Request for Proposal and Program Requirements
Complaints and Grievances Templates
- CHC G(1): Notice for Failure of CHC-MCO to Meet Complaint or Grievance Time Frames
- CHC G(2): Notice for Payment Denial Because the Service(s)/Item(s) was Provided Without Authorization by a Provider not Enrolled in the PA Medical Assistance Program
- CHC G(3): Notice for Payment Denial Because the Service(s)/Item(s) was not a Covered Benefit for the Participant
- CHC G(4): Notice for Denial of Payment after a Service(s) has been Delivered Because the Emergency Room Service(s) was not Medically Necessary
- CHC G(5): Notice for Denial of Request to Dispute Financial Liability
- CHC G(6): First Level Complaint Acknowledgement Letter
- CHC G(7): Failure to Provide Service(s)/ Item(s) in a Timely Manner Acknowledgement Letter
- CHC G(8): First Level Complaint Decision Notice
- CHC G(9): Complaint Decision Notice
- CHC G(10): Second Level Complaint Acknowledgement Letter
- CHC G(11): Second Level Complaint Decision Notice
- CHC G(12): Expedited Complaint Decision Notice
- CHC G(13): Grievance Acknowledgement Letter
- CHC G(14): Grievance Decision Notice
- CHC G(15): Expedited Grievance Decision Notice
- CHC G(16): Notice of Failure to Receive Provider Certification for an Expedited Complaint or Grievance
- CHC G(17): External Grievance Review Acknowledgement Letter
- CHC G(18): Scheduling Review Template
- CHC G(19): In-Person Scheduling Review Template
- CHC G(20): Consent For Provider to File a Grievance for Participant
Waiver Application
Community HealthChoices 1915(b) Managed Care and 1915(c) Home and Community-Based Waivers
The Commonwealth of Pennsylvania operates the CHC §1915(c) waiver application concurrently with a §1915(b) waiver application. CHC is Pennsylvania’s managed Long-Term Services and Supports (LTSS) initiative. The 1915(b)/1915(c) waivers allow the Commonwealth to require Medicaid beneficiaries to receive both LTSS, including nursing facility, hospice, home and community-based services (HCBS), and physical health services through managed care organizations (MCOs).
- 1915(b) Waiver Document
- CHC Independent Assessment
- CHC Independent Assessment Attachment 1
- CHC Independent Assessment Attachment 2
- CHC Independent Assessment Attachment 3
- 1915(c) Waiver Document (Effective April 1, 2023)
- 1915(c) Waiver Document (Effective July 1, 2022, Obsolete)
Public Input
As part of the initial application process in 2017, the Department solicited written comments regarding the proposed CHC 1915(b) and the proposed CHC 1915(c) waiver amendment. Comments received during the 30-day comment period were reviewed and considered for revisions to the applications prior to submitting to CMS. The Department has posted the comment and response documents for stakeholder review.
2023
As part of the re-procurement of the CHC program, the Department solicited public comments on the CHC Request for Information (RFI) between March 6, 2023 and April 14, 2023. The Department has posted a link to the RFI and a summary of those public comments for stakeholder review..
CHC Concept Paper
This concept paper describes the features of CHC and is intended to gather feedback from stakeholders.
The commonwealth invites feedback on this document from participants, advocacy organizations, providers, managed care organizations, care coordination agencies, legislators, family members, and other interested members of the public. Feedback received will be used to finalize the program design and issue a Request for Proposals (RFP) in November 2015. Were you unable to make it to one of our public hearings?
Related Documents
- CHC MCO Accreditation Status
- Request for Proposal — March 2016
- Summary of RFP and Agreement — March 2016
- Appendix A for submitting comments
- Companies that Submitted Bids on CHC RFP
- Agreement Comment Form (Excel)
- Public Hearing Presentation
- Discussion Document
- Long-Term Services and Supports — Fee-for-Service vs. Managed Care
- Federal Register: Final Rule Modernizing Medicaid Managed Care Regulations — (May 6, 2016)
- Public Comments — November Release
- Public Comments — December Release