Jennifer BurnettDeputy Secretary

Office of Long-Term LivingDepartment of Human Services

All Staff Webinar

July 21, 2017

Welcome to the OLTL all Staff Webinar

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• 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 10th and a provider and service coordinator session was held on July 11th. The encounter data session will be held on August 8th. A Webinar was held on June 30th with the Nursing Facility Associations and the MCOs to discuss billing scenarios.

• Biweekly meetings with MCOs and Bureau of Data Claims Management (BDCM) continue.

CHC Readiness Review (RR) Update

• 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

Independent Enrollment Broker (IEB) Status

Upcoming Provider 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

Behavioral

Health

Physical

Health

Home- and

Community-

based

Services

Nursing

Facility

Service

coordinator/A

rea Agency

on Aging

TOTAL

Cranberry

Twp.58 10 112 124 41 345

Cranberry

Thurs.26 7 42 36 19 130

Pittsburgh 36 18 158 78 50 340

Altoona 49 6 104 117 26 302

1,117

Total as of

4pm Tuesday

July 18, 2017

CHC-Southwest Educational Conference Attendance

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 1st.

• 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 Authorization Review Process (PARP)

and

Quality Management and Utilization

Management (QM/UM)

Prior Authorization Review Process (PARP)

“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—PARP Process

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)

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Prior Authorization Review Process (PARP)

Documents to be submitted to OLTL per CHC Agreement

HealthChoices Process (OMAP)

Monthly PARP Submission

Drug Formulary

Annual Formulary Submission

Formulary Changes (Additions & Deletions)

P&T Committee Meeting Minutes

Member Notifications for Drugs

Specialty Pharmacy

PARP Comprehensive Policy List for the MCO

Individuals authorized to sign PARP policies

MCO DUR Report

Quality Management and Utilization

Management (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 Description2. QM/UM Work Plan Submissions3. QM/UM Policy and Procedure Manual4. QM/UM Annual Program Evaluation5. QM/UM Licensed Proprietary Products6. QM/UM Prior Authorization Review (PARP) Annual Submission and Quarterly Updates

BackgroundThe 21st 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.

Electronic Visit Verification (EVV)

The 21st Century Cures Act Requires

System verification of:

The type of service provided

Individual receiving the service

Individual providing the service

Date of the service

Location of the service delivery

Time the service begins and ends

Services verified by:

The recipient’s home landline telephone

Smart phone

Biometric recognition systems or

Fixed visit verification device-an electronic random numbers device in the beneficiary’s home

• 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.

EVV-CHC Agreement Requirement

Act 150 Program

Adult Autism Waiver

Adult Community Autism Program

Aging Waiver

Attendant Care Waiver

COMMCARE Waiver

Community HealthChoices

Program

Pennsylvania Proposal

EVV will be required for Personal Care and Home Health Services provided in the following DHS Programs:

Consolidated Waiver

Fee-For-Service

HealthChoices Program-Physical and Behavioral Health

Independence Waiver

OBRA Waiver

Person/Family Directed Support Waiver

• The Department is soliciting input from beneficiaries, family caregivers, provider agencies and individuals who furnish personal care services or home health care services, managed care organizations, and other stakeholders on the current use of EVV in the Commonwealth and the impact of EVV implementation.

• The Department would like feedback on existing best practices; EVV systems currently in use in Pennsylvania; and preference for a state, state-contracted or provider agency-operated EVV system.

• The Department intends to implement the EVV requirements so that the system is minimally burdensome and will take into account the input from stakeholders. Input received within 30 days will be reviewed and considered as the Department works to comply with the EVV requirements. Input should be submitted to RA-evvnotice@pa.gov.

• Input received within 30 days will be reviewed and considered as the Department works to comply with the EVV requirements. Input should be submitted to RA-evvnotice@pa.gov.

• The following link has the text of the 21st Century Cures Act: HR 34, the 21st Century Cures Act.

Stakeholder Input

MLTSS SubMAAC Officer Update

• Purpose:

Advise the MAAC on policy development and program administration of the State's managed long-term services and supports programs, including the range of services available to older Pennsylvanian’s and adults with physical disabilities

• MLTSS SubMAAC Membership: Appointment of New Chair and Vice Chair

Pam Mammarella-Chair

Fred Hess-Vice Chair

• Next meeting: Wednesday, August 2, 2017

• Time: 10:00 a.m. – 1:00 p.m.

• More info:

http://www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/

OLTL Bureau Of Quality & Program Analytics Highlights

• Bureau team relies heavily on all of the work and data that support OLTL

programs. This means that collectively:

OLTL received a favorable review from CMS from the evidentiary-based reports (EBR) submission for the Aging Waiver assurances. Thanks to each of the Bureau’s for providing information to include in the reports.

OLTL continues to have success with the implementation of the Participant Review Tool (PRT) in obtaining data pertaining to OUR waiver participants.

Analysis of the PRT data by members of the OLTL PRT Committee involves assisting OLTL with the identification of participant problems and concerns, which in turn aides OLTL to develop corrective measures that facilitates program improvements.

QMETs have successfully completed the majority of the required individual provider site visits for the HCBS Final Rule, while continuing with ongoing monitoring visits.

OLTL is participating in a CMS supported Medicare-Medicaid Data Integration (MMDI) project along with the MIPPA agreement to assist PA in addressing the challenges of successfully integrating Medicare and Medicaid data to improve care coordination for individuals we serve. The results of this project will allow us to help better our Waiver participants in both the current system as well as in CHC.

Bureau of Participant Operations Highlights

The NHT program has welcomed at least 10 new providers across the state who will help OLTL increase the number of people transitioning to the community. We are developing upcoming pilots on housing and technical assistance that will enhance transition work in pilot counties.

We’ve been working diligently to increase provider capacity for new employment services and assist service coordinators who are introducing the topic of employment to OLTL participants. These actions are part of the Governor’s Employment First Initiative.

Every day, OLTL receives incidents and reports of need for people served in our programs. Our incident management unit is focused on addressing them and working with SCs as needed to address health and welfare issues. We are currently integrating the incident processing for the Aging Waiver with the overall processing for the other waivers that use Enterprise Incident Management.

Division of Regional Operations Highlights

• The Plan Review Unit is nearly complete with Annual Reviews for 2017/2018. This is the first time we will have been finished in in July and the first time that staff from other units did not have to assist.

• Enrollment Unit has been assisting with the data clean-up activity - one example of their progress is correcting discrepancies between CIS and HCSIS for enrollments into the COMMCARE Waiver. While there were over 200, through completing the 1768s and working with Service Coordinators to correct errors, there are now only 8 remaining.

• The Case Management Unit has been assisting with the OBRA Re-Assessment which is underway. This unit is effectively managing the process through coordination with AAA’s and Service Coordinators, while the process will not be complete until September 30, nearly ½ are already done.

QUESTIONS

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