Do you operate a Medicaid certified nursing facility in Pennsylvania with a CMS five-star rating of three stars or above?
You may be interested in joining PCQPAC, a 501(c)(6) non-profit corporation with the mission of assisting long-term care Provider Members in the transition to Community Health Choices (“CHC”) Medicaid Managed Care and in the process of contracting with Community Health Choices Managed Care Organizations (“MCOs”).
Pennsylvania Coalition for Quality Post-Acute Care (PCQPAC)’s mission is to represent its high quality postacute care providers/members in contracting with Managed Care Organizations (CHC-MCOs) and to ensure that providers are receiving sustainable future reimbursement rates. PCQPAC provides members with ongoing support and representation, both from a lobbying and legal perspective, in managing all ongoing operational issues with DHS and CHC-MCOs as they arise.
BACKGROUND ON MANAGED CARE IN PENNSYLVANIA
Long-term care providers in the Commonwealth now face new challenges in the transition to Community Health Choices Managed Care. Community Health Choices has already been implemented in the Southwest region of Pennsylvania (effective January 2018) and Southeast region of Pennsylvania (effective January 2019). It will be implemented in the rest of the state in January of 2020. During the continuity of the care period, which is a period of 18 months from implementation, DHS mandates that the CHC MCOs contract with all existing Medicaid certified nursing facility providers if those nursing facility providers are willing to do so and are willing to accept the Community Health Choices rates for payment. During this transition period, the CHC MCOs have agreed to pay providers a “rate floor” for the first three years after implementation of CHC in the region, which consists of an average of the four quarterly Medicaid rates effective prior to the date of implementation in the region.
Providers should appeal any and all audit reports issued by DHS that impact this “rate floor,” as they will be living with these rates for a three year period unless an alternative rate schedule is negotiated. After the continuity of care period, providers will essentially be on their own as to whether they will be able to contract with one or all three of the CHC MCOs. Moreover, after the end of the rate floor, providers will again be completely on their own with respect to negotiating their rates for Medicaid recipients, with essentially private entities that are the CHC MCOs.
Questions on CHC Managed Care in Pennsylvania ? Contact Daniel Natirboff, Esq. at or 717-233-4101
WHAT ARE PCQPAC'S QUALITY PARAMETERS?
A current CMS rating between 3 –5 stars or a 3 –5 star CMS rating during the last 2 quarterly reporting periods. The PCQPAC Board may vote to amend or supplement these parameters in the future.
WHAT IS PCQPAC's MEMBERSHIP FEE?
Members will be charged a $30 per bed yearly fee. There is a $30,000.00 cap for multi-facility organizations with common ownership. Membership will run annually from the initial date of membership.
The PCQPAC Board has the jurisdiction to vote on modifying the membership fee, if deemed necessary.
Click HERE to view PQCPAC's Organizational Bylaws