After a series of delays, Community HealthChoices was implemented in southwest Pennsylvania as of January 1. MLTSS outlines a new way for aging residents of the state to receive medically necessary care and long-term services, including rehabilitation services.
With the initial and continued roll-out of MLTSS, what impacts can Skilled Nursing Facilities expect regarding rehabilitation services?
MLTSS primarily seeks to better coordinate and improve the quality of care and lives of eligible populations. Under MLTSS, healthcare benefits are delivered by any one of three managed care organizations (MCOs):
- AmeriHealth Caritas
- PA Health & Wellness
- UPMC Community Health Choices
How Does MLTSS Affect Skilled Nursing and Rehabilitation Services?
The short answer is: Nothing will change—for now.
CHC covers the same physical health benefits currently contained in the Medicaid Adult Benefit Package. There will be no changes to the way rehab services are currently provided and reimbursed under Community HealthChoices and HealthChoices in 2018.
Those eligible for long-term services and supports can also receive all the services available in waivers offered by the Office of Long-Term Living; however, CHC replaces the waiver programs.
To be qualified as a provider of healthcare services under MLTSS, Skilled Nursing Facilities and other providers need to establish a relationship with the MCOs.
MCOs have been tasked with creating a provider network that meets the needs of eligible participants and also allows for them to choose their providers. The provider network includes contracted and qualified LTSS providers of all types.
The Department of Human Services is allowing participants to maintain services with their current providers by requiring MCOs to enroll any willing and qualified providers for the first six months after CHC implementation.
What’s Next? The Continued Roll-Out of MLTSS
For the purposes of MLTSS implementation, the state has been divided by region, with southwest Pennsylvania designated as Phase 1, effective this past January 1.
Phase 2 is scheduled to go into effect January 2019 and will include the southeast portion of the state. The final phase, Phase 3, will include the remaining northwest, northeast, and Lehigh/Capital areas of the state and is scheduled to take place in January 2020.
Patients in the Phase 2 and Phase 3 implementation zones will be provided information four months prior to implementation to aid their selection—and have until a designated to choose a plan or have one chosen for them. You can see when CHC will begin by county here.
While it’s still early days in the transition to MLTSS, the state is committed to ensuring continuity of care.
The over-arching objective of MLTSS is to improve the quality of care for an estimated 130,000 seniors and adults with physical disabilities who are currently receiving LTSS by providing more community-based living options, better coordination of services, increased accountability, enhanced innovation and increased efficiency.
Skilled Nursing Facilities navigating this paradigm shift should continue to focus on efficient and effective quality of care. It will also be essential to partner with service providers who have a demonstrated track record of delivering superior outcomes, while maintaining a keen focus on innovation and efficiency.
Apex Rehab Solutions is committed to partnering with Skilled Nursing Facilities to help navigate the impacts of MLTSS. Get started today by calling (412) 964-9698 or clicking here.