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Tags Posts tagged with "BH-MCO"

BH-MCO

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The Department of Human Services (Department) issued bulletin OMHSAS-16-03, “Revised Procedure for Waiver of Office of Mental Health and Substance Abuse Services (OMHSAS) Program Regulations and Standards,” on April 19, 2016, to update and clarify the procedure for submitting and processing of waiver requests to OMHSAS. OMHSAS has issued OMHSAS-24-04 to further update regulatory waiver language and the process to appeal a waiver determination. The issued bulletin can be found here. OMHSAS-16-03 is obsoleted by this bulletin.

OMHSAS licenses or approves community mental health facilities and agencies and other service providers operating in the Commonwealth of Pennsylvania. In accordance with this responsibility, the Department’s authorized agents periodically inspect mental health facilities and agencies. If regulatory requirements are met, certificates of compliance or approvals are granted under Article IX of the Human Services Code (62 P.S. §§ 901 – 922) or under Article X of the Human Services Code (62 P.S. §§ 1001 – 1080).

Pursuant to applicable regulations, a facility or agency may request a time limited waiver of regulations or program standards, or a portion of regulations or program standards. All regulatory waiver requests are subject to applicable waiver of standard requirements as outlined by each chapter or bulletin. In reviewing any such waiver request, OMHSAS will consider whether the facility or agency has demonstrated that substitute measures assure the health, safety, and welfare of all individuals who reside in the facility or who receive services from the agency.

Please contact RCPA COO and Mental Health Policy Director Jim Sharp with any questions.

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On July 19, 2024, the Office of Mental Health and Substance Abuse Services (OMHSAS) presented a Value-Based Purchasing (VBP) Provider Technical Assistance Webinar. The webinar, developed and presented by OMHSAS and their partner Mercer, provided an excellent overview of the VBP landscape and valuable guidance for providers to consider future efforts to incorporate VBPs into their service matrix.

OMHSAS supports providers interested in pursuing VBP programming to contact and collaborate with their respective BH-MCOs on VBP options. The Value-Based Purchasing (VBP) Provider Technical Assistance PowerPoint provides an outline of the information covered in the webinar. Should you have any questions or comments, please contact the OMHSAS VBP Resource Account via email.

If you have any additional questions, please contact RCPA Policy Directors Jason Snyder or Jim Sharp.

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Pennsylvania state Reps. Maureen Madden (D) and Jim Struzzi (R) last week issued a bi-partisan co-sponsorship memo seeking support among their colleagues for a bill that will force the Department of Human Services (DHS) to take a more active role in Pennsylvania’s Opioid Use Disorder Centers of Excellence (COE) while forcing consistency and eliminating interpretation among the five behavioral health managed care organizations (BH-MCO).

RCPA has been working to address multiple components of COE inconsistency, including: interpretation of COE definition; compliance with COE requirements; and policies, procedures, and payment models being implemented by the commonwealth’s five BH-MCOs.

RCPA, on behalf of its SUD treatment provider members that operate COEs, has repeatedly asked DHS to enforce consistency in the COE program from MCO to MCO. Despite DHS considering the COEs overall to be a “wild success,” they have refused to take any action to ensure the success continues in the transition to managed care. In the past several months, RCPA and provider members that operate COEs have testified in front of the House Democratic Policy Committee and the House Human Services Committee on the disjointed and burdensome transition of the COEs into Pennsylvania’s Medicaid state plan. You can read RCPA’s testimony or watch the Human Services hearing.

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During the past few years, the state Medicaid program, HealthChoices, has begun to implement and expand the use of Value-Based Purchasing models in procurement contracts with all Physical Health Managed Care Organizations (PH-MCOs). With a goal of increasing clinical outcomes, patient satisfaction, and cost management, the PH-MCOs have called for increased use of such Value-Based Purchasing models as Pay for Performance, Patient Centered Medical Homes, and Bundled Payments. On May 25, the leadership of the Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) conducted a webcast to review the implementation process used in HealthChoices by the PH-MCOs and their provider networks, and to introduce the process of expanding Value-Based Purchasing to the Behavioral Health Managed Care Organizations and their provider networks. The OMHSAS target for introducing this expansion is January, 2018 with a focus on integrated and collaborative behavioral and physical health and care coordination.

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