April 21, 2016 VIA EMAIL (THDALLAS@PA.GOV) Theodore Dallas, Secretary Department of Human Services 625 Forster Street, Third Floor Harrisburg PA 17120 Dear Secretary Dallas, Re: Ensuring IEB and IEE Are Responsive To Consumer Needs In Community Health Choices We are Pennsylvanians who rely on long term services and supports and organizations that serve those individuals. We write with concerns about the capacity of the emergency Independent Enrollment Broker (IEB) for current waivers and the capacity of the future Independent Enrollment Entity (IEE) in Community HealthChoices. Pennsylvania is on the eve of finalizing the request for proposal for the Independent Enrollment Entity and has implemented the terms of its emergency procurement with Maximus, the current enrollment broker, but there has been no public input to date on this particular aspect of Community HealthChoices. We would like to review and comment before procurement for the IEE begins. The comment period does not need to be as long as the CHC-MCO request for proposals and draft agreements. We can respond quickly. We cannot overstate the importance of this request. The structure and capacity of the IEB and IEE is just as significant, if not more so, than the selection of the Community HealthChoices MCOs. The IEE/IEB has a much greater role in CHC than the IEB in HealthChoices. The Department expects Participants to rely primarily on the broker/entity to find out and apply for long term services and supports and to select or change Community HealthChoices MCOs. We agree with the April CHC Enrollment Questions & Recommendations raised by the Consumer Subcommittee (attached). In addition, we urge you to 1) consider specific responsibilities and requirements for the IEB and 2) involve Participants and their advocates in a process to ensure the capacity of the IEE to carry out those expanded responsibilities. 1
Concerns Regarding the Expanded IEB Function On April 1 st, Maximus became responsible for enrollment of individuals seeking the Aging waiver, which had previously been done by the Area Agencies on Aging (AAAs). Based on the presentation by Maximus at the April Long Term Services and Supports (LTSS) Subcommittee, it is clear that Maximus will not be providing applicants the same level of hands-on enrollment assistance previously provided by AAAs, particularly assistance obtaining physician certifications and identifying and obtaining the necessary bank statements and other documents for the financial eligibility process. Relying on community partners to fill this gap is not a suitable plan and will leave many unable to complete the enrollment process. Furthermore, Maximus should be required to send eligibility notices in languages other than English when needed. We are particularly concerned by OLTL s report at the same LTSS Subcommittee meeting that 60 percent of persons applying for OLTL waivers do not actually get on the waiver. It appears a large number of denials are because applicants did (or could) not complete an application. We recommend OLTL review the past three months of waiver applications that were not successfully completed with a direct follow-up, preferably by phone, with the applicant or his/her representative to determine what went wrong and whether additional assistance is needed. Going forward, OLTL should require Maximus to track the reasons why enrollments are not completed along with performance measures and the currently collected data points. We believe this is an important way to monitor the effectiveness of the IEB/IEE and determine the areas of the application process for which applicants may require greater assistance. This information should be shared with the public on a quarterly basis. Need For Readiness Review Committee With Consumer Members We are concerned by the Department s decision to enter an emergency procurement with the existing Independent Enrollment Broker (IEB) (Maximus) on a temporary basis and to expand its responsibilities to a wide range of new functions related to Community HealthChoices. Maximus has struggled to assist individuals applying for OLTL waivers programs in a timely manner. We write separately from the Consumer Subcommittee with two specific recommendations regarding the expanded emergency procurement with Maximus: 2
