Policies and Notices

PerformCare policies and procedures

PerformCare policies posted to this website are updated semi-annually. It is possible a more current version of a policy is available. Please contact your Account Representative or Care Manager for such policy inquiries.

Corporate compliance

•CC-001: Reporting Suspected Provider Fraud, Waste, and Abuse (PDF) September 13, 2018

Attachments

CC-001-01: Attachment 1: MCO Fraud, Waste, and Abuse Reporting Requirements (PDF) September 13, 2018
CC-001-02: Attachment 2: BPI MCO Referral Form (PDF) September 13, 2018
CC-001-03: Attachment 3: BPI MCO Referral Supporting Documentation Checklist (PDF) September 13, 2018

•CC-002: Fraud, Waste, and Abuse Program (PDF) September 5, 2017

Attachments

CC-002-01: Attachment 1: MCO Fraud, Waste, and Abuse Reporting Requirements (PDF) September 5, 2017
CC-002-02: Attachment 2: BPI MCO Referral Form (PDF) September 5, 2017
CC-002-03: Attachment 3: Fraud, Waste, and Abuse (FWA) Plan (PDF) September 5, 2017

•CC-003: Provider Audits Conducted by the Special Investigation Unit (PDF) December 21, 2018

Attachments

CC-003-01: Attachment 1: Special Investigation Unit Recovery Audit Spreadsheet (PDF) December 21, 2018
CC-003-02: Attachment 2: Case Summary Report (PDF) December 21, 2018
CC-003-03: Attachment 3: Special Investigation Unit Recovery Letter (PDF) December 21, 2018

•CC-005: Provider Dispute Policy (PDF) June 8, 2018

Attachments

CC-005-01: Attachment 1: Special Investigation Unit Audit Spreadsheet (PDF) June 8, 2018
CC-005-02: Attachment 2: Special Investigation Unit Overpayment Letter (PDF) June 8, 2018
CC-005-03: Attachment 3: Special Investigation Unit First-Level Dispute Response Letter (PDF) June 8, 2018
CC-005-04: Attachment 4: Special Investigation Unit Second-Level Dispute Response Letter (PDF) June 8, 2018

•CC-006: Payment Adjustments for Provider-Preventable Conditions Including Health Care-Acquired Conditions (HCACs) (PDF) September 11, 2018

Attachments

CC-006-01: Attachment 1: Federal Register: Medicare Programs; Payment Adjustment for Provider-Preventable Conditions Including Health Care-Acquired Conditions (PDF) September 11, 2018
CC-006-02: Attachment 2: Medical Assistance Bulletin: Provider-Preventable Conditions (PDF) September 11, 2018
CC-006-03: Attachment 3: Medicare/Medicaid HCACs for FY 2011 (PDF) September 11, 2018

•CC-012: Recipient Verification of Services (PDF) September 11, 2018

Attachment

CC-012-01: Recipient Verification of Services Sample Recipient Verification Letter (PDF) September 11, 2018

Care management

•CM-006: Documentation Standards for Providers (PDF) July 1, 2007

Attachment

CM-006-02: Mental Health Targeted Case Management (TCM) Documentation Requirements (PDF)

•CM-007: Service Denial Behavioral Health Inpatient Services (PDF) November 19, 2018

•CM-009: Use of IQ and Adaptive Functioning Testing to Diagnose Mental Retardation (PDF) January 1, 2004

Attachments

CM-009-02: Attachment 2: Office of Mental Health and Substance Abuse Services Policy Clarification — #02-04 (PDF)
CM-009-03: Attachment 3: Office of Mental Health and Substance Abuse Services Policy Clarification — #03-03 (PDF)

•CM-011: Clinical Care Management Decision Making (PDF) November 19, 2018

•CM-012: Authorization of Psychological and Neuropsychological Testing (PDF) November 6, 2018

Attachments

CM-012-01: Attachment 1: Psychological and Neuropsychological Testing Request Form (PDF) November 6, 2018
CM-012-02: Attachment 2: Guidelines for Psychological Testing (PDF) November 21, 2018
CM-012-03: Attachment 3: Guidelines for Psychological/Neuropsychological Tests and Times For Administration, Scoring, Interpretation, and Report (PDF) November 21, 2018

•CM-013: Denial Notice Procedure (PDF) December 1, 2006

•CM-019: Bed Hold Payment and Therapeutic Leaves (PDF) December 1, 2006

•CM-020: Provider Notification to PerformCare of Inpatient Stays When Member Has Other Primary Insurance (PDF) January 1, 2004

•CM-024: Peer Support and Peer Support Waiver Exceptions (PDF) July 2, 2014

Attachment

CM-024-01: Attachment 1: Peer Support Authorization Request (PDF)

•CM-028: Authorization Requests for Preauthorized Drug and Alcohol Services (PDF) February 14, 2012

•CM-029: Authorization Requests for Drug and Alcohol Hospital and Non-Hospital-Based Detoxifications (PDF) April 11, 2012

•CM-034: Emergency Services Coverage Reimbursement (PDF) July 24, 2003

•CM-036: Mental Health/Substance Abuse Targeted Case Management Initial and Reauthorization Requests and Discharges (PDF) May 20, 2008

•CM-037: Mental Health/Substance Abuse Targeted Case Management Reimbursable and Non-Reimbursable Services (PDF) August 15, 2018

