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Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

Date: 07-03-2017

  • Background
  • Overview
  • Eligible Providers
  • Eligible Recipients
  • CCBHC Covered Services
  • Noncovered Services
  • Billing Expand CCBHC Services
  • Additional CCBHC Billing and Payment Provisions
  • Legal References
  • Background

    CCBHCs are authorized under Section 223 of the Protecting Access to Medicare Act (PAMA) (PL 113-93). The goals of CCBHCs are to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high-quality care for individuals covered by Medicaid. Minnesota is one of eight states selected to operate the two-year CCBHC demonstration project. As a condition of participation in the demonstration project, Minnesota certified six participating clinics as meeting the federal certification criteria for the demonstration program effective July 1, 2017, through June 30, 2019.

    Overview

    CCBHCs provide a community clinic model of care aimed at improving access to and quality of mental health and substance use disorder services by ensuring the CCBHC providers have the capacity to deliver and coordinate all services under the CCBHC model. CCBHCs must have established collaborative relationships with other providers and healthcare systems to coordinate care for their recipients. All treatment delivered within the CCBHC is person and family-centered, recovery-oriented, evidence-based and trauma-informed. The individual treatment needs of Minnesota Health Care Programs (MCHP) recipients are documented in an integrated treatment plan across all services.

    CCBHC providers are required to provide or have access to the full array of CCBHC services and need to be enrolled as an eligible MHCP provider for each service. Required CCBHC services include existing MHCP services and an expanded set of billable services unique to CCBHC providers which must be provided in accordance with standards outlined in this CCBHC MHCP provider manual page.

    In addition to billing for the usual coverage that applies to currently covered CCBHC services, CCBHCs can receive two types of additional payment:

  • • Payment for new and expanded services described below
  • • A monthly supplemental wrap payment which is based on the difference between all other reimbursements and a daily cost-based rate which has been determined individually for each CCBHC (see Billing section for more details)
  • The above additional payments are limited to the six CCBHCs participating in this demonstration program, and are only available for services provided to recipients of Medical Assistance (MA), which is federally-funded Medicaid. These additional CCBHC payments are not available to recipients of MinnesotaCare or other types of health care coverage which do not include federal Title XIX funding. These payment limitations do not absolve the CCBHC from serving people regardless of ability to pay under CCBHC criteria.

    For additional information on all CCBHC requirements, including those not directly related to MHCP billing policy, please see the CCBHC Variance and the federal certification criteria.

    Eligible Providers

    Eligible CCBHC providers must have the capacity to deliver and coordinate services required under the CCBHC model and be selected as a CCBHC provider by the Department of Human Services to participate in the federal CCBHC demonstration program.

    CCBHC providers selected to participate in this demonstration are:

  • • Northwestern Mental Health Center
  • • Northern Pines Mental Health Center
  • • People Incorporated
  • • Ramsey County Mental Health Center
  • • Wilder Children and Family Services
  • • Zumbro Valley Health Center
  • Eligible Recipients

    MHCP eligible recipients must meet the following criteria to be considered a CCBHC recipient:

  • • For new recipients (those not served by the clinic in the six months prior to the current service):
  • • Receive a preliminary screening and risk assessment and one CCBHC service, or
  • • Receive a crisis assessment
  • • Existing recipients (those served in any CCBHC in the six months prior to service), are eligible upon receipt of a CCBHC service after July 1st, 2017
  • Preliminary Screening and Risk Assessment

    Although not a billable service, providers must complete the preliminary screening and risk assessment with all new recipients of a CCBHC. A new recipient is defined as a person who has not received a service at a CCBHC within the last six months.

    Assessment Components
    The purpose of the preliminary screening and risk assessment is to determine acuity of need. When determined to be an emergency or crisis need, appropriate action is taken immediately. When determined to be an urgent need, schedule the person to receive an initial evaluation within one business day. If determined to be a routine need, schedule the person to receive an initial evaluation within 10 days.

    CCBHC Covered Services

    CCBHC providers are required to provide or have access to the full array of CCBHC services and need to be enrolled as an eligible MHCP provider for each service. Required CCBHC services include existing MHCP services in addition to an expanded set of billable services unique to CCBHC providers.

