This program is eligible for 1 hour of CLE credit in 60-minute states. In 50-minute states, this program is eligible for 1.2 hours of CLE credit. Credit hours are estimated and are subject to each state’s approval and credit rounding rules.
Overview
Community Health Choices – HCBS Appeals
Katy McKee & Pam Walz
Individuals in the Community HealthChoices waiver program are eligible to receive services at home to help them continue living safely in their communities. Access to the services is controlled by the Community HealthChoices managed care plans (CHC-MCOs). When a CHC-MCO denies or seeks to reduce or terminate a waiver service, the participant has the right to written notice and an appeals process. There is plenty of room for advocacy in this process! During this session, the presenters will review how CHC waiver services are determined, the appeal framework, reviewing key MCO records (interRAI, PSST, PCSP, etc.), preparing evidence in support of a participant’s appeal, potential arguments and strategies for appeals as well as considerations in settling appeals, with a focus on personal assistance services (PAS).
Recorded in February 2025.
Faculty
Pamela Walz, Esq.
Ms. Walz is a Supervising Attorney at the Health and Independence Unit at Community Legal Services (CLS) in Philadelphia, where she represents low-income older adults and individuals with disabilities in matters involving nursing home and personal care home residents’ rights, access to home and community based long term services and supports, public benefits and guardianship. In addition to representing clients, Ms. Walz engages in administrative and legislative policy advocacy and provides community education on elder law issues. She is an appointed member of the Pennsylvania Supreme Court’s Advisory Council on Elder Justice in the Courts. She also serves as a consumer advocate on the Long Term Services and Supports Subcommittee of the Department of Human Services’ Medical Assistance Advisory Committee. Ms. Walz is the immediate past Chair of the Pennsylvania Bar Association Elder Law Section. She received her J.D. from Harvard Law School in 1989 and graduated from the University of California, San Diego in 1986 with a degree in English Literature.
Katy McKee, Esq.
Katy McKee is a Supervising Attorney working in PHLP’s Pittsburgh Office. She is an expert in Medicaid and dual eligibility. Prior to joining PHLP in 2018, she worked as a staff attorney for more than 10 years for Neighborhood Legal Services, representing low-income tenants, victims of domestic violence, unemployed workers, seniors, and people with disabilities. Katy is a graduate of the College of Wooster and the University of Pittsburgh School of Law
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