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What do I do if my child's behavioral health services are denied?
As of July 1, 2007, all counties are included in Behavioral HealthChoices – PA's Medicaid Behavioral Health Managed Care Program. In areas that are new to HealthChoices, there is some confusion regarding implementation, including services available and the appeals process. Families hear that services for their children will be limited or eliminated. MHAPA has received calls from families and advocates concerned that needed services for children with behavioral health disorders will be unavailable.
ELIGIBILTY AND SERVICES
Children and adolescents with significant behavioral health problems are usually eligible for PA's publicly funded services. Those services are mandated by federal regulations known as Early and Periodic Screening, Assessment and Treatment (EPSDT).
IF YOUR CHILD’S SERVICES ARE DENIED
The Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS), Department of Public Welfare, oversees the implementation of the Behavioral HealthChoices Program. OMHSAS, with the help of advocates, families and consumers, has developed a process when the HealthChoices Program services are not satisfactory or denied.
- Families should first contact the Member’s Services Department of their Health Choices Managed Care Organization. They may also contact the organization’s Special Needs Unit. The Pennsylvania Medicaid Managed Care Organization (MCO) Directory is a complete listing of each county’s MCOs with contact information.
- If that is not successful families may begin the formal Grievance and Appeal Process. OMHSAS staff presented a guide to the Grievance and Appeal Process at the July 2007 PA Mental Health Planning Council on this process.
- During this process there are automatic protections which prevent treatment and medication from being disrupted (See OMHSAS guide).