RCPA - Rehabilitation and Community Providers Association


Pennsylvania HealthChoices
Behavioral Health Services for Medical Assistance Recipients

The following information is available to all families through distribution of a brochure by the Department of Public Welfare, Office of Mental Health and Substance Abuse Services. Copies of the brochure are available by contacting the Department as indicated below.

You and Your Family's Behavioral Health-Managed Care

What Are Behavioral Health Services?
Behavioral Health Services are mental health and drug and alcohol services.

Who Can Get Behavioral Health Services?
Adults, children and teenagers who are in the HealthChoices Program can get behavioral health services when needed.

How Are People enrolled in a Behavioral Health-Managed Care Plan?
Even though you or your family members may not need behavioral health services, enrollment in a Behavioral health Plan automatically happens when you and your family member enroll in the HealthChoices Program.

How Are You Told of Your Enrollment in Behavioral Health Services?
You and your family members will be told of your enrollment by the HealthChoices Behavioral Health-Managed Care Organization (BH-MCO) in the county where you live. Your Behavioral Health-Managed Care Organization will be sending you a member handbook.

Point of Contact
The Behavioral Health-Managed Care Organization will give you the name of one person at the BH-MCO to be your "point of contact". This person will tell you about behavioral health services. They will help you get behavioral health services when needed.

What if You or Your Family Member Has a Special Need AND Needs Behavioral Health Services?
You or your family member may have a special need such as a disability, chronic health conditions, HIV/AIDS, pregnancy, etc. Tell the Enrollment Specialist to connect you with the Enrollment Specialist's Special Needs Unit, if you or your family member has a special need.

How Do You Know if Behavioral Health Services are Needed?
If you or any of your family members are troubled by the following problems, you might need behavioral health services. Call your Behavioral Health Managed Care Organization if:

  • feeling hopeless, guilty, worthless, helpless, sad, or losing interest in activities, school, or work
  • having changes in sleep patterns, weight or appetite, feeling tired, irritable, less energetic, restless, having difficulty concentrating, remembering or making decisions
  • having great mood swings, much more energy, much less need for sleep, poor judgement
  • wanting or planning to hurt yourself or others
  • believing that behavior is being controlled by outside forces or that messages are being sent from strangers, radio, television, etc.
  • feeling over-concerned about death or hearing voices or seeing things that others do not see or hear or believing that others are plotting against you
  • feeling like you should cut down on your drinking or drug use or feeling bad or guilty about drinking or drug use or feeling bothered by people who criticize your drinking or drug use, or you are hiding your drinking
  • having blackouts or drinking or using drugs when waking up to steady nerves or to get rid of a hangover

If your child or teenager is troubled by the following problems call your Behavioral Health Managed Care Organization:

  • Feeling really sad and hopeless and the feelings don't go away, feeling angry, cries a lot, overreacts to things or feels worthless, guilty, anxious, or worries a lot, or is struggling with the loss of a loved one.
  • Has poor concentration, unable to sit still or focus attention, does much worse in school or loses interest in things usually enjoyed
  • Feels very fearful, has persistent nightmares, or feels life is too hard to handle, or considers suicide
  • Hears voices that can't be explained, has thoughts that race, needs to wash or perform routines many times throughout the day, avoids friends or family and wants to be alone all the time
  • Always worried about physical problems or appearance, eats large amounts of food then makes self vomit, abuses laxatives or takes enemas to avoid weight gain, or continues to diet and/or exercise although thin
  • Constantly violates the rights of others or breaks the law without regard for other people; does things that can be life threatening to self or others
  • Uses alcohol or other drugs

Special treatment and/or help to detox may be available for you or your family member if you use alcohol or other drugs and:

  • You are pregnant or have children at home who depend on you to care for them or
  • You are using a needle to inject drugs or
  • You are involved in the legal system because of drug or alcohol use
  • You had "DT's", seizures or convulsions from alcohol withdrawal now or in the past or
  • You are taking tranquilizers, nerve pills or sleeping pills even if prescribed by a doctor or
  • If you have any serious medical condition like diabetes (blood sugar problems), liver, kidney or heart problems.

