Community HealthChoices (CHC) is Pennsylvania’s Managed Long-Term Services & Supports Program. CHC affects older adults and persons with disabilities who are: dual eligible (on Medicare and Medicaid), getting long term care services at home through an Office of Long Term Living waiver, or in a nursing home paid for by Medicaid. Specifically, CHC changes how these individuals get their Medicaid coverage. For those getting long term care services, it also changes that coverage. Read about important CHC program updates below.
1. Southeast Participants Speak Out at Listening Session
In late October, senior state officials from the Department of Human Services (DHS) heard from CHC participants and their caregivers at a listening session at the Philadelphia Corporation on Aging (PCA) in Philadelphia. The listening session, which was hosted by the Con- sumer Subcommittee of the Medical Assistance Advisory Commit- tee, was an opportunity for participants in the Southeast to share their experiences with CHC.
During the three-hour listening session, participants, and caregivers voiced concerns about a range of issues, including service coordina- tion caseloads, difficulty communicating with CHC Plans, and delays in home modifications. Participants also raised questions about how CHC can better serve participants with visual impairments and more effectively utilize the consumer-directed services model. There was also discussion about whether CHC is adequately serving participants with intellectual disabilities.
Deputy Secretary of the Office of Long Term Living, Kevin Hancock, attended the listening session. Representatives from all three CHC Plans also attended.
2. More Service Coordination Entities Terminated in Southeast
More than 20,000 CHC participants in Southeastern Pennsylvania will experience a change in service coordinator after two (2) of the three (3) CHC plans announced they are not renewing contracts with most external service coordination agencies effective January 1, 2020. Keystone First CHC is terminating contracts with 20 of its 23 external service coordination agencies and UPMC CHC is terminating the contract of one of its two remaining external service coordination agencies.
Impacted participants already should have received a letter from their CHC plan explaining next steps. Participants may choose a new service coordinator who works directly for their CHC plan or choose one from the external service coordination agencies still contracted with their CHC plan. The remaining external agencies for Keystone First CHC are Liberty Community Connections, Participant Care Coordination, and United Disability Services; and for UPMC CHC it is All Abilities.
Participants who wish to keep their current service coordination agency can switch to PA Health & Wellness (PHW) if the agency has a contract with PHW; all but three of the service coordination agencies whose contracts with the other plans are ending do have a contract with PHW. Participants considering switching plans should make sure their preferred service providers, such as their home health agency, participates with PHW before making any plan changes. People on Medicaid only (i.e. non-waiver participants and non-duals) should also make sure their preferred medical providers are part of PHW, or else they risk losing access to these providers. To change CHC plans, participants should call the Independent Enrollment Broker at 1-844-824-3655. Participants can compare the three plans using the plan comparison tool.
Individuals affected by the service coordination agency contract changes who do not switch plans or choose a service coordinator will be assigned to one by their CHC Plan.
Participants are supposed to have a choice of service coordinators and may switch service coordina- tors if they are not satisfied with the one they have. The CHC plans are also responsible for helping participants find a different service coordinator to ensure that services are not disrupted.
3. Community HealthChoices Will Be Statewide January 1, 2020
CHC will complete its three-phase roll out on January 1, 2020 when the program begins in the Northwest, Northeast, and Lehigh/Capital Regions ("Phase Three"). Once that happens, CHC will be statewide for the first time.
140,000+ people in the Phase Three regions will move to CHC on January 1, 2020. As of mid-November, most (61%) of them had not chosen a CHC managed care plan yet. The state auto-assigned these individuals to one of three CHC plans—i.e., AmeriHealth Caritas, PA Health and Wellness, or UPMC. However, most participants who were enrolled in an OLTL waiver and receiving Medicaid-funded long-term services and supports at home did select a CHC plan and were not auto- assigned.
It is not too late for people to choose a different CHC plan for January 1. Participants have until Friday, December 20, 2019 to choose so that plan selection prevails. This option to switch plans before January 1st applies to everyone, whether they were auto-assigned to a plan, or a person who already made an affirmative plan selection but has since had a change of mind.
To minimize the risk of disruptions in healthcare services, it is advisable that those auto-assigned to a CHC plan take time to choose a plan that includes their critical healthcare providers. This is particularly true of the nearly 3,000 who were auto-assigned to a CHC Plan whose only insurance is Medicaid.
People with Medicaid as their only insurance are most at risk of disruption in their healthcare services when CHC starts. This is because they must see providers who are in their CHC plan’s network. In contrast, people who have both Medicare and Medicaid (duals) may continue to see their Medicare providers and the CHC plan must pay the Medicaid portion of their medical bills even if the provider is not in the CHC plan’s network.
While there is a brief period—60-days—during which CHC plans must pay out-of-network medical providers for ongoing treatment or prior authorized services, this “continuity of care” period does not apply in all situations and can be challenging to obtain even when required. Therefore, relying solely on continuity of care to be able to access medical providers is a risk that should be avoided. (The 60- day continuity of care period applies to regular physical health services. A longer and more tightly monitored 180-day continuity of care period applies to waiver services such as personal assistance services.)
To determine in which plans specific providers are participating, individuals may call the CHC Enrollment Broker at 1-844-824-3655 or use its provider search tool.
Once CHC begins on January 1, participants may switch plans at any time. There is no lock-in. However, depending on when a plan change is made, it could take anywhere from two (2) weeks to one-and-a-half (1.5) months for the change to take effect. Choosing the right CHC plan now will save time and potential problems accessing care later.