Temporary service rate increases, effective 10/1/21, are part of Section 9817 of the American Rescue Plan Act of 2021 (ARPA). (d) Payments for services provided to non-established CCBHC members will be separately billable. OK SPA 21-0041 Certified Community Behavioral Health (CCBH) Reimbursement CCBHC Demonstration. What is a CCBHC? Per Diem Rates. Did the provider properly exclude contacts with clinicians who do not meet the standard for a billable clinician under the visit definition? DO CCBHCs ACTUALLY WORK? Implementation Findings from the National Evaluation of the Certified PPTX PowerPoint Presentation For example, if CCBHC service costs account for 70% of total service costs, then 70% of total overhead will be allocated to CCBHC for purposes of the CCBHC rate. Under the demonstration, states receive enhanced federal funding for CCBHC services provided to Medicaid beneficiaries. Local commanders must forward all rate review requests to the Services Military Advisory Panel (MAP) member for submission to the DTMO PRB for review. The CCBHC model addresses financing shortfalls by paying clinics a Medicaid rate inclusive of their anticipated costs of expanding service lines and serving new consumers. To the extent possible within the state Medicaid program and as allowed by state law, CCBHCs utilize mobile in-home, telehealth/telemedicine, and on-line treatment services to ensure consumers have access to all required services. Receive the latest updates from the Secretary, Blogs, and News Releases. This article was originally published inCompliance Watch, a bimonthly newsletter for behavioral health organizations, which keeps you up-to-date on regulatory changes and best practices in corporate compliance, giving you the information and guidance needed to reduce and manage risk. 2. For additional questions, email the DTMO Policy and Regulations Team. All other Government Employees. Since 2018, Congress has appropriated annual funds for CCBHC expansion grants, designed to further the reach of these effective and efficient organizations. That screening may occur telephonically. This population includes individuals eighteen (18) years of age and over with SMI and complex needs including those with co-occurring substance use disorder (SUD). Health and Recovery Plans (HARP) Behavioral Health Home and Community Based Services (BH HCBS) Fee Schedule Codes that HARP plans and HIV-SNPs will be using to bill Medicaid for HCBS services that are provided to HARP enrollees (or HIV-SNP enrolled HARP-eligible). This data is treated as confidential and is stored securely in accordance with applicable law and regulations. Payment Services are supported by grant funding that is limited in scope and Another risk area in the establishment of the initial CCBHC rate relates to overhead allocation. CCBHCs were created to transform mental health and substance use treatment across the country and provide sustainable funding for robust community outpatient mental health treatment. Insufficient funding has long posed a barrier to increasing Americans access to behavioral health care. Provider-specific rates are updated between rebasing periods based on the Medicare Economic Index (MEI). Certified Community Behavioral Health Clinic (CCBHC) is an integrated clinic and service delivery model that uses a cost-based reimbursement structure. 8168 0 obj <> endobj To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911. To develop its base year rate, the CCBHC will be required to report all of its allowable visits, including visits with both Medicaid and non-Medicaid patients. The service selection is deliberate, expanding the range of care available. PDF CCBHC Rate Methodology Legislative Report - Minnesota An independent contractor has been selected by SAMHSA to conduct a national evaluation of the Demonstration Project across the eight (8) participating states. Comments or questions about the information on this page can be directed to the Bureau of Financial Planning or the Division of Managed Care. Certified Community Behavioral Health Clinics (CCBHC) - Oklahoma.gov In return, CCBHCs receive an enhanced Medicaid reimbursement rate based on their anticipated costs of expanding services to meet the needs of these complex . Illustrated Blank (REVISED 4/12/2023) 8190 0 obj <>stream A .gov website belongs to an official government organization in the United States. If an authorizing official (AO) knows that lodging or meal costs during travel will be lower than usual due to prearrangements, special discounts, or other reasons, the AO may request a reduced per diem rate. Behavioral Health Division . (3) Special population 2. [N]o individuals are denied behavioral health care services, including but not limited to crisis management services, because of an individuals inability to pay for such services. Certified Community Behavioral Health Center(CCBHC) services include a comprehensive set of outpatient, community-based behavioral health services and supports that take an integrated, whole-person approach through coordination with physical health and social service providers. 