Managed Long Terms Services & Supports (MLTSS)

In January 2017, southwestern Pennsylvania will undergo a major overhaul of its Home and Community Based Services (HCBS) system. These services will be delivered under a managed-care system. This means that the state will contract with various Managed Care Organizations (MCOs) to provide all the services that are currently provided by the Office of Long Term Living waivers.

All adults using Medicaid for their primary care (hospitals and doctors) will now be using the same type of organization (an MCO) for their long-term care. All adults who receive long-term support waiver services and those who receive both Medicaid and Medicare (even if they don’t use long-term supports and services) will be included in the new program, called Community Health Choices. Also included are those who reside in nursing facilities.

LATEST NEWS (8/30/2016)Pennsylvania Announces Selection for Community HealthChoices Managed Care Agreements

What These Changes Mean to You

Changes will occur gradually over the first six months (180 days), possibly longer. This is when MCOs will be settling into the region and establishing their procedures. At the end of that period:

  • Service Coordination will begin to change: MCOs will have some choice as to how they provide service coordination. They may choose to contract with existing service coordination entities, or create a new method for delivery of service coordination.
  • You may have new providers for your waiver services: The MCOs that participate in Community Health Choices will be use providers of their choosing, so long as those providers meet established qualifications.
  • A new standardized assessment tool will be used statewide: This new tool will be used to determine how much support a person needs, and what specific kinds of supports they will qualify for.

Find Out More & Get Involved!

For more information, see this link.
Project Manager, Brenda Dare serves on the Managed Long Term Services and Supports Subcommittee. Call her at 724-223-5115.