The 180-day continuity of care period for Community Health Choices (CHC) participants getting long-term services and supports (LTSS) at home ended on June 30 for participants in Phase Three counties. This means CHC plans can change participants’ LTSS providers and CHC plans can terminate, reduce, or change the type and amount of LTSS participants receive. The state declined to extend the continuity of care period for Phase Three counties or to extend the COVID-19 state of emergency.
As a reminder, an in-person InterRAI assessment and person-centered service plan (PCSP) must be completed before a CHC plan can change any home and community-based service. Although the state had temporarily permitted telephone assessments during the COVID-19 emergency, this flexibility has now been phased out in counties that have entered the green phase. The state’s transition plan calls for assessments to be done in-person, unless risk factors (such as recent contacts with a COVID-positive person by the participant or someone in their household) make it unsafe to do so. Also, CHC plans may not reduce services based on assessments—either in-person or telephonic--that are more than 90-days-old. All three CHC plans are currently in the process of resuming in-person assessments with enhanced safety protocols.
CHC plans are required to send their members written notice of reductions and denials of services and supports. If a CHC plan acts to reduce, change, or end a participant’s in-home LTSS, the CHC plan must send the member a written notice 10 days before the change takes place. These notices must detail the reasons for the shift. Justifications like “you have been assessed as not needing these services” or “the services are not medically necessary” without any further explanation are insufficient. CHC participants, their family members, or other supports are encouraged to read notices denying or changing services carefully.
Individuals who receive such a notice can appeal the CHC plan’s decision by requesting a grievance. The CHC plan’s written notice will tell the member how to do this. To keep LTSS in place during the appeal process, the member must request a grievance within 10 days of the mail date on the CHC plan’s written notice.
Vigilance from CHC participants, their advocates, and their providers is needed to ensure participants’ needs are met. We continue to encourage CHC participants (or their advocates) to call PHLP’s Helpline at 1-800-274-3258 or email us at firstname.lastname@example.org if they experience issues with the person-centered planning process (including not receiving a copy of the plan), receive a notice that doesn’t give adequate detail, or want advice or help with their appeal. Information about appealing a CHC decision can also be found on PHLP’s website.