Policies and Notices

CC-001: Reporting Suspected Provider Fraud, Waste, and Abuse (PDF)

CC-002: Fraud, Waste, and Abuse Program (PDF)

CC-003: Provider Audits Conducted by the Special Investigation Unit (PDF)

CC-005: Provider Dispute Policy (PDF)

CC-006: Payment Adjustments for Provider-Preventable Conditions Including Health Care-Acquired Conditions (HCACs) (PDF)

CC-012: Recipient Verification of Services (PDF)

CM-007: Service Denial Behavioral Health Inpatient Services (PDF)

CM-009: Use of IQ and Adaptive Functioning Testing to Diagnose Mental Retardation (PDF)

CM-011: Clinical Care Management Decision Making (PDF)

CM-012: Authorization of Psychological and Neuropsychological Testing (PDF)

CM-013: Denial Notice Procedure (PDF)

CM-019: Bed Hold Payment and Therapeutic Leaves (PDF)

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

CM-028: Authorization Requests for Preauthorized Drug and Alcohol Services (PDF)

CM-029: Authorization Requests for Drug and Alcohol Hospital and Non-Hospital-Based Detoxifications (PDF)

CM-034: Emergency Services Coverage Reimbursement (PDF)

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

CM-037: Mental Health/Substance Abuse Targeted Case Management Reimbursable and Non-Reimbursable Services (PDF)

CM-039: Targeted Case Management Contact Expectations (PDF)

CM-040: Targeted Case Management Role Expectations (PDF)

CM-042: Continued Stay Review Process (PDF)

CM-043: Authorization Requests for Preauthorized Mental Health Services (PDF)

CM-045: Requests for Initial, Continuation and Maintenance for Electroconvulsive Therapy (PDF)

CM-046: Psychiatric Rehabilitation (PDF)

CM-053: Request for ACT/CTT Services P&P (PDF)

CM-CAS-042: Initial and Re-Authorization Requirements for Individual IBHS and ABA Services (PDF)

CM-CAS-043: Initial and Re-Authorization Requirements for IBHS Group, Evidence-Based Practice and Other Services (PDF)

CM-CAS-044: Procedure to Request Additional Service Units During an Authorization Period and Extension Requests for Family-Based Mental Health Services (FBMH (PDF)S)

CM-CAS-047: Pre-Discharge Planning Meeting Requirements for Residential Treatment Facility (RTF) (PDF)

CM-CAS-048: Pre-Discharge Planning Meeting Requirements for Community Residential Rehabilitation (PDF)

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

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

CM-CAS-053: Initial and Re-Authorization Requirements for CRR-HH and CRR-HH-ITP (PDF)

CM-CAS-054: Initial and Re-Authorization Requirements for RTF (PDF)

CM-CAS-055: Best Practice Evaluations and Continued Care Evaluation Requirements (PDF)

CM-CAS-056: Children's Services Team Meeting and ISPT Planning (PDF)

CM-CAS-057: Children's Service Provider Transfer Process (PDF)

CM-CAS-058: Initial Requirements for Individual IBHS Concurrent With CRR-RTF (PDF)

CM-CAS-059: Behavioral Health Technician Skills Training and Development (PDF)

CM-CAS-060: Initial IBHS Service Capacity Monitoring (PDF)

CM-CAS-061: School, Day Care, and Other Community Input Into IBHS Request Process (PDF)

CM-CAS-062: Adding or Increasing IBHS During a Current Authorization Time Frame (PDF)

CM-MS-003: Outpatient Treatment Requests, Denials, and Authorizations (PDF)

PR-001: Service Authorization Procedures and Standards for Out-of-Network Providers (PDF)

PR-005: Payment Authorization Procedures (PDF)

PR-014: Assessment of Provider Cultural Sensitivity (PDF)

PR-015: Distribution of Medical Necessity Criteria to PerformCare Providers (PDF)

PR-016: DHS Notification of Drop in Provider Capacity (PDF)

PR-019: Processing Provider MA Enrollment Applications (Supplemental Services and Out of Network) (PDF)

PR-020: Routine and Non-Routine Site Visits (PDF)

PR-023: Advance Directives (PDF)

PR-025: PerformCare Position on the Bundling of Psychiatric Services (PDF)

PR-026: Provider Rate Setting (PDF)

PR-027: Interpreter Costs in Service Delivery (PDF)

