PH 95 Copayment for HealthChoices

PH 95 Copayment for HealthChoices


On September 14 counties and behavioral health managed care organizations (BH-MCOs) contracting with the Department of Public Welfare were notified that the “…PH 95 co-payment initiative will proceed as indicated in the Notice that was published in the Pennsylvania Bulletin.” Communication from the Office of Mental Health and Substance Abuse Services (OMHSAS) noted that the proposed capitation adjustments for BH-MCO contractors have not been completed and are not available to counties and BH-MCOs. OMHSAS rate calculations will be critical for counties and BH-MCOs in determining how to proceed with management of the co-payment implementation.

OMHSAS has notified counties and BH-MCOs that they have the option of whether or not to implement the co-payment. If a county does choose to implement a co-payment rather than absorb the cost impact as the physical health managed care organizations are likely to do, then a rollout plan including timeframes, the approach to implementation, policies and procedures, draft member notifications, draft provider notices, etc., must be submitted to OMHSAS for review and approval. OMHSAS is requesting coordination among counties that work with the same BH-MCO to submit one plan on behalf of all counties served by that BH-MCO.

Provider agencies that serve individuals in Medicaid Fee-for-Service covered by the co-payment requirement will begin seeing payments reduced in October for services provided for newly eligible PH95 children and beginning November 1 for existing PH95 children.

Parental Bereavement Act

 

Parental Bereavement Act 

Legislation has been introduced in the U.S. Senate that would amend the Family and Medical Leave Act to give parents grieving the death of their child as many as 12 weeks of job-protected leave. Currently, the FMLA allows parents extended, unpaid time off to care for newborn babies, adopted children and family members with serious health conditions.

Sign this bill to show your support for this legislation.

“I, the undersigned, support the Parental Bereavement Act of 2011 (S 1358) (also known as The Farley-Kluger Amendment). This amendment to the FMLA will expand coverage and existing benefits to employees that have experienced the death of a child.

I have included the following to give you a brief overview of the existing Family Medical Leave Act and its benefits:

The FMLA applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees. These employers must provide an eligible employee with up to 12 weeks of unpaid leave each year for any of the following reasons:

For the birth and care of a newborn child; * for placement with the employee of a child for adoption or foster care; * to care for an immediate family member with a serious health condition; * to take medical leave because of a serious health condition; or * to care for an injured service member in the family

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

It is my opinion that the death of a child is one of the worst experiences that anyone can endure. I find it unacceptable that the death of a child is not included as a protected reason to qualify for the benefits that are set forth in the Family Medical Leave Act of 1993.

As your constituent, I encourage you to give this issue serious consideration and to make the necessary modification to the Family Medical Leave Act of 1993.

I support Senator Jon Tester, Kelly Farley, Founder of the Grieving Dads Project (www.GrievingDads.com) and Barry Kluger, Author and grieving father in their efforts to make this necessary change to the Family Medical Leave Act of 1993.”

To sign this bill, please click here.