CHC (COMMUNITY HEALTH CHOICES) EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

CHC (COMMUNITY HEALTH CHOICES) EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 What is CHC? - AnswersPA's mandatory managed care program for dually eligible individuals and individuals with physical disabilities. CHC is being developed to: - AnswersEnhance access to and improve coordination of medical care and create a person-driven, long-term support system in which people have choice, control, and access to quality services that provide independence, health, and quality of life. What does LTSS do? - AnswersHelp eligible individuals to perform daily activities in their home such as bathing, dressing, preparing meals and administering medications. Who will be enrolled in CHC? - AnswersIndividuals that are 21 years or older and are: 1. Receiving both Medicare and Medicaid; OR 2. Receiving LTSS in the Attendant Care, Independence, or Aging Waivers; OR 3. Receiving services in the OBRA waiver AND determined nursing facility clinically eligible; OR 4. Receiving care in a nursing home paid for by Medicaid. 5. An Act 150 participant who is dually eligible for Medicare and Medicaid. What individuals are NOT eligible for CHC? - AnswersIndividuals that are: 1. Receiving LTSS in the OBRA waiver and are NOT nursing facility clinically eligible; OR 2. An Act 150 program participant, who is not dually eligible for Medicare and Medicaid; OR 3. A person with an intellectual or developmental disability who is receiving services through the Department of Human Services' Office of Developmental Programs; OR 4. A resident in a state operated nursing facility, including the states veterans' homes. LIFE Program vs. CHC Program - AnswersIndividuals who already participate in a Living Independence for the Elderly (LIFE) program can remain in their LIFE program and will not be moved in to CHC unless they specifically ask to change. Anyone who's enrolled in CHC who would prefer to switch to a LIFE program AND qualifies will be free to do so. What does CHC cover? - Answers1. 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. 2. The OBRA waiver will continue to exist for those 18-20 year olds who qualify for Medicaid LTSS and fort hose who have a severe developmental physical disability and need an intermediate Facility/Other Related Conditions (ICF/ORC) level of care. Behavioral health services are not a part of: - AnswersCHC. The CHC MCO must coordinate care with their members' HealthChoices Behavioral Health MCOs. CHC MCOs have the same.. - AnswersResponsibility for coordination of members' Medicare coverage. Will individuals have a choice of CHC MCOs? - AnswersYES. Each CHC participant may choose his or her MCO. The MCOs are AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices. Who is part of CHC? - AnswersIndividuals who are 21 or older and dually eligible for Medicare and Medicaid. -Individuals with intellectual or developmental disabilities who are eligible for services through the Office of Developmental Program will not be enrolled in CHC. Who is part of CHC (Part 2) - AnswersIndividuals who are 21 or older and eligible for Medicaid (LTSS) because they need the level of care provided by a nursing facility. -This care may be provided in the home, community, or nursing facility. -Individuals currently enrolled in the LIFE Program will not be enrolled in CHC unless they express select to transition from LIFE to a CHC managed care organization (MCO). How does CHC work? - AnswersDHS-MCO-Participants DHS..(How does CHC work?) - Answers-Pays a per-member, per-month rate to MCOs. -Holds the MCOs accountable for quality outcomes, efficiency, and effectiveness. MCO..(How does CHC work?) - Answers-Coordinates and manages physical health and LTSS for participants. -Works with Medicare and behavioral health MCOs to ensure coordinated care. -Develops a robust network of providers. Participants...(How does CHC work?) - Answers-Choose their MCO. -Should consider the provider network and additional services offered by the MCOs. What are the goals of CHC? (Goal 1) - AnswersEnhance opportunities for community-based living. What are the goals of CHC? (Goal 2) - AnswersStrengthen coordination of LTSS and other types of health care, including all Medicare and Medicaid services for dual eligibles. What are the goals of CHC? (Goal 3) - AnswersEnhance quality and accountability. What are the goals of CHC? (Goal 4) - AnswersAdvance program innovation. What are the goals of CHC? (Goal 5) - AnswersIncrease efficiency and effectiveness. FFS vs. Managed Care (FFS) - AnswersFEE-FOR-SERVICE -Providers enroll as Medicaid providers. -Providers contract with the commonwealth. -Providers bill PROMISE. FFS vs. Managed Care (MC) - Answers-Providers enroll as Medicaid providers. -Providers contract with MCOs. -Providers bill MCOs. Current Barriers to LTSS - Answers-Participants show a tendency to under-plan and under-insure for long term care until there is a crisis. -Confusing information about how to receive services. -The system is difficult to navigate, particularly when transitioning between care delivery systems (Lack of coordination between primary, acute, and LTSS organizations.Limited coordination between Medicare Special Needs Plans and LTSS organizations.) -There is limited availability of long-term care insurance products. Available products limit coverage and are costly. Covered Services (Physical Health Services) - AnswersAll participants will receive the Adult Benefit Package, which is the same package they receive today. This includes services such as: Primary Care Physician, Specialist Services, Please note that Medicare coverage will not be available. Covered Services (Behavioral Health Services) - Answers-All participants will receive behavioral health services through the Behavioral Health HealthChoices MCOs. -This is new for Aging Waive participants and nursing facility residents, who receive behavioral health services through the fee-for-service. Covered Services (For participants who qualify for LTSS) - Answers-Home and community-based long-term services and supports including: Personal assistance services, Home adaptations, Pest eradication. -Long-term services and supports in a nursing facility. -Participant-directed services will continue as they exist today. Continuity of Care - Answers-MCOs are required to contract with all willing and qualified existing Medicaid providers for 180 days after CHC implementation. -Participants may keep their existing providers for the 180-day continuity of care period after CHC implementation. -For nursing facility residents, participants, will be able to stay in their nursing facility as long as they need this level of care, unless they choose to move. -The commonwealth will conduct ongoing monitoring to ensure the MCOs maintain provider networks that enable participants choice of provider for needed services. Identifying needs (Screening, Comprehensive Needs Assessment and Reassessment) - AnswersCHC-MCOs must: -Screen each new participant who are healthy duals within 90 days of the start date. -Conduct a comprehensive needs assessment of every participant who is determined NFCE. -Conduct a comprehensive assessment when the participant makes a request, self identifies as needing LTSS, or if either he CHC-MCO or the Independent Enrollment Broker (IEB) identifies that the participant has unmet needs, service gaps or a need for service coordination. -Conduct a reassessment at least every 12 months unless a trigger occurs.