PR-028: Requirements for School-Based Outpatient Services (PDF)

PR-029: Expansion Request Process for State Plan Service for Providers (PDF)

PR-032: Provision of Reasonable Access to BHS Provided by FQHC Within Access Travel Guidelines (PDF)

QI-004: Internal Documentation, Review, and Follow-Up of Quality of Care Issues (PDF)

QI-014: Member and Provider Satisfaction Surveys (PDF)

QI-019: Provider Profiling Reports (PDF)

QI-026: Provider Treatment/Service Record Reviews (PDF)

QI-042: Six-Criteria Complaint Policy (PDF)

QI-043: Dissatisfaction Complaint Policy (PDF)

QI-044: Grievance Policy (PDF)

QI-045: Provider Complaint Process (PDF)

QI-049: Documentation Standards for Providers (PDF)

QI-CIR-001: Critical Incident Reporting (PDF)

QI-CIR-002: Sentinel Event Review (PDF)

QI-CIR-003: Restraint and Seclusion Monitoring (PDF)

QI-CR-001: Credentialing and Re-Credentialing Criteria — Facilities (PDF)

QI-CR-002: Credentialing and Re-Credentialing Criteria — Practitioners (PDF)

QI-CR-003: Credentialing Progressive Disciplinary Action for Providers (PDF)

QI-CR-005: Credentialing Committee (PDF)

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

2024

• AD 24 109: Unit of Service Where Rounding is Permitted (PDF)
• AD 24 108: Differentiating Between Trauma-Informed Care and Trauma Treatment (PDF)
• AD 24 107: Overdose Risk (PDF)
• AD 24 105: Provider Notification to PerformCare When Member Has TPL for MH IP and SUD Residential Services (PDF)
• AD 24 104: PerformCare’s New Online Prior Authorizations — Coming July 1 (PDF)
• AD 24 103: Addressing Members’ SDOH Needs (PDF)
• AD 24 102: Recipient Language by County (PDF)
• AD 24 101: Street Medicine Place of Service Codes (PDF)
• AD 24 100: Sharing Integrated Care Plans With Providers (PDF)

2023

• AD 23 122: Provider Notice Resources (PDF)
• AD 23 119: Collection of Race, Ethnicity, and Language (REL) as Well as Sexual Orientation and Gender Identity (SOGI) Data (PDF)
• AD 23 118: DEI Provider News Regarding Interpreter & Translation Services — More Than a Requirement (PDF)
• AD 23 117: NaviNet Registration Change (PDF)
• AD 23 116: DEI Provider News: Improving Member Engagement Through the Use of Equitable Language (PDF)
• AD 23 115: Recipient Language by County (PDF)
• AD 23 114: Diversity, Equity, and Inclusion Updates (PDF)
• AD 23 112: Trauma-Informed Care (PDF)
• AD 23 110: ICD-10 2023 Updates to F and Z Diagnosis Codes (PDF)
• AD 23 109: Administrative Compliance Concerns (ACC) Clarification (PDF)
• AD 23 108: Member Medicaid ID Changes (PDF)
• AD 23 107: Update on MH and SU Confidentiality Act 32 and Act 33 (PDF)
• Act 32 and Act 33 Provider Legal Guidance (PDF)
• Department of Drug and Alcohol Programs (DDAP) Licensing Alert (PDF)
• AD 23 106: Language Data by County (PDF)
• AD 23 105: Administrative and Treatment Quality Concerns — Changing to Administrative Compliance Concerns (PDF)
• AD 23 103: Telehealth Using Site Based Clinic Model (PDF)
• AD 23 102: Federal Legislation Impacts Members' Medical Assistance Eligibility (PDF)
• AD 23 101: Cease CIR Reporting for COVID-19 Positive Members (PDF)
• AD 23 100: Service Description Expectations (PDF)
• PerformCare Service Description Checklist (PDF)
• Service Description Review Time Frame (PDF)

2022

• AD 22 110: CPT Code Updates (PDF)
• AD 22 109: End of Temporary Suspension of DHS Regulations 10/31/2022 (PDF)
• AD 22 108: Recipient Language by County (PDF)
• AD 22 107: OMHSAS Telehealth Update (PDF)
• AD 22 106: Telehealth POS & Audio Only Modifier Change (PDF)
• AD 22 104: Recipient Language Data by County (PDF)
• AD 22 102: Recipient Language Data by County (PDF)
• Member Language Summary (as of March 1, 2022) (PDF)
• AD 22 101: Authorization Correction Process (PDF)
• AD 22 100: Reporting Social Determinants of Health (SDOH) Diagnoses (PDF)

