DPW Overview Healthy PA Presented by Secretary Beverly
DPW Overview & Healthy PA Presented by: Secretary Beverly Mackereth Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 1
DPW Quick Facts DPW is the largest Human Services Agency in the Country: • Staff complement as of July 2014: • 15, 617 full-time filled complement • 96 part-time • 845 wage • 134 annuitants • Total DPW budget for FY 2014 -15: $31. 5 Billion • $11. 2 billion in state (general fund) • $17. 6 billion in federal • $ 3. 0 billion in other funds • DPW is 39% of the General Fund Budget • Approximately 22. 7% (2. 89 million) of all Pennsylvanians were enrolled in a DPW benefit program as of May 31, 2014 (Based on the US Census Bureau 2012 Pennsylvania population estimate of 12, 763, 536). Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 2
DPW Quick Facts Facilities Operated by DPW: • 94 County Assistance Offices • 6 Youth Development Centers/Youth Forestry Camps that served around 777 children in FY 2013 -14 • 5 State Centers for Persons with Intellectual Disabilities that were serving 996 individuals as of June 30, 2014 • 7 State Mental Health Hospitals that were serving 1, 522 individuals as of July 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 3
Program Office Service Delivery DPW Central Office Other 29 Intermediate Units OLTL OMAP 500 School Districts DPW Regional Offices OIM ODP OMHSAS OCDEL 94 CAOs OA OCYF 52 Area Agencies on Aging 42 CCIS 67 County/Joinders 10 Managed Care Organizations 67, 000 Providers ~100 Service Coordination Organizations www. dpw. state. pa. us > 4
Office of Administration (OA) Hearings and Appeals • Conducts administrative hearings on appeals received from recipients and DPW funded agencies services Financial Operations • Organizes and conducts audits, guides procurement process, evaluates RFP’s, and executes and monitors contracts Information Systems Administrative Services • Supports all information technology needs for Departments of Welfare, Aging and Insurance • Services include: forms and publications, printing, automotive fleet operations, guardianship programs, facilities and property management, and emergency operations Program Integrity • Detects and deters fraud waste and abuse in the Medicaid program and administers third party recoveries in the Medicaid program Human Services • Licensing Licenses, inspects, and regulates more than 8, 500 out-of-home care settings. Human Resources • Administers DPW’s HR systems including labor relations, employee training, recruitment, classification, and placement Equal Opportunity • Ensures nondiscrimination and equal opportunity in all activities The Bureau of Human Services Licensing ensures safe living conditions for over 100, 000 adults and children with mental illnesses, intellectual disabilities, physical disabilities, and behavioral and/or cognitive disorders. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 5
Office of Child Development and Early Learning (OCDEL) Certification Services Early Intervention Services • Child Care Certification Subsidy Services • Early Intervention Infant/Toddler • Early Intervention Preschool Early Learning Services • Child Care Works • Keystone STARS • Keystone Babies • Pennsylvania Pre-K Counts • Full Day Kindergarten • Head Start State Supplemental Assistance Program • Early Head Start • Parent-Child Home Program • Nurse-Family Partnership • Children’s Trust Fund As of December 2013, nearly 112, 423 children were provided monthly subsidies through Child Care Works. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 6
Office of Children, Youth and Families (OCYF) Juvenile Justice Services Adult Education Adoption • Youth Development Centers • Youth Forestry Camps • County Juvenile Probation Offices • Private Agency Delinquency Services Placement • Homemaker/Caretaker Service • Life Skills Education • Adoption Services • Adoption Assistance • Foster Family Service • Community Residential Service and Group Home Service • Supervised Independent Living Service • Residential Service • Secure Residential Service • Emergency Shelter Service • Protective Services (Child Abuse) Protective Services • Protective Services (General) • Counseling/Intervention Services Administration & Oversight • Information and Referral Services • Service Planning Day Services • Day Care Service • Day Treatment Service From Sept. 30, 2009 to March 31, 2014, out-of-home placements of children have decreased by 19% in PA. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 7
Office of Mental Health and Substance Abuse Services (OMHSAS) Behavioral Health & Substance Abuse Services • Health. Choices Behavioral Health (HC-BH) Program • Fee-for-Service • Behavioral Health Services Initiative (BHSI) State Facilities • State Hospitals and Restoration Center • Other Initiatives • Base • Act 152 Integration Programs • CHIPP Pharmacy • Special Pharmacy Benefits Program for Mental Health (SPBP-MH) 1, 952, 895 of MA covered Pennsylvanians were covered by Health. Choices Behavioral Health as of March 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 8
Office of Developmental Programs (ODP) Intellectual Disabilities: HCBS • Consolidated Waiver Autism: HCBS • P/FDS Waiver • Base Services Intermediate Care Facilities • Adult Autism Waiver (AAW) • Adult Community Autism Program (ACAP) • State Centers • Private Facilities Over 28, 000 individuals were served by ODP waivers as of May 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 9
