NOTICES
DEPARTMENT OF
PUBLIC WELFARE
List of Behavioral Health Managed Care Organizations
[39 Pa.B. 6703]
[Saturday, November 21, 2009]The Department of Public Welfare (Department) maintains an ongoing list of qualified behavioral health managed care organizations (BH-MCOs) as potential contractors for the HealthChoices Behavioral Health Program (HCBHP), a mandatory managed care program for Medicaid recipients in this Commonwealth. New submissions are currently being requested from managed care organizations (MCOs) which are not currently on the list. The development of this list was introduced at 31 Pa.B. 888 (February 10, 2001) as the first step in a two-step process for obtaining a behavioral health contractor, should the need arise.
Additional information about HCBHP is available at the Department's web site: http://www.dpw.state.pa.us/PartnersProviders/MentalHealthSubstanceAbuse/00368 0389.htm.
The list of qualified BH-MCOs would be utilized in the following circumstances:
• Contract negotiations with a potential contractor selected through a Request for Proposal (RFP) process fail.
• A potential contractor selected through the RFP process fails the Readiness Review.
• An existing contractor terminates the contract or is terminated by the Department.
As stated at 31 Pa.B. 888, the qualified BH-MCO list will be opened periodically to new submissions. MCOs selected for the list of qualified bidders will remain active on the list for at least 5 years. Qualified MCOs will be periodically required to resubmit information for consideration to remain on the list.
The following is a list of requirements necessary to qualify as a potential HCBHP contractor:
• Experience with a State Behavioral Health Medicaid Program.
• Not currently under suspension or debarment by the Commonwealth or any other state or Federal Government.
• Licensed by the Departments of Health and Insurance of this Commonwealth.
• Management Information System (MIS) experience in processing HIPAA compliant 837 files.
To apply as a potential HCBHP contractor, submit a letter of interest on official corporate letterhead, as well as the required deliverables detailed, by December 21, 2009, to Mike Root, Office of Mental Health and Substance Abuse Services, Room 238, Beechmont Building, DGS Annex Complex, Harrisburg, PA 17110. You may also fax this request to (717) 772-7964.
List of Deliverables:
1. Describe any experience in providing services to Medicaid recipients, including:
• Type of behavioral health (mental health and drug and alcohol) services covered.
• Description of all categories of aid and populations covered.
• Number of years experience with Medicaid programs.
2. Provide a report detailing the number of claims processed (for Medicaid population) in the most recent 6-month period, including timeliness of processing clean claims and the number of claims paid/rejected.
3. Provide a flow chart of the MIS.
4. Provide verification of capacity to submit HIPAA compliant 837 files.
5. Provide a copy of current licenses from both the Departments of Health and Insurance of this Commonwealth.
6. Provide a copy of the most recent audited, annual filing with the State Insurance Department.
7. Provide a copy of the most recent audited, annual company financial statement.
8. Outline a plan to start up or expand (if currently operating in this Commonwealth) operations in this Commonwealth.
9. Provide the name, address and phone number of three references familiar with the MCO's operations. (Must provide one reference from a State Medicaid program.)
Department staff will verify the information submitted by the MCOs. As part of the verification process, the Department may conduct an onsite visit. Each MCO will be notified of its qualification status.
The following process is outlined in the event that the list is utilized to obtain a contractor. The Department will:
• Contact the vendors on the list and verify their continued interest in obtaining a HCBHP contract.
• Inform the vendors of the county or counties requiring a BH-MCO contractor.
• Release a procurement document to the interested vendors on the list containing the HCBHP requirements along with instructions on how to submit a bid.
• Evaluate all responses to the procurement document and select a contractor.
Questions should be directed to Ray Klabe, Office of Mental Health and Substance Abuse Services, Room 241, Beechmont Building, DGS Annex Complex, Harrisburg, PA 17110, (717) 772-7928, fax: (717) 772-7964.
Persons with a disability who require an auxiliary aid or service should submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD).
ESTELLE B. RICHMAN,
Secretary
[Pa.B. Doc. No. 09-2156. Filed for public inspection November 20, 2009, 9:00 a.m.]
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