RCPA - Rehabilitation and Community Providers Association


OMHSAS Releases Managed Care Expansion Plan
January 13, 2006

The Office of Mental Health and Substance Abuse Services (OMHSAS) has released Implementing the Behavioral Health Carve-out Statewide Managed Care Options Paper, its plan for behavioral health managed care expansion across the commonwealth. This paper describes more fully the information noted in PCPA’s January 10 Info. The options paper clarifies that the implementation date for the four-county northeast region is July 1. Blair, Cambria, and Erie counties – if they continue to move forward with the county right of first opportunity – are scheduled for implementation July 1, 2007. Implementation for the remainder of the commonwealth is January 1, 2007.

The request for proposals (RFP) for Blair, Cambria, and Erie is to be issued by the end of June and for the two zones (east central and west central) that include the remaining 35 counties, by mid-February. Current requirements of the HealthChoices Program Standards and Requirements document and contract would remain applicable for Blair, Cambria, and Erie, as well as for the newest zones in a manner similar to the Greene County contract. In addition, the new contract would include a risk corridor through which counties and the Department of Public Welfare would share risk for the first two years of the contract. The counties must also agree to a two-month capitation payment delay.

OMHSAS may consider the county right of first opportunity in future contracts. Each county or county grouping would need a minimum coverage of 40,000 individuals in order to establish a contract. This opportunity could occur eighteen months before the end of the five-year contract period. If current county or affiliation contracts change resulting in less than 40,000 covered individuals in the contract, the county or affiliation would be added to the direct behavioral health managed care contract or one of the existing multi-county groupings.

OMHSAS intends to use its advisory committee structure and the Medical Assistance Advisory Committee as conduits for feedback on the expansion plan in addition to meeting with the counties to solicit input. Local educational sessions are planned prior to implementation. Counties and the selected managed care vendors will identify local stakeholders to participate in oversight activities.

Please contact Betty Simmonds with questions.

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