Managed Care Interface with PPS Payments
As states steadily transition their Medicaid populations into managed care, managed care organizations will be crucial partners in the success of CCBHC implementation. During the planning year, states are faced with key decisions on the intersection of managed care and the Prospective Payment System (PPS). Will they administer CCBHC payments through the managed care capitation rate? Or will they allow CCBHCs to negotiate their own rates with managed care organizations and provide a wraparound payment to ensure the full PPS rate is delivered? Get familiar with the ramifications of each approach through our resources and consulting options below.
Resources from the National Council