[52 Pa.B. 4497]
[Saturday, August 6, 2022]
[Continued from previous Web Page] Office of Policy
GUIDANCE MANUALS:
• Provider Handbook—Physician—updated 09/2021
• Provider Handbook—Dentist—updated 07/2021
• Provider Handbook—Podiatrist—updated 09/2021
• Provider Handbook—Medical Supplier—updated 09/2021
• Provider Handbook—Short Procedure Unit/Ambulatory Surgical Center—updated 10/2017
• Provider Handbook—Chiropractor—updated 09/2021
• Provider Handbook—Birth Centers—updated 09/2021
• Provider Handbook—Independent Medical/Surgical Clinic—updated 10/2017
• Provider Handbook—Inpatient Hospital (Encompasses provider types General Hospital, Rehabilitation Hospital, Private Mental Hospital, State Mental Hospital and Extended Acute Psychiatric Care—updated 10/2017
• Provider Handbook—Outpatient Hospital (Encompasses provider types General Hospital, and Rehabilitation Hospital)—updated 10/2017
• Provider Handbook—Optometrist—updated 09/2021
• Provider Handbook—Independent Laboratory—updated 09/2021
• Provider Handbook—Ambulance Company—updated 09/2021
• Provider Handbook—Pharmacy—updated 09/2021
• Provider Handbook—Renal Dialysis Center—updated 09/2021
• Provider Handbook—Funeral Director—updated 09/2021
• Provider Handbook—Home Health Agency—updated 09/2021
• Provider Handbook—Rural Health Clinic—Federally Qualified Health Center—updated 09/2021
• Provider Handbook—Drug and Alcohol Clinic—updated 09/2021
• Provider Handbook—Outpatient Psychiatric Clinic—updated 10/2017
• Provider Handbook—Family Planning Clinic—updated 09/2021
• Provider Handbook—Midwives—updated 09/2021
• Provider Handbook—Psychiatric Partial Hospitalization Facility—updated 10/2017
• Provider Handbook—Hospice—updated 09/2021
• Provider Handbook—Psychologist—updated 09/2021
• Provider Handbook—Comprehensive Outpatient Rehabilitation Facility—updated 10/2017
• Provider Handbook—Physical Therapist—updated 10/2017
• Provider Handbook—Certified RN Anesthetist—updated 09/2021
• Provider Handbook—Certified RN Practitioner—updated 09/2021
• Provider Handbook—Early Periodic Screening, Diagnosis and Treatment (EPSDT) Provider—updated 09/2021
• Provider Handbook—Nutritionist—updated 09/2021
• Provider Handbook—PA Department of Aging (PDA) Waiver—updated 10/2017
• Provider Handbook—COMMCARE Waiver—updated 09/2021
• Medical Assistance Transportation Program—Standards and Guidelines—updated 11/2016PROVIDER QUICK TIPS
• # 11: The Eligibility Verification System (EVS) (Updated November 7, 2019)
• # 85: Department of Human Services (DHS) Breast and Cervical Cancer Prevention and Treatment Program (updated February 2021)
• # 121: Certificate Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (Updated March 4, 2022)
• # 176: Presumptive Eligibility for Pregnant Women—Income Limits (Updated February 2021)
• # 207: MA Program Fee Schedule Updates for Act 62 Procedure Codes (Updated May 26, 2020)
• # 223: Availability of the Provider Directory on the Department of Human Services Website—June 20, 2019
• # 225: The Auditor General is conducting performance audits—March 2020
• # 226: Version 37 of all Patient Refined-Diagnosis Related Group (APR DRG) Implementation—March 2020
• # 227: Provider Enrollment Updating Documentation Requirements—March 2020
• # 228: ICD-10-CM Official Coding Guidelines Related to COVID-19—March 2020
• # 229: Telemedicine Guidelines Related to COVID-19—March 2020
• # 230: COVID-19 Response: Pharmacies May Override Early Refill Alerts for Medications—April 7, 2020
• # 231: Directions to bypass the prior authorization requirements for CT Scans of the Chest for COVID-19 patients—March 2020
• # 232: Billing Guidance for Alternative Screening Sites Related to COVID-19—Updated June 23, 2021
• # 233: Waiver of Prudent Pay during COVID-19 emergency—March 20, 2020
• # 234: New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19) Effective April 1, 2020—March 2020
• # 235: Elective Services should not be provided during the COVID-19 emergency disaster—March 2020
• # 236: Hydroxychloroquine Quantity Limits—April 1, 2020
• # 237: Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics—Updated June 23, 2021
• # 238: 90-Day Supplies of Medications—COVID-19—April 7,2020
• # 239: Short-Acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List—April 7, 2020
• # 240: Provider enrollment and revalidation changes during the COVID-19 emergency—April 9, 2020
• # 241: Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID-19 Emergency Disaster—May 7, 2020
• # 242: Telemedicine Guidelines Related to COVID-19—April 20, 2020
• # 243: Use of the CR Modifier and DR Condition Code for COVID-19 Disaster/Emergency Related Claims—April 16, 2020
• # 244: MA Eligibility During COVID-19 Emergency Disaster Declaration - Updated June 23, 2021
• # 245: All Patient Refined-Diagnosis Related Group (APR-DRG) to be Updated with COVID-19 Billing Codes—April 30, 2020
• # 246: Rescinding Prior Guidance on Elective Services—May 7, 2020
• # 247: Nonemergency Ambulance Transportation Related to COVID-19—Updated June 23, 2021
• # 248: DexCom Continuous Glucose Monitoring Products Coverage—May 19, 2020
• # 249: New MA ACCESS Card—June 24, 2020
• # 250: Version 37.1 of All Patient Refined-Diagnosis Related Group (APR-DRG) Implementation (Updated August 14, 2020)
• # 251: Medical Assistance Beneficiaries Turning 21 during the COVID-19 Emergency—July 29, 2020
• # 252: Medical Assistance Beneficiaries Turning 21 during the COVID-19 Emergency—January 25, 2021
• # 255: Provider Revalidation Requirements—September 21, 2021
• # 256: Procedure Code/Modifier Combinations to be Utilized when Requesting Home Accessibility Durable Medical Equipment (DME) in the Fee-for-Service Delivery System—September 28, 2021
• # 257: Medicare Sequestration Payment Reductions on All Claims Media Fee-for-Service (FFS) Claims Reinstated—March 30, 2022
• # 259: Documentation for Shift Nursing (SN) and Home Health Aide (HHA) Prior Authorization and Program Exception Requests in the Fee-for-Service (FFS) Delivery System—April 15, 2022OTHER:
• PA 67 Section 1915(b) Waiver
OTHER COVID-19 GUIDANCE:
• Medical Assistance (MA) Program Coverage of 2019-Novel Coronavirus Testing and Related Services Frequently Asked Questions (FAQs)—March 24, 2020
Children's Health Insurance Program Contact: J. Diane Brannon-Nordtomme (717) 585-6482
POLICY TRANSMITTALS:
