Special Member Notice 2024

This notice includes important information for PerformCare members. You will find the following topics in our Special Member Notice:

We are here to help you!

PerformCare is available to answer questions you have about your behavioral health plan, your services, and your benefits. You can call anytime! We have trained staff who can help you if you need behavioral health services or if you have any questions about your plan.

We can help you:

  • Find services.
  • Find out what is covered.
  • Find information about providers.
  • Get language assistance.
  • Know what to do in case of an emergency.
  • File a complaint or grievance.

These and other topics can be found in your Member Handbook. You can download the handbook from our website. You can also call Member Services to ask for a copy.

Our mission

The core of PerformCare’s mission is to help ensure behavioral health care is available to all members, while supporting the unique needs of each individual member. PerformCare is committed to finding ways to break down any barriers to behavioral health care access and help ensure discrimination does not occur, in any form. Multicultural resources are also available.

PerformCare non-incentive statement

PerformCare and the people who work for PerformCare will not deny or reduce the number, amount of time, or type of service that a member needs because of any promised gift or money. In utilization management (UM), we use a set of guidelines to help us decide if a requested service is necessary. This is done to make sure PerformCare members get the right services and supports at the right time, in the right amount, and for as long as they need them. This is the sole reason for our decisions.

  • We do not give gifts of money or other items to the staff at PerformCare who make UM decisions that limit or stop services.
  • People who work for PerformCare make UM decisions by looking at whether the service and care are right for the member and whether the member joined HealthChoices.
  • PerformCare does not give gifts to doctors or other people for saying “no” to a member’s coverage or service.

Updating your data

PerformCare needs your help in making sure our data about your race, ethnicity, and language is correct. This is voluntary, but by providing this information you are helping us provide better services. You can call Member Services to provide your information or fill out our secure contact form.

  • Under Subject, pick Member - Race, Ethnicity, Language Updates.
  • Put your updated information into the Comments.
  • Hit Submit.

You may also voluntarily submit information on sexual orientation and gender identity (SOGI). In the secure contact form, select Member - Sexual Orientation and Gender Identification Update. We will make sure our system is up to date.

Member Services numbers for your county

Capital Area (Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties):

Member Services: 1-888-722-8646

Member Services TTY: 1-800-654-5984 or PA Relay 711

Franklin and Fulton counties:

Member Services: 1-866-773-7917

Member Services TTY: 1-800-654-5984 or PA Relay 711

Multi-language interpreter services

Language interpreter services are available at no cost. Call the Member Services number for your county for help. Read this information in other languages (PDF).

Covered in-plan services

To learn more about your mental health benefits, visit our Covered In-Plan Services page.

It explains covered services like outpatient, inpatient, drug and alcohol treatment, and partial hospitalization programs, and how to obtain those services. For more information, contact Member Services.

Provider information

As a member of PerformCare, you have the right to:

  • Obtain care from any in-network behavioral health providers you wish.
  • See another provider for a second opinion. If you are unhappy with your current provider, you can change at any time.
  • Choose a provider by using our online provider directory or calling the Member Services number for your area.
  • Ask for information about a provider, including:
    • Name, address, and phone number
    • Professional qualifications
    • Specialty
    • Board certification status

If you have special needs, such as a language request, or are hard of hearing, PerformCare can help you find the right provider.

PerformCare will help you find the closest provider to your home.

We pay the bills for services we have approved. You are not supposed to pay for any behavioral health services that we approve. If you ever get a bill from our providers, please call and tell us. You can also send the bill to: PerformCare, 8040 Carlson Road, Harrisburg, PA 17112.

If you need urgent or emergency services

An urgent situation means you or another responsible person thinks you need care before the situation turns into an emergency.

You can get care within 24 hours. Here’s what to do:

  • Call 988 to reach the Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline). Compassionate, accessible care and support is available for anyone experiencing mental health-related distress — thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.
  • Call PerformCare at the number listed for your county.
  • Contact any PerformCare provider.
  • Call the Crisis Intervention number for your county:

Cumberland County Crisis

  • 717-763-2222

Dauphin County Crisis

  • 717-232-7511

Franklin County Crisis

  • 717-264-2555

Fulton County Crisis

  • 717-264-2555

Lancaster County Crisis

  • 717-394-2631

Lebanon County Crisis

  • 717-274-3363

Perry County Crisis

  • 717-243-6005

If the provider cannot see you within 24 hours, they will contact PerformCare. We will help you get the care you need. If you feel unsafe to the point where you think you may harm yourself or others, then you may need mental health inpatient care. Go directly to the nearest ER.

Call 911 or the local crisis number if you cannot remain safe until you get to the nearest ER. You do not need to call us first for approval.

