Pennsylvania EVV Implementation: Updates, Training, and Provider Workshops
Stay informed about Pennsylvania's Electronic Visit Verification (EVV) system implementation timeline, upcoming provider workshops, and training details. Providers can learn more about CHC monitoring reports and essential updates.
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Third Thursday Webinar Third Thursday Webinar CHC Monitoring Report Update CHC Monitoring Report Update April 18, 2019 April 18, 2019 Kevin Hancock/Deputy Secretary Office of Long-Term Living Department of Human Services 1
AGENDA AGENDA CHC Provider Workshop Schedule and Registration Electronic Visit Verification (EVV) CHC Monitoring Report Updates QMUM 7 Denial Log OPS-003/OPS-004 Complaints and Grievances OPS-008 Missed Services OPS-021 Person Centered Service Plan Changes 2
UPCOMING PROVIDER WORKSHOPS UPCOMING PROVIDER WORKSHOPS Save the date for our upcoming provider summits in the Northeast, Northwest, and Lehigh/Capital zones. These summits are educational conferences specifically for providers to learn more about CHC. Please register at: www.healthchoices.pa.gov/providers/about/community/index.htm Lehigh/Capital Zone Monday, May 13: Harrisburg Area Community College Tuesday, May 14: Shippensburg University Wednesday, May 15: Kutztown University Thursday, May 16 (Transportation Session Only): Kutztown University Northwest Zone Monday, May 20: Edinboro University Tuesday, May 21: Lock Haven University Wednesday, May 22: University of Pittsburgh-Bradford Thursday, May 23 (Transportation Session Only): University of Pittsburgh-Bradford Northeast Zone Tuesday, June 4: East Stroudsburg University Wednesday, June 5: University of Scranton Thursday, June 6: Bloomsburg University Friday, June 7 (Transportation Session Only): Bloomsburg University 3
ELECTRONIC VISIT ELECTRONIC VISIT VERIFICATION (EVV) VERIFICATION (EVV) 4
WHEN WILL PENNSYLVANIA IMPLEMENT EVV? WHEN WILL PENNSYLVANIA IMPLEMENT EVV? April-May 2019 Technical specifications and DHS Addendum to be distributed to providers. August-September 2019 Provider training to be offered with phased in system use. Training will continue to be offered through full implementation. September-October 2019 Go live and soft launch of DHS EVV system. January 2020 Full implementation of system as required by the 21st Century Cures Act. OLTL waiver services included in the initial implementation of EVV include: Personal Assistance Services (Agency and Participant-Directed Model) Participant-Directed Community Supports Respite (unlicensed settings only) Implementation of EVV for home health services will also be required by January 1, 2023. 5
EVV PROVIDER TRAINING EVV PROVIDER TRAINING DHS will offer training for providers choosing to utilize the DHS EVV system. Train the Trainer Model Two attendees from each provider agency (Owner, Administrator, Administrative staff) Agencies will need to train caseworkers on the mobile application, telephony, and web portal processes Training formats will include: Classroom Training Webinar Training Self-paced Training Additional resources Locations, dates, times and registration instructions for the various trainings will be posted on the DHS EVV website: http://www.dhs.pa.gov/provider/billinginformation/electronicvisitverification/index.htm 6
CHC MONITORING CHC MONITORING REPORT UPDATES REPORT UPDATES 7
QMUM 7 Denial Log: Home and Community-Based Services Purpose: Monthly report that identifies denials of medical necessity, terminations, reductions and changes for covered services 4/4/2025 8
