Pennsylvania HealthChoices Agreements Include New 90-Day Rate Change Processing Requirement

The Pennsylvania Department of Human Services (DHS), to reduce the burden on Community Health Centers when there is a PPS rate change, has added language to the Physical HealthChoices managed care organization (MC0) agreements requiring timely processing. The agreements contain a 90-day MCO processing requirement for rate changes that DHS hopes will help all providers receive timely payments and reduce the burden of fighting for retroactive adjustments with MCOs. The 2022 Physical HealthChoices MCO agreement is available on the DHS website. The first test of the new provision will be when DHS notifies MCOs of the Medicare Economic Index (MEI) adjustment to PPS rates in October.