    Existing MHCP services required to be provided by CCBHC are to be billed in accordance with the current corresponding MHCP Provider Manual section.

    Existing MHCP services for CCBHC include:

  • Adult crisis response services
  • Adult day treatment
  • Adult rehabilitative mental health services (ARMHS)
  • Alcohol and drug abuse services
  • Certified peer specialist services
  • Children’s mental health crisis response services
  • Children’s therapeutic services and supports (CTSS)
  • Diagnostic assessment
  • Dialectical behavior therapy (DBT)
  • Functional assessment for adults (can be billed outside of an ARMHS service)
  • • Functional assessment for children or administering and reporting standardized measures (can be billed outside of a CTSS service)
  • Mental health family peer specialist
  • Mental health provider travel time
  • Mental health targeted case management for adults (AMH-TCM)
  • Mental health targeted case management for children (MH-TCM)
  • Neuropsychological services
  • Psychiatric consultation to primary care providers
  • Psychological testing
  • Psychotherapy
  • Psychotherapy for crisis
  • Expanded CCBHC services include:

  • Preliminary screening and risk assessment
  • Initial evaluation
  • Comprehensive evaluation
  • Integrated treatment plan
  • Clinical care consultation
  • Family psychoeducation
  • Certified peer recovery specialist
  • Comprehensive substance use disorder assessment
  • • Care coordination
  • Initial Evaluation

    The initial evaluation is required for any new recipient age five and older.

    The initial evaluation will include the reason the recipient is presenting for assistance, a preliminary diagnosis, make referrals to services within the CCBHC (specifically: outpatient SUD services, ARMHS, TCM, CTSS, peer services and psychotherapy) and establish medical necessity for those services.

    Required Assessment Components
    Providers may gather the required elements of the initial evaluation by reviewing previous diagnostic assessments or documents from other providers that are less than one year old or elements acquired by other internal staff and include:

  • • Date of birth
  • • Gender
  • • Ethnicity
  • • Race
  • • Insurance status and type
  • • Primary language
  • • Current living situation
  • • A determination of whether the person presently is or ever has been a member of the U.S. Armed Services
  • • Referral source
  • • Reason for seeking care, as stated by the recipient or other individuals who are significantly involved
  • • A drug profile including the person’s prescriptions, over-the-counter medications, herbal remedies and other treatments or substances that could affect drug therapy, as well as information on drug allergies
  • • Assessment of recipient risk to self or to others, including suicide risk factors and other recipient safety concerns
  • • Assessment of need for medical care with referral and follow-up as required
  • • Screening for co-occurring mental health and substance use disorders
  • • Brief narrative within each of the 6 dimensions of the ASAM criteria addressing:
  • • All reasons for seeking care
  • • Strengths, cultural influences, life situations, learning differences, and legal issues
  • • The narrative for dimension 3 must include a brief diagnostic discussion including symptoms, duration, preliminary diagnoses and how symptoms impact the person’s functioning
  • • Identification of the person’s immediate clinical care needs for mental and substance use disorders related to the diagnoses and impact on functioning including:
  • • Recommendations for identified mental health and substance use disorder services (specifically: SUD services, ARMHS, TCM, CTSS, peer services and psychotherapy)
  • • Determination of medical necessity for those services. For substance use disorder services, utilization of the Minnesota Matrix (DHS-5204B) (PDF) to provide scores on the 6 Dimensions and the diagnosis of a substance use disorder is required only for those for whom substance use is identified
  • • Documentation of next steps for service initiation that may include recipient-defined initial goals, short-term objectives and suggested interventions, including need for further assessment
  • Although some of the elements of the initial evaluation may be gathered by other clinic staff, a mental health professional or practitioner working under a licensed professional as a clinical trainee must complete a face-to-face interview with the recipient and a review and synthesis of gathered data.

