All Staff Webinar July 21, 2017 Jennifer Burnett Deputy Secretary - PowerPoint PPT Presentation

All Staff Webinar July 21, 2017 Jennifer Burnett Deputy Secretary Office of Long-Term Living Department of Human Services

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

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. 3

CHC Readiness Review (RR) Update • 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 10 th and a provider and service coordinator session was held on July 11 th . The encounter data session will be held on August 8 th . A Webinar was held on June 30 th with the Nursing Facility Associations and the MCOs to discuss billing scenarios. • Biweekly meetings with MCOs and Bureau of Data Claims Management (BDCM) continue.

Independent Enrollment Broker (IEB) Status • 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

Upcoming Upcoming Pr Provider vider Meetings 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

CHC-Southwest Educational Conference Attendance Home- and Service Behavioral Physical Community- Nursing coordinator/A TOTAL Health Health based Facility rea Agency Services on Aging Cranberry 58 10 112 124 41 345 Twp. Cranberry 26 7 42 36 19 130 Thurs. Pittsburgh 36 18 158 78 50 340 Altoona 49 6 104 117 26 302 1,117 Total as of 4pm Tuesday July 18, 2017

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 1 st . • 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 Prior Authoriza uthorization tion Review view Pr Proces ocess s (P (PARP) ARP) and and Quality Quality Mana Management and Utiliza gement and Utilization tion Mana Manageme gement (QM/ nt (QM/UM UM)

Prior Prior Authoriza uthorization R tion Review P view Process (P ocess (PARP) ARP) “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 CHC — PARP Pr ARP Process ocess 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) 19

Prior Prior Authoriza uthorization R tion Review P view Process (P ocess (PARP) ARP) Do Documents to o be su submitted to o OLTL per r CHC Agreement HealthChoices Process (OMAP)  Mon  Mem onthly ly PARP Submis ission ember Not otif ifications for or Drugs Dr  Dr Drug Formulary ry  Spec ecia ialty Pharmacy  Annual Formulary Submission  PARP Co Comprehen ensiv ive Polic olicy Lis List t for or th the e MCO  Formulary Ch Changes (A (Addit itions &  In Indiv ividuals ls auth thorized to o Dele De letions) sign ign PARP polic olicies es  P&T Co Committee ee Mee eeti ting  MCO DU DUR Rep eport Min inutes es

Quality Quality Mana Management and Utiliza gement and Utilization tion Mana Management (QM/UM gement (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 Description 2. QM/UM Work Plan Submissions 3. QM/UM Policy and Procedure Manual 4. QM/UM Annual Program Evaluation 5. QM/UM Licensed Proprietary Products 6. QM/UM Prior Authorization Review (PARP) Annual Submission and Quarterly Updates

Electronic Visit Verification (EVV) Background  The 21 st 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.

The 21 st Century Cures Act Requires System verification of: Services verified by:  The type of service provided  The recipient’s home landline telephone  Individual receiving the service  Smart phone  Individual providing the service  Biometric recognition systems or  Date of the service  Fixed visit verification device-an  Location of the service delivery electronic random numbers device  Time the service begins and in the beneficiary’s home ends

EVV-CHC Agreement Requirement • 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.