Pennsylvania's HealthChoices FAQ

On this page you will find information about Pennsylvania's HealthChoices program, its goals and services.

What is HealthChoices?

HealthChoices is the Commonwealth of PA’s mandatory program to restructure the medical assistance fee-for-service system into a managed care system. The conversion to a managed care environment had already occurred for some of the other counties in Pennsylvania.

What are the Goals of HealthChoices?

• Improve access to preventive services, primary care and early prenatal care for PA’s Medical Assistance population.
• Ensure that every recipient has access to and regular contact with their own primary care provider.
• Stabilize PA’s current Medical Assistance (MA) spending and place future spending on a more predictable, sustainable course.

Why Should Counties Participate?

• County governments have a statutory responsibility for administering community-based psychiatric and substance abuse services.
• County governments have 30 years’ experience in delivering services to the medical assistance population.
• County governments administer other publicly funded human service programs and can develop coordination among these funding streams.
• County governments’ participation in HealthChoices has broad-based public support and endorsement from behavioral health consumers and family organizations.
• County governments will be able to coordinate services more effectively for consumers who need services paid for by HealthChoices and the Counties’ base funding.
• County governments will be able to reinvest any savings resulting from HealthChoices back into the local system of care.
• County Governments will maintain local oversight over the system of care and assure access to services.

What Services are Included in the HealthChoices Program for Behavioral Health?

The Commonwealth Request for Proposal (RFP) requires that the HealthChoices behavioral health program includes medically necessary mental health and substance abuse services. The Behavioral Health-Managed Care Organization will provide timely access to diagnostic, assessment, referral, and treatment services for Members for the following benefits:

• Inpatient psychiatric hospital services, except when provided in a State Mental Hospital;
• Inpatient drug and alcohol detoxification;
• Psychiatric partial hospitalization services;
• Inpatient drug and alcohol rehabilitation;
• Non-hospital residential detoxification, rehabilitation and half-way house services for drug/alcohol abuse or dependence;
• Psychiatric outpatient clinic, licensed psychologist and psychiatric services;
• Behavioral health rehabilitation services Early Periodic Screening Diagnosis, and Treatment (EPSDT) for children and adolescents with psychiatric, substance abuse or mental retardation disorders;
• Residential treatment services for children and adolescents (Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited and non-JCAHO);
• Outpatient Drug & Alcohol (D&A) services, including Intensive Outpatient and Methadone Maintenance Clinic;
• Methadone and LAAM (Levo-Alpha-Acetyl-Methadol) when used to treat narcotic/opioid dependency and dispensed by an In-Plan drug and alcohol services Provider;
• Laboratory studies ordered by behavioral health physicians and clozapine support services;
• Crisis intervention services with in-home capability;
• Family-based mental health services for children and adolescents;
• Target mental health case management (intensive case management and resource coordination);
• Effective January 1, 2000 the following will be an in-plan service: psychiatric rehabilitation services with mobile capability for adults.

For more information, go to the Office of Mental Health and Substance Abuse Services (OMHSAS):
OMHSAS HealthChoices link to: http://www.dpw.state.pa.us/about/omhsas/ \