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PH 95 Copayment for HealthChoices
September 17, 2012

On September 14 counties and behavioral health managed care organizations (BH-MCOs) contracting with the Department of Public Welfare were notified that the “…PH 95 co-payment initiative will proceed as indicated in the Notice that was published in the Pennsylvania Bulletin.”  Communication from the Office of Mental Health and Substance Abuse Services (OMHSAS) noted that the proposed capitation adjustments for BH-MCO contractors have not been completed and are not available to counties and BH-MCOs. OMHSAS rate calculations will be critical for counties and BH-MCOs in determining how to proceed with management of the co-payment implementation.

OMHSAS has notified counties and BH-MCOs that they have the option of whether or not to implement the co-payment.  If a county does choose to implement a co-payment rather than absorb the cost impact as the physical health managed care organizations are likely to do, then a rollout plan including timeframes, the approach to implementation, policies and procedures, draft member notifications, draft provider notices, etc., must be submitted to OMHSAS for review and approval.  OMHSAS is requesting coordination among counties that work with the same BH-MCO to submit one plan on behalf of all counties served by that BH-MCO.

Provider agencies that serve individuals in Medicaid Fee-for-Service covered by the co-payment requirement will begin seeing payments reduced in October for services provided for newly eligible PH 95 children and beginning November 1 for existing PH95 children.

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