By Joe Quinn, EI blogger

Under the auspices of the Department of Human Services and the Department of Aging, Pennsylvania is planning to implement a Managed Long-Term Services and Supports (MLTSS) program to be known as Community HealthChoices (CHC). A document was released last June initiating a public comment and discussion period. Actual implementation won’t begin until early 2017 and be phased in through 2019.

That may seem a long time away, but this effort will entail big changes in the way long-term health care services are delivered to certain populations. This should be of great interest to us since a chief focus of this program will be on the elderly and other vulnerable groups now served by traditional Medicaid (and in some cases Medicare) programs.

As defined by the Centers for Medicare and Medicaid Services (CMS), MLTSS is a way of delivering long-term services and supports through capitated managed care programs. Capitated refers to the payment of a fixed amount of money per patient per unit of time paid in advance to the medical provider, as opposed to the typical fee-for-services (FFS) model. States are increasingly incorporating populations and services that have long been excluded from capitated managed care arrangements.

The news is that the new model will go beyond providing medical services and will include non-medical Home and Community Based (HCBS) services that will help seniors with daily living activities such as dressing, eating, and bathing, toileting, in addition to housekeeping, shopping, and keeping track of medications. While these services are available now to those who can afford to pay for them privately, the thrust of the MLTSS program is to provide them directly in a recipient’s home or in a local community setting using the capitated Medicaid model. The services will come to the client, rather than the client having to travel to the services. This would allow many recipients to remain in their homes and avoid placement in expensive assisted living facilities. The hope is that for many seniors this will increase access to needed services by eliminating the need to travel and by keeping them in a safe, familiar setting.

So this is an ambitious vison and a vast undertaking. One that will attempt to encompass many of the traditional medical services along with more personal and personalized services that will allow seniors to maintain normal daily living activities in familiar home settings. As if that were not enough, the CMS strongly recommends that MLTSS programs focus on enhancing the consumers’ engagement, control, choice and independence. Further they must be staffed with providers with specialized training who are linguistically and culturally competent to serve diverse populations in community settings. CMS is blunt about the challenges and pressures this new delivery model will bring to bear on already stressed state administrations and budgets. This is not, they warn, something that can or will be done overnight, nor without considerable financial expenditures.

CMS also recognizes that this cannot not be a one-size-fits-all initiative. Each state will have to build a program that meets its constituents’ needs and that is realistically (and politically) achievable based on available resources.

Pennsylvania will be implementing MLTSS as part of a new initiative known as Community HealthChoices (CHC). Here are a few of the main points about the proposed CHC included in a concept paper released last September:

“The vision for CHC is an integrated system of physical health and long-term Medicare and Medicaid services that supports older adults and adults with physical disabilities to live safe and healthy lives with as much independence as possible, in the most integrated settings possible. CHC will serve an estimated 450,000 individuals, including 130,000 older persons and adults with physical disabilities who are currently receiving LTSS in the community and in nursing facilities.”

“We are committed to creating a system that allows Pennsylvanians to receive services in the community, preserves consumer choice, and allows consumers to have an active voice in the services they receive. This initiative will result in a more strategic care delivery system and improve health outcomes for seniors and individuals with disabilities.”

Certainly worthy goals and inspiring rhetoric. However, given the commonwealth’s political realities, the fierce pushback on the conservative front against existing, not to mention additional, managed medical care programs (e.g., Obamacare), and the current state budget impasse, we are justified in asking just how realistic these laudable goals are. We can surely hope that over the period of the proposed three-year rollout for CHC, circumstances will change for the better and enable this program with its much-needed benefits for seniors and other vulnerable populations to become a reality. Stayed tuned.

More information on Pennsylvania’s CHC plan is available here:

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