Year Subject Effective Date Transmittal Number 2012 Release of CHIP Policy and Procedures Manual 10/20/2012 2012-06 2012 Discontinuance of Act 68 Quarterly Complaints and Grievances Reports (Medical and Behavioral Health/Substance Abuse); Options for Review Process 12/31/2012 2012-07 2013 Revised CHIP Policy and Procedures Manual—Chapter 37.2: Benefits Package 02/05/2013 2013-01 2013 HIPAA Breach Reports 01/17/2013 2013-02 2013 Aetna Discontinuance in 18 Counties 01/17/2013 2013-04 2013 Exhausted Dental and Orthodontia Benefits Reporting CY2013 01/01/2013 2013-05 2013 834 Monthly Audit/Compare File 03/01/2013 2013-06 2013 Internal Cross Match 03/01/2013 2013-07 2013 Revised Letter to Physician (Appendix 19E) 02/27/2013 2013-09 2013 CHIP and Adult Basic Notice of Privacy Practices 09/16/2013 2013-11 2013 Elimination of the Uninsured Period 10/23/2013 2013-13 2014 Incomplete Applications for Children's Tax Filing Status 02/18/2014 2014-01 2014 Instructions for Processing Federally-Facilitated Marketplace (FFM) Referrals 02/21/2014 2014-03 2014 CHIP Policy & Procedure Manual Updates 04/08/2014 2014-05 2014 Changes to the Prospective Payment System (PPS) 05/12/2014 2014-07 2014 Revised CHIP Policy and Procedures Manual—Chapters 39 and 40 Contact Information 05/30/2014 2014-08 2014 HIPAA Breach Reports 06/12/2014 2014-09 2014 Discontinuance of Submission of Quarterly Pharmacy Data 06/12/2014 2014-10 2014 Discontinuance of 834 Monthly Audit/Compare File 11/17/2014 2014-12 2014 Discontinuance of the Monthly Internal Cross Match Report 11/17/2014 2014-13 2015 HIPAA Breach Reports 02/02/2015 2015-02 2015 Changes to CHIP Application and Renewal Notices 02/26/2015 2015-04 2015 Compliance with Utilization Review Methodology of Act 106 of 1989 07/01/2015 2015-05 2015 Handling Service Limits on Children Moving To/From At-Cost CHIP 07/01/2015 2015-06 2015 Contractor Compliance 08/04/2015 2015-07 2015 Revised Letter to Physician (Appendix 19E) 02/27/2015 2015-08 2015 Including Minimal Essential Coverage Benefits to Free and Low-Cost CHIP 08/28/2015 2015-09 2015 Transformed Medicaid Statistical Information System (TMSIS) 10/13/2015 2015-10 2015 Extended Dental Benefits and Orthodontia Reporting Stated in CY 2012 11/01/2015 2015-12 2016 CHIP PPS Monthly Reporting Requirements 03/15/2016 2016-01 2016 2016 CHIP Routine Reporting Requirements 03/18/2016 2016-02 2016 Changes to COMPASS and HealthCare Handshake Routing Rules 06/27/2016 2016-03 2016 Monthly HEDIS Measures 06/20/2016 2016-04 2016 Federal Final Rule Nondiscriminatory 07/18/2016 2016-05 2016 Application Form Revisions (English and Spanish Versions) 09/08/2016 2016-06 2016 Federal Final Rule ''Notice of Nondiscrimination and Taglines'' 11/08/2016 2016-07 2016 Salzmann Index 11/23/2016 2016-08 2016 Healthcare Effectiveness Data and Information Set (HEDIS®) 2017 and the Consumer Assessment of Health Plans Survey (CAHPS)® 2017 Survey 01/12/2017 2016-09
(Revised)2017 Federal Poverty Income Guidelines for 2017 02/23/2017 2017-01 2017 2017 CHIP Routine Reporting Requirements 04/26/2017 2017-02 2017 Maternal Depression Screening 04/10/2017 2017-03 2017 Release of CHIP Eligibility and Benefits Handbook 04/17/2017 2017-04 2017 CHIP Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) Cost Settlement Report Template and Reporting Requirements 05/23/2017 2017-05 2017 CHIP MCO Enrollment 06/06/2017 2017-06 2017 Changes to CHIP Renewal Notices 06/20/2017 2017-07 2017 CHIP Provider Enrollment 08/04/2017 2017-08 2017 Updated CHIP Paper Applications 09/11/2017 2017-09 2017 Healthcare Effectiveness Data and Information Set (HEDIS®) 2018 and the Consumer Assessment of Health Plans Survey (CAHPS)® 2018 Survey 11/13/2017 2017-10 2017 CHIP Returned Mail Procedures 04/1/2018 2017-11 2017 CHIP's HIPPA Privacy Coordinator 01/26/2018 2017-12 2017 Contractor Service Area Change Requests 01/22/2018 2017-13 2018 Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance Requirement 01/26/2018 2018-01 2018 CHIP Performance Improvement Projects 01/22/2018 2018-02 2018 Federal Poverty Income Guidelines for 2018 02/28/2018 2018-03 2018 2018 CHIP Routine Reporting Requirements 03/08/2018 2018-04 2018 2017 Annual Report to the General Assembly 2018-05 2018 Children's Health Insurance Program (CHIP) Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) Cost Settlement Report Template 06/28/2018 2018-06 2018 CHIP Provider Network Identification 08/14/2018 2018-07 2018 Children's Health Insurance Program (CHIP) Dental Periodicity Schedule 08/03/2018 2018-08 2018 CAPS IRS Tax Filing Threshold 10/22/2018 2018-09 2018 Healthcare Effectiveness Data and Information Set (HEDIS®) 2019 and the Consumer Assessment of Health Plans Survey (CAHPS)® 2019 Survey 12/21/2018 2018-10 2018 CHIP Provider Service Location Enrollment Deadline 02/04/2019 2018-11 2019 Transformed Medicaid Statistical Information System (T-MSIS) Data Quality 01/07/2019 2019-01 2019 2019 CHIP Routine Reporting Requirements 02/01/2019 2019-02 2019 Federal Poverty income Guidelines for 2019 03/01/2019 2019-03 2019 Provider Enrollment Communications to Members and Providers 04/29/2019 2019-04 2019 Retro-Activity Requests 06/03/2019 2019-06 2020 Routine Reporting Requirements 2/10/2020 2020-01 2020 CHIP Federal Poverty Income Guidelines 3/10/2020 2020-03 2020 CHIP COVID-19 FAQ 1 3/11/2020 NA 2020 CHIP COVID-19 FAQ 2 3/26/2020 NA 2020 CHIP COVID-19 FAQ 3 5/5/2020 NA 2020 CHIP COVID-19 FAQ 4 5/19/2020 NA 2021 Routine Reporting Guidelines 01/21/2021 2021-02 2021 HEDIS/CAHPS 02/08/2021 2021-03 2021 CHIP MCO Provider Agreement Checklist 02/18/2021 2021-04 2021 Federal Poverty Income Guidelines for 2021 02/17/2021 2021-05 2022 HEDIS/CAHPS 01/21/2022 2022-01 2022 Routine Reporting Requirements 01/25/2022 2022-02 2022 Federal Poverty Income Guidelines 03/01/2022 2022-03 2022 Postpartum Expansion 05/25/2022 2022-05 2022 Updated Appendix 12-E Letter Addressed to Physician from Department 05/25/2022 2022-06 POLICY CLARIFICATIONS:
Year Subject Date Issued Clarification Number 2012 Change to Household Composition Computation 05/25/2012 2012-01 2012 Processing CAO Referrals with Zero Income 06/29/2012 2012-02 2012 Delay in Health Choices Expansion 09/04/2012 2012-03 2014 Outreach and Enrollment to Children Denied for Incomplete Applications Due to Tax Filing Status 03/28/2014 2014-01 2014 Implementation of Transmittal 2014-5 04/30/2014 2014-02 2014 Acceptable Income Verification Documentation within 60 Days 05/08/2014 2014-03 2014 Processing Applications and Renewals Without Verified Income Deductions 06/04/2014 2014-04 2014 CHIP Application Revision 07/03/2014 2014-05 2014 Vision Benefits—Eyeglass Replacement 07/28/2014 2014-06 2014 Issues Related to CAPS Release 21 08/13/2014 2014-07 2015 FFM Application Received within 90 Days of Renewal Due Date 01/30/2015 2015-01 2016 Lead Screening Requirements 06/14/2016 2016-01 2016 Federal Final Rule ''Nondiscrimination in Health Programs and Activities'' 09/22/2016 2016-02 2017 Eligibility and Benefits Handbook 2017 04/05/2017 2017-01 2017 Ordering, Referring, and Prescribing Providers 09/13/2017 2017-02 2017 Provider Enrollment Claims Processing 12/22/2017 2017-03 2018 Claims Denial for Non-Enrolled Network Providers and Impacts on the CHIP Enrollee Coverage 2018-01 2018 2018 CHIP Routine Reporting Requirements 09/05/2018 2018-02 2019 American Indian and Alaskan Native Cost Sharing 12/9/2019 2019-03 2019 Reassessment 12/10/2019 2019-02 2020 Billing Guidance for alternative Screening Sties Related to COVID-19 3/24/2020 2020-02 2020 Directions to ByPass the Prior Authorization Requirements for CT Scans of the Chest for COVID-19 Patients 3/24/2020 2020-03 2020 COVID-19 Response: Pharmacies may Override Early Refill Alerts for Medications 3/27/2020 2020-04 2020 Self-Attestation; Enrolling children prior to first premium payments; continuation of coverage 4/1/2020 2020-05 2020 Provider Revalidation Verification File 720 4/8/2020 2020-06 2020 Provider Enrollment 4/13/2020 2020-07 2020 COVID-19 Unemployment Compensation Calculation 5/7/2020 2020-08 2021 Support Act 05/11/2021 2021-01 2021 Provider Enrollment & Revalidation 05/20/2021 2021-02 2021 Out of State Insurance 05/25/21 2021-03 OTHER:
Children's Health Insurance Program (CHIP) State Plan approved 4-25-2019
December 2018 Children's Health Insurance Program Procedures Handbook
CHIP Eligibility and Benefits Handbook 4/5/2017
Children's Health Insurance Program (CHIP) State Plan Amendment effective 3/1/2020.
