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OMAP

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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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The PA Office of Medical Assistance Programs (OMAP) issued a new Bulletin that applies to personal assistance and community habilitation services under the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP). The key changes from earlier guidance include:

  • Providers 85% Compliance Requirement Effective January 1, 2025: Providers must ensure at least 85% of EVV records are verified without manual edits.
  • Starting January 2026, DHS will issue alerts to fee-for-service providers whose manual edits exceed 15% in the prior quarter. Managed care organizations (MCO) will also receive lists of noncompliant providers for follow-up.
  • Providers failing to meet the 85% thresholds for two consecutive quarters will be required to submit corrective action plans. Continued noncompliance may lead to sanctions, potentially including loss of license.
  • FMS and Participant-Directed Models are also responsible for EVV compliance. Persistent noncompliance can result in termination from participant-directed service models.
  • Additional Resources: DHS EVV Guidance and Handbook now available.
  • Compliance Reports are available on the Sandata platform. The reports allow providers to identify the non-compliant visit dates, participants, and caregivers to initiate internal corrective action.

If you have any questions, contact Fady Sahhar.

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Pennsylvania’s Office of Medical Assistance Programs (OMAP) Deputy Secretary Sally Kozak has been featured in the Center for Health Care Strategies’ Lessons in Leadership series, which shares stories from public sector leaders from across the country. Deputy Secretary Kozak shares how she has prioritized mentorship in her career to ensure sustainability beyond any one person and offers a blueprint for how intentional, adaptive mentoring can create lasting change for individuals and the institutions they serve.

Read the full article here.

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The Pennsylvania Office of Medical Assistance Programs (OMAP) Pediatric Shift Care Team held a Stakeholder Update Call on December 16, 2024. The presentation provided an overview of the Pediatric Shift Care Initiative Updates, implementation of the Pediatric Complex Care Resource Centers, and online training curriculum as well as content development.

Please send any questions electronically to the Pediatric Shift Care Team.

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Photo by Markus Winkler on Unsplash

The office of Medical Assistance has issued an update on EVV compliance to advise providers of changes to the manual edit thresholds for Electronic Visit Verification (EVV) records in both personal care services (PCS) and home health care services (HHCS), effective with dates of service on and after January 1, 2025.

This bulletin applies to providers enrolled in the MA Program who render PCS and HHCS to beneficiaries or participants in the MA fee-for-service (FFS) delivery system, including through home and community-based services waivers and the managed care delivery system via Physical HealthChoices or Community HealthChoices. Beneficiaries may receive services in the following programs:

  • Office of Developmental Programs (ODP): Adult Autism Waiver, Community Living Waiver, Consolidated Waiver, Person/Family Directed Support Waiver, and Base Funded Program;
  • Office of Long-Term Living (OLTL): OBRA Waiver, Act 150, and Community HealthChoices; or,
  • Office of Medical Assistance Programs (OMAP): MA FFS and Physical HealthChoices.

Read the full bulletin here. This bulletin will be a key topic at the RCPA PD&A meeting on September 11, for which you can register here.

If you have any questions, please contact Fady Sahhar or Melissa Dehoff.

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Photo by Markus Winkler on Unsplash

The Medical Assistance Bulletin 08-24-04, issued by the Department of Human Services (DHS) Office of Medical Assistance Programs (OMAP), provides updates to the PROMISe (Provider Reimbursement and Operations Management Information System) Provider Handbook 837, Professional/CMS-1500 Claim Form, specifically focusing on Appendix E – FQHC/RHC (Federally Qualified Health Center/Rural Health Center) Handbook. Released on March 1, 2024, the bulletin outlines revisions to Federal and State requirements for FQHCs and RHCs in Pennsylvania participating in the Medical Assistance (MA) Program.

Notable changes include the addition of pharmacists and licensed dietician-nutritionists as eligible practitioners for billable encounters starting March 1, 2024. The revision addresses group therapy encounters and introduces guidelines for telehealth, telemedicine, and teledentistry in FQHC and RHC services. A new section on alternative payment methodologies is included, along with updates to the MA Cost Reporting and Wraparound Reporting sections. The Centers for Medicare & Medicaid Services’ clarification designates “hospital” as an allowable place of service for FQHC and RHC services. Providers are encouraged to review the revised handbook for detailed information on these changes.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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The Pennsylvania Office of Medical Assistance Programs (OMAP) Pediatric Shift Care Team is conducting a survey to identify individuals interested in participating in the development of education and training content for a new online learning portal. More will be shared about this effort during the upcoming Stakeholder Update Call, which is taking place on August 15 from 10:30 am – 12:00 pm.

If you are interested in participating in the initiative, please take this short 2-minute survey: Pediatric Shift Care Subject Matter Expert Interest Survey. The survey has been extended and will close on August 18, 2023, following the Stakeholder Update Call.

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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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