231 List of Behavioral Health Managed Care Organizations

DEPARTMENT OF PUBLIC WELFARE

List of Behavioral Health Managed Care Organizations

[31 Pa.B. 888]

   The purpose of this notice is to provide prior public notice of the Department of Public Welfare's (Department) intent to develop a list of qualified Behavioral Health Managed Care Organizations (BH-MCO) as potential contractors for the HealthChoices Behavioral Health Program (HCBHP). The development of this list is the first step in a two-step process for obtaining a Behavioral Health contractor, should the need arise. HealthChoices is a mandatory Managed Care program for Medicaid recipients in this Commonwealth. Additional information about HCBHP is available at the Department's website: www.dpw.state.pa.us/omap/dpwomap.asp

   The list of qalified BH-MCOs would be utilized in the following cases:

   *  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.

   The list of qualified BH-MCOs will be opened periodically for new submissions. MCOs selected for the list of qualified bidders will remain active on the list for 2 years. After 2 years they will be required to resubmit information. The following is a list of requirements necessary to qualify as a potential HealthChoices Behavioral Health 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 or demonstrated ability to be licensed by the Departments of Health and Insurance of the Commonwealth.

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

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

   In order to apply, submit a letter of interest on official corporate letterhead, to qualify as a potential HealthChoices Behavioral Health contractor by February 26, 2001, to Karen Rosenthal, Office of Mental Health and Substance Abuse Services, Room 236, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105. Letters may be faxed to [phone]. Submit the following information to the Department of Public Welfare, Division of Procurement, P. O. Box 2675, Room 106, Health & Welfare Bldg., Commonwealth & Forster St., Harrisburg, PA 17105-2675 by 2 p.m. March 15, 2001.

List of Deliverables:

   1.  Describe experience in providing services to Medicaid recipients including:

   *  Type of behavioral health (mental health and drug and alcohol) services covered.

   *  Description of categories of aid/population covered.

   *  Number of years experience with Medicaid programs.

   2.  Provide a report on the number of claims processed (for Medicaid population) in the most recent 6-month period, including timeliness of processing clean claims and the number of claims paid/rejected.

   3.  Provide a flow chart of the MIS.

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

   5.  Provide one of the following:

   *  A copy of current Pennsylvania license from the Departments of Health and Insurance.

   *  A current application for Pennsylvania license from the Departments of Health and Insurance with a time frame for receiving the license.

   *  A work plan with a time line to obtain a license from the Departments of Health and Insurance of the Commonwealth.

   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 to a State Medicaid program).

   Department staff will verify the information submitted by the BH-MCOs. As part of the verification process, the Department may conduct an on-site 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 HealthChoices 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 above two-step process will not replace the RFP process to obtain a HCBH contract in the remaining North/Central zone. The procurement process for the North/Central zone will follow the same procedure as followed in the Southeast, Southwest and Lehigh/Capital zones, which required a response to a RFP.

   Any questions may be directed to Raymond Klabe, Office of Mental Health and Substance Abuse Services, Room 247, Beechmont Building, P. O. Box 2675, Harrisburg, PA 17105, [phone], Fax: [phone].

   Persons with a disability may use the AT&T Relay Service by calling [phone] (TDD Users) or [phone] (Voice Users). Persons who require an alternate format should contact Thomas Vracarich, Office of Legal Counsel, [phone].

FEATHER O. HOUSTOUN,   
Secretary

[Pa.B. Doc. No. 01-231. Filed for public inspection February 9, 2001, 9:00 a.m.]