National Association of Medicaid Directors November 8, 2016 Jennifer Burnett, Deputy Secretary Department of Human Services Office of Long-term Living

History of Managed Care in Pennsylvania Mandatory Medicaid managed care was introduced in the 5 county Philadelphia area in 1997. Implemented through a geographically phased roll-out. Completed statewide implementation in 2013 MA total enrollment:  2.8 million (as of Oct 2016; includes newly eligible under Medicaid Expansion)

The Basics What is Community HealthChoices (CHC)? CHC is a Medicaid managed care program that will include physical health benefits and long-term services and supports. Who is part of CHC? Individuals who are dually eligible for Medicare and Medicaid Individuals who are eligible for Medicaid long-term services and supports (LTSS) because they need the level of care provided by a nursing facility

CHC Population Duals in Waivers 49,759 Non-Duals in Waivers 15,821 Duals in Nursing Facilities 77,610 Non-Duals in Nursing Facilities 7,314 Non-LTSS Duals 270,114 TOTAL 420,618 9/18/2018

Community HealthChoices Goals

CHC Roll Out 9/18/2018

Readiness Review Measures readiness of Managed Care Organizations (MCO) prior to CHC going-live Readiness Review criteria and benchmarks are set by the Department Completed as desk review and on-site Readiness Review Teams: One team will be assigned to each MCO Average team consists of 3-4 staff from the Department Each team will have up to 10 Subject Matter Experts (SME) CHC Readiness Review will review all LTSS components. Physical Health will be reviewed in conjunction with HealthChoices.

Launch: Indicators to be Reviewed Participants are enrolled and receive LTSS services without interruption Service Coordination is functioning well LTSS providers continue delivering services and are paid promptly Networks are Robust Communication is effective (stakeholders have the information they need)