CHC is a relatively new program introduced in three phases (geographic regions) over a three-year period. The final phase was introduced in January 2020, which means that HCC is now available nationwide. Individuals who received services through the Pennsylvania Department of Aging Medicaid Waiver were automatically enrolled in the CHC as soon as it became available in their area. In July 2020, the Pennsylvania Department of Human Services (DHS) announced that the applicants had been selected through an Application Form (RFA) for Pennsylvania`s HealthChoices program, the Medicaid Physical Health Managed Care program that provides health care to more than 2.6 million people. To be eligible for Medicaid, there are both income and asset limits. For the state of Pennsylvania, the basic rule is that seniors must have an income not exceeding 300% of the federal benefit rate (RBF). Starting in 2020, this means that a single senior cannot have an income of more than $2,349 per month. The asset limit for a single senior is $2,000, although the state of Pennsylvania allows non-compliance with an additional $6,000, allowing for total negligence of $8,000. In addition, some exceptions are allowed,.B i.e. their own home, since the person lives in the house or intends to return to it and the net worth is less than $595,000, household items and personal belongings.
In October 2019, the ministry again issued a Request for Applications (RFA) calling on MCOs to manage HealthChoices in the five zones. In July 2020, DHS again announced the selected candidates for PA`s HealthChoices Physical Health program. The candidates selected for each service area are: Northeast: Aetna Better Health, AmeriHealth Caritas Northeast, Geisinger Health Plan CHC provides medical services to the elderly and physically disabled as well as long-term support services to promote independent living and avoid unnecessary stays in nursing homes. Benefits include personal care services such as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADL) such as bathing, meal preparation and medication management. Enrolment in this program is mandatory for those who meet the admission requirements. Three times since 2015, the state has issued tenders from managed care companies, and every three times, at least one of the losing parties has responded to their defeat with a lawsuit. . Southeast: Aetna Better Health, Health Partners, Keystone First and UnitedHealthcare.
• Information and Models on Complaints and Complaints The Pennsylvania Community HealthChoices (CHC) program is a Medicaid-managed care program for people 21 years of age or older who are eligible for both Medicaid (known in Pennsylvania as Medicaid Assistance) and Medicare (the federal health insurance program) or those who need a retirement home. While this program is not exclusively for seniors, it is highly relevant to seniors, as many are doubly eligible for Medicaid and Medicare and/or require a level of care equivalent to that of a nursing home. . * Please note that eligible applicants who are on Medicare will continue to receive the same services as before. • DHS NewsroomLeave the latest news from the department Readers interested in more information about HealthChoices` procurement and RFA requirements can view them here. To be eligible for Long-Term Services and Support (THSS), a person must need a level of care that matches that of a nursing home. PHLP will keep readers informed as the procurement process evolves. Individuals who enroll in the CHC must choose a Managed Care Organization (MCO), which will provide medical assistance (Medicaid). Current MMOs include AmeriHealth Caritas Pennsylvania, Pennsylvania Health and Wellness, Keystone First, and UPMC Community HealthChoices. To choose your package, call 844-824-3655 or do it online here. If you don`t choose a plan, you`ll automatically be signed up for a plan. .
A variety of services, including long-term care services, are covered by this program and may include: Existing health plans will remain in place until the protests are resolved. Current HealthChoices plans by region are: People who are not yet approved for PA Medicaid should determine if they are eligible. If they are not eligible, they might consider working with a Medicaid planner. If they are eligible, they should contact their local county support office. PA Health and Wellness (PHW) has recently introduced new ambulatory/purchase and billing biopharmaceutical forms that providers can use for J-code or pharmacy requests for medical benefits. This new form ensures that PHW`s clinical investigators have all the information they need to complete your biopharmaceutical pre-approval. Please include all relevant medical documents with this new form to ensure timely determination of your pre-approval. Lehigh/Capital: Gateway Health, Geisinger Health Plan, Health Partners Plans, UPMC for You and Vista Health Plan (AmeriHealth Caritas), Current Registration by Area, County and Managed Care Plan can be found here. The current HealthChoices program is being implemented as part of the renewal of contracts originally awarded in 2012. The Pennsylvania Department of Human Services (DHS) strives to make data-driven decisions to better serve Pennsylvanians. DHS reported at the July meeting of the Medical Assistance Advisory Committee that four of the managed care plans offered submitted protests: Aetna Better Health, Gateway Health, PA Health & Wellness (Centene) and UnitedHealthcare.
These protests stop the process. DHS cannot begin the “readiness test” process or award contracts to selected plans. The Philadelphia Inquirer looked at the challenges that prevented Pennsylvania from awarding new HealthChoices Medicaid managed care contracts in the article “Insurers want Pa`s Medicaid business so much. they sue the state.” Many think this is because the state`s Medicaid managed care contracts are so lucrative — a stark contrast to the state`s Medicaid payments to providers, which are generally considered bad. The delay is not surprising. Readers may recall that the procurement process for physical HealthChoices was strained due to protests and lawsuits by Managed Care Organizations (MBOs) that lost their Medicaid benefit management offerings. Instead of awarding separate contracts for each region, as has been the case in the past, DHS combined the contracting process for all of its regional areas. This change, combined with the growth in program enrollments following Medicaid expansion, has sparked unprecedented interest and offerings from regional and national insurance companies. In Pennsylvania, these contracts are worth billions of dollars a year. Lehigh/Capital: Aetna Better Health, AmeriHealth Caritas, Gateway Health, UnitedHealthcare, UPMC for You The case is now before the State Commonwealth Court, and the stakes are high: the contracts have a five-year term, with a possible option for three more.
For the past six years, Pennsylvania has tried to revive its HealthChoices Medicaid managed care contracts, but every time that`s the case, the losing bidders sue the state and the procurement process stops. To be eligible for Community HealthChoices, you must be at least 21 years of age and reside in Pennsylvania. Applicants must also need a nursing home or be eligible for both Medicaid and Medicare. Transition Letters from MCO in Physical Health to MCO in Community HealthGIV Choice for the Southeast Region: We will be adding more resources to this section in the coming months. Looking for Ambetter? Please visit the Ambetter website. .