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What is the PA CHC Agreement?
The PA CHC Agreement is a contract between the Pennsylvania Department of Human Services (DHS) and managed care organizations (MCOs) in the state. The agreement is about providing care for individuals who are eligible for both Medicare and Medicaid. These individuals are known as “dual eligibles.”
The PA CHC Agreement is designed to improve the quality of care for dual eligible individuals. It aims to create a more coordinated approach to care, reduce healthcare costs, and improve health outcomes for this vulnerable population.
Who is Eligible for the PA CHC Agreement?
Dual eligible individuals who live in one of the 14 counties included in the program are eligible for the PA CHC Agreement. These 14 counties are: Bucks, Chester, Delaware, Montgomery, Erie, Philadelphia, Allegheny, Armstrong, Beaver, Butler, Greene, Fayette, Washington, and Westmoreland.
The PA CHC Agreement is not mandatory for dual eligible individuals. They can choose to opt-out of the program if they prefer to receive their Medicare and Medicaid benefits through traditional fee-for-service programs.
What are the Benefits of the PA CHC Agreement?
The PA CHC Agreement offers several benefits to dual eligible individuals in the participating counties. These benefits include:
1. A single point of contact for healthcare services: The PA CHC Agreement assigns each dual eligible individual a care coordinator who serves as a single point of contact for all their healthcare needs. This helps ensure that individuals receive the appropriate care and services they need.
2. Comprehensive care: The PA CHC Agreement provides access to comprehensive healthcare services, including medical, behavioral health, and long-term services and supports.
3. Coordinated care: Through the PA CHC Agreement, healthcare providers work together to coordinate care for each individual. This helps prevent duplication of services, reduces the risk of adverse drug interactions, and ensures that individuals receive the most appropriate care.
4. Cost savings: The PA CHC Agreement aims to reduce healthcare costs by coordinating care, eliminating unnecessary services, and preventing hospital admissions and readmissions.
Conclusion
The PA CHC Agreement is an innovative program designed to improve the quality and coordination of healthcare for dual eligible individuals in Pennsylvania. By working together, healthcare providers and managed care organizations can provide comprehensive, coordinated care to improve health outcomes and reduce healthcare costs. If you are a dual eligible individual living in one of the 14 participating counties, consider enrolling in the PA CHC Agreement for better healthcare services.