FAQs

PCC provides participants with service coordination for the following waivers: Community HealthChoices, Independence Waiver, Attendant Care Waiver / Act 150 Program, OBRA Waiver and Aging Waiver. Service coordination includes but is not limited to advocacy, community referral, skills training, community transition services and coordination of waiver and non-waiver services and supports. PCC also provides Nursing Home Transitions to those participants that have an interest in returning back to the community from a nursing home setting.

Pennsylvania’s mandatory managed care program for dually eligible individuals and individuals with physical disabilities — serving more people in communities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. CHC will improve services for hundreds of thousands of Pennsylvanians. CHC is being developed to: (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. LTSS help eligible individuals to perform daily activities in their home such as bathing, dressing, preparing meals, and administering medications.

Individuals will be enrolled in CHC if they are 21 years old or over and are:

• Receiving both Medicare and Medicaid; OR
• Receiving LTSS in the Attendant Care, Independence, or Aging waivers; OR
• Receiving services in the OBRA waiver AND determined nursing facility clinically eligible; OR
• Receiving care in a nursing home paid for by Medicaid.
• An Act 150 participant who is dually eligible for Medicare and Medicaid.

Individuals are NOT eligible for CHC if they are:

• Receiving LTSS in the OBRA waiver and are NOT nursing facility clinically eligible; OR
• An Act 150 program participant, who is not dually eligible for Medicare and Medicaid; OR
• A person with an intellectual or developmental disability who is receiving services through the Department of Human Services’ Office of Developmental Programs; OR
• A resident in a state-operated nursing facility, including the state veterans’ homes.

CHC covers the same physical health benefits that are part of the Medicaid Adult Benefit Package today. If you are eligible for LTSS, you can also get all services now available in waivers offered by the Office of Long-Term Living. With one exception, CHC will replace these waiver programs. The OBRA waiver will continue to exist for those 18-20 year olds who qualify for Medicaid LTSS and for those who have a severe developmental physical disability and need an Intermediate Care Facility/ Other Related Conditions (ICF/ORC) level of care. Behavioral health services are not a part of CHC. The CHC-MCO must coordinate care with their members’ HealthChoices Behavioral Health MCOs. CHC-MCOs have the same responsibility for coordination of members’ Medicare coverage.

LIFE or Living Independently for Elderly is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual. Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania have “LIFE” in their name. The first programs were implemented in Pennsylvania in 1998.

Agency Option – Participants utilize a home health agency that hires, trains, pays, fires, and assigns the personal assistants to the Consumer; Consumer Option – Participants are free to take charge of any and all aspects of their personal assistance services including recruitment and termination of their attendants.

PCC is proud to be a contracted in-network provider with Keystone First and PA Health and Wellness and will accommodate your individualized needs through our internal Service Coordination teams working under the 2 MCO’s.

PCC is dedicated to ensuring that you have the most accurate information to make informed decisions when it comes to your community care needs. With that considered, PCC has dedicated staff that are available to assist in starting the CHC process by calling 215-725-7200 ext. 1001 and speaking with the intake coordinator.

You may also contact the:

• PA CHC Helpline at 844-824-3655 or the
• PA Enrollment Broker at 877-550-4227 (TTY: 877-824-9346)