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Thefollowingprintoutwasgeneratedbyrealtimecaptioning,anaccommodationforthedeafandhardofhearing.Thisuneditedprintoutisnotcertifiedandcannotbeusedinanylegalproceedingsasanofficialtranscript.>>CAPTIONER:Onstandbyforwebinar.(Recordingthatwebinarwouldbestartingsoonstopped.Waitingforwebinaraudiotobegin.)>>JEN:Goodafternoon,everyone.ThisisJenniferBurnettdeputysecretaryofofficeoflongtermliving.IamjoinedbyKevinHancockourchiefofstaffandPatBradyandsellersDorseywiththelogisticofthethirdThursdaywebinars.WelcometothirdThursdaywebinar.WewillstartwithalittlebitofhousekeepingthatIwillaskPattogothroughandthenshewillgiveitbacktomefortheactualprogram.>>PAT:Thanks,Jen.Justasinpreviouswebinars,ontheright-handsideofyourscreen,youwillseethecontrolpanel,hopefullyinaminute--okay.Therewego.Ontheright-handsideofthescreenyoucanseethereisacontrolpanelandthisiswhere,towardsthebottom,youcantypequestions;andyoucanalsoselecthowyouparticipate,eitherthroughusingthemicrophoneandspeakersonyourspeakerorthroughthetelephone.Wearegoingto,asinthepast,askyoutosubmitquestionsandcommentstothequestionpanel,thenwewilltaketimetoanswerthosequestionsduringthepresentation.Iam.>>JEN:Thankyou,Pat.IamgoingtostartoutwithanagendaonthethirdThursdaywebinar.Verybriefly,wewillspendalittlebitoftimethisafternoongoingthroughanupdateonwherewearewithCommunityHealthChoices.Theupdate--wewillalsogothroughtheconceptpaper

1:30-3:00OfficeofLongtermLivingWebinar Transcript

comments.Wehaveselectedaboutfiveorsixcommentpapercommentsthatwewanttowalkyouthroughsoyoucanseethechangeswemadebaseduponthepublicinputwegotontheconceptpapertoleadustothenextstep.Thethirdthingwewillcover,whichIthinkyouwillfindveryinteresting,weinvitedGarySullivanfromTennesseetospeaktohisexperienceinmanagedlong-termservicesandsupportsinTennessee.WearefortunatetohaveMaccgoaledfromSellersDorseyfacilitatethatconversationwithGarySullivan.Weareveryexcitedandwanttohearfromconsumerswhoareexperiencedinmanagedlong-termservicesandsupports.Wewillopenitupforquestionsattheendoftheconceptpapercomments.Wewillhaveafewminutes,thenpassontoGary.AfterGary'spresentation,hewillopenitupforquestionsandwewillmakesurethatwehaveafacilitatedconversationwiththequestionsthatareasked.Iwanttotalkbrieflyaboutthedraftprocurementtimeline.Asyouknow,wehadtheconceptpaperopenuntilOctober16th;atthatpointweclosedthatforcomments,receivedmany,manycommentsand--sothatkindofledustoourlatestrelease,whichwasonMondayofthisweek.IwanttoprovideyouwithanupdateofwherewearewithdevelopmentofCommunityHealthChoices.IalsocertainlywanttotalkaboutsomeofthecommentsthatweincorporatedintotheRFP.ThenewreleaseonMondaythe16thofNovemberwasa--itwasadraftRFPanddraftprogramrequirements.Wearelookingformoreinputonthisprocess;that'ssomethingweheardfrompeople.Weareissuingthisindraft.ThisissortofanewprocessfortheDepartmentofHumanServices.Wedon'tusuallyissuedraftRFPs,butwearedoingitthistimebecausewearemakingchangesthatwereallywanttohearcommentson.OnDecember11th,wewillbeclosingthatcommentperiod;soallofthecommentsonthedraftrelease,releasedonMonday,needtocomebackbyDecember11th.OnDecember14th,wewillreleaseaseconddraft,whichisalsobeingreleasedforpubliccomment.Thiswillcoveradditionalmaterialsandmorespecificinformationontheeligibilityandenrollmentprocess,whichisnotpartofthereleasethatweputoutonMonday.ThosecommentswillbeduebackonJanuary8thof2016.Sowewerelookingforadditionalcommentsonthedraftmaterialsandinformationoneligibilityenrollmentandwhatyouthinkaboutwhatweputoutonthe14thofDecember.

SometimeinJanuary--wedonothavethedate--wewillhavetheofficialreleaseoftheRFP.Thereasonwehavenotspecifiedadateforthatiswejustdon'tknowhowmanycommentswearegoingtobegettingbackonJanuary8th.Weneedtomakeanadjustmenttothatofficialreleaseoncewehaveabettersenseoftheamountofcommentswereceiveback.Iwanttotalksomeaboutotherstakeholderprocessesthatwehavebeengoingthroughjustbywayofanupdate.OnNovember4thand5th,weheldwhatwecallthemanagedcareorganizationandstakeholdermeetandgreets.Wedecidedtoholdthesemeetingsbecauseofbestpracticesfromotherstates,andalso,really,tofacilitateanopportunityforthemanagedcareorganizationsandinterestedstakeholderstomeetandtobegindevelopingthoserelationshipsthataregoingtobecriticaltothesuccessofthisprogram.Thefirstday,onthe4th,washeldattheRadissoninCampHill.Atthattime,wehadhalfaday--whichwasmanagedcareorganization,specificeducation,aboutlong-termservicesandsupports.Inparticular,itreflectedonthesystemthatPennsylvaniahasinplacewithlong-termservicesandsupports,includingourservicesinnursingfacilities,aswellasourservicesinhomeandcommunity-basedservicesandthetypesofhomeandcommunity-basedservicesavailable.Followingthat,wehadatwo-hourmeetingwiththehomeandcommunity-basedserviceproviders.WeaskedtheSCBSserviceproviderstodoapresentation,actually,forallofthesemeetandgreetswedid,weaskedthetypeofprovidertodoapresentationaboutahalfhourpresentationonwhattheydoandhowtheydoit;thenweaskedthemanagedcareorganizationstotalkabouthowtheydotheirwork;thatmanagedcareconversationwasledbyformerDCWsecretaryEstelleRichmanwhoaskedconsistentquestionsforeachofthedifferentprovidertypes.Wedidthatwithhomeandcommunity-basedserviceproviders.Thenwehadatwo-hoursessionwithcurrentparticipants,thenwehadatwo-hoursessionthenextday,whichwasheldatPaTTAN,whichisjustontheoutskirtsofHarrisburg.Itisanicefacilitytoholdalargemeeting.TheseconddaywestartedwiththeAreaAgenciesonAgingcomingandtalkingaboutthemselvesandhearingaboutmanagedcareorganizationsandthensortofthemeetandgreet.Thenwedidservicecoordinationentities.TheydidanicepresentationonhowtheyoperateinPennsylvania.Then,finally,weinvitedthenursingfacilitiesinPennsylvaniatocomeandtalkwiththemanagedcareorganizationsabouttheservicesthattheymake

