Service Program Information

This page contains information about Service Programs used in PROMISe™.

 

Service
Program
Code

Service
Program
Name

Description

Determination

HCB01HealthCare Benefits Package 1Recipients under 21 years of AgeFFS program
HCB02HealthCare Benefits Package 2Categorically needy recipients Ages 21 and OverFFS program
HCB03HealthCare Benefits Package 3GA categorically needy, recipients Ages 21 and overFFS program
HCB04HealthCare Benefits Package 4Medically needy only recipients Ages 21 and overFFS program
HCB05HealthCare Benefits Package 5GA medically needy only recipients ages 21 and overFFS program
HCB06HealthCare Benefits Package 6Presumptive eligibility pregnant women all agesFFS program
HCB07HealthCare Benefits Package 7State Blind Pension recipients ages 21 and overFFS program
HCB08HealthCare Benefits Package 8Medicare coverage categorically needy recipients ages 21 and overFFS program
HCB09HealthCare Benefits Package 9Medicare cost-sharing only recipients ages 21 and overFFS program
HCB10HealthCare Benefits Package 10Medicare coverage, specified low-income Medicare beneficiaries (SLMB), Medicare part B premium buy-in, medically needy only recipients age 21 and overFFS program
HCB11HealthCare Benefits Package 11State Blind Pension, Medicare cost-sharing only recipients ages 21 and overFFS program
HCB12HealthCare Benefits Package 12Medical employability assessment applicants ages 21 through 58FFS program
HCB13HealthCare Benefits Package 13Medicare coverage, qualified Medicare beneficiaries (QMBs), Medicare Part A & B premium Buy-in, Medicare cost sharing, Medically needy only recipients ages 21 and overFFS program
HCB14HealthCare Benefits Package 14Medicare coverage, specified low-income Medicare beneficiaries (SLMB), Medicare part B premium buy-in, categorically needy recipients age 21 and overFFS program
WAV01Aging WaiverThis program gives a limited # of individuals who qualify for MA, the option of obtaining LTC services in a community-based setting rather than receiving those services in a nursing home. Clients aged over 60.Specific diagnosis and procedure codes
WAV08COMMCARE Waiver Program (COMMCARE)This program gives individuals with traumatic brain injury, who qualify for MA, the option of obtaining services in a home or community-based setting rather than receiving those services in a special rehabilitative nursing facility. Recipients must be 21 or older.Specific diagnosis and procedure codes
WAV18Adult Autism WaiverThe Adult Autism Waiver is a 1915(c) waiver for those who meet the following eligibility criteria: live in Pennsylvania; are 21 or older; have a diagnosis of Autism Spectrum Disorder; are Medical Assistance eligible; meet functional eligibility (ICF/ORC or ICF/MR).FFS Program
LCAP1Living Independence for the Elderly – LIFE (Formerly known as the Long Term Care Capitated (FULL) Assistance Program (LTCCAP)This community based program providers lifetime services to the elderly by providing comprehensive medical, restorative, social, pharmaceutical, and supportive services including acute and long term care services covered by both Medicare and Medicaid. This program is based on the federal Program of All-inclusive Care for the Elderly (PACE) and is Pennsylvania’s only fully integrated long term care managed  care program. Only provider type 58 can participate and recipients must be 55 years old or older and nursing facility clinically eligible.  
SPBP1Special Pharmaceuticals Benefit Program (SPBP1)SPBP is a program for low and moderate income individuals and families that helps pay for specific drug therapies used for the treatment of persons with HIV/AIDS or a DSM IV diagnosis for schizophrenia. SPBP is not an entitlement program. Persons who are not institutionalized or receive pharmaceutical coverage under Medical Assistance or Medical Assistance managed care are not eligible for SPBP coverage. SPBP has no age limits. This service program covers drug treatment(s) for eligible clients with a diagnosis of HIV/AIDS.For Future Use
SPBP2Special Pharmaceuticals Benefit Program (SPBP2)SPBP is a program for low and moderate income individuals and families that helps pay for specific drug therapies used for the treatment of persons with HIV/AIDS or a DSM IV diagnosis for schizophrenia. SPBP is not an entitlement program. Persons who are not institutionalized or receive pharmaceutical coverage under Medical Assistance or Medical Assistance managed care are not eligible for SPBP coverage. SPBP has no age limits. This service program covers drug treatment(s) for eligible clients with a DSM IV diagnosis of schizophrenia.For Future Use
SPBP3Special Pharmaceuticals Benefit Program (SPBP3)SPBP is a program for low and moderate income individuals and families that helps pay for specific drug therapies used for the treatment of persons with HIV/AIDS or a DSM IV diagnosis for schizophrenia. SPBP is not an entitlement program. Persons who are not institutionalized or receive pharmaceutical coverage under Medical Assistance or Medical Assistance managed care are not eligible for SPBP coverage. SPBP has no age limits. This service program covers drug treatment(s) for eligible clients with a dual diagnosis of HIV/AIDS and a DSM IV diagnosis for schizophrenia.For Future Use
EPOMSCCR POMS EncountersThere are no eligibility requirements. The person must have a valid MCI number for the encounter to process. No age limitsFor Future Use