1. OLTL should solicit input from the MLTSS Subcommittee, Consumer Subcommittee, LTC Subcommittee and other interested parties regarding responsibilities of Maximus in its expanded role as IEB; and 2. OLTL should create a readiness review committee which would include Participant members of the MLTSS Subcommittee and other interested stakeholders to ensure that Maximus has hired and properly trained the staff necessary to handle both the increased number of individuals to be assisted by Maximus under CHC (including dual eligibles and individuals in nursing facilities) and the additional scope of assistance. The committee should also review and provide feedback on Maximus work plan and protocols to be sure the needs of consumers are adequately addressed. * * * Again, we urge the Department to release the draft RFP for the Community HealthChoices Independent Enrollment Entity (IEE) for review and public comment prior to finalizing it and welcoming bids. We also urge the Department to make public the terms of its emergency procurement with Maximus. We look forward to the Department s response to these requests at upcoming meetings of the Medical Assistance Advisory Committee and its subcommittees. Sincerely yours, Kathy Cubit THE CENTER FOR ADVOCACY FOR THE RIGHTS AND INTERESTS OF THE ELDERLY (CARIE) Pam Walz COMMUNITY LEGAL SERVICES OF PHILADELPHIA Laval Miller-Wilson David Gates PENNSYLVANIA HEALTH LAW PROJECT cc (via email): Jennifer Burnett, Deputy Secretary, OLTL Enclosure: April 2016 Recommendations of the Consumer Subcommittee regarding Community HealthChoices Enrollment 3
Jack Poplar Additional Groups & Individuals Concerned About the Capacity of the Independent Enrollment Broker (IEB) & Independent Enrollment Entity (IEE) in Community HealthChoices ACADIA COMMUNITY-INTEGRATED NEUROREHABILITATION Nancy Murray THE ARC OF GREATER PITTSBURGH ACHIEVA Jim McQuown AGING SERVICES, INC. Wendy L. Campbell ALZHEIMER'S ASSOCIATION DELAWARE VALLEY CHAPTER Hillary Hasson CENTER FOR INDEPENDENT LIVING OPPORTUNITIES (YORK, ADAMS, FRANKLIN COUNTIES) Theo Braddy CENTER FOR INDEPENDENT LIVING OF CENTRAL PA Lynn Fields-Harris CENTER IN THE PARK Cathleen Holdsworth DISABLED IN ACTION Peri Jude Radecic DISABILITY RIGHTS PENNSYLVANIA Loretta Dugan EINSTEIN GERIATRICS Marisa C. Ferst ELDERNET OF LOWER MERION AND NARBERTH Celia Feinstein Kristin Ahrens INSTITUTE ON DISABILITIES, TEMPLE UNIVERSITY 4
David Griffith LGBT ELDER INITIATIVE Thomas Earle LIBERTY RESOURCES, INC. (LRI) LuAnn Oatman MEALS ON WHEELS ASSOCIATION OF PENNSYLVANIA Elisabeth Healey PARENT EDUCATION & ADVOCACY LEADERSHIP CENTER (PEAL CENTER) Pam Barton PENNSYLVANIA ADULT DAY SERVICES ASSOCIATION Rebecca May-Cole PENNSYLVANIA ASSOCIATION OF AREA AGENCIES ON AGING Susan Tachau PENNSYLVANIA ASSISTIVE TECHNOLOGY FOUNDATION PENNSYLVANIA COUNCIL ON INDEPENDENT LIVING (PCIL) Vicki Hoak PENNSYLVANIA HOMECARE ASSOCIATION Lynn Keltz PENNSYLVANIA MENTAL HEALTH CONSUMERS' ASSOCIATION Richard Edley REHABILITATION & COMMUNITY PROVIDERS ASSOCIATION Karen C. Buck SENIORLAW CENTER Nan Sninsky TRI COUNTY PATRIOTS FOR INDEPENDENT LIVING Jeffrey Cooper UNITED CEREBRAL PALSY OF PENNSYLVANIA Mary J. Fallon UUH OUTREACH PROGRAM 5
Carl W Bailey, MEMBER OF THE LONG TERM SERVICES AND SUPPORTS SUBCOMMITTEE OF THE MAAC Eva Bednar, ADVOCATE Terri Clark, SERVICES AND ADVOCACY FOR GLBT ELDERS (SAGE) TRAINER AND CONSULTANT Brenda Dare, CONSUMER MEMBER OF THE MANAGED LONG TERM SERVICES AND Grace Egun, ADVOCATE Fred Hess, CONSUMER MEMBER OF THE MANAGED LONG TERM SERVICES AND Jennifer Howell, CONSUMER MEMBER OF THE MANAGED LONG TERM SERVICES AND Richard Kovalesky, CONSUMER MEMBER OF THE MANAGED LONG TERM SERVICES AND Michael Pellicano, CONSUMER MEMBER OF THE MANAGED LONG TERM SERVICES AND John Vogel, MEMBER OF THE LONG TERM SERVICES AND SUPPORTS SUBCOMMITTEE OF THE MAAC Katherine G. Weiss, ELDER CARE ATTORNEY, CERTIFIED SENIOR ADVISOR & APPRISE COUNSELOR 6
Consumer Subcommittee Meeting April 27, 2016 CHC Enrollment Questions & Recommendations With this document, the Consumer Subcommittee and its legal counsel memorialize many of the recommendations that have been offered during the recent webinars on Community HealthChoices enrollment provided by the Office of Long Term Living. We appreciate the willingness of OLTL to engage in these continued conversations and to consider the questions and recommendations that we pose below. We hope to continue this conversation during the April 27 th Consumer Subcommittee meeting. I. Initial Roll-Out & Transition Period As we have discussed at some length, it is crucial that the written letters and notices mailed to CHC participants be clear, accurate, and literacy appropriate so that they can understand Community HealthChoices and make meaningful decisions regarding their care. It is also critical that CHC participants have access to knowledgeable resources and entities to counsel and advise them, especially during the tumultuous transition period. While the Independent Enrollment Entity (IEE) will be the primary resource for some issues, such as those pertaining to CHC MCO selection, the capacity and expertise of the IEE (and of Maximus) to provide accurate advice regarding other topics is very much in question. Counseling and advice on how CHC will affect a participant s Medicare coverage, for example, and whether they should change their Medicare coverage, is one area where other entities, like the APPRISE program, will be needed. Recommendations: For the reasons discussed above, we recommend: 1. The Consumer Subcommittee and the consumers who sit on the state s MLTSS Advisory Committee be provided draft copies of all written materials being sent to consumers with adequate time for review and comment; 2. Consumer notices should provide contact information/phone numbers for entities (e.g., CILs and AAAs) to call for counseling and advice. 3. Pre-transition letters and all subsequent notices sent to the CHC population be tailored to provide specific populations with information relevant to their particular situation (i.e., duals receiving HCBS services, residents of nursing homes, duals not getting any LTSS services, HCBS recipients who are not dually-eligible); 1