•CM-039: Targeted Case Management Contact Expectations (PDF) June 9, 2008

•CM-040: Targeted Case Management Role Expectations (PDF) July 1, 2008

•CM-042: Continued Stay Review Process (PDF) July 1, 2014

•CM-043: Authorization Requests for Preauthorized Mental Health Services (PDF) February 14, 2012

•CM-045: Prior Authorization Requests for Electroconvulsive Therapy (ECT) (PDF) April 10, 2012

•CM-046: Psychiatric Rehabilitation (PDF) December 1, 2016

Attachment

CM-046-01: Attachment 1: Psychiatric Rehabilitation Form (PDF)

•CM-047: Authorization and Delivery of Music Therapy Services (PDF) November 13, 2017

Attachments

CM-047-01: Attachment 1: Music Therapy Request Form (PDF)

•CM-048: Functional Behavior Assessment (FBA) (PDF) October 18, 2018

•CM-CAS-010: Interagency Services Planning Teams — Community Rehabilitation Host Home (CRR-HH) and Residential Treatment Facility (RTF) (PDF) October 1, 2005

•CM-CAS-029: Completion and Submission of Best Practice Evaluations and Continued Care Evaluations (PDF) September 13, 2018

•CM-CAS-044: Procedure to Request Additional Service Units During an Authorization Period and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) February 4, 2019

•CM-CAS-047: Pre-Discharge Planning Meeting Requirements for Residential Treatment Facility (RTF) (PDF) October 23, 2018

•CM-CAS-048: Pre-Discharge Planning Meeting Requirements for Community Residential Rehabilitation (PDF) October 23, 2018

•CM-CAS-050: Community Rehabilitation Host Home (CRR-HH) November 15, 2017 (PDF) November 15, 2017

•CM-CAS-051: Procedure for Prior Authorization and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) November 15, 2017

Attachments

CM-CAS-051-01: Attachment 1: FBMHS Referral Form (PDF) November 15, 2017
CM-CAS-051-02: Attachment 2: FBMHS Treatment Review Update Form (PDF) November 15, 2017
CM-CAS-051-03: Attachment 3: FBMHS Interagency Service Planning Team Meeting Form (PDF) November 15, 2017
CM-CAS-051-04: Attachment 4: FBMHS Prescription Letter (PDF) November 15, 2017

•CM-CAS-052: FBMSHS Provided Concurrently with BHRS (PDF) October 23, 2018

•CM-MS-003: Outpatient Treatment Requests, Denials, and Authorizations (PDF) October 16, 2003

Contact Center

•CC-CG-002: Provider Complaint Process (PDF) June 11, 2015

Provider relations

•PR-001: Service Authorization Procedures and Standards for Out-of-Network Providers (PDF) December 21, 2008

•PR-005: Payment Authorization Procedures (PDF) October 19, 2017

•PR-014: Assessment of Provider Cultural Sensitivity (PDF) February 22, 2018

Attachments

PR-014-01: Attachment 1: PerformCare Initial and Recredentialing Site Visit Form (PDF) February 22, 2018
PR-014-02: Attachment 2: PerformCare Part II Credentialing Site Visit Form (PDF) February 22, 2018
PR-014-03: Attachment 3: PerformCare Provider Self Site Review Form (PDF) February 22, 2018

•PR-015: Distribution of Medical Necessity Criteria to PerformCare Providers (PDF) February 22, 2018

•PR-016: DHS Notification of Drop in Provider Capacity (PDF) March 28, 2018

•PR-019: Processing Provider MA Enrollment Applications (Supplemental Services and Out of Network) (PDF) April 30, 2018

•PR-020: Routine and Non-Routine Site Visits (PDF) April 30, 2018

•PR-023: Advance Directives (PDF) May 8, 2018

•PR-025: PerformCare Position on the Bundling of Psychiatric Services (PDF) May 8, 2018

•PR-026: Provider Rate Setting (PDF) May 14, 2018

Attachments

PR-026-01: Attachment 1: PerformCare Rate Request Form (PDF) May 14, 2018
PR-026-02: Attachment 2: RTF Criteria and Rate-Setting Tools (PDF) May 14, 2018

•PR-027: Interpreter Costs in Service Delivery (PDF) May 8, 2018

•PR-028: Requirements for School-Based Outpatient Services (PDF) May 7, 2018

•PR-029: Expansion Request Process for State Plan Service for Providers (PDF) May 23, 2018

•PR-032: Provision of Reasonable Access to BHS Provided by FQHC Within Access Travel Guidelines (PDF) May 23, 2018

Quality improvement

•QI-006: Monitoring Plan for Service Transitions (PDF) October 24, 2018

•QI-014: Member and Provider Satisfaction Surveys (PDF) October 24, 2018

•QI-019: Provider Profiling Reports (PDF) August 7, 2018

•QI-026: Provider Treatment/Service Record Reviews (PDF) August 10, 2018

•QI-040: Evaluator Monitoring (PDF) October 1, 2015

•QI-042: Six-Criteria Complaint Policy (PDF) August 22, 2018

Attachment

QI-042-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018

•QI-043: Dissatisfaction Complaint Policy (PDF) August 22, 2018

Attachment

QI-043-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018

•QI-044: Grievance Policy (PDF) August 22, 2018

Attachment

QI-044-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018

•QI-CIR-001: Critical Incident Reporting (PDF) February 2, 2018

Attachments

QI-CIR-001-01: Attachment 1: Critical Incident Report Form (PDF) February 2, 2018
QI-CIR-001-02: Attachment 2: Provider-Preventable Conditions (PDF) February 2, 2018

