Pennsylvania

Integrated Care Activities

  • Financial Alignment Demonstration: No
    Dual Eligible Special Needs Plan Contracting: Yes
    Medicaid Managed Long-Term Services: Yes
    Approved Medicaid Health Home: No
    Program of All-Inclusive Care for the Elderly (PACE): Yes

Related Resources

  • Other Resource

    State and County Data File, 2012

    The most recent demographic, enrollment, and expenditure data for dually eligible beneficiaries is in the zip file "State and County Data File 2012" found on the Medicare-Medicaid Coordination Office website. Additional data and statistical resources for the years 2007, 2008, 2009, and 2011 can be found in the Medicare-Medicaid Enrollee State Profiles. See also Defining Medicare-Medicaid Enrollees in CMS Data Sources. (Centers for Medicare & Medicaid Services)
    Topic: Data for Medicare-Medicaid Integration
  • Other Resource

    Cooperative Agreement between Pennsylvania Dept. of Public Welfare and Medicare Advantage Health Plan

    (Pennsylvania Dept. of Public Welfare)
    Topic: State Contracting Strategies
  • Brief

    Promoting Information Sharing by Dual Eligible Special Needs Plans to Improve Care Transitions: State Options and Considerations

    This brief examines the approaches used by three states – Oregon, Pennsylvania, and Tennessee – to develop and implement information-sharing processes for their Dual Eligible Special Needs Plans (D-SNPs) that support care transitions. The brief includes examples of contract language and strategies to encourage plan collaboration and problem solving around information sharing. It can help states, D-SNPs, and other stakeholders assess how to meet the new D-SNP contracting requirements and improve the care of dually eligible individuals. (Center for Health Care Strategies)
    Topic: Foundational Steps, Dual Eligible Special Needs Plans (D-SNPs), State Contracting Strategies
  • Case Study

    Extending Lessons from a Medicaid Pilot to Improve Care for Medicare and Dual Eligible Beneficiaries

    This case study highlights a chronic conditions special needs plan (C-SNP) for Medicare and dual eligible beneficiaries with serious mental illness that integrates physical and behavioral health services for enrollees. (Center for Health Care Strategies)
    Topic: Behavioral Health, Behavioral Health
  • Other Resource

    Integrated Care Plan Template - Connected Care Pilot

    This web-based integrated care plan, developed for the Southwestern Pennsylvania Rethinking Care Program pilot, allows physical and behavioral health plans to share data with care managers. (UPMC Health Plan)
    Topic: Behavioral Health
  • Brief

    Moving Toward Value-Based Payment for Medicaid Behavioral Health Services

    This brief describes how innovative states and Medicaid managed care organizations are building on models developed for physical health services and incorporating value-based purchasing arrangements into behavioral health programs. (Center for Health Care Strategies)
    Topic: Behavioral Health
  • Brief

    Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems

    This brief explores the experience of six states that have achieved varying levels of behavioral health and physical health integration or collaboration for dually eligible beneficiaries within a managed care environment. It describes: (1) opportunities for explicit state action and requirements to push development of integration components; and (2) opportunities for states to signal the importance of integration elements while providing flexibility to allow plans to innovate. (Integrated Care Resource Center)
    Topic: Behavioral Health, Behavioral Health
  • Technical Assistance Tool

    State Contracting with Medicare Advantage Dual Eligible Special Needs Plans: Issues and Options

    This tool describes how 13 states used their contracts with D-SNPs to more effectively coordinate care and services for Medicare-Medicaid beneficiaries. (Integrated Care Resource Center)
    Topic: State Contracting Strategies, Oversight and Monitoring

State Integration Activities

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