Children's Health Insurance Program (CHIP) letter insert describing changes to programs for families, posted on web and included with CHIP letters from MCOs starting 4/10/2020.
• 1135 Waiver Request Checklist—March 25, 2020
• Approval of Federal Section 1135 Wavier Request—March 27, 2020
• Providing Direct Services via Telemedicine in the School-Based ACCESS Program (SBAP) During the COVID-19 Emergency—April 3, 2020
• OMAP Announcement 04-07-2020-02: MATP Mileage Reimbursement Notice—April 7, 2020
• Request for State Plan Amendments Related to Novel Coronavirus Disease (COVID-19) National Emergency/Public Health Emergency—April 22, 2020
• OMAP Announcement 05-08-2020-01: MATP Guidance during the COVID-19 Pandemic—May 8, 2020
• OMAP Announcement 05-08-2020-02: MATP Consumer Notice—May 8, 2020
• Providing Direct Services in the School-Based ACCESS Program (SBAP) During the COVID-19 Emergency—May 28, 2020Office of Mental Health and Substance Abuse Services—Contact: Barry Decker (717) 772-7640
POLICY STATEMENTS:
Year Code
CitationSubject Date Issued Bulletin Number 1980 1981 Ch. 5310 Ch. 4210 Ch. 4226 Ch. 4220 Ch. 4226 Ch. 4000 Fee for Service Funding of Mental Health Community Residential Rehabilitation (CRR) Programs
Office of Mental Health County Program Record Retention Policy
Interpretation of Section 6404.3.2 of the 6400 MH/MR Regulations Search of Visitors and Residents/Patients at State-Operated Mental Hospitals, Long-Term Care Units and Restoration Centers
Responsibility for Collection of Tuition Exp. Under Act 199 of 1980 for Out-of-State Residents12/05/80 02/17/81 02/20/81 12/07/81 03/17/82 6100-80-02 5000-81-01 6000-81-02 99-81-59 199-82-01 1982 Ch. 4210 Ch. 11
Ch. 5310 Ch. 5310 Ch. 11
Ch. 5100
Ch. 11
Ch. 5310 Ch. 11Procedures for Discharge of Mentally Retarded Patients at State Mental Hospitals
Financial Competency Statements
8600 Letters of Agreement Between CRR Service Providers and County Administrative Programs
Building Occupancy Requirement for CRR Service Providers
Vecchione Competency Determinations, Procedures, and Alternatives
Voting Rights and Procedures
New Vecchione Petition Forms
Community Residential Rehabilitation Services for Young Adult Clients
Monitoring the Guardianship Petitioning Process at State Centers and State Mental Hospitals04/02/82 04/16/82 05/10/82 06/25/82 07/16/82 08/17/82 08/20/82 09/15/81 09/24/82 99-82-14 99-82-14 8000-82-04 8000-82-06 99-82-33 99-82-36 99-82-39 99-82-50 99-82-47 1983 Ch. 1101 1150
Ch. 11
Ch. 5100
Ch. 5100
Ch. 5100
Ch. 5310
Ch. 5210 Ch. 5100 Ch. 20Payment of Residential Placement Costs for Mentally Retarded or Severely Emotionally Disturbed Children in Residential Facility
Guardianship Petitioning Process—Redeterminations
Informed Consent to Non-Psychiatric Health Care at State Mental Hospitals.
Referral Procedures for ''Guilty but Mentally Ill'' Individuals
Notification of State Mental Hospital 302 Commitments
Guidelines for the Development of Children's Community Residential Rehabilitation Services (CRRS) Programs
Patient Care Review Committee
Child and Adolescent Partial Hospitalization Programs Associated with School Programs
Guidelines for Voluntary and Involuntary Patients Refusing Physical Examination on Admission
Expiration of 4th Provisional Cert. of Compliance03/08/83 07/18/83 08/02/83 08/08/83 08/08/83 09/15/83 09/21/83 11/14/83 11/22/83 12/15/83 99-83-10 99-82-47
9-83-26
99-83-23 99-83-29 99-83-35 99-83-38 99-83-41 99-83-42 99-83-491984 Ch. 13
Ch. 4300 Ch. 4210 Ch. 5100 Ch. 4310Charges for Evaluation and Reports Requested by OVR
Guidelines for the Physical Structure of Seclusion Rooms
County Indirect Cost Allocation Plan Guidelines
Treatment Team Management
Guidelines for Delivery of MH Forensic Svs. To Persons in Co. Jails & Persons on Prob. Or Parole
Use of Authorized Absence at Discharge
Care and Maintenance Policy
Standards for Psychological Services in State Mental Hospitals and South Mountain Restoration Center04/13/84 05/01/84 06/13/84 08/01/84 08/27/84 08/23/84 08/29/84 10/12/84 99-84-11
99-84-19 99-84-22 99-84-30 99-84-38 99-84-39 99-84-42 99-84-491985 Ch. 4300 County Indirect Cost Allocation Plan Guideline Update—Maintenance In Lieu of Rent as a Direct Cost (Joint MH/MR Bulletin) 08/22/85 99-85-17 Ch. 1153 Requirements for Treatment Plans & Documentation of Treatment 10/31/85 29-85-02
33-85-02Ch. 4210 Readmission from Community Placement Within 30 Days of Discharge 05/03/85 99-85-21 Ch. 5100 Ch. 5100 Ch. 11
Ch. 4310 Ch. 5100Administration of Psychotropic Medication to Protesting Patients
Treatment of Persons During Pendency of a 304 or 305 Commitment Petition
Predischarge Money Management Planning
Care and Maintenance Policy Guidelines for Indigent Certification
Guidelines for Use of Electroconvulsive Therapy (ECT)03/11/85 07/22/85 10/28/85 12/10/85 03/05/85 99-85-10 99-85-19 99-85-38 99-85-44 99-86-06 1986 Ch. 4000 Procedures for Review of Service Eligibility and Termination Decisions 01/17/86 99-86-01 Ch. 3490 Implementation of Act 33 of 1985 03/19/86 99-86-11 Ch. 5100 Involuntary Outpatient Commitment
Community Support Programs: Social Security Work Incentives
Education: A Crucial Strategy in the Rehabilitation of the Mentally Ill
Community Support Programs: The Job Training Partnership Act
Families of Mentally Ill Self-Help Movement05/08/86 06/23/86 05/21/86 03/18/86 03/18/86 99-86-14 99-86-20 99-86-16 99-86-10 99-86-07 1987 Ch. 4305 Client Liability Community MH/MR Liability 05/21/87 4305-87-02 Ch. 5100 Ch. 4305 Ch. 3490 Notice of Grievance & Appeal Proc. Involuntary Outpatient Commitment
Revised MH/MR Client Liability Community Services Regulations
Model Policy and Procedures AIDS/HIV
Blind/Visually Impaired Patients
The Consumer's Self-Help Alternative
OMH Policy on Application of Act 33 and Administrative Bulletin 00-85-9609/08/87 01/08/87 07/22/87 01/15/87 01/15/87 01/16/87 99-87-23 4305-87-01 99-87-26 99-87-08 99-87-05 99-87-04 1988 1989 1990 1991 1992 Ch. 4305 Ch. 1151 1163
Ch. 1101 1150
Ch. 1153 Ch.1101
Ch. 4210 Ch. 1550 Ch. 5100 Ch. 1151 Ch. 1153 Ch. 5100 Ch. 4300 Ch. 1151 Ch. 1151 Ch. 1153 Ch. 5310 Ch. 5310 Ch. 5100 Ch. 14Quarterly Liability Summaries
MA Revisions to Chapters 1151 and 1163 Regulations
Fee Schedule Revisions and Transportation Requirements
Do Not Resuscitate (DNR)
Appropriate Billing for Psychiatric Partial Hospitalization Providers and Outpatient Psychiatric
Clinics
County Payment Exception for TCM Services
Abatement for Liability for Psychological Evaluations
Signature Requirements
Accessibility of Appropriate MH Services for Persons who are Hearing Impaired
Requirement to Notify County Administrators