•QI-CIR-002: Sentinel Event Review (PDF) January 22, 2018

•QI-CIR-003: Restraint and Seclusion Monitoring (PDF) January 22, 2018

Attachment

QI-CIR-003-01: Attachment 1: Report of Restraint or Seclusion Form (PDF) January 22, 2018

•QI-CIR-001: Credentialing and Recredentialing Criteria — Facilities (PDF) August 10, 2017

Attachments

QI-CR-001-01: Attachment 1: PerformCare Site Visit Tool (PDF) August 10, 2017
QI-CR-001-02: Attachment 2: Recredentialing Provider Summary (PDF) August 10, 2017
QI-CR-001-03: Attachment 3: Facility Credentialing and Recredentialing Application (PDF) August 10, 2017

•QI-CR-002: Credentialing and Recredentialing Criteria — Practitioners (PDF) December 21, 2018

Attachments

QI-CR-002-01: Attachment 1: PerformCare Site Visit Tool (PDF) December 21, 2018
QI-CR-002-02: Attachment 2: Recredentialing Provider Summary (PDF) December 21, 2018

•QI-CR-003: Credentialing Progressive Disciplinary Action for Providers (PDF) December 21, 2018

Attachments

QI-CR-003-01: Attachment 1: Referral to Credentialing Committee Form Template (PDF) December 21, 2018
QI-CR-003-02: Attachment 2: Oversight Agreement Form Template (PDF) December 21, 2018

•QI-CR-005: Credentialing Committee (PDF) November 28, 2018

Attachment

QI-CR-005-01: Attachment 1: Credentialing Committee Confidentiality and Non-Discrimination Statements (PDF) November 28, 2018

•QI-SIU-001: Development and Monitoring of Quality Improvement Plans (QIPs) Issued by the Special Investigation Unit (PDF) June 8, 2018

Attachments

QI-SIU-001-01: Attachment 1: Special Investigation Unit QIPs Monitoring Log (PDF) June 8, 2018
QI-SIU-001-02: Attachment 2: QIP Approval Letter Template (PDF) June 8, 2018

PerformCare provider notices

Administrative

2015

AD 15 100: Process Change for OP Requests Requiring MNC or Registration (PDF)
AD 15 101: Behavioral Health Screening Programs (PDF)
AD 15 102: Treatment Record Review and Risk Assessment (PDF)
AD 15 106: Enhanced Care Management (ECM) Program (PDF)
PC-13: Collaborative Documentation (PDF)
- 45-PC 02-14-01: Compensation & Progress Notes (PDF)
  Providers of Peer Support Services should review the policy clarification 45-PC 02-14-01 which was released by the Office of Mental Health and Substance Abuse Services Bureau of Policy, Planning and Program Development on April 16, 2014. This policy clarification contains important information about billing and time spent completing progress notes.
AD 15 108: Quality Improvement Resources Available on PerformCare Website (PDF)

2014

AD 14 105 OMHSAS 14-03: Bulletin ACA Re-enrollment Requirement (PDF)
- AD 14 105 Att 1: OMHSAS Bulletin On MA Enrollment (PDF)
- AD 14 105 Att 2: OMAP Bulletin Re-enrollment 99-14-06 (PDF)
AD 14 107: PerformCare Harrisburg Mailing Address Change (PDF)

2013

AD 13 103R: NCCI Claims Edits (PDF)
PC-02: Mobile Crisis Intervention (PDF)
PC-03: Mental Health Targeted Case Management (TCM) Transportation Clarification (PDF)
PC-04: TCM Concurrent Billing With PH-BH Appointments (PDF)
PC-06: Electronic Signatures (PDF)

2012

AD 12 100: Common Problem Areas and Provider Performance Reports (PDF)
AD 12 112: 2013 CPT Code Update Implementation (PDF)

2011

AD 11 109: Clarification of Payment Policy (PDF)
Day of admission and day of discharge for inpatient services
AD 11 115: MA Bulletin 99-11-05 (PDF)
"Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation"

2010

AD 10 002: Coordination With Crisis Intervention Services (Capital Area) (PDF)
AD 10 006: Billable Reportable Time (PDF)
AD 10 110: Compliance and Billing Reminders (PDF)
MH partial hospitalization, MH outpatient, CRR, BHRS, FBMHS and concurrent services

2009

AD 09 109: Provider Corporate Compliance Initiatives and OMAP Bulletin 99-02-13 (PDF)
AD 09 111: Additional Fraud and Abuse Requirements (PDF)
per Section 6034 of the Deficit Reduction Act

2004

AD 04 003: Notification Requirements for PerformCare as Secondary Payer (PDF)

2002

AD 02 012: EVS and Authorization Requirements (PDF)
AD 03 001: Naming Conventions for Provider Communications (PDF)

Behavioral Health Rehabilitation Services (BHRS)

