Pennsylvania’s new plan for managed long-term services and supports for older adults and those with disabilities is expected to serve about 450,000 people, including 130,000 older adults and adults with physical disabilities who currently receive LTSS in the community and in nursing facilities, once it is fully implemented in 2019.
Features of the plan are described in a new concept paper released by the state’s human services and aging departments. Stakeholders are invited to comment through Oct. 16.
The managed LTSS plan, named Community HealthChoices, is an integrated system of physical health and LTSS with goals of improving health outcomes and enabling individuals to live as independently as possible, according to the departments. CHC is designed to support individuals dually eligible for Medicare and Medicaid, whereas the current LTSS system operates separately from the Medicare and Medicaid physical health systems.
Additional features of the plan, according to the concept paper:
- Participants will have a choice of two to five CHC managed care organizations, or MCOs, in each region of the state.
- Value-based incentives will be used to increase the use of home- and community-based services and meet other program goals.
- Measures of both program and participant-level outcomes will be standardized so that overall program performance may be assessed and the program can be improved over time.
- CHC MCOs will be accountable for most Medicaid-covered services, including preventive services, primary and acute care, LTSS (HCBS and nursing facilities), prescription drugs and dental services.
- Dual-eligible participants will have the option to have their Medicaid and Medicare services coordinated by the same MCO.
The concept plan was created after verbal feedback was received in June and July at six public forums across the state that were attended by a total of more than 800 stakeholders. Also, 316 organizations and individuals sent comments via mail and e-mail.
Feedback will shape the November request for proposals for CHC MCOs, according to the state. The RFP is tentatively scheduled to be awarded in March. CHC will go live in the Southwest region of Pennsylvania in January 2017, in the Southeast region in January 2018, and in the Northwest, Lehigh-Capital and Northeast regions in January 2019.