Pennsylvania law requires every county (or group of counties) to have certain services available to persons who need them because of mental health, behavioral health or intellectual disability concerns. Carbon-Monroe-Pike Mental Health and Developmental Services (CMP MH/DS) is responsible for the availability of these services within the three-county region.
You may call or visit any of our offices to receive information and help in obtaining services. A receptionist may ask you a few questions, schedule an appointment, or refer you to a caseworker for assistance. Routine appointments are scheduled within seven (7) days.
Any person in the three-county area with mental health, behavioral health or mental retardation issues or an infant/toddler with developmental disabilities is eligible for services provided by Carbon-Monroe-Pike MH/DS.
No one is denied service because of inability to pay. Services are available without regard to race, color, sex, creed, age, disability, handicap, ancestry, or national origin.
The agency’s goal is to assure that persons with mental disabilities can receive any service necessary to enhance their involvement in the community and to enable them to remain and function in the community in the least restrictive setting. Families are encouraged to contact their local MH/DS office to discuss the programs available to meet the needs of a family members with disabilities.
The Carbon-Monroe-Pike MH/DS is committed to promoting the philosophy and practices of self-determination through a program model referred to as individual supports. Consumers and their families access services through a person-focused planning process which emphasizes choice and selection of providers/services. Budgets are derived from these plans which essentially tie funding to individuals.
A case manager/service coordinator will ask you a few questions to determine what needs you or your family member may have and will check on your insurance coverage and other financial information. If your call is urgent, your crisis will be handled within the hour. See the numbers on the inside cover for 24-hour availability of mental health crisis workers. Otherwise, you or your family member will be scheduled within 7 days of your call or in the next 24 hours, depending on your need.
If you cannot keep your appointment, please call as soon as possible (at least 24 hours in advance) to cancel. Your time can be used by someone else seeking services.
At your first appointment you will meet with a case manager/service coordinator to discuss your concerns, needs, resources, and have an intake interview completed for you or your family member. You will also find out about program availability, costs, and your particular benefit package. There is no charge for this visit.
You and your case manager/service coordinator will develop an individual service plan which recommends what type(s) of services would best meet your needs and choices. Natural and community resources are preferred to formal services whenever possible. Your assigned case manager/service coordinator is responsible for arranging and authorizing services for you and knowing your progress, needs, and issues.
This is an approval by MH/DS for you to receive a specified type and number of services at the program you have selected based on your level-of-care need and the service providers’ availability. If you believe you have been denied a medically necessary service, you may file a grievance.
1. A psychiatrist or other physician (or a psychologist in some cases) must make a determination of medical necessity for any medically based mental health services;
2. All MH/DS services are authorized only to the extent of the funding available.
3. Medical Assistance coverage confers an entitlement to covered services when determined to be medically necessary.
Costs are based on the type of service you receive, your insurance coverage, and the amount you must pay per month (called your liability). This is calculated according to a formula developed by the state. There is no charge for most of the services within the mental retardation or early intervention systems. Your health benefit plan (insurance) may cover the costs of some services.
Your liability is determined on the first visit. Therefore, YOU WILL KNOW YOUR MAXIMUM COSTS BEFORE SERVICE BEGINS. ELIGIBILITY, BENEFITS, AND FINANCIAL LIABILITY MUST BE DETERMINED BEFORE SERVICES ARE BEGUN. Information which should be brought to the first intake includes:
- ACCESS Card
- Medicare Card
- Medical Assistance Card
- Amount of benefits (such as Social Security or SSI)
- Other health insurance or HMO cards
- Three (3) current pay stubs (both spouses)
- Medical bills incurred during the current year that were not covered by medical benefits
- Prior year tax return forms
- Real estate tax receipt
- School tax receipt
Persons with ACCESS or Medical Assistance cards may not be charged for eligible services. Past due accounts are turned over to a collection agency. Consumers with past due accounts may not continue to receive services.
Managed Care Organization or Health Maintenance Organization (MCO /HMO). Health coverage which requires the user to receive services through its network. Services occur via referral and have to be preauthorized. Not all MCOs will subsidize services via MH/DS providers. You will be required to use a provider in the MCO’s network.