    ASAM 6 Dimensions
    The initial evaluation, comprehensive evaluation and the integrated treatment plan must be written in the format of the ASAM 6 Dimensions, outlined below:

  • • Dimension 1: Acute intoxication or withdrawal potential
  • • Dimension 2: Biomedical conditions and complications
  • • Dimension 3: Emotional, behavioral and cognitive
  • • Dimension 4: Readiness for change
  • • Dimension 5: Relapse, continued use and continued problem potential
  • • Dimension 6: Recovery environment
  • Comprehensive Evaluation

    The comprehensive evaluation is a review and synthesis of all information previously gathered from external sources or in the preliminary screening and risk assessment, crisis assessment, initial evaluation and any other service received at the CCBHC.

    Assessment Components
    The comprehensive evaluation must include the following components:

  • • Updates to all required components of the initial evaluation
  • • A psychosocial evaluation including housing, vocational and educational status, family or caregiver and social support, pregnancy and parenting status, legal issues and insurance status
  • • For an adult, the functional assessment (FA) completed within the previous 60 days satisfies this requirement
  • • It is allowable, but not required to complete the WHODAS
  • • For children age 5-18 years old, complete the Strengths and Difficulties Questionnaire (SDQ)
  • • Behavioral health (including mental health, chemical health and physical health) history (including trauma history and previous therapeutic interventions and hospitalizations)
  • • Assessment of imminent risk (including suicide risk, danger to self or others, substance withdrawal, urgent or critical medical conditions, other immediate risks including threats from another person)
  • • Depression screening tool
  • • Basic competency or cognitive impairment screening (including the person’s ability to understand and participate in his or her own care)
  • • Developmental incidents and history
  • • A description of attitudes and behaviors, including cultural and environmental factors, that may affect the person’s treatment plan
  • • The recipient’s strengths, goals and other factors to be considered in recovery planning
  • • Depending on whether the CCBHC directly provides primary care screening and monitoring of key health indicators and health risk, either: (a) an assessment of need for a physical exam or further evaluation by appropriate health care professionals, including the person’s primary care provider (with appropriate referral and follow-up), or (b) a basic physical assessment
  • • Brief narrative within each of the 6 dimensions of the ASAM criteria addressing:
  • • All reasons for seeking care
  • • Progress in the last 60 days
  • • Remaining barriers that will lead to formation of the treatment plan
  • • Strengths, cultural influences, life situations, learning differences, and legal issues
  • • The narrative for ASAM dimension 3 must include a mental status exam and a brief diagnostic discussion including symptoms, duration, preliminary diagnoses and how symptoms impact the person’s functioning
  • • The narrative for ASAM dimension 4 must identify the stage of change for all reasons the recipient sought care
  • • Establish medical necessity for services and level of care (LOC) needs for recommended services (Approved LOC tools: LOCUS for adults, CASII for children and adolescents, and ECSII for children up to five years old)
  • • Assessment of need and medical necessity for behavioral health services beyond what is already provided including:
  • • For substance use disorder services, utilization of the Minnesota Matrix to provide scores on the 6 Dimensions and the diagnosis of a substance use disorder
  • • Assessment of the social service needs of the consumer with necessary referrals made to social services and, for pediatric consumers, to child welfare agencies as appropriate
  • • For children under five years old, the DC:0-3R diagnostic system for young children must be utilized for assessment. For CCBHC providers, the comprehensive evaluation for this age group must include the elements above and be completed in a minimum of three sessions and billed under the extended comprehensive evaluation code
  • Integrated Treatment Plan

    The integrated treatment plan is the culmination of a person and family-centered planning process in which the recipient, any family or recipient-defined natural supports, CCBHC service providers, external service providers as appropriate, and care coordination staff are engaged in creation of the integrated treatment plan. The development of the integrated treatment plan must be completed in a face-to-face interaction with the recipient and, at minimum, a mental health professional as well as all the interested parties listed above.

    The CCBHC must collaboratively complete a person-centered or family-centered integrated treatment plan within 60 days of the recipient’s first point of contact for new recipients or within 90 days of first CCBHC service for existing recipients.

