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  • 17,803 complaints received
  • 5,003 Field Investigations
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  • October 1, 2013 - September 30, 2014

    Office of Medical Assistance Programs

    Our Mission and Goals:

    Service - We will provide responsive, timely, and quality service to consumers and stakeholders (families, providers, advocates, employees and business partners).

    Partnership - We will recognize the needs of consumers and stakeholders through the use of open and public input and feedback processes.

    Stewardship - We will be prudent and efficient in our use of public resources. Innovation - We will seek and adopt creative solutions to improve performance.

    Respect - We will value different perspectives, and appreciate the contributions of all consumers, stakeholders and employees.

    GOALS:

    • To implement mandatory managed care statewide.
    • To expand home and community based services.
    • To improve the quality of services to consumers and providers in all our health care delivery systems.
    • To improve our technology infrastructure by supporting H-Net Development and re-designing MAMIS.

    The Office of Medical Assistance Programs administers the joint state/federal Medical Assistance (also known as Medicaid) program that purchases health care for close to 1.9 million Pennsylvania residents. Local County Assistance Offices determine eligibility for Medical Assistance.

    Medical Assistance purchases services through contracts with managed-care organizations and under an indemnity, or traditional, fee-for-service system. Facility based services are reimbursed under case-mix for long-term care for the elderly, while other facilities are paid on a prospective, or cost, basis. A medical provider is required to enroll in the program and must meet applicable national, federal and state licensing and credential requirements.

    The Office of Medical Assistance Programs is also responsible for enrolling providers, processing provider claims, establishing rates and fees, contracting and monitoring of managed care organizations, and detecting and deterring provider and recipient fraud and abuse.

    We will recognize the needs of consumers and stakeholders through the use of open and public input and feedback processes. We will be prudent and efficient in our use of public resources. We will seek and adopt creative solutions to improve performance. We will value different perspectives, and appreciate the contributions of all consumers, stakeholders and employees.

    Learn about the Medical Assistance Advisory Committees

    Please use the links below to view information about our individual Bureaus.