OPs Memo

What is the OPs Memo?

The OPs Memo (Operations Memorandum) is an additional contractual requirement/clarification to the PA Medicaid, Mandatory Managed Care (HealthChoices) Program. This requirement became effective in 2009 and is monitored by the Pennsylvania Department of Public Welfare (PA DPW), Office of Medical Assistance Programs, (OMAP). It was written to address the issues that youth with special health care needs (YSHCN) may encounter when transitioning from pediatric to adult health care.

Who benefits from the OPs Memo?
Everyone benefits from planned transitioning for youth.

  • Parents
    • For parents of YSHCN, finding an appropriate adult doctor for their child can be a daunting challenge. Oftentimes, parents cannot afford to "try out" different adult doctors for their child because insurance won't cover the cost.
    • The goal of the OPs Memo is to ease the stress of transition by mandating that all Medicaid providers allow a child with special needs to meet with an adult provider while still seeing their pediatrician.
  • Youth
    • The OPs Memo makes it easier for youth to stay connected to their pediatrician until they find the adult provider who can best accommodate their special need(s).
  • Medical Professionals
    • Under the OPs Memo, pediatricians have a better understanding of their patient's future health care treatment and are more involved in the transition process.
    • Treating YSHCN for the first time doesn't have to be a "make or break" moment for adult providers. The OPs Memo allows for multiple visits before a final decision about the youth's health care has to be made.

Fostering overlapping visits allows youth, families and providers to discuss and coordinate the member's care from a pediatric to an adult provider. A transition plan can be developed and issues, such as what aspects of the members care should be transitioned and when the transition should take place, can be thoughtfully discussed. Optimally, this overlapping time with pediatric and adult primary care providers will improve the quality of patient and family centered care.

Who should utilize the Ops memo?
Youth who are (a) Still seeing a pediatrician when they are 18 years or older; (b) Covered under PA Managed Medicaid insurance; (c) Identified as "medically fragile" by their Medicaid provider.
FYI: A youth doesn't need to be technology-dependent or have a severe physical disability to qualify as "medically fragile" – the OPs memo defines "medically fragile" as any youth who has or is at risk for a chronic physical, developmental, or behavioral condition, and who requires more medical support than a generally-healthy child might.

Who do I contact if I have questions?
For questions on how to best use this option, please contact the Special Needs Unit of the HealthChoices PH-MCO providing the member's physical health care. The numbers of the Special Needs Units are listed below.

In Addition:
A video demonstrating use of the Ops Memo has been produced by PEAL and can be found here.

HealthChoices Special Needs Units:

Aetna Better Health: 1-866-638-1232 
AmeriHealth Mercy Caritas: 1-800-684-5503
AmeriHealth Northeast: 1-888-498-0766
Coventry Cares: 1-866-427-9721
Gateway Health Plan: 1-800-642-3550
Geisinger Health Plan Family: 1-855-214-8100
Health Partners: 1-866-500-4571
Keystone First Health Plan: 1-800-521-6860
United Health Care Community Plan: 1-877-844-8844
UPMC for You: 1-866-463-1462 
(University of Pittsburgh Medical Center Health Plan)