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Tags Posts tagged with "BH-MCO"

BH-MCO

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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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