2021

• AD 21 111: Re-Credentialing Process and Requirements (PDF)
• AD 21 110: Telehealth Audio Only Modifier 95 (PDF)
• AD 21 109: Compliance Training & Attestation (PDF)
• Attestation of Training Completion (PDF)
• AD 21 108: Tobacco Cessation Resources (PDF)
• AD 21 107: Recipient Language by County (PDF)
• AD 21 105: Fraud, Waste, and Abuse Notice (PDF)
• AD 21 104: CPT Code Updates and Family Therapy Rate Change — TMCA (PDF)
• AD 21 103: CPT Code Updates and Family Therapy Rate Change — CABHC (PDF)
• AD 21 102: Collecting Social Determinants of Health (SDOH) Data (PDF)
• AD 21 101: False Claims Certification (PDF)
• AD 21 100: Tobacco Cessation Resources (PDF)

2019

• AD 19 104: Medicare Crossover Claims (PDF)
• AD 19 103: Using Your CLIA ID When Filing Claims (PDF)
• AD 19 102: Collecting Social Determinants of Health (SDoH) Data to Address Members’ Unmet Needs (PDF)
• AD 19 101: Transition of Bedford-Somerset HealthChoices Contract (PDF)
• AD 19 100: Service Location Enrollment Deadline (PDF)

2018

• AD 18 106: Tobacco Cessation Providers (PDF)
• AD 18 105: Capital Area Performance Incentive Payments (PDF)
• AD 18 104: Changes to Prior Authorization and Denial Process (PDF)
• AD 18 103: Do You Want to Save Time and Shorten Your Reimbursement Cycle? (PDF)
• AD 18 102: Discharge Planning: Using the Teach Back Method (PDF)
• AD 18 101: Discharge Management Plans (PDF)
• AD 18 100: Partner With Us to Prevent Health Care Fraud Waste and Abuse (PDF)

2017

• AD 17 104: Ordering, Rendering, and Prescribing Providers (PDF)  Updated – March 1, 2019

2016

• AD 16 106: Information System Update and Timeline (PDF)
• AD 16 104: Franklin, Fulton Retroactive Performance Incentive Payments (PDF)
• AD 16 103: Information System Transition (PDF)
• AD 16 101: Utilization Management Process (PDF)

2015

• 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)

2002 - 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)
• 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)
• AD 12 100: Common Problem Areas and Provider Performance Reports (PDF)
• AD 12 112: 2013 CPT Code Update Implementation (PDF)
• 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"
• 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
• 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
• AD 04 003: Notification Requirements for PerformCare as Secondary Payer (PDF)
• AD 02 012: EVS and Authorization Requirements (PDF)
• AD 03 001: Naming Conventions for Provider Communications (PDF)

2024

• AD 24 111: Claim Attachment Transaction is Now Available via Availity (PDF)
• AD 24 110: Claim Dates of Service Clarification (PDF)
• AD 11 109: Update to Payment Policy for Day of Admission and Day of Discharge for Inpatient and Residential Programs (PDF)

2023

• AD 23 121: Pre-Payment Claims Edits for Duplicate and Disallowed Services (PDF)
• AD 23 120: Attachment Implementation for Electronic Claims (PDF)
• AD 23 111: Upgrade of the EDI claims compliance to Strategic National Implementation Process (SNIP) Level 4 (PDF)
• AD 23 104: Change Healthcare Link Updates (PDF)

2021

• AD 21 104: CPT Code Updates and and Family Therapy Rate Change (corrected) (PDF)
• AD 21 103: CPT Code Updates and and Family Therapy Rate Change (PDF)

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 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 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)

2024

• MH 24 105: FBMHS Prescribers (PDF)

2022

• MH 22 105: Provider Profile Migration Update (PDF)
• MH 22 104: Provider Profile Migration (PDF)
• MH 22 101: FBMHS Extensions in the Value Based Purchasing Program (PDF)

2017

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

2014

• 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)

2023

• MH 23 106: MH IP and OP Coordination of Care for Members With an SU Diagnosis (PDF)