Third-Party Insurance. Includes private insurances and those purchased by employers for their employees/dependents (for example, Aetna, Blue Cross/Blue Shield). If MH/DS and/or a provider has an agreement with your particular insurance company, we can bill for any services included in your plan to the extent of the plan coverage.
Medicare. A government-sponsored health care plan which covers some behavioral health services for elderly and disabled people. The amount and frequency of the services may be limited, and you are responsible for a deductible and co-pays.
Medicaid or Medical Assistance (MA, ACCESS). A government-sponsored health care plan for people with certain income limits which covers you for specific physical and behavioral health services. There may be a deductible and co-pay depending on your income and the required services. MH/DS and all its providers accept MA as payment for in-plan medical services.
Children’s Hospital Insurance Program (CHIP). A state plan of health care benefits for children of families whose income exceeds MA limits who have no other coverage. It covers children from birth until their 19th birthday. They must be U.S. citizens or lawful aliens and have resided in Pennsylvania for at least 30 days (except for newborns). Call 1-800-986-KIDS to apply if your children have no health coverage.
Special Pharmaceutical Benefits Program (SPBP). If you have a DSM IV diagnosis for schizophrenia and are prescribed an atypical antipsychotic, you may be eligible for medication coverage. Ask your case manager/service coordinator about this special program or call 1-800-922-9384.
Carbon-Monroe-Pike MH/DS provides payment for services based on a consumer’s eligibility and liability when there are no other sources of payment for services which have been determined to be medically necessary. It contracts with a network of providers who will provide you with authorized services for which MH/DS is billed. You will be obligated to pay the provider your calculated monthly liability as your portion of the cost. This amount may be as low as zero, depending on your income and the types of services to be received.
Many mental retardation or early intervention services are paid for with state and federal matching funds under a waiver allowing services to be provided in the community. Your case manager/service coordinator will explain the requirements and eligibility for waiver services.
Consumers may call the county transportation system to secure transportation to medically necessary programs and appointments. The Medical Assistance Transportation Program (MATP) set up in each county will assist you in arranging the ride you need to get to your medical service. Each county may have different guidelines for its program. Call the number for the county in which you live:
Carbon County: Shared Ride (570-669-6380 or 1-800-990-4287)
Monroe County: Shared Ride (570-839-8210)
Pike County: Shared Ride (570-296-9333; ask for Transportation Manager)
You do, with the help of our trained staff who review your needs, wishes, and resources available to help you. Your choices drive all decisions. You must meet medical necessity standards for certain services.
It depends on your insurance coverage whether you may seek services or treatment privately, through other organizations, or via MH/DS. Some benefit plans will require you to go through MH/DS for authorization. Counseling and psychotherapy are offered by individuals, private groups, and various nonprofit organizations. Members of the clergy and self-help groups may provide assistance and support. Your telephone book lists resources available in your area. If you are to receive services through MH/DS, MH/DS will offer you a choice of network providers.
Intakes for persons with intellectual disabilities or for early intervention services can be completed in our office or in your home. You must have an active status with MH/DS to receive services.
Staff members have varied educational backgrounds and training. There are case managers/service coordinators, social workers, psychiatric nurses, psychiatrists, and mental health and mental retardation specialists to meet the varied needs of consumers. All our facilities and those of our providers are licensed according to standards set by the state. Certain programs are accredited by national accreditation groups, and staff members must be credentialed.
You will discuss how long to expect to be involved, depending on the type of service and your needs. Some services (such as social rehabilitation and training) may be ongoing for longer periods of time, while others such as outpatient treatment or family support services may only require several sessions or be used periodically. This varies with the individual.
No. By law, information that you are a consumer or any details of your treatment may not be revealed to a third party without your written consent, except in certain restricted situations, such as suspected child abuse, emergencies, or under an order of the court.
Insurance companies require certain information (such as dates of services, diagnoses, treatment plans, and charges) before they will pay for services rendered. MH/DS and its provider network are required to use all sources of payment before subsidizing any services or the consumer becomes responsible for the total costs.
1. You have the right to considerate, respectful care.
2. You have the right to choose which providers and services you believe will best suit your needs.
3. You have the right to expect that all communications and records pertaining to your care will be treated as confidential.
