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Physical Health Managed Care
Operations Memorandums


2024

​Number
​Category
​Subject
​Posted
​Status
MCS-03-2024-004Technology Assessment GroupTechnology Assessment Group (TAG) Coverage DecisionsMarch 21, 2024Active
MCS-03-2024-003General OperationsNational Correct Coding Initiative (NCCI) EditsMarch 21, 2024Active
MCS-03-2024-002General OperationsRevised Model Member Handbook TemplateMarch 21, 2024Active
​MCS-01-2024-001
​General Operations
​​Payment for Services Associated with Qualifying Clinical Trials
​January 03, 2024
​Active

2023

​Number
​Category
​Subject
​Posted
​Status
​MCS-11-2023-016
​General Operations
​​Opioid Centers of Excellence
​November 08, 2023
​Active
​MCS-10-2023-015
​Technology Assessment Group
​Office of Medical Assistance Programs (OMAP) Coverage Decisions
​October 18, 2023
​Active
​MCS-10-2023-014
​Technology Assessment Group
Office of Medical Assistance Programs (OMAP) Coverage Decisions
​October 18, 2023
​Active
​MCS-10-2023-013
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​October 18, 2023
​Active
​MCS-10-2023-012
​General Operations
​Street Medicine
​October 05, 2023
​Active
​MCS-09-2023-011
​General Operations
​Requirements for Consumer Incentive Submissions
​September 12, 2023
​Active
​MCS-09-2023-010
​General Operations
​Requirements for MY 2023/RY 2024 HEDIS®, CAHPS® and Pennsylvania Performance Measure (PAPM) Submissions
​September 6, 2023
​Active
​MCS-07-2023-009
​General Operations
​Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review 2023
​July 27, 2023
​Active
​MCS-06-2023-008
​General Operations
​Prior Authorization of Opioids
​June 29, 2023
​Active
​MCS-05-2023-007
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​June 21, 2023
​Active
​MCS-05-2023-006
​Technology Assessment Group
​Office of Medical Assistance Programs (OMAP) Coverage Decisions
​June 21, 2023
​Active
​MCS-05-2023-005
​General Operations
​New Member Outreach
​June 21, 2023
​Active
​MCS-05-2023-004
​General Operations
​Reviewing Requests for Private Duty Nursing, Home Health, and Personal Care Services For Medical Necessity
May 15, 2023
​Active
​MCS-05-2023-003
​General Operations
​Record Review of Managed Care Organizations' Complaint and Grievance Process and Procedure
​May 10, 2023
​Active
​MCS-05-2023-002
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​May 5, 2023
​Active
​MCS-01-2023-001
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​January 31, 2023
​Active

2022

​Number
​Category
​Subject
​Posted
​Status
​MCS-11-2022-011
​General Operations
​Transportation Requests Referrals
​November 30, 2022
​Active
​MCS-11-2022-010
​General Operations
​Opioid Centers of Excellence
​November 21, 2022
​Obsolete
​MCS-11-2022-009
​General Operations
​Requirements for Consumer Incentive Submissions
​November 14, 2022
​​Obsolete
​MCS-11-2022-008
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​November 03, 2022
​Active
​MCS-09-2022-007
​General Operations
​Requirements for MY 2022/RY 2023 HEDIS®, CAHPS® and Pennsylvania Performance Measure (PAPM) Submissions
​September 19, 2022
​Active
​MCS-07-2022-006
​General Operations
​Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review 2022
​August 04, 2022
​Active
​MCS-07-2022-005
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​July 26, 2022
​Active
​MCS-07-2022-004
​General Operations
​Reinstatement of Prior Authorization Requirements for Private Duty/Shift Nursing Services
​July 26, 2022
​Active
​MCS-07-2022-003
​Technology Assessment Group
​Technology Assessment Group (TAG) Coverage Decisions
​July 13, 2022
​Active
​MCS-02-2022-002
Technology Assessment Group
Technology Assessment Group (TAG) Coverage Decisions - TAG 08-21
​February 14, 2022
​Active
​MCS-02-2022-001
​General Operations
​Requirements for MY2021/RY2022 HEDIS, CAHPS and Pennsylvania Performance Measure (PARM) Submissions
​February 10. 2022
​Active