Office of Income Maintenance (OIM) • For Families with Children Medical Assistance • For the Aged and Disabled • Long Term Care Cash Assistance • Temporary Assistance for Needy Families (TANF) • SSI State Supplement • Select Plan for Women Supplemental Nutrition Assistance Program (SNAP) Employment and Training Programs Homeless Assistance • Nutritional support for lowincome families • A suite of programs that provide job readiness, placement, retention training, and supportive services • Provides services to families and children in immediate need of shelter and to those in imminent danger of becoming homeless Low Income Home Energy Assistance Program (LIHEAP) • Assistance to low-income families in need of assistance with their heating and cooling bill Child Support Enforcement • Establishes paternity and support orders and provides medical support and employment services for non -custodial parents Legal Assistance • Provides free services to assist clients to resolve civil legal problems As of July 2014, CAOs helped more than 397, 000 households to stay safe and warm in their homes. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 10
Office of Medical Assistance Programs (OMAP) Medical Assistance • Managed Care • Fee for Service What is Medical Assistance? • Medicaid is an entitlement program jointly funded by the federal and state governments that provides health care coverage to low income children and adults, the elderly, and disabled. The Pennsylvania Medicaid Program is known as Medical Assistance (MA) because it includes both the federal Medicaid Program as well as state funded only programs, i. e. , General Assistance and State Blind Pension recipients How are services delivered? • Fee for service administered through the federally-approved Medicaid State Plan • Mandatory Medicaid managed care program known as Health. Choices administered through a federally-approved 1915(b) waiver Pennsylvania Medicaid Facts • 17. 8% of Pennsylvanians are currently covered by some form of MA • Over 81, 000 MA providers • 58, 136, 763 claims processed for FY 13 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 11
Office of Long-Term Living (OLTL) Attendant Care • Attendant Care Waiver • Act 150 Nursing Facilities • MA Nursing Facilities AIDS • AIDS Waiver Community Service Programs for People with Physical Disabilities (CSPPPD) Aging LIFE • Independence Waiver • COMMCARE Waiver • OBRA Waiver • Aging Waiver • Living Independence for the Elderly (LIFE) Over 47, 000 individuals were served by OLTL waivers as of May 2014. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 12
Strategic Planning for the Department Vision Statement Our vision is to see Pennsylvanians living safe, healthy and independent lives. Mission Statement Our mission is to improve the quality of life for Pennsylvania’s individuals and families. We promote opportunities for independence through services and supports while demonstrating accountability for taxpayer resources. Strategic Focus Areas Communications Back to Basics Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare Accountability www. dpw. state. pa. us > 13
DPW Budget Priorities Expanding Services for Older Pennsylvanians and Individuals with Physical Disabilities: Increase of $25. 3 million in General and Lottery funds to serve: • An additional 1, 764 older Pennsylvanians through the Medicaid Home and Community-Based Aging Waiver ($11. 6 million); • An expansion in the LIFE program ($4. 7 million); • An additional 1, 599 individuals with physical disabilities in community settings ($9 million). Expanding Services for Individuals with Intellectual Disabilities and Autism: Additional $13. 1 million to provide home and community-based options for: • 700 young adults who are graduating from the special education system to continue to live independently in the community; • 400 individuals who are on the emergency waiting list to access crucial services to keep them in their homes and communities; and • 100 adults with autism spectrum disorders. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 14
DPW Budget Priorities Moving Individuals from Institutional Care to Community-Based Care: An additional $2. 8 million to increase community placement for individuals currently in state mental hospitals and state intellectual disability facilities. This enables the transition of clients from state mental hospitals to progressive mental health treatment in home-like settings as well as clients from state intellectual disability facilities to home and community-based settings. Act 150: Funding was allocated to serve individuals currently on the Act 150 waiting list who are determined eligible. Child Care Assistance: Increase of $15 million in federal funds to allow an additional 2, 895 children currently waiting for services to receive child care assistance. Child Advocacy Centers: $2 million for the support and expansion of Child Advocacy Centers in Pennsylvania, supporting a recommendation from the Task Force on Child Protection. Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 15
DPW Budget Priorities Balancing Incentive Program - $94 million ($75 m in FY 2014 -2015) • Enhanced federal funds (2% increase in federal matching funds, or FMAP) on community-based long-term services and supports • Available to states that spend less than 50% of their long term supports on community based services • The increase in FMAP is time limited and expires September 2015 • Requirements to receive the increase include: • No wrong door approach • Core elements required by CMS and consistency between assessment tools • Conflict free • Provide utilization and outcome data • Application approved by the federal government on June 18, 2014 • BIP funding began July 1, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 16
Long-Term Care Commission • Commission Responsibilities – Identify and examine the critical issues and trends in Pennsylvania’s long-term care services and supports delivery system – Study existing long-term care resources available for individuals with physical disabilities, older adults, their families and caregivers – Consult with various commonwealth departments and agencies on: • Regulations • Licensure • Financing • Other responsibilities relating to long-term care – Review current and proposed state and federal legislation and regulations relating to long-term care – Make written recommendations to the Governor on findings Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 17
