The new Prospective Payment System (PPS) for CCBHCs finally puts behavioral health organizations on equal footing with other partners in the health care safety net. Under a PPS, you’ll have access to a payment rate that reflects your anticipated costs and is inclusive of many activities that have not been reimbursable in the past, such as care coordination or services delivered outside the four walls of your clinic. But the new reimbursement rates are based on estimated costs—meaning that CCBHCs that do a good job of calculating their costs during the planning year will thrive, while those that fail to accurately calculate anticipated costs will struggle. Get acquainted with the new principles of cost-reimbursement and the strategic choices ahead through the links below, and please check back to this page often for the latest updates and new resources.
- Understanding Medicaid cost-reimbursement
- Calculating costs
- Deciding on most advantageous cost allocation plans
- Strategy and structure for collecting and reporting costs
- Managing the financial arrangements with DCOs
- Developing sliding fee schedules
- Compliance issues under cost-based reimbursement
Resources from the National Council
Integrated CCBHC Certification Criteria Feasibility and Readiness Tool
Becoming a CCBHC: Where Do You Stand?
Follow the Money: Investing in the Success of Your CCBHC with Cost Reporting
Hot Topics in CCBHC Implementation: Cost Reporting, Clinic Licensure, State Financing and More
- Excellence in Mental Health Act: An Introduction
- What is a CCBHC?
- CCBHC Implications and Opportunities
RESOURCES FROM SAMHSA & CMS
The Substance Abuse and Mental Health Services Administration has published a variety of tools to help states and providers prepare for CCBHC implementation. These include:
- State Certification Guide
- PPS Reference Guide
- Care Coordination Resources (including information on care transitions, working with a DCO, using telehealth, and more)
- Cultural Competence Resources
- Governance and Oversight Resources (including addressing governing board requirements, and more)
The Centers for Medicare and Medicaid Services has established a webpage with additional resources related to cost reporting and prospective payment systems, including two sets of FAQs on CCBHC payment.
NEED MORE HELP?
If you have questions or need additional information, please contact Mohini Venkatesh at MohiniV@TheNationalCouncil.org