What should You do in an Emergency?
An emergency is a physical or behavioral health problem that cannot wait for attention. Here are examples when you may be in danger with a behavioral health problem that cannot wait:

  • You have overdosed on drugs or alcohol
    You are about to hurt yourself or someone else
    You are having an allergic reaction to you medication. (Always ask your pharmacist and Primary Care Physician (PCP) about the medication you are taking so you will know what might be an allergic reaction.)

Call your Behavioral Health-Managed Care Organization or Crisis Intervention if you or your family member have a mental health or drug and alcohol problem.

If the problem is a physical problem, call your Primary Care Physician (PCP), 911, or go to the nearest emergency room.

What If You, or Your Teenager, or Child or Other Family Member Have A Problem With the Behavioral Health-Managed Care Organization?
People in HealthChoices have the right to complain when unhappy with the behavioral health plan. If you or a family member is unhappy with your Behavioral Health-Managed Care Organization, you can file a complaint with your health plan.

Complaints should be in writing. Write the word "complaint" at the top of the page. Your complaint should tell about your problem and how you want it fixed. You can write the complaint yourself or call your plan and file a complaint over the phone. Your plan must put your words in writing.

If your health plan has denied a service for you, your teenager, child or other family member or a service has been cut back or stopped; you can file a "grievance" with your health plan. Your health plan will review your grievance and give you a decision within 5 days.

If you believe that not getting the service could cause an emergency, file an expedited grievance with your health plan. The health plan will review your "expedited grievance" and must give you a decision within 24 hours.

If you, your teenager, child or other family member have been receiving services that are being cut, changed, or stopped and you file a grievance with your health plan or request a fair hearing with the Department of Public Welfare (DPW) within 10 days from the date of your written denial or written reduction letter, the services can continue.

You can file a grievance with your health plan and request a fair hearing with the Department of Public Welfare (DPW) at the same time. To ask for a fair hearing, send a letter to:

Department of Public Welfare
Office of Mental Health & Substance Abuse Services
Division of Grievance and Appeals
PO Box 2675
Harrisburg, PA 17105

If you need legal help, concerning grievances or complaints, please call or write:

Pennsylvania Health Law Project
650 Smithfield Street, Suite 2330
Pittsburgh, PA 15222

When you and your family are in HealthChoices, you must choose a Physical Health-Managed Care Organization (PH-MCO) and a Primary Care Physician (PCP) in the HealthChoices network. They will give you most of your care. The independent enrollment specialist has information about doctors, specialists and hospitals available in each Physical Health-Managed Care Organization

The Enrollment Specialist can help by giving you the information you need to choose a plan that is best for you and your family.

When you and your family enroll in the Physical Health-Managed Care Organization (PH-MCO) you are also enrolled into a Behavioral Health-Managed Care Organization in the county where you live.

Remember, to enroll in a Physical Health MCO, call the free HealthChoices hotline at 1-800-485-5998. TDD/TTY users call, 1-800-250-5352.

More Help for You and Your Family
To learn more about behavioral health care services and get help for you and your family, call:

Alliance for the Mentally Ill of Pennsylvania (AMI)

Pennsylvania Mental Health Consumers' Association (PMHCA)
1-800-887-6422 (web site: www.epix.net/~pmhca)

Parents Involved network of Pennsylvania (PIN)
1-800-688-4226 (e-mail: pin@mhasp.org)

Western Pennsylvania Coalition for Children's Advocacy (WPCCA)
1-888-811-9477 (web site: www.wpcca.org)

Your phone book has numbers for other helpful services. You can call the county Mental Health and Mental Retardation Office, vocational rehabilitation office, local Alcoholics Anonymous (AA) group, Narcotics Anonymous (NA) group, local Consumer Satisfaction Team and the Mental Health Association. If you are older or take care of an older person, call the Area Agency on Aging to learn about other help. Your Behavioral Health-Managed Care Organization can give you these phone numbers also.

Sponsored by:
Commonwealth of Pennsylvania
Department of Public Welfare
Office of Mental Health and Substance Abuse Services
Tom Ridge, Governor
Feather Houstoun, Secretary
Charles Curie, Deputy Secretary

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