sion, reimbursement and reporting of CCBHC services, and is intended to complement existing policy. Switch to Chrome, Edge, Firefox or Safari. Use this table as a quick reference to compare the CCBHC criteria 2015 (PDF | 755 KB) and corresponding section of the PPS guidance. Payment for DCO services is included within the scope of the CCBHC PPS, and DCO encounters will be treated as CCBHC encounters for purposes of the PPS. Comments or questions about the information on this page can be directed to the Bureau of Financial Planning or the Division of Managed Care. To sign up for updates or to access your subscriber preferences, please enter your contact information. Official websites use .gov A directorate of the Defense Support Services Center, under the Defense Human Resources Activity, An official website of the United States government, Government Travel Charge Card Regulations , dodhra.mc-alex.dtmo.mbx.per-diem@mail.mil, further guidance on per diem reporting procedures and responsibilities [PDF, 4 pages], email the DTMO Policy and Regulations Team, Hosted by Defense Media Activity - WEB.mil. 1.d.2. Rates are updated at the beginning . SAMHSA . 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. CCBHCs Medicaid rates cover costs associated with hiring new staff such as licensed counselors or peer support specialists, paying employees a competitive wage in the local market, and training staff in required competencies such as careu coordination and evidence-based practices. 5600 Fishers Lane, Rockville, MD 20857 Fiscal/Billing Resources. The official rules are published by the Oklahoma Secretary of StateOffice of Administrative Rulesas Title 317 of the Oklahoma Administrative Code. 317:30-5-267. 651-431-2460. What is a CCBHC? Provider-specific rates are updated between rebasing periods based on the Medicare Economic Index (MEI). . It includes payment amounts for the CPT coded services based on current peer group rates and procedure weights. GSA Employees. (a) In order to be eligible for payment, CCBHCs must have an approved provider agreement on file with the OHCA. A complete Hotel and Restaurant Report (DS-2026) providing up-to-date price data from the location. reimbursement rate (demonstration participants) OR Grant funds: $2 million/year for PPS includes the cost of the scope of services covered by the demonstration, including designated collaborating organization (DCO) costs. Data/system requirements may be more likely to be currently available at CMHCs. The GSA Office of Government-wide Policy is responsible for submitting all non-foreign OCONUS rate review requests originating in GSA to the DTMO PRB for review. These clinics serve anyone who requests care for mental health or substance use, regardless of their ability to pay, and connect people to the care they need., CCBHCs are transforming behavioral health systems in this country, and we know that the model of care works, said Miriam Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. Individuals between eighteen (18) and twenty-one (21) years of age can be served in either special population 1 or 2 depending on the member's individualized needs; and. (f) Initial provider-specific rates are rebased after one (1) year based on actual cost and visit data. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911. Toll Free Call Center: 1-877-696-6775, Note: All HHS press releases, fact sheets and other news materials are available at, Content created by Substance Abuse and Mental Health Services Administration (SAMHSA), HHS Announces Over $120 Million In Funding Opportunity for Certified Community Behavioral Health Clinics Providing Mental Health and Substance Use Disorder Care Across the Country, CCBHC Planning, Development, and Implementation (CCBHC-PDI) grant, CCBHC Improvement and Advancement (CCBHCIA) grant, awarded 15 states each with $1 million, one-year CCBHC planning grants, Biden-Harris Administration Hosts Inaugural Asian American, Native Hawaiian, and Pacific Islander Mental Health Summit, Statement by HHS Secretary Xavier Becerra Celebrating the One-Year Anniversary of the Launch of 988, 988 Suicide & Crisis Lifeline Adds Spanish Text and Chat Service Ahead of One-Year Anniversary, The HHS Office for Civil Rights Celebrates National Recovery Month. This tool enables users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates. During the planning process, the Division of Behavioral Health (DBH) determined that 19 community behavioral healthcare organizations serving 25 of the states 28 behavioral health service areas were in substantial compliance with the new federal standards for Certified Community Behavioral Health Clinics" (CCBHCs), and that they were eligible to participate in the Demonstration Project. Disclaimer. PPS 4.2.b. CCBHCs are required to provide: The populations of focus for the Demonstration Project in Missouri include: CCBHCs are required to provide services to members of the armed forces and veterans consistent with guidelines set forth by the Veterans