Third Thursday Webinar September 21, 2017 · August28‐31st NASUAD Annual Conference: •...

Jen Burnett Deputy Secretary

Office of Long‐Term Living Department of Human Services

Third Thursday Webinar September 21, 2017

Welcome to the Third Thursday MLTSS Webinar

Communication Access Real-time Transcription (CART) is available by clicking here: • https://archivereporting.1capapp.com • Username/password: OLL

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http:https://archivereporting.1capapp.com

GoToWebinar Housekeeping: What Attendees See

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GoToWebinar Housekeeping: Attendee Participation

Your Participation Open and close your control panel

Join audio: • Choose Mic & Speakers to use

VoIP • Choose Telephone and dial using

the information provided

Submit questions and comments via the Questions panel

Note: Today’s presentation is being recorded and will be available on our website.

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Third Thursday Webinar Agenda

Communication Stakeholder Engagement Recent CHC Media

Coverage Readiness Review Care Coordination Quality Assurance

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SW Participant Communication Updates

Early September: Attendant Care & Independence Waiver letters COMMCARE Waiver reminder letters

Late September thru early October: First round SW Pre‐transition notices and enrollment packets prior to implementation

October 11th thru November 2nd : Southwest CHC participant education & outreach sessions. Participants have received invitations for events and are already registering

Mid to late October: Second round SW Pre‐transition notices

Late November to mid‐December: last round SW Pre‐transition notices. Participants will have a plan pre‐selection made in the event that they have not

selected one prior. This is to insure enrollment for January 1st

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Provider Communications Updates

Communications Sent: Late August: Continuity of Care Provider Fact sheet sent to providers outlining CHC provisions to

maintain continuity and avoid service disruptions

Ongoing & Future Communications: o CHC 101 training for Service Coordinators and Nursing Facilities in the SW is almost finalized and will

be made available via webinars and online

o Bi‐weekly fact sheets on CHC related topics continue to be distributed

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CHC Internal Commonwealth Staff Communications Updates

On August 23rd a CHC 101 presentation was held at the Forum for DHS, PDA, DOH, and DDAP staff with four additional scheduled Community HealthChoices webinars to keep commonwealth staff informed of changes:

o September 15th Physical Health & CHC Behavioral Health o September 22nd Nursing Facility o October 2nd Home and Community‐Based Services o October 11th Service Coordination

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Stakeholder Presentations & Events

August 28‐31st NASUAD Annual Conference: • National Association of States United for Aging and

Disabilities bringing together more than 1,500 representatives of all 50 states, advocacy groups, contractors and Federal agencies.

o Two major recurring themes of the conference were implementation of the CMS Home and Community Based Settings Rule and Electronic Visit Verification systems, required by the 21st Century Cures Act of 2016.

o Several OLTL staff attended the conference and acquired valuable information from other states facing the same challenges as Pennsylvania

September 13th Meetings: o PALPA Board Meeting‐ DHS Acting Secretary Teresa Miller

participated in a discussion on the expansion of the LIFE Program

o P4A Membership Meeting

September 14th

o PACAH Conference‐CHC Overview

September 15th

o Webinar on Protective Services and Critical Incident Management in a CHC Managed Care Environment was held for MCO’s and Service Coordinators. 589 participants joined the webinar.

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Upcoming Stakeholder Presentations, Events and Media Coverage

September 25th

o Interview on Winning Images with PCTV 21

September 27th

o CHC Overview at PHCA Conference

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Ongoing Stakeholder Engagement

MLTSS SubMAAC Partnership with Pennsylvania Health Funders Network Next Meeting: October 4

Monthly meetings with provider association Third Thursday Webinars

Next Webinar: October 19 Video and website

Provider Communications Media inquiries

Provider Summits

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PROVIDERS

• Bi‐weekly email blasts on specific topics Examples: Billing, Service Coordination,

Medicare, HealthChoices vs. CHC, Continuity of Care

• Established provider page on website

• Provider events in local areas to meet with MCOs and gain information about CHC

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ts/article_4b7b7ba7‐

Recent CHC Media Coverage Post‐Gazette: State notifying 100,000 Medicaid consumers in region of pending changes http://www.post‐gazette.com/news/health/2017/08/04/Community‐HealthChoices‐Pennsylvania‐long‐term‐care‐managed‐care‐aging‐disabled/stories/201708040131

Post‐Gazette: A Q‐and‐A on state's pending changes to Medicaid‐funded long‐term care http://www.post‐gazette.com/aging‐edge/gary‐rotstein‐s‐what‐s‐new‐in‐aging/2017/08/07/Aging‐Edge‐Community‐HealthChoices‐Pennsylvania‐long‐term‐care‐managed‐care/stories/201708070012

Altoona Mirror: State changing medical services http://www.altoonamirror.com/news/local‐news/2017/08/state‐changing‐medical‐services/

Observer‐reporter: State Medicaid changes will affect area seniors http://www.observer‐reporter.com/20170830/state_medicaid_changes_will_affect_area_seniors

