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Physical Health Managed Care
Operations Memorandums

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-03-2021-004
​General Operations
Requirements for MY2020/RY2021 HEDIS, CAHPS and Pennsylvania Performance Measure (PAPM) Submissions​March 17, 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
​Active
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-05-2020-010
​General Operations
​MA Eligibility During COVID-19 Emergency Disaster Declaration
​​April 17, 2020
​Active
MCS-04-2020-009
​General Operations
​Telemedicine Guidelines Related to COVID-19
​​April 16, 2020
​Active
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
​Active
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
​Active
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
PROMISe 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
​Active
MCS-09/2018-015
​General Operations
PROMISe 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
​Active
​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