Human Services Webinar: HCBS Waiver Enrollment Process & Key Definitions
Join the Third Thursday Webinar on July 18, 2019, to learn about the Department of Human Services (DHS) Resource & Referral Tool, HCBS Waiver Enrollment Process, and Assessment Data. Get insights from experts Tyrone Williams and Amy High on the enrollment process and key definitions like IEB, FED, PIA, PC, NFCE, CAO, and HCBS. Understand the flow shapes legend and the PIA assessments process in detail. Discover how the HCBS Waiver Eligibility FED Assessment Process works and how IEB manages the application process efficiently. Don't miss this informative session on essential topics in the field of human services.
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Presentation Transcript
Third Thursday Webinar Third Thursday Webinar July 18, 2019 July 18, 2019 1
GoToWEBINAR GoToWEBINAR HOUSEKEEPING: What Attendees HOUSEKEEPING: What Attendees See See 2
AGENDA AGENDA Department of Human Services (DHS) Resource & Referral (R&R) Tool Waiver Enrollment Process And Assessment Data 3
HCBS Waiver Enrollment Process HCBS Waiver Enrollment Process And Assessment Data And Assessment Data Tyrone Williams/Chief, Assessments Unit Amy High/Chief, Enrollment Unit Office of Long-Term Living Department of Human Services
Key Definitions IEB-Independent Enrollment Broker FED-Functional Eligibility Determination PIA-Pennsylvania Individualized Assessments PC-Physician Certification NFCE-Nursing Facility Clinically Eligible CAO-County Assistance Office HCBS-Home and Community Based Services 6
Flow Shapes Legend Terminator-The start and stop points in a process Process- A process or Action Step Decision-Indicates a question in the process flow 7
PIAAssessments Process IEB creates/updates applicant profiles IEB (Maximus) FED Results FED Requests The PIA system is used to request and complete the FED assessments PIA FED Requests FED Results IAE (Aging Well) IAE through contracted FED assessors create applicant profiles and do FED Assessments 8
HBCS Waiver Eligibility FED Assessment Process IEB concurrently request FED assessment through PIA to FED assessor and sends PC to applicant s physician. FED Assessor schedules and conducts FED within 10 business days Applicant contacts IEB FED assessor submits FED results to the IEB via PIA IEB Starts application IEB receives PC No MA at referral: application starts upon receipt of PA 600L or COMPASS Application 9
CAO sends written notice to applicant informing of ineligibility w/right to appeal HCBS Waiver Eligibility Enrollment process No IEB conducts in-home visit (MCO choice counseling) CAO does financial Review Applicant Financially eligible? CAO issues notice to participant IEB issues approval to CAO Yes NFCE Matches PC? Yes IEB retrieves NFCE Result CAO updates DHS database and IEB and MCO are notified No Yes OLTL sends written notice to applicant informing of ineligibility w/ right to appeal Medical Director Agrees with NFCE Result? No Medical Director Review Requested PC, FED and any other additional information is reviewed. Medical history as well as doctor s recommendation is used to determine appropriate level of care for NFCE. 10
Level of Care Assessments-All Program Types Completed FEDs April 1-June 30 2019 12000 11294 10721 10000 9405 8000 6000 4000 2000 0 April '19 May '19 June '19 12
Level of Care Assessments-All Program Types FED Results April 1-June 30 2019 10000 8712 9000 8409 8000 7514 7000 6000 NFCE 5000 NFI 4000 3000 2548 2276 1882 2000 1000 0 April '19 May '19 June '19 13
Level of Care Assessments-All Program Types FED Results Percentage April 1-June 30 2019 21% 79% NFCE NFI 14
Level of Care Assessments-HCBS Enrollment Completed FEDs April 1-June 30 2019 4500 4132 4000 3500 3333 3156 3000 2500 2000 1500 1000 500 0 April '19 May '19 June '19 15
Level Of Care Assessments-HCBS Enrollment FED Results April 1-June 30, 2019 3500 3010 3000 2497 2485 2500 2000 NFCE NFI 1500 1122 1000 859 848 500 0 April '19 May '19 June '19 16
Level of Care Assessments-HCBS Enrollment FED Result Percentage April 1-June 30, 2019 25% 75% NFCE NFI 17
QUESTIONS 18
