“woman’s story personifies failures in Medicaid waiver program” – A long read about “system failures” at the Pittsburgh Tribune-Review
“Fran Morgante moves her mom, Vilma Morgante, 100, to spend some time in the front room, Thursday, June 20, 2019, at the family’s Lower Burrell home. Fran Morgante, a professional musician lives in New York State and has moved back home to care for her mother.” – SOURCE: Pittsburgh Tribune-Review
by Deb Erdley
“Fran Morgante brushed back her mother’s hair tenderly as she offered the tiny elderly woman a drink of water on a hot June day.
“Vilma Morgante, who celebrated her 100th birthday June 21 in her Lower Burrell home, never asked much of the world.
“Her one desire: to die in the neat brick bungalow she and her late husband, Steve, scrimped and saved for and then built from the ground up seven decades ago.
“Frail, suffering from moderate dementia for the previous year and a half and forced to use a wheelchair, she relied on her daughter — a professional violinist with the Buffalo Philharmonic — to steer her through the complex web of rules and regulations that govern the safety net designed to protect the nation’s most vulnerable citizens.
“‘Years ago, I tried to talk her into coming to live with me, and she said, “Chica, I want to die at home,” Fran Morgante recalled.
“On July 4, Vilma died at home, one year and two days after qualifying for 24-hour home care — care that never arrived.”
Click here to read this Pittsburgh Tribune-Review article in its entirety.
Read the latest information on Community HealthChoices and more at the PA Helath Law Project’s monthly update; click on the above graphic or here to view the file.
Community HealthChoices | Electronic Visit Verification Implementation Update and Technical Specifications
As of January 1, 2020, providers of Personal Care Services (PCS) overseen by the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP) will be required to verify specific data elements in order to receive payment for each PCS claim submitted. As you are aware, PCS consists of services supporting activities of daily living (ADL) and instrumental activities of daily living (IADL). PCS providers will be required to use an Electronic Visit Verification (EVV) system to verify the following specific data elements: the type of service performed, the name of the individual receiving the service, the name(s) of individual(s) providing the service, the date and location of the service, and the time the service begins and ends. Beginning in October 2019, the PA Department of Human Services (DHS) will expect provider agencies, Agencies with Choice (AWC), and Vendor Fiscal (VF) agents to use EVV for the capture and verification of PCS visits. PA DHS has contracted with DXC and Sandata Technologies LLC to deliver the PA DHS EVV system, as well as provide system orientation and training to providers related to the PA DHS EVV system.
EVV data will be collected in the EVV Aggregator and compared to claim data before a claim can be paid. The EVV Aggregator will collect EVV data from both the PA DHS EVV System as well as any third-party EVV systems. Effective January 1, 2020, DHS will deny PCS claims that do not have corresponding visit(s) recorded in the EVV Aggregator regardless of whether providers use the PA DHS EVV system or a third party EVV system. Continue reading →
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually-eligible for Medicare and Medicaid and individuals 21 years of age or older with physical disabilities. Managed care is new for long-term services and supports, but Pennsylvania has provided physical and behavioral health care through a managed care model for many years.
This transition will create questions. Please reference the attached fact sheet for information about how care providers will work with CHC’s managed care organizations to deliver quality care to CHC Participants.
CHC is live in the Southwest and Southeast, and we are preparing for implementation in the remainder of the state on January 1, 2020. Make sure you and your coworkers have the information you need about CHC. Take our 30-minute online training here.
If you have other questions about CHC, view our comprehensive question and answer document online here.
A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page
Harrisburg, PA – The Department of Human Services (DHS) today held the first of a series of information sessions for health care and service providers in preparation for the third phase of implementing the Community HealthChoices (CHC) program. CHC will coordinate health care coverage to improve quality for older Pennsylvanians and those with physical disabilities, serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
The third phase is scheduled for January 1, 2020, and will cover counties in central, northeast, and northwest Pennsylvania and the Lehigh Valley.
