Medicare, Managed Care, and Other Payments
Updates on Medicare, Medical Assistance, and other insurers' regulations, changes in policy, reimbursement issues, and coding and documentation guidelines, with links to related websites.
September: OMHS Autism
Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder.
OMHS Autism (pdf)
August: DHS Provides Listing of TiP providers
DHS Announces TiPs Providers and Psychiatric Consultations for Kids (pdf)
NEW
Additional resources for the TiPs program
Telephonic Psychiatric Consultation Service program (pdf)
August: DHS is Revamping BHRS
DHS Strategy for Kids with Behavioral Health Needs (pdf)
August: Olmstead Plan
Updated Olmstead Plan (pdf)
August: Supporting Pennsylvanians through housing
The Department of Human Services’ (DHS) five-year housing strategy is a comprehensive plan to connect Pennsylvanians to affordable, integrated and supportive housing.
Supporting Housing Initiative (pdf)
August 2016: PA DOH unveils State Health Improvement Plan; Health Innovation Plan
Pennsylvania State Health Improvement Plan 2015-2020 (pdf)
Mental Health and Substance Use (pdf)
August 2016: Governor/DHS releases information on Opioid Centers of Excellence
Centers of Excellence (pdf)
DHS receive federal funding to assist with opioid issues (pdf)
Governor Wolf announces COEs (pdf)
Health Innovation in Pennsylvania Plan (pdf)
Appendices for the Health Innovation in Pennsylvania Plan (pdf)
Update! July 2016: PA Medicaid Managed Care Organization Directory
Updated MCO Listing (pdf)
Update! July 2016: MACRA Resources Available for Member Review
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently repealed the old Medicare SGR formula and set in motion entirely new programs for quality reporting and new payment models. Since MACRA was implemented, there have been numerous questions about payment models (including alternative payment arrangements), the Merit-Based Incentive Payment System (or MIPS), how Electronic Health Records interface with the system, and overall confusion on how both public and private practices will comply with the requirements of MACRA.
The APA held a webinar on June 29, 2016 for members and district branch executives to become acquainted with MACRA's payment reform and quality reporting measures. Download the PowerPoint. Members can also access the most up-to-date information on MACRA at www.psychiatry.org/MACRA. Information there includes APA comments on the Proposed Rule and background on the MACRA (Medicare Access & CHIP Reauthorization Act), MIPS (Merit-Based Incentive Payment System), and APMs (alternative payment models).
The webinar also included information on the Centers for Medicaid and Medicare (CMS) Transforming Clinical Practice Initiative (TCPI). The APA is a participant in the TCPI. According to the APA, CMS' Practice Transformation Networks, or PTNs, can assist psychiatrists with quality improvement, workflow redesign, data collection and analysis, and EHR optimization. Connect with a PTN in your region by visiting www.psychiatry.org/sansgrant or contacting SAN@psych.org.
Additional information will be available on both the Society's and APA's websites at they are available.
January 2015: ICD-10 Final Ruling and New Deadline
DEA Final Rule Rescheduling Hydrocodone Combination Products (PDF)
Prior Authorization/Six Script Limit/Therapeutic Duplication Documentation Template (PDF) - for use in documenting problems associated with the Department of Public Welfare pharmacy initiatives. After completing the form, please return to the Pennsylvania Psychiatric Society for inclusion with other data being provided to the Department of Public Welfare to address concerns with the six-script limits and prior authorization changes
Release of records to insurers - the Shrager case (July 2006)
Medicare Private Contracting — "Opting Out" v. "Non-Participation"
Medicare: Local Carrier Link — HGSAdministrators
September: OMHS Autism
Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder.
OMHS Autism (pdf)
August: DHS Provides Listing of TiP providers
DHS Announces TiPs Providers and Psychiatric Consultations for Kids (pdf)
NEW
Additional resources for the TiPs program
Telephonic Psychiatric Consultation Service program (pdf)
August: DHS is Revamping BHRS
DHS Strategy for Kids with Behavioral Health Needs (pdf)
August: Olmstead Plan
Updated Olmstead Plan (pdf)
August: Supporting Pennsylvanians through housing
The Department of Human Services’ (DHS) five-year housing strategy is a comprehensive plan to connect Pennsylvanians to affordable, integrated and supportive housing.
Supporting Housing Initiative (pdf)
August 2016: PA DOH unveils State Health Improvement Plan; Health Innovation Plan
Pennsylvania State Health Improvement Plan 2015-2020 (pdf)
Mental Health and Substance Use (pdf)
August 2016: Governor/DHS releases information on Opioid Centers of Excellence
Centers of Excellence (pdf)
DHS receive federal funding to assist with opioid issues (pdf)
Governor Wolf announces COEs (pdf)
Health Innovation in Pennsylvania Plan (pdf)
Appendices for the Health Innovation in Pennsylvania Plan (pdf)
Update! July 2016: PA Medicaid Managed Care Organization Directory
Updated MCO Listing (pdf)
Update! July 2016: MACRA Resources Available for Member Review
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently repealed the old Medicare SGR formula and set in motion entirely new programs for quality reporting and new payment models. Since MACRA was implemented, there have been numerous questions about payment models (including alternative payment arrangements), the Merit-Based Incentive Payment System (or MIPS), how Electronic Health Records interface with the system, and overall confusion on how both public and private practices will comply with the requirements of MACRA.
The APA held a webinar on June 29, 2016 for members and district branch executives to become acquainted with MACRA's payment reform and quality reporting measures. Download the PowerPoint. Members can also access the most up-to-date information on MACRA at www.psychiatry.org/MACRA. Information there includes APA comments on the Proposed Rule and background on the MACRA (Medicare Access & CHIP Reauthorization Act), MIPS (Merit-Based Incentive Payment System), and APMs (alternative payment models).
The webinar also included information on the Centers for Medicaid and Medicare (CMS) Transforming Clinical Practice Initiative (TCPI). The APA is a participant in the TCPI. According to the APA, CMS' Practice Transformation Networks, or PTNs, can assist psychiatrists with quality improvement, workflow redesign, data collection and analysis, and EHR optimization. Connect with a PTN in your region by visiting www.psychiatry.org/sansgrant or contacting SAN@psych.org.
Additional information will be available on both the Society's and APA's websites at they are available.
January 2015: ICD-10 Final Ruling and New Deadline
DEA Final Rule Rescheduling Hydrocodone Combination Products (PDF)
Prior Authorization/Six Script Limit/Therapeutic Duplication Documentation Template (PDF) - for use in documenting problems associated with the Department of Public Welfare pharmacy initiatives. After completing the form, please return to the Pennsylvania Psychiatric Society for inclusion with other data being provided to the Department of Public Welfare to address concerns with the six-script limits and prior authorization changes
Release of records to insurers - the Shrager case (July 2006)
Medicare Private Contracting — "Opting Out" v. "Non-Participation"
Medicare: Local Carrier Link — HGSAdministrators
