If you are a Pennsylvania individual currently receiving Home and Community Based Services(HCBS) through one of the existing Medicaid Waivers (Aging Waiver, Attendant Care Waiver, Independence Waiver, OBRA Waiver and COMMCARE Waiver) or an individual who is dually eligible for Medicare and Medicaid, it is important for you to know that the PA Department of Human Services will be terminating all of the current waivers and replacing them with one, comprehensive program called Community HealthChoices(CHC).
(Note: There will be NO change for participants receiving services through the Act 150/Attendant Care Program. The Act 150 Program will continue to be managed by the state.)
Community HealthChoices will become Pennsylvania’s MLTSS(Managed Long Term Services & Supports) program for all Pennsylvanians who are elderly, disabled, or qualify for both Medicaid and Medicare, will be managed by Managed Care Organizations(MCOs) and be rolled-out in phases over the next few years beginning in January 2018.
The goal of CHC is to improve the health, safety, and wellness of nearly 450,000 Pennsylvanians by coordinating Health Care, Behavioral Health Care, and Long Term Services & Supports through a plan that combines all of these services. See the link below to access complete information on the Community HealthChoices Program.
Selection of Managed Care Organizations
After the completion of a strategic Request For Proposals, three Managed Care Organizations (MCOs) were awarded by Pennsylvania’s Department of Human Services to manage this new initiative. The transition of this plan will be in three phases – Southwestern Pennsylvania beginning January 2018; Southeastern Pennsylvania beginning July 2018; the remainder of the state beginning January 2019.
The MCOs awarded are AmeriHealth Caritas; Pennsylvania Health & Wellness (Centene); and, UPMC for You (University of Pittsburgh Medical Center).
Services will be offered through Community HealthChoices to all current participants of Department of Human Services Office of Long Term Living(OLTL) age 21 and older, Adults age 21 or older to who require Medicaid waiver services(whether in the community or in a nursing facility) and individuals who are dually eligible for Medicaid and Medicare services whether or not they need or receive waiver services.
What do consumers need to know to get ready for this change?
Affected individuals will be notified at least 90 days before Community HealthChoices (CHC) begins in each zone. Within this time period, consumers will have the choice of which MCO plan they want to enroll in. All current supports coordination and other services plus all existing service providers will continue during this period.
After the initial implementation, new enrollees and those that transfer to a different CHC-MCO will have a 60-day continuity of care period for existing services and providers. During this time, participants will be helped by their service coordinator and CHC-MCO to choose providers who meet their needs.
Who is responsible for service coordination in Community HealthChoices (CHC)?
The CHC-MCOs will be responsible for assuring that service coordination is provided. That will be done either through contracts with existing service coordination entities or through internal CHC-MCO service coordination staff.
Will JEVS at Home continue to provide my services?
For the 180 day transition period, all current providers will continue to provide services. After the first 180 days, the MCOs will have the ability to either include or exclude providers in their networks based on the quality of services of each provider. Rest assured, JEVS at Home will continue providing the exceptional services that consumers have trusted for years.
Commission on Accreditation of Rehabilitation Facilities (CARF)
CARF International is an independent, nonprofit accreditor of health and human service providers. Obtaining CARF Accreditation provides evidence that an organization strives to improve efficiency, fiscal health, and service delivery and demonstrates accountability and conformance to internationally accepted standards that promote excellence in services. JEVS at Home is currently pursuing CARF Accreditation which further emphasizes our commitment to quality and service excellence.
JEVS at Home will continue to navigate you through this transition. Email email@example.com for any questions or concerns that you might have.
You can visit dhs.pa.gov for complete information regarding Community Health Choices.
We strongly encourage you to provide us with your name and email address so that we can provide you with the most up-to-date information on Community Health Choices in the most efficient way possible. Please send your email information to us at firstname.lastname@example.org