Third Thursday Webinar

December 21, 2017

Kevin Hancock

Acting Deputy SecretaryOFFICE OF LONG-TERM LIVING

DEPARTMENT OF HUMAN SERVICES

WELCOME TO THE THIRD THURSDAY WEBINAR

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➢ Communication Access Real-time Transcription

(CART) is available by clicking here:

• https://archivereporting.1capapp.com

• Username/password: OLL

GoToWEBINAR HOUSEKEEPING: What Attendees See

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AGENDA

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➢ CHC Updates• Communications and Outreach• CHC Transition and Launch Status• CHC Provider Resources• CHC Participant Protections• PROMISe Eligibility Verification System (EVS) • Resources

➢ Next Third Thursday Webinar

COMMUNICATIONS & OUTREACH

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CHC COMPLETED & UPCOMING EVENTS

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➢ Completed:➢ 11/20-12/31 Post Enrollment Packets Confirming Plan Selection Mailed➢ 12/5/2017 MLTSS SubMAAC Meeting➢ 12/7/2017 Governor Wolf attended SW CHC Kick Off Event➢ 12/11/2017 LTSS SubMAAC Meeting➢ 12/13/2017 Consumer SubMAAC➢ 12/14/2017 MAAC Meeting

➢ Upcoming:➢ 12/26 – 1/12 MCO Mailings to Participants➢ 1/1/2018 CHC Launch in SW Pennsylvania➢ 1/3/2018 MLTSS SubMAAC Meeting

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CHC TRANSITION AND LAUNCH

STATUS

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CHC SOUTHWEST TRANSITION ACTIVITY

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System Logic Developed to Identify SW CHC

Participants

(2016)

Pre-Transition Notice Mailed

(September)

Pre transition Extract made Available to the

IEB

(September)

Call Center Go Live

(End of September)

Pre-Enrollment Mail Campaign

(Late September and October)

Outbound Reminder Calls

(October)

Website Live with Provider Information

then Enrollment (October and November)

Processing Plan Selections

(October and November)

CHC Transition (November 18, 2017)

Post Enrollment Packets (End of November and

December)

Plan Change

(Last Day for a January 1, 2018 Effective Date, December 29, 2017)

CHC Go-Live

(January 1, 2018)

POST ENROLLMENT

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• November 27th – IEB began sending out Post Enrollment Packets which include:

o Confirmation notice for those that made plan selections; ORo Auto Assignment notice for those that were auto assignedo A LIFE Flyero Community HealthChoices Brochure

• If Participants have not received their packets, please contact the IEB at 1-844-824-3655 OR (TTY 1-833-254-0690).

CHC PLAN CHOICE INFORMATION AS OF 12/20/17

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CHC PLAN CHOICE INFORMATION AS OF 12/20/17

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CHC LAUNCH FOCUS: Essential Priorities

ESSENTIAL PRIORITIES

• No interruption in participant services

• No interruption in provider payment

HOW WILL WE ENSURE NO INTERRUPTIONS?

• The Department of Human Services (Department) is engaged with the MCOs in a rigorous readiness review process that looks at provider network adequacy and IT systems.

• The Department of Health must also review and approve the MCOs to ensure they have adequate networks.

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Primary

Aim

Key

Activities

Tools

Stake-

holders

Pre-LaunchLaunch

(Begins at “Go Live”)

Steady State (9-12

Mos. & Beyond)

Readiness Continuity Program Improvement

Readiness Reviews

System Testing

Baseline Analyses

Readiness Review Tool

Report Templates

Quality Strategy

Consumer Communications

Provider Communications

Local Advisory group

SubMAAC, 3rd Thurs.

CHC Website

Frequent Meetings with MCOs

Monitor Launch Indicators & Reports

Conduct Implementation Study

Launch Indicators

Process Measures

Hot-lines (Consumer & Provider)

Program and Financial Reports

MCO Participant Advisory Coms.

Local Advisory Group

SubMAAC, 3rd Thurs.

