Fee-For-Service System In Pennsylvania
In Pennsylvania, MA recipients obtain services through either the fee-for-service or the managed care delivery system.
In the fee-for-service system, recipients have been able to obtain covered services from any provider enrolled in the MA program, and DPW pays the provider directly.
In the managed care system, DPW contracts with, and pays, licensed Managed Care Organizations (MCOs) for covered services.
DPW administers a mandatory managed care program in twenty-five counties.
Moreover, voluntary enrollment with an MCO is available in twenty-six of the forty-two fee-for-service counties.
The Project does not affect those covered under either the mandatory or voluntary managed care delivery systems.
In addition, approximately thirty-four percent of fee-for-service recipients are dual eligibles, i.e., eligible under the MA Program and Medicare, and they are exempt from participation in the Project. (RFP No. 31-06, IV-2(a).)