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OMHSAS Announces Behavioral Health Managed Care Expansion
January 10, 2006

The Office of Mental Health and Substance Abuse Services (OMHSAS) has announced that managed care for behavioral health will be expanded across the remainder of the commonwealth. The need for behavioral health managed care expansion was raised repeatedly during the recent Governor’s Listening Tour sessions across the state and the administration has responded. A request for proposals (RFP) will be issued by the end of January for two zones, eastern and western, covering 35 counties. Successful bidders will contract directly with the commonwealth similar to the model that exists in Greene County. Two vendors are to be selected; one for each of the two zones. The same vendor will not be selected to operate in both zones. The successful regional vendors must agree to capitation payment delay for a two month period. Payments to providers are not to be delayed. The goal is to increase access to services and supports while maintaining financial stability. The projected implementation date is January 2007.

Guiding principles for the HealthChoices expansion include maintaining the carve out of behavioral health services; development of unified systems; increasing the availability of alternative services; fostering county interaction; local control and oversight by counties, families, and consumers; funding for Consumer/Family Satisfaction Teams and the management structure for oversight; and return of reinvestment dollars to counties. Consumers and county representatives are to be involved on the vendor evaluation teams. PCPA will strive to have providers included in the vendor selection process.

Three counties have indicated their intent to remain separate and move forward with individual contracts. These are Blair, Cambria, and Erie counties. The vendor(s) selected for these counties would be eligible for selection for either of the larger regions noted above. Although county right of first opportunity is the preference of OMHSAS, the timeline does not permit this practice for all counties; therefore the regional approach will be used. The original contract will be for 18 months and then may be extended for five years. After the five-year period the right of first opportunity could be reconsidered. A threshold of approximately 50,000 Medical Assistance recipients per area is preferred, which would require grouping of rural counties.

Please contact Betty Simmonds with questions.

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