availableforPennsylvanians.Alltogether,wehadover800participantsoverthecourseofbothdays.Wedidhaveverypositivefeedbackfromallpartiesinvolvedandthatincludesboththeproviders,theconsumersandthemanagedcareorganizations.Weareplanningtocontinuetheconversationovertheupcomingmonths.Wethinkthatthesefacilitatedconversationsbetweenmanagedcareorganizationsandotherinterestedpartiesisreallyimportant.Iwanttotalkalittlebitaboutournewwebsite,ifyouhaven'ttakenalookatit,pleasetaketimetogooverandcheckitout.Becausewemigrated,alloftheDepartmentofHumanServices,hasmigratedtoanewwebsiteplatforminthelastthreeweeks,Iwouldsayithasoccurred.Becausewereorderedthings,IjustwantedtoshowyouwhereyoucanfindinformationonCommunityHealthChoices.Thisisthehomepageofthedepartment--thenewDepartmentofHumanServiceswebpage.Downwheretheredarrowis,clickonthat,thelivelinkundertopissues,whichtakesyoutotheCommunityHealthChoiceswebsite.Idon'thaveitontheslideherebutitisaneasynavigationrightonthehomepage.OnceyougettotheCHCwebsite,ithouseslinkstothedraftRFPwejustissuedandthedraftagreementwejustissued,aswellassummarydocumentsthat--summarydocumentsthatoutlinesthecustomizationsimmediatetopreviouslyexistingagreementtohelpmoldtherequirementprisonerto--italsohousesCommunityHealthChoicespriorthirdThursdaywebinars,otherdocumentssuchasthediscussiondocumentsandtheconceptpaper,andthethirdThursdaywebinars--italsohasalinktothemanagedlong-termservicesandsupportssubcommitteeofthemedicalassistanceadvisorycommittee.Ifyougothere,youcangetallofthearchivesofthemeetingsthatwereheldsofar.Iwanttomoveintotalkingalittlebitabouttheconceptpapercomments.Thesearecommentsreceivedontheconceptpaper,whichweusedtohelpusdraftwhatwasissuedonMonday.ThecommentperiodclosedFridayOctober16th.Wehadover1500commentersfromovernearly250commenters.Thesearesomeofthehighlightsofwhatweheardfromthosecommenters.Theywantedustoenhanceparticipantingrievanceappealsprocessesandgivethosespecificsinthedocument.Theyareconcernedwithproviderandcredentialingdetailsinmanagedcareorganizations.

Wehadcommentstoincludeservicesforthedeaf-blindpopulation.WealsohadcommentsthatweshouldbeincorporatingproviderstandardsaspartoftheRFPanddraftagreement.Andnowwewouldliketosharesomeofthespecificchangeswithhehavemadeasaresultofthatpublicinputfromboththediscussiondocumentandtheconceptpaper.Therequirements--thefirstonewasonthe25%serviceplanreduction.Therequirementforthestatetoapproveanyperson-centeredplanthatproposesareductioninanyoneserviceby25%shouldbemodifiedtoreviewanyplanthatproposesareductioninanyoneserviceby10%.Thelargerpercentageissignificantdecreasethatcanresultinsignificantimpairmentandpoorhealthoutcome.Thatisadirectquotefromoneofthecommentators.Thisparticularcommentasksthatwechangethat25%thresholdto10%threshold.We,actually,decidedtogowithnothereheshallholdatall.Areeliminatingthethresholds.Continuumofhousingoptions.Tosupporttheadministration'srebalancinggoals,theCHCservicepackageshouldincludeservicesprovidedtoconsumersinassistedlivingfacilitiesandpersonalcarehomes.SuchservicesareessentialiftheCHCprogramistoaddressthebarrierofadequatecommunity-basedalternativetonursinghomecareandaccomplishitsrebalancinggoals,anotherdirectquotefromacommentator.TheCommonwealthisinterestedinthefullcontinuumofhousingoptionsandservicedeliveryforindividualsneedinglong-termservicesandsupports.ForindividualsresidinginnursingfacilitywhenCommunityHealthChoicesrollsout;that'sthespecificgeographicregion,thoseindividualswillhavetheoptionofremaininginthatfacilityaslongastheywish.Werecognizethefactthatthisistheirresidenceandwewillleavethatfortheoptionthattheychoosetodoso,however,wewillalsoexpectthatthemanagedcareorganizationsprovideresources,ifthoseindividualsdonotwanttoremaininthenursingfacility.Iftheirpreferenceistotransitionoutofafacility,thatwouldbeencouragedaswell.SoparticipantchoiceisreallyattheheartofCommunityHealthChoices.SpecificinformationonwhattypesofhousinglikeassistedlivingisreallywelcomeinthisnewRFPprocess.Wewouldreallyliketohearspecificsonhowwemightbeabletoincorporatealternativelivingarrangementslikeassistedliving.Pleaseprovideuswiththosespecifics.Communityeducationexaifn.Anotherquote"launchamajoreducation

campaignthatenlistsallcommunitypartnersineffortstoactivelyinformconsumers,theirfamilies,caregivers,providersandotherstakeholdersaboutthemovetoamanagedcareenvironmentforLTSS".TheCommonwealthisworkingonaproposal.DHSisworkingonaproposalthatoutlinestheexpectationsoftheCommonwealthaswemoveforwardseekingcommunitypartnerstoassistinaneducationandoutreacheffort.Weare,actually,engagedinaprocessofdoingthat.Ourcampaigngoal,thegoalofsuchcommunityeducationcampaignistomakesurewetouchorcontactallfutureenrolleeseventhosenotenrolledinservicesandsupportsystemtoensurethatthefirsttimethattheyhearaboutCommunityHealthChoicesisnotwiththeirenrollmentnotice.Participantdirectionlanguage.IwilljustturnthisovertoKevin,whoisgoingtotalkalittlebitaboutparticipantdirectionlanguage.Hewilltakeusthroughtherestofthechangeswemadeandopenitupfor10minutesofcommentsandthenwewillturnitovertoGarySullivanandMarc.>>KEVIN:Thankyou,Jen,asnotedforparticipantdirectionlanguage,thiscommenterstatedthereisoftenconfusionregardingthevariousentitiesthatsupportaself-directedparticipant.InsomestatesthislackofclarityisduetothelackofspecificityinstatecontractswiththeMCEsormanagedcareorganizations.Orpoliciesandproceduremanualsregardingparticipantdirectedservicesandnecessarysupportiveservicessuchasfinancialmanagementservices.Tobeclear,wewilladdressthisconfusionbyintroducingaconceptofasupportsbrokerservice.ThesupportsbrokerservicewillprovideeducationandalsonavigationforprogramparticipantsthatareusingparticipantdirectionasthedeliverymodelfortheirpersonalassistantservicesandthatsupportbrokerserviceisnotactuallygoingtobepartofCommunityHealthChoicescontractitwillbecoordinatedbyfinancialmanagementservicesentityorthefinancialmanagementservicesbrokerthat'sprocuredseparately.Wewillhaveasupportsbrokerservicethatwilladdressconfusion,thesupportsbrokerservicewillpartofFMScontractanditwillbecoordinatedbythecommunityhealthmanagedcareorganizationsaspartoftheoverallmanagementofparticipant-directedservices.ThequestionwasDHSrelatingtothedraftRFPreleaseforpubliccomments,specificallyDHSshouldrelieveCommunityHealthChoicesbeforebiddingisopentoallowformeaningfulstakeholderinputsoncontractsbeforeitistoolatetomakechangestotheprogram.Toaddressthis,Jenhasalreadytalkedaboutthiswiththetimeline,there'sa

plannedinclusionofstakeholderorparticipantadvisorycommitteeon--inseveralareas.Oneareaspecificallyisthegrievanceandappealsdevelopmentprocess.Inaddition,wearegoingto,asJenhadnoted,wearereleasingthedraftprogramrequirementsforpubliccomment.TheyarecurrentlyreleasedrightnowforpubliccommentandwillbemadeavailableuntilDecember11th.ThosecommentswillbethenprocessedintowhatwillbethefinalrequestforproposalandfinalprogramrequirementsthatwillbepublishedinJanuaryasJenhadstated.Inadditiontoallofthis,wehavedoneeverythingwecouldtomakesurethatwewereenhancingandpubliccommentsandhavingastransparentaspossiblestakeholderprocessforthisprocess;thathasincludedthe45daysofcommentaryweallowedforthediscussiondocumentwereleasedinJune,the30daysofcommentaryweallowedfortheconceptpaperwereleasedinSeptemberaswellastheRFPandprogramrequirementsbereleasedonMonday.Wearealsogoingtobeincludingafour-weekcommentperiodfortheremainingcomponentsofthedraftagreements,asJenmentioned,thatwillbereleasedinDecemberaswell,onDecember14th.Wearelookingforwardtoallofthesecommentsdevelopingwhatwethinkisacompletelyunderstandable--althoughtheprogramisverycomplex,itwillbeacompletelyunderstandabledocumentandacompletelyunderstandableprogramthatwillbesupportingtheneedsoftheCommunityHealthChoicesprogramparticipants.Anothercommentwereceivedistoexpandhomeandcommunity-basedservicesmenu.Thiswouldincludeenhancingthecurrentmenuofhomeandcommunity-basedservicestoincludescermnation,interpreterservices,arobustportfolioofhousingservicestoincludeassistivedevices,homeadaptationsandalternative--assistedliving,personalcareboardinghomes,etcetera.Wespecificallylistedextermenationservices--youwillbeabletoseethat.Oneexampleofanareawherewethoughtitmadesensetoexpandtheservicesandbeexplicit.Forsomeotherservices,suchasinterpreterservices,Iwillgointoalittlebitmoredetailaboutthisinaminute>>Jenn.>>JEN:WehadatechnicalgiveeandlostPowerPoint.Everybodyshouldbeabletoseeitnow.Thankyou.>>Kevin:Ipromiseyouwillwillnotrepeatthisfromthebeginning.

