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HealthChoices Changes for Children in Substitute Care
July 7, 2009

Effective August 1, the Office of Mental Health and Substance Abuse Services (OMHSAS) is making changes to HealthChoices behavioral health contracts regarding Children in Substitute Care (CISC). Children placed in a foster care home, shelter, or group home will no longer revert to the Fee-for-Service system.  They will remain the payment responsibility of the behavioral health managed care organization (BH-MCO) from the placing county for services.  Providers of in-plan or supplemental services (outpatient, partial, behavioral health rehabilitation services, residential treatment, and psychiatric inpatient) that serve a significant number of CISC from outside of the HealthChoices zone where the county children and youth agency responsible for the child is located, may need to be credentialed by all applicable BH-MCOs. 

Because it may not be feasible for providers that serve only a few children outside of their HealthChoices zone to become a network provider it may be advisable for services to be delivered as an “out of network provider.”  Providers should explore this option with the appropriate BH-MCO.  As previously reported, OMHSAS will require the BH-MCOs to review medical necessity criteria and determine authorization for drug and alcohol non-hospital detoxification and residential rehabilitation services for CISC, regardless of whether the provider is located within or outside of the member’s HealthChoices zone. Questions regarding this change may be directed to the following individuals in OMHSAS field offices:

Harrisburg Field Office                           
Ms. Julie Barley, Manager  
717-705-3895 

Norristown Field Office
Ms. Thomasina Bouknight, Manager
610-313-5844

Pittsburgh Field Office
Ms. Valerie Vicari, Manager
412- 565-5226

Scranton Field Office
Mr. Michael Orr, Manager
570-963-3040

 

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