Herald‐Standard: State Mandatory health care program leaves local residents a choice to make residen http://www.heraldstandard.com/new_today/state‐s‐new‐mandatory‐health‐care‐program‐leaves‐local‐

a972‐5be6‐9430‐a72dbda2d49c.html

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http://www.heraldstandard.com/new_today/state-s-new-mandatory-health-care-program-leaves-local-residenhttp://www.observer-reporter.com/20170830/state_medicaid_changes_will_affect_area_seniorshttp://www.altoonamirror.com/news/local-news/2017/08/state-changing-medical-serviceshttp://www.post-gazette.com/aging-edge/gary-rotstein-s-what-s-new-in-aging/2017/08/07/Aging-Edge-Community-HealthChoiceshttp://www.post-gazette.com/news/health/2017/08/04/Community-HealthChoices-Pennsylvania-long-term-care-managed-care-aging

Readiness Review Updates

Each MCO is required to submit policies and procedures to address items on the Readiness Review Tool which is based on the CHC Agreement for review and approval. Network Adequacy is separate.

These are the broad categories that are part of the RR Tool:

o Participants Materials o Covered Services o Participant Services o Payment and Data Systems o Staffing and Training o Contracts and Administration o Provider Materials o Record and Data Reporting o Provider Services o Financial Requirements o QM/UM o IT Systems

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Readiness Review Updates On‐Site review visits were completed at each of the MCOs and went well. We met with the staff to review the

following:

o Structure of Organization

o Oversight and Organizational Accountability

o Participant contact center

o Training programs for participant contact center

o Call monitoring plan – quality of call and resources

o Scripts and Resources for participant contact center

o Structure of Case Management

o Documentation of case management

o Training and resources for care management

o Provider overview with adequacy

o Training of providers

o Dispute process for providers

o Oversight by PHW of providers and subcontractors

o Service Coordination structure

o Documentation of SC services

o Training and Resources for SC services

o Systems – demonstration of documentation, script samples, etc.

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We continue to accept and review MCO policies

Each MCO submitted a file of all their contracted Providers for review by DHS and DOH on Sept 8th. Follow up is being done to insure that their networks are adequate by Sept 30th

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MCOs are submitting their OPS5 Provider Files for review.

Weekly on‐going meetings with each MCO to discuss and resolve issues

The following Technical Assistance Webinars have been provided:

Behavioral Health 101

Program Integrity Compliance Training

Housing Innovations Meeting & Templates

Protective Services and Critical Incident Management in a CHC Managed Care

Environment for MCO’s and Service Coordinators

D‐SNP and CHC‐MCOs coordination

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Update of Care Coordination for Duals

The Department has engaged all Dual Eligible Special Needs Plans (D‐SNPs) in the following activities:

• Clarified new reporting requirements contained in the current MIPPA Agreement.

• Held a technical assistance webinar on reporting requirements.

• Current MIPPA contract:

http://www.healthchoices.pa.gov/info/resources/publications/community/mippa‐

documents/index.htm

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http://www.healthchoices.pa.gov/info/resources/publications/community/mippa

Quality Assurance & Program Analytics Activities

August 24th D‐SNP webinar overview of the new LTSS program, CHC, DHS

expectations of PA D‐SNPs, Reporting Requirements, and Instructions on

Docushare was held

September 20th D‐SNP Care Coordination and MIPPA Agreement Reporting

Requirements T/A session was held

October 4th Presentation to MLTSS Subcommittee on:

• CHC Launch Indicators

• CHC Evaluation

CHC Quality

Readiness Review

Monitoring &

Compliance

Network Standards

Grievances & Appeals

Critical Incidents

Performance Measures Surveys

External Quality Review (EQR)

Performance Improvement Projects (PIP)

Value‐based Payment (future)

Independent Evaluation

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CHC WEBSITE

www.HealthChoices.PA.gov 20

http:www.HealthChoices.PA.gov

Aging Well

Third Thursday Webinars

We will host an informational webinar on the third Thursday of each month throughout the implementation of CHC. An invite and registration link will be sent out on the ListServe. To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

The next webinar will be held: October 19, 2017 @ 1:30 PM

General HealthChoices Web Page that includes Community HealthChoices: http://www.healthchoices.pa.gov/index.htm

Webinar participants will also find this presentation at http://www.healthchoices.pa.gov/info/resources/publications/community/third-thursday-webinars/

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http://www.healthchoices.pa.gov/info/resources/publications/community/third-thursday-webinarshttp://www.healthchoices.pa.gov/index.htmhttp:http://listserv.dpw.state.pa.us

QUESTIONS 22

Pennsylvania’s Living Independence

for the Elderly (LIFE) Program

Jonathan Bowman/Joan Bradbury/Joann Gago September 21st 2017

Third Thursday Webinar

10/3/2017 1

Agenda

• LIFE History • LIFE Program Design • LIFE Facts • LIFE Eligibility and Services • LIFE Participant Testimony • The LIFE Experience • LIFE and Community Health Choices • Questions