Iwillmentionwearegoingtobeaddingexterminnateorservicesaspartofexpansionofallservicesunderconsideration.Wehavelanguageforassistedlivingrelatedservicesthatyouwillnote.Youwillalsonotethattheservicedefinitionforallofthewaiverservicesarealsoincludedintheprogramrequirement.Iwillgointoalittlebitofdetailhereinamomentaboutthesupportiveservicesthatwererequested.Wereceivedalotofrequestsforsupportiveservicesthatwouldbehelpingspecifically.Wedidnotexplicitlystatethoseserviceswouldbeaseparateserviceintheprogram.Whatwewouldliketodoisincludethoseservicesaspartofanexistingwaiverservice.WhatwewouldliketoreceiveinresponsetothepubliccommentsfortheprogramrequirementsissomesuggestionsorguidancefromstakeholdersonwherethebestfitwouldbeforthosetypesofservicesinthemenuofservicesthatarelistedintheexhibitCDDintheprogramrequirementsection.Thisisarequesttostakeholderstoprovidethebestsuggestionforwherethoseserviceswouldbeagoodfit.Wewouldliketomakesurethatthoseservicesareavailableforpeople,especiallywheretheyareneededanddifferentareasincludinghealthcarenavigation.Wewanttomakesurethattheservicesareinthemostappropriateplaceornotedinthemostappropriateplace.Wearelookingforstakeholderstoprovidecommentsonwherethey--wheretheythinktheywouldbebest--[indiscernible]Youwillnotehere,resourceinformation,onCommunityHealthChoicesandonwherealotsofthisinformationshouldbeavailable,younoteCommunityHealthChoiceswebsitewillhaveallofourpublisheddocumentsincludingprogramrequirementsanddraftRFPthathavebeenpublishedforpubliccomments.Iwon'treadthewebsite.Youcanseeitonyourscreens,butifyougototheCommunityHealthChoiceswebsite,youwillbeabletofindandaccessthosedocumentsforsubmissionofpubliccomments.Inaddition,youwillbeabletofindanyupdatesonanyrelatedprogramactivitiesandanyrecentcommunicationsatthemanagedlong-termservicesandsortssubMAACwebpagelink.Youwillbeencouragedtoreceiveupdatesbyregisteringforlistserv.Iwillreadthishttp://listserv.dpw.state.pa.us/.TheemailisRH-MLTSSatepa.gov.Withthat,wewillbeaccepting10minutesofcommentsforwhatwehaddiscussedinourupdate.ThenwewillbeturningitovertoMarc,whowillbe

guidingusthroughourdiscussionwiththepersonwhohasbeenenengagedinamanagedcareprogram.AquestionwasstatedinthedraftitstatesservicecoordinatorsneedtobesupervisedbyRN.Iamcurioustoknowhowthatwasinterpretedinthe--theywillnotbeneedtobesupervisedbyregisternurse.Theirroleismanagingtheperson-centeredplanningprocess.Theywillbecoordinatingservicesandregisterednursewillbepartoftheperson-centeredplanningteamwithoutadoubtaspartofthisprogrambuttheywillnotbesupervisedbyaregisterednurse.Theservicecoordinatorshaveaseparateresponsibilitythatwillinvolvecoordinationofserviceswitharegisterednurse.Ifthereisapointofclarificationthatneedstobeintherequirementsdocument,please,pleaseforwardthattousandwewillmakesurethatthatisclearlymade.ThenextquestionweareveryconcernedthatthedraftdocumentsaysMCOcontractswiththestatewillbeforfiveyears.ItisaverylongtimeforMCOswhohaveneverdoneanyworkornoexperiencewithmanagedlong-termservicesandsupports.Theystronglyencouragethedepartmenttorethinkthisasatwotothree-yearcontractatamaximum.Weappreciatethatcommentandencourageyoutosubmitthatcommenttous.Wewillconsideranytypeofconfigurationaswecontinuetogoforward.>>JEN:Idowanttosaythatthedepartmentcanterminateacontractatanytimeforduecause.Ifwefindwearegoingtobedoingveryclearmonitoringandoversightofthesemanagedcarecontracts.Ifwefindthatacontractisnotperformingtothequalitystandardsthatweareexpectingandrequiring,thenwecanterminatethatcontractatanytime.>>KEVIN:Thankyou,Jen.Iampleasedtoseeyouarechangingthethresholdsfrom25%to10%.Asyoudescribeyourproposedchangehavingtheauthoritytoreviewanycase,myquestionwouldbe,whatwouldtriggerareview?Ifthereisnothreshold,howwillthestatedeterminewhatdeterminesreview.Aminimumthresholdrequiresreview.ThishasbeenbroughtupinsubMAACwearedevelopingautomatedtriggersthatwouldrequirethereview.Itwouldnotnecessarilybebasedonapercentage,however.Wewelcomecommentsorsuggestionsforhowthatwouldoccur,butwearelookingformoreofaholisticwaytoviewplansthatdoesn'tconsideraspecificpercentageanddoesn'tnecessarilylockusintoaparticularthresholdthat'sbasedonachangeoftheoverallplan.Sothetriggerisgoingtobe--triggerswillbemulti-faceted.Theywillrelatetodifferentcomponentsoftheperson-centeredserviceplan.

Weareverymuchopentosuggestionsforwhatthosewouldbe.>>JEN:Ijustwantedtosharewithyouthattheideaofapercentagethreshold,wedidhearfrommembersofmanagedlong-termservicesandsupportssubcommitteeandmedicaladvisorycommittee.Infact,oneofthemembersmadeitverycleartousthatonelittlechangeforheris--shecallsadominoaffect.Onechangecantriggerawholeseriesofchangesandproblemsforherandthereforeshewouldendupinaninstitution.Shehashadthatexperience.Sowereallylistenedverycloselytothatfeedbackfromourmember;that'swhywereducedthispercentagethresholdbecauseitseemedartificial.Insteadwearegoingwithsomethingthatismoreholistic.>>KEVIN:Afourthquestion:HowwillproviderseasilyidentifywhichMCOeachconsumerhasselected.Themostobviousidentificationmaterialwillbetheperson'sbenefitcard.TheywillhaveacardthatidentifieswhichMCOtheyparticipatein.Thatcard--wearelookingforopportunitiestobe--ifapersonhasboth--isdualeligibleandhasbothaspecialneedsplanandaplanfromaCommunityHealthChoicesmanagedcareorganization,wearelookingfortheopportunitytohavethatpersononlyhaveonecardaspartofthisenrollmentinthisprogram.Theeasyidentificationwouldbethecard.It'sbeenproventobeeffectiveatthispointdecadesofexperiencewithmanagedcareandwithcoverageingeneral.AnothercommentandthenIthinkwearerunningoutoftimesoonbeforewemoveovertoMarc.Areyousayingthatthereisaseparationofwhocan--specificallybetweenconsumersopttoreceiveservicesthroughPPLasFEAandthoseconsumerswhowanttheirservicesprovidedthroughagency.HCBSaswellasPennsylvania'sattendantcareactmakesnodistinctionbetweenFEAandagency.Itsimplystatesconsumerreceivingattendantcareserviceshastherighttomanage,directlysupervise,scheduleandhireandfiretheirselectedworkers.Myresponsetothis--theresponsethatwewereprovidingaboutthesupportsbrokerwasspecificforthoseindividualswhoaregoingtobeenrollinginourparticipantdirectedmodelofservicesandthoseindividualswhowillbeusingservicesthroughourfinancialmanagemententity.Sointhiscasethesupportsbrokerwouldbemadeavailabletotheindividualsusingfinancialmanagemententity.Theexpectationisthatindividualswhoneedsupportbrokerorthistypeofserviceandreceivingservicesthroughthe

