Third Thursday Webinar Kevin Hancock Acting Deputy Secretary - - PowerPoint PPT Presentation

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Third Thursday Webinar Kevin Hancock Acting Deputy Secretary - - PowerPoint PPT Presentation

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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

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Third Thursday Webinar

Dec ecemb ember 21 er 21, , 20 2017 17 Kevin Hancock Acting Deputy Secretary

OFFICE OF LONG-TERM LIVING DEPARTMENT OF HUMAN SERVICES

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WEL WELCOME COME TO O THE THE THIRD THIRD THURSD THURSDAY Y WEBIN WEBINAR AR

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➢ Communication Access Real-time Transcription (CART) is available by clicking here:

  • https://archivereporting.1capapp.com
  • Username/password: OLL
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GoT GoToWEBIN

  • WEBINAR

AR HO HOUSEKEEPING: USEKEEPING: Wha hat A t Att ttendees endees See See

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AGEND GENDA

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➢ 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

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COMMUNICATIONS & OUTREACH

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CHC CHC COMPLETED COMPLETED & UPCOMIN & UPCOMING G EVENTS EVENTS

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➢ 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

  • ..
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CHC TRANSITION AND LAUNCH STATUS

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CHC CHC SOUTHWEST SOUTHWEST TRANSIT TRANSITION ION ACTIV CTIVITY ITY

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System Logic Developed to Identify SW CHC Participants (2016) Pre-Transition Notice Mailed (September) Pre transition Extract made Available to the IEB (September) Call Center Go Live (End of September) Pre-Enrollment Mail Campaign (Late September and October) Outbound Reminder Calls (October) Website Live with Provider Information then Enrollment (October and November) Processing Plan Selections (October and November) CHC Transition (November 18, 2017) Post Enrollment Packets (End of November and December) Plan Change (Last Day for a January 1, 2018 Effective Date, December 29, 2017) CHC Go-Live (January 1, 2018)

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POST EN POST ENROLLMEN OLLMENT T

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  • November 27th – IEB began sending out Post Enrollment Packets

which include:

  • Confirmation notice for those that made plan selections; OR
  • Auto Assignment notice for those that were auto assigned
  • A LIFE Flyer
  • 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).

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CHC CHC PLA PLAN N CHOICE CHOICE INFORMA INFORMATION TION AS AS OF OF 12 12/20/1 /20/17 7

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CHC CHC PLA PLAN N CHOICE CHOICE INFORMA INFORMATION TION AS AS OF OF 12 12/20/1 /20/17 7

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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.

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Primary Aim Key Activities Tools Stake- holders

Pre-Launch Launch (Begins at “Go Live”) Steady State (9-12

  • Mos. & Beyond)

Readiness Continuity Program Improvement

Readiness Reviews System Testing Baseline Analyses Readiness Review Tool Report Templates Quality Strategy Consumer Communications Provider Communications Local Advisory group SubMAAC, 3rd Thurs. CHC Website Frequent Meetings with MCOs Monitor Launch Indicators & Reports Conduct Implementation Study Launch Indicators Process Measures Hot-lines (Consumer & Provider) Program and Financial Reports MCO Participant Advisory Coms. Local Advisory Group SubMAAC, 3rd Thurs. CHC Website Regular Meetings with MCOs Quarterly Quality Reviews Conduct Evaluation Analyses Monitor Reports Outcome Measures Program and Financial Reports Program Imp. Projects (PIPs) Pay for Performance (P4Ps) MCO Participant Advisory Coms. Ad Hoc Public Engagements SubMAAC, CHC Website

CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS

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LA LAUN UNCH CH INDICA INDICATOR OR DOMAINS DOMAINS (Ca (Cate tegories) gories)

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Service Continuity Service Coordination Continuity Provider Participation Information Transfers

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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)

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LA LAUN UNCH CH OVERS VERSIGHT IGHT

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  • Daily Meetings with the MCO’s (Began December 18th)
  • Daily DHS Launch Lead Meetings
  • Weekly Stakeholder Meetings
  • Weekly Provider Association Meetings (Nursing Facilities included)
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CHC PROVIDER RESOURCES

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PR PROVIDE VIDER R COMMUN COMMUNICA ICATIONS TIONS AND AND TRAI TRAINING NING

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➢ A CHC 101 training was developed for nursing facilities in the SW and presented through webinars on November 2nd 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-

  • utreach-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

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PROVIDER COMMUNICATIONS AND TRAINING

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  • 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

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COMMUNICATIONS AND TRAINING

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  • 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

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COMMUNICATIONS AND TRAINING

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  • 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

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Q&A’s FOR PROVIDERS

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  • 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

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Q&A’s FOR PROVIDERS - CONTINU CONTINUED ED

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➢ Service Coordinator Questions ➢ Electronic Visit Verification System Questions ➢ Network Adequacy Questions ➢ CHC Transition Questions ➢ Quality and Oversight Questions ➢ Benefits Questions

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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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CHC PARTICIPANT PROTECTIONS

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PAR ARTICIP TICIPANT ANT COMM COMMUN UNICA ICATION TION

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  • Post-enrollment Packets:
  • All post enrollment packets were mailed by 12/8/2017.
  • Post-enrollment packets included auto assignment information.
  • CHC Member Handbooks and Enrollment Packets:
  • Participant information will be mailed to the MCOs the week of 12/25/2017 and

will be available on the MCO websites.