0 Uniformed Services. endstream endobj startxref (a) In order to be eligible for payment, CCBHCs must have an approved provider agreement on file with the OHCA. An additional, qualifying service must be provided in the calendar month for the CCBHC to receive the PPS payment. Oklahoma Human Services In December 2016, Missouri was one of only eight (8) states selected by SAMHSA and the Centers for Medicare/Medicare Services (CMS) to actually pilot the prospective payment system. Receive the latest updates from the Secretary, Blogs, and News Releases. The rate is defined as follows: Total annual allowable CCBHC costs For reimbursement purposes, members are categorized as follows, and are assigned to special populations by the State: (2) Special population 1. St. Paul, MN 55164-0981 . The DoS Office of Allowances is responsible for submitting all non-foreign OCONUS rate review requests originating in the DoS to the DTMO PRB for review. Those services, as defined in the federal statute, include crisis mental health services; screening, assessment, and diagnosis; patient-centered treatment planning; outpatient mental health and substance use services; primary care screening; targeted case management; psychiatric rehabilitation services; peer support and counselor services; and certain specialized services for members of the armed forces and veterans.[1]. For more information contact: Minnesota Department of Human Services . 267. Reimbursement - Oklahoma.gov CCBHCs may receive Medicaid payment for services provided outside the four walls of their clinic; for example, via mobile crisis teams, home visits, outreach workers and, emergency or jail diversion programs. Capitalized HIT systems may otherwise be considered overhead and allocated to CCBHC services through depreciation as part of the PPS rate development process, and therefore, are included in the PPS rate. (c) Preliminary screening, risk assessment, and care coordination services are required activities to establish CCBHC members but do not trigger a PPS payment. SAMHSA's mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. Data/system requirements may be more likely to be currently available at CMHCs. Because there can be an incentive to under-report non-CCBHC service costs, the auditor will scrutinize the cost report to determine whether the provider has fully disclosed the extent of its non-CCBHC service costs. PDF What is a CCBHC? - National Council for Mental Wellbeing In return, CCBHCs receive an enhanced Medicaid reimbursement rate based on their anticipated costs of expanding services to meet the needs of these complex populations. Anyone seeking treatment for mental health or substance use issues should call SAMHSAs National Helpline at800-662-HELP (4357)or visitfindtreatment.samhsa.gov. (b) Reimbursement is made using a provider-specific prospective payment system (PPS) rate developed based on provider-specific cost report data. These services include, but are not limited to: CCBHCs are available to any individual in need of care, including (but not limited to) people with serious mental illness, serious emotional disturbance, long-term chronic addiction, mild or moderate mental illness and substance use disorders, and complex health profiles. MHOTRS Reimbursement Rates. CPT Procedure Weight and Rate Schedule (REVISED 12/07/2022) The full CCBHC demonstration program provides reimbursement through Medicaid for the full cost of services that CCBHCs provide, at higher, more competitive rates than community mental health centers previously received. These grants have provided organizations an opportunity to expand access to comprehensive and evidence-based mental health and addiction care by offering the required array of services. No payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and B. Psychiatric Rehabilitation Peer and Family Support Services The populations of focus for the Demonstration Project in Missouri include: Adults with serious mental illness Children and adolescents with serious emotional disorders Children, adolescents and adults with moderate to severe substance use disorders The CCBHC has a training plan. Certified Community Behavioral Health Clinics (CCBHCs) Today, there are more than 500 CCBHCs, in 46 states, the District of Columbia, Guam, and Puerto Rico. RATE PERIOD: After "From:" enter the beginning date on which the PPS rate will take effect. Care where people live, work, and play. 1.a.3. (f) Initial provider-specific rates are rebased after one (1) year based on actual cost and visit data. Auditors will scrutinize whether the CCBHC has adequately narrowed the scope of service costs that it identifies as CCBHC costs. h. Whether the cost report contains consolidated satellite facilities or not. If a state chooses to provide CCBHC services via telehealth, costs related to those services should be included in the PPS. Overhead administrative expenses include costs of running the business such as legal, accounting, telephone, depreciation on office equipment, and general office supplies. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Call or text988or chat988lifeline.org. SAMHSA . CCBHCs Medicaid rates include the cost of activities that have traditionally been near-impossible to reimburse, yet play a critical role in behavioral health services. The Excellence in Mental Health and Addiction Act demonstration established a federal definition and criteria for Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs Medicaid rates include the cost of purchasing or upgrading electronic systems to support electronic information exchange. Reimbursement [Revised 09-12-22] (a) In order to be eligible for payment, CCBHCs must have an approved provider agreement on file with the OHCA. PPS 4.2.b. This document is made available electronically by the Minnesota Legislative Reference . See JTR Section 0503 for more information on per diem for Service members, and Section 0539 for more information on per diem for civilian employees. Look up per diem rates by location or