As the commonwealth moves forward with Community HealthChoices and a request for proposals soliciting managed care organizations to administer physical health and long-term services and supports to eligible individuals, information will be posted here to provide context and historical data about programs and populations.
DETAILS: Community HealthChoices Historical Data Summary (PDF)
General Overview of Office of Long-Term Living Programs
The Department of Human Services administers Pennsylvania’s Medical Assistance program, including programs that provide long-term services and supports to Medical Assistance-eligible older adults and adults with physical disabilities.
Medical Assistance Long-Term Services and Supports are provided through home and community-based services waivers, nursing facilities and managed care services (the LIFE Program). Pennsylvania Living Independence For the Elderly (LIFE) is a managed care option that allows the elderly to live independently while receiving services and supports that meet the health and personal needs of the individual. The LIFE program is a Program of All-Inclusive Care for the Elderly under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
The Community HealthChoices (CHC) population includes:
Persons included in the CHC population will be required to enroll in CHC or the LIFE Program. However, persons who currently are enrolled into the LIFE program will not be enrolled into CHC unless they specifically ask to be enrolled. Supporting CHC population data, broken down by county, by month can be found here.
Historical Claims Data
This report was created by Mercer. It provides historical claims and eligibility data for CHC eligibles. The exhibits include data for the Commonwealth’s Fiscal Year (July 1) SFY 2012-13 and SFY 2013-14 and are summarized by zone, population group and category of service.
LIFE Program Historical Data
This report gives total expenditures (capitation payments) and non-duplicated participants statewide for all LIFE MCOs for SFY 2012-13, SFY 2013-14 and SFY 2014-15. This data was extracted from the DHS Data Warehouse as of February 2016.
More information on the LIFE (PACE) Program can be found here.
Incidents by County and CHC Zone
This report shows aggregate information for the Aging Waiver and all other OLTL under the age of 60 waiver programs. These aggregate reports were split because they have different data sources. All OLTL waivers except the Aging Waiver incidents were extracted from DHS Data Warehouse, source system Enterprise Incident Management system. The Aging Waiver incidents were extracted from SAMS. All incidents were compiled for SFY2012-13, SFY2013-14 and SFY2014-15 as of October 2015. Incidents were counted by incident number and by participant identifier (Master Client Index).
Nursing Facility Occupancy by County and CHC Zone
This data was extracted from the Nursing Facility Assessment Database as of October 2015. These reports were created by Myers and Stauffer LC. These reports include only MA facilities that were active for the whole year (Assessment quarters 34-37 for SFY2011-12; 38-41 for SFY 2012-13; and 42-45 for SFY 2013-14).
Chronic Conditions Costs and Services by CHC Zone
This reports the chronic conditions costs and services by county and CHC zone for Calendar Years (CY) CY2012 and CY2013. The source for this data is the CMS MMA file. The report displays Chronic Condition Rates per 1,000 Dual Eligible Recipients Receiving Medicare on Fee-For-Service basis.