|
PA Health Law News
Click here for the September 2019 Health Law News. This issue includes:
- Public Charge Updates
- DDAP Bulletin: Continuation of Services During an Authorization Appeal
- Final Phase of CHC Enrollment Underway
- Changes to the Maximus HCBS Application Process
- Get Ready for the Medicare Open Enrollment Period
- Medicare Part D Costs for 2020
- PHLP Offers Medicare 2020 Webinar
|
|
|
Helping Jeff Keep His
Personal Assistance Services
Jeff, a 61-year-old living in Southwestern Pennsylvania, contacted PHLP for help after his Community HealthChoices (CHC) health insurance plan reduced his Personal Assistance Services (PAS) from 60 hours per week to 49. Jeff has Cerebral Palsy and requires hands-on help with various activities of daily living such as bathing, dressing, personal hygiene and mobility. He also cannot prepare his own meals or leave the house without help and is a fall risk due to balance problems. The home and community-based services Jeff gets through CHC are essential, especially since those services allow him to continue to live with his twin sister in their family home.
Jeff reached out to PHLP for help and we were able to represent him in his appeal. During his appeal hearing, Jeff and his sister provided additional information about his need for help. We highlighted that the insurance plan’s assessment, used to make the decision to reduce his services, was not accurate and we argued that 60 hours of assistance continued to be medically necessary for Jeff to continue to live in the community with his sister.
After the hearing, the CHC insurance plan approved 56 hours per week but continued to deny the remaining 4 hours. Jeff decided to continue to fight this and filed another appeal. His tenacity paid off; the CHC plan ended up approving all 60 hours per week! Jeff and his sister were thrilled with the outcome, noting “We wish we had you beside us always fighting life's battles. Please accept our sincere appreciation in all you have done for us.”
|
|
|
|
PHLP in the News
Local Leaders Named to Governor's Authority that Will Develop New Health Insurance Exchange, Pittsburgh Business Times, August 30, 2019
“The Pennsylvania Health Insurance Exchange Authority was created July 2 to start an online individual health insurance marketplace that would replace the commonwealth's reliance on the federal-run program created by the Affordable Care Act. Open enrollment on the individual market for the state-based exchange is set to start for 2021. It impacts about 400,000 Pennsylvanians who are not covered by employer or federally-run health insurance.
Sheryl Kashuba of UPMC Health Plan, Mark Nave of Highmark and Jessica Brooks of the Pittsburgh Business Group on Health are among the members of the authority. Also joining the authority will be Paula Sunshine (Independence Blue Cross), Tia Whitaker (Pennsylvania Association of Community Health Centers), Antoinette Kraus (Pennsylvania Health Access Network), Todd Shamash (Capital Blue Cross), and Laval Miller-Wilson (Pennsylvania Health Law Project). Also on the authority are Health Secretary Dr. Rachel Levine, Human Services Secretary Teresa Miller and Insurance Commissioner Jessica Altman.”
Community HealthChoices Toolkit, PA Assistive Technology Foundation, September 2019
This Toolkit was created by Pennsylvania Assistive Technology Foundation (PATF) in collaboration with PHLP. It has informational materials about Community HealthChoices (CHC), including an overview of the program, a description of person-centered service planning, how to appeal a denial, how to obtain funding for assistive technology, and where to call for help with CHC.
Understanding Community Health Choices, Smart Talk, WRTI Harrisburg National Public Radio, September 23, 2019
“Healthcare is complicated, especially for people with physical disabilities, seeking to remain at home. Pennsylvania is launching a state-wide program to help Pennsylvanians manage their health care and, hopefully, remain in their homes longer. Appearing on Smart Talk on Monday to offer program details were Kevin Hancock, Deputy Secretary for Long Term Living, Pennsylvania Department of Human Services and Laval Miller-Wilson, Executive Director of the Pennsylvania Health Law Project.”
|
|
|
PHLP Welcomes New Staff
Katy Frank joins PHLP as our Project Administrator, based in our Philadelphia office. Katy has previously worked as a Family Law paralegal at Philadelphia Legal Assistance, as well as in communications and libraries.
Cayla McNally is the Communications and Development Associate, based in PHLP’s Philadelphia office. Previously, she was PHLP’s Project Administrator for three years.
|
|
|
|
|
|
