This section of PALawHelp.org has information and resources about Managed Care issues in Pennsylvania.
Click on a resource category listed below to see information related to that category.
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
How to Appeal a Denial in HealthChoices
If your HealthChoices managed care plan denies your request for a service, such as a medication, home health care, or durable medical equipment, you have the right to appeal. You can also appeal if your plan stops, reduces, or changes a service you have been getting. [PDF]
How to Appeal a Denial in HealthChoices
This consumer fact sheet from the Pennsylvania Health Law Project provides information on how to appeal service denials under the HealthChoices program. (Feb 2019)
Accessing Drug & Alcohol Treatment Services in HealthChoices: Know Your Rights
Information for consumers using HealthChoices seeking to access drug and alcohol services or have an assessment to determine if treatment is needed.
Appealing the Denial, Reduction, or Termination of Wraparound Services in HealthChoices - A Guide for Parents/Guardians and Advocates
Information on how to appeal a determination that denies, reduces or terminates wraparound services under HealthChoices. (November 2011)
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
How to Make a Complaint to Your MA Managed Care Plan
This fact sheet from the Pennsylvania Health Law Project describes the process for filing a complaint with your managed care plan about a participating provider, or about the coverage, operations, or management of the plan, and what to do if you are not satisfied with the complaint outcome. (September 2020)
Medical Assistance Managed Care in Pennsylvania - A Guide to Pennsylvania’s HealthChoices Program for Families
This brochure explains the basics of Medical Assistance (MA) Physical Health coverage for children in Pennsylvania through the HealthChoices Program.
Person Centered Service Planning in Community HealthChoices (CHC)
Information on what Pennsylvanians with disabilities need to know about getting long term services and supports in Community HealthChoices.
Southeastern PA Consumer Guide: Where to Call for Help With Community HealthChoices
Information on where consumers in southeast Pennsylvania can get help with problems with Community HealthChoices. (March 2019)
Troubleshooting Service Coordination Problems in Community HealthChoices - A Toolkit for CHC Participants
This self-help guide from Pennsylvania Health Law Project is designed to help Community HealthChoices participants with common issues with their service coordinators. It includes instructions on how to file a complaint.
Understanding “Wraparound” Services for Children in HealthChoices
This guide is about how to obtain services for children through the Behavioral Health Managed Care Organization.
Writing a Letter of Medical Necessity for Personal Assistance Services (PAS): A Guide for Health Care Providers
This brochure explains how to write a strong letter of medical necessity to support your patient’s request or appeal involving Personal Assistance Services (PAS). It includes a list of topics to include in your letter and some sample language that may be useful in explaining your medical opinion.
Managed Care Information - Pennsylvania Department of Health
Information from the Pennsylvania Department of Health on Managed Health Care
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Pennsylvania Health Care Facilities Search
Search aid from the Pennsylvania Department of Health to help you locate health facilities in Pennsylvania.