HealthChoices is the Commonwealth of Pennsylvania’s mandatory Medical Assistance (Medicaid) managed care program administered by the Department of Human Services (DHS).
The HealthChoices Program has three primary goals:
- Improve access to health care services for Medical Assistance recipients;
- Improve the quality of health care available to Medical Assistance recipients; and
- Stabilize Pennsylvania’s Medical Assistance spending.
This integrated and coordinated healthcare delivery system was introduced by the Commonwealth to provide medical, psychiatric, and substance abuse services to Medical Assistance recipients. The three components of the HealthChoices program are:
- Physical Health
- Enrollment Assistance Program
- Behavioral Health (mental health and substance abuse treatment services)
The Office of Medical Assistance Programs (OMAP) administers the first two components. The Office of Mental Health and Substance Abuse Services (OMHSAS) oversees the third component, the behavioral health program.
The DHS introduced the HealthChoices program on a staggered basis, starting first in southeastern Pennsylvania and expanding the program throughout the state over a period of ten years. As of July 1, 2007, the HealthChoices program was fully implemented throughout the Commonwealth.
Because of the cross-cutting coordination needs of Medical Assistance recipients, the unique structure of the behavioral health and human service delivery systems administered by the counties, and their over 30 years’ experience in administering behavioral health service programs, DHS determined that county government would be offered the right-of-first opportunity to enter into a capitated contract with the Commonwealth to manage the behavioral health programs. Bedford and Somerset Counties accepted the opportunity to manage the local HealthChoices program and entered into a full-risk capitation contract with the Commonwealth. The Counties formed a 501(c)3 corporation called Behavioral Health Services of Somerset and Bedford Counties, Inc. (BHSSBC), which has the responsibility of managing the HealthChoices contract with DHS.
Effective July 1, 2014, BHSSBC changed to a full-risk model and contracted with PerformCare as an Administrative Service Organization (ASO) performing defined administrative functions. BHSSBC provides oversight and monitoring of all PerformCare’s activities to ensure full compliance with its contract with DHS. Services provided by PerformCare include:
- 24/7 member services
- care management
- community education
- provider network development
- advocacy assistance
- claims management
The needs of the high risk populations included in the HealthChoices managed care program requires broad-based coordination to assure appropriate access, service utilization, and continuity of care for persons with serious mental illness and/or addictive diseases. To meet these needs, BHSSBC provides local clinical care management by employing Clinical Care Managers to manage and coordinate care for complex, high risk, and high cost members.
The Local Clinical Care Managers (LCM) at BHSSBC reside in our community and are familiar with the people we serve and the resources available in Bedford and Somerset Counties. They use a person-centered approach to care management, following the members on their caseload through the various levels of care they are receiving. The LCM’s can be reached through PerformCare Member Services (866-773-7891) or PerformCare’s provider line (888-700-7370).