April 18 2019 1 Kevin HancockDeputy Secretary Office of LongTerm Living Department of Human Services AGENDA CHC Provider Workshop Schedule and Registration Electronic Visit Verification EVV ID: 935674
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Slide1
Third Thursday Webinar
CHC Monitoring Report Update
April 18, 2019
1
Kevin Hancock/Deputy Secretary
Office of Long-Term Living
Department of Human Services
Slide2AGENDA
CHC Provider Workshop Schedule and Registration
Electronic Visit Verification (EVV)
CHC Monitoring Report UpdatesQMUM 7 Denial LogOPS-003/OPS-004 Complaints and Grievances
OPS-008 Missed ServicesOPS-021 Person Centered Service Plan Changes
2
Slide3UPCOMING PROVIDER WORKSHOPS
Save the date for our upcoming provider summits in the Northeast, Northwest, and Lehigh/Capital zones. These summits are educational conferences specifically for providers to learn more about CHC.
Please register at:
www.healthchoices.pa.gov/providers/about/community/index.htm
Lehigh/Capital Zone
Monday, May 13:
Harrisburg Area Community College
Tuesday, May 14:
Shippensburg University
Wednesday, May 15:
Kutztown University
Thursday, May 16 (Transportation Session Only):
Kutztown University
Northwest Zone
Monday, May 20:
Edinboro University
Tuesday, May 21:
Lock Haven University
Wednesday, May 22: University of Pittsburgh-BradfordThursday, May 23 (Transportation Session Only): University of Pittsburgh-BradfordNortheast ZoneTuesday, June 4: East Stroudsburg UniversityWednesday, June 5: University of ScrantonThursday, June 6: Bloomsburg UniversityFriday, June 7 (Transportation Session Only): Bloomsburg University
3
Slide4ELECTRONIC VISIT VERIFICATION (EVV)
4
Slide5WHEN WILL PENNSYLVANIA IMPLEMENT EVV?
April-May 2019 – Technical specifications and DHS Addendum to be distributed to providers.
August-September 2019 – Provider training to be offered with phased in system use. Training will continue to be offered through full implementation.
September-October 2019 – Go live and soft launch of DHS EVV system.
January 2020 – Full implementation of system as required by the 21st Century Cures Act.
OLTL waiver services included in the initial implementation of EVV include:
Personal Assistance Services (Agency and Participant-Directed Model)Participant-Directed Community Supports
Respite (unlicensed settings only)
Implementation of EVV for home health services will also be required by January 1, 2023.
5
Slide6EVV PROVIDER TRAINING
DHS will offer training for providers choosing to utilize the DHS EVV system.
Train the Trainer Model
Two attendees from each provider agency (Owner, Administrator, Administrative staff)
Agencies will need to train caseworkers on the mobile application, telephony, and web portal processesTraining formats will include:
Classroom TrainingWebinar Training
Self-paced TrainingAdditional resourcesLocations, dates, times and registration instructions for the various trainings will be posted on the DHS EVV website:
http://www.dhs.pa.gov/provider/billinginformation/electronicvisitverification/index.htm
6
Slide7CHC MONITORING REPORT UPDATES
7
Slide8QMUM 7 Denial Log: Home and Community-Based Services
Purpose: Monthly report that identifies denials of medical necessity, terminations, reductions and changes for covered services
4/16/2019
8
Slide9MONITORING REPORT DATA- QMUM-7
HCBS Authorization Denials
9
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Q1
00
0
Q2
0
0
0
Q3
1
1
45
Q4
3
0
86
Jan
1
7
16
Total Denials
Slide10MONITORING REPORT DATA- QMUM-7
HCBS Authorization Denials
10
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
002
Total Denials
Slide11MONITORING REPORT DATA- QMUM-7
Physical Health Prior Authorization Denials
11
4/16/2019
Total Denials
Q
T
R
A
H
C
P
H
W
U
P
M
C
Q1234128134
Q2
406
151
132
Q3
379
542
165
Q4
349
356
107
Jan
53
88
12
Slide12MONITORING REPORT DATA- QMUM-7
Physical Health Prior Authorization Denials
12
4/16/2019
Total Denials
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan002
Slide13MONITORING REPORT DATA- QMUM-7
Pharmacy Prior Authorization Denials
13
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Q1
228285467
Q2
406
305
398
Q3
125
125
300
Q4
174
108
300
Jan
53
54
97
Total Denials
Slide14MONITORING REPORT DATA- QMUM-7
Pharmacy Prior Authorization Denials
14
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
69217228
Total Denials
Slide15MONITORING REPORT DATA- QMUM-7
Dental Prior Authorization Denials
