week Ending Jan 12 Week Ending Jan 19 Week Ending Jan 26Source: EDW
CHC SOUTHWEST Complaints/Grievances
14
8
10
1
4
0 1 2 3 4 5 6 7 8 9 10 11
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
Com
plai
nts
Grie
venc
es
LI7 - Weekly Participants Complaints/Grievances
Week Ending Jan 5 Week Ending Jan 12 Week Ending Jan 19 Week Ending Jan 26Source: MCO
CHC SOUTHWEST Provider Claims Submissions
15
7,480
3,096
16,347
3
61
5
354
6,417
31,488
- 10,000 20,000 30,000 40,000 50,000 60,000 70,000
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
HCBS
NFAl
l Oth
erLI14 - Weekly Claims Submitted to MCO by Provider Type
Week Ending Jan 5 Week Ending Jan 12 Week Ending Jan 19 Week Ending Jan 26Source: MCO
CHC SOUTHWEST Provider Claims Submissions
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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
HCBS
NFO
ther
3,695
9,923
49
12
2,818
14,423
7,480
1,711
5,491
3
8
5
339
39
6,430
-
8,400
933
-
-
-
3
3,950
10,595
LI15 - Weekly Claims Paid, Pending, and Rejected
Paid Pending RejectedSource: MCO
For Week Ending: 1/26/2018
CHC SOUTHWEST Provider Claims Submissions
17
106
1
738
1
7
342
376
83
1,158
21
2 29
2,649
4
1,110
7,135
908
3,538
5,673
- 2,000 4,000 6,000 8,000 10,000 12,000
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
HCBS
NFO
ther
LI15b - Weekly Claims Rejected Breakout
Non Covered Service Pre-authorization RequiredOut of Network Provider Claim Incomplete or Contains ErrorsMedicare Rejection not Documented All Other
Source: MCO
For Week Ending: 1/26/2018
CHC SOUTHWEST Provider Disputes
18
3
0 1 2 3 4 5 6 7 8
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
AmeriHealth Caritas
PA Health and Wellness
UPMC
HCBS
NFAl
l Oth
erLI16 - Weekly Provider Dispute by Type
Week Ending Jan 5 Week Ending Jan 12 Week Ending Jan 19 Week Ending Jan 26Source: MCO
AREAS OF CURRENT FOCUS
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LAUNCH COMMUNICATIONS
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• Daily Calls with individual MCOs, including weekly joint calls with all 3 MCOs.
• Daily Calls with DHS and PDA.• Weekly Participant and Participant Advocate Calls.• Weekly Provider Association Calls, including:o Nursing Facilitieso HCBS Providers
• Weekly Calls with the Aging Network.
AREAS OF CURRENT FOCUS:
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• HHAeXchange• Nursing Facility and HCBS Claims Submission• Medicare/Medicaid Participant and Provider Education• Data Integrity• Enrollment Issues• Reviewing Changes in Person-Centered Service Plans• Claims Processing• Transportation• Complaint and Grievance processes and notices for HCBS Services• Lessons Learned for the Southeast
LAUNCH COMMUNICATIONS
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• Participant Help Line - 1-800-757-5042o OLTL will staff a participant help line to address questions or concerns regarding
their CHC MCO, the IEB, their service coordinator, or anything associated with the program launch.
• Independent Enrollment Broker - 1-844-824-3655 OR (TTY 1-833-254-0690)o If Participants have not received their post enrollment packets, they should
contact the IEB at the above telephone number or visit their website atwww.enrollchc.com (Open Monday through Friday, 8:00 a.m. to 6:00 p.m.).
