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Clarification on Regulations Not Applicable to HealthChoices
October 1, 1999

Some PCPA members in HealthChoices areas have raised questions regarding which regulations providers must follow under MA and which no longer apply to them. OMHSAS released the "Regulations, Bulletins and Contractual Addenda Not Applicable to HealthChoices Behavioral Health Southwest" document in 1997. This document outlines sections of Medical Assistance, drug & alcohol and mental health regulations that do not apply for the Southwest region of HealthChoices.

Marilyn Eckley, Director of the Bureau of Operations & Quality Management, OMHSAS, and Jerry Kopelman, Director of the Bureau of Policy & Program Development, OMHSAS, issued a letter to the Southeast region of HealthChoices informing them that the "Regulations, Bulletins..." document applies to the Southeast as well.

The following are examples of regulations that do not apply for HealthChoices providers:

1. A mental health client in a partial hospitalization program can also be in a D&A outpatient program. See Appendix BB, page 4, 55 PA Code 1223, Outpatient Drug and Alcohol Clinic Services 1223.14, (9)

2. A client can receive both psychiatric outpatient clinic services and psychiatric partial hospitalization services on the same day. See Appendix BB page 3, 55 PA Code 1153, Outpatient Psychiatric Services, 1153.14 (9)
Unfortunately the Medical Assistance requirement for the Drug & Alcohol outpatient client to have a physical exam remains in effect.

If you suspect that a specific regulation is preventing you from providing needed services, please utilize this document to clarify whether or not that regulation has been waived.

In a recent discussion with OMHSAS and PCPA staff, it was stated that if a regulation is preventing a client from needed services, OMHSAS is willing to consider possible solutions as long as the solution is in compliance with HCFA regulations.

For a copy of the above-mentioned documents, please call the Association.

If you have any questions regarding a mental health issue, please contact Rebecca Heidenheim, or if your question is about a drug & alcohol issue, contact Lynn Cooper at the Association.

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