  • BH-MCO Member Handbooks:
  • BH Participant information will be mailed the first two weeks of January, 2018.
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PLAN PLAN CHO CHOICE ICE BEFORE BEFORE LA LAUN UNCH CH DATE TE

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  • Last date to make a plan change before January 1, 2017, by phone or
  • nline:
  • December 29, 2017.
  • This date was not included in the auto assignment letter.
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Par articipa ticipant Help nt Help Lin Line

  • OLTL will staff a participant help line to address questions or concerns regarding their

CHC MCO, the IEB, their service coordinator, or anything associated with the program launch.

  • Call in Number: 1-800-757-5042

Ex Exten tende ded d Con Continu tinuity ity-of

  • f-Car

Care: e:

  • 6 months for long-term services and supports.
  • Grandfather provisions for nursing facilities.

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PAR ARTICIP TICIPANT ANT PR PROTECT TECTIONS IONS

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CON CONTINU TINUITY ITY OF CARE OF CARE

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  • Nursing Facility (NF) Residents:
  • A Participant who resides in a NF, located in the CHC zone on the

Implementation Date, must receive NF services from the same NF until the earliest date with these exceptions:

  • The Participant’s stay in the NF ends.
  • The Participant is disenrolled from CHC.
  • The NF is no longer enrolled in the MA Program.
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CONTINU CONTINUITY ITY OF CARE OF CARE

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  • Nursing Facility:
  • A change in CHC-MCO, a temporary hospitalization, or therapeutic

leave does not interfere with or terminate this continuity of care period, as long as the Participant remains a resident of the NF.

  • The CHC-MCO in which the Participant is enrolled must enter into an

agreement or payment arrangement with the Participant’s NF to make payments for the Participant’s NF services during the continuity of care period, regardless of whether the NF is in the CHC-MCO Network.

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CONTINU CONTINUITY ITY OF CARE OF CARE

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  • HCBS Waiver Recipients:
  • For a Participant who is receiving LTSS on the Implementation Date of

CHC through an HCBS Waiver program, the CHC-MCO must continue services provided under all existing HCBS Waiver service plans through all existing service Providers, including Service Coordination Entities, for one hundred eighty (180) days or until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

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CONTINU CONTINUITY ITY OF CARE OF CARE

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  • HCBS Waiver Recipients:
  • If a Participant chooses to transfer to a different CHC-MCO during the initial one

hundred eighty (180) day continuity of care period, the receiving CHC-MCO must continue to provide the previously authorized services for 1) the greater of sixty (60) days or the remainder of the one hundred eighty (180) days, or 2) until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

  • If a Participant chooses to transfer to a different CHC-MCO after the initial one

hundred eighty (180) day continuity of care period, the receiving CHC-MCO must continue to provide the previously authorized services for sixty (60) days or until a comprehensive needs assessment has been completed and a PCSP has been developed and implemented, whichever date is later.

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  • CHC MCO Monitoring and Oversight:
  • OLTL will have a team of agreement monitors for every CHC
  • MCO. This team will be responsible for oversight and monitoring the

daily operations of the MCO.

  • The team will handle all issues, complaints and situations in regards to

participants, providers and the MCOs. The team will work with various subject matter experts across DHS to address any issues.

  • Daily and weekly meetings will be held as needed.

COMMUN COMMUNITY ITY HEAL HEALTHCHOICES THCHOICES UPD UPDATES TES

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PROMISe ELIGIBILITY VERIFICATION SYSTEM (EVS)

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PR PROMISe OMISe ELE ELEGIBILITY GIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS) Access Methods:

  • PROMISe Provider Portal - http://promise.DHS.state.pa.us/

➢Single interactive inquiry and response for recipient eligibility. ➢Provider can save or print response.

  • Batch EVS:

➢Submit up to 10,000 records (eligibility inquires) per batch. ➢Batch must be submitted by 8pm daily to receive a response the next morning. ➢Batch is returned Monday – Friday.

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PR PROMISe OMISe ELIGIBILITY ELIGIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS)

  • Value Added Network (VAN):

➢Interactive inquiry and response in an ANSI X12 270/271 format. ➢Provider would contract with an existing clearinghouse that supports a VAN connection.

