Effective last year, each Community HealthChoices (CHC) plan must now maintain and staff a Complex Care Unit (originally called a Special Needs Unit). At April 2022’s Managed Long-Term Services and Supports Subcommittee meeting, each CHC plan provided an overview of their CCUs and the work they do.
While the exact makeup of the CCUs differs by CHC plan, they can include nurses, social workers, senior service coordinators and plans’ medical directors.
This team gets involved in cases where a participant is identified as having complex needs or barriers to accessing care due to a medical or behavioral health condition or other circumstances. Keystone/AmeriHealth CHC noted that their CCU is the unit that assists participants with challenges accessing appropriate housing. UPMC emphasized that a substantial focus of its CCU includes assisting new CHC participants transitioning from other Medicaid programs, the Act 150 and Options programs, and jails and prisons.
The work all three plans’ CCUs perform is primarily episodic, providing more intensive case management and services until a participant’s need for assistance is less acute. The specific services provided by the CCUs largely mirror those required to be provided by a service coordinator; for example, coordinating care, ensuring participants have all needed supplies and services when moving from one setting to another, and connecting participants with community services. According to the CHC plans, the CCUs enhance rather than replace the work of service coordinators by providing additional support, relieving some of the administrative burden and adding a clinical lens to cases that require a high touch.
Under the CHC Agreement, each CHC plan is required to “proactively identify and outreach to Participants with special needs.” Keystone/AmeriHealth shared that potential participants who might benefit from the CCU are identified using predictive modeling based on various sources of information. It appears likely that all three plans also take referrals to the CCUs from service coordinators. Only Pennsylvania Health and Wellness, however, identified that they take referrals from all sources, including self-referrals.