SSI Disability for Children Certification of Need—Medical Assistance Patients Under the Age of 21
Clozaril Monitoring and Evaluation Visit
Physicians Services Coverage
Annual Income and Expenditure Reports Certification and Appeal Process Patient/Client Information System
MA Patients Under 21—Certification of Necessity
Transmittal of General Family Based Mental Health Services Program Issues
OMAP Independent Team—Certification of Need—MA Patients Under the Age of 21
Clozapine Support Services
Community Residential Rehabilitation Services (CRRS) Length of Stay Policy
Clarification of CRR Regulation Section 5310.33(e)
Policy and Guidelines on Ensuring the Protection of Human Rights (Patient Rights)
Patient Care Evaluation Studies
MH Crisis Intervention Services Implementation
Community Integrated Employment Program Definitions
Patient Abuse Investigations Investigator's Resource Manual01/29/88 06/29/88 06/30/88 07/12/88 03/01/88 11/04/88 09/14/89 09/25/89 10/10/89 11/28/89 09/27/90 06/24/91 11/06/91 06/10/91 10/21/91 07/01/91 04/30/91 02/27/92 02/21/92 01/31/92 04/03/92 04/03/92 05/05/92 06/24/92 10/15/92 11/10/92 12/14/92 4305-88-01
11-88-02
00-88-14 00-88-12 00-88-03 1101-89-01 00-89-17 00-89-07 00-89-09 00-89-12 00-90-24 13-91-01 29-91-07 SMH-91-03 OMH-91-13 OMH-91-09 OMH-91-05 OMH-91-19 13-92-03 01-92-04 OMH-92-05 OMH-92-06 OMH-92-07 SMH-92-01 OMH-92-16 OMH-92-12 OMH-92-141993 CH. 1101 Ch. 5221 Ch. 1101 Ch. 4210 PAYMENT FOR MENTAL HEALTH SERVICES PROVIDED IN A RESIDENTIAL TREATMENT FACILITY FOR ELIGIBLE INDIVIDUALS UNDER 21 YEARS OF AGE
Patient Smoking
Tuberculosis Surveillance and Management
Immunization of Patients/Residents and Employees
Resource Coordination Implementation
Cooperation with Utilization Review
MH Crisis Intervention Service Guidelines
Medical Assistance for Children01/01/93 06/15/93 06/15/93 07/09/93 07/30/93 09/17/93 08/09/93 09/15/93 1165-93-07 01-93-04 SMH-93-02 SMH-93-03 SMH-93-04 OMH-93-09 OMH_93-08 OMH-93-10 00-93-23 Ch. 5221 Intensive Case Management Record Requirement
Providing Service to Persons with Autism/Pervasive Developmental Disorder09/21/93 11/09/93 5221-93-01 00-93-29 1994 Ch. 1150 Ch. 1101 Ch. 1101 Ch. 1153 Outpatient Psychiatric Services for Children Under 21 Years of Age
Responsibilities of South Mountain Restoration/Long Term Care Facilities Regarding Implementation of Nursing Home Reform Legislation
Responsibilities of South Mountain Restoration/Long Term Care Facilities Regarding Implementation of Nursing
Home Reform Legislation
180-Day Exception Requests and Invoice Submission Time Frames
180-Day Exception Requests and Invoice Submission Time Frames
Prior Authorization of Partial Hospitalization Services for Children Beyond the Limit of Total Number of Hours
Plan of Care Summary Form Referenced in 01-94-01
Guidelines for Assuring Accessibility of State Mental Hospital Services for Person who are Hearing Impaired01/11/94 02/14/94 02/23/94 04/11/94 05/27/94 12/30/94 04/01/94 06/28/94 41-94-01
48-94-01
49-94-01
50-94-01 OMH-94-02 OMH-94-03 OMH-94-07 OMH-94-09 33-94-04 01-94-05 SMH-94-021995 CH. 1153 ACCESSING OUTPATIENT WRAPAROUND MENTAL HEALTH SERVICES Not Currently Included in the Medical Assistance Program Fee Schedule for Eligible Children Under 21 years of Age 09/08/95 1153-95-01 Ch. 1163 Revision of Utilization Guidelines for Inpatient Hospital Drug and Alcohol Services Under the Medical Assistance Program 11/06/95 01-95-20
11-95-12
1163-95-01Ch. 1163 Guidelines for Inpatient Hospital Drug and Alcohol Services—Non Availability of a Non-Hospital Bed 11/06/95 01-95-21
11-95-13
12-95-08Ch. 1150 Mental Health Services Provided in Non-JCAHO Accredited Residential Facility for Children Under 21 Years of Age 09/08/95 1157-95-01
01-95-12
11-95-08
12-95-04
13-95-01
14-95-01
17-95-05
41-95-03
50-95-03
53-95-01Ch. 1101 Ch. 4000 Ch. 1101 Ch. 5100 Ch. 20 Update—JCAHO—Accredited RTF Services
Room and Board Payments for MH-only Children in Residential Facilities Which are Not JCAHO Accredited
Signature Requirement
Crime Victim Notification: Act 155 Expanding the Bill of Rights for Victims of Crime
License/Approval Process for Community Based Mental Health Service Programs
Guidelines for Safeguarding Patient Property
Distribution of PARF Position Statement for State Hospital Vocation Adjustment Services
Guidelines for Supporting the Development of Consumer Self-Help09/08/95 04/03/95 02/01/95 08/25/95 06/12/95 03/01/95 03/15/95 03/15/95 01-95-13
11-95-09
12-95-05
13-95-02
14-95-02
17-95-06
41-95-04
50-95-04
53-95-02
1165-95-01 4000-95-01 01-95-01 SMH-95-01 OMH-95-08 OMH-95-05 OMH-95-04 OMH-95-031996 Ch. 20
Ch. 1150Non-Renewal of Licenses for Community Based Mental Health Providers that have Suspended Services
Procedure for Claiming Federal Reimbursement of Administrative Costs for Medicaid Funded MH services
Tuberculosis Infection Control Program
Implementation of Act 28 of 1995 in OMH-Operated Long Term Care Units and South Mountain Restoration Center05/24/96 06/14/96 08/09/96 08/26/96 OMH-96-02 OMH-96-04 SMH-96-01 SMH-96-02 1997 Ch. 14
Ch. 4305 Ch. 1150Reporting Alleged Neglect of Care of Dependent Persons under Act 28 of 1995
Quarterly Liability Summaries Supplement and Amendment
Role of State Mental Hospital and Restoration Center Boards of Trustees
Training for EPSDT Expanded Services Providers (Provider Type 50) on Completing MA Invoices
Change in Billing Procedures for Psychotherapy01/15/97 02/07/97
3/21/97
07/07/97 07/14/97OMH-97-01 00-97-02 SMH-97-01 50-97-03
29-97-06--- Change in Procedure for Requesting and Billing Therapeutic Staff Support (TSS) Services 09/17/97 01-97-16 41-97-02
48-97-02
49-97-06
50-97-051998 Ch. 4300 Reporting Requirements for Services Funded Through County Base and CHIPP Funds 02/17/98 OMH-98-01 Ch. 1223 Drug and Alcohol Clinics with Provisional Licenses 03/03/98 28-98-01
1123-98-01Ch. 1163 Revision of Utilization Guidelines for Inpatient Hospital Drug and Alcohol Services Under the Medical Assistance Program 05/18/98 1163-98-01 Ch. 5310 Ch. 1153 Ch. 1163 Licensing Compliance Prediction Instrument Application in the Licensing of Community Residential Rehabilitation Services
Clozapine Support Services
Revision of Utilization Guidelines for Inpatient Hospital Drug and Alcohol Services under MA08/01/98 12/29/98 05/18/98 OMH-98-02 01-98-19 01-98-06 1999 Emeriti v. Philadelphia Center for Human Development 720 A.2d 1032 (Pa. 1998) (Duty to Ward Third Parties—Tarasoff in Pennsylvania) 09/15/99 OMHSAS-99-09 50-99-03 Ch. 1153 Medication Management Visit 04/26/99 28-99-02
