Last month, PHLP submitted comments on the Office of Long-Term Living’s (OLTL’s) proposed amendments to the Community HealthChoices (CHC) waiver. The majority of our comments focused on preserving the current scope of home and community-based services, clarifying the scope of waiver services where there has been confusion, and ensuring that the CHC waiver includes language to enhance CHC-MCO compliance with federal Medicaid rules.
Our most significant comments focused on the scope of the personal assistance services and participant directed in-home services definitions. For example:
- We vehemently objected to OLTL’s proposal to prohibit paying direct care workers for providing safety supervision to CHC participants with whom they live. This shift in policy would have negatively impacted hundreds of CHC participants, including those with cognitive impairments who rely on live-in caregivers whom they trust to keep them safe in the community. The change in policy also would have put in jeopardy federal funding Pennsylvania anticipates to provide enhanced home and community based services under the American Rescue Plan Act, a fact we shared in a letter to the Department of Human Services separate from our comments. After receiving our letter, OLTL confirmed that they would not pursue the proposed amendment to limit the types of task for which live-in direct care workers may be compensated.
- We urged OLTL to further clarify that CHC plans cannot compel family, friends and others to provide unpaid services to CHC participants. Under federal regulations, unpaid “informal” supports must be voluntary. We understand OLTL accepted some of our recommendations on this issue.
- We asked OLTL to make clear that personal assistance services are not limited to “hands-on” care, but includes cueing and supervision. Although the personal assistance services definition includes supervision and cueing, because of the way it is drafted, one CHC-MCO plan repeatedly only authorized services for hands on tasks. We understand that the amended waiver will include language further clarifying that cueing and supervision are appropriate personal assistance services tasks.
You can read PHLP’s full comments on the 2022 CHC Waiver here.