RCPA Shares Agenda for 2025 Annual Membership Meeting and PAC Golf Outing on May 13
OMHSAS Data Shows Significant Increases in BH-MCO Denials of Services
In a presentation to the Medical Assistance Advisory Committee today, Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Secretary Jen Smith shared data that shows a significant increase over the past three years in behavioral health managed care organization (BH-MCO) decisions to deny services to their members or contracted providers.
In addition to denial data for calendar years 2022 through 2024, the report also provides data on grievances and complaints and defines what each of those is. Notably, the 2024 data does not include the fourth quarter of the year.
The most egregious service type denials are seen in two categories: 1) non-hospital residential withdrawal management, rehabilitation and halfway-house services for drug/alcohol abuse or substance use disorders; and 2) IBHS for children and adolescents with mental health or substance use disorders. Although the IBHS denials appear down slightly in 2024, when the fourth quarter data is added, the number is likely to increase. On the SUD side, even without fourth quarter data, denials for the non-hospital residential substance use disorder treatment services are up 45 percent over 2023.
The presentation breaks down the number of denials per year per BH-MCO since 2022.
The increases in denials in 2024 occurred at the same time OMHSAS acknowledged a significant miscalculation of capitation rates, resulting in underfunding of the behavioral health system, including primary contractors and BH-MCOs, by hundreds of millions of dollars.
Deputy Secretary Smith cautioned that there are multiple factors to consider when reviewing the data and increase in denials, including Pennsylvania’s SUD treatment system’s ongoing alignment with ASAM Criteria and the increased BH-MCO scrutiny on providers and individual BH-MCO interpretation of ASAM Criteria.
Forum Spotlights Fears Over Potential for Medicaid Cuts, RCPA Honorary Board Member Jim Cook Quoted
Proposed Restructured Funding Plan for DHS Released
Medicaid Matters: A Community Forum to Be Held April 21, With Panelists Including RCPA Honorary Board Member Jim Cook
This community-focused advocacy forum brings together experts and stakeholders to discuss the local impact of federal funding cuts to Medicaid, particularly on vulnerable populations and essential services.
The event will be moderated by Chip Minemyer, publisher of The Tribune-Democrat, and panelists will include RCPA Honorary Board Member Jim Cook, who serves as Executive Director of Cambria Residential Services.
The event will be held Monday, April 21, at 6:30 pm. You can view the flyer here for more details.
IPRC Webinar: Treating FND — “Not Your Parent’s Functional Neurologic Disorder” on May 20
Treating Functional Neurologic Disorder (FND) — “Not Your Parent’s Functional Neurologic Disorder”
Tuesday, May 20, 2025
1:00 pm – 2:00 pm EDT; 12:00 pm – 1:00 pm CDT;
11:00 am – 12:00 pm MDT; 10:00 am – 11:00 am PDT
Register Here
Presenter Bios:
Samuel Zachary, MOT, OTR/L
Sam is an occupational therapist at Children’s Hospital of Philadelphia (CHOP) in the inpatient rehabilitation and amplified musculoskeletal pain syndrome (AMPS) programs. Sam brings experience from a variety of medical-based pediatric settings, including acute care, in-patient rehabilitation, and multi-disciplinary outpatient clinics.
Over the past four years, Sam’s practice has focused on the AMPS Intensive Program and Clinic at CHOP. He is passionate about treating children and adolescents with AMPS, functional neurological disorder, or both. He brings great enthusiasm while sharing his knowledge and best practices for caring for this unique population.
Lori Kile, PTA
Lori is a physical therapist assistant at Children’s Hospital of Philadelphia (CHOP) working in the inpatient rehabilitation and amplified musculoskeletal pain syndrome (AMPS) programs. She began her career at CHOP in 1998 and has dedicated over 25 years of service to the institution. She worked in a variety of pediatric settings, including outpatient, acute care, and inpatient rehab, prior to finding her passion for treating youth and teens with Amplified Musculoskeletal Pain and Functional Neurological Disorder. Lori now specializes with these populations; she is also involved with the International FND society, where she helps to develop deliverables and build the knowledge base regarding the diagnosis. She loves to share her knowledge and lessons learned to build the skills of others and promote best practices in treatment of patients with FND.
Objectives: Following this course, the learner will:
- Identify recent changes in the understanding, diagnosis, and treatment of pediatric patients with FND.
- Obtain a best practice framework for treating pediatric patients in the rehabilitation setting.
- Learn about best practice for measuring outcomes with pediatric patients with FND.
Audience: This webinar is intended for all interested members of the rehabilitation team.
Level: Beginner
Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.
Complimentary webinars are a benefit of membership in IPRC/RCPA. Registration fee for non-members is $179. Not a member yet? Consider joining today.
RCPA Member Children’s Crisis Treatment Center to Host Advocacy Event “Creating Cultures of Growth and Healing”
Greenspace Health to Host “Measurement-Based Care & CARF Accreditation” Webinar on May 15
The team at Greenspace Health are hosting a timely and insightful panel to explore the evolving role of Measurement-Based Care (MBC) in accreditation and clinical practice. The session, Measurement-Based Care & CARF Accreditation: Driving Quality Through Measurable Outcomes, brings together an exceptional group of experts to discuss how organizations can leverage MBC to improve outcomes, align with accreditation standards, and elevate care quality across their services. The webinar will be held May 15 at 1:00 pm EDT. Register here.
Speakers include:
- Michael Johnson, Senior Managing Director of Behavioral Health at CARF;
- Dr. Kimberly Gordon-Achebe, Medical Director of Mobile Response and Stabilization Services at iMind Behavioral Health, a CARF accredited organization leveraging MBC;
- Dr. James Boswell, Associate Professor and Director of Clinical Training at the University at Albany; and
- Host: Jeremy Weisz, CEO and Co-Founder at Greenspace Health.
Whether you’re preparing for CARF accreditation, already using MBC, or exploring how to integrate it into your practice, this webinar will offer actionable insights, real-world strategies, and guidance on meeting CARF’s updated 2025 standards which now require ongoing progress measurement.
If you are unable to participate live, you can still register to receive the recording and resources after the session.
OCYF Publishes Quarterly Post on Policy Newsletter
The Office of Children, Youth and Families (OCYF) Division of Policy has published their quarterly Post on Policy newsletter, highlighting policy updates, work group activities, staff contacts, upcoming changes, and special events. This newsletter was designed to inform and update on all things policy in the Office of Children, Youth, and Families Bureau of Programs, Policy and Operations/Division of Policy. Read the newsletter here.
Please contact Policy Associate Emma Sharp with any questions or concerns.
OPEN MINDS: Rewriting Recovery
Article reprinted with permission from OPEN MINDS. To sign up for a free OPEN MINDS news feed on https://www.openminds.com/market-intelligence/, go to https://www.openminds.com/membership/
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