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Children's Services

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In an effort to gain a better understanding of providers’ ongoing needs and challenges in addressing third party liability (TPL) claims, RCPA is requesting that our members complete the following TPL Survey. This survey was designed to capture critical barriers so as to develop strategic pathways to ensuring access and equity.

In January 2024, Governor Shapiro announced that commercial insurers would be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits by categorizing autism services as a mental health benefit. With this action, all autism services will be treated as mental health services, leading to greater mental health parity for those with autism spectrum disorders. The goal of the Shapiro Administration’s legislation is to improve much-needed access to services for individuals diagnosed with autism, a challenge that the Commonwealth has faced for decades.

As providers of mental health, autism services, and substance abuse disorders, our members treat a vast array of individuals who are insured by either commercial insurance, Medicaid insurance, or both. For those who have just Medicaid, billing is simple: providers bill the Medicaid payor, and they pay the claim. The same is true for those who have just commercial insurance if the provider is in network with the commercial insurance carrier.

Complications occur when an individual has both commercial insurance and Medicaid. Coordination of Benefits (COB) requires that the commercial insurance is billed first, and then Medicaid pays what is not covered. Services like the delivery of Applied Behavior Analysis (ABA) or Intensive Behavioral Health Services (IBHS) are two good examples of services that can fall into this category.

With this survey, we hope to gather information that will assist RCPA and members in addressing the barriers in insurance coverage for children, families, and individuals in Pennsylvania. We thank you for taking the time to complete the survey so that we can continue to seek solutions to access services in our communities.

If you have any questions, please contact RCPA Policy Associate Emma Sharp.

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Happy New Year! Now that you have turned the page to your 2025 calendars, we want to be sure that you do not miss saving the dates for the RCPA Annual Conference in 2025. We will be holding the conference earlier than we traditionally have, so we want to be sure you know the date. We will be meeting again at the Hershey Lodge, September 9 – 12, 2025! But not to worry — we will be offering the same high level of quality you have come to expect from our selection of workshops, speakers, and activities! Stay tuned to our social media and Conference website for future developments.

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Image by Gerd Altmann from Pixabay

RCPA is excited to host a Membership Benefits webinar on Wednesday, January 15, 2025, at 1:00 pm, as an opportunity for members to orient themselves with all that RCPA membership includes. This is not just for new and future members. For current members, there may be benefits associated with our membership that you may not be aware of, including targeted meetings and groups that occur throughout the year.

Registration is required; please register here to attend the webinar. Items we will review include the below and much more:

  • Virtually meet the dedicated RCPA Policy Staff and RCPA lobbyists;
  • Discuss the 2025 Legislative and Administrative priorities;
  • Preview RCPA divisional committee and subcommittee meetings and what they offer;
  • View the RCPA member-only website;
  • Review exclusive yearly educational and networking events; and
  • Understand the value of the National Association memberships included with RCPA membership.

Visit the RCPA member benefits web page for more information, or contact Tieanna Lloyd for benefit details.

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Hands touching in a circle
Photo by Hannah Busing on Unsplash

The Office of Developmental Programs (ODP) and the Office of Mental Health and Substance Abuse Services (OMHSAS) are pleased to announce the latest edition of the Positive Approaches Journal.

This issue of the Positive Approaches Journal takes a deep dive into the importance of community safety and wellness for individuals and families. Topics include emergency preparedness, interventions and programs for youth, justice and community supports and services, and navigating crises situations. Remember, a community that prioritizes health, safety, and well-being is one that thrives and prospers.

This issue of Positive Approaches Journal is in digital form, available for viewing online or for downloading at MyODP’s website. To print a copy of the PDF, online journal, or a specific article, you will find these options within your left navigation bar on any Positive Approaches Journal page. A new window will open with your selected document. In your browser, you may click the Print button in the top left corner of the page, or by using the Print capability within your browser.

Please submit feedback regarding your experience with the Positive Approaches Journal on MyODP by selecting the feedback image on MyODP within your left navigation bar on any Positive Approaches Journal page.

The Positive Approaches Journal is published quarterly. For additional information, please contact ODP Training’s inbox.

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The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the OMHSAS-24-05 Peer Support Services (PSS) Bulletin and PSS Provider Handbook, updating the requirements for Peer Support Services. OMHSAS significantly reorganized the existing language in the Handbook to better clarify which requirements apply to OMHSAS licensure and which apply to Medical Assistance payment. Along with these formatting changes, OMHSAS-24-05 includes the following updates:

  • Staff Qualifications and Requirements for Certified Peer Specialists (CPS)
    • The requirement for a CPS to have a high school diploma or GED has been removed.
    • The requirement for a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) has been replaced with a requirement to have a mental health diagnosis. Please note, to be eligible to receive PSS services, there is still a requirement for “the presence or history of an SMI or SED.”
    • The clause requiring CPSs “to attain certification through the PCB within six months of hire” has been removed, as the certification examination is now available on-demand, eliminating the need for a grace period for testing to be completed.
  • Staff Qualifications and Requirements for CPS Supervisors
    • Adding a new qualification category for individuals with an associate degree.
    • Supervisory meetings held in an audio-only format shall not be considered supervision.
    • Supervisory meetings shall be provided at a minimum of one hour each week.
  • Telehealth
    • The prior requirement that only 25% of total services provided per beneficiary per calendar year can be delivered by telephone has been removed.
    • PSS may be provided via telehealth technology, including audio-only service delivery, when it is clinically appropriate to do so.
    • PSS providers must ensure that the preference of individuals receiving services (or their legal guardian) is given a high priority when determining the appropriate service delivery modality.

Please review all other revisions to OMHSAS-24-05 here.

Comments and questions regarding this bulletin should be directed to:
Office of Mental Health and Substance Abuse Services, Bureau of Policy, Planning and Program Development,
P.O. Box 2675,
Harrisburg, PA 17105
General Office Number: 717-772-7900
Email

If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

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Capitol hill building in the morning with colorful cloud , Washington DC.

On December 21, President Biden signed into law the 2025 American Relief Act, a stopgap funding bill passed by Congress on December 20 that funds the federal government through March 14, 2025, and includes over $110 billion for disaster relief.

The bill extends certain Medicare telehealth flexibilities through March 31, 2025, under Section 3207, including the six-month in-person requirement for mental health services, the expanded originating sites, and coverage of audio-only services.

The bill also extends funding for several expiring health care programs through March 31, 2025, including the National Health Service Corps at $85 million and the Teaching Health Center Graduate Medical Education Program at $43 million, both under Section 3101.

In addition, the stopgap bill delays scheduled reductions to the Medicaid Disproportionate Share Hospitals allotments, which are currently set to result in a total reduction of $32 billion between 2025 and 2027. Under Section 3401, the bill delays these cuts through April 1, 2025.

You can read the bill text and a summary of the health care provisions.

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