Hospital Association of Pennsylvania > Advocacy > Health Insurance Coverage Expansion > HAP Comment Letter to DHS on Managed Long Term Services and Support


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HAP Comment Letter to DHS on Managed Long-Term Services and Support

October 16, 2015

Secretary Ted Dallas
Pennsylvania Department of Human Services
333 Health and Welfare Building
P.O. Box 2675
Harrisburg, PA  17110-2675

SUBJECT:  Managed Long-Term Services and Support (MLTSS) Comments

Dear Secretary Dallas:

Thank you again for the opportunity to provide input on Community HealthChoices (CHC), the commonwealth’s MLTSS Program. These comments are intended to supplement the July 15, 2015, letter submitted by The Hospital & Healthsystem Association of Pennsylvania (HAP) relating to the Department of Human Services (DHS) Discussion Document.

Following the release of the Discussion Document during June of this year, DHS conducted six listening sessions across the commonwealth to hear stakeholders and consumers’ thoughts and concerns relative to its plan to implement MLTSS in Pennsylvania for older Pennsylvanians and adults with disabilities.

On September 16, 2015, DHS issued a Concept Paper which outlines its thoughts relative to MLTSS in more detail. DHS is accepting comments on its Concept Paper until October 16, 2015.

HAP understands and supports the goals of the MLTSS, but has identified some areas of concern for our members. These general areas are outlined below:

Stakeholder Feedback Opportunities:  While we understand that DHS is not releasing a draft request for proposal, we are pleased that you plan to share a draft contract and accept comments from stakeholders. As you know, CHC seeks to fundamentally alter the manner in which long-term care services are delivered in Pennsylvania. This is an enormous undertaking on DHS’ part, and it is important that consumers and others stakeholders have an opportunity to review and comment on key aspects of the program, including rate setting, network adequacy, and behavioral-physical health coordination requirements. We anticipate providing more detailed comments after we have an opportunity to review the draft contract language.

Program Release:  DHS plans on implementing CHC in three stages. The western part of the state will be rolled out during 2017, the southeastern part of the state will be implemented during 2018, and the final zone will be established during 2019. Despite this staggered implementation timetable, DHS intends to award the RFP for all of the state’s zones at one time. Instead, DHS should consider awarding the RFP in stages. This approach would allow DHS to benefit from any “lessons learned” from the initial rollout.

Historically, with any significant program change or implementation, there are always unforeseen consequences that require an ability to change course to achieve a more positive outcome.

Network Adequacy:  Much has been written about network adequacy in the context of long-term service and support. This subject is currently being debated by the National Association of Insurance Commissioners as it seeks to update its network adequacy model law.

Historically, network adequacy has been monitored by the Department of Health (DOH) in connection with commercial insurance plans. DOH also monitors network adequacy in HealthChoices, along with DHS.

Since CHC will be a new program with provider types for which existing protocols may not apply, it is important that DHS share its proposed network adequacy model and provide enough time for consumers and providers to understand and comment on the proposed standards. Network adequacy standards also must be strictly enforced.

Any Willing Provider:  Any willing provider provisions are generally included to ensure that there is a sufficient number of providers for consumers to select. We urge DHS to consider adopting this provision for the CHC program, especially during the early years, so consumers have adequate access to care. It is worth noting that this provision is not unprecedented, as it currently exists in HealthChoices for the pharmacy benefit.

Provider Protections:  DHS should require that managed care organizations’ (MCO) policies are generally consistent. To the greatest extent possible, critical components of the program such as credentialing, utilization review, and payment should be aligned to prevent the imposition of unnecessary administrative burdens on providers. If each MCO has its own approaches, it will create a significant administrative burden for providers and add cost to the program.

HAP also recommends that the program include stringent claims processing timelines, and that the CHC MCO be required to establish robust provider dispute resolution programs.

Rates/Reimbursement:  It is critical that DHS ensures that there are sufficient funds to adequately compensate skilled nursing facilities and other long-term services and support providers. Among other things, the contract should include provisions that reimbursement can be no lower than existing rates and provide for annual cost increases.

There also should be an opportunity for providers to negotiate value-based payment arrangements, to award the provision of cost effective and high-quality care. The adequacy of reimbursement rates also should be evaluated and monitored by the commonwealth as the program is rolled out statewide.

Operational Issues:  The implementation of CHC provides an opportunity for DHS to improve and streamline aspects of the long-term care program that have traditionally not worked well in Pennsylvania. Specifically, the commonwealth should take steps to improve and automate the nursing facility eligibility determination process, to facilitate timely, accurate, and consistent eligibility determinations.

MCO Education:  This program will be new to Pennsylvania. It’s likely that many providers may be unfamiliar with managed care principles and operations. As a result, DHS should put in place mandatory educational programs and provide on-going technical assistance so that providers can quickly and efficiently navigate the complexities associated with MLTSS.

Thank you for the opportunity to comment. We look forward to the chance to review the draft contract, and provide more detailed comments relating to the program design. We also are looking forward to a continued partnership in launching this exciting new program for Pennsylvania.


Jeffrey W. Bechtel, JD
Senior Vice President, Health Economics and Policy      

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