Federal Funding Update for Mental Health and Addiction Programs

Federal Funding Update for Mental Health and Addiction Programs

Recently, Congressional leaders passed a $1.3 trillion spending bill that set government funding through Sep. 30, 2018. The 2018 bill boosts federal health spending by about $10 billion, including increases for the Substance Abuse and Mental Health Services Administration (SAMHSA) and specifically dedicated opioid crisis funding. The bill provides increased funding for mental health and addiction programs and rejects the cuts to key behavioral health care programs proposed in previous FY 2018 budget. Here is a summary of funding for key programs: MENTAL HEALTH & ADDICTION TREATMENT AND EDUCATION Certified Community Behavioral Health Clinics (CCBHCs): Includes $100 million in new funding to support the ongoing Certified Community Behavioral Health Clinic program active in eight states. Primary and Behavioral Health Care Integration and Technical Assistance Center: $49 million, which is level funding compared to 2017. Mental Health First Aid: $19 million, an increase of 5 million over 2017 funding level. Mental Health Block Grant: $701 million, an increase of $160 million over 2017. Substance Abuse and Prevention and Treatment Block Grant: $1.8 billion, which is $3.4 million more than 2017 funding. We are waiting on further information on how SAMHSA and other agencies will allocate the new funding for CCBHCs and the other funded programs noted above. A more detailed chart of mental health and addiction 2018 appropriations is available here and provided by The National Council of Behavioral Health.   Mathew Hamlin, CPA is a member of the Jones & Roth Behavioral Health team. He specializes in working with clinics who rely on grants and payer system revenue streams and provides audit, reporting and compliance advisory services for Behavioral Health clinics across...
Oregon CCBHC Program Successes to Date

Oregon CCBHC Program Successes to Date

Now that we are about a quarter of the way through the 2 year demonstration program, the National Council for Behavioral Health surveyed CCBHCs to find how they have been able to expand and improve services. Survey results show that when community behavioral health clinics are incentivized to provide evidence-based care and provided compensation that adequately covers their cost of doing business, they can provide access to care in their communities. According to the National Council for Behavioral Health, CCBHCs are increasing access to mental health and addiction treatment; expanding capacity to address the opioid crisis; collaborating with partners in hospitals, jails, prisons and schools; and attracting and retaining qualified staff who offer science-based, trauma-informed services – often on the same day patients present for care. Click to see results from the 8 Oregon CCBHC’s that responded to the survey. Noteworthy results from the Oregon CCBHC survey: 172 new staff positions have been hired by Oregon CCBHC’s because of the program. Oregon CCBHC’s are able to recruit and maintain better and more diverse positions and credentials. Some Oregon CCBHCs reported doubling of provider time with clients. 75% of Oregon CCBHC reported an increase in new clients that had pre-existing conditions that were previously untreated. Oregon CCBHC’s have expanded programs to assist in opioid treatment The majority of Oregon CCBHC’s are experiencing: Improved outreach New technologies supporting more efficient and effective care Same day access implementation and protocols New care programs and partnerships with schools, veterans and criminal justice systems Expanded crisis care capacity     Mathew Hamlin, CPA is a member of the Jones & Roth Behavioral Health team. He specializes...
CCBHC Expansion Bill Introduced in the Senate

CCBHC Expansion Bill Introduced in the Senate

In December, Senators form Missouri and Michigan and Representatives from New Jersey and California introduced the Excellence in Mental Health and Addiction Treatment Expansion Act, H.R. 3931/S. 1905. This legislation would expand and extend the Excellence Act demonstration program in Medicaid (CCBHC program). Currently, this demonstration is a 2 year, 8 state initiative to expand Americans’ access to community-based mental health and addiction care. The program started in Oregon in the spring of 2017. It lays the foundation for transformation of care delivery by setting standards for Certified Community Behavioral Health Clinics (CCBHCs) and establishing a Medicaid payment rate that supports the costs of comprehensive service. The new bill, the Excellence in Mental Health and Addiction Treatment Expansion Act (H.R. 3931/S. 1905) would expand the program to include 11 more states that were not selected as part of the original and current 8 states. The bill would also extend the life of the original 8 states to include an additional year. “This expansion is critical in making sure communities across the country have the resources they need to improve the lives of anyone living with mental illness or recovering from addiction,” said Senator Debbie Stabenow (MI). “Each and every state that came forward with a plan to increase access to community mental health services should have the support they need.” “This bill will allow all states in the pilot program to continue the important work that’s underway, and enable more states to join the effort. I urge my colleagues to support this bipartisan bill, and help get us closer to our goal of treating mental health like all other health in...
CCBHC Demonstration Service Procedure Code Billing Cycle

