Office of Long-Term Living Enrollment Services Subsystem
The Office of Long-Term Living's (OLTL) Enrollment Services ECM module will be used by an enrollment services entity, DHS, and the Pennsylvania Department of Aging (PDA) to manage the process to assist individuals in exploring and applying for Long-Term Services and Supports (LTSS). It will also provide a Customer-Facing Portal (CFP), allowing anyone from the public to view or compare information on a variety of programs and services, as well as providing the ability for applicants and other authorized individuals to track the progress of their LTSS Application.
OLTL currently contracts with an Independent Enrollment Broker (IEB), which provides application and enrollment services and choice counseling to individuals who apply for LTSS under an OLTL Program. Through the ECM initiative, DHS will bring in-house functionality that the IEB's system currently provides and has issued a Request for Application (RFA) seeking an organization to operate as an Enrollment Services Entity (ESE). The ESE will leverage OLTL Enrollment Services to provide services the IEB is currently delivering. In addition to application and enrollment services, the ESE will be responsible for managing all requests for, and completion of, the Functional Eligibility Determination (FED) and Preadmission Screening and Resident Review (PASRR) Level II Assessments.
With the implementation of the ECM system, OLTL will have the ability to manage aspects of application and enrollment services by streamlining processes and enhancing communication among the ESE, DHS, the PDA, and clients. ECM will accommodate OLTL's desire for increased visibility into the enrollment process, allowing for direct access to data the ESE gathers. The goal of the ECM system for OLTL is to improve the management of activities in which the ESE is involved, and to increase access to data. The system will also provide a means to reduce the amount of paper consumed throughout the application and enrollment process.
The benefits of implementing OLTL Enrollment Services functions on the ECM system include the following:
the need for physical files, where possible, allowing documentation to live within the ECM system or an integrated content management system for access by authorized users.
Allows for users to schedule the Intake Visit Assessment (IVA) electronically at the start of the application and enrollment process.
Reduces the administrative burden required for data entry into multiple systems (e.g., InterRAITM, ECM).
Allows the ESE to equip Case Managers with a Wi-Fi enabled device to facilitate data entry and compile necessary information while conducting the IVA. The ECM system should provide the ability for Case Managers to complete the following activities in real-time regardless of whether internet access is available:
Review a checklist of information that County Assistance Offices (CAO) may need to process an application for LTSS.
Complete FEDs using the Pennsylvania Individualized Assessment (PIA) system and upload the assessment to the InterRAITM system.
Conduct PASRR Level I and II Assessments.
Transmit the PA 1768 form to the CAOs electronically, holding and automatically sending when connectivity is available.
Enhances the ability for an individual (or those designated by the individual) to see the current status of their LTSS Application, allowing them to see the activities that have been completed and the activities that still need to be completed, as well as the timeframe for completion of the application.
Leverages leading technologies that are easier to maintain than the technology currently used and improve the ability to respond to changes in program policies and procedures.
Increases data accessibility by hosting the ECM system within DHS control, allowing OLTL to gain more visibility into activities in which the ESE is involved.
Improves business processes by automating manual tasks performed by the ESE, such as generating correspondence related to an individual's case, and improves communication among applicable stakeholders including LTSS Applicants, the ESE, and OLTL.
Allows the ESE to conduct activities currently performed by an Independent Assessment Entity, Area Agency on Aging (AAA), and the IEB that may not be related to completing eligibility and enrollment for Long-Term Care (LTC) benefits. These activities include:
Conducting the FED for individuals who apply for Domiciliary Care.
Conducting the PASRR Assessment for individuals seeking admission to skilled NFs regardless of intent to apply for LTSS.
In addition to the key benefits mentioned above, below is a summary of enhancements to current state IEB functions and services the ESE will be expected to provide in the future.
- IEB Website
OLTL would like a web-based CFP accessible to individuals in the general public that includes all functionality the current IEB website offers, with additional enhancements. Enhancements include the ability for users to:
- Confirm their intent to apply for Home and Community-Based Services (HCBS) or LTC in a Facility;
- Schedule an Intake Visit Assessment (IVA) within a timeframe specified by DHS, based on the availability of case managers in the individual's geographic area; and
- Submit a complaint if there is one.
- In addition to the enhancements mentioned above, the User Story team has specified the need for an improved ability of an individual (or those designated by the individual) to see the current status of their process to be approved for LTSS, allowing them to have a better idea where they stand and what may be holding up the process.
- Conducting the IVA
- OLTL has moved the in-person visit with individuals who confirm their intent to apply for HCBS or Long-Term Care in a Facility to the beginning of the application and enrollment process in order to better assist individuals with tasks needed to complete their application for LTSS.
- ECM will allow the ESE to equip Case Managers with a Wi-Fi enabled device to facilitate data entry and compile necessary information while conducting the IVA. ECM should provide the ability for Case Managers to complete the following activities in real-time regardless of whether internet access is available:
- Review a checklist of information CAOs may need to process an application for HCBS.
- Record e-signatures.
- Complete FEDs using PIA, and upload the assessment to the InterRAITM system, if supported by PIA.
- Complete PASRR Level I and II Assessments.
- Transmit the Home and Community Based Services (HCBS) Eligibility/Ineligibility/Change Form (PA 1768) to the CAOs electronically, holding and automatically sending when connectivity is available.
- Requests for only FED or PASRR Level II Assessments
- The ESE will be responsible for activities currently performed by the Independent Assessment Entity, the AAAs, and the IEB that may not be related to completing eligibility and enrollment for LTSS benefits. These activities include:
- Conducting the FED for individuals who apply for Domiciliary Care.
- Conducting the PASRR Assessment for individuals who do not intend to apply for LTSS.
- Defending FED Results
- OLTL confirmed the ESE will be responsible for defending the results of the FED when an individual appeals the result of their Level of Care (LOC) determination.
- The ESE should establish a procedure to ensure the same individual who completed the FED is not assigned to assist the appellant.
- LOC Determination
- OLTL would like the ESE to generate and send functional eligibility denial notices, as well as the Nursing Facility Ineligible (NFI) redetermination notice. OLTL sends the functional eligibility denial notices today.
- Living Independence for the Elderly (LIFE) Automation
- The ESE will be expected to process LIFE enrollments they receive within the DHS Daily Proprietary File, which will trigger LIFE Automation functionality within eCIS that was implemented with Community HealthChoices (CHC). Currently, the IEB is being instructed to disregard Waiver Code 96 (LIFE waiver code) within this file.