29-99-01Ch. 1153 Ch. 1223 Ch. 1141 Ch. 4300 Increase Fees for Outpatient Psychiatric Clinics, Psychiatric Partial Hospitalization Programs and Outpatient Drug and Alcohol Clinics
Maximum Allowable Rates of Reimbursement for Psychiatric Physicians
Mental Health Research Involving Human Subjects
Sanctions Policy for Noncompliance with MH/MR Income and Expenditure, Consolidated Waiver, and Cost Settlement Reporting Requirements06/23/99 03/24/99 07/28/99 11/02/99 28-99-03
29-99-02
33-99-01 OMHSAS-99-02 OMHSAS-99-06 OMHSAS-99-102000 Guidelines for Identifying Persons with Mental Retardation and Mental Illness for State Mental Health Hospital Discharge 05/15/00 00-00-04 Ch. 4300 The Roles and Responsibilities of County Mental Health/Mental Retardation Programs in the Development of a Child's Individual Education Program
Clarification of Billing Instructions for Methadone Maintenance Services
Changes in Terminology in MA Program Fee Schedule for Type of Services/Procedure Code AG/W1855
Freedom of Choice for MA Recipients Requiring Behavioral Health Services
Prior Authorization of Therapeutic Staff Support Services10/04/00 08/21/00 03/13/00 12/29/00 OMHSAS-00-04 28-00-03 28-00-01 01-00-16 2001 Ch. 5100 Age of Consent for Voluntary Outpatient Mental Health Treatment 06/18/01 OMHSAS-01-04 Accessibility of Community Mental Health and Substance Abuse Services for Persons Who Are Deaf, Hard of Hearing, Late Deafened, or Deaf-Blind 10/01/01 OMHSAS-01-06 Ch. 5100 Procedures for Client Rights Grievances and Appeals 08/10/01 SMH-01-03 Ch. 4300 Accessibility of State Mental Health Facilities for Persons who are Deaf, Hard of Hearing, or Deaf-Blind Community Support Services Fee Schedule
The Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities (RTF)06/18/01
4/26/01
06/01/01 07/23/01SMH-01-01 OMHSAS-01-02 53-01-01 2002 Coordination of treatment and support for people with a diagnosis of serious mental illness who also have a diagnosis of mental retardation 12/17/02 00-02-16 Ch. 1223 Drug and Alcohol Clinics with Provisional Licenses 10/26/02 28-02-02 Ch. 5100 Interpretation of Pennsylvania Law Related to 402(b) Commitment 09/12/02 OMHSAS-02-04 The Use of Seclusion and Restraint in Mental Health Facilities and Programs 04/08/02 OMHSAS-02-01 Performance Expectations and Recommended Guidelines for the County Child and Adolescent Service System Program (CASSP) 06/06/02 OMHSAS-02-02 Ch. 1101 Generic Drugs
Documentation and Recordkeeping Requirements
Residential Treatment (RTF) Services Provided in a Secure Setting04/01/02 03/21/02 10/01/02 SMH-02-01 29-02-03
01-02-112003 Ch. 1223 Ch. 4300 Ch. 1101 Ch. 1101 Elimination of the Requirement for the Outpatient Drug and Alcohol Clinic's Supervisory Physician to Perform a Comprehensive Medical Examination Within 15 days following the Intake and Before the Provision of Treatment
Community Support Services Fee Schedule
Additional Place of Service (Office) for Psychotherapy
Availability of Training for Completion of Provider BHRS Reports
Site Visits and Access to Records by Pennsylvania Protection and Advocacy, Inc.
Process to Handle Residential Treatment Facility Reports of Death, Serious Injury, or Attempted Suicide (Serious Occurrences)
Obligation of MA Providers Participating in Managed Care Delivery System to Comply with MA Regulations
OMHSAS Bulletin Series Update (1980-2003)10/01/03 07/01/03 01/06/03 01/31/03 02/19/03 06/13/03 08/01/03 12/19/03 28-03-02 OMHSAS-03-01 01-03-01 01-03-02 00-03-02 53-03-01 99-03-09 OMHSAS-03-04 2004 Ch. 1223 Methadone Take-Home Services
Services for Children Placed Out of County in Pre-Adoptive or Foster Homes
Employee and Contractor's Use of Personal Pager and Cellular Telephones02/01/04 07/19/04 11/05/04 28-04-01 00-04-02 SMH-04-02 2005 Ch. 1153 Psychological/Psychiatric/Clinical Re-Evaluations and Re-Authorization for Behavioral Health Rehabilitation (BHR) Services for Children and Adolescents with Behavioral Health Needs Compounded by Developmental Disorders 06/24/05 07-05-01 Ch. 5100 Transporting Patients 02/28/05 SMH-05-02 Ch. 5100 Administrative Transfers between State Mental Hospitals Civil Sections 04/29/05 SMH-05-04 Ch. 4300 Cost Settlement Policy and Procedures for Community-Based Medicaid Initiatives 08/15/05 OMHSAS-05-01 Integrated Children's Services Initiative 06/09/05 00-05-05 Quality at the End of Life for Consumers and Residents
Limited English Proficiency (LEP)
MA Program Fee Schedule Procedure Code Changes for Case Management Services09/16/05 01/20/05 10/27/05 SMH-05-05 00-04-13 21-05-03 2006 Memorandum of Understanding Between the Office of Mental Health and Substance Abuse Services and the Pennsylvania Department of Aging
02/01/06 OMHSAS-06-01 Service Priority For: Older Adult Population 02/01/06 OMHSAS-06-02 Co-Occurring Disorder Competency Approval Criteria for All Facilities Licensed by the Department of Health Division of Drug and Alcohol Program, License or the Department of Public Welfare, Office of Mental Health and Substance Abuse Services 02/10/06 OMHSAS-06-03 Writing of Orders by Administrators 02/13/06 SMH-06-01 Ch. 5100 Community Incident Management & Reporting System 07/18/06 OHMSAS-06-04 Ch. 1153 Ch. 5200 Mobile Mental Health Treatment 11/30/06 08-06-18 Ch. 1151
Ch. 1153
Ch. 1223BH-FFS Transfer from OMAP to OMHSAS 08/15/06 OMHSAS-06-07 Ch. 4210 Ch. 4210 Guidelines for Following Mental Health Advanced Directives in State Mental Hospitals
Admissions/Discharges to County Programs from State Mental Health Facilities
Selected Discharges to County Programs from State Mental Health Facilities where the Admitting BSU is Different from the Discharge BSU09/19/06 11/01/06 12/27/06 SMH-06-03 1527-06-19 1527-06-24 2007 Ch. 1101 Observation Levels of Intensive Treatment
Guidelines for Establishing and Granting Levels of Independence in the State Mental Hospitals
Responsibility of MA Providers to Provide Requested Medical/Psychological Information to the Disability Advocacy Program06/18/07 07/27/07 05/18/07 SMH-P-07-01 SMH-P-07-02 99-07-08 Ch. 5100 Ch. 1151 Ch. 1163 Ch. 5310 Ch. 5320 Clarification of Act 169, also known as the Older Adult Protective Services Act (OAPSA), in regard to hiring practices for inpatient and residential facilities. 08/02/07 OMHSAS-07-01 2008 Ch. 5310
Ch. 5320Guidelines for Interagency Planning for Children
in Need of Behavioral Health Rehabilitation Services or Partial Hospitalization on Services during the School Day01/04/08 OMHSAS-08-01 Assertive Community Treatment (ACT) 09/02/08 OMHSAS-08-03 Ch. 3490 Implementation of Act 179 of 2006 & Act 73 of 2007 Amending The Child Protective Services Law
Therapeutic Leave Approval Process
