Podręcznik dostawcy


In 1997, the Commonwealth of Pennsylvania introduced a new integrated and coordinated delivery health care system, known as HealthChoices, to provide medical, psychiatric and substance abuse services to Medical Assistance members. There are two components that make up the HealthChoices program: Physical Health services and Behavioral Health services. Although these services are provided through separate contractors, the state requires coordination and interaction between all Physical Health and Behavioral Health Managed Care Organizations. Each HealthChoices member is assigned a Behavioral Health plan based on his or her county of residence. Under the Behavioral Health component, the counties are required to ensure high quality care and timely access to appropriate mental health and substance abuse services and facilitate effective coordination with other needed services.

The goals of the HealthChoices physical and behavioral health care programs are to improve the accessibility, continuity, and quality of services for Pennsylvania’s Medical Assistance populations, while controlling the program’s rate of cost increases. The Commonwealth recognizes that broad-based coordination is essential to assuring appropriate access, service utilization, and continuity of care for persons with serious mental illness and/or addictive diseases. It also recognizes that, in the absence of effective services, coordination, and management, there is increased likelihood that children, adolescents, and adults with complex psychiatric and drug and alcohol disorders will be separated from their families. This could occur either through placement in long-term treatment facilities, homelessness, or incarceration in county or state correctional facilities. Such action could lead to development of more serious psychiatric and substance abuse disabilities.

Carelon is a Pennsylvania based Managed Care Organization operating in the Commonwealth. Carelon now provides mental health and substance abuse services to approximately 312,000 Medical Assistance (MA) recipients in 11 Western Pennsylvania counties: Armstrong, Beaver, Butler, Fayette, Indiana, Lawrence, Washington, Westmoreland, Crawford, Mercer, and Venango.