Third Thursday Webinar Kevin Hancock Acting Deputy Secretary OFFICE OF LONG-TERM LIVING DEPARTMENT OF HUMAN SERVICES Dec ecemb ember 21 er 21, , 20 2017 17
WEL WELCOME COME TO O THE THE THIRD THIRD THURSD THURSDAY Y WEBIN WEBINAR AR ➢ Communication Access Real-time Transcription (CART) is available by clicking here : • https://archivereporting.1capapp.com • Username/password: OLL 2
GoT GoToWEBIN oWEBINAR AR HO HOUSEKEEPING: USEKEEPING: Wha hat A t Att ttendees endees See See 3
AGEND GENDA ➢ 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 4
COMMUNICATIONS & OUTREACH 5
CHC COMPLETED CHC COMPLETED & UPCOMIN & UPCOMING G EVENTS EVENTS ➢ 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 o . . 6
CHC TRANSITION AND LAUNCH STATUS 7
CHC CHC SOUTHWEST SOUTHWEST TRANSIT TRANSITION ION ACTIV CTIVITY ITY System Logic Developed Pre transition Extract Pre-Transition Notice to Identify SW CHC made Available to the Call Center Go Live Mailed Participants IEB (End of September) (September) (2016) (September) Website Live with Pre-Enrollment Mail Processing Plan Outbound Reminder Provider Information Campaign Selections Calls then Enrollment (Late September and (October and (October and (October) October) November) November) Plan Change Post Enrollment Packets CHC Go-Live CHC Transition (Last Day for a January (End of November and (November 18, 2017) 1, 2018 Effective Date, (January 1, 2018) December) December 29, 2017) 8
POST EN POST ENROLLMEN OLLMENT T • November 27 th – IEB began sending out Post Enrollment Packets which include: o Confirmation notice for those that made plan selections; OR o Auto Assignment notice for those that were auto assigned o A LIFE Flyer o 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). 9
CHC CHC PLA PLAN N CHOICE CHOICE INFORMA INFORMATION TION AS AS OF OF 12 12/20/1 /20/17 7 10
CHC CHC PLA PLAN N CHOICE CHOICE INFORMA INFORMATION TION AS AS OF OF 12 12/20/1 /20/17 7 11
CHC CHC LA LAUN UNCH CH FOCU FOCUS: S: Essen Essential tial Priorit Priorities ies ES ESSE SENTIAL NTIAL PRI PRIORITI ORITIES ES • No interruption in participant services • No interruption in provider payment HO HOW W WILL WILL WE ENS WE ENSURE URE NO NO INTE INTERR RRUPT UPTIO IONS NS? • 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. 12
CHC LA CHC LAUN UNCH CH INDICA INDICATOR ORS Launch Steady State (9-12 Pre-Launch (Begins at “Go Live”) Mos. & Beyond) Primary Readiness Continuity Program Improvement Aim Frequent Meetings with MCOs Regular Meetings with MCOs Readiness Reviews Key Quarterly Quality Reviews Monitor Launch Indicators & Reports System Testing Conduct Implementation Study Conduct Evaluation Analyses Activities Baseline Analyses Monitor Reports Launch Indicators Outcome Measures Readiness Review Tool Process Measures Program and Financial Reports Tools Report Templates Program Imp. Projects (PIPs) Hot-lines (Consumer & Provider) Quality Strategy Program and Financial Reports Pay for Performance (P4Ps) Consumer Communications MCO Participant Advisory Coms. Stake- Provider Communications MCO Participant Advisory Coms. Local Advisory Group Local Advisory group Ad Hoc Public Engagements holders SubMAAC, 3rd Thurs. SubMAAC, 3 rd Thurs. SubMAAC, CHC Website CHC Website CHC Website 6
LA LAUN UNCH CH INDICA INDICATOR OR DOMAINS DOMAINS (Ca (Cate tegories) gories) Service Service Coordination Continuity Continuity Provider Information Participation Transfers 14
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 results NFCE 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) 15
LA LAUN UNCH CH OVERS VERSIGHT IGHT • Daily Meetings with the MCO’s (Began December 18 th ) • Daily DHS Launch Lead Meetings • Weekly Stakeholder Meetings • Weekly Provider Association Meetings (Nursing Facilities included) 16
CHC PROVIDER RESOURCES 17
PR PROVIDE VIDER R COMMUN COMMUNICA ICATIONS TIONS AND AND TRAI TRAINING NING ➢ A CHC 101 training was developed for nursing facilities in the SW and presented through webinars on November 2 nd 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 18
PROVIDER COMMUNICATIONS AND TRAINING • 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 19
COMMUNICATIONS AND TRAINING • 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 20
COMMUNICATIONS AND TRAINING • 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 21
Q&A’s FOR PROVIDERS • 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 22
Q&A’s FOR PROVIDERS - CONTINU CONTINUED ED ➢ Service Coordinator Questions ➢ Electronic Visit Verification System Questions ➢ Network Adequacy Questions ➢ CHC Transition Questions ➢ Quality and Oversight Questions ➢ Benefits Questions 23
COMMUN COMMUNITY ITY HEAL HEALTHCHOICES THCHOICES UPD UPDATES TES • 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.
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