Consumer Meeting Involvement
Consumer Possession and Use of Cellular Telephones06/27/08 03/20/08 03/20/08 03/20/08 3490-08-03 SMH-P-08-02 SMH-P-08-03 SMH-P-08-04 2009 Ch. 1223 Requirements for Clinics Supervisory Physician Reviews and Reevaluations of Diagnoses, Treatment Plans and Updates 04/18/09 OMHSAS-09-03 Best Practice for Family Involvement with Youth who are in Residential Treatment Facilities (RTFs) 06/15/09 OMHSAS-09-04 Ch. 5100 Ch. 13 Use of Restraints, Seclusion and Exclusion in State Mental Hospitals and Restoration Center 11/30/09 OMHSAS-09-06 Ch. 1150
Ch. 14
Ch. 3800Inclusion of External Advocates in Hospital Administrative Investigations
Strategies and Practices to Eliminate the Use of Unnecessary Restraints
Prone Restraints in Children's Facilities01/05/09 12/19/09 SMH-P-09-01 3800-09-01 3800-09-02 2010 Ch. 1153
Ch. 2380
Ch. 5200
Ch. 5210
Ch. 6400
Ch. 6500Medication Prescribing Practices of CRNP's in Mental Health Programs and Mental Retardation Programs 03/27/10 OMHSAS-10-01 Ch. 4000 Educational Portions of ''Non-Educational'' Residential Placement 01/04/10 OMHASA-10-02 Ch. 5221 Blended Case Management (BCM) (Revised) 06/14/10 OMHSAS-10-03 Ch. 4210 Ch. 5100 Ch. 14 Referrals for Admission from Department of Corrections and County Jails
Response to Incident of Alleged Improper Sexual Behavior
State Hospital Referrals for Potential Nursing Home Placement
Management of Incidents of Incidents: SI-815 Incident reporting and Risk Management Policy and Procedural Change02/01/10 03/10/10 11/17/10 11/10/10 SMH-P-10-01 SMH-P-10-02 SMH-P-10-03 SMH-10-01 2011 Non-Discrimination Toward Lesbian, Gay, Bisexual, Transgender, Questioning and Intersex People 01/07/11 OMHSAS-11-01 Guidelines to Ensure Affirmative Environments and Clinically Appropriate Services for Lesbian, Gay, Bisexual, Transgender, Questioning and Intersex Consumers and Their Family Members 01/07/11 OMHSAS-11-02 Ch. 14 Administrative Investigations 10/20/11 OMHSAS-11-08 Unscheduled Use of Medication in the State Hospital System PRN and STAT Medication Orders 04/26/11 SMH-11-01 2012 Ch. 4300 Cost Centers for County Based Mental Health Services 03/26/12 OMHSAS-12-02 Ch. 5100 Unsupervised Leave of Patients Found Not Guilty by Reason of Insanity 04/04/12 SMH-P-12-01 Ch. 5100 Proper Implementation of Discharge or Transfer Procedures for Certain Person in the Category ''Acquitted Because of Lack of Criminal Responsibility.'' (Not Guilty by Reason of Insanity) 04/04/12 SMH-P-12-03 Ch. 5100 Information Sharing Between Regional Forensic Psychiatric Centers and State or County Correctional Facilities Upon Admission and Discharge 04/04/12 SMH-P-12-04 Ch. 5221 Mental Health Targeted Case Management (TCM) Documentation Requirements 06/14/12 OMHSAS-12-03 2013 Ch. 5221 Targeted Case Management (TCM) Travel and Transportation Guidelines 01/18/13 OMHSAS-13-01 Ch. 1101 Policy Clarification Regarding Written Prescriptions Orders and Requests—Statement of Policy 06/27/13 OMHSAS-13-02 2013 HCPCS Updates Related to Behavioral Health Services 10/18/13 OMHSAS-13-03 2014 Affordable Care Act (ACA) Re-enrollment Guidance for Behavioral Health Providers 08/01/14 OMHSAS-14-03 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) Information Sharing Policies and Procedures—Those who Supervise Foster Children and PH and BH-MCOs 09/05/14 05/23/14 OMHSAS-14-04
01-14-012015 Community Incident Management & Reporting System OMHSAS Bulletin Series Update—Obsolete Bulletins 04/01/15 10/07/15 OMHSAS-15-01 OMHSAS-15-02 2016 Ch.1500
Ch. 1101Mental Health Emergency Services Guidelines
Revised Procedure for Waiver of OMHSAS Program Regulations and Standards
Guidelines for Referrals and Coordination of Admission to South Mountain Restoration Center for Individuals Discharged from Correctional Facilities
Payment for Room and Board when Services are Provided by a CARF or COA Accredited Residential Treatment Facility (RTF)
Security Guidelines for Regional Forensic Psychiatric Centers
Admissions, Transfers, Level of Care and Service Area Designation for the Regional Forensic Psychiatric Centers
Nursing Home Pre-Admission Screening and Resident Review Requirements Related to Mental Health Services
(OMAP/OMHSAS) Payment for Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder01/08/16 04/19/16 05/10/16 05/16/16 06/23/16 07/14/16 11/10/16 08/17/16 OMHSAS-16-01 OMHSAS-16-03 OMHSAS-16-05 OMHSAS-16-06 OMHSAS-16-08
OMHSAS-16-10
OMHSAS-16-11
99-16-152017 Special Pharmaceutical Benefits Program—Mental Health
Physician/Certified Registered Nurse Practitioner Collaboration Procedures08/29/17 08/29/17 OMHSAS-17-03 OMHSAS-17-04 2018 Consent to Mental Health Treatment for Minor Children 06/29/18 OMHSAS-18-01 2019 Ch. 5100 Admissions, Discharges, and Continuity of Care for State Mental Hospitals
Service Location Enrollment for Behavioral Health Providers
Serious Mental Illness: Adult Priority Group
Guidelines for Implementing Assisted Outpatient Treatment
Peer Support Services03/20/19 07/30/19
08/6/19
11/6/19
12/19/19OMHSAS-19-01 OMHSAS-19-02 OMHSAS-19-03 OMHSAS-19-04 OMHSAS-19-05 2020 Ch. 5240 Ch. 5310 Ch. 5320 Ch. 5240 Ch. 5240 Ch. 5240 Ch. 5310 Ch. 5320 Ch. 5240 Ch. 1151 Ch. 1153 Ch. 1155 Ch. 1223 Ch. 5100 Ch. 5200 Ch. 5210 Ch. 5221 Ch. 5230 Ch. 5310 Ch. 5320 Ch. 5240 Ch. 1153 Ch. 5240 Ch. 5240 Procedure Codes for IBHS Agencies
◦ ATTACHMENT: Intensive Behavioral Health Services Agency Procedure Codes
OHMSAS COVID-19 Frequently Asked Questions (FAQs)
Guidance for County Emergency Behavioral Health/Disaster Crisis Outreach and Referral Teams (EBH/DCORT).
Visitation Guidelines under COVID-19 for Residential Treatment including Long-Term Structured Residences (LTSR), Community Residential Rehabilitation (CRR) Services, Residential Treatment Facilities for Adults (RTF-A) and Crisis Residences.
Guidelines for the Delivery of IBHS and BHRS Group Services Through Telehealth
Guidelines for the Delivery of TSS, BHT, BHT-ABA, or Assistant BC-ABA Service Through Telehealth
COVID-19 Frequently Asked Questions (FAQs)
Supplement 1
Telehealth Guidelines Related to COVID-19 (Updated)
Payment for IBHS Prior to Licensure
◦ ATTACHMENT: Intensive Behavioral Health Services (IBHS) Attestation Form
Prior Authorization during the COVID-19 Disaster Emergency Declaration Period
OMHSAS Behavioral Health Services in Counties Moving from RED Phase to YELLOW Phase
Applying Department of Health Testing Guidance for Long
Term Care Facility Residents and Healthcare Personnel to Community Residential Rehabilitation (CRR), Long Term Structured Residence (LTSR) and Residential Treatment Facility for Adults (RTF-A) Providers.
