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Tags Posts tagged with "medical assistance"

medical assistance

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The Pennsylvania Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Medical Assistance Programs (OMAP) have jointly issued the Medical Assistance Bulletin Targeted Case Management Services for Eligible Juveniles Enrolled in Medical Assistance Prior to Release From a Carceral Setting, implementing Section 5121 of the Consolidated Appropriations Act, 2023. Eligible juveniles are individuals under 21 years of age who are determined eligible for MA or an individual 18–25 years of age who was determined eligible for the mandatory eligibility group for former foster care children.

This bulletin advises providers of billing procedures for the physical health (PH) and behavioral health (BH) Targeted Case Management (TCM) services provided to eligible juveniles enrolled in the Medical Assistance (MA) Program within 30 days of release from a carceral setting and for at least 30 days following release. This bulletin also advises providers of a new provider specialty (Spec) for TCM services.

Questions and comments can be sent electronically. You can also contact RCPA Policy Associate Emma Sharp with any questions.

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Governor Josh Shapiro and members of the General Assembly have agreed to a $50.1 billion budget for the 2025/26 Fiscal Year. This is $2.3 billion more than last year’s budget but less than the Governor’s $51.5 billion proposed budget. The budget includes a $105 million increase in basic education, $665 million for highway improvements, and $1 billion for highway maintenance.

For Human Services, the General Budget bill includes the following increases from 2024/25 to the 2025/26 budget:

  • Medical Assistance – Capitation: +3.5%
  • Medical Assistance – Fee For Service: +.4%
  • Medical Assistance for Workers with Disabilities: +12.3%
  • Medical Assistance – Transportation: +5.9%
  • Medical Assistance – Long-Term Living: +4.7%
  • Medical Assistance – Community Health Choices: +10.7%
  • Long-Term Managed Care: +6.8%
  • Intellectual Disabilities – Community Base Program: +4.4%
  • Intellectual Disabilities – Intermediate Care Facilities: +2.9%
  • Intellectual Disabilities – Community Waiver Program: +6.1%
  • Autism Intervention Services: +12.9%
  • Early Intervention: 7.1%

The following lines have been flatlined or cut between the 2024/25 and 2025/26 budgets:

  • Behavioral Health Services: 0.0%
  • Mental Health Services: -1.9%
  • Intellectual Disabilities State Centers: -5.2%

Please find the entire 2025/26 Budget spreadsheets here.

Additionally, in other Code bills, $20 million was appropriated for county-based mental health funding, and the Four Walls payment issue was resolved in the human services code bill by abrogating 1153.15(6) and 1223.14(11) from 55 Pa. Code.

RCPA will continue to update members as more information from the budget is available. We will discuss the budget in detail during the Government Affairs meeting next Thursday, November 20, 2025. You can register for the meeting here.

Contact Jack Phillips with any questions.

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The provider revalidation process has been reinstated after the expiration of the Public Health Emergency. Providers will receive a reminder from the Office of Long-Term Living (OLTL) 90 days prior to the due date of the revalidation date. View the documents below for details.

OLTL will be participating in the PD&A meeting on June 18 and will answer any questions RCPA members may have at that time. In the meantime, if you have any questions, please contact Fady Sahhar.

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Last year, RCPA met with its provider members regarding the provision of group psychotherapy services via telehealth in the client’s home. RCPA then met with the Office of Mental Health and Substance Abuse Services (OMHSAS) to discuss the possibility of allowing this flexibility in an effort to fully realize the use of telehealth technology to enhance access.

Today, the Department of Human Services’ Medical Assistance (MA) Bulletin #99-25-02 outlines revisions to the MA fee schedule. The following changes are specific to behavioral services and are effective May 1, 2025:

  • Procedure code 99452 (Interprofessional Services) is now open for provider type (PT)/Specialty combination 08/184 (Outpatient Drug and Alcohol).
  • Place of Service (POS) 10 — Telehealth Provided in Patient’s Home is now available to use with the procedure code 90853 (group psychotherapy) for PT/Specialty combination 08/110 (Psychiatric Outpatient).

Please see the section titled “Behavioral Health Services” on page 6 of the bulletin for additional information related to these revisions.

If you have questions about these changes, please reach out to OMHSAS electronically or RCPA COO and Policy Director Jim Sharp.

