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BEHAVIORAL HEALTH SERVICES PROVIDER IN PENNSYLVANIA

  • Writer: Fatumata Kaba
    Fatumata Kaba
  • Oct 8
  • 4 min read

DELIVERING EVIDENCE-BASED MENTAL AND BEHAVIORAL HEALTH SUPPORT TO PROMOTE WELLNESS, FUNCTIONALITY, AND COMMUNITY PARTICIPATION

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Behavioral Health Services in Pennsylvania are Medicaid-funded supports designed to help individuals with mental illness, emotional disturbances, autism spectrum disorders (ASD), or co-occurring behavioral challenges achieve stability, manage symptoms, and improve quality of life. Services range from individual therapy to community-based behavioral support and are delivered under the oversight of the Office of Mental Health and Substance Abuse Services (OMHSAS), managed care organizations (BH-MCOs), and the Office of Developmental Programs (ODP) for individuals with IDD.

 

1. GOVERNING AGENCIES

Agency: Pennsylvania Department of Human Services (DHS) – Office of Mental Health and Substance Abuse Services (OMHSAS)

Role: Oversees Medicaid-funded behavioral and mental health services across all counties.

Agency: Behavioral Health-Managed Care Organizations (BH-MCOs)

Role: Coordinate and authorize behavioral health services for individuals enrolled in HealthChoices.

Agency: DHS – Office of Developmental Programs (ODP)

Role: Oversees behavioral supports for individuals with intellectual or developmental disabilities under waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Ensures federal compliance for Medicaid behavioral health programs.

Agency: Pennsylvania Department of State & Department of Health (DOH)

Role: Handles provider licensing, business registration, and facility regulation.

 

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral Health Services address mental illness, behavioral challenges, and emotional disturbances using therapeutic, clinical, and rehabilitative interventions.

Approved providers may deliver:

  • Individual & Group Therapy: CBT, DBT, trauma-informed therapy, and more.

  • Mobile Therapy / Behavioral Health Rehabilitation Services (BHRS): In-home and community-based treatment for children and youth.

  • Functional Behavioral Assessments (FBA): Development of behavior support plans (BSP).

  • Applied Behavior Analysis (ABA): Evidence-based therapy for individuals with autism or developmental delays.

  • Behavior Specialist Consultant (BSC): Designs and oversees behavioral interventions.

  • Crisis Intervention & De-escalation: On-call support to address psychiatric or behavioral emergencies.

  • Psychiatric Evaluations & Medication Management: Conducted by licensed psychiatrists or psychiatric nurse practitioners.

  • Documentation: Service notes, treatment plans, encounter forms, and Medicaid billing logs.

 

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

  • Register your business with the PA Department of State.

  • Obtain an EIN and Type 2 NPI.

  • Apply for a mental health agency or outpatient psychiatric clinic license through the Department of Health (DOH), if applicable.

  • Enroll as a Medicaid behavioral health provider via PROMISe™.

  • Contract with relevant BH-MCOs by region (e.g., Community Care Behavioral Health, Magellan, PerformCare).

  • Ensure clinical staff hold proper PA licensure (LCSW, LPC, LMFT, BCBA, psychiatrist, etc.).

  • Develop a Behavioral Health Services Policy & Procedure Manual aligned with OMHSAS and CMS guidelines.

 

4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS

Step 1: Form your business entity and secure EIN, NPI, and necessary insurances.

Step 2: Apply for licensure with DOH (if operating as a clinic or facility).

Step 3: Enroll in PROMISe™ as a behavioral health service provider.

Step 4: Contract with your regional BH-MCO(s) based on county coverage area.

Step 5: Submit clinical staff credentials, supervision plans, and policy manuals for approval.

Step 6: Begin accepting authorizations and coordinating with Managed Care referral sources.

 

5. REQUIRED DOCUMENTATION

  • Articles of Incorporation and business registration

  • EIN and NPI confirmation

  • DOH license (if applicable)

  • Proof of credentialing for licensed clinicians and supervisors

  • Insurance certificates (liability, malpractice, workers’ comp)

  • Behavioral Health Policy & Procedure Manual including:

    • Treatment plan development and review timelines

    • Clinical documentation and progress note standards

    • Confidentiality and HIPAA compliance

    • Client intake, risk screening, and safety planning

    • Emergency/crisis response procedures

    • Staff training and credentialing policies

    • Billing templates and audit readiness tools

 

6. STAFFING REQUIREMENTS

Role: Licensed Therapist (LCSW, LPC, LMFT, Psychologist)

Requirements: Active PA license; trained in trauma-informed care and evidence-based practices.

Role: Behavior Specialist Consultant (BSC)

Requirements: PA BSC license or autism endorsement for ASD cases; clinical supervision as needed.

Role: Mobile Therapist / Therapeutic Support Staff (TSS)

Requirements: BA/MA-level professionals with behavioral health training.

Role: Psychiatrist / Psychiatric Nurse Practitioner (optional)

Requirements: Licensed and credentialed for medication evaluation and management.

All staff must complete:

  • FBI/Child Abuse/PA State Police background checks

  • HIPAA, trauma-informed care, and abuse prevention training

  • Annual continuing education and credential renewals

  • Supervision documentation and clinical quality review

 

7. MEDICAID WAIVER PROGRAMS & COVERAGE

Behavioral Health Services are funded under:

  • HealthChoices (BH-MCOs):

    • Covers outpatient therapy, mobile therapy, ABA, and psychiatric services

  • ODP Waivers:

    • Behavioral Support Services (BSS) and behavior plan implementation for individuals with IDD

  • Children’s Waiver Services:

    • Behavioral Health Rehabilitation Services (BHRS) or Intensive Behavioral Health Services (IBHS)

  • Medicaid Fee-for-Service (FFS):

    • For individuals not enrolled in an MCO (rare cases)

 

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Application

Timeline: 1–2 months

Phase: Medicaid Enrollment & BH-MCO Contracting

Timeline: 2–3 months

Phase: Staff Hiring, Credentialing & Supervision Setup

Timeline: 30–60 days

Phase: Referral Development & Service Launch

Timeline: Begins once contracts are in place and billing system is activated

 

9. CONTACT INFORMATION

PA DHS – Office of Mental Health and Substance Abuse Services (OMHSAS)

PA Department of Health – Facility Licensing

PROMISe™ Provider Enrollment

BH-MCO Contacts:

Centers for Medicare & Medicaid Services (CMS)

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PENNSYLVANIA BEHAVIORAL HEALTH PROVIDER

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA BEHAVIORAL HEALTH PROVIDER

WCG supports the launch of high-quality, compliance-ready behavioral health practices across Pennsylvania for mental health and IDD-focused providers.

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Scope of Work:

  • Business registration, licensing, and Medicaid enrollment

  • BH-MCO contracting and regional referral mapping

  • Behavioral Health Policy & Procedure Manual development

  • Clinical staff onboarding and supervision logs

  • Medicaid documentation templates and audit prep tools

  • HIPAA, client rights, and trauma-informed care training toolkits

  • Compliance consulting and quality assurance planning



Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements. 

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