OLTL Updates

August 1 - CHC Provider Service Coordination
PA Health & Wellness will be providing service coordination through appropriately qualified service coordinators who are employed or under contract with the health plan. Service Coordination includes activities to identify, coordinate, and assist participants in obtaining access to needed health services and in-home supports, as well as social and housing services needed to help participants live in their communities.  Read More...

July 17 - Understanding Community HealthChoices vs. Healthchoices
HealthChoices is Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants. Participants receive quality medical care and timely access to all appropriate physical and behavioral health services and/or drug and alcohol services. Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care for dual-eligible individuals and individuals with physical disabilities — serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. When implemented, CHC will improve services for hundreds of thousands of Pennsylvanians, including older Pennsylvanians and individuals with disabilities. Read More...

July 17 - CHC Provider Update
Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. CHC will use managed care organizations (MCOs) to coordinate physical health care and long-term services and supports (LTSS). Read More...

July 6 - You are Invited to an Educational Conference for Providers in the Southwest Region
JULY 24 - Cranberry Township, The RLA Learning and Conference Center, JULY 25 - Pittsburgh, Wyndham Grand Pittsburgh Downtown, JULY 26 - Altoona, Blair County Convention Center, JULY 27 - Cranberry Township, The RLA Learning and Conference Center Read More...

June 14 - Third Party Liability & Coordination of Benefits
Third Party Liability (TPL) is when the financial responsibility for all or part of a participant's health care expense rests with an individual entity or program other than the CHC managed care organization (CHC MCO), such as Medicare or commercial insurance. Read More...

June 2 - CHC-Provider Relationship Information
For years, Pennsylvania has provided physical and behavioral health care through a managed care delivery model. That did not include long-term services and supports — that is changing. Pennsylvania will be providing services for older adults and persons with physical disabilities through three Community HealthChoices managed care organizations (CHC MCOs). The Department of Human Services (DHS) will have full, ongoing oversight and monitoring. DHS will review and approve processes, policies, manuals, and procedures of each CHC MCO. Read More...