Administration. The CCBHC has a training plan. Section 223 of the Protecting Access to Medicare Act (PL 113-93) includes the following requirements related to establishing a PPS: (1) IN GENERAL Not later than September 1, 2015, the [HHS] Secretary, through the Administrator of the Centers for Medicare & Medicaid Services [CMS], shall issue guidance for the establishment of a prospective payment system [PPS] that shall only apply to medical assistance for mental health services furnished by a certified community behavioral health clinic [CCBHC] participating in a demonstration program under subsection (d). %PDF-1.6 % All other provider-specific rates are rebased once every two (2) years. endstream endobj startxref Addiction care is embedded throughout the CCBHC range of services, including screening for substance use disorders, detoxification, outpatient addiction services, peer support services, and other addiction recovery services at state discretion. For more information contact: Minnesota Department of Human Services . Uniformed Services. American Rescue Plan Act Rate Increase Summary Physician services provided to these members by the CCBHC are reimbursable using the SoonerCare fee schedule. The first area relates to the numerator shown above. AN O V E R V I E W Certified Community Behavioral Health Clinics (CCBHCs) Erica Matti (MPH), Nancy Baum (PhD, MHS), Marianne Udow-Phillips (MHSA) In recent years, the federal government has increased its investment in programs that integrate physical and behavioral health services. Full descriptions of the 9 core services can be found in the CCBHC Scope of Services Manual or in the CCBHC MCO Operations Manual on pages 3-52. In developing the rates, states may include estimated costs related to services or items not incurred during the planning phase but projected to be incurred during the demonstration. At the same time, bipartisan federal legislation, known as the Excellence in Mental Health and Addiction Treatment Expansion Act (S. 824/H.R. 1.c.1. Another risk area in the establishment of the initial CCBHC rate relates to overhead allocation. 0 This schedule gives the base weight, peer group base rates, an updated list of APG/CPT services, definitions, and weights. For reimbursement purposes, members are categorized as follows, and are assigned to special populations by the State: (2) Special population 1. CCBHCs Medicaid rates include the cost of purchasing or upgrading electronic systems to support electronic information exchange. Calculation of travel per diem rates within the Federal government is a shared responsibility of the General Services Administration (GSA), the Department of State (DoS), and the Defense Travel Management Office (DTMO). 2.a.2. CCBHC Cost Report. Auditors will examine whether the CCBHC prepared its cost report in compliance with applicable federal and state law. Illustrated Blank (REVISED 4/12/2023) (c) Preliminary screening, risk assessment, and care coordination services are required activities to establish CCBHC members but do not trigger a PPS payment. Immediate screening and risk assessment for mental health, addictions, and basic primary care needs to ameliorate the chronic co-morbidities that drive poor health outcomes and high costs for those with behavioral health disorders. A reduced per diem rate must be authorized before travel begins. If you or someone you know is struggling or in crisis, help is available. 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. This point is not directly addressed in the guidance. Visit the SAMHSA Facebook page It bears noting that while higher costs (numerator) lead to a higher rate, a lower number of visits produces a higher encounter rate. 8168 0 obj <> endobj Options For Deaf /Hard of Hearing TTY Users: Use your preferred relay service or dial 988 and then press 711. GSA sets per diem rates for the contiguous 48 States and the District of Columbia. 2, Behavioral Health Substance Use and Mental Illness, List of Certified Community Behavioral Health Organizations, Map of Certified Community Behavioral Health Organizations, Narrative Section of Missouris Application to Participate in the Demonstration, List of Required Evidence-based Practices, Progress in Development and Testing of CVS, DBH Targets for Value Based Payments - FY 2022 & FY 2023, Clients Screened but Determined Ineligible for Services/Programs, CCBHC Health Screen Requirements, Bulletin 040, CCBHO Clinical Implications for Community Support, Peer Support, and Family Support Services in CPR and CSTAR Programs, Bulletin 041, CCBHC Clinical Implications for Assertive Community Treatment (ACT) and ACT/Transition Age Youth (TAY), Bulletin 042, CCBHC Clinical Implications for Screening, Assessment and Treatment Planning in CPR, CSTAR, Outpatient Mental Health and Outpatient Substance Use Disorder Programs, Bulletin 044, CCBHC Clinical Implications for Outpatient Substance Use Treatment Programs, Bulletin 045, CCBHC Criteria for Access to Care, Bulletin 050, CCBHC/O DCO Requirements for Crisis Behavioral Health Services, Locate Treatment & Services for Substance Use or Mental Illness, Substance Awareness Traffic Offender Program (SATOP), Outpatient Mental Health and Substance Use Disorder Treatment Services, Screening and Monitoring of Health Risks and Status, Children and adolescents with serious emotional disorders, Children, adolescents and adults with moderate to severe substance use disorders, Children and adolescents in state custody who have behavioral health issues. 