Long-Term Care Commission • Areas of Focus for Work Groups – Prevention – Accessibility – Provision of Service – Quality Outcomes and Measurements Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 18
Long-Term Care Commission • Held 7 public sessions across the state • More than 200 individuals provided input at the public meetings or submitted comments • Report due to the Governor no later than December 31, 2014 • The Executive Order expires on December 31, 2014 Tom Corbett, Governor Beverly Mackereth, Secretary of Public Welfare www. dpw. state. pa. us > 19
Healthy PA Overview
Healthy Pennsylvania at a Glance Increased health care access for 600, 000 Pennsylvanians Improve health outcomes Benefits match health care needs Increased personal responsibility Reformed Medicaid program 21
Introduction This session provides an overview of the Healthy PA Program and the components being introduced in January 2015. New Components • Newly Eligible Adult Group • Health Screening • Healthy Behaviors Simplified Benefit Plan Structure • Low Risk • High Risk 22
Overview Topics Healthy PA Components Simplified Benefit Plan Structure Healthy PA Timeline 23
Healthy PA Newly Eligible Ages 19 -64 Income ≤ 133% FPL 24 Not eligible for Medicaid
Healthy PA Newly Eligible Ages 19 -64 Income ≤ 133% FPL Up to approximately $15, 500 for an individual and $20, 900 for a family of two. 25 Not eligible for Medicaid
Applying for Benefits There is ‘no wrong door’ when applying for health care! Consumer Service Center COMPASS 26 Paper Application
Health Screening • Aligns health care needs to the appropriate benefit package • Basic information about a person’s health conditions, similar to what you may provide when first visiting a doctor’s office • Completion of the tool is not required for eligibility • Questions may be skipped • Information is confidential • If not completed, individuals will be placed in either the low risk plan or the Private Coverage Option. 27
Health Screening Who will need to complete the screening tool? • Adults between the ages of 21 through 64 applying for Medicaid or the Private Option Coverage • The following individuals will not complete the screening tool: • Children up to the age of 21 • Adults 65 years of age and older • Pregnant woman • Individuals on SSI (or in a SSI related eligibility category), • Those applying for or receiving MA home and community base (waiver) services • Individuals residing in institutional settings (nursing homes, intermediate care facilities) 28
Healthy Behaviors Annual Wellness Visit Meet Cost-Sharing Obligations • Continue to pay as assigned • Providers can deny services if: • Individual refuses to pay copay; • Current practice is to deny services with refusal to pay copay; and • Household income is >100% of the applicable FPL 29
Overview Topics Healthy PA Components Simplified Benefit Plan Structure Healthy PA Timeline 30
New Medicaid Benefit Plans High Risk Low Risk • Adults who have complex health care needs, either medical or behavioral health, including pregnant women • Administered by current Health. Choices managed care plans • Screened High • Includes adults 65 and over • Adults, ages 21 through 64, who do not have complex health care needs, either medical or behavioral, and are eligible for Traditional MA. • Administered by current Health. Choices managed care plans • Not screened high • Opted out of how risk plan No changes have been made to the children’s benefit plan. 31
High Risk and Low Risk Plans Both the high risk and low risk plans meet the federal standards for essential health benefits, mental health and drug & alcohol parity. Benefit Categories Covered Physician services, including primary care Outpatient services Emergency room services and emergency transportation (ambulance) Hospitalization Maternity and newborn care Mental health and substance use disorder services and treatments Lab services, x-rays, imaging (MRI, CT, etc. ) Rehabilitation and habilitation services and devices Preventive and wellness services Prescription drugs Dental services 32
Private Coverage Option Private market health insurance plan for individuals up to 133% of FPL who do not qualify for Medicaid Pennsylvania Enrollment Services will assist in enrolling individuals in a health insurance plan Cost sharing obligations identical to current MA plans Covers cost sharing for in-network services 33
Medically Frail Individuals who are screened as medically frail will be placed in the Medicaid high risk benefit plan. Medical Frail includes individuals who have a: • Disabling mental disorder • Chronic substance abuse disorder • Serious and complex medical condition • Physical disability that significantly impairs his or her functioning • Intellectual or developmental disability • Disability determination designation by the Social Security Administration 34
A Pennsylvania-specific Plan Medical Assistance (Vulnerable Pennsylvanians) Private Coverage Option (January 1, 2015) • Low income parents/ caretaker relatives with incomes up to 44% FPL • Childless adults • Adult parents/caretaker relatives • Incomes up to 133% FPL • Children • Working poor • Medically frail/Individuals with disabilities • Seniors 35
Overview Topics Healthy PA Components Simplified Benefit Package Structure Healthy PA Timeline 36
Implementation Timeline November 2014 • Letter sent to recipients changing packages • If transitioning to low risk or PCO plan, includes invitation to complete health screening • Notices of transition mailed December 2014 • PCO enrollment begins 37 January 2015 • Effective date of new MA and PCO plans
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