Community HealthChoices (CHC) Waiver Transitions – DRP

Community HealthChoices (CHC) is a managed care program that will better coordinate the way participants receive their physical health services and long-term services and supports (LTSS) so that Pennsylvania can serve more people in their homes and their communities. CHC will serve Medicaid participants 21 years of age or older who also receive Medicare, need LTSS in their home or community, or are in nursing facilities. Today, there are five waivers in which participants receive LTSS. In the future there will be two ways.

 

CHC: will serve participants currently in the Aging, Attendant Care, Independence, and COMMCARE waivers. OBRA participants who are nursing facility clinically eligible will also move to CHC.

OBRA Waiver: will continue to serve participants 18 years of age and older who have a severe developmental disability requiring the level of care provided in an intermediate care facility/other related conditions (often referred to as ICF/ORC).

As CHC is phased in, there will be several steps taken to assure the individuals continue to receive services. The attached document shows the timeline of when these steps will occur.

 

ATTENDANT CARE AND INDEPENDENCE WAIVERS

What will happen?

·         Since CHC only serves participants 21 years of age and older, participants in the Attendant Care and Independence waivers who are between 18 to 20 years of age will be enrolled in the OBRA Waiver to receive LTSS services.

·         The OBRA Waiver will provide the same services available in Attendant Care and Independence waivers.  

·         It is DHS’ priority to ensure that participants’ services are not impacted in any way.

 

When will this happen?   

Southwest Zone: August 2017 to October 2017

Southeast Zone:  February 2018 to May 2018

Remaining Zones:  August 2018 to October 2018

 

COMMCARE WAIVER

What will happen?

·         The COMMCARE Waiver will end December 31, 2017. Any new applicants who would have been eligible for the COMMCARE Waiver after September 1, 2017, will be eligible for and enrolled in the Independence Waiver.

·         This means that participants who are receiving services in the COMMCARE Waiver who do not live in the Southwest Zone will be enrolled in the Independence Waiver before December 31, 2017. 

·         It is DHS’ priority to ensure that participants’ services are not impacted in any way.

 

When will this happen?   

COMMCARE Waiver participants residing outside of the Southwest Zone will be enrolled in the Independence Waiver by their service coordinators between July 2017 and November 2017.   

COMMCARE participants in the Southwest Zone will transition to CHC on January 1, 2018.

 

OBRA WAIVER

What will happen?

·         OBRA Waiver participants whose level of care determination was completed before November 18, 2016, will get an assessment to determine their eligibility for CHC. Those determined ineligible for CHC will remain in OBRA.

·         DHS is working with the Area Agencies on Aging, service coordinators, and providers to ensure assessments are completed in a timely manner. Participants will be contacted by their Area Agency on Aging to schedule a time for the assessor to meet with them to go through the assessment process. 

 

When will this happen?      

Southwest Zone: May 2017 to August 2017

Southeast Zone: October 2017 to February 2018

Remaining Zones: April 2018 to August 2018

 

*There are no additional transitions for Aging Waiver participants. Aging Waiver participants will simply transition to CHC when CHC begins in their zones.

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