agencymodelofservices,willbebothreceivingtheserviceswithsupportofmanagedcareorganizationitselfandwiththemanagedcareorganizationscontractedproviderforpersonalassistantserviceswiththeagencymodel;that'saverygoodquestion.Weappreciateyouaskingit.Forpointofclarification,thesupportbrokerwillbeofferedfromthefinancialmanagementservicesprocurement.>>JEN:Thesupportbrokerserviceisoptionalserviceforpeoplewhoneedit.Thefeedbackwereceivedisthatthereareindividualswhowanttogetontotheself-directedmodelusingPPLastheirfiscalmanagementserviceandtheyhaveaveryhardtimefiguringouthowtohire,fire,advertise,supervise,train,etcetera.Theyarejustnotequippedtodoit.Theygobacktoagencymodelbecausetheyhaven'thadsomebodyhelptheminreallydevelopingtheircapacitytoparticipateinself-direction.Thosearethecommentsweheardback,whichiswhywehavemovedtowardshavingthisserviceavailableasanindividualwantsit.It'snotgoingtobearequiredservice.It'sanoptionalservice.>>PAT:Twominutesleft.>>KEVIN:Great.Iwilljustaskthislastquestion.Itwasaskedifwecouldgivemorenoticeonthemeetandgreetmeetingsthatareavailable,wewilldothat.Withthatbeingsaid,wewillturnitovertoMarcGoldwhowillintroduceourparticipantformanagedcareservices.>>MARC:Goodafternoon,everyone.IamMarcGoldIworkforSellersDorseywhoisassistingCommonwealthonCommunityHealthChoices.IworkwilledinTennesseefor30yearswhichincludedontheTexasmanagedlong-termservicesandsupportsprogramknownasstarplus.ThelastnineyearsIamresponsibleforTexastext'sOlmsteadmoneyfollowspersonandbalancethecenterprogram.Thepurposeofthediscussionistogiveallofyouaconsumer'sperspectivewithmanagedlong-termservicesandsupportsfromanindividualcurrentlyreceivingthoseservicesintheStateofTennessee.WeallknowthereisalotofquestionsfromPennsylvaniaconsumersonhowCHCisgoingtoimpactthem.Thereareconcernsabouttheircurrentservice--aboutproviderbaseonwhichtheycurrentlyreceivethoseservicesandsupports.IndividualssometimesI'veheardhorrorstoriesfromotherstatesthatdon'tmanagelong-termserviceandsupportswillnotbeasgoodaswheretheyreceivethemnow.

Alotwerefrighteningstories.Thewewerehopingtodaytoshowyou,infact,fagmanagedcarereallyimprovesthequalityofyourlife.Therefore,PennsylvaniathoughtitwasimportantforyoutohearfromanindividualreceivingmanagedcarefromMLTSS.GarySullivanisfromTennessee.Hewillberespondingtoaseriesofquestionsthatwewillposetohim,listinghisimpressions,hisrealtimeexperiencewithmanagedlong-termservicesandsupports.Whatarethebenefits?Whatneedstobeimproved?WhatrecommendationshewouldmaketoPennsylvaniaastheCommonwealthproceedswithitsRFP.PMr.Sullivanwillgiveabriefinteresttonguestohimselfandcurrentsituation.Iwillthenhaveaconversationwithhimfollowedbyyourquestionsposeddirectlytohim.IalsowanttomentionMr.Sullivandida15-minutevideo.TheCommonwealthwillsharethatlink.Itisanamazingvideo.Iencourageyoutodownloadit.Mr.SullivanisveryarticulateandhasgivengreatthoughttohisansweredregardingMLTSS.Therefore,Iwouldlike,withgreatpleasure,introduceGarySullivan.Garywillgiveusaverybriefintroductionofhimselfandhiscurrentsituation.ThenIamstartaskinghimaseriesofquestionstotrytogettheinformationthatwebelieveallconsumersoflong-termservicesandsupportsneedtohaveexpressed.Gary?>>GARY:Well,thankyou,Marc.Goodafternoon,everybody.MynameisGarySullivan.Iam75yearsold.IliveinthesuburbofNashville,Tennessee,withmywife.Wehave8children,16grandchildren.InmyformerlifeIwasapracticingpersonalinjuryattorney.Ihadthegreatpleasure,afterIbasicallyretiredfromlaw,orIshouldsayfromapracticeoflaw,IbecameaCourtofAppealsjusticeandservedasassociatejusticeandsixyearsaschiefjusticeoftheCourtofAppeals.Basically,IhadMS.IwasdiagnosedwhenIwas35yearsold.IknewearlyonIwasgoingtohaveaproblem.Asaresultofthat,Isatdown.Isaid,whatisitgoingtotaketohaveaverymodest,youknow,incomeandhowcanIprotectmyselfandmyfamilyasbestasIcan.IcameupwithafigurethatIfeltwasveryrealistic.Iwasfortunateandveryblessedtohavedoubledthatfigure.WhenIfinallygaveitup,manyyearslater,Iwasabletomeetthatgoal,likeIsaid,doubleit.Unfortunately,itjustdidn'tturnouttobeenough.BythetimethecostsandexpensesofbeingasdisabledasIamhitme,

basically,IwokeuponemorningandIwasonagovernmentprogram.TheprogramthatIamoninTennesseeiscalledthechoicesprogram.Ihavebeenwithitforsixyears,now.Basically,Iamahands-onrecipient.Iconsidermyselfaconstructivequadriplegic.Ican'treallydoanything.Ican'tfeedmyself.Ican'tuseatoilet.Idon'tdressmyself.WhenIaminbed,Ihavetobeturnedatnightperiodically.IguessyoumightsayIamphysicallyamess.That'saboutit,Marc.>>MARC:Wedon'tthinkyouareamess,Gary.Iwillstartoffbyaskingyou,whatwereyourmostsignificantobstaclestocommunityliving?>>GARY:Ithinkonewas,mywifeisacoupleyearsyoungerthanI.IthinkIwas69whenIstartedonaprogram.Weweregettingupthereinyears.Shewas67.Wewerethinking,arewegoingtohaveenoughhelp?Itwasabigconcern.Ofcourse,housing,durable,medicalequipment,youknow?Modificationstothehome;thattypeofthing.Arewegoingtobeabletoaccommodateallofthat;thosewereourbiggestconcerns.>>MARC:--[indiscernible]relocationpartofyourrodetocommunityliving?Wereyouinanursingfacilityatanytime?Didyouhavetohaveassistancetorelocate?>>GARY:No,actually,Iwasaboutreadytogointoanursinghome.Iknewthatsometimethatwasgoingtohavetohappen.Mywifejustcouldn'tbeartheresponsibilitythatmuchlonger.Shejustdidn'thavethestrength.Shewantedto.Youknow,sheabsolutelywantedmanyhetostayathomebut,youknow,shejustcouldn't--weknewshewasn'tgoingtobeabletohandleit.IamjustaboutreadytogointoanursingfacilitywhenIdecidedtopickupthephoneandcalltoseewhatmightbeavailable>>MARC:Whenyoumadethephonecallwereyouabletogettheinformationyouneededimmediately?Werethestate,governmentalofficialsintheStateofTennesseeresponsive?>>GARY:Well,atthattime,itwasthewaiversprogramtheydidnothavemanagedcare.Itwasalittlediscouldbelobrated.Igottoapersontohelpme.OnceIgottothatperson,Igotthehelpandontheprogramatthatpointintime>>MARC:Youmentionedyouwereonafee-for-serviceprograminthebeginning,inthewaiverprogram.Iassumetheywerethe1915(c)waiver