4. You have the right to refuse to participate.
5. You have the right to expect reasonable continuity of care.
6. You have the right to ask for alternate consultation, evaluation, and/or treatment.
7. You have the right to decide whether to allow a student intern to participate in an interview or services.
8. You have the right to have questions answered about procedures at any time.
9. You have the right to actively participate in your own service/treatment plan.
10. You have the right to full information about the service/treatment goals, expected benefits, risks, and alternatives.
11. You have the right to be respected and treated in a culturally competent manner.
12. You have the right to voice complaints and make recommendations and/or suggestions with regard to your service/treatment plan.
13. You have the right to refuse or withdraw from treatment or services.
14. You have the right to nondiscriminatory treatment without prejudice to race, color, sex, creed, age, disability, handicap, ancestry, or national origin.
15. You have the right to file a formal grievance regarding denial or termination of services or issues regarding service quality.
16. You have the right to participate in consumer satisfaction surveys, public meetings, and monitoring/planning opportunities.
You are expected:
1. To help develop your service plans and goals and to participate actively in any services you receive.
2. To help decide when your goals have been reached.
3. To pay for any charges for services on a regular basis according to your liability and/or insurance coverage.
4. To inform staff when you cannot keep an appointment or attend a scheduled service.
5. To work toward your goals in cooperation with staff.
6. To maintain confidentiality about others.
Interpreters and other supports will be arranged as necessary to accommodate the special needs of consumers. Persons with a hearing disability may use a TTY line at (570) 420-1904 or the AT&T Relay Service by calling 1-800-654-5984 for TDD users or 1-800-654-5988 for voice users. AT&T language interpreters are available at 1-800-528-5888. A Spanish edition of the handbook is available upon request.
First, talk it over with your case manager/service coordinator, whose job it is to be your advocate and help you get the services you need. If there is still a complaint, you should state it in writing to the Program Director of the provider organization or MH/DS. Ask your case manager/service coordinator who this is or call the MH/DS office for this information.
Complaints may relate to such things as courtesy or timeliness of services. It is expected that all consumer complaints will be addressed by the program within 30 days of receipt. If you are not satisfied, you may contact the Administrator regarding your complaint and how you would like it resolved:
Administrator: Carbon-Monroe-Pike MH/DS
724 Phillips Street, Suite 202
Stroudsburg, PA 18360
Phone: (570) 420-1900
Your case manager/service coordinator will help you write the complaint, if you wish, or do it for you. You should indicate exactly what the complaint is about, who is involved, the date and time the problem or incident occurred, and the outcome you would like. A form is available which may be used for this purpose. The final step in the procedure, if you have not received satisfaction, is to send your complaint to:
Manager: Office of Mental Health & Substance Abuse Services
Scranton Field Office, DPW, Division of Eastern Operations
Scranton State Office Building
100 Lackawanna Avenue, Room 321
Scranton, PA 18503
Phone: (570) 963-4944
Northeast Region Mental Retardation Program
Scranton State Office Building
100 Lackawanna Avenue
Scranton, PA 18503
Phone: (570) 963-4749
If you have been denied a service which has been prescribed for you by a physician, you may file a grievance, which is a request for reconsideration of the denial. Instructions on how to file a grievance are included in your denial of payment letter. A Grievance Form
is available which may be used for this purpose. You also have the right to have any denial of service considered by the Department of Public Welfare at the same time or instead of going through the grievance process.
Submit your request for a Fair Hearing to MH/DS or to:
Office of Mental Health & Substance Abuse Services Division of Grievance and Appeals
Beechmont Building, Harrisburg State Hospital
P.O. Box 2675
Harrisburg, PA 17105
Office of Mental Retardation, DPW Bureau of Hearings and Appeals
Bertolino Building, 6th Floor
P.O. Box 2675
Harrisburg, PA 17105-2675
OMR Grievances Hotline: 888-565-9435
Any appeal regarding service eligibility or termination should be handled in the same manner as a grievance. Any complaint of discrimination should be directed to the above Field Office in Scranton and to the:
Pennsylvania Human Relations Commission
101 South Second Street, Suite 300
Harrisburg, PA 17101