Medical Necessity Guidelines for Intensive Behavioral Health Services (IBHS)
◦ Attachment 1—Individual Services
◦ Attachment 2—Applied Behavior Analysis
◦ Attachment 3—Group Services
Temporary Suspension of Specified Regulatory Requirements for Inpatient Psychiatric Services, Outpatient Psychiatric Services, Intensive Behavioral Health Services, Outpatient Drug and Alcohol Services, Mental Health Procedures, Partial Hospitalization, Intensive Case Management, Psychiatric Rehabilitation Services, Community Residential Rehabilitation Services, and Long-Term Structured Residences
UPDATED IBHS Provider Attestation Bulletin
◦ ATTACHMENT: Intensive Behavioral Health Services (IBHS) Attestation Form
◦ Attachment 2: Description of Applied Behavior Analysis IBHS Fee-for-Service Prior-Authorization Bulletin
◦ Attachment A: Handbook for Prior Authorization of Intensive Behavioral Health Services Rendered (IBHS) in the Fee-for-Services Delivery System
01/31/20 03/25/20 03/30/20 03/31/20 05/05/20 05/05/20 05/05/20 05/05/20 05/12/20 05/18/20 05/22/20 06/17/20 07/13/20 10/22/20 12/18/20 12/18/20 OMHSAS-20-01 OMHSAS Memo
OMHSAS Memo
OMHSAS Memo
OMHSAS Memo
OMHSAS Memo
OMHSAS Memo
OMHSAS Memo OMHSAS-20-04
OMHSAS Memo
OMHSAS Memo
OMHSAS Memo
OMHSAS-20-05 OMHSAS Memo OMHSAS-20-06 OMHSAS-20-072021 Ch. 1153 Ch. 5240 Ch. 1153 Ch. 5240 Ch. 1151 Ch. 1153 Ch. 1155 Ch. 1223 Ch. 5100 Ch. 5200 Ch. 5210 Ch. 5221 Ch. 5230 Ch. 5310 Ch. 5320 Ch. 5240 Ch. 5310 Ch. 4210 Obsolete Behavioral Health Rehabilitation Services (BHRS) Bulletins
Provision of One-to-One Intensive Behavioral Health Services in a Licensed Location
◦ Attachment A: Additional Information for Service Descriptions for IBHS Agencies that Intend to Provide One-to-One Services in a Center
Updates to Procedure Codes for Intensive Behavioral Health Services Agencies
◦ Attachment 1: Intensive Behavioral Health Services Agency Procedure Codes
Temporary Suspension of portions of bulletins and other guidance documents for Peer Support Services, Blended Case Management, Resource Coordination, Mental Health Crisis Intervention, Assertive Community Treatment, Behavioral Health Rehabilitation Services, Residential Treatment Facilities, and Family Based Mental Health Services
Procedure for Providing a Specialized Behavioral Health Treatment Program in Community Residential Rehabilitation Host Home Settings
◦ Attachment A: Service Description Format
◦ Attachment B: Fee-for-Service Prior Authorization Instructions
◦ Attachment C: Contact List for OMHSAS's Regional Field Offices
Contracted Delegate Services03/30/21 01/22/21 01/22/21 02/18/21 03/30/21 03/10/21 OMHSAS-21-01 OMHSAS-21-02 OMHSAS-21-03 OMHSAS Memo OMHSAS-21-04 OMHSAS-21-05 Opioid Treatment Program Services for Dually Eligible Individuals 07/08/21 OMHSAS-21-06 Guidelines for the Use of Telehealth Technology in the Delivery of Behavioral Health Services 08/26/21 OMHSAS- 21-09 2022 Mental Health Emergency Services: Applying the 120-Hour Timeframe for Emergency Involuntary Commitments 04/1/22 OMHSAS-22-01 GUIDANCE MANUALS:
• Community Hospital Integration Projects Program (CHIPP) Guidelines
• Updated Olmstead Plan for Pennsylvania's Mental Health System
• OMHSAS Community Integration Project
• Chapter 5200 Psychiatric Outpatient Clinics Regulatory Compliance GuideOffice of Policy Development—Contact: Tanoa Fagan (717) 787-8307
GUIDANCE MANUALS:
• Human Services Development Fund (HSDF) Instructions and Requirements
• HSDF Fiscal Year Update for FY 21-22
• HSDF Instructions and Requirements for FY 21-22
• HSDF Fiscal Year 2020-2021 Supplemental Funding Allocation
• Supporting Pennsylvanians Through Housing (DHS Five-Year Housing Strategy)
Pennsylvania
INSURANCE DEPARTMENT
(PID)
I. NOTICES
A. Executive Office
1. Insurance Department Notices
No. Date Pub'd Description 2022-10 06/25/22 Per Diem Charges for Market Conduct Examinations Conducted by the Insurance Department 2022-09 06/25/22 Per Diem Charges for Financial Examinations Conducted by the Insurance Department 2022-08 06/11/22 Availability of Technical Advisory Relating to External Grievance Process for Medical Assistance Managed Care Organizations in 28 Pa. Code § 9.707 2022-07 05/28/22 1332 Waiver Reinsurance Program—Program Parameters 2022-06 05/07/22 1332 Waiver Reinsurance Program; Public Comment Period and Public Forum N/A 04/09/22 Insurance Coverages or Risks Eligible for Export by the Acting Insurance Commissioner 2022-05 04/09/22 Non-Enforcement of Prohibition on Data Collection 2022-04 03/12/22 Autism Spectrum Disorders Coverage—Maximum Benefit Adjustment 2022-03 03/05/22 Medical Care Availability and Reduction of Error Fund 2022-02 02/19/22 Workers' Compensation Security Fund Assessment N/A 01/22/22 Qualified Unlicensed Reinsurers List 2022-01 01/01/22 Increase in the Accident Surcharge Dollar Threshold (Cap) to $1,900 2021-12 10/30/21 Medical Care Availability and Reduction of Error Fund; Notice of and Amount of Assessment Action N/A 10/23/21 Qualified Jurisdictions for Certified Reinsurers 2021-10 07/31/21 Act 46 of 2021 2021-05 05/08/21 Annual Attestations under Acts 89 and 92 2021-04 04/24/21 Notice Regarding the Need to Assess the Impacts of the COVID-19 Pandemic in Property and Casualty Rate Filing 2021-03 03/06/21 Notice Regarding Coronavirus (COVID-19) Insurance Coverage 2021-02 02/27/21 COVID-19 Guidance—Discontinuation of Renewal and Continuing Education Extensions 2020-21 10/03/20 COVID-19 Guidance—Discontinuation of Temporary Resident Producer Licensure 2020-19 06/27/20 Notice Regarding Coronavirus (COVID-19) Surprise Bills 2020-17 06/27/20 Acceptance of Non-Essential Filings 2020-11 04/25/20 COVID-19 Guidance Regarding Premium Finance Agreements 2020-09 04/25/20 Applicability of Notice Regarding Coronavirus (COVID-19) Insurance Coverage (Notice 2020-03) to Issuers and Producers of Limited Benefit Policies 2020-08 04/25/20 COVID-19 Guidance Regarding all Volunteer Physicians, Podiatrists and Certified Nurse Midwives Practicing under a Reactivated License 2020-07 04/25/20 COVID-19 Guidance Regarding all Insurers Writing Automobile Insurance, Personal and Commercial, within the Commonwealth 2020-04 04/25/20 Notice to Insurance Companies Regarding Policyholders Affected by the COVID-19 Virus 2020-03 03/21/20 Notice Regarding Coronavirus (COVID-19) Insurance Coverage 2019-07 11/02/19 Insurance Department and Health Insurance Exchange Authority Guidance Regarding Compliance in Marketplace Activities 2019-03 06/15/19 Use of Opioid Overdose Reversal Agents in Underwriting and Rating 2018-10 11/17/18 Repeal of Outdated Notice Regarding Form and Rate Filings; Notice of Form and Rate Filing Requirements under the Accident and Health Filing Reform Act 2018-08—