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM HCBS Authorization Denials HCBS Authorization Denials QMUM- -7 7 5% Total Denials HCBS Denial Rate Southwest Q T R A H C P H W U P M C AHC PHW UPMC 4% Q1 0 0 0 3% 3% Q2 0 0 0 2% 2% 2% Q3 1 1 45 Q4 3 0 86 1% 1% Jan 1 7 16 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Qtr 1 2018 Qtr 2 2018 Qtr 3 2018 Qtr 4 2018 Jan-19 4/4/2025 9
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM HCBS Authorization Denials HCBS Authorization Denials QMUM- -7 7 HCBS Denial Rate Southeast 5% Total Denials 4% Q T R A H C P H W U P M C 3% Jan 2% 0 0 2 1% 1% 0% 0% 0% Jan-19 KF PHW UPMC 4/4/2025 10
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Physical Health Prior Authorization Denials Physical Health Prior Authorization Denials QMUM- -7 7 Physical Health Denial Rate Southwest Total Denials A H C Q T R P H W U P M C 45% 42% 40% 35% 29% 29% 28% 30% Q1 234 128 134 23% 25% 21% 21% Q2 406 151 132 20% 17% 16% 14% 13% 15% 12% Q3 379 542 165 11% 8% 10% 7% Q4 349 356 107 5% 0% Jan 53 88 12 Qtr 1 2018 Qtr 2 2018 Qtr 3 2018 Qtr 4 2018 Jan-19 AHC PHW UPMC 4/4/2025 11
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Physical Health Prior Authorization Denials Physical Health Prior Authorization Denials QMUM- -7 7 Physical Health Denial Rate Southeast 10% 9% 9% 8% 7% 7% 6% 5% Total Denials A H C 5% Q T R P H W U P M C 4% 3% 2% 1% Jan 0 0 2 0% Jan-19 KF PHW UPMC 4/4/2025 12
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Pharmacy Prior Authorization Denials Pharmacy Prior Authorization Denials QMUM- -7 7 Pharmacy Denial Rate Southwest Total Denials 70% Q T R A H C P H W U P M C 63% 60% 60% 50% 46% 45% 43% Q1 228 285 467 42% 40% 40% 37% 40% 36% 35% 34% 32% Q2 406 305 398 29% 30% Q3 125 125 300 20% Q4 174 108 300 10% 6% Jan 53 54 97 0% Qtr 1 2018 Qtr 2 2018 Qtr 3 2018 Qtr 4 2018 Jan-19 AHC PHW UPMC 4/4/2025 13
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Pharmacy Prior Authorization Denials Pharmacy Prior Authorization Denials QMUM- -7 7 Pharmacy Denial Rate Southeast 60% 49% 50% 40% Total Denials 32% 30% Q T R A H C P H W U P M C 20% 9% 10% Jan 692 17 228 0% Jan-19 KF PHW UPMC 4/4/2025 14
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Dental Prior Authorization Denials Dental Prior Authorization Denials QMUM- -7 7 Dental Denial Rate Southwest 3% 3% Total Denials 2% Q T R A H C P H W U P M C 2% 1% 1% 1% Jan 0 0 1 0% 0% 0% Jan-19 AHC PHW UPMC 4/4/2025 15
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Dental Prior Authorization Denials Dental Prior Authorization Denials QMUM- -7 7 Dental Denials Southeast 60% 52% 50% 40% Total Denials 30% Q T R A H C P H W U P M C 21% 20% 8% 10% Jan 380 162 25 0% Jan-19 KF PHW UPMC 4/4/2025 16
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Home Modification Authorization Denials Home Modification Authorization Denials QMUM- -7 7 Home Modification Denial Rate Southwest 3% 3% 2% Total Denials 2% Q T R A H C P H W U P M C 1% 1% 1% Jan 0 0 1 0% 0% 0% Jan-19 AHC PHW UPMC 4/4/2025 17
MONITORING REPORT DATA MONITORING REPORT DATA- - QMUM Home Modification Authorization Denials Home Modification Authorization Denials QMUM- -7 7 Home Modification Denials Southeast 100% 90% 80% Total Denials 70% 60% Q T R A H C P H W U P M C 50% 40% 30% 20% Jan 0 0 0 10% 0% 0% 0% 0% Jan-19 KF PHW UPMC 4/4/2025 18
OPS-003 Department of Health (DOH) Complaints and Grievances Purpose: Quarterly report on the number and status of participant complaints and grievances reported by the CHC-MCO to DOH OPS-004 Complaints and Grievances Detail Purpose: Quarterly report that itemizes reasons for participant filing a complaint or grievance 4/4/2025 19