2022

• MH IP 22 103: MI IP Active Discharge Planning (PDF)

2021

• MH IP 21 101: MH IP Effective Discharge and After Care (PDF)

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)

2023 

• MH 23 109: Specialized In-Home Treatment (SPIN) Transition to Family-Based Mental Health Services (FBMHS) (PDF)
• IBHS 23 108: Changes to IBHS Written Orders (PDF)
• IBHS 23 107: IBHS Forms Clarification (PDF)
• IBHS 23 106: Best Practice Evaluations (PDF)
• IBHS 23 105: IBHS TPL/EOB Clarifications Update (PDF)
• IBHS 23 104: IBHS Updates (PDF)
• IBHS 23 103: Discharge Planning (PDF)
• IBHS 23 102: Expanded Use of 97151 (PDF)
• IBHS 23 101: IBHS Rural Rates (PDF)
• IBHS 23 100: IBHS Performance Standards and Best Practices (PDF)

2022

• IBHS 22 109: IBHS Documentation and Written Order Updates (PDF)
• IBHS 22 108: IBHS Assessment Authorization Update (PDF)
• IBHS 22 107: Fee-for-Service Transition to PerformCare (PDF)
• IBHS 22 106: Temporary OMHSAS Regulation Suspensions Ended 10/31/2022 (PDF)
• IBHS 22 104: IBHS Monitoring and Referral Process for Members with Primary Insurance (PDF)
• IBHS 22 103: IBHS Group and ABA Group (formerly Summer Therapeutic Activities Program — STAP) (PDF)
• IBHS 22 102: IBHS Code Authorization Bundling (PDF)
• IBHS 22 101: IBHS Group Services Guidelines (PDF)
• IBHS 22 100: Revised IBHS Referral Management Process (PDF)

2021

• IBHS 21 108: IBHS Written Order Update: Center-Based Recommendations (PDF)
• IBHS 21 107: IBHS Update: Temporary OMHSAS Regulation Suspensions End 9/30/21 (PDF)
• IBHS 21 106: Adding or Increasing IBHS During a Current IBHS Authorization Period (PDF)
• IBHS 21 105: BCBA Billing (PDF)
• IBHS 21 104: IBHS Updates (PDF)
• IBHS 21 103: IBHS TPL / EOB Clarifications (PDF)
• IBHS 21 102: IBHS Billable Activity (PDF)
• IBHS 21 101: IBHS Assessment Requirements (PDF)
• IBHS 21 100: IBHS ABA Billing Guide (PDF)
• Attachment: Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services (PDF)

2020

• IBHS 20 105: Clarification of Written Order Prescriptions for IBHS-ABA Services (PDF)
• IBHS 20 103 Update: Provider Notice Children's Level of Care and Prescriptions (PDF)
• IBHS 20 102 Update: Dual Prescription Recommendation (PDF)
• IBHS 20 101 Update: IBHS 20 101 CABHC IBHS Rate Notice (PDF)
• IBHS 20 101 Update: IBHS 20 101 TMCA IBHS Rate Notice (PDF)
• IBHS 20 100 Update: All IBHS/BHRS/Other Children’s Level of Care and Evaluators (PDF)

2024

• MH 24 111: Transcranial Magnetic Stimulation (TMS) Implementation TMCA (PDF)
• MH 24 110: Transcranial Magnetic Stimulation (TMS) Implementation CABHC (PDF)
• MH 24 109: Requests for Initial, Continuation and Maintenance for ECT (PDF)
• MH 24 108: FQHC Billable Encounters (PDF)
• MH 24 107: Interprofessional Consultation Services TMCA (PDF)
• MH 24 106: Interprofessional Consultation Services CABHC  (PDF)
• MH 24 104: Spravato Billing Guidelines Update (PDF)
• MH 24 103: Updated P&P for ACT/CTT Providers (PDF)
• MH 24 102: ACT/CTT Form Updates (PDF)
• MH 24 101: Capital Area FUH VBP Payments (PDF)
• MH 24 100: Revised Psychological/Neuropsychological Testing Request Form (PDF)

