Third Thursday Webinar September 21, 2017 Jen Burnett Deputy - - PowerPoint PPT Presentation

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Third Thursday Webinar September 21, 2017 Jen Burnett Deputy - - PowerPoint PPT Presentation

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Third Thursday Webinar September 21, 2017 Jen Burnett Deputy Secretary Office of Long Term Living Department of Human Services Welcome to the Third Thursday MLTSS Webinar Communication Access Real-time Transcription (CART) is available by

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Jen Burnett Deputy Secretary Office of Long‐Term Living Department of Human Services

Third Thursday Webinar September 21, 2017

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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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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

  • Ea

Early Sept Septem ember: ber:

  • Attendant Care & Independence Waiver letters
  • COMMCARE Waiver reminder letters
  • La

Late Sept Septem ember ber th thru ru earl early Oct October: ber:

  • First round SW Pre‐transition notices and enrollment packets prior to implementation
  • Oct

October ber 11 11th

th th

thru ru Nov November mber 2nd

nd :

  • Southwest CHC participant education & outreach sessions.
  • Par

artic icip ipants ha have re receive ved in invitations fo for ev even ents ts and and ar are alr alread ady re registe stering

  • Mi

Mid to to la late Oct October: ber:

  • Second round SW Pre‐transition notices
  • La

Late Nov November mber to to mi mid‐De Decemb mber:

  • 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:
  • La

Late Augus August: Continuity of Care Provider Fact sheet sent to providers outlining CHC provisions to maintain continuity and avoid service disruptions

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

be made available via webinars and online

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

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CHC Internal Commonwealth Staff Communications Updates

  • On

On Augus August 23 23rd

rd 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:

  • September

September 15 15th

th Physical Health & CHC Behavioral Health

  • September

September 22 22nd

nd Nursing Facility

  • Oct

October ber 2nd

nd Home and Community‐Based Services

  • Oct

October ber 11 11th

th Service Coordination

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Stakeholder Presentations & Events

  • Augus

August 28 28‐31s 31st NASU NASUAD AD Annual Annual Conf nfer erence ence:

  • 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.

  • 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.

  • Several OLTL staff attended the conference and

acquired valuable information from other states facing the same challenges as Pennsylvania

  • Septe

ptembe ber 13 13th

th Meetings:

Meetings:

  • PALPA Board Meeting‐ DHS Acting Secretary Teresa Miller

participated in a discussion on the expansion of the LIFE Program

  • P4A Membership Meeting
  • Septe

ptembe ber 14 14th

th

  • PACAH Conference‐CHC Overview
  • Septe

ptembe ber 15 15th

th

  • 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

September 25 25th

th

  • Interview on Winning Images with PCTV 21
  • September

September 27 27th

th

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

  • Structure of Organization
  • Oversight and Organizational Accountability
  • Participant contact center
  • Training programs for participant contact center
  • Call monitoring plan – quality of call and resources
  • Scripts and Resources for participant contact center
  • Structure of Case Management
  • Documentation of case management
  • Training and resources for care management
  • Provider overview with adequacy
  • Training of providers
  • Dispute process for providers
  • Oversight by PHW of providers and subcontractors
  • Service Coordination structure
  • Documentation of SC services
  • Training and Resources for SC services
  • Systems – demonstration of documentation, script samples,

etc.

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Readiness Review Updates

  • 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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Readiness Review Updates

  • 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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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 w w w.HealthChoices.PA.gov

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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 w ebinar w ill be held: October 19, 2017 @ 1:30 PM General HealthChoices Web Page that includes Community HealthChoices: http://w w w.healthchoices.pa.gov/index.htm Webinar participants w ill also find this presentation at http://www.healthchoices.pa.gov/info/resources/publications/community/third-thursday-webinars/

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QUESTIONS

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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

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Agenda

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

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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

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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

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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

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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

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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

8 10/3/2017

LIFE PROGRAM ELIGIBLE

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LIFE Program Model and Services

LIFE PARTICIPANT

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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

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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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The LIFE Experience PA LIFE Provider Alliance (PALPA) Board Chair Joann Gago

LIFE Pittsburgh – Allegheny County jgago@lifepittsburgh.org

10/3/2017 12

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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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Slide 13

Hancock, Kevin, 9/20/2017

HK1

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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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Slide 14 HK1

Hancock, Kevin, 9/20/2017

HK2 Too much information on this slide. Suggest splitting into two.

Hancock, Kevin, 9/20/2017

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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

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Contact Information

Jonathan Bowman Office of Long-Term Living, LIFE Program 717-772-1145 RA-PWLIFE@pa.gov Joan Bradbury PA LIFE Provider Alliance (PALPA) 717-283-0488 info@palpaonline.org Joann Gago jgago@lifepittsburgh.org

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Questions

10/3/2017 17