4. CHC Participants be allowed to elect a representative who has the authority to contact the IEE and make enrollment decisions on behalf of the Participant, as is required by federal regulation. See 42 CFR 435.923; 5. APPRISE be provided funding adequate to allow it to be able to counsel dual eligibles and answer their questions on how CHC will affect their coverage and services and rights under Medicare; 6. The Department consider contracting with Area Agencies on Aging and Centers for Independent Livings, who are already trusted resources in the community for older adults and persons with disabilities, to educate their communities on CHC and assist/counsel with regard to enrollments into CHC-MCOs; We are very concerned by the Department s recently-announced plan to enter into an emergency procurement with the existing Independent Enrollment Broker (IEB) (Maximus) on a temporary basis to have it wide range of new functions related to Community HealthChoices. As the current enrollment broker, Maximus has been limited in its role to assisting individuals who are applying for an OLTL waiver program. We have significant concerns about the capacity of this vendor to perform additional functions given that it: has no experience with working with state s nursing home population; has no experience counseling consumers with plan choices and enrollment into plans; has not worked with duals or counseled them on how dual eligibility works; and is already occupied with ongoing enrollments into waiver programs and Act 150. We urge the Department to release the draft RFP for the Community HealthChoices Independent Enrollment Entity (IEE) for review and public comment prior to finalizing it and welcoming bids. We also urge the Department to send out a draft of the terms of its emergency procurement with Maximus for review and comment prior to finalizing a contract with the current enrollment broker. II. Ongoing Enrollment Recommendations: With respect to the enrollment process that will be ongoing after Community HealthChoices is implemented, we recommend that: 1. The IEE be required to assist applicants who need help completing a Medicaid application (simply mailing out a PA600 is insufficient assistance); the IEE should actually help an applicant in completing the application and in gathering the necessary verification documents; 2
2. The IEE should have a clear option for applicants to appoint a representative and/or name their POA, if applicable (this is currently requested on page 10 of the PA600L); 3. If a representative has been elected, that person should be permitted to contact the IEE and make a plan selection for the participant; 4. If a representative has been elected, copies of all notices sent to the applicant by DHS and the IEE should also be sent to the representative/poa, as provided by federal regulation. See 42 CFR 435.923(b)( Applicants and beneficiaries may authorize their representatives to (3) Receive copies of the applicant or beneficiary's notices and other communications from the agency. ); 5. The IEE should revisit the MCO selection issue several times during the application process to reinforce the information provided, advise the person about how to choose or where they can go for help making a choice, and encourage them to choose as the deadline for enrollment/eligibility determination gets closer; 6. Authorized representatives should be allowed for the NFI population as well (as is currently asked about on page 15 of the PA 600HC), and copies of all written materials also should be mailed to the representatives of the NFI population. Questions: 1. What is the process for handling new duals and new enrollees into waivers or nursing homes who enroll into the system between the time the pre-transition letters are sent in August and the end of the year? 2. How will the process work for Medicaid consumers who need only short-term care in a nursing home and not long term care (who currently lose their HealthChoices plans after 30 days in a facility)? Will they now move to Community HealthChoices for even a short term need for SNF care? 3. Will the nursing home be able to submit an application for a resident? Can NH residents or their family members still submit applications directly to the CAO? 3