2019

BHRS 19 100: Child/Adolescent Strengths and Needs (CANS) and Initial BHRS Request Submissions (PDF)
BHRS 18 100: Differential Reimbursement of TSS with the RBT Credential (PDF)
BHRS 17 102: Use of HP Modifier for BSC Services for Individuals with BCBA Credential (PDF)

2017

BHRS 17 106: Behavioral Health Rehabilitation Services (BHRS) Exception Reporting (PDF)
BHRS 17 105: Addendum Submission Process (PDF)
BHRS 17 104: Best Practice Evaluation Submission Process (PDF)
PC-20: Medicaid Enrollment of Ordering, Referring and Prescribing (ORP) Providers and Expected Impact on BHRS (PDF)
BHRS 17 103: Revised Default School TSS Start/End Date Methodology (PDF)
BHRS 17 101: Initial BHRS Authorization Monitoring Process (PDF)
BHRS 17 100: Psychologist Attestations, BHRS Prescriptions, and Best Practice Evaluations (PDF)

2016

BHRS 16 102: CPT Codes and Modifiers for Applied Behavioral Analysis (ABA) Services (PDF)
BHRS 16 101: ProviderConnect Best Practice Evaluations and Evaluator Participation in Interagency Service Planning Team (ISPT) Meetings (PDF)
AD 16 105: Capital area Child and Adolescent Needs and Strengths (CANS) Assessment Retroactive Payments (PDF)
BHRS 16 100: Revised Functional Behavioral Assessment (FBA) Request Process (PDF)
- CM-048: Functional Behavioral Assessment (FBA) (PDF)

2015

BHRS 15 100: Prescription Event Notice (PDF)

Prescription Event Instructions (PDF)

BHRS 15 101: Act 62 and Primary Insurance Process Update (PDF)
BHRS 15 102: ProviderConnect® Evaluation Event Update (PDF)

2014

AD 14 106: BHRS and FBMHS Provider Capacity Mandatory Reporting (PDF)
BHRS 14 101: BSC ASD Services Modifier (PDF)

2013

BHRS 13 100: ISPT Meeting Event (PDF)
BHRS 13 102: Electronic Packet Submission (PDF)
BHRS 13 003: Changes to FBA Authorizations (PDF)
PC-05: BHRS Program Director Qualifications and BSC/MT Progress Note Sign Off (PDF)

2012

MH 12 102: Residential Treatment Facilities (RTF) as a Comprehensive Service (PDF)

2011

AD 11 117: OMHSAS Policy Regarding BSC Education Requirements and Applicability (PDF)
BHRS 11 100: Therapeutic Staff Support (TSS) and Mobile Therapy (MT) Billing Increments (PDF)
Effective March 1, 2011
BHRS 11 101: TSS Schedule and CM-CAS-049 Policy Revision (PDF)
Not applicable for Franklin/Fulton County members
BHRS 11 102 BHR Authorization Periods, Submission Timelines and TRR (PDF)
BHRS 11 104 Updated Rural ZIP Code List (PDF)
Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties

2010

BHRS 10 001: CRR Host Home Incidents of AWOL (Absent Without Leave) (PDF)
BHRS 10 102: Best Practice Evaluation and Elimination of Specialized Evaluator Program (PDF)
Effective May 1, 2010
BHRS 10-003: Developmental Disorder (DD) Extended Authorization Concurrent Reviews (PDF)
BHRS 10 107: Therapeutic Staff Support (TSS) Training and Supervision Requirements (PDF)

2009

AD 09 101: Primary Insurance Coverage REVISED for Act 62 (PDF)
BHRS 06 000R: BHRS and Exception Service Unit Calculation (PDF)
BHRS 09 000: Authorization and Billing for Functional Behavior Analysis (FBA) (PDF)
BHRS 09 000: Clarification on Conducting Functional Behavioral Assessment (FBA) (PDF)
BHRS 09 000: Process for Transferring TSS Hours to Home and Community Setting (PDF)
BHRS 09 102: Program Exception Services - Attestation (PDF)
BHRS 09-104: BHRS Authorizations for Services In the School Setting (PDF)

2007

Attending Grievance Meetings (PDF)

Claims

2017

AD 17 107: New NaviNet Electronic Claim Inquiry Enhancement (PDF)
AD 17 106: Clarification of Rejected and Corrected Claim Rules (PDF)
AD 17 105: NaviNet Authorization and Claims Reports for Providers (PDF)
AD 17 101: Timely Filing of Claims Requirements for all Behavioral Health Services of Somerset and Bedford Counties (PDF)
AD 17 101: Timely Filing of Claims Requirements for all Capital Area Behavioral Health Collaborative (PDF)
AD 17 101: Timely Filing of Claims Requirements for all Tuscarora Managed Care Alliance (PDF)

2016

AD 16 102: Additional Pre-payment Claims Edits for Duplicate/Disallowed Services (PDF)
PC-18 FQHC/RHC Prospective Payment System (PDF)

2015

AD 15 107: HIPAA 5010 X12 Format Requirements (PDF)
AD 15 104: Remittance Advice Update (PDF)
PC-17: Pharmacogenomics Tests for Psychiatric Medications (PDF)

2014

AD 14 101: New 1500 Claim form Corrected Claims March 2014 (PDF)

2013

AD 12 110R: Electronic Submission of Corrected Claims (PDF)
AD 13 103R: NCCI Claims Edits (PDF)
PC-14: Provider Memo TCM Billing for Records Review (PDF)

