Governor Wolf’s proposed 2015-16 budget committed to increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. To do so, the governor directed the Departments of Human Services (DHS) and Aging (PDA) to develop a plan to implement a Managed Long-Term Services and Supports (MLTSS) program for older Pennsylvanians and adults with physical disabilities called Community HealthChoices (CHC).
PHCA developed a Question and Answer document that provides a comprehensive update on many of the topics of interested to PHCA members including questions and answers (if available) on reimbursement, provider enrollment, readiness review, etc.
Community HealthChoices Contract Checklist
Currently, each of the CHC-MCOs are forwarding draft provider agreements to nursing facilities which the CHC-MCOs and individual nursing facilities will negotiate and execute. These agreements address each CHC-MCO’s relationship with individual nursing facilities under CHC, so it is critical that nursing facilities understand the proposed terms of the agreements and are able to use this understanding to negotiate the most favorable terms possible.
The draft agreements sent by the CHC-MCOs are all different and complex and may be very different from contracts that you review regularly. In order to assist in your review, PHCA is offering the Community HealthChoices Checklist, which provides a guideline by calling out specific questions that should be discussed and potentially negotiated.
Community HealthChoices Waiver Approved by CMS
The Department of Human Services submitted the Community HealthChoices (CHC) 1915(b) managed care waiver and the CHC 1915(c) home and community-based services waiver applications to CMS on April 28, 2017. These applications have been approved by CMS and will become effective January 1, 2018. The waivers will govern the operation of the CHC Program, Pennsylvania’s managed long-term services and supports initiative.
What is MLTSS?
Managed Long-Term Services and Supports (MLTSS) is the delivery of long-term services and supports through capitated Medicaid managed care programs. It refers to an arrangement between Pennsylvania’s Medicaid programs and contractors. The contractors receive capitated payments for LTSS and are accountable for the health and welfare of participants through the delivery of services and supports that meet quality and other standards set in the contracts.