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…)
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…)
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 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.
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…)