CHC Website

Regular Meetings with MCOs

Quarterly Quality Reviews

Conduct Evaluation Analyses

Monitor Reports

Outcome Measures

Program and Financial Reports

Program Imp. Projects (PIPs)

Pay for Performance (P4Ps)

MCO Participant Advisory Coms.

Ad Hoc Public Engagements

SubMAAC, CHC Website

CHC LAUNCH INDICATORS

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LAUNCH INDICATOR DOMAINS (Categories)

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Service Continuity

Service Coordination

Continuity

Provider Participation

Information Transfers

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Continuity of Services

(Ensure Participants are enrolled and receiving LTSS services without interruption)

Enrollment of participants into MCOs Participant critical incidents

Disenrollment of participants from MCOs Participant complaints/grievances to MCO

Enrollment of legacy waiver participants into CHC waiver Calls to the OLTL participant line

Disenrollment of participants from CHC waiver Calls to participant hotline (contracted call center)

HCBS participants receive HCBS without interruption Hearings and Appeals - Participants

Service Coordination and Continuity of Function

(Service coordination continues to function without interruption)

HCBS participants assigned to a service coordinator (SC) Participants who received a comprehensive needs assessment and

resultsNFCE Participants who received a risk screen and results

Provider Participation

(Providers continue delivering services without interruption and are paid promptly)

Aggregate claims submitted to MCO by provider and provider type Calls to OLTL provider line

Claims paid, pending, and rejected Calls to provider hotline (contracted call center)

Provider disputes with MCOs

Information Systems

(Key information systems are effective and interoperable during the launch)

Enrollment transmitted from IEB to MCOs Transition Advanced Plan Selection sent to DHS and the MCOs.

LCD communicated among FED entity, IEB, and MCOs Financial Reporting

Ongoing Advanced Plan Selection communicated to MCOs and DHS FMS (Participant Directed Services)

LAUNCH OVERSIGHT

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• Daily Meetings with the MCO’s (Began December 18th)

• Daily DHS Launch Lead Meetings

• Weekly Stakeholder Meetings

• Weekly Provider Association Meetings (Nursing Facilities included)

CHC PROVIDER RESOURCES

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PROVIDER COMMUNICATIONS AND TRAINING

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➢ A CHC 101 training was developed for nursing facilities in the SW and presented

through webinars on November 2nd and 3rd, 2017.

➢ Web-based training will continue to be available on the LTLTI website for both nursing

facilities http://www.ltltrainingpa.org/chc-outreach-education-nursing-facility-

training/ and service coordinators http://www.ltltrainingpa.org/chc-education-and-

outreach-service-coordination-training/.

➢ Bi-weekly fact sheets on CHC related topics continue to be distributed.

➢ Third Thursday webinars will continue on monthly basis during the CHC rollout.

➢ Established Provider webpage http://www.healthchoices.pa.gov/info/resources/publications/community/index.htm

PROVIDER COMMUNICATIONS AND TRAINING

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• CHC Overview Training➢Who enrolls in CHC➢ Info on Providers/Services➢ FAQ’s

• Provider Training➢CHC Direct Service Providers➢Key Concepts➢Participant Transition➢MCO Role➢ Service Coordinator Role Moving Forward➢Needs Assessment Process➢Providers & Participants➢Maintaining Standards

COMMUNICATIONS AND TRAINING

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• Service Coordinators Training➢ SC Training For the General Public

➢CHC Service Coordination➢Key Concepts➢Participant Transition➢Roles & Implementation➢Maintaining Standards & Safety

➢ SC Training for Service Coordinators Only➢ Link to LTLTI website for training of Service Coordinators➢ Includes test for competency verification

COMMUNICATIONS AND TRAINING

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• Nursing Facilities Training➢Nursing Facility Training For the General Public

➢CHC Nursing Facilities➢Key Concepts➢ Transition and Continuity of Care for NF’s➢Roles & Implementation➢ Service Coordination for NF Residents➢Maintaining Standards & Safety