10/3/2017 2

LIFE History in Pennsylvania

• Implemented in Pennsylvania (PA) in 1998

• Called the LIFE Program in PA – Living Independence for the Elderly

• Nationally known as PACE – Program of All-Inclusive Care for the Elderly

10/3/2017 3

LIFE Managed Model of Care

• Managed care model for the frail elderly

• Integrates Medicare and Medicaid funding through monthly capitation payments to providers

• Risk based model – provider incentive to keep the participant as healthy as possible

• The LIFE Provider is responsible for coordinating and managing all of the participant’s personal and health care needs

10/3/2017 4

LIFE Model of Care Benefits

• Provides the following benefits: – Acute care – Long-term care – Pharmaceuticals – Behavioral health services – Social and community services – Transportation

• Goal is to enable older adults to live independently in their home and community as long as possible

• Focused around a day health center

10/3/2017 5

LIFE Program Eligibility

• Age 55 and older

• Determined Nursing Facility Clinically Eligible (NFCE)

• Determined financially eligible for Medicaid

Long-term Care or able to pay privately

• Reside safely in the community

• Reside in area served by LIFE Provider

10/3/2017 6

LIFE Service Area Coverage

Erie

Susquehanna Warren McKean Bradford Tioga Potter Crawford Wayne

Forest Wyoming Sullivan Lackawanna Elk Cameron Venango Pike

Mercer Lycoming Clinton Clarion Luzerne

Jefferson Columbia Monroe Montour Lawrence Clearfield Centre Union Carbon

Northumberland Butler

Armstrong Snyder Northampton

Beaver Schuylkill Mifflin Indiana Lehigh Dauphin Juniata

Allegheny Cambria Blair Berks Perry Bucks Lebanon Westmoreland Huntingdon Washington

Cumberland Montgomery

Greene Fayette

Somerset Bedford Fulton Franklin

Adams York

Lancaster Chester

Delaware Philadelphia

LIFE Counties,Sept. 2017 - Active, Developing, Assigned, Inactive

Active Blue ; Developing Coral ; Assigned Crosshatch ; Inactive White

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LIFE Program Eligibility

810/3/2017

LIFE PROGRAM

ELIGIBLE

LIFE Program Model and Services

LIFE PARTICIPANT

10/3/2017 9

LIFE Program Providers Address Housing

Innovative ways in which some LIFE Program Providers address housing needs:

– Community partnerships

– Co-location arrangements

– Services and supports agreements

– Public Housing Authority agreements

– HUD Housing arrangements

– Nursing Home Transition (NHT) program

10/3/2017 10

LIFE Participant Testimony

Link to LIFE Participant Testimony

(begins at 4 minutes and 28 seconds)

https://elisco.wistia.com/medias/vdw26oq9os

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https://elisco.wistia.com/medias/vdw26oq9os

The LIFE Experience

PA LIFE Provider Alliance (PALPA) Board Chair Joann Gago

LIFE Pittsburgh – Allegheny County

[email protected]

10/3/2017 12

mailto:[email protected]

LIFE and Community HealthChoices HK1

• If eligible, two MLTSS options: CHC or LIFE

• LIFE is the existing, voluntary managed care enrollment alternative to the CHC program

• Pre-transition information, enrollment packet, outreach and education efforts will discuss LIFE

• Individuals already enrolled in LIFE will remain in LIFE and will not be enrolled into CHC unless they ask to change programs

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Hancock, Kevin, 9/20/2017HK1

LIFE and Community HealthChoices HK1

• IEB will provide a warm hand-off to the local LIFE program for individuals interested in LIFE and during CHC statewide implementation, the LIFE provider will facilitate LIFE enrollment

HK2

• Post-implementation, anyone enrolled in CHC that qualifies for LIFE may choose to enroll in a LIFE program

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HK1 Hancock, Kevin, 9/20/2017

HK2 Too much information on this slide. Suggest splitting into two. Hancock, Kevin, 9/20/2017

LIFE Program Information

• DHS website (keyword “LIFE”) – www.dhs.pa.gov

• Pennsylvania LIFE Provider Alliance – www.palifeprograms.org – New

• National PACE Association – www.npaonline.org

• Centers for Medicare & Medicaid Services – www.cms.hhs.gov/PACE

10/3/2017 15

www.cms.hhs.gov/PACEhttp:www.npaonline.orghttp:www.palifeprograms.orghttp:www.dhs.pa.gov

Contact Information

Jonathan Bowman Office of Long-Term Living, LIFE Program

717-772-1145 [email protected]

Joan Bradbury PA LIFE Provider Alliance (PALPA)

717-283-0488 [email protected]

Joann Gago [email protected]

10/3/2017 16

mailto:[email protected]:[email protected]:[email protected]

Questions

10/3/2017 17

Third Thursday Webinar 92117.Final pptx2017-09-21 Third Thursday Webinar LIFE program_revised

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