Managed care organizations, providers, and stakeholders can access guidance and updates to help them improve the quality of care and ensure compliance with state regulations.
Below are Managed Care Operations Memorandum listed by year.
Jump to year:
2024
| Number | Category | Subject | Posted | Status |
|---|---|---|---|---|
| MCS-O5-2024-006 | General Operations | Guidance for Use of Service History Data Files That Include Substance Use Disorder Encounters | May 21, 2024 | Active |
| MCS-05-2024-005 | General Operations | Permitting Outreach to Members who have lost coverage up to 90 days after disenrollment | May 2, 2024 | Active |
| MCS-03-2024-004 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | March 21, 2024 | Active |
| MCS-03-2024-003 | General Operations | National Correct Coding Initiative (NCCI) Edits | March 21, 2024 | Active |
| MCS-03-2024-002 | General Operations | Revised Model Member Handbook Template | March 21, 2024 | Active |
| MCS-01-2024-001 | General Operations | Payment for Services Associated with Qualifying Clinical Trials | January 03, 2024 | Active |
2023
| Number | Category | Subject | Posted | Status |
|---|---|---|---|---|
| MCS-11-2023-016 | General Operations | Opioid Centers of Excellence | November 08, 2023 | Active |
| MCS-10-2023-015 | Technology Assessment Group | Office of Medical Assistance Programs (OMAP) Coverage Decisions | October 18, 2023 | Active |
| MCS-10-2023-014 | Technology Assessment Group | Office of Medical Assistance Programs (OMAP) Coverage Decisions | October 18, 2023 | Active |
| MCS-10-2023-013 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | October 18, 2023 | Active |
| MCS-10-2023-012 | General Operations | Street Medicine | October 05, 2023 | Active |
| MCS-09-2023-011 | General Operations | Requirements for Consumer Incentive Submissions | September 12, 2023 | Active |
| MCS-09-2023-010 | General Operations | Requirements for MY 2023/RY 2024 HEDIS®, CAHPS® and Pennsylvania Performance Measure (PAPM) Submissions | September 6, 2023 | Active |
| MCS-07-2023-009 | General Operations | Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review 2023 | July 27, 2023 | Active |
| MCS-06-2023-008 | General Operations | Prior Authorization of Opioids | June 29, 2023 | Active |
| MCS-05-2023-007 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | June 21, 2023 | Active |
| MCS-05-2023-006 | Technology Assessment Group | Office of Medical Assistance Programs (OMAP) Coverage Decisions | June 21, 2023 | Active |
| MCS-05-2023-005 | General Operations | New Member Outreach | June 21, 2023 | Active |
| MCS-05-2023-004 | General Operations | Reviewing Requests for Private Duty Nursing, Home Health, and Personal Care Services For Medical Necessity | May 15, 2023 | Active |
| MCS-05-2023-003 | General Operations | Record Review of Managed Care Organizations' Complaint and Grievance Process and Procedure | May 10, 2023 | Active |
| MCS-05-2023-002 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | May 5, 2023 | Active |
| MCS-01-2023-001 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | January 31, 2023 | Active |
2022
| Number | Category | Subject | Posted | Status |
|---|---|---|---|---|
| MCS-11-2022-011 | General Operations | Transportation Requests Referrals | November 30, 2022 | Active |
| MCS-11-2022-010 | General Operations | Opioid Centers of Excellence | November 21, 2022 | Obsolete |
| MCS-11-2022-009 | General Operations | Requirements for Consumer Incentive Submissions | November 14, 2022 | Obsolete |
| MCS-11-2022-008 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | November 03, 2022 | Active |
| MCS-09-2022-007 | General Operations | Requirements for MY 2022/RY 2023 HEDIS®, CAHPS® and Pennsylvania Performance Measure (PAPM) Submissions | September 19, 2022 | Active |
| MCS-07-2022-006 | General Operations | Utilization Review Criteria Assessment Process - Licensed Proprietary Product Review 2022 | August 04, 2022 | Active |
| MCS-07-2022-005 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | July 26, 2022 | Active |
| MCS-07-2022-004 | General Operations | Reinstatement of Prior Authorization Requirements for Private Duty/Shift Nursing Services | July 26, 2022 | Active |
| MCS-07-2022-003 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions | July 13, 2022 | Active |
| MCS-02-2022-002 | Technology Assessment Group | Technology Assessment Group (TAG) Coverage Decisions - TAG 08-21 | February 14, 2022 | Active |
| MCS-02-2022-001 | General Operations | Requirements for MY2021/RY2022 HEDIS, CAHPS and Pennsylvania Performance Measure (PARM) Submissions | February 10. 2022 | Active |
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-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 2020 | Dec. 30, 2020 | Obsolete |
| 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-04-2020-010 | General Operations | MA Eligibility During COVID-19 Emergency Disaster Declaration | April 17, 2020 | Obsolete |
| 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 | Obsolete |
| 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 | Obsolete |
| 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 | PROMISeTM 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 | Obsolete |
| MCS-09/2018-015 | General Operations | PROMISeTM 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 | Obsolete |
| 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 |