 OVERVIEW
In Pennsylvania, over 1 million children are covered under Medicaid. In addition, PA Medicaid covers children with special health care needs under a “Family of One” provision which allows the child’s income only to determine eligibility. Medicaid is delivered under both mandatory managed care (HealthChoices) and Fee for Service (AccessPlus). Approximately 30% of children are covered under AccessPlus and 70% are covered under HealthChoices.
PA AAP EFFORTS FOR YOU AND YOUR PATIENTS
The PA Chapter works to improve Medicaid services for children and reimbursement for the pediatric practices who care for them. Through our pediatric representatives who serve on various Medicaid committees, pediatrics has a voice within the system. In addition, the PA AAP meets with the Medicaid Chief Medical Officer on a regular basis to discuss pediatric concerns. The AccessPlus and HealthChoices Medical Directors are invited to two meetings per year with the PA AAP Board of Directors to dialogue on pediatric issues and troubleshoot problems. Recent accomplishments have been:
• Two consecutive years of increased E&M code reimbursements.
• EPSDT schedule matched to AAP Bright Futures Guidelines for Health Supervision.
• Increased pediatric pay for performance opportunities under AccessPlus.
INVOLVED PEDIATRICIANS
Kathryn Crowell, MD (Hershey) –
PA AAP representative to the Medical Assistance Advisory Committee which meets monthly in Harrisburg
Andrea McCoy, MD (Phila) –
PA AAP representative to the PA Dept of Public Welfare Peer Review Committee
Cheston Berlin, MD (Hershey) –
PA AAP representative to the PA Dept of Public Welfare Pharmacy & Therapeutics Committee
Barry Clark, MD (Tioga County) and David McConnell, MD (Warren County) –
PA AAP representatives on the AccessPlus Regional Advisory Committees
RESOURCES
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