An individual eligible for MA under BCCPT is approved in category PH and program status code 20.
Initial applications are received in the CAOs from the Community Health Coordinators.
When a completed PA600B is received from the Community Health Coordinator, the CAO authorizes MA eligibility under BCCPT within five work days unless the individual reports having health insurance.
If an individual reports having health insurance, a referral to HIPP must be made by the CAO for a determination. The CAO will not approve MA under BCCPT until the HIPP staff shows whether or not the individual has creditable coverage. HIPP staff has five days to determine creditable coverage.
These applications must be authorized within five work days from the HIPP response if determined there is no creditable coverage.
All applications must be reviewed for other categories of MA based upon information on the application.
NOTE: When a referral to HIPP is needed to confirm creditable coverage, the five day work requirement begins the date the CAO receives a response.
NOTE: Medicare Part A and Medicare Part B are considered creditable coverage. Select Plan is not considered creditable coverage.
NOTE: Do not delay the opening of Medicaid under BCCPT while reviewing for other categories of Medicaid.
Enter health insurance information into the TPL system where appropriate.
An automated notice is generated to the applicant telling them of their eligibility or ineligibility.
A partial renewal is needed for each individual enrolled under BCCPT whose initial length of treatment is expected to last less than twelve months. A complete renewal is needed every twelve months for a woman enrolled in MA under BCCPT who continues to need treatment.
The partial or annual renewal date is based upon the ICD.10 codes that the provider checks on the PA600B or the PA 600BR. This information is entered on the Disability screen in e-CIS.
At the partial renewal, the need for continued treatment must be proven before the eligibility period can be extended.
The Office of Medical Assistance Programs (OMAP) will review all medical records presented during the partial review to make sure that all steps taken and services given were medically necessary under the rules of the Office of the Medical Director (OMD).
The CAO will be notified that:
There is a continued need for a specific length of treatment or
A shorter period of eligibility or
Treatment is stopping because it is no longer needed or because the individual has failed to provide proof of the need for treatment.
The CAO should either continue or end eligibility under BCCPT based upon the recommendation from OMAP, even if it's different from what the provider states on the document.
A referral to HIPP is necessary for all individuals who report having health insurance.
If BCCPT eligibility ends, the CAO worker will review for other categories of MA.
At the complete renewal, the continued need for treatment must be proven. If the renewal form shows that the individual has creditable coverage, that must be proven too.
About 45 days before the partial or annual renewal date, the CAO receives an alert. The CAO must mail the PA 600BR form to the individual with a letter telling the individual what is needed and the deadline for getting the information to the CAO.
The individual and their medical provider complete the form and return it with medical records supporting the need for treatment to:
Attention: OMAP/DMR/BCCPT at fax #: 717-265-8292.
Office of Medical Assistance Programs
Division of Medical Review/BCCPT
P.O. Box 8050
Harrisburg, PA 17105
NOTE: The preferred method to submit BCCPT Renewal forms is to fax the form to OMAP at 717-265-8292.
OMAP will review all medical records submitted with the form for medical necessity under the rules of the Office of the Medical Director (OMD). OMAP will notify the CAO of continued eligibility, a shorter period of eligibility, or the stopping of eligibility under BCCPT.
If not notified by OMAP of the renewal status within 10 days after the due date, the CAO will contact OMAP at RA-FFSBCCPT@pa.gov (PW, FFS_BCCPT) to determine whether the renewal was received and/or is in process.
NOTE: OMAP will respond to CAO inquiries related to medical review and renewal only (i.e., receipt of renewal form, clinical documentation required). For all other inquiries related to the BCCPT process or policy, the CAO may submit a policy clarification.
The CAO will not end BCCPT benefits before receiving confirmation from OMAP that the renewal was not received and/or is in process. If the individual fails to turn in the PA 600BR, the CAO must then take the steps to end benefits.
NOTE: A notice must be sent at every partial or complete renewal. The notice will indicate that the individual is no longer eligible for BCCPT or that there is a change in category of eligibility.
(See Appendix A for reason and option codes.)
Updated June 30, 2025, Replacing April 2, 2019