2011

AD 11 104: Claims Submission and POS 03 for Services Provided In Schools Reminder (PDF)
AD 11 107: NPI (National Provider Identifier) and Claims Submission Reminder (PDF)
AD 11 108: Claims Submission and POS 50 In Federally Qualified Health Centers (FQHC) (PDF)
AD 11 111: Change In Mailing Address and Handling of Paper Claims (PDF)
AD 11 114: EMDEON Payer ID for Electronic Claims (PDF)
AD 11 113: Transition to EMDEON for ERA and EFT (PDF)

2010

AD 10 109: Claims Submission and POS 03 for Services Provided in Schools (PDF)

2009

AD 09 102: Faxed Claims No Longer Accepted (PDF)

Family-based mental health services

2017

MH 17 100: Improving Family Based Mental Health Services 7-Day Routine Access (PDF)

2014

AD 14 106: BHRS and FBMHS Provider Capacity Mandatory Reporting (PDF)
PC-15: Billing for FBMH No Shows (PDF)

2012

FBMH 12 100: Family-Based Mental Health Services Update (PDF)

2008

FBMH 08 000: Clarification of Family-Based Mental Health Services Billing for Travel Time (PDF)

2004

FBMH 04 002: FBMHS Coordination and Reporting (PDF)

Inpatient

2017

PC-21: Clock Time Requirements for Inpatient Psych Services – Revised (PDF)

2014

AD 14 100: Verification of Psychiatric and Substance Abuse Inpatient Rehab Hospital Admission (PDF)
AD 14 102: Change In Initial Assessment Continued Stay and Discharge (PDF)
- AD 14 102A: UM MH (PDF)
- AD 14 102B: UM SA (PDF)
- AD 14 102C: MSS Bedsearch (PDF)
AD 14 104: Change In UM Contact Process (PDF)

2013

PC-11: CRNP for Inpatient Hospital Care v.3 (PDF)

2011

AD 11 101: Federal Regulations 42, CFR Subpart D Related to JCAHO Accreditation (PDF)
Final ruling

2010

MH 10 106: MH IP Discharge Planning and Member Letter (PDF)

2009

Referral to Peer Support Services at Discharge From Inpatient Unit (PDF)

2008

MH 08 000: Psychiatric Inpatient Admissions for Member on a Medical Floor (PDF)

2003

AD 03 003: Blood Alcohol Levels and Level of Care Determinations (PDF)

Outpatient and other

2018

MH 18 100: Partial Hospitalization Continued Stay and Discharge Process (PDF)

2017

MH 17 101: Eliminating the Distinction of Acute vs. Non-Acute Partial Hospitalization (PDF)
PC-19: Medicaid Enrollment of Ordering, Referring, and Prescribing Providers (PDF)

2016

MH 16 101: Trauma-Focused Cognitive Behavior Therapy (TF-CBT) Modifier (PDF)
MH 16 100: New CPT Code 96127 Brief Emotional-Behavioral Assessment (PDF)

2015

AD 15 100: Process Change for OP Requests Requiring MNC or Registration (PDF)

2014

MH 14 100: Assertive Community Treatment Code Changes (PDF)
- MH 14 100A: Assertive Community Treatment ACT Authorization form (PDF)
AD 14 103: Outpatient Codes for Initial Services BS Level in Standard (PDF)

2013

PC-07: MH-OP Treatment Plan No Show v.2 (PDF)
PC-09: OP Treatment Plan Frequency v.2 (PDF)
PC-12: Physician Services In MH OP Clinics (PDF)

2011

MH 11 100: Utilization of FBAs In a Partial Hospital Program (PDF)

2010

MH 10 102: Addition of Interactive Telecommunications Modifier for Peer Support (PDF)
per revised bulletin OMHSAS-09-07
MH 10 105: Psychiatric Rehabilitation Coding Changes (PDF)

2003

MH 03 005: Medication Management and Psychotherapy as Stand-Alone Services (PDF)

2002

AD 02 011: Medication Management and Partial Hospital Requirements (PDF)

Substance use

2018

SA 18 101: Inpatient Withdrawal Management Notification of Admission (PDF)
- Withdrawal Management Notification Form (PDF)
SA 18 100: DDAP Transition to American Society of Addiction Medicine (ASAM) for Substance Use Disorder Levels of Care (PDF)

2016

SA 16 100: SA IOP Registration/Prior Authorization Requirement (PDF)
- SA IOP Request Form (PDF)

2014

AD 14 100: Verification of Psychiatric and Substance Abuse Inpatient Rehab Hospital Admission (PDF)
AD 14 102: Change In Initial Assessment Continued Stay and Discharge (PDF)
- AD 14 102A: UM MH (PDF)
- AD 14 102B: UM SA (PDF)
- AD 14 102C: MSS Bedsearch (PDF)
AD 14 104: Change In UM Contact Process (PDF)
PC-16: Lab Changes During Substance Abuse Treatment (PDF)

2013

PC-08: Use of Member Incentives In Substance Abuse Treatment (PDF)
- PC-08: Advisory Opinion No.08-14 Attachment (PDF)

2012

SA 12 100: Substance Abuse Intensive Outpatient Program Expectations (PDF)
Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties
SA OP 12 103: Compliance Reminders (PDF)
Documentation and delivery substance abuse outpatient, methadone and suboxone services