  • Interactive Voice Response (IVR):

1-800-766-5387 ➢Single entry and response via telephone keypad. ➢Limited search and response capabilities. ➢Inability to save or print response. ➢Single day inquiry only.

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PR PROMISe OMISe EL ELIGIBILITY IGIBILITY VE VERIFIC RIFICATION TION SY SYST STEM EM (EVS (EVS) EVS Search Criteria:

  • Valid and Active Provider Number – 13 digit Medicaid Number.
  • Valid Date of Service (DOS).

➢DOS - Single day or span-dated query to maximum of 31 days

  • Provider can inquire on recipient eligibility up to the end of the

current month.

  • Recipient Search options (listed in the order preference and success):

➢Recipient Identification Number (RID) and 2 digit Access Card Number. ➢RID and Date of Birth. ➢Social Security Number and Date of Birth. ➢Recipient Name and Date of Birth.

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PR PROMISe OMISe ELIGIBILITY ELIGIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS) EVS Limitations:

  • EVS will only return Third Party Liability for Date of Service inquires

within the last two years

  • EVS can be searched single day or span-dated up to 31 days.
  • EVS can be searched in the future up to the last day of the current

month.

  • Example Today is 12/21/2017. The EVS will supply recipient eligibility

up to and including 12/31/2017.

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PR PROMISe OMISe ELIGIBILITY ELIGIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS)

  • Helpful Links and Hints:

➢Access methods -

http://www.dhs.pa.gov/provider/softwareandservicevendors/eligibilityverificationinformation/

➢EVS Error Codes - http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/s_001986.pdf ➢Provider Electronic Solutions Software (PES) -

https://promise.dpw.state.pa.us/ePROM/_ProviderSoftware/softwareDownloadMain.asp

➢PROMISe Transaction Certification Registration Form -

https://promise.dpw.state.pa.us/eprom/_ProviderCertification/softwareCertificationForm.aspx

➢Provider Assistance Center (PAC) email address – papac1@dxc.com

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PR PROMISe OMISe ELIGIBILITY ELIGIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS)

  • The Internet Help Manual, located on the PROMISe™ Internet home page,

includes a section for EVS requests. These instructions are specific to an internet request, not the ANSI X12 270/271 transactions. The EVS section is 6.16 and begins on page 185.

  • The EVS internet tutorial is part of the PA PROMISe Internet e-learning

course, also available on the PROMISe home page and circled below. The section begins with “How to access EVS”.

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PR PROMISe OMISe ELIGIBILITY ELIGIBILITY VER VERIFICA IFICATION TION SY SYSTEM STEM (EVS) (EVS)

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RESOURCES

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RESOU RESOURCE CE INFO INFORMA RMATION TION

CHC CHC LIS LISTS TSER ERV V // // ST STAY INFORM Y INFORMED ED htt http:// p://lis lists tser erv.dp .dpw.s .sta tate.pa.us te.pa.us/oltl

  • ltl-community

community- healthc healthchoices.ht hoices.html ml COM COMMU MUNIT NITY Y HEAL HEALTHCHOICES THCHOICES WEBSI WEBSITE TE www.healthchoicespa.com ML MLTS TSS S SUBMA SUBMAAC C WEBSI WEBSITE TE

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

EMAIL COM EMAIL COMMENTS MENTS T TO: O: RA-PWCHC@pa.gov PR PROVIDER LINE: VIDER LINE: 1-800-932-0939 PART ARTICIP ICIPANT ANT LINE 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.)

  • r visit www.enrollchc.com

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CHC CHC MCO MCO CONT CONTACT CT INFORMA INFORMATION TION

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➢ AmeriH iHealt lth Car arit itas | CHCProvid iders@amerih ihealthcaritas.com ➢ www.amerihealt lthcarit itaschc.com - 1-85 855-235 235-5115 5115 (T (TTY 1-855 855-235 235-5112 5112) ➢ Pennsylv lvania ia Health an and Welln llness (C (Centene) | | in information@pahealt lthwelln llness.com ➢ www.PAHealt lthWelln llness.com – 1-84 844-626 626-6813 (T (TTY 1-844 844-349 349-8916) ➢ UPMC Community Heal althChoices | | CHCProvid iders@UPMC.edu ➢ www.upmchealthpla lan.com/chc - 1-84 844-833 833-0523 (T (TTY 1-86 866-407 407-8762)

  • ..
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THIRD THIRD THURSD THURSDAY Y WEBIN WEBINARS ARS

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  • ..

We will host an informational webinar on the third Thursday of each month throughout the implementation of CHC. An invite and registration link will be sent out on the ListServe. To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address. The ne he next w xt webinar binar wi will be held: ll be held: Januar anuary 18, 2018 @ 1:30 PM y 18, 2018 @ 1:30 PM Webinar participants will also find this presentation at www.healthchoicespa.gov/info/resources/publications/community/third-thursday-webinars/