Health Choices Agreement Exhibit B(5): Community Based Care Management Program
Authors: PA DHS
Website link: https://www.dhs.pa.gov/HealthChoices/HC-Services/Documents/HC%20Agreement%202021.pdf
Publicly Available: Yes
Billing and Reimbursement:
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
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.