2009

SA 09 100: Methadone Billing for Take Home Services (PDF)

DHS notices, bulletins and clarifications

2019

99-89-05: DPW Bulletin Signature Requirements and Encounter Forms (PDF) November 7, 2019

99-89-05 Attachment 01: Encounter Form (PDF)

Service location enrollment for behavioral health providers (PDF) October 1, 2019
Provider enrollment application consolidation (PDF) July 1, 2019
Applied Behavior Analysis (PDF) May 16, 2019

2018

Requirements for certified peer specialist grandparenting (PDF)
- Certified peer specialist grandparenting application (PDF)
- Certified peer specialist grandparenting application FAQs (PDF)
OMHAS-18-01: Consent to Mental Health Treatment for Minor Children (PDF) June 29, 2018

2017

OMAP 99-17-02: Submission of Claims that Require the National Provider Identifier (NPI) of a Medical Assistance Enrolled Ordering, Referring or Prescribing Provider (PDF) January 30, 2017

2016

OMHSAS-16-12: Peer Support Services - Revised (PDF) December 12, 2016
- Amendment to Provider Handbook for Psychiatric and Partial Hospitalization Services (PDF)
OMAP 99-16-15: Payment of Claims for Autism Spectrum Disorder (ASD) (PDF) August 17, 2016
OMHSAS Policy Clarification 03-16-01: Encounter Coding (PDF) March 21, 2016
OMHSAS-16-09: Medical Necessity Guidelines for ABA (PDF) July 1, 2016

Description of Service (PDF)

OMHSAS-16-07: Enrollment and Payment of Provider Entities, Applied Behavior Analysis (PDF) June 6, 2016
OMAP 99-16-04: Enrollment of Co-Located Providers (PDF) May 31, 2016
OMHSAS-16-06: Payment for Room and Board when Services are Provided by a CARF or COA Accredited Residential Treatment Facility (PDF) May 16, 2016
OMHSAS-16-04: Training Requirements for Licensed Behavior Specialists Who Use Behavioral Specialist Consultant-Autism Spectrum Disorder Services to Provide Applied Analysis (PDF) April 26, 2016
OMHSAS-16-03: Revised Procedure for Waiver of Office of Mental Health and Substance Abuse Services Program Regulations and Standards (PDF) April 19, 2016
Pennsylvania Opioid Use Disorder Centers of Excellence Cover letter (PDF)

DHS Opioid Use Disorder Centers of Excellence Application (PDF)

OMAP PowerPoint on Health IT Initiative Update on Behavioral Health Opportunities (PDF) April 1, 2016
DHS FQHC / RHC Prospective Payment System (PPS) FAQ (PDF)
OMHSAS 16-01: Mental Health Emergency Services Guidelines (PDF) January 8, 2016
OMHSAS-16-02: Training and Supervision Requirements for Therapeutic Staff Support (TSS) Workers that Implement Treatment Plans that Include Applied Behavioral Analysis (PDF) March 11, 2016

TSS Training (PDF)

OMHSAS Applied Behavioral Analysis Attestation (ABA) Memo (PDF) March 10, 2016

ABA Attestation (.docx)
ABA Behavioral Specialist Consultant Confirmation (.docx)

2011 – 2015

2015

DHS 01-15-28 Provider Preventable Conditions (PDF) September 1, 2015
DHS Mandatory Reporting Requirements covered by Adult Protective Services Act (PDF) April 8, 2015
- Mandatory Abuse Report Form Instructions (PDF)
- Mandatory Abuse Report Form (PDF)
DPW Adult Protective Services (APS) Letter (PDF) May 26, 2015
OMHSAS Medical Assistance (MA) Coverage of Services to Children With Autism Spectrum Disorder (ASD) (PDF) March 18, 2015

2014

OMAP 99-14-09: Implementation of Healthy PA (PDF) November 4, 2014
OMHSAS 14-04: DSM Fifth Edition (PDF) September 5, 2014
OMHSAS 14-03: Affordable Care Act (ACA) Provider Re-Enrollment for Behavioral Health Providers (PDF) August 1, 2014
OMHSAS 14-02: Payment of Licensed Providers for Children with ASD (PDF) May 23, 2014
OMHSAS DPW Policy Clarification 01-14-01: MA Payment for Diagnostic Laboratory Services (PDF) April 30, 2014
OMHSAS 14-01: Guidelines for Telepsych Services Approval (PDF) March 18, 2014
OMHSAS Policy Clarification 03-14-02: BHMCO Attestation Form (PDF) March 10, 2014
OMAP 99-14-01: Re-enrollment/Revalidation of Medical Assistance (MA) Providers (PDF) March 7, 2014
OMHSAS Policy Clarification 03-14-01: Psych Rehab Codes (PDF) March 6, 2014
OMHSAS Policy Clarification 02-14-01: Compensation Progress Notes (PDF) February 25, 2014
OMHSAS Policy Clarification 01-14-01: Group Services in Partial Hospitalization Programs (PHPs) (PDF) January 15, 2014
OMHSAS Policy Clarification 01-14-01: Diagnostic Lab Payment in D&A Clinics (PDF) January 15, 2014

