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PA Bulletin, Doc. No. 05-898

DEPARTMENT OF
PUBLIC WELFARE

Implementation of ACCESS Plus Program

   This notice announces the Department of Public Welfare's (Department) intent to implement an enhanced primary care case management program, effective March 1, 2005.

   To further the Department's goals of improving access and quality of care to its Medical Assistance (MA) clients, the Department explored potential alternatives to improve both quality and management of services in the current fee-for-service (FFS) delivery system. The Department has determined the viability of utilizing the existing Family Care Network (FCN) Program as a base in developing an enhanced program model integrating primary care case management and a voluntary disease management program.

   The FCN Program served MA recipients under 21 years of age. The new program, known as the ACCESS Plus Program (Program), will serve most new and existing children and adult MA recipients who reside in the 42 counties of this Commonwealth not currently served by the mandatory managed care program, HealthChoices.

   The Program will operate under the authority of a 1915(b) Federal waiver for recipients under 21 years of age and a State Plan Amendment for recipients 21 years of age or older, and will operate in the following counties only: Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne and Wyoming.

   Most MA recipients who currently receive their health care services through the FFS delivery system, including those recipients currently enrolled in the FCN Program, will receive their health care services through the Program. Recipients who are currently enrolled in voluntary managed care will have the option of remaining in the voluntary managed care plan or enrolling in the Program. MA recipients who are also receiving services through one of the Department's approved 1915(c) Home-and Community-Based Waiver Services Programs will receive primary care case management and disease management services through the Program in addition to the services they receive through their waiver program and designated waiver providers.

   The Program will enable enrollees to choose their own primary care providers and to receive the advantages of active care coordination, case management and, if eligible, voluntary disease management services. MA recipients in the Program may elect to receive disease management services if they have at least one of the following high-risk conditions: asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease or congestive heart failure.

   The Department will implement the Program in three phases. The first phase became effective March 1, 2005, when all current FCN enrollees in the 42 counties were transferred to the Program. The second phase will be implemented after March 1, 2005, when all newly eligible MA recipients will be enrolled in the Program. The final phase becomes effective May 1, 2005, when all other existing MA recipients eligible for the Program will be enrolled in the Program. Throughout the implementation phase, individuals enrolled in a voluntary managed care organization (MCO) will have the option to remain enrolled with an MCO or to change their enrollment to the Program.

Fiscal Impact

   The estimated cost for Fiscal Year (FY) 2004-2005 is $5.429 million ($2.584 million in State funds). The estimated savings for FY 2005-2006 is $21.738 million ($9.454 million in State funds).

Comment Period

   A copy of this notice is available for review at local county assistance offices. Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Attn: Regulations Coordinator, Department of Public Welfare, Office of Medical Assistance Programs, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-417. (1) General Fund; (2) Implementing Year 2004-05 is $2.584 million; (3) 1st Succeeding Year 2005-06 is $0; 2nd Succeeding Year 2006-07 is $0; 3rd Succeeding Year 2007-08 is $0; 4th Succeeding Year 2008-09 is $0; 5th Succeeding Year 2009-10 is $0; (4) 2002-03 Program--$727.979 million; 2001-02 Program--$666.832 million; 2000-01 Program--$705.750 million; (7) Medical Assistance Outpatient; (8) recommends adoption. The Fiscal Year 2004-2005 costs are included in the General Appropriation Act (Act 7A-2004). This change will result in savings of $9.454 million in Fiscal Year 2005-2006 and $10.632 million in Fiscal Year 2006-2007 and thereafter.

[Pa.B. Doc. No. 05-898. Filed for public inspection May 6, 2005, 9:00 a.m.]


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