Out-of-town emergency care

If you are away from home and have a behavioral health emergency or a life-threatening situation, go to a hospital emergency room. We will pay for your behavioral health services if you have to go into the hospital. Please let the hospital know you are a member of PerformCare and which county you live in. Ask the hospital to call PerformCare as soon as possible to let us know about the emergency. You should not get a bill. Please call us right away if you do get a bill.

Out-of-network care

If you are already getting behavioral health treatment and have enrolled in HealthChoices, you might not need to go to a different provider. Ask your provider if they are part of PerformCare’s network. If your provider is in the network, you do not need to do anything else. If they are not in the network, call PerformCare at our toll-free number and tell us. You can find the PerformCare number for your county on our contact information page and in your Member Handbook.

Remember: PerformCare will make every effort to ensure our provider network can provide all covered services for all members, including special needs populations. PerformCare will use out-of-network providers if the available network cannot provide covered services under any of the following conditions:

  • The member has special needs that cannot be accommodated by the network.
  • Network services are not accessible within time or geographic standards but are available through a qualified non-network provider.
  • The member has experienced a behavioral health emergency while outside of PerformCare’s service area.

PerformCare will contract on a case-by-case basis with non-participating providers, using our existing rates to pay for care. If you are unsure if your provider is in the PerformCare network, call us and we can tell you. Our goal is to not interrupt your treatment.

Transition periods

If you are being treated by a provider and become enrolled with HealthChoices while you are getting treatment, PerformCare may be able to pay the provider for the service for an amount of time known as a “transition period.” This allows for transition time before asking you to change to another provider who is in the PerformCare network. Transition payments can only be paid to Pennsylvania Medicaid-enrolled providers.

Self-management tools

PerformCare cares about our members’ health and wellness. Our website has information about self-management tools that can help you manage your own physical and behavioral health issues. Taking an active part in managing your own health problems is important to recovery.

PerformCare has provided some information and tools to help you screen for problems, reduce your risk, manage your symptoms, and improve your health. PerformCare also offers links to other helpful websites. The self-management tools are based on the latest research and are updated regularly. Our materials are also available in paper form and can be requested by calling Member Services.

Member portal

PerformCare provides a member portal. You have the right to view your health information from PerformCare. Learn more about the portal.

If you do not want to sign up for the portal, but still want to keep physical and behavioral health information in one area, there are also online personal health record links available. Learn more about online personal health records.

Prevention programs

PerformCare created two prevention programs to help our members see early signs and symptoms of certain disorders. One program is for early identification of attention deficit hyperactivity disorder. The second program is for early identification of substance use issues of members with bipolar disorder. Learn more about these programs.

Community resources

If you are experiencing food or clothing shortages, housing issues, or other financial concerns, these community agencies may be able to help you.

Privacy

Privacy rights statement

PerformCare’s Notice of Privacy Practices (PDF) describes how medical information about you may be used and disclosed and how you can access this information. This information is also in the back of your Member Handbook.

We also have an online and mobile communication privacy notice.

Your privacy rights

You have the right to:

  • Get a copy of your health and claims records.
  • Correct your health and claims records.
  • Request confidential communication.
  • Ask us to limit the information we share.
  • Get a list of those with whom we’ve shared your information.
  • Get a copy of this privacy notice.
  • Choose someone to act for you.
  • File a complaint if you believe your privacy rights have been violated.

Your choices

You have some choices in the way we use and share information as we:

  • Answer coverage questions from your family and friends.
  • Provide disaster relief.
  • Communicate through mobile and digital technologies.
  • Market our services and sell your information.

Our uses and disclosures

We may use and share your information as we:

  • Help manage the health care treatment you receive.
  • Run our organization.
  • Pay for your health services.
  • Administer your health plan.
  • Coordinate your care among various health care providers.
  • Help with public health and safety issues.
  • Do research.
  • Comply with the law.
  • Respond to organ and tissue donation requests and work with a medical examiner or funeral director.
  • Address workers’ compensation, law enforcement, and other government requests.
  • Respond to lawsuits and legal actions.

How we protect your information

We are dedicated to safeguarding your protected health information (PHI). We set up policies and procedures to make sure your PHI is secure. We keep your oral, written, and electronic PHI safe using physical, electronic, and procedural means. These safeguards follow federal and state laws.

Some of the ways we keep your PHI safe include offices that are kept secure, computers that need passwords, and locked storage areas and filing cabinets. We have written policies and procedures requiring our employees to protect PHI. The policies limit access to PHI to only those employees who need the data to do their jobs. Employees are also required to wear ID badges to keep unauthorized people out of areas where sensitive data, such as PHI, are kept.

Also, where required by law, our affiliates and non-affiliates must protect the privacy of data we share in the normal course of business. They are not allowed to give PHI to others without your written OK, except as allowed by law.

Mental health directives

A mental health directive, also known as a psychiatric advance directive, is a document that allows you to state the mental health care you want if you become physically or mentally unable to decide for yourself. There are two types of mental health advance directives: Mental Health Declarations and Mental Health Powers of Attorney.