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -004 004 Complaints per 10,000 Southwest Total Complaints 40 36 Q T R A H C P H W U P M C 36 35 35 29 30 26 25 Q1 1 53 76 23 25 19 20 Q2 4 42 63 15 Q3 5 74 114 10 Q4 3 84 80 4 4 3 5 1 0 Q1 2018 Q2 2018 Q3 2018 Q4 2018 AHC PHW UPMC 20 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -004 004 Grievances per 10,000 Southwest Total Grievances 35 31 31 Q T R A H C P H W U P M C 30 25 21 Q1 6 23 32 20 17 15 14 15 Q2 24 70 93 11 11 10 9 10 7 Q3 17 40 49 4 5 Q4 14 70 62 0 Q1 2018 Q2 2018 Q3 2018 Q4 2018 AHC PHW UPMC 21 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -003 003 Percent of Complaints In Favor of Participant Southwest 80% 74% 69% 70% 66% 64% 64% 60% 54% 50% 50% 40% 30% 20% 10% 4% 4% 1 1 0% 0% 0% 1 0% Q1 2018 Q2 2018 Q3 2018 Q4 2018 AHC PHW UPMC 1 AHC did not have any complaints in this quarter 22 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -003 003 Percent of Grievances in Favor of Participant Southwest 70% 63% 63% 59% 60% 53% 50% 50% 45% 40% 40% 40% 33% 30% 19% 20% 13% 10% 5% 0% Q1 2018 Q2 2018 Q3 2018 Q4 2018 AHC PHW UPMC 23 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -004 004 LTSS Grievances Per 10,000 By Category Southwest Total LTSS Grievances By Category 8 PHW UPMC AHC AHC 0 1 0 1 PHW 0 0 0 0 UPMC 2 0 0 1 7 DME for NFCE Q1 Q2 Q3 Q4 6 5 0 4 6 4 2 Non-Medical Transport Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 12 5 10 1 5 5 0 0 0 0 0 0 0 0 0 0 0 6 26 3 2 0 2 2 1 1 0 0 PAS 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other LTSS Q1 2018 Q2 2018 Q3 2018 Q4 2018 24 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS Complaints & Grievances Complaints & Grievances OPS- -004 004 Southwest Plan Top Non-LTSS Grievance Categories Top Non-LTSS Complaint Categories Non Covered Physical Health, Other Physical Health Issues, MCO Administration, MCO Courteous Service Non Emergency Medical Transportation, Courteous Provider Office Staff, Courteous Service by MCO MCO Administration, Courteous Office Staff, Non Covered Physical Health, MCO Courteous Service, Quality of Clinical Care Pharmacy, Outpatient Medical Service, Dental, PAS, Dentures AHC Pharmacy, Dental-Dentures, Other Physical Health PHW Home Health, Other Physical Health, Pharmacy, Dental - Other (Includes Denials of Dental Services Other than Braces or Dentures) UPMC 4/4/2025 25
OPS-008 Missed Services Purpose: Monthly report that identifies all services that were not delivered for participants Purpose: Monthly report that identifies all services that were not delivered for participants who utilize home health skilled care, home health aide services and personal assistance who utilize home health skilled care, home health aide services and personal assistance services. This report also identifies all non services. This report also identifies all non- -delivered or late trips for medical, non delivered or late trips for medical, non- -emergency emergency medical and non medical and non- -medical transportation services. medical transportation services. 4/4/2025 26
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % Of Hours Agency Could Not Staff Southwest 0.20% 0.18% 0.18% 0.17% 0.16% 0.14% 0.12% 0.11% 0.10% 0.07% 0.08% 0.06% 0.04% 0.03% 0.02% 0.02% 0.00% Q4 2018 Jan-19 AHC PHW UPMC 27 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % Of Hours Agency Could Not Staff Southeast 0.04% 0.04% 0.04% 0.03% 0.03% 0.02% 0.02% 0.02% 0.01% 0.00% 0.01% 0.00% Jan-19 KF PHW UPMC 28 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % of Hours Participant Refused Southwest 0.35% 0.32% 0.30% 0.25% 0.25% 0.24% 0.25% 0.20% 0.14% 0.15% 0.10% 0.05% 0.05% 0.00% Q4 2018 Jan-19 AHC PHW UPMC 29 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % of Hours Participant Refused Southeast 0.18% 0.16% 0.16% 0.14% 0.12% 0.12% 0.10% 0.08% 0.06% 0.04% 0.02% 0.01% 0.00% Jan-19 KF PHW UPMC 30 