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PCPA Children’s Committee November 13, 2012 Changes and Challenges in Policy Planning and Practice.

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Presentation on theme: "PCPA Children’s Committee November 13, 2012 Changes and Challenges in Policy Planning and Practice."— Presentation transcript:

1 PCPA Children’s Committee November 13, 2012 Changes and Challenges in Policy Planning and Practice

2 Summer Therapeutic Activity Program Planning  Request for 2012 bulletin impact data  Key concerns and issues Description approval process Authorization and rate setting timing Unit of service issue (1 hour unit) Misinterpretations of therapeutic activity types OMHSAS workgroup participation Informing schools/families of ESY impact and needs

3 DPW Autism Service Behavior Specialist Consultant Licensure Requirement  Support for quality service delivery  PCPA Position on DPW interpretation of Act 62  BS license mandate conflicts with state Clinic Model  BH-MCO assessment of provider panel impact and service reductions  Challenges to obtaining the BS license Approval of submitted training curricula University transcript review and confirmation ASD direct care hour confirmation Volume and timing of Dept. of State/Medical Licensing Board review/licensing  Recommendations for solutions

4 BHRS “Redesign”  Impact on prescribing and medical-ethical implications  Impact on services authorization, reduction in prescribed units, appeals  Allowable service billing interpretations  Impact on schools and the community  Recommendations for solutions

5 PH-95 Copayment and Premium Next Steps  Acknowledging our partners Advocates, Practitioners, BH-MCOs, Legislature  Current proposal from PCPA and partners “fair share” for families Efficient, Effective Administration  Next Steps, DPW work group and premium proposal to CMS

6 Act 62 Payment Shortfall  Rate of denials and collections from commercial plans  Rate of denials and collections from MA plans  Quality of administrative cooperation from commercial and MA plans  Strategic complaints to PA Insurance Department?  Recommendations for solutions

7 County Block Grant Impact  County plan hearing process and provider input  Local service reductions driven by the 10% cuts MH, IDD, Schools, OCYF, other Redistribution of up to 20% of block funds  Local service reductions driven by county priorities MH, D&A, IDD, Schools, OCYF, other

8 Threats to Evidence Based Practice as Priority Services in PA  Purchase of service is FFS, not community capacity  Rates vs Costs (training, services, adherence, reporting, etc.)  Service needs vs referral trends  Local Status of PCIT, MST, FFT, MDFT, ABFT, Sanctuary, FBMHS, etc.  Recommendations for solutions

9 Changes and Challenges in Policy, Planning and Practice And Looking Ahead to  Adoption of the DSM V  Implementation of New CPT Codes  Implementation of ACA and Parity Essential Benefits, Insurance Exchanges, MA Expansion  Child Abuse & Mandated Reporter Changes  Early Childhood Mental Health Challenges  Service Co-Location Schools, Primary Health Care, other

10 Changes and Challenges in Policy, Planning and Practice


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