What We Do

Managed Care

As the primary contractor for Behavioral HealthChoices with the PA Department of Human Services, Tuscarora Managed Care Alliance (TMCA) oversees management and coordination of care to an array of high-quality mental health and substance abuse treatment services available for Medicaid eligible Franklin and Fulton County residents.

TMCA is responsible for coordination of care and addressing the mental health and substance abuse service needs of Medicaid managed care members in the two-county region. This is achieved through direct collaborative planning with each county’s Human Services System and through a subcontract with PerformCare to provide day-to-day operations. These duties include care management, utilization review, claims payment, complaint and grievance management, provider network development and credentialing, and quality assurance activities.

Additionally, TMCA assumes all financial risk for the cost of treatment to Franklin and Fulton Medicaid members. TMCA is committed to ensuring members receive the right service, at the right time, for the right duration and frequency to achieve optimal personal growth and recovery. We ensure that services are evidence based, actively engage members and utilize whole person care.  Through effective management of the behavioral health system, TMCA has realized financial gains that we have reinvested into new and/or complimentary services not mandated by the DHS Agreement.

TMCA Through the Years

The year 2007-2008 was a historical turning point in the Franklin and Fulton County Behavioral Health System. After ten years of preparation and delays, Franklin and Fulton County entered into an agreement with the Pennsylvania Department of Public Welfare, now the Pennsylvania Department of Human Services to manage Behavioral HealthChoices for Medicaid eligible individuals in the two-county region. The Commissioners of both counties formed an Intergovernmental Agreement to create Tuscarora Managed Care Alliance (TMCA) to serve as the oversight entity for the Behavioral HealthChoices Agreement.

After determining that certain activities, required as part of the agreement, were best delivered by a subcontracted organization experienced in managing care, County representatives and employees of TMCA began the process of choosing a Behavioral Health Managed Care Organization to fulfill the requirements. After a competitive RFP process, the group chose Community Behavioral Health Network of Pennsylvania (CBHNP) to serve as their managed care partner. CBHNP was acquired by AmeriHealth Mercy in 2008 and now operates as PerformCare.