    Integrated Treatment Plan Components
    The components must be in the format of the 6 dimensions of the ASAM Criteria and must contain the following core elements:

  • • Recipient-defined vision
  • • Identified problems or functional barriers
  • • Measurable goals toward obtaining the recipient-defined vision
  • • Measurable objectives toward reaching the goals
  • • Interventions
  • • Strengths and resources that inform the objectives
  • • Cultural considerations
  • • Timeline (frequency and duration)
  • • Signatures of the mental health professional and the person with dates
  • • For a child, the signature of a parent or guardian or other adult authorized by law to provide consent for treatment
  • • A client’s parent or guardian may approve the integrated treatment plan by secure electronic signature or by documented oral approval that is later verified by written signature
  • • In instances where oral approval is verified by a later written signature, the effective date is the date of oral approval, which is documented in the integrated treatment plan
  • The integrated treatment plan incorporates all information gathered about and by the recipient including the initial evaluation, comprehensive evaluation and any progress made in all utilized services and:

  • • Documentation of recipient involvement in plan development
  • • Documentation of parental or guardian consent for those under 18 years old or under legal guardianship
  • Integrated Treatment Plan Update
    Providers must update the person-centered or family-centered integrated treatment plan at least every 90 days, or more often when there is significant change in the recipients’ situation or functions. Also, in services or service methods to be used, or at the request of the recipient or the recipient’s legal guardian. It must be completed with the recipient present, and any recipient-defined support people, CCBHC service providers, and any external service providers of the recipient’s choosing must be engaged in the process. It must incorporate the following components:

  • • A review of the previous comprehensive evaluation, progress notes and information gathered since the last comprehensive evaluation
  • • A review of the previous integrated treatment plan, progress notes and information gathered since the last integrated treatment plan
  • • Brief summary of progress made and barriers that remain
  • • Diagnostic updates based on any changes, as needed
  • • Assessment of need for behavioral health services beyond what is already provided
  • • Treatment plan updates including goal achievement and identification of new goals and objectives
  • • Status updates:
  • • Whether recipient received some peer service as of date of update
  • • Whether recipient received some telemedicine service as of date of update
  • • Type of health insurance
  • • Housing or residential status
  • Clinical Care Consultation

    The CCBHC demonstration program expands clinical care consultation services to adult MHCP recipients (21 years old and over). CCBHC providers should refer to the MHCP Provider Manual for Children’s Mental Health Clinical Care Consultation for a definition of the covered service.

    Family Psychoeducation

    The CCBHC demonstration program expands family psychoeducation services to adult MHCP recipients (21 years old and over). CCBHC providers should refer to the MHCP Provider manual for Family Psychoeducation for a definition of the covered service.

    Certified Peer Services

    Mental health certified peer specialist services can be provided along the entire continuum of mental health services as long as it is determined to be medically necessary by a mental health professional or practitioner working as a clinical trainee. CCBHC certified peer specialist services are subject to the same standards outlined in the Certified Peer Specialist Services section of the MHCP Provider Manual.

    Mental health certified family peer specialist services can be provided along the entire continuum of mental health services as long as it is determined to be medically necessary by a mental health professional or practitioner working as a clinical trainee. CCBHC mental health certified family peer specialist services are subject to the same standards outlined in the Mental Health Certified Family Peer Specialist section of the MHCP Provider Manual.

    Certified peer recovery specialist services can be provided throughout SUD services as long as it is determined to be medically necessary by a mental health professional, a mental health practitioner working as a clinical trainee or a licensed alcohol and drug counselor. Providers must provide certified peer recovery specialist services according to the following guidelines:

  • • Certified peer recovery specialist qualifications:
  • • Have a minimum of one year in recovery from substance use disorder
  • • Hold a current credential from a certification body approved by the commissioner that demonstrates skills and training in the domains of ethics and boundaries, advocacy, mentoring and education, and recovery and wellness support
  • • Receive ongoing supervision in areas specific to the domains of the recovery peer's role by an alcohol and drug counselor or an individual with a certification approved by the commissioner
  • • Certified Peer Recovery Specialist services include:
  • • Education
  • • Advocacy
  • • Mentoring through self-disclosure of personal recovery experiences
  • • Attending recovery and other support groups with a client
  • • Accompanying the client to appointments that support recovery
  • • Assistance accessing resources to obtain housing, employment, education and advocacy services
  • • Nonclinical recovery support to assist the transition from treatment into the recovery community
  • Comprehensive Substance Use Disorder Assessment