CCBHC Demonstration Service Procedure Code Billing Cycle

One of the key factors to becoming a successful Certified Community Behavioral Health Clinic (CCBHC) will be to have an efficient and effective Medicaid CCBHC demonstration service code billing cycle. If billings are not accurate or timely, cash flow will squeeze quickly. To have an effective billing cycle you must have accurate and timely encounter chart notes, an experienced billing team, proper oversight and self-audit procedures, and a billing system that is user-friendly with a robust reporting mechanism. High Quality Chart Notes The quality of a CCBHC billing cycle will only be as good as the provider chart notes documented for each encounter. Chart notes initiate the whole process and if you’re off track on step one, you’re already setup for failure. Chart notes can often be under-documented or overly-wordy. Providers, operations management, and key billing staff should corroborate to find the balance that best works for your CCBHC and meets Medicaid demonstration program service billing standards. Focus on the main service areas that act as trigger words for billing. For assistance with this, Oregon Health Authority (OHA) has provided a helpful demonstration service key. Quality chart notes will directly lead to quality billings. This means less rebilling, better capacity for providers and billing staff, and reliable program cash flows.   Self-Audit and Reporting Metrics An essential part of a self-sustaining billing cycle is adequate oversight. There should be personnel available within the organization that have the accountability and capacity to spot check billings before submission to Medicaid. This team member can also look at encounter data and compare it against collections to identify any weak areas. The answers...
Prospective Payment System (PPS) Critical to Oregon CCBHCs

Prospective Payment System (PPS) Critical to Oregon CCBHCs

Why is the PPS critical to CCBHCs? It’s how the CCBHC drives its mission. CCBHCs are paid through a PPS similar to that used by Federally Qualified Health Centers and other types of providers. States may select from two options for their PPS: a daily rate or a monthly rate. Oregon has selected to use the daily rate (PPS-1). Based on this selection, Oregon CCBHCs will be paid a single daily rate for each Medicaid patient who receives services at the clinic (or Designated Collaborating Organization) during that day. The same rate is paid regardless of the services provided to the patient. PPS rates are specific to each CCBHC. In establishing PPS rates, CCBHCs must create a cost report, including the cost of providing all services to all patients, in order to establish the per-day cost of serving Medicaid patients in your CCBHC. The PPS rate is applicable to Medicaid patients only. The cost report will likely include estimated costs related to new services and/or new costs to be provided and incurred during the demonstration phase. The cost of DCO services is included in the CCBHC PPS rates, and DCO encounters are treated as CCBHC encounters for purposes of the PPS. If there is one thing a provider needs to get right on the forefront of operations as a new CCBHC, it’s ensuring it is paid sufficiently for the service rendered to secure operational sustainability. The CMS released its template CCBHC Cost Report and CCBHC Cost Report Instructions for use by states participating in the two-year Demonstration Program. The CMS CCBHC cost report and instructions assist states in developing their unique PPS-1 rates...
Impact to Oregon’s Changing Behavioral Health Landscape

Impact to Oregon’s Changing Behavioral Health Landscape

Who will be affected by the CCBHC demonstration program beginning spring 2017? The Excellence in Mental Health Act demonstration program will result in profound changes to this country’s mental health landscape. First, behavioral health clientele and members of our communities will benefit directly. We expect to see better needs assessment, client reach, access, and depth of care. CCBHCs will also better integrate care with the clients’ primary care provider to ensure the clients’ health is reviewed holistically. Second, behavioral health providers becoming CCBHCs will see an array of new opportunities and requirements: CCBHCs will become a new provider type in Medicaid. CCBHCs will be defined by their trauma-informed care and recovery and wellness focus, not just on their comprehensive range of services provided. Trauma-informed care is the foundation of the new CCBHC standard of care. CCBHCs will be eligible for improved billings through a prospective payment system (PPS) aimed to reimburse providers consistent with expected costs of servicing clients in their communities. This allows CCBHCs access to reimbursements for client services not typically funded through current payers. CCBHCs are responsible for meeting unique requirements and for providing nine required services. This includes coordination of care through community health and social service provider partnerships. Finally, community health and social service providers working with CCBHCs will see both benefits and requirements increase. These organizations, coined “Designated Collaborating Organizations (DCOs),” will partner with CCBHCs through contractual agreements to provide supporting services to CCBHC clients. DCOs will see expanded demand for their reserves, coupled with new and better paying funding streams. DCOs will be required to provide services consistent with CCBHC standards.   We...