2021

​Number
​Category
​Subject
​Posted
​Status
​MCS-06-2021-007​​General Operations​​Updates to Prior Authorization Requirements for Certain Services During the COVID-19 Public Health Emergency​June 15, 2021​Active
​MCS-06-2021-006​​General Operations​Technology Assessment Group (TAG) Coverage Decisions​June 15, 2021​Active
​MCS-06-2021-005​​General Operations​Technology Assessment Group (TAG) Coverage Decisions
​June 15, 2021​Active
​MCS-02-2021-003
​​General Operations
​Increased Timeframe For Continuation of Services
​Feb. 22, 2021
​Active
​MCS-01-2021-002
General Operations
​Technology Assessment Group (TAG) Coverage Decisions - TAG 11-19
​Jan. 5, 2021
​Active
​MCS-01-2021-001
​General Operations
​Technology Assessment Group (TAG) Coverage Decisions - TAG 2-5-20
​Jan. 5, 2021
​Active

2020

​Number
​Category
​Subject
​Posted
​Status
​MCS-12-2020-018
​General Operations
Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review LLP 2020Dec. 30, 2020
​Obsolete
MCS-12-2020-017
​​General Operations
​Technology Assessment Group (TAG) Coverage Decisions
​​Dec. 8, 2020
​Active
​MCS-11-2020-016
General Operations
​Paying Legally Responsible Family Members to Provide Personal Care Services as Caregivers
​​Nov. 24, 2020
​Active
​MCS-09-2020-015
​General Operations
​Verifying Medicare noncovered Durable Medical equipment (DME)
​Sept 29, 2020
​Active
​MCS-06-2020-014
​General Operations
​No Charge to medical Assistance Beneficiaries for Personal Protective Equipment
June 12, 2020
Active
​MCS-05-2020-013
​General Operations
​Removal of Prior Authorization for SublocadeTM (buprenorphine extended-release) Injection
May 26, 2020
​Active
​MCS-05-2020-012
​General Operations
​Elective Services
​​May 7, 2020
​Active
​MCS-04-2020-011
​General Operations
​CR Modifier and DR Condition Code for COVID-19-Disaster/Emergency Related Claims
​​April 27, 2020
​Active
​MCS-04-2020-010
​General Operations
​MA Eligibility During COVID-19 Emergency Disaster Declaration
​​April 17, 2020
​Obsolete
​MCS-04-2020-008
​General Operations
​New ICD-10-CM Code for the 2019 Novel Coronavirus (COVID-19)
​​April 12, 2020
​Active
​MCS-03-2020-005
​General Operations
​Requirements Related to COVID-19
​​March 25, 2020
Obsolete
​MCS-03-2020-004
​General Operations
​PROMISeTM Managed Care Payment System Table
​March 24, 2020​Active
MCS-02-2020-002
 ​General Operations
​Contraception Dispensing
 Feb. 21, 2020
 ​Active
​MCS-01-2020-001
 ​General Operations
 ​Requirements for 2020 HEDIS, CAHPS and Pennsylvania Performance Measure Submissions
 ​Feb. 3, 2020
​Active