➢ Training for Nursing Facilities Only➢ Link to LTLTI website for NF Training

Q&A’s FOR PROVIDERS

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• PROVIDER FREQUENTLY ASKED QUESTIONS➢ CHC Acronym Glossary Guide➢ Organized Health Care Delivery System Questions➢ Provider Billing Questions➢ Provider Dispute Questions➢ Provider Education Questions➢ Provider Rate Questions➢ Eligibility Verification System Questions➢ Independent Enrollment Broker Questions➢ Continuity of Care Questions➢ General CHC Questions

Q&A’s FOR PROVIDERS - CONTINUED

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➢ Service Coordinator Questions➢ Electronic Visit Verification System Questions➢ Network Adequacy Questions➢ CHC Transition Questions➢ Quality and Oversight Questions➢ Benefits Questions

COMMUNITY HEALTHCHOICES UPDATES

• CHC MCO Provider Education:

• As a requirement, the CHC-MCO must develop and maintain a Provider Network

that is knowledgeable and experienced in treating and supporting Participants in

CHC.

• The CHC-MCO must submit and obtain prior approval from the Department of an

annual Provider education and training work plan that outlines its strategy to

educate and train Network Providers and its process for measuring outcomes.

• This training requirement is continuous in CHC.

CHC PARTICIPANT PROTECTIONS

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PARTICIPANT COMMUNICATION

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• Post-enrollment Packets:

• All post enrollment packets were mailed by 12/8/2017.

• Post-enrollment packets included auto assignment information.

• CHC Member Handbooks and Enrollment Packets:

• Participant information will be mailed to the MCOs the week of 12/25/2017 and will be available on the MCO websites.

• BH-MCO Member Handbooks:• BH Participant information will be mailed the first two weeks of January, 2018.

PLAN CHOICE BEFORE LAUNCH DATE

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• Last date to make a plan change before January 1, 2017, by phone or online:• December 29, 2017.

• This date was not included in the auto assignment letter.

Participant Help Line

• 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.

• Call in Number: 1-800-757-5042

Extended Continuity-of-Care:

• 6 months for long-term services and supports.

• Grandfather provisions for nursing facilities.

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PARTICIPANT PROTECTIONS

CONTINUITY OF CARE

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• Nursing Facility (NF) Residents:

• A Participant who resides in a NF, located in the CHC zone on the Implementation Date, must receive NF services from the same NF until the earliest date with these exceptions:

• The Participant’s stay in the NF ends.

• The Participant is disenrolled from CHC.

• The NF is no longer enrolled in the MA Program.

CONTINUITY OF CARE

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• Nursing Facility:

• A change in CHC-MCO, a temporary hospitalization, or therapeutic leave does not interfere with or terminate this continuity of care period, as long as the Participant remains a resident of the NF.

• The CHC-MCO in which the Participant is enrolled must enter into an agreement or payment arrangement with the Participant’s NF to make payments for the Participant’s NF services during the continuity of care period, regardless of whether the NF is in the CHC-MCO Network.

CONTINUITY OF CARE

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• HCBS Waiver Recipients:

• For a Participant who is receiving LTSS on the Implementation Date of CHC through an HCBS Waiver program, the CHC-MCO must continue services provided under all existing HCBS Waiver service plans through all existing service Providers, including Service Coordination Entities, for one hundred eighty (180) days or until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

CONTINUITY OF CARE

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• HCBS Waiver Recipients:• If a Participant chooses to transfer to a different CHC-MCO during the initial one

hundred eighty (180) day continuity of care period, the receiving CHC-MCO must continue to provide the previously authorized services for 1) the greater of sixty (60) days or the remainder of the one hundred eighty (180) days, or 2) until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

• If a Participant chooses to transfer to a different CHC-MCO after the initial one hundred eighty (180) day continuity of care period, the receiving CHC-MCO must continue to provide the previously authorized services for sixty (60) days or until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

• CHC MCO Monitoring and Oversight:

• OLTL will have a team of agreement monitors for every CHC MCO. This team will be responsible for oversight and monitoring the daily operations of the MCO.

