Pennsylvania Behavioral Health HealthChoices

Pennsylvania Human Service Agencies to Unify?

Earlier this month, Governor Wolf announced his proposed plan to unify four human service agencies under one Department of Health and Human Services (HHS): the Department of Health, the Department of Human Services, the Department of Drug and Alcohol Programs and the Department of Aging. (more…)

HealthChoices and Medicaid Expansion: Ensuring Healthcare for all Pennsylvanians

This year marks the 20th anniversary of HealthChoices, Pennsylvania’s Medicaid program. Since the program was implemented in February 1997, it has expanded to all 67 counties and has provided the state’s most vulnerable residents access to a wide array of services in a cost-effective manner. Today, HealthChoices serves almost 3 million Pennsylvanians through primary, preventative and specialty care, mental health and substance abuse services, dental services and prescription drug coverage. (more…)

Will the Physical Health MCO Contracts Ever Be Resolved?

Update, September, 2017

The Pennsylvania Department of Human Services (DHS) is currently in a stay regarding the rollout of new Physical HealthChoices contracts scheduled to begin on January 1, 2018. Bidder protests which were denied by DHS are being appealed to Commonwealth Court. Until those appeals are resolved, all existing Physical Health MCOs will continue to operate in their respective zones.

Pennsylvania’s effort to rebid its Physical HealthChoices agreements has hit a number of snags, as bidders who stand to lose market share have lodged protests against the state. The RFP has now been issued twice, each time yielding different contract awards, as well as formal protests from different potential losers. (more…)

The Medicaid Managed Care Final Rule and IMD Exclusion

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The CMS Medicaid and CHIP Managed Care Final Rule, issued in April, is the first overhaul of Medicaid managed care plans in a decade. Spanning over 400 pages in the Federal Register, the rule covers a broad range of topics related to the operation, contracting, oversight, and payment of Medicaid managed care plans. The topic that may be the most impactful for Pennsylvania is the Institution for Mental Diseases (IMD) Exclusion.

Opioid Use Disorder Treatment Update: Pennsylvania to Implement Additional Centers of Excellence

Render illustration of "OPIOID ADDICTION" script on head silhouette with cloudy sky as a background.

On August 29th, Governor Wolf announced that Pennsylvania will implement an additional 25 Centers of Excellence (COE) to help combat opioid-related substance abuse disorders. These centers, added to the original announced earlier this year, will bring the total to 45 centers to be implemented by January 1, 2017. As described in July’s post, COEs will coordinate care for Medicaid recipients who have an opioid use disorder, as well as co-occurring behavioral and/or physical health conditions. (more…)

Pennsylvania Targets Opioid Use Disorder Treatment

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Pennsylvania leads the nation in drug overdose deaths among young males ages 12 to 25, and is among the leaders in the country for all age groups. The Pennsylvania Department of Human Services (DHS) is working to reverse this trend. Recently, DHS announced two programs aimed at expanding and transforming substance abuse services statewide. (more…)

Autism Spectrum Disorder and HealthChoices

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Diagnosing a child with an Autism Spectrum Disorder (ASD) can be challenging because of the varying features of these disorders and because of the inconsistencies among the various diagnostic classification schemes (e.g. ICD-9, ICD-10, DSM-IV, DSM 5) that might apply at any point in time.