    An alcohol and drug counselor must coordinate a comprehensive assessment of the client's substance use disorder .The counselor may rely on current information provided by a referring agency or other sources as a supplement when information is available. Information gathered more than 45 days before the date of admission is not current. The assessment must include sufficient information to complete the assessment summary. The comprehensive assessment must include information about the client's problems that relate to chemical use and personal strengths that support recovery, including:

  • • Age, sex, cultural background, sexual orientation, living situation, economic status and level of education
  • • Circumstances of service initiation
  • • Previous attempts at treatment for chemical use or dependency, compulsive gambling or mental illness
  • • Chemical use history including amounts and types of chemicals used, frequency and duration of use, periods of abstinence, and circumstances of relapse, if any. For each chemical used within the previous 30 days, the information must include the date and time of the most recent use and any previous experience with withdrawal
  • • Specific problem behaviors exhibited by the client when under the influence of chemicals
  • • Current family status, family history, including history or presence of physical or sexual abuse, level of family support, and chemical use, abuse, or dependency among family members and significant others
  • • Physical concerns or diagnoses, the severity of the concerns and whether or not the concerns are being addressed by a health care professional
  • • Mental health history and current psychiatric status, including symptoms, disability, current treatment supports and psychotropic medication needed to maintain stability
  • • Arrests and legal interventions related to chemical use
  • • Ability to function appropriately in work and educational settings
  • • Ability to understand written treatment materials, including rules and client rights
  • • Risk-taking behavior, including behavior that puts the client at risk of exposure to blood borne or sexually transmitted diseases
  • • Social network in relation to expected support for recovery and leisure time activities that have been associated with chemical use
  • • Whether the client is pregnant and if so, the health of the unborn child and current involvement in prenatal care
  • • Whether the client recognizes problems related to substance use and is willing to follow treatment recommendations
  • An alcohol and drug counselor must prepare an assessment summary. The narrative summary of the comprehensive assessment results must meet the following requirements:

  • • An assessment summary must be prepared by an alcohol and drug counselor and include:
  • • A risk description according to Minnesota Rule, part 9530.6622, for the ASAM 6 dimensions
  • • Narrative supporting the risk descriptions
  • • A determination of whether the client meets the DSM criteria for a person with a substance use disorder
  • • Contain information relevant to treatment planning and recorded in the ASAM 6 dimensions
  • Noncovered Services

    Preliminary risk assessments are not billable but are required for CCBHC providers to deliver prior to recipient participation in the CCBHC.

    Care coordination is a required service of CCBHC even though it is not considered a billable encounter. Required care coordination tasks include:

  • • Development of a person or family-centered plan of care
  • • Assistance with obtaining appointments and confirming the appointments were kept
  • • Creation of a crisis plan
  • • Tracking recipient’s medications
  • • Establishing a health IT system that contains the required elements in the CCBHC criteria
  • • Implement care coordination agreements according to required standards in the CCBHC criteria
  • Billing Expanded CCBHC Services

    Follow the billing guidelines in the following tables.

    General Billing Guidelines

  • • CCBHC billing is subject to the same standards outlined in the MHCP Billing Policy manual page.
  • • All mental health CCBHC services are billed as a professional claim in the 837P electronic claim format.
  • • Outpatient chemical dependency service claims may be billed as an institutional (837I electronic format) or a professional claim (837P electronic claim format.
  • Any non-CCBHC services delivered by CCBHC providers must be submitted separately from CCBHC service claims.
  • Initial Evaluation

    Code

    Modifier

    Description

    Unit

    90791

    Q2 52

    Initial evaluation

    1 session

    90791

    Q2 52 HN

    Initial evaluation completed by a clinical trainee

    1 session

    90792

    Q2 52

    Initial evaluation with medical services

    1 session

  • • Although some of the elements of the initial evaluation may be gathered by other clinic staff, a mental health professional or practitioner working under a licensed professional as a clinical trainee must complete a face-to-face interview with the recipient and a review and synthesis of gathered data.
  • Comprehensive Evaluation