revised11/17/18 Short-Term Limited Duration Insurance—Guidance for Compliance Filings 2018-05 06/23/18 Certification as an Independent Review Organization; Long Term Care Benefit Trigger Determinations 2017-10 10/07/18 Arson and Insurance Fraud Reporting 2017-03 02/25/17 List of Approved Guide Source Method Vendors 2016-16 12/03/16 Private Passenger Motor Vehicle Liability Insurance Policies; Limited and Full Tort Data Reporting 2016-15 10/29/16 Guidance Regarding Parity in Mental Health and Substance Use Disorder Coverage 2016-11 09/17/16 Long Term Care Partnership Program Revised Guidance Announcement 2016-10 09/10/16 Principle-Based Reserving Operative Date 2016-05 04/30/16 Notice Regarding Nondiscrimination 2015-07 09/19/15 Provider Directories 2015-06 08/22/15 Price Optimization 2015-01 01/31/15 Terrorism Risk Insurance Program Reauthorization Act of 2015; Expedited Rate, Rule and Form Filing Review Process 2014-12 10/25/14 General Guidance for Disclosure of Prescribed Differences from NAIC Statutory Accounting Principles 2014-10 09/27/14 Deregulation of Certain Commercial Lines Property and Casualty Forms 2014-08 06/14/14 Repeal of Outdated PA Bulletin Notices. 2012-04 02/18/12 Effective Dates for Small Group Health Insurance Rate Filings 2011-06 07/30/11 Advisory Notice—Rate Review Process Determination 2011-03 05/14/11 Use of Misleading Professional Designations by Insurance Producers Selling Life Insurance or Annuities to Seniors 2010-10 10/02/10 Provisions of Act 51 of 2010 2010-09 08/14/10 Mini-COBRA Coverage 2010-08 07/17/10 Application for Written Consent 2010-06 07/03/10 Repeal of Outdated Notices 2010-02 01/02/10 Review Procedure Hearings; Cancellation or Refusal of Insurance 2009-07 07/31/09 Updated Guidelines for Record Retention 2009-06 06/27/09 Autism Review Process 2009-03 04/11/09 Autism Coverage 2009-02 02/14/09 Property and Casualty Insurance Companies and Producers Issuing Certificates of Insurance in Pennsylvania 2009-01 02/14/09 Community Health Reinvestment Activities 2008-05 04/19/08 Long-Term Care Partnership Program Effective Date and Revised Guidance Announcement 2007-06 12/01/07 Arson and Insurance Fraud Reporting 2006-12 11/18/06 Flood Insurance Training Requirements 2006-08 07/08/06 Repeal of Outdated Bulletins and Notices 2006-07 06/24/06 Professional Corporations, Professional Associations and Partnerships 2006-06 06/24/06 Notice of Agent Education and Training Requirement Changes 2005-07 07/23/05 Agreement on Community Health Reinvestment 2005-04 03/26/05 Viatical Settlement Broker License Testing Requirements for Licensed Life Insurance Producers 2005-02 02/05/05 Reporting and Disclosure of Criminal Convictions 2003-11 11/29/03 Coverage for Chiropractic Care 2003-07 09/20/03 Notice to Companies Writing Private Passenger Auto Insurance in Pennsylvania 2003-06 08/09/03 Drug and Alcohol Use and Dependency Coverage 2002-10 10/19/02 Proper Reporting of Uncovered Medical Liabilities and Expenses (Uncovered Claims) 2001-07 06/30/01 Deregulation of Life Insurance Forms 2001-04 04/21/01 Book Transfers 2000-04 02/26/00 The Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C., Sections 1033 and 1034 2000-03 02/19/00 Federally Mandated Health Care Fraud and Abuse Reporting 1995-09 08/23/95 Deregulation of Commercial Lines Property and Casualty Forms 1995-07 07/19/95 Modification of Contract for Use When an Annuity Premium Tax is Not Applicable 1994-14 10/03/94 Separate Account Modified Guaranteed Life Insurance 1994-13 10/03/94 General Account Modified Guaranteed Life Insurance 1994-12 10/03/94 Separate Account Modified Guaranteed Annuity 1994-11 10/03/94 General Account Modified Guaranteed Annuity 1994-09 07/07/94 Approval and Solicitation of Long Term Care Policies for Continuing Care Retirement Communities 2. Statements of Policy
• 31 Pa. Code, Chapter 67, Sections 67.41—67.45 and Appendix A, Motor Vehicle Financial Responsibility Law, Subchapter D. Adopted 05/19/1989.
• 31 Pa. Code, Chapter 89, Sections 89.451—89.474, Approval of Life, Accident and Health Insurance. Subchapter H. Statements of Policy. Adopted 02/05/1982.
• 31 Pa. Code, Chapter 90c, Sections 90c.1—90c.25, Individual Applications. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90d, Sections 90d.1—90d.9, Individual Accidental Death Benefits; Provided by Riders or Built into Policies. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90e, Sections 90e.1—90e.13, Individual IRA Endorsements for Life Insurance and Annuities. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90f, Sections 90f.1—90f.16, Individual Imminent Death/Lifetime Health Care Facility Confinement Benefits Provided as Accelerated Death Benefit or Settlements of Death Benefit; Provided by Riders or Built into Policies. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90g, Sections 90g.1—90g.16, Individual Health Care Facility Benefits Provided as Accelerated Death Benefit or Settlement of Death Benefit; Provided by Riders or Built into Policies. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90h, Sections 90h.1—90h.11, Individual Waiver of Surrender Charges for Life and Annuity Contracts Resulting From Health Care Facility Usage; Provided by Riders or Built into Policies. Adopted 01/18/1991.
• 31 Pa. Code, Chapter 90i, Sections 90i.1—90i.3, Certificates of Assumption. Adopted
03/05/1993.
• 31 Pa. Code, Chapter 119, Sections 119.1—119.26, Anti-Fraud. Adopted 08/27/1993.
• 31 Pa. Code, Chapter 120, Sections 120.1—120.5, Loss Cost Adjustment Filing. Adopted 08/27/1993.
• 31 Pa. Code, Chapter 150, Sections 150.1—150.5, Uniform Health Insurance Claim Form. Adopted 07/02/1993.
• 31 Pa. Code, Chapter 152, Sections 152.101—152.105, Preferred Provider Organizations, Primary Care Gatekeeper PPO Products. Adopted 09/27/1991.
• 31 Pa. Code, Chapter 153, Section 153.2, Permission to file accident and health, life and
annuity insert pages. Adopted 10/19/1990.
• 31 Pa. Code, Chapter 153, Section 153.3, Simplified review of company merger, assumption or
name change form and rate filing. Adopted 06/28/1991.
• 31 Pa. Code, Chapter 301, Sections 301.201—301.204, Health Maintenance Organization, Subchapter H. Point-of-Service Products Group Specific Community Rating. Adopted 09/27/1991.
• 31 Pa. Code, Chapter 301, Sections 301.301—301.321, Health Maintenance Organization, Subchapter I. Contractual Arrangements Between HMOs and IDSs. Adopted 04/05/1996.
• 31 Pa. Code, Chapter 303, Section 303.1, Out-of-State Health Maintenance Organization Investments. Adopted 03/25/1988.
Contact: Katie Merritt, Policy Director, 717-783-0652; fax 7l7-705-3873
II. OTHER
A. dministrative Hearings Office
• Digest of Automobile Policy Terminations (Act 68 and 78)
Insurance Commissioner Decisions on Automobile Insurance Administrative Hearings• Digest of CAT Fund Adjudications
Insurance Commissioner Decisions on Automobile CAT Fund Administrative Hearings• Digest of Homeowners Policy Terminations (Act 205)
Insurance Commissioner Decisions on Homeowners Insurance Administrative Hearings• Digest of Agency Terminations (Act 143)
Administrative Hearing Officer Decisions on Insurance Agency Administrative Hearings• Practice and Procedure Digest
Describes the Administrative Hearing Process
Contact: Administrative Hearings Office, 7l7-783-2126; fax 7l7-787-8781B. Office of Insurance Product Regulation and Administration
• Regulatory Procedures Manual
Internal procedures regarding drafting of regulations
Contact: Katie Merritt, Policy Director, 717-783-0652; fax 7l7-705-3873
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