Long-Term Care SubMAAC Updates & Aging Waiver Enrollment Information

Long-term Care SubMAAC Updates October 11, 2016

Timeline Agenda IEB Updates and Aging Waiver Enrollment Information CHC Timeline Assumptions CMS Waiver Authority 2

Aging Waiver Enrollment How many Aging Waiver consumers have been enrolled since April 1 and how many have started services? As of 9/30/2016, 3,846 individuals have been enrolled in the Aging Waiver. Aging Waiver Enrollments by Enrollment Source 1000 900 800 700 600 500 400 300 200 100 0 AAA Maximus 3

Aging Waiver Enrollment Month 2014 2015 2016 January February March April May June July August September October November December Average Monthly 346 256 589 573 389 526 484 498 611 594 409 483 480 474 463 628 533 402 545 644 873 749 654 492 556 584 477 681 946 856 814 857 285 496 538 Aging Waiver Enrollments 2014, 2015, 2016 661 1000 900 800 700 600 500 400 300 200 100 0 Septemb er 611 749 538 Novembe r 409 492 Decembe r 483 556 January February March April May June July August October 2014 2015 2016 346 474 477 256 463 681 589 628 946 573 533 856 389 402 814 526 545 857 484 644 285 498 873 496 594 654 2014 2015 2016 4

Aging Waiver Enrollment At August s meeting, stated that Aging Waiver enrollment is up an average of 94% from February through June 2016 compared to February through June 2015 but these figures were not shown or distributed. (And this data isn t reflected with the data presented in DHS September monthly data report.) The Monthly Data Report is total census and is adjusted for attrition. The Aging waiver has a significant attrition rate. 5

IEB Updates How many waiver applications have been mailed out by Maximus since April 1, 2016? As of August 31, 2016, 11,366 applications have been mailed to referred applicants. Since April 1, 2016, how many waiver applications have been mailed by Maximus but not returned by the consumer? Of this number, how many were 60 or over? As of August 31, 2016, 8,621 (76%) applicants were not returned. As of August 31, 2016, 6,858 (80%) were sent to people over the age of 60 and not returned. 6

IEB Updates What percentage of individuals who started the application process by calling Maximus during the period April 1, 2015 to June 30, 2015 subsequently filed a PA 600? For this time period, 1,458 applications were started with a referral source within the application of call. All returned a PA600. Additional applications were started but did not have a referral source entered. Please note that other applications started without PA600 returned may have been AAA referrals, but the referral source field was left blank. 7

IEB Updates What is the average length of time between application and eligibility determination as well as eligibility determination and service start-up for Aging Waiver applications initiated since July 1, 2016? As of August 31, 2016: 37.3 Days for all waiver programs 47.6 for Aging Waiver Only 8

IEB Updates Percentage of Applications Closed within 30 days: Open Month April May June July August Sept Total Number Closed Closed within 30 days % Closed within 30 days Total Cases 3,724 4,905 7,602 5,939 7,432 6,564 36,166 3,158 4,169 6,156 4,257 4,495 351 22,586 472 1,628 1,711 1,248 879 351 6,289 14.9% 39.1% 27.8% 29.3% 19.6% 100.0% 27.8% 9

IEB Updates Data not yet available: Disposition for closed cases (will be available after November, 2017) The Number of individuals enrolled in the Aging Waiver who have started services Aging Waiver Attrition Rate 10

CHC Timeline Assumptions Five Protests Under Review DHS has 15 days to respond after a protest is filed The 5 protestor has 10 days to respond to our response DHS OA has 35 days to review the protests and make a decision This timeline does not assume relief sought in Commonwealth Court Anticipated Late Fall Resolution 11

Waiver Authority Schedule Activity Planned Date October, 2016 Changed Date October/November, 2016 January, 2017 Submission of the CHC Waiver Submission of Agreement with MCO Signature Submission of Rate Ranges Submission of Fully Executed Contract October, 2016 October, 2016 January, 2017 January, 2016 March, 2017 12

Applicant Experience/ADRC/PCC To support applicants through the Medicaid and Long-term Care Financial eligibility processes, OLTL is working closely with PDA, planning to adapt the existing Person-Centered Counselor (PCC) Role associated with the Aging and Disability Resource Centers to provide navigation as a relief to applicants maneuvering through the Medicaid Long-term Care eligibility process. This will involve a personal interview, resource review, decision support, and follow-up and will be initiated in phases starting as early as Fall, 2016. Operational Components: Requires IEB Referral Involves the ADRC Call Center to schedule PCC sessions PCC will support Medicaid Enrollment and other components such as Physician Certification Applicant will have the choice to use the service or not SAMS will be used to track activity. 13

Applicant Experience/IEB Support This proposal involves changing the process flow to offer an in-home visit at the beginning of the process to address concerns by applicants, providers and advocates about how the IEB can be more responsive to address the specific needs of the applicant for information about the process, what to expect, and completion of required forms, including assistance completing the PA 600L if requested. Operational Components: Applicant will have choice to have an in-home visit at the front of the process not a requirement for all applicants Currently has staff familiar with this process throughout the state, may need additional field staff who can be deployed for in-home visits when requested Will require the IEB to make a phone contact to all individuals following the referral AND an additional follow-up via phone contact to ensure information received and if questions/ assistance needed for completion of PA 600L 14

CHC Updates Selected Offerors Announced on August 30, 2016 PA Health and Wellness UPMC For You Amerihealth Caritas Nine debriefs requested and six have been completed Five protests have been received 15

Questions 16