    Code

    Modifier

    Description

    Unit

    90791

    Q2

    Comprehensive evaluation

    1 session

    90791

    Q2 HN

    Comprehensive evaluation completed by a clinical trainee

    1 session

    90791

    Q2 TG

    Extended comprehensive evaluation

    1 session

    90791

    Q2 TG HN

    Extended comprehensive evaluation completed by a clinical trainee

    1 session

    90792

    Q2 TG

    Extended comprehensive evaluation with medical services

    1 session

  • • The DC:0-3R diagnostic system for young children must be utilized for assessment of children up to 5 years and is to be billed as an extended comprehensive evaluation.
  • • When billing an extended comprehensive evaluation, follow current guidance for extended diagnostic assessment.
  • • Although some of the elements of the comprehensive evaluation may be gathered by other clinic staff, a mental health professional or practitioner working under a licensed professional as a clinical trainee must complete a face-to-face interview with the recipient and a review and synthesis of gathered data.
  • • See MHCP Mental Health Service Provider Manual for definition of mental health professional under MHCP.
  • Integrated Treatment Plan

    Code

    Mod

    Brief Description

    Units

    H0032

    Q2 UD

    Service plan development by non-physician

    Per 15 mins

    H0032

    Q2 UD TS

    Service plan development by non-physician update

    Per 15 mins

  • • Although the integrated treatment plan and update must be developed with all service providers, a mental health professional must complete, date and sign it, along with the signature of the recipient or for a child, the child’s parent or guardian.
  • Clinical Care Consultation for Recipients 21 Years Old or Older

    Procedure Code

    Modifier

    Brief Description

    Unit

    90899

    Q2 U8

    Clinical care consultation, face-to-face

    5 to 10 minutes

    90899

    Q2 U9

    Clinical care consultation, face-to-face

    11 to 20 minutes

    90899

    Q2 UB

    Clinical care consultation, face-to-face

    21 to 30 minutes

    90899

    Q2 UC

    Clinical care consultation, face-to-face

    31 minutes and above

  • • Submit one claim line per day for each service. (Add up all the minutes of service provided for face-to-face or non-face-to-face services for each client for that day and submit a single claim regardless of the number of consultations.)
  • • Use modifier U4 for non-face-to-face service
  • • For recipients under 21 years of age, use the billing codes outlined in the MHCP Provider Manual page for Children’s MH Clinical Care Consultation.
  • Family Psychoeducation Benefits for Adults 21 Years Old and Older

    Proc Code

    Modifier

    Brief Description

    Unit

    H2027

    Q2

    Family psychoeducation individual (with a single recipient)

    15 min

    Q2 HQ

    Family psychoeducation recipient group (with multiple recipients)

    Q2 HR

    Family psychoeducation recipient and family (with a single recipient and their family)

    Q2 HS

    Family psychoeducation family (with a single family individual not present)

    Q2 HQ HR

    Family psychoeducation family group (with multiple families with individuals present)

    Q2 HQ HS

    Family psychoeducation family group (with multiple families individuals not present)

  • • Submit claims only for the recipient who is the primary subject of the family psychoeducation sessions, regardless of the number of other family or group members in the session.
  • • When more than one family member is a recipient (such as two or three siblings, each receiving treatment within a specific timeframe), bill only for the time spent conducting family psychoeducation with each recipient.
  • • When two professionals render group family psychoeducation, submit only one claim for each recipient. Professionals must determine which recipient will bill for or one professional may claim for all recipients and reimburse the other professional.
  • • Enter the treating provider NPI number on each claim line.
  • • Use HN modifier for services performed by a clinical trainee.
  • • For recipients under 21 years of age, use the billing codes outlined in the Family Psychoeducation for Children and Youth section of the MHCP Provider Manual.
  • CCBHC Peer Specialist Services

    Code

    Mod

    Brief Description

    Units

    H0038

     

