CHC & Inglis

CHC - Covered Services and Continuity of Care

What Services Are Included?

• CHC covers all physical health services and Long-Term Services and Supports (LTSS)
• Physical health services include inpatient and outpatient hospital and clinic services, dental services, nursing facility services, and more
• LTSS include items such as employment services, pest eradication, assistive technology, and more
• A comprehensive list of all services covered and not covered by CHC is available on pages 9-15 of the CARIE Advocates Guide to CHC by following this link (link opens in a new window). 
• Each MCO provides a list of the services they will cover under each of their plans. (plans are listed alphabetically).  
  • KeystoneFirst CHC
  • PA Health & Wellness
  • UPMC

Continuity of Care

• Continuity of Care (COC) refers to the form of protection participants will receive to more easily manage the transitions occurring under CHC. It gives both participants and Medicaid providers extended time to adapt and adjust to CHC.
• MCOs are required to contract with all willing and existing qualified Medicaid providers during the first 180 days after CHC implementation
• During this period, participants will be able to keep their existing healthcare providers; this applies to:
   
  • individuals participating in any Home and Community-Based Services (HCBS) Waiver Program
  • Inglis House Residents
  • Individuals within the community that have eligibility for CHC (see above)
     
• A few exceptions and special cases to CoC that are important to note:
  • Nursing Facility (NF) residents: those residing in or receiving care from a nursing facility paid for by Medicaid at the same time CHC is being introduced in the Southeast can remain in or keep their existing nursing facility. This is regardless of whether or not the nursing facility is part of any given CHC-MCO’s networks. Thus, the participant can enroll in any CHC-MCO.
  • If the participant is admitted into an NF after enrolling into CHC, they will receive a 60-day CoC period as described for other existing services besides NFs and HCBS
  • ​​​​​​HCBS Waiver Program and other CHC-eligible participants: if a participant switches to a different CHC-MCO DURING the 180-day CoC period:
    • they will receive their healthcare and relevant services for whichever of the following dates comes later:
      1. the greater of 60 days or the remainder of the 180 days
      2. Date that a comprehensive needs assessment (CNA) has been completed and a PCSP has been developed and implemented
    • if a participant switches to a different CHC-MCO AFTER  the 180-day CoC period:
      • they will receive CoC for whichever of the following dates comes later:
        1. 60 days CoC
        2. CNA has been completed and a PCSP has been developed and implemented