Pennsylvania is changing the way it provides home and community-based care. The plan is called Community HealthChoices.
Here are a few things older Pennsylvanians should know: (also known as MLTSS or Managed Long Term Services and Supports)
WHAT IS COMMUNITY HEALTH CHOICES?
- A new way to get health care, and home and community-based services (HCBS), with a goal to help more older adults live in their homes.
- Provided through an insurance company called a Managed Care Organization (MCO): Health Insurance + Delivery of Care + Coordination.
- MCO manages all health care and services: Hospital Care + Medical Care + HCBS + Prescription Drugs + Preventive Care.
- Goal to make it easier to get needed HCBS such as meals, or the help of an aide to get washed and dressed.
- Consumers have a choice of MCO providers and providers within the MCO network such as physicians, home health, etc. MLTSS will provide the option and encourage the use of self-direction of services (consumer-directed model) and the consumer will be the focus of planning for care (person-centered planning)
WHO IS INCLUDED?
- People who are eligible for Medicare AND Medicaid (Dual-eligible).
- Nursing Facility Clinically Eligible (NFCE) – including those who may be getting services in nursing facilities or HCBS waivers like the Aging Waiver.
- Those in the LIFE program are NOT included.
WHAT RIGHTS DO CONSUMERS HAVE?
- Consumers have the RIGHT to appeal loss of care or care that is denied.
- Consumers have the RIGHT to complain about problems or the care they get.
WHEN AND WHERE?
- To start in July 2017 in Western PA.
- Moving to Southeast in January 2018.
- The entire state will be included by January 2019.
- Goal is for a smooth transition away from Aging Waiver services to MLTSS without loss of care and services.
WILL CONSUMERS BE PART OF THE PLANNING PROCESS?