Frequently Asked Questions (FAQ)
What does Community HealthChoices (CHC) do?
- Gives administration of the Attendant Care, Independence, CommCare and Aging Waivers to Managed Care Organizations.
- Gives administration of Medical Assistance coverage of nursing facility services to Managed Care Organizations.
- Puts most adults with Medical Assistance and Medicare into Managed Care Organizations for Medical Assistance.
Who will be excluded from the Community HealthChoices plan?
Individuals who are:
- Under the age of 21
- Using certain other waivers including:
- Consolidated waiver
- PFDS waiver
- Adult Autism waiver
- Anyone in or applying for the Act 150 program
- Individuals using the OBRA Waiver and are Nursing Facility Ineligible (NFI) (those who do not have significant physical limitations)
- Anyone in or applying for the LIFE program (another managed care program)
- Anyone not in a nursing facility with an intellectual disability or mental illness as a primary diagnosis
Why are only some people with the OBRA Waiver transitioning to Community HealthChoices?
Once a re-assessment of your ‘level of care’ occurs, individuals with significant physical limitations will be transitioned from the OBRA Waiver into a different waiver, called Independence. Individuals with developmental disabilities without a particular physical manifestation are not considered to have significant physical limitations and will not be included in Community HealthChoices.
What change will happen for people on CommCare?
CommCare will be transferred to Independence. Then, Independence will be amended to add residential habilitation and structured day habilitation to allow people now on CommCare to continue to receive those services. CommCare will be amended to become the global waiver for Community HealthChoices.
What types of services will Community HealthChoices provide?
Community HealthChoices global waiver will include all services currently covered by Independence, CommCare and Aging waivers. Community HealthChoices will also add the following services:
How will each affected waiver type be transferred?
- Aging→ Community HealthChoices (CHC)
- Independence→ CHC
- Attendant Care→ CHC
- CommCare→ becomes CHC waiver
- OBRA- if NFCE→ Independence
- Act 150: stays with OLTL
How will this change affect young adults, age 18-20?
Young adults, aged 18-20 who meet eligibility criteria for OLTL waivers will not be enrolled in Community HealthChoices until they turn 21. However, since OBRA will remain as a stand-alone waiver with minimum age of 18, they will be able to access home and community based services through OBRA until they turn 21.
How long will it take for a Managed Care Organization switch to become effective?
What is the contact number to speak with an Enrollment Broker?
How will Level of Care Assessments take place?
What type of assistance will the broker provide?
The broker will provide phone assistance, but not hands-on assistance. Once found eligible, the broker will assist with your choice of Community HealthChoices- Managed Care Organization.
How will service determination occur?
- The Community HealthChoices- Managed Care Organizations will conduct a “comprehensive needs assessment” for each of their enrollees to determine the type and amount of home and community based services or nursing facility they will authorize.
- After a “comprehensive needs assessment,” you and your service coordinator will develop a “Person-Centered Service Plan.”
- The plan will be submitted to Community HealthChoices- Managed Care Organization for review.
What qualifications will service coordinators have?
Service Coordinators must have an RN or bachelor’s degree in social work, psychology or other related fields, and at least three years of experience in a social service or health care related setting except those Service Coordinators hired prior to the Community HealthChoices zone effective date, who will be subject to qualifications and standards proposed by the Community HealthChoices- Managed Care Organizations and approved by the department.
Service Coordinator Supervisors must be an RN or a PA licensed social worker or PA licensed mental health professional with at least three years of relevant experience except that:
- Service Coordinator supervisors hired prior to the effective date with a master’s degree, but not a license, must obtain a license within their first year under the new Community HealthChoices contract in their zone.
- Service Coordinator supervisors hired prior to the Community HealthChoices zone effective date will be subject to qualifications and standards proposed by the Community HealthChoices- Managed Care Organizations and approved by the department.
How can you stay up to date on Community HealthChoices?
- Read the information on Department of Human Services website: http://www.dhs.pa.gov/citizens/communityhealthchoices
- Sign up to get email updates and webinar invitations: http://listserv.dpw.state.pa.us/oltl-community-healthchoices.html
- View OLTL webinars every third Thursday