The Office of
Medical Assistance Programs (OMAP) has distributed a draft of the Peer Review
Committee By-Laws for Fee-for-Service (FFS) Medical Assistance (MA) Practitioners
for review and comment, as well as a draft MA Enrollment Application. Peer
review has been done for practitioners associated with managed care for some
time. It has not been established for the MA FFS program. According to the
draft, the Peer Review Committee will make recommendations to the Bureau of
FFS Programs regarding initial credentialing or recredentialing and quality
of care reviews. The committee’s purpose is to “(1) assure that
practitioners enrolled as MA providers in the FFS and Access Plus delivery
systems have the necessary credentials based on solid professional and documentary
evidence and that they are qualified to provide both safe and clinically sound
services; (2) provide clinical perspective in the area of credentialing related
to the qualifications of MA providers; and (3) provide enhanced professional
evaluation of quality of care rendered based on generally accepted community
standards of care.”
The credential verification organization, Medical Verification Solutions, will compile the specified information and submit it to the Bureau of FFS programs, which will in turn provide the information to the chair of the Peer Review Committee or a designee for review and action. The information is then processed for credentialing or referred to the Peer Review Committee for further review in accordance with the Peer Review Committee By-Laws.
PCPA members are invited to review the draft by-laws and application form and comment directly to Holly Alexander in the Office of the Medical Director (halexander@state.pa.us) by close of business October 12. Please contact Betty Simmonds with questions.
