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

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 clicking here: • https://archivereporting.1capapp.com • Username/password: OLL 2

GoToWebinar Housekeeping: What Attendees See 3

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. 4

Third Thursday Webinar Agenda  Communication  Stakeholder Engagement  Recent CHC Media Coverage  Readiness Review  Care Coordination  Quality Assurance 5

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 11 th th th mber 2 nd nd : October ber 11 thru ru Nov November  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 1 st 6

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: o CHC 101 training for Service Coordinators and Nursing Facilities in the SW is almost finalized and will be made available via webinars and online o Bi ‐ weekly fact sheets on CHC related topics continue to be distributed 7

CHC Internal Commonwealth Staff Communications Updates  On 23 rd rd a CHC 101 presentation was held at the Forum for DHS, PDA, DOH, and DDAP staff On Augus August 23 with four additional scheduled Community HealthChoices webinars to keep commonwealth staff informed of changes: 15 th th Physical Health & CHC Behavioral Health o September September 15 22 nd nd Nursing Facility o September September 22 ber 2 nd nd Home and Community ‐ Based Services o Oct October 11 th th Service Coordination o Oct October ber 11 8

Stakeholder Presentations & Events  Augus August 28 28 ‐ 31s 31st NASU NASUAD AD Annual Annual Conf nfer erence ence:  Septe 13 th th Meetings: ptembe ber 13 Meetings: • National Association of States United for Aging and o PALPA Board Meeting ‐ DHS Acting Secretary Teresa Miller Disabilities bringing together more than 1,500 participated in a discussion on the expansion of the LIFE representatives of all 50 states, advocacy groups, Program contractors and Federal agencies. o P4A Membership Meeting o Two major recurring themes of the conference were  Septe 14 th th ptembe ber 14 implementation of the CMS Home and Community o PACAH Conference ‐ CHC Overview Based Settings Rule and Electronic Visit Verification systems, required by the 21 st Century Cures Act of  Septe ptembe ber 15 15 th th 2016. o Webinar on Protective Services and Critical Incident o Several OLTL staff attended the conference and Management in a CHC Managed Care Environment was acquired valuable information from other states facing the same challenges as Pennsylvania held for MCO’s and Service Coordinators. 589 participants joined the webinar. 9

Upcoming Stakeholder Presentations, Events and Media Coverage  September 25 th th September 25 o Interview on Winning Images with PCTV 21  September 27 th th September 27 o CHC Overview at PHCA Conference 10

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 11

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 12

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 http://www.heraldstandard.com/new_today/state ‐ s ‐ new ‐ mandatory ‐ health ‐ care ‐ program ‐ leaves ‐ local ‐ residen ts/article_4b7b7ba7 ‐ a972 ‐ 5be6 ‐ 9430 ‐ a72dbda2d49c.html 13

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: o Covered Services o Participants Materials o Payment and Data Systems o Participant Services o Staffing and Training o Contracts and Administration o Provider Materials o Record and Data Reporting o Provider Services o Financial Requirements o IT Systems o QM/UM 14

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: o Structure of Organization o Provider overview with adequacy o Training of providers o Oversight and Organizational Accountability o Dispute process for providers o Participant contact center o Oversight by PHW of providers and subcontractors o Training programs for participant contact center o Call monitoring plan – quality of call and resources o Service Coordination structure o Scripts and Resources for participant contact center o Documentation of SC services o Training and Resources for SC services o Structure of Case Management o Systems – demonstration of documentation, script samples, o Documentation of case management etc. o Training and resources for care management 15

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 8 th . Follow up is being done to insure that their networks are adequate by Sept 30 th 16

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 17

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 18

Quality Assurance & Program Analytics Activities  August 24 th 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 20 th D ‐ SNP Care Coordination and MIPPA Agreement Reporting Performance Requirements T/A session was held Critical Measures Surveys Incidents External Grievances Quality  October 4 th Presentation to MLTSS Subcommittee on: & Appeals Review (EQR) Network Performance • CHC Launch Indicators Standards Improvement Projects (PIP) • CHC Evaluation Monitoring Value ‐ based & Payment Compliance (future) Readiness CHC Independent Review Quality Evaluation 19

20 w w w.HealthChoices.PA.gov CHC WEBSITE