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Jennifer BurnettDeputy Secretary
Office of Long-Term LivingDepartment of Human Services
All Staff Webinar
July 21, 2017
Welcome to the OLTL all Staff Webinar
• Communication Access Real-time Transcription (CART) is
available by clicking here:
• https://archivereporting.1capapp.com
• Username/password: OLL
GoToWebinar Housekeeping: What Attendees See
3
GoToWebinar Housekeeping: Attendee Participation
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Submit questions and comments via
the Questions panel
Note: Today’s presentation is being
recorded and will be available on our
website.
• Ongoing weekly Readiness Review check-in meetings with each CHC-MCO and the contract monitor teams.
• MCOs have begun to submit policies and procedures for readiness review. Readiness Review Teams are beginning the review process.
• MCOs continue to reach out to and recruit providers for their networks. They have submitted a network adequacy report as of July 1, 2017.
• OLTL, DOH, PA Health Law Project (PHLP), and participants continue to meet and discuss LTSS Provider Network Standards. OLTL is continuing to run historical claims data on LTSS services.
• Future Technical Assistance Sessions have been identified and scheduled for the CHC-MCOs. The quality session was held on July 10th and a provider and service coordinator session was held on July 11th. The encounter data session will be held on August 8th. A Webinar was held on June 30th with the Nursing Facility Associations and the MCOs to discuss billing scenarios.
• Biweekly meetings with MCOs and Bureau of Data Claims Management (BDCM) continue.
CHC Readiness Review (RR) Update
• RFP for IEB is currently in a Stay
• Emergency Procurement to extend the Maximus contract from June 1, 2017
to December 31, 2017
• Additional updates will follow
Independent Enrollment Broker (IEB) Status
Upcoming Provider Meetings
SW Region Providers Educational Conference
July 24-27
Objectives:• CHC Basics (level the playing field)
• CHC Updates
• Breakout Sessions
o Nursing Facilities
o Home and Community based Services
o AAA/Service Coordinators
o Physical health
o Behavioral Health
o MCO Presentations
Behavioral
Health
Physical
Health
Home- and
Community-
based
Services
Nursing
Facility
Service
coordinator/A
rea Agency
on Aging
TOTAL
Cranberry
Twp.58 10 112 124 41 345
Cranberry
Thurs.26 7 42 36 19 130
Pittsburgh 36 18 158 78 50 340
Altoona 49 6 104 117 26 302
1,117
Total as of
4pm Tuesday
July 18, 2017
CHC-Southwest Educational Conference Attendance
1915 (b) and (c) Waiver Process
• On April 28, DHS submitted a concurrent 1915(b) and 1915(c) waiver
application to CMS.
• These applications give DHS the federal authority to provide services
through Community HealthChoices
• OLTL received a total of 44 informal questions on these two waivers;
CMS has accepted the responses provided for these questions.
Pennsylvania Status
• The Standard Terms and Conditions for the (b) waiver have been received
and agreed upon by both OLTL and CMS.
• CMS continues to move forward with the approval process.
Pennsylvania Transition to CHC
CommCare Waiver is being amended as vehicle for the Community
HealthChoices 1915 (c) Waiver.
• All CommCare participants will either be transitioned to CHC in the
Southwest zone or to the Independence Waiver prior to January 1st.
• The Residential Habilitation and Structured Day Habilitation services are
being added to the Independence Waiver effective October 1, 2017.
• The Independence Waiver will be added to CommCare provide’rs
offerings.
Participants should receive no disruption in services as a result of these
changes.
Pennsylvania Transition to CHC Phases and Zones
• Participants enrolled in the Aging, Attendant Care, and Independence Waivers
will be transitioned to the CHC Waiver as CHC is implemented in each zone.
• The Aging, Attendant Care, and Independence Waivers will continue to operate
in zones where CHC is not implemented.
• Phase 1 - Southwest January 1, 2018
• Phase 2 - Southeast July 1, 2018
• Phase 3 – remainder of state January 1, 2019
Pennsylvania Transition to CHC
OLTL will continue to operate the OBRA program statewide.
• OBRA participants age 21 and over will be reassessed to determine if
they are eligible for the CHC program prior to the implementation of
each phase (NFCE).