ONGOING COMMUNICATIONS
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• MLTSS SubMAAC• CONSUMER SubMAAC• LTSS SubMAAC• MAAC• Third Thursday Webinars
FUTURE AGENDA ITEMS
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AGENDA ITEMS FOR FUTURE MEETINGS
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• Performance Measures for CHC• Coordination between Medicare and Medicaid• Services My Way• Behavioral Health for Older Adults• InterRAI Presentation• Transportation • LIFE Program
Additional Updates
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Additional Updates
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• IEB Procurement• FMS Procurement• Aging Well and FED
Transportation
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CHC Agreement Transportation Requirements
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• The CHC-MCO must provide all Participants with Medically Necessary emergency ambulance transportation and Medically Necessary non-emergency ambulance transportation.
• The CHC-MCO must provide all NFCE Participants with non-medical transportation.
• The CHC-MCO may provide non-medical transportation to other Participants at its own discretion and own cost.
• Non-medical transportation includes transportation to community activities, grocery shopping, religious services, Adult Daily Living centers, employment and volunteering, and other activities or LTSS services as specified in the Participant’s PCSP.
CHC Agreement Transportation Requirements
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• The CHC-MCO must provide non-emergency medical transportation for Nursing Facility residents.
• The CHC-MCO must also provide any specialized non-emergency medical transportation for Participants, including transportation for Participants who are stretcher-bound.
• All other non-emergency transportation for Participants to and from Medicare-covered services and Covered Services must be arranged through the MATP vendor.
CHC Agreement Transportation Requirements
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• The Medical Assistance Transportation Program (MATP) is responsible for the following:
• Non-emergency transportation to a medical service that is covered by Medicare or CHC. This includes transportation for urgent care appointments. Participants whose service is paid by Medicare can receive MATP service as long as the service is performed by a Network Provider and all other eligibility requirements are met.
• Transportation to another county, as Medically Necessary, to get medical care as well as advice on locating a train, bus, and route information.
• Reimbursement for mileage, parking, and tolls with valid receipts, if the Participant used own car or someone else's car to get to the Provider.
CHC Agreement Transportation Requirements
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• When requested, the CHC-MCO must arrange non-emergency medical transportation for urgent appointments for its Participants through the MATP.
• Some Participants may qualify for non-emergency medical transportation through programs such as Shared Ride.
• Because MATP is the payor of last resort, for Participants who require CHC-MCO assistance in coordinating non-emergency medical transportation the CHC-MCO must coordinate access to transportation through all available programs and not just the MATP program.
CHC Agreement Transportation Requirements
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• MATP agencies have been instructed to contact the CHC-MCO for verification that a Participant’s request is for transportation to a Covered Service. The CHC-MCO should jointly undertake activities with MATP agencies such as sharing Provider Network information, developing informational brochures, and establishing procedures which enhance transportation services for Participants.
• The CHC-MCO must arrange and coordinate transportation with the MATP providers so Participants receive the MATP services outlined in their person-centered service plan.
CHC-MCO TransportationPresentations
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RESOURCES
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RESOURCE INFORMATIONCHC LISTSERV // STAY INFORMED http://listserv.dpw.state.pa.us/oltl-community-healthchoices.html
COMMUNITY HEALTHCHOICES WEBSITE www.healthchoicespa.com
MLTSS SUBMAAC WEBSITE www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/
EMAIL COMMENTS TO: [email protected]
PROVIDER LINE: 1-800-932-0939
PARTICIPANT LINE: 1-800-757-5042
INDEPENDENT ENROLLMENT BROKER: 1-844-824-3655 OR (TTY 1-833-254-0690)(Open Monday through Friday, 8:00 a.m. to 6:00 p.m.)
or visit www.enrollchc.com
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CHC-MCO CONTACT INFORMATION
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AmeriHealth Caritas | [email protected] www.amerihealthcaritaschc.com - 1-855-235-5115 (TTY 1-855-235-5112)
Pennsylvania Health and Wellness (Centene) | [email protected] www.PAHealthWellness.com – 1-844-626-6813 (TTY 1-844-349-8916)
UPMC Community HealthChoices | [email protected] www.upmchealthplan.com/chc - 1-844-833-0523 (TTY 1-866-407-8762)
o..
QUESTIONS38
