Updates and Key Takeaways from Recent LTSS Sub-MAAC Meetings and Workshops
Stay informed with comprehensive updates from recent LTSS Sub-MAAC meetings covering program enrollment, provider workshops, transportation summits, and changes in MCO-Provider relationships. Key takeaways include evaluation of innovative transportation support, service coordination expectations, and enrollment service procurement updates.
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Presentation Transcript
OLTL Updates LTSS Sub-MAAC Meeting June 11, 2019 4/4/2025 1
Agenda CHC Updates Program Enrollment Updates 2
CHC Updates 4/4/2025 3
Phase 3 Provider Workshops Lehigh/Capital Zone: OLTL conducted Provider Workshops in Harrisburg, Shippensburg, and Kutztown. A Transportation Summit was also held in Kutztown. Approximately 600 people attended. Northwest Zone: OLTL conducted Provider Workshops in Edinboro, Lock Haven, and Bradford. A Transportation Summit was also held in Bradford. Approximately 420 people attended. Northeast Zone OLTL conducted Provider Workshops in East Stroudsburg, Scranton, and Bloomsburg. A Transportation Summit was also held in Bloomsburg. Approximately 520 people attended. 4
Transportation Summits Key Takeaways Evaluate potential areas for innovation to support the informal transportation supports currently being provided by direct care workers. Continue to facilitate discussion to ensure MCOs, providers, and other stakeholders understand the various transportation resources offered through Commonwealth programs. Increase communication to service coordinators regarding the role of the transportation brokers in CHC. 5
CHC Southeast Continuity of Care The Continuity of Care period ends in the Southeast zone of CHC on June 30th. What can participants expect at the end of the continuity of care period? A comprehensive needs assessment Person-centered service planning A revised person-centered service plan 6
CHC Southeast Continuity of Care MCO Provider Relationships UPMC has notified 72 providers, primarily service coordination entities, that they will discontinue contracts. Keystone First has notified 67 service coordination entities that they will discontinue contracts. The 5,844 Keystone First participants and the 4,337 UPMC participants who are impacted have also been notified so they may begin selecting new service coordinators. 7
Enrollment Updates 4/4/2025 8
Enrollment Services Procurement Enrollment Services Procurement Enrollment services RFI released for comment. Comments received were integrated into a Draft RFA that will be released for comment by the end of June 2019. A summary of the comments received will also be published. RFA Publication 45 day response period Data Source: Maximus IEB 9
Average Number of Days in Enrollment Status Average Number of Days in Enrollment Status SNAPSHOT - Average Days in Status STATUS PC & LCD Pending PC Received/LCD Pending PC Pending/LCD Received APP_REVIEW READY_ASSESSMENT SCHEDULED ASSESSMENT_INPROCESS OLTL_READY MMS_READY READY_TRANSITION 6/29/2018 9/28/2018 12/31/2018 1/31/2019 9 7 14 11 40 37 2 3 2 2 7 12 3 2 9 4 2 2 2/28/2019 8 15 36 11 3 9 11 5 1 EXPLANATION Application Started, PC and LCD Requested PC Received/LCD Pending PC Pending/LCD Received LCD and PC under review NFCE, In process of scheduling the In Home Visit In Home visit scheduled In Home visit completed and under review Eligibility under review by OLTL Eligibility under review by Maximus Functionally eligible, pending Nursing Facility discharge date 12 18 42 6 5 15 5 9 4 9 14 40 4 4 14 5 0 1 61 58 59 55 57 APPROVED 1768_DENIAL FINANCIAL_DENIAL Functionally eligible, 1768 sent to CAO Functionally ineligible, notice pending Financial Denial Received, application in process of completion 33 2 29 2 39 4 39 2 30 3 5 0 9 0 0 FINANCIAL_APPROVAL Financial Approval Received, enrollment in process of being finalized 3 5 1 4 8 Data Source: Maximus IEB 10
