Understanding Medicaid Cost-Reimbursement
Federally Qualified Health Centers have benefited from a Prospective Payment System (PPS) for decades—but the concept and principles of PPS are new territory for most community behavioral health organizations. Get familiar with the basics of PPS (and what it means for you) with our resources and consulting options below.
Resources from the National Council
Integrated CCBHC Certification Criteria Feasibility and Readiness Tool
- Download: PDF | DOCX
Sections C and D of our readiness assessment tool walk you through the Prospective Payment System rate support requirements and other critical considerations for Medicaid cost reimbursement. Use this tool to identify where you’re already well-prepared to collect the needed cost and rate data, and where you may need additional preparation or infrastructure.
- Compliance Hotspots for CCBHCs: Establishing a Base Year Rate: This article from the National Council’s Compliance Watch, written by attorney Susannah Vance Gopalan of Feldesman Tucker Leifer Fidell, explores considerations for setting a sound rate during the CCBHC planning year. Learn key considerations for calculating your allowable vs. un-allowable costs, allocating clinician salaries and overhead, and accurately capturing all encounters. For more on compliance and CCBHCs, subscribe to Compliance Watch.
- Emerging Compliance Hotspots for CCBHCs: Billing Medicaid, by attorney Susannah Vance Gopalan of Feldesman Tucker Leifer Fidell, explores new administrative requirements that will be imposed on Certified community behavioral health clinics (CCBHCs) as they move to a prospective payment system (PPS). Learn how these changes will affect you and your business. The article also provides an in-depth look at compliance issues that may stem from billing Medicaid for CCBHC services and services provided under managed care. For more on compliance and CCBHCs, subscribe to Compliance Watch.
RESOURCES FROM SAMHSA & CMS
- Prospective Payment System Reference Guide: This SAMHSA website offers information on the PPS requirements from the statute as well as a crosswalk between CCBHC criteria and related PPS guidance.
- CMS Section 223 Site: Visit this CMS website for an overview of PPS and cost reporting guidance, along with two sets of answers to frequently asked questions about PPS.