• The team will handle all issues, complaints and situations in regards to participants, providers and the MCOs. The team will work with various subject matter experts across DHS to address any issues.

• Daily and weekly meetings will be held as needed.

COMMUNITY HEALTHCHOICES UPDATES

PROMISe ELIGIBILITY VERIFICATION SYSTEM

(EVS)

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PROMISe ELEGIBILITY VERIFICATION SYSTEM (EVS)

Access Methods:

• PROMISe Provider Portal - http://promise.DHS.state.pa.us/

➢Single interactive inquiry and response for recipient eligibility.

➢Provider can save or print response.

• Batch EVS:

➢Submit up to 10,000 records (eligibility inquires) per batch.

➢Batch must be submitted by 8pm daily to receive a response the next morning.

➢Batch is returned Monday – Friday.

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

• Value Added Network (VAN):

➢Interactive inquiry and response in an ANSI X12 270/271 format.

➢Provider would contract with an existing clearinghouse that supports a VAN connection.

• Interactive Voice Response (IVR): 1-800-766-5387

➢Single entry and response via telephone keypad.

➢Limited search and response capabilities.

➢Inability to save or print response.

➢Single day inquiry only.

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

EVS Search Criteria:

• Valid and Active Provider Number – 13 digit Medicaid Number.

• Valid Date of Service (DOS).

➢DOS - Single day or span-dated query to maximum of 31 days

• Provider can inquire on recipient eligibility up to the end of the current month.

• Recipient Search options (listed in the order preference and success):

➢Recipient Identification Number (RID) and 2 digit Access Card Number.

➢RID and Date of Birth.

➢Social Security Number and Date of Birth.

➢Recipient Name and Date of Birth.

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

EVS Limitations:

• EVS will only return Third Party Liability for Date of Service inquires within the last two years

• EVS can be searched single day or span-dated up to 31 days.

• EVS can be searched in the future up to the last day of the current month.

• Example Today is 12/21/2017. The EVS will supply recipient eligibility up to and including 12/31/2017.

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

• Helpful Links and Hints:

➢Access methods -http://www.dhs.pa.gov/provider/softwareandservicevendors/eligibilityverificationinformation/

➢EVS Error Codes - http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/s_001986.pdf

➢Provider Electronic Solutions Software (PES) -https://promise.dpw.state.pa.us/ePROM/_ProviderSoftware/softwareDownloadMain.asp

➢PROMISe Transaction Certification Registration Form -https://promise.dpw.state.pa.us/eprom/_ProviderCertification/softwareCertificationForm.aspx

➢Provider Assistance Center (PAC) email address – papac1@dxc.com

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

• The Internet Help Manual, located on the PROMISe™ Internet home page, includes a section for EVS requests. These instructions are specific to an internet request, not the ANSI X12 270/271 transactions. The EVS section is 6.16 and begins on page 185.

• The EVS internet tutorial is part of the PA PROMISe Internet e-learning course, also available on the PROMISe home page and circled below. The section begins with “How to access EVS”.

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

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RESOURCES

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RESOURCE INFORMATION

CHC 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: RA-PWCHC@pa.gov

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 | CHCProviders@amerihealthcaritas.com➢ www.amerihealthcaritaschc.com - 1-855-235-5115 (TTY 1-855-235-5112)

➢ Pennsylvania Health and Wellness (Centene) | information@pahealthwellness.com➢ www.PAHealthWellness.com – 1-844-626-6813 (TTY 1-844-349-8916)

➢ UPMC Community HealthChoices | CHCProviders@UPMC.edu➢ www.upmchealthplan.com/chc - 1-844-833-0523 (TTY 1-866-407-8762)

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THIRD THURSDAY WEBINARS

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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: January 18, 2018 @ 1:30 PM

Webinar participants will also find this presentation at

www.healthchoicespa.gov/info/resources/publications/community/third-thursday-webinars/