chc overview third thursday webinar
TRANSCRIPT
![Page 1: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/1.jpg)
CHC Overview
Third Thursday WebinarMay 17, 2018
1
Office of Long-Term LivingDepartment of Human Services
![Page 2: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/2.jpg)
CHC LAUNCH UPDATE
2
![Page 3: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/3.jpg)
2018 FOCUS
3
CHC SOUTHWEST LAUNCH:• Assuring no participant service interruptions• Assuring no interruption in provider payment• Successful launch first phase
CHC SOUTHEAST IMPLEMENTATION:• Preparation for January 1, 2019 launch• Comprehensive participant communication• Robust readiness review• Provider communication and training• Pre-transition and plan selection for southeast participants• Incorporation of southwest implementation and launch lessons
learned
![Page 4: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/4.jpg)
CHC SOUTHWEST (Population Distribution)
4
NFI Duals73%
HCBS Duals10%
HCBS Non Duals3%
LTC Duals13%
LTC Non-Duals1%
PA CHC Total Enrollments by Population
NFI Duals HCBS Duals HCBS Non Duals LTC Duals LTC Non-Duals
![Page 5: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/5.jpg)
CHC SOUTHWEST (Plan Distribution)
5
DistributionAmerihealth
Caritas
Pennsylvania Health and Wellness
UPMC COMMUNITY
HEALTHCHOICES
Percentage 19% 27% 54%
![Page 6: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/6.jpg)
IMPLEMENTATION FEEDBACK
6
![Page 7: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/7.jpg)
SOUTHWEST IMPLEMENTATION
• Successfully implemented in the Southwest on January 1, 2018
• Approximately 80,000 Participants were transitioned to the CHC program
• Lessons Learned (so far)
• Earlier stakeholder engagement opportunities
• Enhanced communication materials and training regarding Medicare vs. CHC
• More education and communication on continuity-of-care
• MCO Provider Training and outreach to occur earlier and more often
• Earlier OBRA reassessments
• Earlier data clean-up in HCSIS and SAMS
• Earlier pre-transition notices
• Transportation issues
7
![Page 8: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/8.jpg)
PARTICIPANT FEEDBACK
8
• Problems Experienced: • Transportation services are difficult to navigate and schedule.
• Historically, service coordinators filled in the gaps for transportation but the CHC-MCOs are following the requirements of the service definition.
• Transportation is difficult to schedule and often does not meet the person-centered transportation needs of participants.
• Participants are worried about losing access to their existing service coordinator.
• Approvals for home modifications and continued DME access are more difficult than before.
• Common questions:• What will happen to important service coordinator relationships after the continuity of care
period ends?
![Page 9: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/9.jpg)
PROVIDER FEEDBACK
9
• Problems Experienced: • Communication challenges with the MCOs that, at times, have resulted in delays of payment.
• Non-Medical Transportation: MCOs handling it differently.
• Transportation Brokers are unclear about process for getting non-emergency medical and non-medical transportation.
• Transportation Brokers do not understand how waiver services were working before CHC.
• Billing coding challenges
• New Referrals:
• Some external service coordinators are getting some referrals from MCOs, not through HHA, but by phone or fax.
• Some providers’ referrals originate from service coordinators but providers are told they cannot accept these referrals.
• Provides may not receive the scope, duration, frequency and proceed with general personal assistance services with the referrals.
![Page 10: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/10.jpg)
CHC PROVIDER CLAIMS EXPERIENCE
10
The following are the top 10 reasons that HCBS claims are being denied.
Top HCBS Denial Reasons
Definite Duplicate Claim
Member Not Eligible at Time of Service
Service Prior to Subscriber Effective Date
All Enroll Events are Future
Denied Claim Disallow
Members Birthdate Submitted is Not Valid
Over Max Procedure/Benefit Limit (R46)
Over Max Procedure/Benefit Limit (X46)
Not a Contracted Service
Code Not Payable for Provider/Specialty
![Page 11: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/11.jpg)
CHC PROVIDER CLAIMS EXPERIENCE
11
The following are the top 10 reasons that SNF claims are being denied.
Top SNF Denial Reasons
Definite Duplicate Claim
Inappropriate Coding for Contract/Agreement
Service Prior to Subscriber Effective Date
Member Not Eligible at Time of Service
Members Birthdate Submitted Is Not Valid
Code Not Payable for Provider/Specialty
Diagnosis Inv/Missing/Deleted
Denied Claim Disallow
Resubmit on UB04
Duplicate Claim Previously Paid at Correct Rate/Cap
![Page 12: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/12.jpg)
CHC PROVIDER CLAIMS EXPERIENCE
12
The following are the top 10 reasons that Physical Health claims are being denied.
Top Physical Health Denial Reasons
Claim Pending: Medicare EOB Request
Code Not Payable for Provider/Specialty
Definite Duplicate Claim
No Precert/Authorization or Referral
Member Not Eligible at Time of Service
No MAID on File
Denied Claim Disallow
Service Prior to Subscriber Effective Date
Not a Covered Service
Members Birthdate Submitted is Not Valid
![Page 13: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/13.jpg)
SOUTHWEST
CONTINUITY-OF-CARE
13
![Page 14: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/14.jpg)
SERVICE COORDINATION TRANSITIONS/UPMC
14
• UPMC will be offering long-term contracts to nine external service coordinators impacting 2,102 participants.
