489.3 Office of Long-Term Living (OLTL) HCBS Waiver Programs

489.31 General  

OPS-15-04-04 Living Independence for the Elderly (LIFE) Program (also known as the Long-Term Care Capitated Assistance Program (LTCCAP)) - April 29, 2015  

PMN17657489 Data Entry of Living Independence for the Elderly (LIFE) Program Dates in eCIS - September 1, 2015


The Office of Long-Term Living (OLTL) administers the Community HealthChoices (CHC) and Omnibus Reconciliation Act (OBRA) Waivers as well as the Living Independence for the Elderly (LIFE)  program.

 

OLTL uses an agency called the Independent Enrollment Broker (IEB) to determine an individual’s medical eligibility and to provide enrollment services for its HCBS Waiver programs.  The IEB works with consumers, service providers, and CAOs to ensure that consumers are enrolled in the HCBS program that best serves their needs.

The IEB will inform the CAO of a consumer’s medical eligibility by sending a Home and Community Based Services (HCBS) Eligibility/Ineligibility/Change Form (PA 1768) with all necessary information completed.  Upon receipt of the PA 1768 and a PA 600 form, along with required documentation, the CAO will determine financial eligibility.

 

IEB Contact Information:

Toll free helpline: 877-550-4227 Toll free TTY line: 877-824-9346 Fax number: 717-540-6201

 
PA Independent Enrollment Broker

P.O. Box 61560

Harrisburg, PA 17106

489.32 Community HealthChoices (CHC) Waiver

The CHC Waiver consolidates the OLTL waivers into a single waiver, except for the Living Independence for the Elderly (LIFE) and the Omnibus Budget Reconciliation Act (OBRA) Waivers. It provides services to individuals age 21 and over who need an NFCE level of care. CHC waiver recipients are enrolled into a managed care plan which helps coordinate the recipient's services.

 

489.321 CHC Population

The CHC Population includes:

·         Nursing Facility Ineligible Dual (NFI Dual) population.

·          Nursing Facility Clinically Eligible Dual (NFCE Dual) population.

·         Nursing Facility Clinically Eligible Non-Dual (NFCE Non-Dual) population.

The CHC population does not include:

·         Individuals under age 21.

·         Individuals receiving their services through the State-funded Options Program (Act 150 Program).

Exception: NFI Duals enrolled in Act 150 will be enrolled in CHC for their physical health services and will receive their waiver services through Act 150.

·          Individuals with intellectual/developmental disabilities (ID/DD), who receive services through the DHS Office of Developmental Programs (ODP).

·         Residents of state-operated nursing facilities, including the State Veterans’ Homes and South Mountain Restoration Center.

Individuals enrolled in a CHC managed care plan may change their MCO by contacting the IEB.

 

489.33 Living Independence for the Elderly (LIFE) Program

The LIFE Program, once known as the Long-Term Care Capitated Assistance Program (LTCCAP) in PA, is known nationally as the Program for All-inclusive Care for the Elderly (PACE).  LIFE is a managed-care program for individuals eligible for HCBS who, when provided with proper support services, can safely be maintained in their own homes. The LIFE Program is administered by the OLTL.  It is designated with waiver code 96 in eCIS.

To be eligible for LIFE, an individual must meet the following conditions:

The LIFE Program is like other waiver programs in the following ways:

 

NOTE: SSI recipients will remain in the SSI category with waiver code 96.

 

 

The LIFE Program is different than other waiver programs in the following ways:

NOTE:  The LIFE waiver code 96 must remain on the case as long as the individual is enrolled in the LIFE Program.

NOTE:  The LIFE provider is responsible for payment to the facility from their capitated rate from the date of admission to the 30th day.

NOTE:  The begin date of the LTC facility category and 902Z cost of care TPL is always the first day of the calendar month the 31st day fell in.

Example:  Andrew has been open and receiving MA and HCBS in the LIFE Program since 5/10/19.  On 1/21/21, he enters an LTC facility.  On 2/20/21, Andrew has resided in the LTC facility for 31 days.  Andrew should be authorized in an LTC facility category (PAN, PJN, PMN) and a cost of care should be determined effective 2/1/21, the first day of the calendar month in which Andrew has resided in the LTC facility for 31 days.

The transition from the HCBS budget to the LTC budget must be processed in two separate workflows.  The system will end the 96 waiver code on the last day of the month in which processing occurs.  As a result, the CAO must re-enter the 96 waiver code with a begin date on the first day of the following month in addition to:


NOTE:  Do not designate the Medicare B monthly premium as code 12 “Medicare B” on the Medical Expenses screen for LIFE consumers residing in an LTC facility.  The use of the 96 medical expense code will ensure that the premium is correctly deducted from the LIFE consumer’s monthly income.

NOTE:  Should the LIFE consumer later be found eligible for the Buy-In program, the medical expense code 96, reflecting the monthly Medicare B premium, should be end dated prior to the month Buy-In begins based on information received via Data Exchange 3.

LIFE/Forum Place 6th Floor
PO BOX 8025
Harrisburg, PA 17105-8025

 

489.34 Omnibus Budget Reconciliation Act (OBRA) Waiver

OBRA serves individuals who are ages 18 to 21 assessed NFI with an Intermediate Care for Persons with Other Related Conditions (ICF/ORC) level of care who have been diagnosed with severe developmental disabilities. Once an individual turns 21 the system creates an alert (011) to notify the caseworker to rerun eligibility for enrollment into a CHC Managed Care plan.

Note: Individuals who were enrolled in OBRA prior to 07/01/2006 will remain in an OBRA waiver until the age of 60 when they will be transitioned systematically into a CHC waiver.

 

Updated August 30, 2021,  Replacing  October 14, 2020