Policy Areas

RCPA has become aware that there have been higher than normal claims denials by both Medicare and Medicaid related to certain diagnoses. Those diagnoses are Schizophrenia and Post Traumatic Stress Disorder (PTSD) as defined by the DSM-V and ICD-10.

The DSM-V only identifies Schizophrenia Not Otherwise Specified (NOS) and PTSD NOS, versus the ICD-10 which offers eight schizophrenia diagnoses and three PTSD diagnoses. As a result, our practitioners are likely choosing Schizophrenia or PTSD NOS, since they are mostly using the DSM-V. Billing staff have options of eight or three diagnoses respectively, but will use what the practitioner has selected, the only DSM-V diagnosis available. It is highly probable that the individual being evaluated meets something other than NOS. There are very specific criteria for the NOS diagnosis which can certainly be used as the criteria is met, but when the criteria is not met, the claims are accurately denied. RCPA wants to hear from you about how this is affecting your business.

The second billing issue is related to electronic health records (EHR) that have not yet loaded the ICD-10 codes for billing. It is our understanding that there are at least two vendors doing business in Pennsylvania who have not loaded the ICD-10 billing codes into the EHR. RCPA wants to hear from members about how they are billing in the absence of the EHR, not having the ICD codes, and other universal billing concerns.

Please find more information about claims rejections here. Send comments to Sarah Eyster by Friday, April 15.

The Department of Human Services (DHS) has announced the selection of 16 locations to participate in the Certified Community Behavioral Health Clinic (CCBHC) planning grant. The federal grant encourages states to adopt innovative approaches to community-based behavioral health services.

This initiative will further the Wolf Administration’s goal of improving the delivery of care for behavioral health and substance use treatment in the community where people live, providing Pennsylvanians with easier and more consistent access to the services they need. In an effort to provide CCBHC access to all affected Pennsylvanians, the 16 locations are comprised of both rural and urban locations throughout the state.

The federal Excellence in Mental Health Act established the CCBHCs as a way to improve quality and use evidenced-based practices in behavioral health.

The CCBHCs will provide nine core services:

  • Crisis services;
  • Targeted case management;
  • Outpatient mental health and substance abuse services;
  • Patient-centered treatment planning;
  • Screening, assessment, and diagnosis;
  • Psychiatric rehabilitation services;
  • Peer and family support;
  • Care for veterans and members of the military; and
  • Outpatient primary care screening and monitoring.

The following clinics were selected:

  • Berks Counseling Center, Berks
  • Cen Clear Child Services, Clearfield
  • Cen Clear Child Services, Jefferson
  • Cen Clear Child Services, Blair
  • Community Council Mental Health and Mental Retardation, Philadelphia
  • Community Counseling Center of Mercer County, Mercer
  • Community Guidance Center, Clearfield
  • Creative Health Services, Montgomery
  • Kidspeace, Monroe
  • NHS Delaware County, Delaware
  • Northeast Treatment Centers, Philadelphia
  • Pittsburgh Mercy, Allegheny
  • Public Health Management Corporation, Philadelphia
  • Resources for Human Development, Philadelphia
  • Safe Harbor, Erie
  • The Guidance Center, McKean

As part of being selected as a CCBHC, the CCBHC Assessment and Readiness Review webinar is taking place on Friday, April 8 at 9:00 am. You are welcome to join DHS in person in the Clothestree Conference Room. To join via webinar, please register using this link. Once registered, you will receive a confirmation email with your connection link. Please note, this link will be unique to you and should not be shared with others.

RCPA, through the National Council, will be offering support to all selected CCBHCs. In addition, all selected CCBHCs are welcome to attend a monthly nationwide call with National Council and state leaders. More information will be available later this week.

RCPA congratulates all selected CCBHC providers. Please contact Sarah Eyster for more information.

Pennsylvania is the first state to name April “Autism Acceptance Month.”
As autism awareness continues to grow, Pennsylvania is taking a step forward in the education and inclusion of individuals with autism, as Governor Tom Wolf proclaims April “Autism Acceptance Month.” Pennsylvania is one of the first states in the country to change from “awareness” to “acceptance.” This furthers the work of many families and self-advocates who have expressed the importance of moving from simply raising awareness about autism, to also include, better understand, and accept individuals with autism into full participation in community life.

Data Seminars: Developing, Collecting, and Analyzing
This is a free, statewide training opportunity for professionals who implement autism intervention support plans, collect and develop data tools, analyze data, and make instructional decisions. These seminars will be held across the state at various locations and facilitated by Bureau of Autism Services (BAS) clinical staff. More information and how to register is available on the BAS website.

The Department of Human Services (DHS) Office of Long-Term Living (OLTL) will be submitting amendments to the Aging, Attendant Care, and Independence waivers. The public notice announcing the amendments will appear in the April 2, 2016 Pennsylvania Bulletin.

To view a side-by-side comparison of the current and revised language, and to access the amendments in their entirety (including specific HCBS Allowable Settings Transition Plans and the Community HealthChoices Transition Plans for each waiver, contained in the Main Module), visit the OLTL Waiver Amendment, Renewals, and Accompanying HCBS Transition Plans website and select the individual waiver amendment you would like to review under “Related Topics.”

OLTL is seeking public comment on the Aging, Attendant Care, and Independence waiver amendments. Those interested are invited to submit written comments to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Aging Waiver, Independence Waiver, or Attendant Care Waiver, PO Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email, using the comment form link. On this site, select the individual waiver amendment you would like to view under “Related Topics” and the comment form will be listed in the documents.

The public comment period ends on Monday, May 2, 2016. Comments received within the 30-day comment period will be reviewed and considered for revisions to the amendments.

OLTL will offer two webinars in April for public input and discussion:

Aging, Attendant Care, and Independence Waiver Changes Webinar
Wednesday, April 13, 2:00 – 3:00 pm

Aging, Attendant Care, and Independence Waiver Changes Webinar
Tuesday, April 19, 10:00 – 11:00 am