ADRC Involvement in the Application Process ADRC Involvement in the Application Process Date Period: March 2018 through March 2019 PCC REFERRALS VIA IEB BY MONTH 180 153 160 130 140 120 96 94 100 83 74 80 59 55 60 50 50 60 39 38 40 20 0 Data Source: Aging and Disability Resource Office 11
ADRC Involvement in the Application Process ADRC Involvement in the Application Process Data Period: March 2018 through March 2019 PCC Referrals via IEB by Age Group 32% 68% Over 60 Under 60 Data Source: Aging and Disability Resource Office 12
ADRC Involvement in the Application Process ADRC Involvement in the Application Process Data Period: March 2018 through March 2019 PCC Referrals via IEB by County 700 600 500 400 300 200 100 0 Data Source: Aging and Disability Resource Office 13
Current IEB Report All Waivers 2018QTR2 2016 QTR4 2017 QTR1 2017 QTR2 2017 QTR3 2017QTR4 2018QTR1 24715 14860 11584 2018QTR3 25464 15842 12252 351 80% Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 23251 15437 12287 275 81% 19068 11902 9396 318 82% 18599 9735 8401 258 89% 25355 15379 13286 308 88% 26323 17597 14639 347 85% 25505 15795 12833 350 83% 414 81% 59 55 58 55 61 56 59 56 All unduplicated applications in process this quarter Total unduplicated applications completed this quarter Total unduplicated applications completed during the quarter in 90 days Total unduplicated applications completed during the quarter and over 90 days, but with excuse of a delayed enrollment Using the above fields = (row 3 + row 4)/ row 2 Average to complete excluding excused applications Note: Reapplications removed 1. 2. 3. 4. 5. 6. Data Source: Maximus IEB 14
Current IEB Report 2018QTR2 2018QTR3 14948 9303 7246 234 80% 57 Over 60 Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 2016 QTR4 2017 QTR1 2017 QTR2 2017 QTR3 2017QTR4 2018QTR1 14072 9802 7280 155 76% 11804 7495 5791 206 80% 10462 5654 4837 154 88% 14084 8548 7318 201 85% 13275 8555 6892 188 83% 14362 8702 6816 249 81% 15072 9442 7604 231 83% 64 62 59 60 59 58 56 2018QTR2 2018QTR3 10516 6539 5006 117 83% 62 Under 60 Grand Total Complete Complete in 90 Days Complete > 90 Days With Excuse Compliance Percentage Average Days To Complete 2016 QTR4 2017 QTR1 2017 QTR2 2017 QTR3 2017QTR4 2018QTR1 9179 6149 5504 126 92% 7925 5066 4212 129 86% 8137 4081 3564 104 90% 11272 6832 5968 107 89% 10280 6781 5535 137 84% 10353 6158 4768 162 83% 10433 6353 5229 119 78% 45 54 53 62 58 60 55 2018 QTR 4 data is not yet available 1. 2. 3. 4. All unduplicated applications in process this quarter Total unduplicated applications completed this quarter Total unduplicated applications completed during the quarter in 90 days Total unduplicated applications completed during the quarter and over 90 days, but with excuse of a delayed enrollment Using the above fields = (row 3 + row 4)/ row 2 Average to complete excluding excused applications Note: Reapplications removed 5. 6. Data Source: Maximus IEB 15
IEB Issues Average Application Processing Timelines For applications that closed during the 3rd quarter of 2018 App Begin to Enrollment/Denial 56 days From Referral to Enrollment/Denial 57 days 2018 QTR 4 data is not yet available 4/4/2025 16
Consumer Eligible for Services Monthly HCBS Total Enrollment by Month 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - FFS Aging FFS Non-Aging CHC 60 and over CHC Under 60 FFS Non-Aging includes: Attendant Care, Independence, and OBRA waivers Data Source: eDW Monthly Standard Reports 17
