Behavioral Health Provider Stakeholder HPA GA Assignment

To: Behavioral Health Providers and Stakeholders
From: Dennis Marion, Deputy Secretary, OMHSAS
Subject: General Assistance recipients assigned to the Healthy PA Private Coverage Option (PCO)
coverage on and after Jan. 1, 2015
Date: January 9, 2015
The issue:
Individuals who received state-funded Medical Assistance (MA) coverage under the GA category during
2014 and were determined eligible for coverage under the new Healthy PA federal Medicaid eligibility
standards starting on January 1, 2015 were matched to one of two newly defined benefit plans under
Healthy PA: Healthy PA PCO or Healthy Plus.
• Individuals with various qualifying physical or behavioral health care needs are considered
medically frail and were assigned to the Healthy Plus benefit package. This was determined
based on available claims data and/or completion of the health screening tool.
• Individuals who were not identified as having qualifying health needs were assigned to the
Healthy PA PCO.
How was the benefit plan determination made?
• In October, DHS conducted an electronic search of two years of MA claims data. The DHS
objective was to identify individuals who met the medically frail criteria to qualify for the
Healthy Plus (high risk) benefit plan delivered by their existing HealthChoices Managed Care
Organization (MCO).
• In November, all GA recipients, who were not identified as being medically frail based on
available claims data, were invited to complete a voluntary screening process if they believed
they had complex health care needs. The supplied information was used to help match each
individual to the appropriate benefit plan.
How were the recipients notified of their benefit plan?
• In December, DHS sent a notice to GA recipients at their mailing address contained in their
eligibility record indicating the determination of eligibility for the new federally-funded Healthy
PA program and which benefit plan they would be receiving as of January 1, 2015.
• Individuals had 30 days to appeal this notice.
• If the individuals who were to be placed into the Healthy PA PCO benefit plan appealed this
decision within the first 10 days, they remained in HealthChoices and received the same benefits
they did prior to January 1, 2015.
In December, behavioral health providers, Behavioral Health Managed Care Organizations (BH-MCOs)
and others began to identify individuals who were active in behavioral health treatment during 2014,
but were slated for transfer to Healthy PA PCO coverage.
DHS found that factors, including the timing of available claims data, prevented some individuals from
being matched to the Healthy Plus benefit plan through the initial electronic searches.
Office of Mental Health and Substance Abuse Services
P.O. Box 2675 | Harrisburg, PA 17105 | 717.787.6443 | www.dhs.state.pa.us
What is DHS doing to address this?
DHS is working with the BH-MCOs and county behavioral health programs to prevent interruption of
service for these eligible individuals.
• DHS requested and received additional information from Single County Drug and Alcohol
Authorities (SCAs) and BH-MCOs to identify other GA recipients that should be reviewed for
enrollment in the Healthy Plus benefit plan.
• As previously stated, DHS will shift these newly identified medically frail GA recipients from
Healthy PA PCO to Healthy Plus benefit plan delivered through HealthChoices.
• DHS is resetting the plan enrollment for each identified eligible individual from Healthy PA PCO
to the HealthChoices Healthy Plus benefit plan with an effective date of January 1, 2015.
o This process is underway for already identified cases and changes for these individuals
will be completed by January 30.
o This special review process is limited to eligible GA cases that were in behavioral health
care during 2014 and were assigned to Healthy PA PCO coverage as of January 1, 2015.
Information regarding any additional cases for review must be submitted to DHS by
January 16.
Thank you for your cooperation and patience. DHS is committed to assisting these individuals and will
provide you with updates accordingly.
For more information please contact the OMHSAS Administrative Office at 717-787-6443.

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