2023

• MH 23 110: FBMHS Provider Choice Form (Revised) (PDF)
• MH 23 108: Psychologist and Psychiatrist Attestation Requirements and Forms (PDF)
• MH 23 107: Spravato Billing Guidelines (PDF)
• MH 23 106: MH IP and OP Coordination of Care for Members With an SU Diagnosis (PDF)
• MH 23 105: Revised Psychological/Neuropsychological Testing Request Form (PDF)
• MH 23 104: Follow-Up After Hospitalization Value-Based Purchasing Payment (PDF)
• MH 23 102: Peer Support Services Referrals (PDF)
• MH 23 101: Payment for Psychological and Neuropsychological Testing (PDF)
• MH 23 100: Children's Continuity Of Care Protocols (PDF)

2022

• MH 22 106: Care Coordination Upon Discharge From Emergency Department (PDF)
• MH 22 102: Partial Hospitalization Provider Profile Migration (PDF)
• MH 22 100: CRR and RTF Authorization Updates (PDF)

2021

• MH 21 101: Capital Area Performance Payments (PDF)
• MH 21 100: Pennsylvania Act 65 of 2020 (PDF)

2020

• MH 20 101: Capital Area Performance Payments 2020 (PDF)
• MH 20 102: RTF Packet Attachment 8 (PDF)
• MH 20 104: Change in Partial Hospitalization Unit Definition (PDF)
• MH 20 100: RTF Bed Hold Update (PDF)

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) (Updated May 22, 2017)
• 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)

2002 - 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)
• 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)
• MH 11 100: Utilization of FBAs In a Partial Hospital Program (PDF)
• 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)
• MH 03 005: Medication Management and Psychotherapy as Stand-Alone Services (PDF)
• AD 02 011: Medication Management and Partial Hospital Requirements (PDF)

2024

• SU 24 102: H2036 Authorization Reminders for SUD 3.5 & 3.7 (PDF)
• SU 24 101: SUD Discharge Planning Template (PDF)
• SU 24 100: Certified Recovery Specialist (PDF)

2023

• SU 23 104: ASAM Minimum Rates Implementation (PDF)
• SU 23 103: Coordinating Methadone and Other SU Services (PDF)
• SU 23 102: SUD Co-Occurring Enhanced Requirements (PDF)
• SU 23 101: Availability of Procedure Code 90846 (PDF)
• SU 23 100: Methadone Unbundling Implementation (PDF)

2022

• SU 22 105: Best Practice Discharge Update (PDF)
• SU 22 104: New Procedure Codes Effective July 1, 2022 (PDF)
• SU 22 103: Change in SU Partial Hospitalization Unit Definition (PDF)
• SU 22 102: ASAM Minimum Rates Implementation (PDF)
• SU 22 101: Inpatient Withdrawal Management Notification of Admission Program (PDF)
• SU 22 100: SU Intensive Outpatient Registration Change (PDF)
• Substance Use Disorder IOP Program Prior Authorization Request and Discharge Form (PDF)

2021

• SU 21 102: Opioid Treatment Program Services for Dually Eligible Individuals (PDF)
• SU 21 100: Medication Assisted Treatment in SU Programs (PDF)
• SA 21 101: ASAM Alignment and MAT Webinar (PDF)

2020

• SU 20 101: ASAM Alignment 3.5 Short-term vs. Long-term Non-Hospital Rehab (PDF)
• SU 20 102: Change in Statutory Treatment Limits (PDF)
• SUD 20 103: Opioid Treatment Programs Billing Medicare (PDF)

2018

• SA 18 101: Inpatient Withdrawal Management Notification of Admission (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)

• OMHSAS Street Medicine (PDF) October 1, 2023

• OMHSAS Opioid Centers of Excellence (PDF) July 13, 2023
• OMAP 01-23-18: Prior Authorization of Opioid Use Disorder Treatments (PDF) July 10, 2023
• OMHSAS-23-05: Confidentiality of Records Changes Due to ACT 32 of 2022 and Aligning with Health Insurance Portability and Accountability Act of 1996 (PDF) May 12, 2023
• OMHSAS-23-04: Mental Health Emergency Services: Applying the 120-Hour Timeframe for Emergency Involuntary Commitments — Revised (PDF) May 11, 2023
• OMHSAS-23-03: Aligning Co-Occurring Services with the American Society of Addiction Medicine Criteria (PDF) April 7, 2023
• OMHSAS Interim Telehealth Guidance (PDF) March 30, 2023
• OMHSAS-23-02: Emergency Services: 24/7 Call Centers (PDF) March 8, 2023
• OMHSAS-23-01: Act 65 of 2020: Consent to Mental Health Treatment for Minors (PDF) January 24, 2023

