Community HealthChoices

There are two managed care programs in Pennsylvania that provide home health, hospice and homecare services to Medicaid recipients: HealthChoices, which was implemented in 1997, and Community HealthChoices (CHC), which will be implemented in phases beginning in January 2018.

Click here for a guide from the Department of Human Services to help understand the similarities and differences between the programs.

Background

CHC will replace the state’s Medicaid waiver programs for individuals age 21 and older and seniors who need long-term care. This care will be coordinated by CHC managed care organizations (CHC-MCOs) in five zones across the state. Implementation will begin in the Southwest Zone on Jan. 1, 2018, move to the Southeast Zone on Jan. 1, 2019 and complete statewide implementation on Jan. 1, 2020.

The Wolf Administration developed CHC in 2015 with the goal to (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life.

Recent News

  • December 3, 2018: Following the six-month continuity of care period for the southwestern zone, CHC-MCOs have begun making changes to their network of service coordination entities. Service coordination is viewed as an administrative function of the MCO, not a unique provider service as it was in the waiver programs. Affected participants have been individually notified by letter and asked to choose another entity or a coordinator that works directly for the MCO. Click here to view the most recent list of service coordination entities that have been impacted in the southwest zone. As a reminder, the service coordination entities in the southeast zone must remain in network until at least July 1, 2019.
  • November 13, 2018: During an OLTL webinar, officials counseled direct care workers to alert a participant’s service coordinator if they believe a participant may be in need of behavioral health services for depression, anxiety, psychological disorders or other concerning behavior. But in the event of an emergency, where the participant is threatening self-harm or harm to others, direct care workers should immediately call the local County Crisis Intervention hotline. Click here to view a statewide list of County Crisis Intervention centers. Individuals can also contact the National Suicide Prevention hotline 24/7 at 1-800-273-8255.
  • November 7, 2018: OLTL reminds participants that they are able to change their auto-assigned MCO up until December 21 to make the selection effective for the start of CHC on January 1. Once the program is underway, individuals may change their MCO at any time. The date of the change will have an impact on when it becomes effective, but there are no restrictions on a participant’s right to change MCOs throughout the year. Participants can call 1-844-824-3655 or go to www.enrollchc.com to make their MCO choice.
  • Recording available for November 2018 HHAeXchange training webinars. Click here to register to view the recording. Click here to download the presentation. This includes information from each MCO about specific billing protocols.

Provider Resources

CHC-MCO Information

Community Resources