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HIGHMARK BLUE SHIELD PHYSICAL MEDICINE MANAGEMENT PROGRAM

 

Highmark's Physical Medicine Management Program (PMMP) has been delayed until May 2013. This program impacts OT, PT, and chiropractic services provided in outpatient settings. POTA participated in summer meetings with Highmark to learn about their program, and we surveyed POTA members to learn their experiences leading to this implementation. Most recently, we worked collaboratively with the Pennsylvania Physical Therapy Association and the Pennsylvania Chiropractic Association in an effort to clearly articulate our concerns to Highmark. We have requested that Highmark delay the implementation of this program until all stakeholders can ensure that Highmark beneficiaries get the skilled services that they need and that service providers are appropriately reimbursed.


For more information about the program, read Highmark's
Special Bulletin of June 14, 2012. POTA members have access to POTA's letter to Highmark in their member portal.

As always, your help and support are appreciated. To support this effort, you can do any of the following:

1. Express your concerns and address your questions directly to Highmark (Highmark, Physical Medical Management Program, 120 5th Ave #2015 Pittsburgh, PA 15222; (412)544-7000). When you do so, please let POTA know by emailing president@pota.org

2. Encourage your clients who are impacted by this program to contact Highmark and express their concern and/or seek clarification. 

3. Alert your state representatives and senators to the situation and how it will impact your practice and the care of your clients. You can find your representative and senators by clicking on "finding elected officials" under the Advocacy tab on the POTA website.

4. Donate to POTA's legislative fund. We do not know where this situation will lead but because it surfaced after we completed our 2012-2013 budget, we did not allocate resources to it.

Thank you to those of you who have communicated with us on this issue....remember, we can't work FOR you WITHOUT you. Join POTA now!

 

Early Intervention Eligibility Announcement 

POTA commented on early intervention eligibility changes announced by the Office of Child Development and Early Learning (OCDEL). In the October 8, 2012 letter, POTA expressed appreciation for OCDEL's clarification that test scores used to determine EI eligibility do not indicate which specific services are required in the child’s IFSP. Clarification was requested concerning use of standardized assessments. POTA recommended OCDEL issue further guidance on how eligibility through either "Informed Clinical Opinion (ICO)" or “Medical and Other Records” is determined and documented by the team, urging OCDEL to use available research concerning ways that ICO can lead to effective eligibility decisions. Click HERE to access POTA’s full comments in the file library.

 


Picture of Slack logo All POTA members receive 10% off  their purchases at Slack Books.      
Access Promo Code.    


Click on the image below to enter Amazon and a portion of the proceeds from your purchase will be sent to support POTA!

 

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