PAMFT has facilitated a path for LMFTs to become Pennsylvania Medicaid Independent Providers
LMFT services are not included as covered services under Pennsylvania’s Medicaid State Plan as independent providers. However, the HealthChoices Managed Care and Behavioral Health Managed Care Organizations (BH MCO) and CHIP Managed Care Organizations may choose to include LMFTs as supplemental service providers in their networks.
PAMFT worked with the Department of Human Services to create the following provider type and specialty codes within its MA provider enrollment system for LMFTs to apply for enrollment:
For MA (participation in BH MCO networks) you enroll as Provider 11 and Specialty Code 112.
For CHIP LMFTs enroll as Provider Type 11 and Specialty Code 122.
LMFTs will need to be credentialed by the CHIP and BH MCOs who must first notify the Department of Human Services (DHS) that they want you in the network, then the
DHS MA provider enrollment staff will process your MA enrollment applications and you will need to bill according to the MCOs policies.
We cannot change the State MA Plan through legislation as the costs to open it would be enormous at this time and those in the House and Senate do not want to change this if there isn’t a problem. We are hoping that in the next MA revision, which is tentatively scheduled for early 2023, that we will be able to make these changes.
Please use the above codes to apply to become a Medicaid Provider. If you are rejected, please contact PAMFT directly at PAMFT2013@gmail.com with the date of application, and the notice of rejection so that we can show the need for legislative change if necessary. HealthChoices BH-MCO serve specific counties. Please choose your county below.
https://www.dhs.pa.gov/healthchoices/Pages/HealthChoices.aspx
Medicaid Update We need your help!
During 2020, PAMFT continued to work to secure LMFTs are included as independent Medicaid Providers in Pennsylvania.
We have requested the Pennsylvania Department of Human Services (DHS) to create or designate a specific Medical Assistance (MA) code for Licensed Marriage and Family Therapists (LMFT) as exists for social workers, nurses and psychologists.
We presented to the Managed Care Delivery System Subcommittee of the MA Advisory Committee in May and July and to the Behavioral Health Managed Care Organizations (BHMCO) in September of 2020.
The BHMCOs agree that there is need to include LMFTs as specific MA providers.
However, the BHMCOs also offered that they do enroll LMFTs in their organizations and bill them under a different code. This is done on an individual, case by case basis as individual LMFTs apply to the different managed care organizations.
DHS is suggesting that since the BHMCOs are enrolling LMFTs, there isn’t a coding issue and LMFTs do not need a specific, designated MA code.
They have asked that we provide them with failed attempts of LMFTs at obtaining in-network status, including the rationale we are being told that we can't be in-network, whether the network is full or the lack of a code, etc.
We would also like to know, as an independent private practice LMFT, if you have had success joining BHMCOs as an MA provider? If possible, please share which specific code you use to bill for services.
We know that there are practices where LMFTs bill under a LCSWs license in order to accept Medicaid as reimbursement. This is also important information.
MOST IMPORTANT FOR ALL MEMBERS IN THE STATE OF PENNSYLVANIA
PLEASE CONSIDER APPLYING AS A MEDICAID PROVIDER. WE NEED TO SHOW DHS THAT ALTHOUGH WE ARE FEW, WE ARE MIGHTY AND DESERVE RECOGNITION AND EQUALITY IN THE PA MEDICAID SYSTEM LIKE OTHER PROVIDERS. YES, IT IS THE BACK DOOR BUT WE HAVE TO START SOMEWHERE. WE KNOW THAT ONCE OUR WORK IS UTILIZED THE NEED FOR OUR SPECIAL SKILLS IS HIGHER THAN EVER.
We need to know which BHMCOs are accepting LMFTs in order to have DHS recognize the need for LMFTs to have a designated specific MA code.
Please reply to amytielemans@gmail.com and put Medicaid in the Subject Line.
Please reply to
amytielemans@gmail.com and put Medicaid in the Subject Line.
Below is the contact information for the Pennsylvania BHMCOs and a map of their area of coverage.
Providers by county –
Health Choices - Behavioral Health Choices (pa.gov)
Map of zones –
c_295003.pdf (pa.gov)