CCBHC PPS Guidance Proposed Updates
The Centers for Medicare & Medicaid Services is seeking public comment on proposed updates to the Certified Community Behavioral Health Clinic (CCBHC) Prospective Payment System (PPS) Technical Guidance published as part of the Substance Abuse and Mental Health Services (SAMSHA) CCBHC 2015 Notice of Funding Opportunity.
A summary of the proposed updates include:
- Simplifying the PPS-2 methodology to make special population rates optional,
- Addition of two new PPS rate options (PPS-3, daily; PPS-4, monthly) which includes a Special Crisis Service rate component,
- Updating the quality bonus payment measure-set and providing clarification and examples regarding flexibilities for quality bonus payments,
- Updating specific sections of the existing CCBHC PPS Guidance to bring it up-to-date, and provide additional flexibilities as allowable under the Demonstration, and
- Establishing a standard 3-year cadence for states to rebase clinic-specific PPS rates.
You may submit public comments to CCBHC-Demonstration@cms.hhs.gov, with the subject “Public Comment on Updated PPS Guidance” by the Friday June 2, 2023 due date.
The Protecting Access to Medicare Act of 2014, was passed by Congress in March 2014, and signed into law on April 1, 2014 by the President. Section 223 of the Act provides for the creation and evaluation of a demonstration program for up to eight states that will implement CCBHC according to specific criteria that emphasize high quality and evidence based practices. Section 223 authorizes the Department of Health and Human Services to:
- Establish criteria that states will use to certify community behavioral health clinics for a two year demonstration program;
- Provide guidance on the development of a prospective payment system for payment of CCBHC services provided by certified clinics;
- For a state participating in the demonstration, provide federal matching funds equivalent to the standard Children’s Health Insurance Program (CHIP) rate for CCBHC services to Medicaid beneficiaries (or the rate available to newly eligible beneficiaries);
- Award grants to states for planning purposes to develop proposals to participate in the demonstration program;
- Select up to eight states to participate in the demonstration program; and
- Evaluate the project and prepare annual reports to Congress.
States and clinics should submit their questions about the CCBHC PPS methodologies and requests for technical assistance to: CCBHC-Demonstration@cms.hhs.gov
Planning Grants for Certified Community Behavioral Health Clinics
On May 20, 2015 the Centers for Medicare & Medicaid Services (CMS) issued guidance to states and clinics on the development of a prospective payment system (PPS) to be tested under the Certified Community Behavioral Health Clinics (CCBHC) 223 Demonstration Program, as required in Protecting Access to Medicare Act (P.L. 113-93, section 223). See page 70 of the Planning Grants for Certified Community Behavioral Health Clinics RFA for additional information.
HHS awards $22.9 million in Planning Grants for Certified Community Behavioral Health Clinics (CCBHCs)
On October 19, 2015, the Substance Abuse and Mental Health Services Administration (SAMHSA), in conjunction with the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Planning and Evaluation (ASPE), awarded a total of $22.9 million to support 24 states in their efforts to improve behavioral health of their citizens by providing community-based mental health and substance use disorder treatment. View the states receiving grants.
HHS Selects 223 Demonstration States
On December 21, 2016 HHS announced the eight states selected to participate in the section 223 Demonstration Program to Improve Community Mental Health Services. States include: Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon and Pennsylvania. Chosen from among the planning grant states that submitted applications, these states will begin their demonstrations January 1, 2017 to June 30, 2017.
On January 6, 2016, CMS released its Certified Community Behavioral Health Clinic (CCBHC) Cost Report and CCBHC Cost Report Instructions for use by states participating in the Section 223 Protecting Access to Medicare Act (PAMA) one-year planning and two-year Demonstration Programs to Improve Community Mental Health Services. The CMS CCBHC cost report and instructions assists states in determining clinic-specific prospective payment system (PPS) rates for demonstration services, using either the PPS-1 or PPS-2 payment methodology allowed by CMS and specified in CCBHC PPS guidance previously issued by CMS.
SAMHSA releases new quality measurement tools for mental health and substance use treatment
On June 21, 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a new set of OMB-approved quality measures, accompanying technical specifications and resource manual, and data reporting templates designed to help states and behavioral health clinics (BHCs) better assess and document their performance and effectiveness in providing treatment to people with substance use and/or mental disorders. These materials were developed in partnership with CMS. States and clinics will find the technical specifications and reporting templates for all of the quality measures included in the demonstration here: https://www.samhsa.gov/section-223/quality-measures
Demonstration Billing Codes
On November 17, 2016, CMS published the 2017 Alpha Numeric Healthcare Common Procedure Coding System (HCPCS) File & Code Sets which contain dedicated 223 demonstration encounter billing codes and a billing code modifier. The “T” codes are for CCBHCs to bill solely for demonstration encounters while the Q2 modifier can be used for billing service-level data associated with each demonstration encounter. These codes are effective for dates of service on and after January 1, 2017.
Learn more about the full updates on CMS.gov.
|HCPC||Long Description||Short Description|
|T1040||Medicaid certified community behavioral health clinic services, per diem||Comm bh clinic svc per diem|
|T1041||Medicaid certified community behavioral health clinic services, per month||Comm bh clinic svc per month|
|Q2||Demonstration procedure/service||Demo procedure, service|
Reports to Congress
Certified Community Behavioral Health Clinics Demonstration Program Report to Congress, 2017: This 2017 report is the first of 4 annual Reports to Congress and focuses on the statutory requirements of Section 223 of the Protecting Access to Medicaid Act (PAMA) for 2014 (Public Law 113-93), planning phase of the demonstration, implementation, the planning grants that helped states prepare, and how the eight states (Minnesota, Missouri, Nevada, New Jersey, New York, Oregon, Oklahoma, and Pennsylvania) were selected to participate in the demonstration, including activities associated with launching the demonstration programs.
Certified Community Behavioral Health Clinics Demonstration Program Report to Congress, 2018: This 2018 report highlights Section 223 participating states’ CCBHC activities that have been associated with improving access to a comprehensive range of treatment and recovery support services. The range of services includes delivery of mental health, addiction, and either screening for general medical conditions or onsite access to primary care during the first year of the demonstration. It draws on qualitative findings gathered from interviews at the state level and preliminary data from CCBHCs. The report also details how the eight states that were selected to participate in the demonstration are monitoring the CCBHCs for compliance to the certification criteria. Each of the eight demonstration states, Minnesota, Missouri, Nevada, New Jersey, New York, Oregon, Oklahoma, and Pennsylvania is profiled in the report to understand their compliance efforts.