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PA Bulletin, Doc. No. 13-478

NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Ongoing List of Behavioral Health Managed Care Organizations

[43 Pa.B. 1533]
[Saturday, March 16, 2013]

 The Department of Public Welfare (Department) is maintaining an ongoing list of qualified behavioral health managed care organizations (BH-MCO) as potential contractors for the HealthChoices Behavioral Health Program (HC-BHP). New submissions are being requested from BH-MCOs which are currently on the list and new applicants. 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. The HC-BHP is a mandatory managed care program for Medicaid recipients in this Commonwealth. Additional information about HC-BHP is available at the Department's web site www.dpw.state.pa.us. The list of qualified BH-MCOs may be utilized in the following circumstances:

 * Contract negotiations with a potential contractor selected through a Request for Proposal (RFP) process fails.

 * A potential contractor selected through an RFP process fails the Readiness Review process.

 * An existing contractor terminates the contract or is terminated by the Department.

 * An existing contract will expire with no provision for renewal or extension.

 As stated at 31 Pa.B. 888, the list of qualified BH-MCOs will be opened periodically to new submissions which are not currently on the list. BH-MCOs selected for the list of qualified bidders will remain active on the list for at least 5 years. Periodically they will be required to resubmit information for consideration to remain on the list.

 The following is a list of requirements necessary to qualify as a potential HC-BHP contractor:

 * One year 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 Department of Health and the Insurance Department.

 * Management Information System (MIS) experience in processing Health Insurance Portability and Accountability Act (HIPAA) compliant transactions.

 To apply as a potential HC-BHP contractor, submit four copies and a disk of the following information by 2 p.m. on May 3, 2013, to the Department of Public Welfare, Attention Daniel Boyd, Division of Procurement, Health and Welfare Building, 625 Forster Street, Room 402, Harrisburg, PA 17105.

List of Deliverables

 1. Cover letter of interest on official corporate letterhead.

 2. Describe experience in providing services to Medicaid recipients including:

 * Type of behavioral health (mental health and drug and alcohol) services covered.

 * Description of categories of aid/population covered.

 * Number of years experience with Medicaid programs.

 3. Provide a report on 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.

 4. Provide a flow chart of the MIS.

 5. Provide evidence of capacity to submit HIPAA compliant transactions.

 6. Provide a copy of current Commonwealth license from the Department of Health and the Insurance Department.

 7. Provide a copy of the most recent audited, annual filing with a state insurance department.

 8. Provide a copy of the most recent annual audited company financial statement.

 9. Outline a plan to start-up or expand (if currently operating in this Commonwealth) operations in this Commonwealth.

 10. Provide the name, address and phone number of three references familiar with the MCOs operations (one must provide reference from a State Medicaid program).

 Department staff will verify the information submitted by the BH-MCOs. As part of the verification process, the Department may conduct an onsite visit. Each BH-MCO will be notified of its qualification status.

 The second step of the 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 HC-BHP contract.

 * Inform the vendors of the county or counties requiring a BH-MCO contractor.

 * Release a procurement document that contains the requirements for the HC-BHP to the interested vendors on the list along with instructions on how to submit a bid.

 * Evaluate all responses to the procurement document and select a contractor.

 The previous two-step process will not replace the RFP process to obtain a HC-BHP contract in the Commonwealth. Questions should be directed to Valerie J. Vicari, Director, Division of Western Operations, Bureau of Community and Hospital Operations, Office of Mental Health and Substance Abuse Services, 301 Fifth Avenue, Room 480, Pittsburgh, PA 15222-2420, (412) 565-5226, fax (412) 565-5393.

 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 users) or (800) 654-5984 (voice users).

BEVERLY MACKERETH, 
Acting Secretary

[Pa.B. Doc. No. 13-478. Filed for public inspection March 15, 2013, 9:00 a.m.]


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