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. The M&IE rate for the day of return to the permanent duty station is the M&IE rate at the last temporary duty location. 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 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 . PPS 2.1. SAMHSA Blog. The OHCA rules found on this Web site are unofficial. Claim Submission - Attending and Referring Line An OOC Rate Review Request should include: Rate review requests must be submitted in coordination with the agency or components chain-of-command. Home and Community Based Services (HCBS) rate adjustments due to the COVID-19 Emergency as part of the American Rescue Plan Act of 2021 (ARPA), Section 9817, Assertive Community Treatment (ACT) - Regional Rate - File updated 6/20/23, Certified Community Behavioral Health Clinics (CCBHC) - File updated 12/21/2022, Collaborative Care - Statewide Rate - File updated 1/4/2023, Continuing Day Treatment (CDT) - Adult - Regional Rates - File updated 6/20/23, Community Residence - Adult - Provider-Specific Rates - File updated 3/17/2023, Community Residence - Children - Provider-Specific Rates - File updated 3/17/2023, Community Residence Eating Disorder Integrated Treatment - Regional Rates, Childrens Case Management - Regional Rates, Comprehensive Psychiatric Emergency Program (CPEP) - Statewide Rates - File updated 6/20/23, Crisis Services: Mobile & Telephonic Regional Rates - File updated 7/20/23, Crisis Services: Residential Regional Rates - File updated 7/20/23, Crisis Services: Stabilization Regional Rates - File updated 7/20/23, Day Treatment Services for Children - Regional Rates - File updated 6/20/23, Federally Qualified Health Center (FQHC) - Provider-Specific Rates, Partial Hospitalization - Regional Rates - File updated 6/20/23, Personalized Recovery Oriented Services (PROS) - Regional Rates - Updated 6/20/23, Private Psychiatric Hospitals - Rates - Updated 6/15/2023, State Operated Community Residence - Updated 5/26/23, State Operated Inpatient Psychiatric Hospital - Updated 5/26/23, Mobile/Telephonic Crisis Intervention - 5/26/23. For information concerning DWIHN Member Rights and Resources including DWIHN Member Handbook and Provider Directory visit https://www.dwihn.org/member-customer-service OR CALL OUR 24 HOUR HELPLINE at 1-800-241-4949. 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. MN Department of Human Services . 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. Since 2018, Congress has appropriated annual funds for CCBHC expansion grants, designed to further the reach of these effective and efficient organizations. 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. You can also learn about PPS-related requirements from the statute. 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. 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]. Requests for reduced per diem are submitted to the appropriate Military Advisory Panel (MAP) or Civilian Advisory Panel (CAP) representative. Visit SAMHSA on Twitter 24/7/365 mobile crisis team services to help people stabilize in the most clinically appropriate, least restrictive, least traumatizing, and most cost-effective settings. Equally important, CCBHCs are required to serve anyone who requests care for mental health or substance use conditions, regardless of their ability to pay, place of residence, or age, including developmentally appropriate care for children and youth. It is important that supporting documentation be maintained for all . PPS 4.2.c. CCBHCsare required to meet federal standards for the range of services that they provide and are required to connect people with care quickly. 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. In 2024, up to 10 of those will participate in the CCBHC Medicaid demonstration program and receive enhanced Medicaid reimbursement. In designing their CCBHC programs, states will have the discretion to agree to a rebase i.e., the resetting of rates based on updated cost reports for CCBHCs rates in future years, but the use of a rebase is not mandatory. Comments or questions about the information on this page can be directed to Adult MHOTRS or Childrens MHOTRS. A letter on agency letterhead with a signature. For additional questions, email the DTMO Policy and Regulations Team. 2023 The Guidance Center | All Rights Reserved | Privacy Policy, https://www.dwihn.org/member-customer-service. INDIVIDUAL PROVIDERS AND SPECIALTIES, PART 24.
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