OMAP-Bureau of Managed Care Operations | Department of Human Services | Commonwealth of Pennsylvania
Source: https://www.pa.gov/agencies/dhs/departments-offices/omap-info/omap-bureau-managed-care-operations
Archived: 2026-04-23 17:11
OMAP-Bureau of Managed Care Operations | Department of Human Services | Commonwealth of Pennsylvania
Office of Medical Assistance Programs (OMAP)
Bureau of Managed Care Operations
The Bureau of Managed Care Operations is responsible for the administration and oversight of mandatory managed care program known as HealthChoices that provides Medical Assistance benefits to eligible recipients in Pennsylvania.
PA Managed Care Organizations (MCOs)
AmeriHealth Caritas of Pennsylvania
Geisinger Health Plan Family
Health Partners Plans
Highmark Wholecare
Keystone First
United Healthcare Community Plan
UPMC for You
Division & Responsibilities
Division of Monitoring and Compliance:
Monitors the HealthChoices Mandatory Managed Care Program to ensure access and quality of care for consumers
Implements Department program changes and new OMAP initiatives
Responds to recipient and provider concerns
Partners with consumer advocacy groups, provider associations, and other stakeholders
Oversees the Department wide Enrollment Assistance Program
Ensures the provision of enrollment services to recipients
Monitors the Enrollment Assistance Program contract
Division of Quality Management and Special Needs Coordination:
Management and facilitation of the Quarterly Quality Review Meeting (QQRM) Process
Management and Oversight of the Prior Authorization Review Panel (PARP) Process
Clinical Oversight of MCO Quality Management and Utilization Management Programs
Oversight and Coordination with the MCO Special Needs Unit
Management and facilitation of the EPSDT Age-Out Process and Complex Care Process
Oversight of the MCO Complaint and Grievance Processes and Management of the MCO Fair Hearing Process
Management of EQR Activities, HEDIS, PA Performance Measure, CAHPS and Member Level Data and Reporting
Management of the Pay for Performance (P4P) Programs (MCO & Provider) and Community Based Care Management Programs
Program Initiatives, Contract Management & Communications:
Assists with the development of Procurements
Facilitates website updates and postings
Administrates the HealthChoices managed care organizations' Agreements & procurement processes
Develops internal & external management reports
Develops managed care & program informational materials and acts as the primary point of contact for HealthChoices program inquiry and public communications initiatives
Assists the OMAP and BMCO Executive Offices with research and development of new program initiatives
Facilitates incoming Right to Know Law Requests for the bureau
Administrates and monitors OMAP's Technical Assistance and Consultative Services Contract
Medical Assistance Transportation Program:
Monitors the county-based MA transportation program
Monitors the contractor that administers the program in Philadelphia county
Office of Medical Assistance Programs (OMAP)
Bureau of Managed Care Operations
The Bureau of Managed Care Operations is responsible for the administration and oversight of mandatory managed care program known as HealthChoices that provides Medical Assistance benefits to eligible recipients in Pennsylvania.
PA Managed Care Organizations (MCOs)
AmeriHealth Caritas of Pennsylvania
Geisinger Health Plan Family
Health Partners Plans
Highmark Wholecare
Keystone First
United Healthcare Community Plan
UPMC for You
Division & Responsibilities
Division of Monitoring and Compliance:
Monitors the HealthChoices Mandatory Managed Care Program to ensure access and quality of care for consumers
Implements Department program changes and new OMAP initiatives
Responds to recipient and provider concerns
Partners with consumer advocacy groups, provider associations, and other stakeholders
Oversees the Department wide Enrollment Assistance Program
Ensures the provision of enrollment services to recipients
Monitors the Enrollment Assistance Program contract
Division of Quality Management and Special Needs Coordination:
Management and facilitation of the Quarterly Quality Review Meeting (QQRM) Process
Management and Oversight of the Prior Authorization Review Panel (PARP) Process
Clinical Oversight of MCO Quality Management and Utilization Management Programs
Oversight and Coordination with the MCO Special Needs Unit
Management and facilitation of the EPSDT Age-Out Process and Complex Care Process
Oversight of the MCO Complaint and Grievance Processes and Management of the MCO Fair Hearing Process
Management of EQR Activities, HEDIS, PA Performance Measure, CAHPS and Member Level Data and Reporting
Management of the Pay for Performance (P4P) Programs (MCO & Provider) and Community Based Care Management Programs
Program Initiatives, Contract Management & Communications:
Assists with the development of Procurements
Facilitates website updates and postings
Administrates the HealthChoices managed care organizations' Agreements & procurement processes
Develops internal & external management reports
Develops managed care & program informational materials and acts as the primary point of contact for HealthChoices program inquiry and public communications initiatives
Assists the OMAP and BMCO Executive Offices with research and development of new program initiatives
Facilitates incoming Right to Know Law Requests for the bureau
Administrates and monitors OMAP's Technical Assistance and Consultative Services Contract
Medical Assistance Transportation Program:
Monitors the county-based MA transportation program
Monitors the contractor that administers the program in Philadelphia county