Health Choices Agreement Exhibit B(5): Community Based Care Management Program



Authors: PA DHS
Year: 2020
State: PA
Website link: https://www.dhs.pa.gov/HealthChoices/HC-Services/Documents/HC%20Agreement%202021.pdf
Publicly Available: Yes
Billing and Reimbursement:
Certification:
Evidence Generation:
Policy: MCO contract language and reimbursement models
Sustainable Financing: How to engage and work with Medicaid, Including community-based CHWs, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models
Workforce Development:

The Community Based Care Management (CBCM) Program requirements described in this Exhibit B(5) are for care rendered during a CY and defined in the PH-MCO specific CBCM Program approved by the Department per Section I below. Proposals submitted for the CBCM program must increase the use of community-based staff, including certified Community Health Workers where appropriate, to encourage the use of preventive services, identify and resolve barriers to care, and mitigate social determinates of health.



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