What You Should Know About Pennsylvania’s Plan to Implement MLTSS

Pennsylvania is changing the way it provides home and community-based care. The plan is called Community HealthChoices.

Here are a few things older Pennsylvanians should know: (also known as MLTSS or Managed Long Term Services and Supports)

WHAT IS COMMUNITY HEALTH CHOICES?

• A new way to get health care, and home and community-based services (HCBS), with a goal to help more older adults live in their homes.
• Provided through an insurance company called a Managed Care Organization (MCO): Health Insurance + Delivery of Care + Coordination.
• MCO manages all health care and services: Hospital Care + Medical Care + HCBS + Prescription Drugs + Preventive Care.
• Goal to make it easier to get needed HCBS such as meals, or the help of an aide to get washed and dressed.
• Consumers have a choice of MCO providers and providers within the MCO network such as physicians, home health, etc. MLTSS will provide the option and encourage the use of self-direction of services (consumer-directed model) and the consumer will be the focus of planning for care (person-centered planning)

WHO IS INCLUDED?

• People who are eligible for Medicare AND Medicaid (Dual-eligible).
• Nursing Facility Clinically Eligible (NFCE) – including those who may be getting services in nursing facilities or HCBS waivers like the Aging Waiver.
• Those in the LIFE program are NOT included.

WHAT RIGHTS DO CONSUMERS HAVE?

• Consumers have the RIGHT to appeal loss of care or care that is denied.
• Consumers have the RIGHT to complain about problems or the care they get.

WHEN AND WHERE?

• To start in July 2017 in Western PA.
• Moving to Southeast in January 2018.
• The entire state will be included by January 2019.
• Goal is for a smooth transition away from Aging Waiver services to MLTSS without loss of care and services.

WILL CONSUMERS BE PART OF THE PLANNING PROCESS?

• Consumers are encouraged to provide input about the MLTSS plan.
• Send questions and comments to: [email protected].
• No computer? Call CARIE with your comments and we will share.
• Visit https://www.dhs.pa.gov/citizens/communityhealthchoices for more information