• Assessments for the Southwest zone began in May 2017.
• Individuals who do not meet the criteria for the CHC program will
remain in the OBRA program (NFI).
OBRA will also serve individuals between the ages of 18 and 21.
• Participants between the ages of 18 and 21 enrolled in the Attendant
Care or Independence Waiver will be transitioned into the OBRA Waiver
as each CHC phase is implemented.
Prior Authorization Review Process (PARP)
and
Quality Management and Utilization
Management (QM/UM)
Prior Authorization Review Process (PARP)
“Prior Authorization Guidelines”, Exhibit E
HealthChoices Process (OMAP)
CHC-MCOs must submit to DHS all written policies and procedures for the Prior Authorization of services.
Requirements do not apply to LTSS and cannot be made to apply to services for which Medicare is the primary payor except where a Medicare has denied the service.
CHC-MCO must notify the Department of authorized services they will continue to prior authorize and the basis for determining if the service is Medically Necessary.
CHC-MCO must receive advance written approval from DHS to require the Prior Authorization of any services not currently required to be Prior Authorized under the Program.
CHC—PARP Process
HealthChoices Process (OMAP)
Prior Authorization Guidelines (Instructions & Resource Guide)
Reporting Requirements
PARP Calendar (yearly)
MCO Policy Submission Cover Sheet
Central Hub for Document Submission (DocuShare)
Pharmacy and Medical Review Team (DHS-Physicians, Pharmacist)
Administrative Team (ensuring all policies are submitted timely, processed and reviewed by Pharmacy and Medical Team)
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Prior Authorization Review Process (PARP)
Documents to be submitted to OLTL per CHC Agreement
HealthChoices Process (OMAP)
Monthly PARP Submission
Drug Formulary
Annual Formulary Submission
Formulary Changes (Additions & Deletions)
P&T Committee Meeting Minutes
Member Notifications for Drugs
Specialty Pharmacy
PARP Comprehensive Policy List for the MCO
Individuals authorized to sign PARP policies
MCO DUR Report
Quality Management and Utilization
Management (QM/UM)
“Quality Management and Utilization Management Program Requirements”, Exhibit F
CHC-MCOs must submit to DHS a number of written policies and procedures, including reports, to DHS prior to launch and during implementation.
Meet all Standards listed on the CHC Agreement
HealthChoices Process (OMAP)
o QM/UM Reporting Requirement Submission Schedule
o QM/UM Documents during Readiness Review
1. QM/UM Program Description2. QM/UM Work Plan Submissions3. QM/UM Policy and Procedure Manual4. QM/UM Annual Program Evaluation5. QM/UM Licensed Proprietary Products6. QM/UM Prior Authorization Review (PARP) Annual Submission and Quarterly Updates
BackgroundThe 21st Century Cures Act, Public Law 114-255, was signed into law on
December 13, 2016.
Section 12006 of the Act requires all states to implement the use of electronic visit verification (EVV) for Medicaid-funded personal care and home health care services.
As you know, EVV is a system that electronically verifies that personal care and homecare were delivered.
According to the Act, EVV for personal care services must be implemented by January 1, 2019 and for home health care services by January 1, 2023.
The EVV system may be maintained and operated by the state, a state contractor or provider agency.
Electronic Visit Verification (EVV)
The 21st Century Cures Act Requires
System verification of:
The type of service provided
Individual receiving the service
Individual providing the service
Date of the service
Location of the service delivery
Time the service begins and ends
Services verified by:
The recipient’s home landline telephone
Smart phone
Biometric recognition systems or
Fixed visit verification device-an electronic random numbers device in the beneficiary’s home
• The CHC MCO must cooperate with the Department to have in place a fully operational EVV system for in-home personal care and home health services that complies with the requirements of the regulations at 42 U.S.C. § 1396b(l).
• The EVV system must verify and record the required information electronically.
