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PA Bulletin, Doc. No. 01-1516



Ongoing List of Behavioral Health Managed Care Organizations

[31 Pa.B. 4598]

   The Department of Public Welfare's (Department) is maintaining an ongoing list of qualified behavioral health managed care organizations (BH-MCO) as potential contractors for the HealthChoices Behavioral Health Program (HCBHP) and requesting new submissions for consideration. 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. HCBHP is a mandatory managed care program for Medicaid recipients in this Commonwealth. Additional information about HCBHP is available at the Department's website www.dpw.

   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 a RFP process fails the Readiness Review process; or

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

   As stated in the previous announcement, the list of qualified BH-MCOs will be opened periodically for new submissions. New submissions are being requested from MCOs not currently included on the list. MCOs selected for the list of qualified bidders will remain active on the list for 2 years. After 2 years they will be required to resubmit information.

   The following is a list of requirements necessary to qualify as a potential HCBHP 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 Departments of Health and Insurance of the Commonwealth.

   *  Management Information System (MIS) experience in processing UB 92 and HCFA 1500 forms.

   *  MIS capacity to produce person-level encounter data in compliance with the HCBHP requirements.

   To apply as a potential HCBHP contractor, submit a letter of interest on official corporate letterhead by September 28, 2001, to Karen Rosenthal, Office of Mental Health and Substance Abuse Services, Room 236, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105. Letters may be faxed to (717) 772-7964.

   Submit the following information to the Department of Public Welfare, Division of Procurement, P. O. Box 2675, Room 106, Health and Welfare Building, Commonwealth and Forster St., Harrisburg, PA 17105-2675 by 2 p.m. October 26, 2001.

List of Deliverables:

   1.  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.

   2.  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.

   3.  Provide a flow chart of the MIS.

   4.  Provide a file layout/specification of a person-level encounter report.

   5.  Provide a copy of current Commonwealth license from the Departments of Health and Insurance.

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

   7.  Provide a copy of the most recent annual audited 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 MCOs operations (one must provide 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 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 HCBHP contract.

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

   *  Release a procurement document that contains the requirements for the HCBHP 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 HCBHP contract in the remainder of the State. The procurement process for the Northeast, Northwest, Southwest Expansion and the Central zones will follow the same procedure as followed in the Southeast, Southwest and Lehigh/Capital zones, which required a response to a RFP.

   Any questions may be directed to Raymond Klabe, Office of Mental Health and Substance Abuse Services, Room 247, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105, (717) 772-7984, fax:  (717) 772- 7964.

   Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD Users) or (800) 654-5988 (Voice Users). Persons who require an alternate format should contact Thomas Vracarich, Office of Legal Counsel, (717) 783-2209.


[Pa.B. Doc. No. 01-1516. Filed for public inspection August 17, 2001, 9:00 a.m.]

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