MBHTHBehavioral Health Managed CareThis program will be used for processing encounter claims for individuals enrolled in a Behavioral Health managed care plan 
MPHTHPhysical Health Managed CareThis program will be used for processing encounter claims for individuals enrolled in a Physical Health managed care plan 
WAV07Act 150Provides attendant care services to for Mentally alert Pennsylvanians with physical disabilities. These individuals are not covered under Medicaid and are covered by a state-funded program. 
WAV06Attendant Care Waiver (ACP)Provides attendant care services to for Mentally alert Pennsylvanians with physical disabilities. These individuals are also eligible for Medicaid benefitsSpecific diagnosis and procedure codes
FPP01Family Planning Title XIXFamily Planning Service meets contraceptive needs the provision of educational, medical, and social services. The service enables individuals to determine family size, to space children, and to prevent unplanned pregnancy. Female clients age 10 to 56 
FPP03Family Planning Title VServices rendered to Title V eligible clientsClients are eligible for Title V benefits
FPP02Family Planning Title XXServices rendered to Title XX eligible clientsClients are eligible for Title XX benefits
WAV10Independence WaiverProvides services to eligible persons with physical disabilities to prevent institutionalization. Clients over age 18.Specific diagnosis and procedure codes
WAV09OBRA WaiverProvides services for individuals with developmental disabilities so that they can remain as independent as possible in their communitySpecific diagnosis and procedure codes
HBP01Healthy Beginnings PlusProgram for pregnant women to receive expanded services 
ICF01ICF/ORCIndependent Care Facilities for Person with Other Related Conditions. No age limits 
WAV11Infants, Toddlers and Families WaiverThe Infants, Toddlers and Families Waiver is a 1915(c) Medicaid waiver that provides home and community-based services to Medicaid eligible infants and toddlers, birth to age three, who are in need of early intervention services and who would otherwise require the level of care provided in an intermediate care facility for persons with mental retardation or related conditions (ICF/MR/ORC). Eligible services include habilitation services provided in natural environments by qualified professionals with family/caregiver participation. An aggregate cap on waiver services applies. 
WAV12Consolidated WaiverThe Consolidated Waiver is a 1915(c) Medicaid waiver that provides home and community-based services to Medicaid eligible individuals with mental retardation, age three and older, who would otherwise require the level of care provided in an intermediate care facility for persons with mental retardation (ICF/MR). Eligible services include: habilitation (residential, day, prevocational and supported employment), respite, transportation, environmental accessibility adaptations, homemaker/chore, adaptive equipment, specialized therapies (physical, occupational, speech, hearing, language, visual/mobility and behavioral) and private duty nursing services and permanency planning. An aggregate cap on waiver services applies. 
WAV13Person/Family Directed Support WaiverThe Person/Family Directed Support Waiver is a 1915(c) Medicaid waiver that provides home and community-based services to Medicaid eligible individuals with mental retardation, age three and older who would otherwise require the level of care provided in an intermediate care facility for persons with mental retardation (ICF/MR). Individuals served in this waiver cannot require Office of Mental Retardation licensed community residential services. Eligible services include: adaptive appliances and equipment, environmental accessibility adaptations, habilitation services (residential, day, prevocational and supported employment), homemaker/chore, personal support, respite care, therapies (physical, occupational, speech, hearing, language, visual/mobility and behavioral), transportation, and visiting nurse. An annual individual cap on waiver services applies. 
WAV14MR Base ServicesBase services are services provided to individuals of all ages who have mental retardation. Services include intake, service coordination; family aide; family education training; recreational therapy and recreation/leisure time activities; vocational therapy; dental hygienics, innovative services and early intervention. Services available under the Medicaid waivers may also be provided and funded as base services. Base services are generally funded 90% State and 10% County. 
WAV15Early InterventionServices provided to infants and toddlers under three years of age according to Act 212 and the Individuals with Disabilities Education Act, as amended by the Individuals with Disabilities Education Act Amendments of 1997. Infants and toddlers must have a twenty-five percent delay in one or more areas of development when compared to other children of the same age, or a physical disability such as hearing or vision loss, or informed clinical opinion that the child has a delay or the child has known physical or mental conditions which have high probability for development delays. Qualified professionals provide services in natural environments in accordance with the Individual Family Service Plan. Developmental services include, but are not limited to, assessment and evaluation, referral, child oriented services, family oriented services, and service coordination. 
WAV16EI Base Funds