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DHS Begins Sending Community HealthChoices Consumer Packets in Southwest Zone

October 03, 2017

The Department of Human Services (DHS) will implement Community HealthChoices (CHC) in the Southwest Zone effective January 1, and has started mailing pre-enrollment packages to eligible participants. Consumers are being asked to select their health plan, and individuals who do not select a plan by November 13 will be assigned to a plan. Individuals who will be enrolled in CHC are Pennsylvania residents 21 years old or over who receive both Medicare and Medicaid, and those who qualify for a nursing facility level of care.

The Southwest Zone includes Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington, and Westmoreland counties.

CHC’s implementation is taking place across the state in three phases, and is part of Governor Wolf’s plan to improve the quality of care in the commonwealth. CHC is an integrated system of physical health and long-term services and supports, and focuses on improving health outcomes and allowing individuals to live safe and healthy lives with as much independence as possible.

In additional to information made available at its website, DHS has scheduled community meetings to provide more information and answer questions.

To provide services to CHC participants after the continuity of care period (six months), providers must join the network(s) of CHC managed care organizations listed below. A provider is still required to enroll with DHS to be a Medical Assistance provider and receive a Medical Assistance Provider Number.

  • AmeriHealth Caritas CHCProviders@amerihealthcaritas.com
  • PA Health & Wellness Information@PaHealthWellness.com
  • UPMC for You CHCProviders@UPMC.edu

More information for providers about quality, dispute resolution, and claims payment is available online.

HAP shared comments with DHS regarding CHC and its implementation, and was pleased with DHS’ previous decision to delay starting the program to allow time for a deliberate and purposeful implementation. HAP continues to monitor the program’s implementation and provide information to its members.

For more information, contact Jolene Calla, HAP’s vice president, health care finance and insurance.

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