    MH peer services by level I certified peer specialist

    15 min

    U5

    MH peer services by level II certified peer specialist

    HQ

    MH peer services in a group setting

    H0038

    Q2

    Certified peer recovery specialist

    15 min

    H0038

    HA

    Certified family peer specialist services

    15 min

     

    HA HQ

    Certified family peer specialist services in a group setting

    Comprehensive Substance Use Disorder Assessment

    Code

    Mod

    Brief Description

    Units

    H0001

    Comprehensive substance use disorder assessment

    Per session

  • • If billing as an institutional claim, use revenue codes: 0944 (Drug), 0945 (Alcohol), or 0953 (Drug and Alcohol).
  • Additional CCBHC Billing and Payment Provisions

    CCBHCs are eligible to receive up to four kinds of MA payment for CCBHC services:

  • • As enrolled providers of statewide covered services such as outpatient MH and SUD services, MH-TCM, ARMHS, CTSS and other services, CCBHCs receive payment at the same rates and within the same claims processing methodology and restrictions as other similarly enrolled providers. If the recipient is in managed care, the managed care organization (MCO) continues to pay these claims.
  • • CCBHCs can receive payment for new and expanded services which are only available as part of the CCBHC demonstration (see notes on Scope of Services table and MHCP Provider Manual sections pertaining to each of these services). If the recipient is in managed care, these claims are paid by the MCO, with the exception of H0014 Withdrawal Management Level 2, which is paid through fee-for-service (FFS) for all MA recipients.
  • • Based on the claims paid in the two methods above, including managed care, DHS (not the MCOs) makes a monthly supplemental wrap payment (see below for details).
  • • CCBHCs are eligible to receive quality bonus payments averaging up to five percent of the other payments above. DHS makes these payments, not the MCOs. DHS will make quality bonus payments after the end of each demonstration year, based on each CCBHC’s performance on outcome measures.
  • Supplemental Wrap Payments
    The CCBHC demonstration project provides for a cost-based prospective payment system (PPS) rate for each clinic. The rate is based on a cost report from each clinic, using federal cost reporting rules. The cost report includes anticipated changes in costs which are necessary to comply with CCBHC criteria. The report also includes historical and projected numbers of qualifying encounters or visits. DHS and a contracted accounting firm have reviewed all cost reports and determined rates for each CCBHC. Total approved costs for demonstration year one are divided by total anticipated encounters to arrive at a rate per encounter. The rate represents an average cost per encounter for all clients receiving CCBHC services from a particular CCBHC. The rate includes the cost of all procedure codes which are listed in the Scope of Services table.

    A qualifying encounter is the first billable unit for a CCBHC service on a given service date, for dates of service between July 1, 2017, to June 30, 2019. Billable unit is defined by billing policies that apply to each procedure code. Since MH-TCM is currently paid in monthly units, only one service date per month counts as a qualifying CCBHC encounter. Likewise, other services (such as extended diagnostic assessments) that may involve more than one day of actual service, but only one billing unit, are counted as one encounter for purposes of the wrap payment. Staff travel (H0046) is included only if it is required to provide a CCBHC service.

    CCBHCs do not submit a separate claim for the wrap payment. DHS and a contractor calculate the monthly wrap payment by analyzing all claims processed for a CCBHC during the preceding month for CCBHC procedure codes. The payment is determined by the following formula:

  • • The full PPS rate is assigned to each qualifying encounter (i.e. one service date per client)
  • • The PPS rate is offset by all payments for all CCBHC services on that date of service for that client, including MMIS-FFS, MCO payments, Medicare, spenddown, family deductibles, third party liability, etc.
  • • The difference between the PPS rate and the payments is the wrap payment per person per date of service
  • • The amounts in the third bullet may be positive or negative. All of these amounts are added up for each CCBHC for a given month. Since the PPS rates are, on average, about double the current payment levels, we expect the total wrap payment per CCBHC will always be positive
  • • Wrap payment amounts will be continually adjusted back to the start of the demo (July 1, 2017) if previously processed claims are replaced or changed in any way that affects the wrap calculation
  • Legal References

    Minnesota Rule 245.735, Excellence in Mental Health Demonstration Project
    Public Law 113-93

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