2013

OMHSAS Policy Clarification 10-13-01: Recovery of Overpayments (PDF) October 31, 2013
OMHSAS Policy Clarification 09-13-01: Peer Support Applicability (PDF) September 18, 2013
OMHSAS Policy Clarification 09-13-01: HealthChoices Capitation Payments (PDF) September 18, 2013
OMHSAS Policy Clarification 09-13-01: Financial Reporting (PDF) September 13, 2013
OMHSAS Policy Clarification 08-13-01: Assertive Community Treatment (ACT) Substance Abuse Specialist (PDF) August 10, 2013
OMHSAS Policy Clarification 06-13-01: Nurse Billing E&M Code (PDF) June 17, 2013
OMHSAS Policy Clarification 03-13: TSS Simultaneously with OT, ST, or PT in School (PDF) March 27, 2013
OMHSAS Policy Clarification 02-13: Pharmacologic Management (PDF) February 14, 2013
OMHSAS 13-01: Targeted Case Management (TCM) Travel Transportation Guidelines (PDF) January 18, 2013
OMHSAS Policy Clarification 01-13: Prior Authorization Code Clarification for Group Psychotherapy (PDF) January 8, 2013

2012

OMAP 99-12-12: Updates to National Correct Coding Initiative (NCCI) (PDF) October 26, 2012
OMHSAS Policy Clarification 06-12: Pharmacologic Management (PDF) October 9, 2012
OMHSAS Policy Clarification 04-12: Crisis Residential Services (PDF) August 9, 2012
OMHSAS Policy Clarification 02-12: Retroactive Provider Rate Adjustment Policy (PDF) March 18, 2012
OMAP 99-12-03: Updates to Medical Assistance Co-payment Policy (PDF) April 16, 2012
OMAP 99-12-01: PES Software (PDF) April 6, 2012
OMHSAS-12-01: Summer Therapeutic Activities Program (STAP) (PDF) March 1, 2012
OMHSAS Policy Clarification 01-12: Transportation for Psych Rehab Services (PDF) January 24, 2012
OMHSAS Mental Health Case Manager Refresher Training (PDF) January 13, 2012

2011

OMHSAS 11-09: Telepsychiatry Guidelines (PDF) December 12, 2011
OMHSAS Policy Clarification 03-11: Alternative Payment Arrangements (PDF) November 18, 2011
OMAP 99-11-10: National Correct Coding Initiative (NCCI) Announcement (PDF) November 10, 2011
OMAP 99-11-05: Provider Screening of Employees (PDF) August 15, 2011
OMHSAS Use of Safe Physical Management and Time Outs (PDF) July 6, 2011
OMHSAS Policy Clarification 01-11: Psych Diagnostic Coding (PDF) May 6, 2011
OMHSAS 11-05: Permissible Arrangements for BHRS Psychologists (PDF) March 8, 2011

OMHSAS Permissible Arrangements for Psychologists Presentation (PDF)

OMHSAS 11-01: Non-Discrimination Toward LGBTQI (PDF) January 7, 2011

2006 – 2010

2010

DPW 00-10-02: Complex Case Planning (PDF) December 28, 2010
OMHSAS 10-04: Psych/Clinical Re-Evaluation for BHRS (PDF) July 9, 2010

OMHSAS 10-04: FAQ 6 Month Evaluations/Authorization (PDF)

OMHSAS 10-03: Blended Case Management (BCM) Revised (PDF) June 14, 2010

OMHSAS 10-03: Definitions Attachment A (PDF)
OMHSAS 10-03: Services for severely emotional disturbance disorders Appendix A (PDF)
OMHSAS 10-03: Community Support Values and Principles Appendix B (PDF)
OMHSAS 10-03: Fiscal Issues Attachment B (PDF)
OMHSAS 10-03: Provider Enrollment Attachment C (PDF)
OMHSAS 10-03: Recovery Principles Appendix C (PDF)
OMHSAS 10-03: Blended Case Mgmt Guidelines Attachment D (PDF)

OMHSAS Policy Clarification 02-11: Educational requirements for Behavioral Specialist Consultant (BSC) (PDF) June 9, 2010
OMHSAS 10-01: Medication Prescribing Practices of CRNP's in MH and Mental Retardation Programs (PDF) March 27, 2010
OMHSAS Policy Clarification 01-10: Payment for Room & Board in Non-Hospital D&A Facilities (PDF) February 25, 2010
OMHSAS 10-01: Educational Portions of "Non-Educational" Residential Placement (PDF) January 4, 2010
OMHSAS 09-07: Peer Support Services Revised (PDF) January 1, 2010

2009

DPW 3800-09-02: Prone Restraints in Children's Facilities (PDF) December 19, 2009
DPW 3800-09-01: Strategies and Practices to Eliminate Unnecessary Restraints (PDF) December 19, 2009
OMHSAS Policy Clarification 07-09: Payment for Drug and Alcohol Outpatient Services (PDF) October 13, 2009
OMHSAS 09-05: Peer Support Revised (PDF) September 22, 2009
OMHSAS Policy Clarification 06-09: Fraud and Abuse Requirements (PDF) September 8, 2009
OMHSAS Personal Care Home Policy (PDF) August 18, 2009
OMHSAS functional behavioral assessment (FBA) Q&A (PDF) June 16, 2009
OMHSAS Policy Clarification 04-09: Psych Evaluations for STAP (PDF) February 18, 2009
OMHSAS Policy Clarification 03-09: Payment for Federally Qualified Health Clinics (FQHC) and Rural Health Clinics (RHC) (PDF) February 11, 2009
OMHSAS Policy Clarification 05-09: Crisis Intervention vs Emergency Services (PDF) February 10, 2009
OMHSAS 09-04: Family Involvement with Youth in RTF (PDF) June 15, 2009
OMHSAS 09-01: Guidance for Conducting Functional Behavioral Assessments (FBA) (PDF) January 9, 2009