download annual rates for all locations. Non-established CCBHC members are those who receive crisis services directly from the CCBHC without receiving a preliminary screening and risk assessment by the CCBHC and who are not established at another CCBHC, and those referred to the CCBHC directly from other outpatient behavioral health agencies for pharmacologic management. Behavioral health providers should work closely with cost reporting experts to ensure that their cost reports capture all allowable costs as reflected in the guidance. In 2024, up to 10 of those will participate in the CCBHC Medicaid demonstration program and receive enhanced Medicaid reimbursement. Ensuring that the CCBHCs initial cost-based rate is accurate in the ways described above will be critical for several reasons. An OOC Rate Review Request should include: Rate review requests must be submitted in coordination with the agency or components chain-of-command. PDF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC COST REPORT - Medicaid The expansion of Certified Community Behavioral Health Clinics is part of President Bidens commitment to expand and strengthen equitable access to behavioral health services for all Americans, said HHS Secretary Xavier Becerra. The auditor will likely look for the following potential flaws in the visit count: Why Is an Accurate Base Rate So Important? CCBHC RATE METHODOLOGY . 2.a.2. The PPS rate varies by category and level of service intensity and is paid when a CCBH program delivers at least one (1) CCBHC covered service, and when a valid individual procedure code is reported for the calendar month. Visit SAMHSA on Instagram The higher reimbursement rate that comes with licensure as a CCBHC applies only to patients with Medicaid. CCBHCs launched in eight states in 2017. Section 223 (a)(2)(B) requires that CCBHCs not reject or limit services based on a participants ability to pay but does not authorize Medicaid expenditures for services furnished to individuals who are not eligible for Medicaid. APG Peer Group Base Rates - Provider-Specific, Behavioral Health Service Advisory Council, Contact Your Local Mental Hygiene Department. While clinics cannot reject or limit services on the basis of a client's ability to pay, CCBHCs can, however, only bill Medicaid for services provided to Medicaid beneficiaries . Have a question about government service? Secure .gov websites use HTTPS Non-personnel costs for providing CCBHC services may include depreciation on equipment used to provide CCBHC services, and other costs incurred as a direct result of providing CCBHC services.. PPS rates are based on total annual allowable CCBHC costs. A complete Hotel and Restaurant Report (DS-2026) providing up-to-date price data from the location. Auditors will test the visit count to determine whether the encounter count that the CCBHC reported for the base period reflects all clinical touches that meet the definition of a CCBHC billable visit.[2]. To sign up for updates or to access your subscriber preferences, please enter your contact information. It is difficult to overstate the importance of the base year cost report, because the initial cost report establishes the fixed baseline for the encounter rate. Preparing the cost reports properly at the outset will allow the provider to avoid a significant recoupment when the audit is completed. Enhanced patient outreach, education and engagement. For example, all service costs relating to crisis mental health services, whether performed on behalf of Medicaid beneficiaries, uninsured individuals, or patients with other forms of coverage, should be included on the cost report as CCBHC allowable costs. This population includes children and youth [ages six (6) through twenty-one (21)] with SED and complex needs, including those with co-occurring mental health and SUD. Utilized to calculate the PPS base rate. %PDF-1.6 % If the per diem rate for a location is too low, Military Advisory Panel (MAP) or Civilian Advisory Panel (CAP) members, DoS Office of Allowances, GSA Office of Government-Wide Policy, or an appropriate Federal Agency Travel Manager may request a rate review. Contact USA.gov. (e) Additional reimbursement may be made to the CCBHC once in the same calendar month as the PPS payment for care coordination provided by CCBHC staff to members who are involved in a drug court or other specialty court program. The CCBHC Planning, Development, and Implementation (CCBHC-PDI) grant aims to assist clinics to establish and implement new CCBHC programs, and the CCBHC Improvement and Advancement (CCBHCIA) grant seeks to enhance and support existing CCBHCs that currently meet the CCBHC Certification Criteria. It is important that supporting documentation be maintained for all . On the day of departure from the permanent duty station and on the day of return, a traveler receives 75 percent of the applicable M&IE rate regardless of departure or return time. INDIVIDUAL PROVIDERS AND SPECIALTIES, PART 24. The CCBHC records must be detailed, orderly, complete, and available for review or audit. An organization that currently operates a clinic as a Medicaid Demonstration program site, a CCBHC- Expansion grant site, or a site that is certified by the state may be Expanded care coordination with local primary care providers, hospitals, other health care providers, social service providers, and law enforcement, with a focus on whole health and comprehensive access to a full range of medical, behavioral and supportive services.
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