The Office of the Medical Director provides statewide clinical mental health and substance abuse services leadership to all Department of Human Services (DHS) program offices.
The medical director is responsible for ensuring all clinical programs for individuals with mental illness or substance use disorders served throughout the Commonwealth by the Office of Mental Health and Substance Abuse Services (OMHSAS) are of the highest quality, support a unified treatment system, and reflect OMHSAS' commitment to facilitating recovery in adults and resiliency in children. The medical director functions as the chief medical officer of the state hospital system and provides oversight to community services as the chief clinical officer. The medical director's responsibilities include:
- Directing and providing clinical coordination between physical and mental health and substance abuse care benefit plans.
- Directing and providing clinical consultation and technical assistance with counties, state hospitals, managed care organizations (MCOs), health maintenance organizations, and specialty services, such as forensic, long-term nursing care, children, and the elderly.
- Consulting and collaborating with the Bureau of Children's Services and the Bureau of Drug and Alcohol Programs regarding clinical programs and programs for special populations.
- Developing and communicating policy to community mental health facilities, programs, and MCOs regarding pharmacy issues.
- Leading the development and oversight of the psychotropic drug formulary, the related prior authorization policies, and the inclusion of consumers, families, and advocates in the administrative process. The medical director is a member of the DHS Pharmacy and Therapeutics Committee.
- Leading, directing, and maintaining the Drug Utilization Reporting System (DURS) that provides monthly drug usage reports from the state hospital pharmacies. In addition, the medical director is a member of the DHS Drug Utilization Review Board.
- Interfacing with the advocacy community to learn their needs and concerns and to ensure that the clinical programs of the behavioral healthcare system are consumer responsive.
- Interfacing with the professional community to learn their needs and concerns and to inform them of major OMHSAS initiatives and enlist their support in providing high-quality care that is consumer responsive.
- Developing and implementing best practice and expert consensus models for the treatment of individuals with severe mental illness and substance use disorders.
- Promoting the implementation of other best practices as they become available.
The Office of the Medical Director is also responsible for the supervision of the Division of Clinical Review and Consultation as well as the Emergency Behavioral Health Preparedness, Response, and Recovery Program.
Staff:
- Associate Medical Director
- Associate Clinical Director
- Chief Pharmacist for OMHSAS
- Director of Clinical Review and Consultation
- Behavioral Health Disaster Coordinator
Division of Clinical Review and Consultation
The Clinical Review and Consultation Division responsibilities include:
- Review Fee for Services requests for authorization of inpatient, partial hospital, residential treatment facilities for children, and Behavioral Health Rehabilitation Services
- Review Omnibus Budget Reconciliation Act (OBRA) requests for nursing home placements to ensure that those with an identified mental health issue can be effectively served within a nursing home
- Process requests for appeals of authorization determinations
- Participate in the review of complex cases, including the development of creative or alternative solutions when existing programs and services cannot meet the needs of the consumer
Emergency Behavioral Health Preparedness, Response, and Recovery Program
The Emergency Behavioral Health Preparedness, Response, and Recovery Program consists of Disaster Behavioral Health initiatives including preparedness, response, and recovery activities at the county and state level. The Pennsylvania Office of Mental Health and Substance Abuse Services, as well as each of the county mental health offices in the Commonwealth, have initiatives in place to help Pennsylvanians prepare for, respond to, and cope with the psychosocial and emotional consequences related to disasters and public health emergencies. The efforts involve collaboration and partnerships with other national, state, and local response agencies, including public and non-public sector partners. Efforts also include working with federal agencies to ensure a comprehensive, professional, disciplined, and coordinated behavioral health response for Commonwealth citizens who are victims of disasters.
Contact Information:
If you have any questions concerning a member's rights or you have a problem with your MCO, contact the Member Services department of your county's behavioral health managed care organization.
If you are not in a Medicaid managed care plan contact your county mental health and intellectual disabilities office. You may also contact the OMHSAS field office near you.
Members enrolled in Medicaid have the right to request a Fair Hearing from the Department of Human Services anytime a prescribed service or medication is changed or denied. The member will receive a letter from either the MCO or Medical Assistance whenever a medical service is denied or changed. This letter also includes directions for accessing the DHS Fair Hearing process.
Dr. Dale K. Adair, Medical Director
P. O. Box 2675
Harrisburg, PA 17105-2675
Receptionist: 717-787-6443