programslikemanyconsumersinPennsylvaniaarecurrentlyon.>>GARY:Right.>>MACRRC:Whatwasthefearofmovingtotheprogramandhowdifficultwastheprocess.>>GARY:TheconcernwaswillIlosemybenefits?Wewillhavethesamebenefits?Wewereconcernedaboutallofit.Wecameon--theyhaddonealloftheplanningandsoforth.WhenIcameontothewaiversprogram.Theygotintothemanagedcare,youknow,beforeweevengotontothewaiversprogram.>>MARC:Wereyourfearsrealized?>>GARY:No.Absolutelynot.Iwasverypleasantlysurprised.Youknow,Ispentmostofmighthavecareersuingclientsfortheirinsurancemoney--that'swhatpersonalinjuryattorneysdo.Ididnottrustinsurancecompany.Theywere,ofallorganizations,Itrustedprobablytheleast.AndIcouldn'thavebeenmorewrong.>>MARC:.That'sgoodtoknow.ThatwillhelpresonatewiththecitizensofPennsylvania.Asinmostmanagedcareorganizations,wefoundthatintegrationandcoordinationhavebecomebuzzwordsinmanagedlong-termservicesandsupports.Theyarenotveryhelpfuliftheyjustremainbuzzwords.Dotheyreallyhappen?Howimportantisyourservicecoordinatororcasemanager?Yourday-to-daylife?>>GARY:Tosaythatsheiscriticallyimportantwouldbeunderstatingit.IfIhadaproblem,nomatterwhatitis,Imean,ofanyaspect,anyareaofmylife,anythingthataffectsmethatmightbecoveredbytheprogram,Ijustsimplycallher.Oneperson.It'skindoflikeone-stop-shopping.Fullyintegrated.YoupulldownamenuandIhaveonenumbertodial.Onepersontotalktowhoalreadyknowsme.Itcouldn'tbebetter,really.>>MARC:That'sreallywonderful.Canyouexpoundalittlebitforonthesortofactivitiesthatheorshedoesforyouandtalkabouthowtheindividualalsohelpskeepyouintegratedintothecommunity?>>GARY:Well,yeah,sure.Justyesterday,Ihadthe--Ihaveahospitalbed,eventhoughIamathome.Thecord,youknow,oneofthebuttonsdoesn'tworkonit.SoIneeded--Ihavetohaveahospitalbedbecausethat'stheonlywaythattheycanmaneuverme.

SoIcalledherup,askedher,youknow,whereIneededtogo,whatIneededtodoandsoon.Alsoaskedheraboutmywheelchairwhichneedstobeserviced,youknow?AnythingthatIneed,youknow,healthwiseorwithmydurablemedicalequipmentoranythingelse,Icallherandshegetsrightonit.Shemaygivemetheanswerrightoffthebatorotherwise,shegetsonitformeandgetsitdoneandgetsbacktomeandtellsmewhatIneedtodoor,youknow,whatisgoingtohappen.>>MARC:That'sreallywonderful.Wetalkedsometimesinthefee-for-serviceworldthatitisdifficulttofindprimaryphysiciansorservicesupportsandproviders.Hastherebeeneasieraccesstoprimaryphysicians,specialists,servicesandsupportproviderswithinthemanagedcareenvironment?>>GARY:Well,thatgotmyMCOcard.Theysentmeacard.Italreadyhadaprimaryphysicianonit.HeturnedouttobeagreatguywhoIamnotutilizingforthelastsixyears.Heisinvolvedinanetworkofspecialist.NomatterwhatIneed,hejustsays,okay,hereiswhoIwantyoutogosee.AllofthatwascoordinatedbytheMCO.>>MARC:Thereisanassessmentprocess,thepurposeistoseewheretheindividualisanddeveloptheirserviceplanfromthat.Today,fortunately,wetalkaboutperson-centeredplanningandthatthey--thewholeserviceplanissupposedtobegearedtowardstheindividual'sgoals,theindividual'saspirations,whattheywant,plusthoseserviceandsupportsapersonneeds.Didyoufeelthattheassessmentprocesswasfair?Didyougothroughaperson-centeredplanningprocesstodevelopyourserviceplan?>>GARY:I--myservice--whatwecallacarecoordinatorservicecoordinator,shecametomyhouse,satdownwithmeandmywife,askedveryextensivequestions,foundoutexactlywhatmyneedswereandsoforth.Ifeltshewasextremelyfair.Itturnedoutjustbeautifullyforme.Everytimethere'sbeenachange,well,asamatteroffact,shechecksinwithme.Shecallsmeonceamonth,makingsure,youknow,thatIamokayandthat,youknow,things--therehaven'tbeenanymajorchanges.Thenshe--everythreemonthsshehasa--shecomesinforareassessmentformyplanofcare.Icouldn'tbemorepleasedwiththat.--consumerdirectedserviceshavemanydifferentnames.It'stheideathattheindividualgetstodirecttheircareiftheychoose,thishecanactuallyhireanddirectthatindividualwhotakescareof

them.IsthatavailableinTennessee?Doyouusethat?>>GARY:It'savailable.Iamtellingyou,thatis--that'smyheavenhereonearth.Itcouldn'tbebetter.Igettohiremyowncaregiver.Icaninterviewher,findoutexactlywhatsheknows.Itrainhermyself.Sheanswerstome.Shedoesn'tanswertoanybodyelse.Thatisthemostbeautifulpart.Consumerdirectionhastobeapartofanymanagedcareprogram,asfarasIamconcerned.That'sgreat.Wasthereanyfamilyresistancetolivinginthecommunity?Supportiveofyourcaregivers?Familymembers?>>GARY:Well,theconcernwas,youknow,wastheregoingtobeenoughhelpandsoforth.Youknow,obviously,afamily,youknow,afamilyisgenerallyveryloving.Theywanttokeepthepersonathomeandsoforth.Thereisarealpracticalquestion,canwedothis?Areweequippedtodothis?Canwesustaintheburden?That'swherethismanagedcareprogramhasbeenbeautifulformebecauseitjustliftedalloftheweightofthem.Mywifeissupported.Shehasaverygoodrelationshipwithmycarecoordinator,youknow.Theyarejustbuddies,youknow?Soshefeelsliftedup.>>MARC:Thatistremendous.ItisalessonfortheCommonwealthofPennsylvaniatolistentoandunderstandhowimportantthatis.Doyoubelieveyouareintegratedwithinyourcommunity?Areyouinvolvedinsocialactivitiesoutsideofjustbeingtakencareofasanindividualwithadisability?Hasthemanagedcareorganizationsupportedthoseefforts?>>GARY:Yes,theyhave.Idofeelveryintegratedwiththecommunity.Infact,Ihadtotellthemtobackoff,really.Givemesomeprivacy.No,theyhave--asamatteroffact,Marc,theyhaveopenedupanewpathwayforme.TheveryfactthatIamheretodayandabletodosomegood,hopefully,forsomebodyisreallyaproductofthepathwaythattheMCOopenedupforme,becausewhenIstartedgoingtothemwithasledgehammerinmyhand,poundingonthem,thisisn'tright.That'snotright.BasicallywiththecomplaintsIhad,theynotonlylistened,theyencouragedmetotalkmoreandthenwhenthey,insteadofshuttingmeup,they,basically,haveencouragedmetogetoutandtalkasmuchasIcanandspeakfreely.

Ispeakabsolutely,youknow,freelyandwithoutanyreservationorhesitation.It's--they'vedoneagreatjob.Whethertheyintendedtoornot,Idon'tknow.>>MARC:Iwouldhavetosayyourmanagedcareorganizationhasbeenhelpfuflinarrangingforyoutodothispresentationwithus.Areyoureceivinganyvalue-addedservices.Thestatecontractformanagedcareorganizationsprovideasetamount.Sometimesmanagedcareorganizationsdecidetogiveextraservicesbecausetheyfeelitisrelevant,itkeepsapersonhealthy.Itispartoftheprevention.Sometimestheyofferdentalservices,eyeglassesandgymmemberships.Doesyourorganizationprovideanyadditionalvalue-addedservicesanddoyoupartakeofthem?>>GARY:Yes,therearehelpfulthings.Igetacatalogue.FromthatcatalogueIgetsomanycredits,whichrelateto,Iguess,retaildollars.Iorderfromthatcataloguealotoftheover-the-counterstuffthatIwouldordinarilygototheWalgreensorCVSorsomepharmacymaybeWal-Marttoget.Ijustgetthemfromthecatalogueorderthem.Theyaresentrighttomyhome.Allofthatisabsolutelynoexpensetomewhatsoever.Ihavea--myMCOapparentlyhasasubsidiarypharmaceuticalcompany.Igetalotofmydrugsthere.Igetthedrugsatmuch--someofthedrugsthatarenotcoveredbytheplanthatIneed,Igetthematareducedprice,evenfarlessthanIcangetthematanydiscountdrugstoreherelocally.SoIamvery,veryhappyaboutthat.Ihavedentalservices,Igettwocleaningseveryyear.Youknow?Igetvision,ear,hearingaids.Really,Imean,Icouldgoonandon.It'sjust--Iamnotsurewhetherornottheprogramitselfwouldtakecareofsomeofthese,butIthinkmostofthemarelikeyousay,extraaddedtothe--youknow,becauseoftheMCO.>>MARC:Right.Itisagreatanswer.Now,Iknowthatyou'vehadyourhousethathasyourcommunityhousingbeenanissue?>>GARY:No.>>MARC:Um-->>GARY:OnethingIwanttosayaboutthat,myMCOhasbeenkindof--theyhavebeenaleader.TheyhavecreatedwhattheycallaCLS,communitylivingsupport.Afriendofminewhoisaregisterednurse,shehasbeen--shehasMS.Shehasbeenaquadriplegicinanursinghomefor13years.Shehadtwogrownchildren,oneofthemisoutofthecountry.Theotheris

