MLTSS Riding the Tidal Wave of Change A Consumer Perspective on Community HealthChoices Roll Out in SW Pennsylvania October 3, 2018

Today’s Session Who we are and our perspective The Community HealthChoices Southwestern PA Roll Out Who is included Communications Service Coordination – Community and Nursing Facilities Person Centered Planning Service Delivery – PAS, Transportation, Home Modifications Specialized Populations – Brain Injury The Role of PHLP What We Learned / Improvements Riding The Tidal Waive of Change October 3, 2018

The Perspective We Bring TRPIL XtraGlobex Centers for Independent Living are a resource for participants Commitment to the success of Community Health Choices Developing strong partnerships with the Managed Care Organizations Pushing the bar, don’t be afraid to ask questions Supporting participant's through the process Strategic Consultants Grounded in Consumer Advocacy Focus on Quality and Readiness Committed to Providers Succeeding in New Environment Actively Facilitating Communications and Consumer Needs Proactively Bringing Providers Together Riding The Tidal Waive of Change October 3, 2018

Community HealthChoices Roll Out SWPA - Over 82,000 Participants Enrolled Stable Enrollment at End of Continuity of Care period Regional Dominance of UPMC Rebalancing Efforts In Focus by MCO’s Better Execution in PAS than other Services Continuing Challenges in Transportation, Home Modifications, and Special Populations Consumer Confusion about Medicaid / Medicare Coordination SE Roll Out Communications Started Riding The Tidal Waive of Change October 3, 2018

Communication Multiple channels were used to get the message out Issues with communication and how they worked through How the State continues to address issues CHANNELS TO GET COMMUNICATION OUT: Informational Flyers sent out to participants informing them of the changes Community Meetings Aging Well Presentations Notices mailed out to participants with specifics Pre enrollment packets Post – enrollment packets B. Communication with the participants started later than it should have. The state has addressed this issue started communication with the roll out of phase two earlier. C. Participants were overwhelmed with the documents related to choosing a provider. D. Many participants did not receive provider choice documents. E. The enrollment website was not launched prior to the auto assignment date. F. The telephone helpline for enrollment had serious customer service issues. Riding The Tidal Waive of Change October 3, 2018

Consumer Experience: Lauren MAWD recipient, employed full time Uses agency model daily, supports at home and work Has experienced significant stress during rollout Currently has no copy of her service plan or authorization Finds most recent changes to be intrusive Riding The Tidal Waive of Change October 3, 2018

Service Coordination Objectives of Service Coordination in Community Health Choices Administrative function in Pennsylvania controlled by the Managed Care Organizations Needs Assessment Process Appropriate service delivery Coordination of Medicare; Behavioral Health Services and Medicaid Coordination with Non-Medicaid Services Service Coordination Network Consolidation The primary objective of service coordination in CHC was to oversee the person-centered service planning process and to provide support for CHC program participants, targeting participants with um met needs. EXAMPLE: Pest eradiation; unmet housing needs ISSUES: Many service coordination entities were not adequately informed to support participants in understanding choice. Providers fell ill prepared to provide services Communication about the role of service coordination beyond the continuity of care period has been very unclear and stressful for participants. D. State solicits input but responses are inconsistent. Riding The Tidal Waive of Change October 3, 2018

Person Centered Planning Process Person Centered Planning Process is Essential Success Factor Consumer Active Engagement MCO’s / SC’s Providers and Informal Supports Inconsistent Implementation by MCO’s and SC’s Consumer ties the support they need to specific goals Consumers Understanding of Array of Services Now Available – Broad Perspective versus Specific Historical Services Community Participation and Rebalancing Example: Needed supports- Transportation and PAS-Outcome “My DCW will meet me at the pool to support my participation in aquatic exercise class” Outcome: Greater social connection and increased wellness Riding The Tidal Waive of Change October 3, 2018

Role of the Pennsylvania Health Law Project Independent / Unique to Pennsylvania Monitor Implementation / PCPP Establish observation process for new assessments to provide feedback to OLTL Resource for grievance and appeal process Stakeholders Advisory Group Provide Legal support to individuals as needed Riding The Tidal Waive of Change October 3, 2018

Consumer Experience: Keith Long time advocate for and user of consumer employer model PAS Very unhappy about moving from OBRA to CHC Has had difficulty with service coordination changes Fears new policies will inhibit his community activity Riding The Tidal Waive of Change October 3, 2018

Service Delivery Personal Assistance Services Consumer Directed Model Agency Model Transportation – MATP and EMATP Home Modifications Riding The Tidal Waive of Change October 3, 2018

Electronic Visit Verification (EVV) Required by Federal Law to Address Issues of Fraud and Abuse Streamlines Timesheet Processing / Payroll In PA, Intertwined with Authorization, Scheduling and Billing Processes (HHAX) Consumer Concerns About Privacy and Flexibility Direct Worker Concerns Challenging Implementation and Transition for Providers of PAS Riding The Tidal Waive of Change October 3, 2018

Special Populations / Needs Brain Injury Services Cognitive Difficulties Consumer / CLE Engagement Person Centered Planning Specialized Therapies Nursing Facility Participants Access to Transition Information and Supports Housing Community Integration / Transportation Riding The Tidal Waive of Change October 3, 2018

Where are we now? Many hiccups- Program design had all the right elements, just not working as expected Work to establish a rate that enables providers to better meet participants needs Attempts have been made to cut existing plans, communication with the plan is imperative Payments are slow Riding The Tidal Waive of Change October 3, 2018

How We Are Working to Improve Things Communication channels between participants, MCO’s and the stat Community listening sessions Informal peer support Provider Networks Evolving Around Quality Provider Awareness and Readiness Engagement in Measurement of Timely and Quality Delivery of Services Revenue and Payment Cycles Well established communication channels between the state and providers/advocates are in place/ weekly calls / provider networks Community listening sessions have provided a form for consumers to voice concerns Provider Networks In the Rural Southwest, there is a robust network of informal peer support being formed to help consumers navigate their individual issues Riding The Tidal Waive of Change October 3, 2018

Questions? Contact Us: Fady Sahhar : fadysahhar@xtraglobex.com Andrea Costello: acostello@trpil.com Brenda Dare: bdare@trpil.com Riding The Tidal Waive of Change October 3, 2018