2019

​Number
​Category
​Subject
​Posted
​Status
​MCS-12-2019-013
​General Operations
Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review 2019
Dec. 31, 2019
​Obsolete
MCS-12-2019-012
​​General Operations
Complaints, Grievances and Fair Hearing Templates GG (13)(16) and
N (1)-(7) Update
​​Dec. 16, 2019
​Active
​MCS-08-2019-011
General Operations
Technology Assessment Group Coverage Decisions
​​Oct. 22, 2019
​Active
MCS-06-2019-009
​General Operations
Technology Assessment Group Coverage Decisions
​June 5, 2019
​Active
MCS-05-2019-008
​General Operations
Retrospective Review of Hospice Services Provided by managed care network Providers
May 23, 2019
Active
​MCS-04-2019-007
​General Operations
2019 HealthChoices Physical Health Agreement
April 12, 2019
​Active
​MCS-04-2019-006
​General Operations
Removal of Substance use Disorder (SUD) Medications from Specialty Programs and Specialty Drug Lists
​​April 10, 2019
​Active
​MCS-03-2019-005
​General Operations
Technology Assessment Group Coverage Decisions
​​April 2, 2019
​Active
MCS-03-2019-004
​General Operations
Consumer incentive Submission Requirements - Revised
​​March 8, 2019
​Active
​MCS-03-2019-003
​General Operations
Changes to Third Party Liability Requirements Related to Prenatal Services, Effective April 1, 2019
​​Feb. 27, 2019
​Active
​MCS-02-2019-002
​General Operations
Oversight of Opioid use Disorder Centers of Excellence
​​Feb. 1, 2019
​Active

2018

​Number
​Category
​Subject
​Posted
​Status
​MCS-12/2018-024
​General Operations
HealthChoices Physical Health Managed Care Organization (PH-MCO) Responsibility to Pay for Licensed Emergency Medical Agency Services when Emergency Medical Transportation is Not Provided ("Treat-No-Transport")
Dec. 27, 2018
​Active
MCS-12/2018-023
​​General Operations
Increased Rates for Ambulance Services, Effective January 1, 2019
​​Dec. 21, 2018
​Active
​MCS-12/2018-022
General Operations
PROMISeTM Managed Care Payment System Table Update
​​Dec. 14, 2018
​Active
MCS-12/2018-021
​General Operations
To provide MCOs coverage updates on new technologies as discussed in regular Technology Assessment Group (TAG) meetings
​Dec. 5, 2018
​Active
MCS-10/2018-020
​General Operations
All HealthChoices Physical Health Managed Care Organizations and Providers - Statewide
Oct. 23, 2018
Active
MCS-10/2018-019
​General Operations
Policies Concerning Department of Human Services Review of Requests for Residential Placement of Children for Treatment of Physical Health Conditions
Oct. 16, 2018
​Active
​MCS-10/2018-018
​General Operations
Payment Responsibility if a Member has Primary Coverage (Third Party Liability)
​​Oct. 10, 2018
​Active
MCS-09/2018-016
​General Operations
Provider Pay for Performance Program Reports
​​Sept. 26, 2018
​Obsolete
MCS-09/2018-015
​General Operations
PROMISeTM Managed Care Payment System Table
​​Sept. 1, 2018
​Active
​MCS-08/2018-014
​General Operations
Technology Assessment Group Coverage Decisions
​​Aug. 15, 2018
​Active
​MCS-06/2018-012
​General Operations
Utilization Review Criteria Assessment Process - Licensed Proprietary Product
​​June 18, 2018
​Obsolete
​MCS-05/2018-010
​​General Operations
​Pennsylvania Performance Measures Timeline Reporting Requirements
​​​May 25, 2018
​Active
​MCS-05/2018-009
​​General Operations
​Technology Assessment Group Coverage Decisions
​​​May 16, 2018
​Active
​MCS-04/2018-006
​​General Operations
​Public Health Dental Hygiene Practitioner (PHDHP) Enrollment
​​​April 9, 2018
​Active
​MCS-03/2018-004
​​General Operations
​Technology Assessment Group Coverage Decisions
​​​March 16, 2018
​Active
​MCS-03/2018-003
 ​​General Operations
 ​Prior Authorization of Opioids and Medication Assisted Treatment (MAT)
 ​​​March 15, 2018
​Active