onthewestcoast.Shehadnofamilyaround,butshewantedoutofthenursinghome.TheMCOtookituponthemselves,gotpermissionfromtheagencyhere,wecallitTennCare.Theygotpermissionandpilotedaprogramwherethisgalisnowoutofthenursingfacilityforthefirsttime.Sheissharingherapartmentwithanotherpersonthatwanted--thatbasicallyhadthesamedesire.Itisjustremarkable.>>MARC:Themanagedcareorganizationwasresponsibleforherassistingherinthatrelocation.>>GARY:Absolutely.Theywereboldenoughtopushit.Theyknewthatshewantedout.Shewasamemberoftheir,youknow,shewasoneoftheircharges.Shesaid,youknow,Iwantoutofhere.Shekeptafterthem.TheywenttoTennCare.Gotpermissiontostartthispilotprogram.Ithinkitissomethingthatmayeventuallygonationwidebecauseitisworking.>>MARC:That'sgreat.Doyouhavenon-medicaltransportation,aroundtownforactivitiesandsupportsotherthanjustmedicalstuff?>>GARY:No.>>MARC:DoesthemanagedKarasiftinthat.>>GARY:TheywouldifIneededit,yes.>>MALC:Doesmanagedcareorganizationhaveconsumeradvisorycompanyandifsodoyouparticipate?>>GARY:Theydo.Ihavebeenonthecommitteeforsixyearsnow.Aboutfiveyears,Ithink.TheycameonaboutayearafterIwasontheprogram.It'sagreatthing.Ifoundoutthat,youknow,alotoftherestrictions,alotoftheimpositionsthatareplaceduponmeasarecipient,donotcomefromtheMCO.TheyarethefrontlinepersonthatIdealwith,butIfoundoutthatbasically,theyarenotalwaystheonesthatareimposingthatruleorregulation,that'ssomethingthatisupabovethemIfeeltheypartneredwithmeandtriedtoadvocate,youknow,formeinthatregard.Sothroughtheadvisorycommittee,wehaveacollectiveamount,youknow,ofpeerswill,whobasicallyvoicetheirconcerns.Theytakethoseconcernstotheagencyandthenit'sevaluated.Ithasalittlebitmoreweightwhenyouaretalkingaboutnumbers.Youknow,ratherthanindividual.>>MARC:Greatanswer.Waseverythingclearlydescribedtoyou,yourrights?Howthesystemwork?Whotocall?Emergencyprocedures?Grievanceprocedures?Theappealsprocess?>>GARY:Yes.

Itwasalittlebitfoggyatfirst,but,youknow,aseverynewprogramkindofrefinesthemselvesandtheyfindoutwherethebugsare,itworkedoutverywell.Ido,youknow,--alloftheanswers--again,ifanythingisunclear,IhaveonepersonIcancallandsay,here.Iamconfusedaboutthis.Idon'tunderstandthis.What--youknow,whatisthisallabout?Sheeitherknowsandtellsmeorshesays,Gary,Idon'tknowbutIwillfindoutforyouandgetbacktoyou.SoIhavetoanswer,youknow,thatquestionwithaquestion.>>MARC:Good.Whatwouldyoubelieveremainsthebiggestbarrieryoustillencounter?Isyourservicecoordinator,managedcareorganizationsupportive?>>GARY:WhatIhaveisdifferentfromwhatIfirstjoinedtheprogram.Iwasfearfulwithallofthedifferentlayers.Youknow,youhavethefederalgovernment.Youhavethestategovernment,thenyouhaveanMCOandallofthe,youknow,theparticipants,theprovidersandsoforth.Withthat,youhaveawholestackingofalotofrulesandregulations.Well,Ihavefoundthat,youknow,thatthat'snotalwaysthecase.Alotofitisstuffthatcomesdirectlyfromthefederalgovernment,alotofrestrictionsthereandsoforth.Somybiggestfearsare,youknow,whentheycomeoutwithsomething,theywantto--Ithinktheirheartisintherightplace.Theywanttochangethingsforthebetter.Theywanttomakemylifemorequalitiative.Butsometimesitismoremisguided.Mybiggestfearisbeingabletocommunicatewiththem.>>MARC:Canyouuseyourconsumeradvisorycommitteetovoicesomeoftheseconcerns?>>GARY:Absolutely.That'sexactly--IfeellikeIgotapartnerintheMCO.>>MARC:That'sthewayitissupposedtobeworking;it'sgreattohearthat.Whatwouldyousayhasbeenthebiggestadvantagetobeingpartofamanagedlong-termservicesystem?>>GARY:Ithinkthe--well,theconsumerdirectionprogramandhavingmyown,youknow,caregiver,beingabletohirethemanddealwiththemmyself,andnothavethemworryabout,youknow,theiremployerofagencyorwhoeveritmightbe,generallyitisanagency.Ithinkthatisthebiggestadvantage,althoughtheintegrationofservices,youcan't--Imean,howcanyoubeatthat?Imean,that'sreallyterrific.Suchablessingtohaveonepersontogotoforafullmenuofservices.>>MARC:TheysupportIbeingconsumerdirectedandtheprocess.Correct?>>Gary:Right.Exactly.>>MARC:Whathasbeenyourdisappointmentinmanagedcare,ifany?

>>GARY:Ithink,probably,theyarewillingtolistenand,youknow,alotoftimestheywillcomerightalongsideofmeandadvocatewithme,butIthinkit'stheslowerresponseofsomeofthefolkswhoareimposingpoliciesandrulesandregulations.Ithinktheyarewell-intensioned.Itisnotthattheyaretryingtohurtanybody.Theythinktheyareprotectingsomebodywheninreaility,itisjustadingmoreburdennens.>>MARC:WhatrecommendationswouldyoumaketoimprovetheprogramandwhatrecommendationswouldyougivetheCommonwealthofPennsylvaniaasitdevelopsitsprogram?>>GARY:Well,Ithinkthereinliesthegreatquestion.IthinkthebiggestconcernthatIhaveissomeofthenonsensicalbureaucraticrulesthatcomedown.WhentheyfirststartedinTennessee--Tennessee,bytheway,isaleader,youknow,inthehealthcareindustryandinLTSS.Theyarepioneers.Theyhavesomereallygreatprogramsandtheyareveryprogressive.Theyhavealotofbureaucraticnonenonsensicalrulesandregulations,whichareabigproblem.Alotofthefolkswhoareinvolvedinit,peoplelikemyselfwithintheirownfamily;that'soneofthereasonswhytheyareinthebusinessasacareer.Soitisn'tthattheyaretryingtohurtanybody,buttheywanttoprotectandinthathopeofprotecting,theyarebeingmorerestrictive.WhatIwouldadviseistheCommonwealthofPennsylvaniatodoistofirstofallgetaveryclearvisionofwhattheywanttodo.Iwouldsuggest,youknow,ifIcould,justforamoment,agoodclearvisionmightbetogivetherecipientsgreaterflexibilityandcontrol.Nothingwillelevatethequalityoftheirlifethantohavethegreaterflexibilityandcontroloverthatlife.Sohaveaclearvisionofwhattheywanttodo.Thencomeupalongmemberandvieweverythingtheydofromthemember'sperspective.Forexample,iftheyaregoingtoestablishapolicyoraruleorregulation,askthemselves,isthisgoingtoburdenorisitgoingtobenefitthefolksthatIamtryingtobeofserviceto?Tothinkitthrough.Iftheydon'tknowtheanswer,getananswer.TheCommonwealthofPennsylvaniaisdoingaterrificjob.Notbecausetheyarehearingfrommetodaybuttheyarelisteningtotheconsumersandaretakingthetime.Itshowsmetheycareabouttheservicestheyaregiving.Theywantthemtobeofthehighestqualityandareaskingtherightpeople.Theyareaskingthefolkswhohaveactuallygottentheservicesand,quitefrankly,if

