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PA Bulletin, Doc. No. 07-1676



Ongoing List of Behavioral Health Managed Care Organizations

[37 Pa.B. 4952]
[Saturday, September 8, 2007]

   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 (HCBHP). New submissions are being requested, from 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. HCBHP is a mandatory managed care program for Medicaid recipients in this Commonwealth. Additional information about HCBHP is available at the Department's website

   The list of qualified BH-MCOs would be utilized in the following circumstances including:

   *  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 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. 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 for consideration to remain on the list.

   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 Department of Health and Insurance Department.

   *  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 by September 24, 2007, to Mike Root, Office of Mental Health and Substance Abuse Services, Room 238, DGS Complex Annex, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105, fax (717) 772-7964.

   Submit the following information by 2 p.m. on October 8, 2007, to the Department of Public Welfare, Attention Daniel Boyd, Division of Procurement, Room 525, Health and Welfare Building, Commonwealth and Forster Streets, Harrisburg, PA 17120.

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 evidence of capacity to submit HIPAA compliant 837 files.

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

   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 this Commonwealth. The procurement process for the expansion of HealthChoices the HCBHP into future zones will follow a similar procedure as established in the Southeast, Southwest Lehigh/Capital, Northeast, North Central State Option and North Central County Option zones which required a response to an RFP.

   Questions should be directed to Mike Root, Office of Mental Health and Substance Abuse Services, Room 238, DGS Complex Annex, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105, (717) 772-7992, fax (717) 772-7964.

   Persons with a disability who require an auxiliary aid or service should submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5984 (voice users).


[Pa.B. Doc. No. 07-1676. Filed for public inspection September 7, 2007, 9:00 a.m.]

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