“The Department of Human Services has seen great success with the CHC rollout in the Southwest and Southeast,” said DHS Secretary Teresa Miller. “The phased rollout of CHC has given us time to listen to participants, providers, and stakeholders and hear their experience with the program so that by 2020, we will be delivering the best care possible to more than 400,000 seniors and adults with physical disabilities across the commonwealth. We look forward to expanding the service offerings to the final regions in January 2020 and are preparing providers and eligible participants for this transition.”
Ahead of the final implementation, DHS has coordinated efforts with the managed care organizations to host provider information sessions as well as participant information sessions. Throughout May and June, provider sessions are being held in various locations around the Phase Three zone. In the fall, participant information sessions will be held offering eligible community members the opportunity to learn more about this program and to gather resources and ask questions to choose a plan that will meet their needs. Information about which counties are included in the final phase of implementation is available here.
“CHC is providing options for so many Pennsylvanians in their communities,” said Acting Secretary of Aging Robert Torres. “This is especially noteworthy because we know that the majority of older adults want to age in place. CHC is serving seniors so that they can have the opportunity to work and spend time with their families, all while having access to long-term services they need.”
CHC was established to enhance care and service coordination, improve health outcomes, and increase availability of community living options for individuals requiring long-term services and supports. By offering these services and supports in a managed care delivery system, DHS is working towards better quality of services for older Pennsylvanians and individuals with physical disabilities as well as budget predictability. Preliminary data from the Southwest shows that in CHC’s first year, the rate of individuals served in the community increased from 49.7 percent to 52.2 percent.
“One of our top priorities is to continue to enhance the quality, efficiency, and effectiveness of the supports and services available to serve more people in communities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life,” said Secretary Miller. “This continued investment demonstrates a commitment to supporting elderly Pennsylvanians and adults with physical disabilities.”
CHC was first launched in southwest Pennsylvania in January 2018 and southeast Pennsylvania in January 2019. Currently, more than 210,000 older Pennsylvanians and adults with physical disabilities have an active voice when choosing how and where they receive their services and supports through CHC. The rollout in the remainder of the state will include approximately 143,000 individuals. When fully implemented across the state, CHC will impact more than 400,000 Pennsylvanians, 94 percent of whom are dually eligible for both Medicare and Medicaid.
This listserv has been established for ongoing updates on the CHC program.
Due to the Community HealthChoices (CHC) Phase 3 Provider Summits that will be occurring, we will be canceling the regularly scheduled Third Thursday Webinar for Thursday, May 16, 2019. We will resume this series of webinars in June, and hope to see you then.
Please make sure to register for the summits in your respective area at the following links below:
- May 13-15: Lehigh/Capital Region Provider Summits
- May 20-22: Northwest Region Provider Summits
- June 4-6: Northeast Region Provider Summits
Additionally, one day-long transportation summit will be held in each region. RSVP for this summit here.
If you have any questions regarding this notice, please contact the Office of Long-Term Living, Bureau of Policy and Regulatory Management, at 717-857-3280.
A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
The Office of Long-Term Living (OLTL) will be presenting webinars to provide service coordinators (SC) with information about how the implementation of Community HealthChoices (CHC) will impact Attendant Care and Independence Waiver participants who are under 21 years of age. All Phase 3 (Lehigh/Capital, Northwest and Northeast counties) SCs serving participants who are under 21 years of age should plan to attend this webinar.
The implementation of CHC will change the way Attendant Care and Independence Waiver participants who are under 21 years of age receive their Medicaid waiver services. All Attendant Care and Independence Waiver participants who live in Phase 3 and are not yet eligible for CHC because they are under 21 years of age will transition to the OBRA Waiver until they become eligible for CHC.
Please register for one of the following dates:
After registering, you will receive a confirmation email containing information about joining the webinar.
If you have any questions regarding this, please contact the OLTL Participant Helpline Monday through Friday at 800-757-5042 from 9 am – 12 pm and 1 pm – 4 pm or email RA-PWCHCWaiverProTra@pa.gov.