theywilljustcomeupalongsidethatpersonandaskthatquestion,isthisgoingtoburdenorbenefit?Andthen,bemindfulofwhatafellowwhoIhaveagreatdealofadmirationfor,WinstonChurchillsaid,10,000regulationsandpeopleloseallrespectforthelaw.WhatItakethattomeanisthat,youknow,ifyouburdenpeoplewithalotofregulations,justdumpalotofregulationsonthem,theyaregoingtolookforwaystogetaroundthem.Theyaregoingtobepeoplewhoaregoingtodefraudyou.Theyare--justlikeJesussaid,thepoorwillalwaysbewithyou.Thosewhodefraudyouwillalwaysbewithyou.Youwanttominimizeitandsoforth.Gobacktoyourvision.Isthatyourvisiontopreventfraudorisittoserviceandtotrytoraisethequalityoflifeofthepersonthatyouaretryingtohelp?Keeponthat--don'tletvisionslipaway.Educatetheirpeople,educatetheirpartners,makesurethateveryoneinvolvedwantstodothesamethingthattheywanttodo.Andthattheyunderstandthatclearvision,andIthinktheywillwinduphavingaverygoodprogram.Beingwillingtolisten-->>MARC:Iwishwehadanotherhourorsotolistentoyou,butwewant*6dowanttogettopeople'squestions.Ihaveonelastquestion.Mylastquestionforyoubeforeweturnitovertothepublicaskingyouquestionsis,prancetome,maybethemostimportantquestion.Whatwouldyoutellapeer,astheystartedintheenrollmentprocess,withwhatwouldyousaytothepeopleofPennsylvania,theconsumersofPennsylvania,whoarefearfulandrightfullyso,aboutthischangeandtheirservicedeliverysystem,whatadvicewouldyougivertothoseindividualswhoareabouttoeventerenterthesystemorinthesystemandabouttogothroughthechangeandservicedeliverymodel.>>GARY:Firstofall,Iwouldsay,youaredoingtherightthing.Youareabsolutelydoingtherightthing.It'sagreatwaytoreceiveyourhealthcareservices,yourMTLSorLTSS.Knowingthat,relax,andthenIwouldsay,trytofindoutwhichoftheMCOsaregoingtobeavailable.Whoisyourstategoingtocontractwith?Theywillusuallycontractwithtwo,three,fourdifferentones.Findoutwhichones.Maybecontactthem.Contactthedifferentones.Findoutwhoisknowledgeable.Findoutwhatextra-addedservicesthatbasicallyyouaregoingtogetfromeachone.Evaluatethose,andthenpicktheone.

Now,itmayverywellbethattheCommonwealthwillestablish--theywillassignonetoyou,butgenerallyspeaking,theywillallowyoutochange,ifyouwanttochange,youknow--ifyoudon'thavetheMCOthatyouprefer,theywillallowyoutotakeanotherone.Iwouldsay,findoutwhichonesaregoingtobecontractingwithyourstate,whattheyaregoingtooffer,andthenevaluatethatandbasicallypicktheonethatyouwantandgofromthere.>>MARC:Ijustwanttosay,onbehalfoftheCommonwealthofPennsylvaniaandSellersDorsey,wehavesoappreciatedthisverythoughtful,insightfulandhonestconversationbyyouregardingmanagedlong-termservicesandsupports.Wewillturnitovernowtoindividualswhoarelisteningin.Hopefullyyouwillberespondingtotheirquestions.Let'shearthequestionsfromthepeoplelisteningintothewebinar.>>JEN:Hello.Firstofall,IwanttothankGaryforthatverythoughtfulpresentation.IthinkIlearnedalot.Iamreallyexcitedtohavetheopportunitytohearsomeofyourresponsesinregardstowhatkindofthingsyouwouldrecommendthatourparticipantsdoinadvanceofusmovingtomanagedlong-termservicesandsupports.Ialsoappreciatedthecommentsyoumade--Iappreciatedallofyourcomments,butinparticular,therecommendationsyougaveme,asthestateofficialdoingthisorleadingthis,tomakerecommendationsforPennsylvaniaaswemoveintomanagedlong-termservicesandsupportsaswemoveintoourprogram.Ireallyappreciateyourcommentaroundthevision.Wecertainlyworkingashardaswecantomakesurethatweareresponsiveinlisteningtoconsumersinthiswholeprocess.Wehave--becausetherearesomanypeopleparticipatinginthis,wehaveover300peopletoday.Thelinesaremuted.Insteadpeoplearesendinginquestions.WhatIamgoingtodoisreadoffthequestions.Wewouldappreciateif,Gary,youcouldrespondtothat.>>GARY:Sure.>>JEN:Terrific.Thefirstoneis,isyourservicecoordinatorwithmanagedcareorganizationorisshewithaseparateservicecoordinationentity?Didyougetachoiceofeitherchoosingtohaveaservicecoordinatecooerthroughmanagedcareorseparateservicecoordinationentity?Ifso,whydidyouchoosetheoneyouchose?

>>GARY:Myservicecoordinatororcarecoordinatorrorisemployeeofmanagedcareorganization.Ididn'tgetachoice.Iwouldseenoneedtohaveachoice.Sheworkedforthemanagedcareorganization.Eventhoughsheisloyaltothemandsheobviouslyhasherownpositiontoworryabout,sheisalsoworryingaboutme.>>JEN:Okay.Great.Thankyou.Thesecondquestion,whenyouswitchedtomanagedcare,howdidyouchoosewhichMCOtogowith,assumingyouhadoptions?Whatkindsofservices/issueswereofinteresttoyouindeterminingwhichMCOtoselect?WastherecompetitivemarketingbytheMCO?Thosearethreeseparatequestions.>>GARY:Thefirstone,Ididn'thaveachoice.IwasassignedmyMCO.IonlyfoundoutlaterthatIcouldchange.Ihadnoreasontochange.Onethingaboutcompetition,Ithinkweworryabout,youknow,MCOsareinitforprofit.Wethink,well,theyareworriedabouttheirprofit.Theywillworrymoreabouttheirprofitthanme.Well,Ihavelearnedoverthis,istheyhavetoworryaboutme.Iamtheirconsumer.Iftheydon'tlistentome,didtheydon'tsatisfyme,theyarenotgoingtobearound.Thereisalotofbusinessesthatfindthatoutafterawhile.Reallycontrarytoworryingabout,youknow,themworryingMr.Theirprofitandsoforth,theyreallyaremoreworriedaboutmethananybodyelseis.>>JEN:Okay.Thankyou.Thesecondquestionwas,whatkindof--IwouldjustrespondtothataswellinPennsylvaniaweareenvisioningthatpeoplewillhaveachoice.Wearereallygoingtoworkhardtogetpeopletosignupfortheirmanagedcareorganizationontheirown.However,forthosewhodonotsignup,wewillbeautoenrollingthemusingsomelogicthathelpsusmaketherightchoice.Wearetryingtogivechoice.>>GARY:That'sagreatthing,Jen.Greatjobthere.>>JEN:Thenextquestionfromsameaskeriswhatkindofservices/issueswereinteresttoyou--that'sirrelevantyoudidn'thaveachoice.WastherecompetitivemarketingbyMCOsandthatisirrelevantbecauseyoudidn'thaveachoiceatthebeginning.Todayinthemorematureprogram,istherecompetitivemarketing?>>GARY:Thereis.Thatgoesonwithanytheyhavetobecompetitive.Itinspiresthemandforcesthemtobeinnovative.Theyhavetobemoreefficient.Theyhavetolookfornewwaystodothingsandbetterwaystodothings.