• OMHSAS-22-08: Peer Support Services-Revised (PDF) December 28, 2022
• OMHSAS-22-07: Emergency Involuntary Commitments — Revised (PDF) November 29, 2022
• OMHSAS-22-06: Revised Bulletin for Services to Older Adults (PDF) August 23, 2022
• OMHSAS-22-05: Use of ASAM Criteria for Substance Use Disorder in the MAP (PDF) July 28, 2022
• OMHSAS 22-04: Referring Children to the County Intellectual Disability and Autism Programs (PDF) July 12, 2022
• OMHSAS-22-03: Updated: One to One IBHS in a Licensed Location (PDF) June 24, 2022
• OMHSAS-22-02: Revised Guidelines for Delivery of Behavioral Health Services Through Telehealth (PDF) July 1, 2022
• OMHSAS Telehealth FAQs (PDF) August 16, 2022

• OMHSAS-21-09: Guidelines for the Delivery of Behavioral Health Services Through Telehealth (PDF) September 30, 2021
• OMHSAS Telehealth FAQs (PDF) October 29, 2021
• OMHSAS-21-06: Opioid Treatment Program Services for Dually Eligible Individuals (PDF) August 16, 2021
• OMHSAS-21-05: Contracted Delegate Services (PDF) July 1, 2021
• OMHSAS 21-04: Procedure for Providing a Specialized Behavioral Health Treatment Program in Community Residential Rehabilitation Host Home Settings (PDF) March 30, 2021
• OMHSAS 21-01: Obsolete Behavioral Health Rehabilitation Services (BHRS) Bulletins (PDF) March 30, 2021

• OMHSAS-20-04: Payment for IBHS Prior to Licensure (PDF) May 12, 2020
• OMHSAS-20-04: Payment for IBHS Prior to Licensure Attachment (PDF) — Final May 21, 2020
• OMHSAS-20-02: Guidelines for the Use of Telehealth in the Delivery of Behavioral Health Services (PDF) February 20, 2020
• 20-20-02 Attachment B: Attestation Form (PDF)

• OMHSAS-19-05: Peer Support Services — Revised (PDF) December 10, 2019
• 99-89-05: DPW Bulletin Signature Requirements and Encounter Form (PDF)s 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

• OMHAS-18-01: Consent to Mental Health Treatment for Minor Children (PDF) June 29, 2018

• DHS 99-17-11: Limited English Proficiency Requirements (PDF) August 11, 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

• 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-16-03: Revised Procedure for Waiver of Office of Mental Health and Substance Abuse Services Program Regulations and Standards (PDF) April 19, 2016
• 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

• 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 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 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 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
• OMHSAS Policy Clarification 06-13-01: Nurse Billing E&M Code (PDF) June 17, 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
• OMAP 99-12-12: Updates to National Correct Coding Initiative (NCCI) (PDF) October 26, 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
• OMHSAS Policy Clarification 01-12: Transportation for Psych Rehab Services (PDF) January 24, 2012
• 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 11-01: Non-Discrimination Toward LGBTQI (PDF) January 7, 2011
• 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 01-10: Payment for Room & Board in Non-Hospital D&A Facilities (PDF) February 25, 2010
• 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 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 Policy Clarification 08-09: Timeframe for Psych Evals for RTF Admission (PDF) October 20, 2008
• OMHSAS 08-03: Assertive Community Treatment (ACT) (PDF) September 2, 2008
• OMHSAS Policy Clarification 02-07 : Adverse Incident Reporting (PDF) October 5, 2007

• DPW 09-05-16: Clarification of Enrollment Policy for CRNPs (PDF) December 16, 2005
• DPW 28-04-01: Methadone Take-Home Services (PDF) February 1, 2004
• 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
• OMHSAS Policy Clarification 16-02: TPL Issues (PDF) March 30, 2002
• DPW 29-02-03: Medical Record Keeping Requirements (PDF) March 21, 2002

• 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
• DPW 01-98-19: Clozapine Support Services (PDF) December 29, 1998
• DPW 01-95-13: Updated JCAHO Accredited RTF Services (PDF) September 8, 1995
• DPW 01-95-01: Signature Requirements (PDF) January 2, 1995