It looks like Pennsylvania will be heading back to the drawing board in the Physical Health Managed Care Organization (PH-MCO) procurement process. That’s because in April 2018, Commonwealth Courtruled in favor of the bidders protesting the contract award process; Aetna, United HealthCare and Vista Health Plan. The three insurers had filed suit challenging that (more…)
Pennsylvania continues to take steps to address the opioid epidemic by focusing on removing barriers to treatment. In late 2016, the state began implementing its Centers of Excellence program, with the goal of coordinating care for individuals with opioid use disorders and co-occurring behavioral and/or physical health conditions. Originally twenty centers were funded, with twenty-five additional centers implemented several months later. (more…)
In July, the Pennsylvania Department of Human Service (DHS) implemented revisions to Appendix R, Encounter Data Submissions Requirements and Accompanying Sanctions for Noncompliance. The focus of Appendix R is two-fold: DHS is interested in both the timeliness (more…)
In July, the CMS Medicaid and CHIP Managed Care Final Rule went into effect. Included in the rule is a provision that allows states to cover inpatient treatment for adults in an Institution for Mental Diseases (IMD). Previously, these services were totally excluded from federal matching funds. (more…)
NOTE: On November 6th, DHS announced it would delay the implementation of Phases 2 and 3 of the Community Health Choices program. Phase 1 will still begin as planned in 14 Southwestern Pennsylvania counties on January 1st. However, Phase 2 will now begin January 1, 2019 instead of July 1, 2018, and Phase 3 on January 1, 2020 instead of January 1, 2019.
This year has seen its share of hospital system mergers, acquisitions and joint ventures. Earlier this month, Pittsburgh-based University of Pittsburgh Medical Center (UPMC) announced that it has reached an agreement, pending regulatory approval, to acquire Pinnacle Health System of Harrisburg. (more…)
The Pennsylvania Department of Human Service (DHS) has implemented its planned revisions to encounter data submissions requirements and accompanying sanctions for non-compliance. These revisions are contained in a HealthChoices Behavioral Health (HC BH) Amendment dated July 1, 2017 and distributed as an updated Appendix R. (more…)