Otherwise,iftheygiveacertainamountofmoneyandtheycandowhatevertheywanttodowiththat,youknow,then,youknow,theydon'thaveanyincentives.Competitionreallydrivesthem,youknow,tobebetter.>>JEN:Thethirdquestionis,isfamilyabletobehiredinyourstate?>>GARY:No.Well,theyare--ifIhad,say,hadanadultchildwhodidnotlivewithme,Icouldhirethem.Iftheylivewithyou,no.Likemywifeactuallyworksoutsideofthehomebecausewedon'thaveenoughmoneytosustainourselves.Shemakeslessmoneythanmycaregiverdoes.>>JEN:Numberfouris,howdoyoukeepactiveinyourcommunity?DoestheMCOhelp?Ifso,how?>>GARY:Well,theywantmetogetinvolvedwithallkindsofcommunityactivitiesthatgoonandsoforth.Quitefrankly,Iwasn'treallyinterested.Idostayactive,though,intheadvisorygroup.I,actually,serveonanationalcommitteeforthemaswell.Sobeyondthat,Ireallyhavenointerest.IfIdid,theywould--theywouldhavemeinvolvedinallkindsofstuff.>>JEN:IrememberinyourcommentsthroughthequestionsthatMarcaskedyou,yousay,getawayfromme.Iwantmyprivacy.>>GARY:Exactly.[LAUGHTER]>>JEN:Thenextquestionis,howmanyhoursperweektoyoureceiveandhaveyouhadanyhomemodificationsdoneinyourhome?>>GARY:Ireceive56hoursaweek.IhavehadrampsandIhavehadsomebathroommodifications.Ithinkmyprogramallowsupto$6,000;that'swheretheMCOcomesinhandy.Theyshoparound.Theycarryalotofweight.Peopleknowtheyarebiginsurancecompanies.Let'sfaceit.Theyarebigpowerfulcompanies.Theycangetcollectiveofcontractorsandsoforthwhotheywillsupplywithcertainamountofbusinessatadiscount.Theycangetalotmoredonesometimesthanjustanaverageguywhogoesoutandpickedupthephoneandcallssomebodytocomeoutandremodelmybathroom.Ihavehad,youknow,therampsandthebathroommodificationand--Jenn:Okay.That'sgreat.Ourcurrentfee-for-servicewaiverprogramdoeshavehomemodification.Weareplanningthatthatwillbeoneofourrequirementsforourmanagedcareorganizationsaswelltomakesurethattheyareabletoprovidehomemodificationsandprovidedurablemedicalequipmentandsupplies.ThenextquestionwehavehereinPennsylvaniais,howdoyoufindstaffto

workforyou?>>Gary:IadvertiseonCraigslist.Thereisawebsitecare.com.Theyareaprettygoodorganization.Theyhave--theyshowapictureandprofileofalloftheirapplicantants.For$25amonth,youknow,whatIdoiswhenIneedone,Iwillgoaheadandsignup,$25.ThenduringthatmonthIwillinterviewanumberoftheirpeopleandusuallyhaveplentyfromtheCraigslistandbetweenthecaregiverorCare.comfolks.>>JEN:That'sagreatresource.AnotherquestionherefromPennsylvania,whathappensifyouneedtobehospitalized?Howlongdoesittaketogetservicestoturnedbackonandwhathappenstotheconsumer--Iamnotsureaboutwhathappenstotheconsumer,whathappenstotheconsumerandworkersinthemeantime?Whathappensifyouneedtobehospitalizedandhowlongdoesittakeinourfee-for-servicewehavetoturntheservicesbackonwhenyouaredischarged.Whathappensinmanagedcareinthatsituation?>>GARY:Well,themanagedcarecontinues.Thereisnobreakinit.Thetbrobiswiththecaregiver.Thecaregiverisoutofwork;that'stheproblem.I'dhavetodealwithheronthatorhim,basicallyIhavenothadthathappen.Ihavegoneintothehospital,youknow,forashortperiodoftimeovernightoracoupledays,whichisnotproblematic.IfIhadtogoinforanextendedperiodoftime,Iwouldhavetowork--really,unlessit'sgoingtobeformonths,itshouldn'treallypresentmuchofaproblem,becauseIwouldjust,simapplysay,youknow,well,bythetimeyougooutandinterviewandgetsomebodyelse,Iwillbebackoutofthehospitalandso,sincethereisn'tanybreakinthemanagedcareservice,shecancomerightbacktoworktheveryfirstdayI'mbackathome.>>JEN:Okay.Allright.That'sveryhelpful.Thisnextquestionisitlookslikeitisaquestionforme,actually,whatisthepercentofdual-elogyIwilldual-eligiblesintheStateofTennesseeanddoesitmirrorPennsylvania?Penitentiaries,bothTennesseeandPennsylvaniahave18%ofdualsasapercentageofallmedicalenrolleesanddualsasapercentageofdisabledandmedicalenrolleesPennsylvaniahas50%andTennesseehas60%.ThisquestionisaskedbecausewearelookingatCommunityHealthChoiceswestboundfullyintegrateddualMedicaid/Medicareprogram.Thisisaquestion,though,foryou,Gary,isthefullyintegratedwithMedicareandMedicaid?>>GARY:Yes,yes,itis.>>I.

>>JEN:Nextquestion,reflectingonthecommentyoumadeofadvicetoPennsylvaniainthinkingabouthowwerollthisout.Thequestionis,whatarethebadregulationsyouaretalkingabout?>>GARY:Ingivingyouanexample,theyhaddifferentkindsofservicestheyhadpersonalcare,attendantscare,housekeepingandin-homerespite.Theyallhaddifferentpayscalesdifferentrulesandregulationssurroundingthem.Yettheyhadonecommonthing.Thatwasyoucoulddothesametaskregardless.Thatmadenosensetomeatall.>>JEN:Okay.Sohasthatbeenremoved?>>GARY:Yes.Yeah,theyhavedonethebestjobtheycan.Iguessthebottomline,Jenis,keepitsimple,stupid.Makeitassimpleandgenericasyoupossiblycan.Don'tgointoanyfancystuff,whichIthinktheStateofTennesseedidinitiallyandtheyregrettedthat.>>JEN:Okay.Greatadvice.Iappreciateit.Onelastquestionandthenourtimeisupandthereareotherpeoplewaitingtogetintothisroom.Howdoesyourcaregivergetpaid?Wherewouldahomecareagencyfitintoamanagedcareorganization?>>GARY:Well,they--mycaregivergetspaidthroughPPL,thefederalemployeragent.Theyserveallofthefinancialthings,noneofthemoneycomestome,obviously.Thegaltakesherinstructionsfromame.MynameappearsonherW-2.AlloftheproblemsaretakencareofbyPPL,theFEA.>>JEN:Okay.Doyouhaveanyexperience,haveyouhadanyexperienceintheagencymodelwherehomecareagencymightbeinvolved?>>GARY:Ihaven't.Myunderstandingisthattheyarejust--theyarepaid--IthinkprobablythroughPPLaswell,theyjustbill,liketheordinarywouldbilleitherthemanagedcareorganizationortheFEAandthatwouldbeit.>>JEN:Ireallyappreciate,Pennsylvaniareallyappreciatesthetimethatyou'vetakenwithustowalkusthroughhowmanagedcareisworkinginyourlifeandhowitworksinTennessee.Wemightbecheckingbackinwithyoufromtimetotime,ifthat'sokay.>>GARY:Anytime.Asamatteroffact,Jen,feelfreetogivemyemailaddresstoanybodythatwouldliketocomienindicatewithme.Iwouldbehappytocommunicatewiththem.>>JEN:Wereallyappreciatethat.Nowourtimeisuphere.That'stheendoftoday'sthirdThursdaywebinar.LookforthenextoneisDecember.Thankssomuch.

>>GARY:ThankyouThefollowingprintoutwasgeneratedbyrealtimecaptioning,anaccommodationforthedeafandhardofhearing.Thisuneditedprintoutisnotcertifiedandcannotbeusedinanylegalproceedingsasanofficialtranscript.

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