The Departments of Human Services and Aging Monday released a discussion document that is the next critical step in Gov. Wolf’s plan to improve care coordination and to move to a Medicaid Managed Long-Term Services and Supports program.
This document lays out how the Governor’s proposed FY 2015-16 budget commitment to better the lives of older Pennsylvanians and individuals with physical disabilities will occur, by streamlining eligibility for and access to services while enhancing their quality and coordination.
In February 2015, the Governor directed the departments to explore MLTSS as a way to increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. When giving this charge, the Governor encouraged innovation, making it clear that the status quo is not acceptable.
“Over 95 percent of Pennsylvanians want to age in their home and not in an institution. The Governor’s plan will provide more choices for those who want to live in the community,” said Acting DHS Secretary Ted Dallas. “The results will be better access to health care, more choices, and better results.”
This initiative will result in a more strategic care delivery system and improve health outcomes for seniors and individuals with disabilities. By contracting with Managed Care Organizations, MLTSS will create a capitated model that will improve care coordination and health outcomes while allowing more individuals to live in their community.
Dual eligible adults (excluding individuals eligible for Medicaid-funded and Base-funded programs available through the Office of Developmental Programs) over the age of 21 who are entitled to Medicare Part A and/or Part B and Part D and are eligible for Medicaid benefits, all nursing facility clinically eligible non-dual eligible adults age 18 and older who are eligible for the Pennsylvania Medicaid Program, and Non-Medicaid recipients of the Act 150 Program will be enrolled in MLTSS.
DHS and PDA will engage stakeholders to ensure that the system is person-centered, breaks down barriers, and fills in the gaps that exist in the long-term care services and supports system. Pennsylvania currently serves more than 130,000 Pennsylvania adults with LTSS needs in the Medicaid program.
To achieve these goals, MLTSS will be designed to include these components:
— Person-Centered Program Design and Service Plan Development: Services and supports will be based upon the needs of each unique individual. A standard assessment will be developed to ensure that individual service plans address the needs of individuals. The service planning process will be person-centered, maximize opportunities for self-direction, and include transitions between settings to ensure quality outcomes.
— Services and Care Coordination: Vendors will provide physical, behavioral and LTSS services. This coordination is a key component that will ensure the health and welfare of participants and avoid unnecessary duplication of services.
— Access to Qualified Providers: Vendors will contract with appropriately qualified providers. Their network must provide access to an adequate number of providers, meet qualifications and credentialing, and provide participant protections.
— Emphasis on Home and Community-Based Services: MLTSS will be developed consistent with current HCBS waiver requirements. This will require an emphasis on providing services in the least restrictive setting.
— Performance-Based Payment Incentives: A payment structure will be developed that encourages quality outcomes.
— Participant Education and Enrollment Supports: Participant education and enrollment support will provide conflict-free counseling for participants to understand their options, independent enrollment functions, and advocacy and ombudsman services.
— Preventive Services: Preventive services include, but are not limited to, wellness checks, colonoscopies, mammograms, and preventive vaccinations as well as services to promote long-term health.
— Participant Protections: Participants will have grievance and appeals processes available to ensure appropriate services are provided.
— Quality and Outcomes-Based Focus: MLTSS will include a quality evaluation component to ensure that the system is person-centered, coordinated, and provides improved outcomes.
The Wolf Administration is committed to improving the health and welfare of older Pennsylvanians and individuals with physical disabilities by implementing a system that breaks down barriers and fills the gaps that currently exist in the long-term care services and supports system.
Over the next few months, the departments will meet with recipients, caregivers, advocates, providers and other stakeholders through the public input process.
“Currently, individuals using long-term care services and supports are among the most sick and vulnerable, namely our seniors and persons with disabilities. As a Commonwealth committed to providing choice and protections for these diverse populations, the stakeholder engagement process is an important step to ensure that we successfully expand access to home and community-based services while increasing the quality and experience of care,” said PDA Secretary Teresa Osborne.Submit your written comments and feedback via email to: RA-MLTSS@pa.gov. For more information and to view the discussion document, visit the Managed Long-Term Services and Supports webpage.