If you have either a Mental Health Declaration or a Mental Health Power of Attorney, you should give it to your mental health care providers and a trusted family member or friend so that they know your wishes.

If the laws regarding Mental Health Declarations and Mental Health Powers of Attorney are changed, PerformCare will tell you in writing what the change is within 90 days of the change.

For information on PerformCare’s policies on Mental Health Declarations and Mental Health Powers of Attorney, call Member Services at 1-888-722-8646 (Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties) or 1-866-773-7917 (Franklin and Fulton counties). You can also visit our Psychiatric Advance Directives page.

Complaints and grievances

If you are unhappy with PerformCare or your provider, or you do not agree with a decision PerformCare made about the delivery of your care, you can do something about it by filing a complaint or a grievance. There is no cost to file. If you prefer, you can also choose someone to file on your behalf.

  • For more details, please refer to your Member Handbook.
  • You can also visit our Complaints and Grievances page.
  • You can contact PerformCare’s Complaints and Grievances department at 1-888-722-8646 (Capital Area) or 1-866-773-7917 (Franklin and Fulton counties). You can also email performcarecg@performcare.org.

What is a complaint?

A complaint is when you tell us you are unhappy with PerformCare or your provider, or you do not agree with a decision made by PerformCare. Here are some examples of a complaint:

  • You are unhappy with the care you are getting.
  • You are unhappy that you cannot get the service you want because it is not a covered service.
  • You are unhappy that you have not received services you have been approved to receive.

What is a grievance?

A grievance is what you file when you do not agree with PerformCare’s decision that a service you or your provider asked for is not medically necessary or appropriate. You can file a grievance if PerformCare does any of these things:

  • Denies a service you have requested fully or denies part(s) of a service you requested
  • Denies, suspends, or terminates a service you have been receiving
  • Approves less than what was asked for
  • Approves a different service from the one that was asked for

PerformCare’s providers must provide services within seven days for routine appointments and specialty referrals. If a treatment plan is approved, services must be provided according to the prescribed treatment plan.

Consumer representatives

PerformCare is looking for consumer representatives to give input into the decisions about grievances and complaints filed by fellow PerformCare members.

We are looking for adult PerformCare members who have received services in the past or who are currently receiving services.

Parents or guardians of PerformCare members who have received services in the past or who are currently receiving services are also needed.

PerformCare will train you, work around your availability, and reimburse you with an hourly wage for your time.

For more information, contact the Complaints and Grievances department at 1-888-722-8646 (Capital Area) or 1-866-773-7917 (Franklin and Fulton counties). You can also email performcarecg@performcare.org.

Member rights and responsibilities

As a member of PerformCare, you have rights and responsibilities, which are listed below. We invite you to call us using the toll-free number for your county if you need help understanding your rights and responsibilities. Your rights and responsibilities are also in your handbook.

You have the right to:

  • Receive information. Each member has the right to receive information about PerformCare, our policies and procedures, our services, our practitioners and providers, and your rights and responsibilities.
  • Dignity and privacy. Each member is guaranteed the right to be treated with respect and with due consideration for their dignity, right to privacy, and right to confidentiality. Exercising your rights will not affect how you are treated by providers, PerformCare, or the Department of Human Services.
  • Receive information on available treatment options. Each member is guaranteed the right to receive information on medically necessary available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand, regardless of cost or benefit coverage. Each member can also get information about what PerformCare and providers do not cover because of moral or religious reasons.
  • Participate in decisions. Each member is guaranteed the right to participate in decisions regarding their behavioral health care, including the right to refuse treatment. You can be a part of your treatment team by asking questions and getting answers before and during your treatment and by involving family members and other important people in your treatment.
  • Decline treatment. Each member can decline treatment as part of making decisions regarding their care. You have the right, under these circumstances, to get an explanation of what may happen if you don’t get treatment.
  • Ask for a therapist who understands your language and culture.
  • Receive needed services at convenient times and places.
  • Receive emergency care within one hour.
  • Receive urgent care within 24 hours.
  • Receive care within seven days of your request for routine care requests.
  • Be free from restraint or seclusion used to force you to do something, to discipline you, to make it easier for the provider, or to punish you.
  • Voice complaints or appeals about the organization or the care it provides.
  • Make recommendations regarding the organization’s member rights and responsibilities policy.

You are responsible for:

  • Supplying information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
  • Following plans and instructions for care that you have agreed to with your practitioners.
  • To the degree possible, understanding your health problems and participating in developing mutually agreed-upon treatment goals.

PerformCare providers must provide services within seven days for routine (non-emergency) needs, within 24 hours for urgent situations, and within one hour for an emergency situation.

Non-Discrimination Notice

Read our Non-Discrimination Notice (PDF).

Members