• UPMC, as of April 23, 2018, was evaluating all other service coordination entities impacting 4,174 participants.
![Page 15: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/15.jpg)
SERVICE COORDINATION TRANSITIONS/PHW
15
• Pennsylvania Health and Wellness (PHW) will be offering long-term contracts to four external service coordinators.
• PHW will not be terminating contracts with any other external service coordinator at this time.
![Page 16: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/16.jpg)
SERVICE COORDINATION TRANSITIONS/AHC
16
• AHC will not be terminating any service coordination agencies but all of these agencies are subject to additional evaluation.
![Page 17: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/17.jpg)
NETWORK PROVIDERS AFTER CONTINUITY-OF-CARE
17
• The CHC-MCOs have not notified DHS of any network provider termination of agreement including:• HCBS Providers.
• Physical Health providers.
![Page 18: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/18.jpg)
AREAS OF CURRENT FOCUS
18
![Page 19: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/19.jpg)
BEHAVIORAL HEALTH COORDINATION
19
• Meeting on May 9, 2018 that included:• CHC-MCOs, • BH-MCOs• Nursing Facilities• Office of Mental Health and Substance Abuse Services (OMHSAS)
• CHC-MCOs provided an overview of their process for coordination with Behavioral Health Services.• OMHSAS provided an extensive overview of the behavioral health services available to
participants.• The BH-MCOs provided an overview of how to coordinate behavioral health services in the Nursing
Facility. • Discussion on how the relationship between CHC-MCOs, BH-MCOs and Nursing Facilities can be
better coordinated and the referral process.
![Page 20: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/20.jpg)
TRANSPORTATION
20
• The CHC-MCOs are taking steps to address transportation issues.• Increasing communication and training to key stakeholders.
![Page 21: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/21.jpg)
SOUTHEAST IMPLEMENTATION
21
![Page 22: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/22.jpg)
SOUTHEAST IMPLEMENTATION FOCUSES
22
• OBRA Assessments• Notifications have been sent to participants and assessments have begun.
• Participant Communications Planning• An online participant training is being developed from a suggestion made at the MLTSS
SubMAAC.• Initial touchpoint flyer will be mailed in mid-July.
• Provider Outreach and Education• Population Identification
![Page 23: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/23.jpg)
SOUTHEAST PROVIDER SUMMITS
23
June 4-8: Philadelphia CountyTemple University, Ritter Hall1301 Cecil B. Moore Ave., Philadelphia, PA 19122
June 18: Chester CountyWest Chester University, Sykes Student Union700 S. High St., West Chester, PA 19382
June 19: Delaware CountyDelaware County Community College901 Media Line Rd., Media, PA 19063
June 20: Montgomery CountyMontgomery County Community College, Central Campus340 DeKalb Pike, Blue Bell, PA 19422
June 21: Bucks CountyBucks County Community College, Newtown Campus275 Swamp Rd., Newtown, PA 18940
To RSVP, click the following link: http://bit.ly/2HNtzDD
![Page 24: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/24.jpg)
SOUTHEAST POPULATION
24
Population Bucket Count of Individuals
HCBS Dual 28,887
HCBS Non-Dual 12,136
LTC Dual 12,456
LTC Non-Dual 1,365
NFI Dual 72,882
Grand Total 127,726
![Page 25: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/25.jpg)
SOUTHEAST POPULATION
25
County Count of Individuals
Bucks 9,488
Chester 5,216
Delaware 12,435
Montgomery 12,835
Philadelphia 87,691
Under Review 61
Grand Total 127,726
![Page 26: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/26.jpg)
COMMUNICATIONS
26
![Page 27: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/27.jpg)
ONGOING COMMUNICATIONS
27
• MLTSS SubMAAC• Consumer SubMAAC• LTSS SubMAAC• MAAC• Third Thursday Webinars• Review data to be collected:
o Stakeholders• MCO Participant Advisory Committees• Local Advisory Group• SubMAAC• Third Thursday Webinars• CHC Website
![Page 28: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/28.jpg)
RESOURCES
28
![Page 29: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/29.jpg)
RESOURCE INFORMATION
CHC LISTSERV // STAY INFORMED http://listserv.dpw.state.pa.us/oltl-community-
healthchoices.html
COMMUNITY HEALTHCHOICES WEBSITE www.healthchoices.pa.gov
MLTSS SUBMAAC WEBSITE
www.dhs.pa.gov/communitypartners/informationforadvocatesandstakeholders/mltss/
EMAIL COMMENTS TO: [email protected]
OLTL PROVIDER LINE: 1-800-932-0939
OLTL PARTICIPANT LINE: 1-800-757-5042
INDEPENDENT ENROLLMENT BROKER: 1-844-824-3655 OR (TTY 1-833-254-0690)
(Open Monday through Friday, 8:00 a.m. to 6:00 p.m.)
or visit www.enrollchc.com
29
![Page 30: CHC Overview Third Thursday Webinar](https://reader034.vdocuments.site/reader034/viewer/2022052616/628e07c84aa4567ce01e614b/html5/thumbnails/30.jpg)
QUESTIONS30