2008

OMHSAS Policy Clarification 02-09: Mobile Mental Health Tx exempt from TPL (PDF) October 29, 2008
OMHSAS Policy Clarification 08-09: Timeframe for Psych Evals for RTF Admission (PDF) October 20, 2008
OMHSAS Policy Clarification 02-08: Email Communication (PDF) October 1, 2008
OMHSAS 08-03: Assertive Community Treatment (ACT) (PDF) September 2, 2008
OMHSAS Policy Clarification 2008-002: List of Six Claim Adjustment Reason (CAR) Codes (PDF) June 20, 2008
OMHSAS Policy Clarification 03-08: Scope of Practice for CRNPs (PDF) May 8, 2008

2007

OMHSAS Policy Clarification 02-07 : Adverse Incident Reporting (PDF) October 5, 2007
OMHSAS Policy Clarification 01-07: Partial Hospitalization Program (PHP) Services (PDF) September 13, 2007
OMAP 99-07-13: Updated: Regarding False Claims Provisions of Deficit Reduction Act of 2005 (PDF) September 7, 2007
DPW 08-07-09: Peer Support Services (PDF) May 22, 2007

CMS FAQ for Peer Support Services in PA (PDF) May 1, 2007
OMAP 99-07-01: Employee Education about False Claims Recovery (PDF) January 2, 2007 - Employee education about false claims recovery

2006

DPW 08-06-18: Mobile Mental Health Treatment (PDF) November 30, 2006
MA Mobile Mental Health Treatment Handbook (PDF) November 1, 2006

MA Fee Schedule (PDF)

MA Handbook for Other Services (PDF) November 1, 2006

2001 - 2005

DPW 09-05-16: Clarification of Enrollment Policy for CRNPs (PDF) December 16, 2005
DPW TSS Transportation (PDF) July 7, 2005
OMHSAS Policy Clarification 03-05: Qualifications for Behavioral Specialist Consultant (BSC) & Ph.D. (PDF) May 13, 2005
DPW 28-04-01: Methadone Take-Home Services (PDF) February 1, 2004
OMHSAS Policy Clarification 07-03: Licensed Group Homes (PDF) August 5, 2003
OMHSAS Policy Clarification 18-02: Scope of Practice for Physician Assistants (PDF) December 20, 2002
DPW 99-02-13: The Bureau of Program Integrity and the Medical Assistance Provider Self-Audit Protocol (PDF) December 2, 2002
DPW 01-02-11: RTF Services Provided in a Secure Setting (PDF) October 1, 2002
OMHSAS 02-01: The Use of Seclusion and Restraint in MH Facilities and Programs (PDF) April 8, 2002
DPW 01-02-07: Reminder for BHRS Documentation Requirements (PDF) April 3, 2002
OMHSAS Policy Clarification 16-02: TPL Issues (PDF) March 30, 2002
DPW 29-02-03: Medical Record Keeping Requirements (PDF) March 21, 2002
OMHSAS Policy Clarification 02-02: Parent availability for TSS services (PDF) January 14, 2002
OMHSAS Q&A 11-97-176: Responsibility for Pharmaceuticals for an Inpatient BH Admission (PDF) September 2001
DPW 01-01-07: Addition of BHRS to the Medical Assistance (MA) Program Fee Schedule (PDF) June 21, 2001

1994 - 2000

OMHSAS Q&A 3-96-198: Non-Participating Providers allowed to Balance Bill (PDF) June 19, 2000
OMHSAS Q&A 3-96-199: Definable Compensable Services (PDF) June 19, 2000
OMHSAS Q&A 3-96-195: Bypass Primary Payer (PDF) May 8, 2000
OMHSAS Q&A 11-97-66: Network Contracting (PDF) July 7, 1999
DPW 28-99-02: Medication Management Visit (PDF) April 26, 1999
DPW Policy Clarification RH-01: Age Limit for BHRS (PDF) March 4, 1999
DPW 01-98-19: Clozapine Support Services (PDF) December 29, 1998
DPW Inappropriate Delivery and Billing for TSS Services (PDF) January 6, 1998
DPW 99-97-06: Accurate Billing for Units of Service Based on Periods of Time (PDF) September 17, 1997
DPW 01-97-08: Diagnostic and Psychological Evaluations (PDF) May 28, 1997
DPW 01-96-11: Procedures for Service Descriptions (PDF) April 29, 1996
DPW 50-96-03: Summer Therapeutic Activities Program (PDF) April 25, 1996
DPW 01-95-13: Updated JCAHO Accredited RTF Services (PDF) September 8, 1995
DPW 01-95-01: Signature Requirements (PDF) January 2, 1995
DPW 01-94-01: Outpatient Psychiatric Services for Children Under 21 Years of Age (PDF) January 11, 1994