Bureau of Fiscal Management
BFM is responsible for the administration and oversight of fiscal operations for both Fee-for-Service and Physical Health Managed Care delivery systems.
Responsibilities of Divisions
Division of HealthChoices Rates
- Manages the rate-setting process for the Physical Health Managed Care Program, HealthChoices.
- Supports the management of the capitation appropriation, including the development of population projections and input of budget needs.
- Manages the Actuarial Services Contract for Office of Medical Assistance Programs (OMAP), Office of Developmental Programs (ODP), Office of Mental Health and Substance Abuse Services (OMHSAS) and Office of Long Term Living (OLTL).
- Provides data analysis in support of program management, including encounter data expertise, data warehouse validation and data quality improvement.
- Develops, manages and monitors the cost-effectiveness portion of the 1915b PA-67 Waiver that grants PA the authority to administer HealthChoices
Division of Financial Analysis and Reporting
- Oversees the financial monitoring of Managed Care Organizations (MCO).
- Develops MCO financial reporting requirements (FRR) and monitors of MCO financial reports to ensure accuracy and obtain cost and utilization trend reporting, financial strength indicators and ensure third party liability collection.
- Monitors MCO claims processing timeliness.
- Monitors MCO financial health.
Division of Special Payments
- Develops, manages, supports and reconciles MCO capitation, maternity care, risk sharing, risk pool payments and retroactive rate adjustments.
- Provides financial management of the Medical Assistance Transportation Program.
- Administers the MCO Assessment.
Division of Hospital and Outpatient Rate Setting
- Calculates and disburses Disproportionate Share Hospital (DSH) and Supplemental Hospital payments, not to exceed calculated hospital-specific Upper Payment Limit (UPL).
- Manages and collects the Hospital Assessment obligation of hospitals operating in Pennsylvania.
- Desk reviews annual hospital cost reports for hospitals enrolled in the Medical Assistance program.
- Develops payment rates for excluded units of acute care hospitals and other freestanding specialty hospitals.
- Development of payment rates for services deemed to be Program Exceptions.
- Sets Prospective Payment System (PPS) rates Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
- Manages FQHCs/RHCs including rate development and payments.
Division of Budget and Contracts
- Manages the program office budget for the medical assistance program and related grants in coordination with the DHS Budget Office.
- Develops, maintains and addresses issues related to the SFY Budget cycle which includes cyclical submissions of requests/updates, Budget presentations, PRR, cost containment initiatives, Sensitive Budget issues and Budget hearing documentation, state and fiscal year coding and major contracts/new purchases.
- Develops financial and budget strategies to ensure adherence to state and federal regulations, eligibility and maximization of federal funds.
- Coordinates the procurement process for new and extended contracts, payment of invoices, purchases and approvals within ESS and SAP.
Bureau Director: George Rhyne
Phone Number: BMCO/BFM Main Line 717-772-6300