15
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
001
Total Denials
Slide16MONITORING REPORT DATA- QMUM-7
Dental Prior Authorization Denials
16
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
38016225
Total Denials
Slide17MONITORING REPORT DATA- QMUM-7
Home Modification Authorization Denials
17
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
001
Total Denials
Slide18MONITORING REPORT DATA- QMUM-7
Home Modification Authorization Denials
18
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Jan
000
Total Denials
Slide19OPS-003 Department of Health (DOH) Complaints and Grievances
Purpose: Quarterly report on the number and status of participant complaints and grievances reported by the CHC-MCO to DOH
OPS-004 Complaints and Grievances Detail
Purpose:
Quarterly report that itemizes reasons for participant filing a complaint or grievance
4/16/2019
19
Slide20MONITORING REPORT DATA- OPS-004 Complaints & Grievances
20
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Q1
1
53
76
Q2
4
42
63
Q3
5
74
114
Q4
3
84
80
Total Complaints
Slide21MONITORING REPORT DATA- OPS-004 Complaints & Grievances
21
4/16/2019
Q
T
R
A
H
C
P
H
W
U
P
M
C
Q1
6
23
32
Q2
24
70
93
Q3
17
40
49
Q4
14
70
62
Total Grievances
Slide22MONITORING REPORT DATA- OPS-003 Complaints & Grievances
22
4/16/2019
1
AHC did not have any complaints in this quarter
Slide23MONITORING REPORT DATA- OPS-003 Complaints & Grievances
23
4/16/2019
Slide24MONITORING REPORT DATA- OPS-004 Complaints & Grievances
24
4/16/2019
Total LTSS Grievances By Category
AHC
PHW
UPMC
DME for NFCE
Q1
0
0
2
Q2
1
0
0
Q3
0
0
0
Q4
1
0
1
Non-Medical Transport
Q1
0
0
0
Q2
0
0
0
Q3
0
0
0
Q4
0
0
0
PAS
Q1
0
0
0
Q2
3
12
0
Q3
0
5
0
Q4
0
10
0
Other LTSS
Q1
0
1
0
Q2
0
5
0
Q3
0
5
6
Q4
0
0
26
Slide25MONITORING REPORT DATA- OPS-004 Complaints & Grievances
25
Southwest Plan
Top Non-LTSS Grievance Categories
Top Non-LTSS
Complaint Categories
AHC
Pharmacy, Outpatient Medical Service, Dental, PAS, Dentures
Non Covered Physical Health, Other Physical Health Issues, MCO Administration, MCO Courteous Service
PHW
Pharmacy, Dental-Dentures, Other Physical Health
Non Emergency Medical Transportation, Courteous Provider Office Staff, Courteous Service by MCO
UPMC
Home Health, Other Physical Health, Pharmacy, Dental -
Other (Includes Denials of Dental Services Other than Braces or
Dentures)
MCO Administration, Courteous Office Staff, Non Covered Physical Health, MCO Courteous Service, Quality of Clinical Care
4/16/2019
Slide26OPS-008 Missed Services
Purpose: Monthly report that identifies all services that were not delivered for participants who utilize home health skilled care, home health aide services and personal assistance services. This report also identifies all non-delivered or late trips for medical, non-emergency medical and non-medical transportation services.
4/16/2019
26
Slide27MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
27
4/16/2019
Slide28MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
28
4/16/2019
Slide29MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
29
4/16/2019
Slide30MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
30
4/16/2019
Slide31MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
31
4/16/2019
Slide32MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Home Health/HHA/PAS
32
4/16/2019
Slide33MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
33
4/16/2019
Slide34MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
34
4/16/2019
Slide35MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
35
4/16/2019
Slide36MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
36
4/16/2019
Slide37MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
37
4/16/2019
Slide38MONITORING REPORT DATA- OPS-008
MISSED SERVICES – Transportation
38
4/16/2019
Slide39OPS-021 Person Centered Service Plan Changes
Purpose: Monthly report that identifies changes to PCSPs, including increases and decreases
4/16/2019
39
Slide40MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
40
4/16/2019
Slide41MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
41
4/16/2019
Slide42MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
42
4/16/2019
0.0%
Slide43MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
43
4/16/2019
Slide44MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
44
4/16/2019
Slide45MONITORING REPORT DATA- OPS-021
PERSON CENTERED SERVICE PLAN CHANGES
45
4/16/2019