Transcript Document

www.TheNationalCouncil.org
CCBHC State Planning Grants,
Certification Criteria, and Payment
Guidance
National Council for Behavioral Health
Contact: [email protected]
|
202.684.7457
Key Dates
• May 20, 2015 – RFA Announcement
• June 8 and June 10, 2015 – SAMHSA Pre-Application
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Webinars
June 17 – National Council webinar
August 5, 2015 – Planning Grant Applications due from
the states
October 2015 – Planning Grants awarded to the states
October 2016 – Applications due from states to be part
of the 2 year Demonstration Program
January 1, 2017 – Up to Eight States are selected to
participate in the 2 Year Demonstration
Contact: [email protected]
|
202.684.7457
Application information
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Due August 5, 2015
Awards up to $2 million
Estimated number of awards: 25
Planning phase: 1 year
Eligible applicants: State Mental
Health Authorities, Single State
Agencies, State Medicaid Agencies
Contact: [email protected]
|
202.684.7457
Planning Phase Details
• One year – October 2015 to October 2016
• Activities during the year:
A. Solicit input
B. Certify clinics (at least two, can be all)
C. Establish a PPS
D. Develop capacity to provide CCBHC services
E. Develop or enhance data collection and reporting capability
F. Prepare for participation in national evaluation
G. Submit a proposal
• 8 selected states allowed no-cost extension
to finish planning activities
Contact: [email protected]
|
202.684.7457
Required Services
Crisis
Services
(if needed)
Screening,
assessment,
diagnosis
Pt. Centered
treatment
planning
Outpatient
MH/SA
Psychiatric
Rehab
Peer
support
Targeted Case Management
Primary Health Screening & Monitoring
Armed Forces and Veteran’s Services
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202.684.7457
Certification Criteria: Key Changes
• Governance: “meaningful participation”
• “Directly by” CCBHC: Designated Collaborating
Organizations (DCOs)
• Assessments: 60d initial and 90d re-assess
• Staffing: appropriate for size, target, services
• EBPs: state-determination
Contact: [email protected]
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202.684.7457
MTM Certification Criteria Readiness Tool
• Self-assessment tool
based on final
CCBHC criteria
• Objective
measurement of
preparedness
• Individual or statewide applicability
Contact: [email protected]
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202.684.7457
Prospective Payment System (PPS)
Activities during the Planning Phase
• Decide: FQHC-like daily payment or
Alternative monthly PPS
• Determine clinic-specific PPS
• Develop actuarially sound rates for
payments made through managed
care
• “Prepare” to collect cost reports
Contact: [email protected]
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202.684.7457
Federal Match for States
• Federal Match (FMAP) follows beneficiary eligibility:
 Regular Medicaid: Enhanced FMAP
 Expansion population: 100% now, down to 90% by 2020
 Medicaid CHIP Expansion: Enhanced FMAP +23%
 Served by Indian Health Services Clinics: 100%
• State plan authority not necessary for payment
for CCBHC services delivered by certified clinics
• States may claim administrative expenditures that
support the development and implementation of the
demonstration
Contact: [email protected]
|
202.684.7457
PPS Rate Methodology
• Participating states will select 1 of 2 PPS rates
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FQHC-like PPS
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2.
Reimbursement of cost on daily basis
CC PPS Alternative
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Reimbursement of cost on monthly basis
• Both PPS Quality Bonus Payments
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Optional for FQHC-like PPS Option
Required for Alternative PPS Option
• PPS Rate will include cost of DCO services
Contact: [email protected]
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202.684.7457
Rate Element
CC PPS-1
CC PPS-2
Base rate
Daily rate
Monthly rate
Payments for services
provided to clinic users
with certain conditions
NA
Separate monthly PPS rate
to reimburse CCBHCS for
the higher costs associated
with providing all services
necessary to meet the
needs of special
populations.
Update factor for
demonstration year 2
Medicare Economic index
(MEI) or rebasing
MEI or rebasing
Outlier payments
NA
Reimbursement for portion
of participant costs in
excess of threshold
Quality bonus payment
Optional bonus payment
for CCBHCs that meet
quality measures detailed
on page 7
Bonus payment for CCBHCs
that meet quality measures
detailed on page 7.
Contact: [email protected]
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202.684.7457
Costing and Rebasing
• Demonstration Year 1 Rates
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Cost and visit data gathered during planning phase;
May include estimated costs for services/items
projected for demo phase
Updated by Medicare Economic Index (MEI)
• Demonstration Year 2 Rates
• Update of DY1 rates with MEI
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Or
Rebasing
Contact: [email protected]
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202.684.7457
Intersection with Managed Care
State Options
1. Fully incorporate the PPS payment into
the managed care capitation rate; or
2. Use a reconciliation process to make a
wraparound supplemental payment to
ensure that the total payment is
equivalent to CCBHC PPS.
Contact: [email protected]
|
202.684.7457
Planning Grant Status
June 8, 2015 – 17 Green Light
Political Priority States for Demo Expansion
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California
Georgia
Idaho
Indiana
Iowa
Kansas
Nevada
• New
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Hampshire
New Jersey
N. Carolina
Ohio
Pennsylvania
S. Carolina
Contact: [email protected]
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South Dakota
Tennessee
Texas
Wyoming
202.684.7457
National Council Activities
• Assisting states with planning grant
applications
• Toolkit, including
New fact sheet
Detailed RFP summary
Introductory PowerPoint for stakeholders to use
Overview of key planning considerations
• MTM Certification Criteria Readiness Tool
• National webinar on June 17
Contact: [email protected]
|
202.684.7457