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The Department of Human Services (DHS) released the following Medical Assistance (MA) Bulletin on Friday, August 23, 2024:

In addition, an updated version of the ODP Electronic Visit Verification (EVV) Technical Guide can be found below. This updated guide includes essential information on the latest compliance requirements and procedures:

Agencies are encouraged to review these documents thoroughly to ensure compliance and that provider policy and procedures are aligned with the updated requirements.

Thank you for your continued commitment to providing high-quality services for individuals with Intellectual Disabilities and Autism (ID/A) and their families in Pennsylvania.

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The Bureau of Children’s Behavioral Health Services is pleased to invite stakeholders to an informational webinar. This webinar, scheduled for Thursday, July 25, 2024, at 1:00 pm, will highlight significant sections of the proposed Psychiatric Residential Treatment Facility (PRTF) regulations prior to the public comment period. Please note that comments and questions will not be addressed as part of this webinar but may be submitted during the public comment period.

The proposed PRTF regulations will codify the minimum licensing standards and Medical Assistance (MA) participation requirements and payment conditions for PRTFs that provide medically necessary behavioral health treatment to children, youth, or young adults under 21 years of age with a behavioral health diagnosis. Questions/comments about this webinar should be submitted electronically. If you have any additional questions, please contact RCPA CCO and MH Policy Director Jim Sharp.

View the details below to join the webinar:

Microsoft Teams Need help?
Join the Meeting
Meeting ID: 268 368 479 297
Passcode: q2SZFu

Dial in by phone
+1 267-332-8737,,363691933# United States, Philadelphia
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Phone conference ID: 363 691 933#

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The PA Provider Advocacy Coalition, an organization that constitutes a variety of PA providers and advocates across all fields, recently sent a letter to the Shapiro Administration regarding the FY 2024/25 budget. RCPA signed onto the letter, which calls for rate adjustments and investments in Medicaid services in order to address the current workforce crisis. The Coalition states in the letter:

We recognize that addressing these workforce challenges will require a sustained, coordinated, multi-faceted public and private sector response. Earlier this year, our coalition met with representatives of your administration to recommend the creation of a Health Care Workforce Council to help lead this multiyear effort. However, there is one aspect of this overall problem that is relatively straightforward—chronic underpayment by the Medical Assistance program.

RCPA will continue to keep our members informed of updates. If you have any questions, please contact your RCPA Policy Director.

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RCPA recently joined over a dozen PA associations in delivering a joint letter to the Shapiro Administration requesting investments be made in behavioral health services for the Fiscal Year (FY) 2024/25 budget. As noted in the letter, which was compiled by the PA Provider Advocacy Coalition:

The mental health system all too often is unable to deliver the right care, at the right time and in the right setting. We recognize that there is no simple fix and that a sustained, multiyear effort by all stakeholders—the commonwealth, counties, providers, insurers, and advocates—is necessary to rebuild and create a mental health system for the 21st century.

RCPA will continue to keep our members informed of updates. If you have any questions, please contact your RCPA Policy Director.

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The Department of Human Services (DHS) has made the Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) Managed Care Quality Strategy (MCQS) for the Commonwealth available for public review and comment. The MCQS is an updated version of the previous strategy submitted to the Centers for Medicare and Medicaid Services (CMS) in December 2020 and accounts for the ongoing post-pandemic delivery system pressures that have affected how managed care organizations (MCOs) deliver care. The MCQS may be viewed online. Comments may be submitted via email, and those received within 30 days will be reviewed and considered. Additional information is available on the Pennsylvania Bulletin.

If you have any questions, please contact Fady Sahhar.

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The Department of Human Services (DHS) Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) issued a Medical Assistance (MA) bulletin today detailing MA payment for street medicine.

This bulletin informs MA providers that DHS will cover certain services for MA beneficiaries experiencing unsheltered homelessness in their lived environment, known as street medicine. Covered services include physical and behavioral health services, such as primary care, vaccinations, wound care, counseling, and diagnostics in the lived environment. The bulletin applies to enrolled physicians, nurse midwives, nurse practitioners, physician assistants, psychologists, mobile mental health treatment providers, and outpatient practitioners in mental health. Managed care providers should contact their managed care organization(s) for billing questions.

The complete bulletin can be viewed here as well as on the DHS website.

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