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PA Bulletin, Doc. No. 16-717



Availability of the Office of Long-Term Living's Community HealthChoices Home and Community-Based Waiver

[46 Pa.B. 2143]
[Saturday, April 23, 2016]

 The Department of Human Services (Department) is making available for public review and comment the proposed Community HealthChoices (CHC) 1915(b) waiver and the proposed CHC 1915(c) waiver amendment which, if approved, will govern operation of the CHC Program, the Commonwealth's managed long-term services and supports initiative.


 The CHC Program is a new initiative that will provide managed physical health care benefits and long-term services and supports (LTSS) to older persons and adults with physical disabilities (including individuals with acquired brain injuries) who require the level of care of a nursing facility. The CHC Program will also provide physical health coverage to citizens in this Commonwealth who are dually eligible for Medicare and Medicaid but do not require or qualify for LTSS. Services under the CHC Program will be provided through contracted managed care organizations (MCO). The goals of the CHC Program are to enhance opportunities for community-based services; strengthen health care and LTSS delivery systems; allow for new program innovations; promote the health, safety and well-being of enrolled participants; and ensure transparency, accountability, effectiveness and efficiency of the CHC Program.

 The Department intends to implement the CHC Program in three phases beginning in southwestern Pennsylvania in January 2017, following in southeastern Pennsylvania in January 2018 and in the remainder of this Commonwealth in 2019. On March 1, 2016, the Department and the Department of Aging released a Request for Proposal to start the procurement process for the selection of CHC MCOs.

 The Department plans to apply to the Federal Centers for Medicare and Medicaid Services (CMS) to operate the CHC Program under concurrent 1915(b) and (c) waivers. If approved by CMS, the waivers will be effective for a 3 1/2-year period. The 1915(b) waiver will authorize the Department to operate the CHC Program as a mandatory managed care program under which eligible participants will be required to receive services through the CHC MCOs. The 1915(b) waiver will also waive the requirement for all services for categorically-needy individuals to be equal in amount, duration and scope to enable CHC MCOs to provide wellness, care management and other services that are not available to other Medicaid participants not enrolled in CHC.

 The 1915(c) waiver will allow for the delivery of LTSS in home and community-based setting to CHC participants who require the level of care of a nursing facility. The Department intends to amend its existing CommCare waiver to become the CHC 1915(c) waiver. As a result, the CommCare waiver will no longer be available in nonmanaged care counties. Individuals residing in nonmanaged care counties who are currently enrolled in the CommCare Waiver will be transitioned to the Independence Waiver until the CHC Program is implemented in their region. To not disrupt services to these individuals, the Department will also amend the Independence Waiver to add services that are currently offered in the CommCare Waiver. In addition to the LTSS, case management and service coordination services will be delivered to participants as an administrative activity of the CHC MCOs.

 The proposed CHC concurrent 1915(b) and (c) waiver application and a more detailed summary of all provisions, including a list of LTSS which will be covered under the 1915(c) waiver, and a summary of the person-centered planning requirements, participant fair hearing rights and grievance and complaint procedures, participant safeguards, quality management processes, pay- ment methodologies and cost effectiveness demonstration are available for review at or by contacting the Department's Office of Long-Term Living at (717) 783-8412.

Fiscal Impact

 There is no fiscal impact associated with this notice.

Public Comment

 Interested persons are invited to submit written comments regarding the proposed waivers to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: CHC-PN, P. O. Box 8025, Harrisburg, PA 17105-8025. Comments may also be submitted to the Department to the attention of CHC-PN at Comments received within 30 days will be reviewed and considered for revisions to the proposed waiver and waiver amendment and the CMS final rule transition plan.

 In addition, the Department will hold two webinars to receive comments on the proposed CHC Program waiver and waiver amendment. Dates and times of the webinars, including dial-in information, is available at or by contacting the Department's Office of Long-Term Living at (717) 783-8412.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-1014. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 16-717. Filed for public inspection April 22, 2016, 9:00 a.m.]

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