Older Pennsylvanians and individuals with physical disabilities will soon have access to Community HealthChoices (CHC), the commonwealth's new long-term care initiative.
Here are five things physicians and practices should know about the program:
CHC is a managed care program intended to increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes while receiving services. The new program aims to enhance access to and improve coordination of physical health care.
A Pennsylvanian is eligible if he/she is over 21 years old and:
- Is dually eligible for Medicare and Medicaid;
- Qualifies for Medicaid long-term services and supports (LTSS) because of a need for the level of care provided by a nursing facility.
Three MCOs were chosen to proceed with negotiations to deliver services in Pennsylvania:
Implementation will occur in three phases:
Phase 1 began in January 2018 for the Southwest region, which includes these counties: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington, and Westmoreland.
Phase 2 will begin on Jan. 1, 2019 for the Southeast region, which includes these counties: Bucks, Chester, Delaware, Montgomery, and Philadelphia.
Phase 3 will begin in Jan. 1, 2020 for the remainder of the state.
Each MCO must create an adequate provider network that offers participants choice in providers. Prior to implementation, CHC-MCOs will contract with willing and qualified LTSS providers of all types to make up their provider networks.
Pa.'s Department of Human Services (DHS) will require the CHC-MCOs to enroll all willing, qualified providers in their provider network for a minimum of the first six months, to ensure that CHC participants maintain services with their current providers. Physicians and practices interested in being part of a CHC-MCO provider network should reach out to the MCOs now.
For details on how the provider networks will operate, check out DHS' CHC-Provider
Relationship flyer with information on joining the
networks, how the claims payment process will work, quality monitoring and
oversight, and provider dispute resolution.
Pennsylvania physicians and practices should be prepared for questions about CHC from their patients. These patients, many of them elderly, often turn to their physician for advice when new programs are offered. Visit DHS'
Community Health Choices webpage here for more details on CHC.
Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.