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % Of Hours Participant Had Unplanned Hospitalization Southwest 0.30% 0.27% 0.25% 0.25% 0.20% 0.16% 0.15% 0.10% 0.05% 0.04% 0.05% 0.03% 0.00% Q4 2018 Jan-19 AHC PHW UPMC 31 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Home Health/HHA/PAS Home Health/HHA/PAS OPS- -008 008 % Of Hours Participant Had Unplanned Hospitalization Southeast 0.16% 0.15% 0.14% 0.12% 0.10% 0.08% 0.06% 0.05% 0.04% 0.02% 0.01% 0.00% Jan-19 KF PHW UPMC 32 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % Of Trips Missed Southwest 1.4% 1.3% 1.2% 0.9% 1.0% 0.9% 0.8% 0.8% 0.7% 0.6% 0.4% 0.3% 0.2% 0.0% Q4 2018 Jan-19 AHC PHW UPMC 33 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % Of Trips Missed Southeast 4.0% 3.6% 3.5% 3.0% 2.5% 2.1% 2.0% 1.5% 1.0% 0.5% 0.0% 0.0% Jan-19 KF PHW UPMC 34 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % of Trips Late Southwest 5.6% 6.0% 5.0% 3.6% 4.0% 3.0% 3.0% 2.2% 2.0% 0.8% 0.7% 1.0% 0.0% Q4 2018 Jan-19 AHC PHW UPMC 35 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % of Trips Late Southeast 9.00% 7.7% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.04% 0.00% 0.00% Jan-19 KF PHW UPMC 36 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % Of Trips Participant Refused Southwest 25.0% 22.1% 20.0% 15.0% 10.0% 6.6% 5.0% 3.3% 2.8% 0.0% 0.0% 0.0% Q4 2018 Jan-19 AHC PHW UPMC 37 4/4/2025
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS MISSED SERVICES MISSED SERVICES Transportation OPS- -008 008 Transportation % Of Trips Participant Refused Southeast 30.0% 25.8% 25.0% 20.0% 13.9% 15.0% 10.0% 5.0% 0.0% 0.0% Jan-19 KF PHW UPMC 38 4/4/2025
OPS-021 Person Centered Service Plan Changes Purpose: Monthly report that identifies changes to PCSPs, including Purpose: Monthly report that identifies changes to PCSPs, including increases and decreases increases and decreases 4/4/2025 39
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 Percent of PCSPs with An Increase Southwest 8% 7% 7% 6% 6% 5% 4% 4% 3% 2% 2% 2% 2% 1% 1% 1% 1% 0% 0.3% 0.2% 0.1% 0% 0.0% 0% Q1 2018 Q2 2018 Q3 2018 Q4 2018 Jan-19 AHC PHW UPMC 4/4/2025 40
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 Percent of PCSPs with A Decrease Southwest 1.0% 0.9% 0.9% 0.8% 0.8% 0.7% 0.7% 0.6% 0.5% 0.4% 0.4% 0.4% 0.3% 0.3% 0.2% 0.2% 0.1% 0.1% 0.1% 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan-19 AHC PHW UPMC 4/4/2025 41
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 % Of PCSPs Decreased Due to MCO Decision to Reduce Services Following a Reassessment Southwest 0.3% 0.3% 0.3% 0.3% 0.2% 0.2% 0.2% 0.1% 0.1% 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan-19 AHC PHW UPMC 4/4/2025 42
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 Total Number of PAS Hours Reduced Due to MCO Decision to Reduce Services Following a Reassessment Southwest 0 0 0 0 0 0 0 0 0 0 -6 0 -53 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan-19 -500 -1000 -1220 -1500 -2000 -2229 -2500 -2495 -3000 AHC PHW UPMC 4/4/2025 43
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 Number of Participants With A Reduction to Services Due to an MCO Decision Following a Reassessment Southwest 25 20 19 20 15 11 10 0 0 0 0 0 5 1 1 0 0 0 0 0 0 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan-19 AHC PHW UPMC 4/4/2025 44
MONITORING REPORT DATA MONITORING REPORT DATA- - OPS PERSON CENTERED SERVICE PLAN CHANGES PERSON CENTERED SERVICE PLAN CHANGES OPS- -021 021 Average Number of Hours Reduced For Participants With A Reduction to Services Due to an MCO Decision Following a Reassessment Southwest 0 0 0 0 0 0 0 0 0 0 0 -6 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan-19 -20 -40 -60 -53 -80 -100 -111 -120 -111 -140 -131 AHC PHW UPMC 4/4/2025 45
