(Community HealthChoices Logo)
To: Providers of Community HealthChoices (CHC)-covered home health skilled care, home health aide services, and personal assistance services
Subject: Requirement to Report Missed Services to CHC Managed Care Organizations (MCOs)
In administering the Office of Long-Term Living (OLTL) Home and Community-Based Services (HCBS) Waivers, OLTL requires service coordinators to monitor that waiver participants receive all HCBS services authorized in their service plans and to develop a backup plan in case a service could not be provided. If a provider is unable to provide an authorized service, the service coordinator must work with the participant to secure another provider to provide the service as specified in the participant’s backup plan. In addition, service coordinators and providers must report critical incidents, including any critical incident occurring as a result of the participant’s failure to receive services which placed the participant’s health or safety at risk, in accordance with OLTL’s Critical Incident Management Bulletin.
With the implementation of CHC, OLTL is adopting a different reporting process for HCBS similar to the process currently implemented in the HealthChoices program. Since CHC-MCOs cover all authorized home health skilled care, home health aide and personal assistance services, OLTL is expanding the current HealthChoices operations report to identify all missed services for participants who utilize these services.
Providers of CHC-covered home health skilled care, home health aide services, and personal assistance services must submit information on missed services to the CHC-MCOs. CHC-MCOs must submit a missed services operations report to OLTL on a monthly basis that includes detailed information on missed services, such as the date of the missed service, the reason for the missed service and actions taken to address the missed service in both the short and long term.
In its CHC oversight role, OLTL will review these monthly reports along with complaint and grievance, CHC-MCO inquiry, and EIM data to monitor the health and welfare of CHC participants. Providers who do not submit the required information to the CHC-MCO may face corrective actions.
CHC-MCOS will notify their home health and home care network providers of their reporting requirements. Please direct any questions about these reporting requirement to the CHC-MCOs.
A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.
To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.
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