Skip Navigation
Back to Home Page Search
June 23, 2015Alerts

Managed Care Proposal: Comments Are Due July 15

Friends –

Managed Care Proposal: Comments Are Due July 15

The Governor is proposing managed long-term services and supports. This system would be a different system than the one we have today. This new system would be implemented in three phases, starting January 1, 2017. Click here for the Pennsylvania Bulletin notice.

In this new system, managed care companies (health insurance companies) would manage home and community-based services, physical health care, nursing facility care, and the Living Independence for the Elderly (LIFE) program. Behavioral health benefits may be included. At the least, behavioral health benefits would be coordinated with the new system.

The managed care companies would get a set amount of money for each person, called a capitated rate. The managed care companies would contract with providers and have a network of providers.

Managed long-term services and supports is being proposed for the following people:

A. Dual eligible adults over the age of 21 who are entitled to Medicare Part A and/or Part B and Part D and are eligible for Medicaid
B. All nursing facility clinically eligible (NFCE) non-dual eligible adults age 18 and older who are eligible for Medicaid (this includes Office of Long-Term Living waiver program participants)
C. Non-Medicaid recipients of the Act 150 Program

People eligible for Medicaid-funded or Base-funded programs available through the Office of Developmental Programs would not be included. These individuals may be included at a later time.

The Department of Human Services has issued a “Discussion Document” for public comment. Click here for the “Discussion Document.” Comments are due to the Department by July 15. Click here for information on how to submit your comments to the Department. The Department is also holding public meetings across the Commonwealth in June. The last public meeting is this Friday in Philadelphia. Click here for information on how to register.

The Department of Human Services is moving quickly to implement its proposal. The Department intends to issue a Request for Proposal (RFP) this October. The RFP would ask for bids by managed care companies. It is important to raise any concerns and recommendations you may have on managed long-term services and supports by July 15.

For further information:

Click here for information from the Centers for Medicare and Medicaid Services (CMS).

Click here for information from the National Council on Disability.

Click here for information from the Disability Rights Education and Defense Fund.

Click here for information from the Person Driven Services and Supports Coalition.

Contact:

Chava Kintisch, Esquire
Director of Civic and Government Affairs
ckintisch@drnpa.org
215-238-8070, extension 210
877-375-7139 (TTY)

Thank you,

Disability Rights Network of Pennsylvania
Offices in Harrisburg, Philadelphia, and Pittsburgh
1-800-692-7443
www.drnpa.org