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OMHSAS Clarifies Psych Rehab Licensure Requirement in HealthChoices
July 24, 2002

Several PCPA members identified confusion regarding which psychiatric rehabilitation programs must be licensed. Specifically, psychiatric rehabilitation programs (PRS) in HealthChoices counties who are not using HealthChoices dollars were unclear about whether or not they need to be licensed.

In a memo dated January 17, 2002, Laurie Michtich of the Office of Mental Health and Substance Abuse Services stated that "PRS providers that operate in non-HealthChoices counties or in HealthChoices counties using base dollars only, need not be licensed."

As stated in the memo, psychiatric rehabilitation programs in HealthChoices counties, who are not using HealthChoices (Medical Assistance) funding for these services, are not required to be licensed.

The text of the January 17 memo is below. For more information, contact Rebecca May at the Association.

Commonwealth of Pennsylvania
Office of Mental Health & Substance Abuse
January 17, 2002

SUBJECT: Psychiatric Rehabilitation Services (PRS) in Pennsylvania

TO: County MH/MR Administrators, HealthChoices Behavioral Health Contractors, HealthChoices Managed Care Organizations

FROM: Laurie Michtich, Chief, Medicaid Operations Section

This letter is to update you on the Departments plans to incorporate licensing of Psychiatric Rehabilitation Services. In addition, this memo will address the additional requirements associated with PRS as they relate to provider enrollment and service delivery effective January 1, 2002 as listed in the PRS in Pennsylvania memo dated July 20, 2001. Please note that PRS providers scheduled to be closed 12/31/01 as listed in the memo of July 20,2001 have not closed. The date has been extended to 4/30/02.

The Office of Mental Health and Substance Abuse Services (OMHSAS) has invested many years in planning for the implementation of PRS in HealthChoices.

Since the State Budget cut on November 1,2001, PRS will not be required in HealthChoices in 2002. OMHSAS field offices were in the process of conducting site visits in the Southeast and Southwest zones to prepare providers for implementation and licensure when the budget cut occurred. OMHSAS continues to encourage counties to develop PRS services through alternative funding sources and will continue to offer assistance to those counties and providers that wish, to proceed with development of PRS.

OMHSAS executive staff has approved a plan to move forward with PRS as follows:

  • Licensure will be required when a provider intends to develop or continue PRS under HealthChoices (Provider 80) or is using reinvestment dollars.
  • Agencies who are unable to meet the requirements for PRS licensure due to programmatic or financial reasons will be permitted to enroll, under the Provider 80 category of "MH Other' if counties and BH-MCOs, wish to contract with them.
  • Any agency that voluntarily requests to be licensed as a PRS provider may be licensed if they meet the standards.
  • PRS providers that operate in non-HealthChoices counties or in HealthChoices counties using base dollars only, need not be licensed.
  • OMHSAS regional field office staff utilizing the Psychiatric Rehabilitation Survey Tool will conduct licensure site surveys. Licensing requirements will be according to the Psychiatric Rehabilitation Medical Necessity Criteria and Standards (2nd Edition).
  • Provider 80 closure dates will be extended to April 30, 2002. This will allow providers to remain open, to receive authorizations for service and to bill until licensure site visits occur. Please refer to the attached memo, Psychiatric Rehabilitation Services in Pennsylvania dated July 20, 2001.

Since providers may have relationships with more than one county and may have relationships for both CCR-POMS and HealthChoices funding it is important that everyone ensure that notification has been made. Therefore, each county is asked to ensure that all psychiatric rehabilitation providers with whom they are doing business are appropriately identified. When a managed care organization services more than one county proof of credentialing should be available to every county intending to utilize the services of each provider.

If you have any questions, please contact the Behavioral Health Services Hotline at 800-433-4459. Thank you.

Enclosures

cc: Psychiatric Rehabilitation Providers (as listed)
Jean Foltz/Linda Zelch
Carol Ward-Colasante
Celeste Casby
Lisa Page/Wanda Balmer

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