EVV-CHC Agreement Requirement
Act 150 Program
Adult Autism Waiver
Adult Community Autism Program
Aging Waiver
Attendant Care Waiver
COMMCARE Waiver
Community HealthChoices
Program
Pennsylvania Proposal
EVV will be required for Personal Care and Home Health Services provided in the following DHS Programs:
Consolidated Waiver
Fee-For-Service
HealthChoices Program-Physical and Behavioral Health
Independence Waiver
OBRA Waiver
Person/Family Directed Support Waiver
• The Department is soliciting input from beneficiaries, family caregivers, provider agencies and individuals who furnish personal care services or home health care services, managed care organizations, and other stakeholders on the current use of EVV in the Commonwealth and the impact of EVV implementation.
• The Department would like feedback on existing best practices; EVV systems currently in use in Pennsylvania; and preference for a state, state-contracted or provider agency-operated EVV system.
• The Department intends to implement the EVV requirements so that the system is minimally burdensome and will take into account the input from stakeholders. Input received within 30 days will be reviewed and considered as the Department works to comply with the EVV requirements. Input should be submitted to [email protected].
• Input received within 30 days will be reviewed and considered as the Department works to comply with the EVV requirements. Input should be submitted to [email protected].
• The following link has the text of the 21st Century Cures Act: HR 34, the 21st Century Cures Act.
Stakeholder Input
MLTSS SubMAAC Officer Update
• Purpose:
Advise the MAAC on policy development and program administration of the State's managed long-term services and supports programs, including the range of services available to older Pennsylvanian’s and adults with physical disabilities
• MLTSS SubMAAC Membership: Appointment of New Chair and Vice Chair
Pam Mammarella-Chair
Fred Hess-Vice Chair
• Next meeting: Wednesday, August 2, 2017
• Time: 10:00 a.m. – 1:00 p.m.
• More info:
http://www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/
OLTL Bureau Of Quality & Program Analytics Highlights
• Bureau team relies heavily on all of the work and data that support OLTL
programs. This means that collectively:
OLTL received a favorable review from CMS from the evidentiary-based reports (EBR) submission for the Aging Waiver assurances. Thanks to each of the Bureau’s for providing information to include in the reports.
OLTL continues to have success with the implementation of the Participant Review Tool (PRT) in obtaining data pertaining to OUR waiver participants.
Analysis of the PRT data by members of the OLTL PRT Committee involves assisting OLTL with the identification of participant problems and concerns, which in turn aides OLTL to develop corrective measures that facilitates program improvements.
QMETs have successfully completed the majority of the required individual provider site visits for the HCBS Final Rule, while continuing with ongoing monitoring visits.
OLTL is participating in a CMS supported Medicare-Medicaid Data Integration (MMDI) project along with the MIPPA agreement to assist PA in addressing the challenges of successfully integrating Medicare and Medicaid data to improve care coordination for individuals we serve. The results of this project will allow us to help better our Waiver participants in both the current system as well as in CHC.
Bureau of Participant Operations Highlights
The NHT program has welcomed at least 10 new providers across the state who will help OLTL increase the number of people transitioning to the community. We are developing upcoming pilots on housing and technical assistance that will enhance transition work in pilot counties.
We’ve been working diligently to increase provider capacity for new employment services and assist service coordinators who are introducing the topic of employment to OLTL participants. These actions are part of the Governor’s Employment First Initiative.
Every day, OLTL receives incidents and reports of need for people served in our programs. Our incident management unit is focused on addressing them and working with SCs as needed to address health and welfare issues. We are currently integrating the incident processing for the Aging Waiver with the overall processing for the other waivers that use Enterprise Incident Management.
Division of Regional Operations Highlights
• The Plan Review Unit is nearly complete with Annual Reviews for 2017/2018. This is the first time we will have been finished in in July and the first time that staff from other units did not have to assist.
• Enrollment Unit has been assisting with the data clean-up activity - one example of their progress is correcting discrepancies between CIS and HCSIS for enrollments into the COMMCARE Waiver. While there were over 200, through completing the 1768s and working with Service Coordinators to correct errors, there are now only 8 remaining.
• The Case Management Unit has been assisting with the OBRA Re-Assessment which is underway. This unit is effectively managing the process through coordination with AAA’s and Service Coordinators, while the process will not be complete until September 30, nearly ½ are already done.
QUESTIONS
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