The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. As described in detail in the report, the PPS-2 states established rates for the general population and rates for special populations. We conducted the first and second rounds of interviews at two points in DY1--September to October 2017 and February to March 2018, respectively. This may be due to lower staffing costs or other factors. It is important to note that the rates, which were set prior to the beginning of the demonstration, might differ from the actual costs, reported by the clinics at the end of DY1. For both PPS-1 and PPS-2, payment rates were lower for clinics that served a higher number of clients versus those that served a smaller number. To help clinics resolve these early challenges, state officials provided ongoing technical assistance in the form of training webinars and direct support through multiple channels (phone, online, in-person) to: (1) explain the measures and the information needed from the CCBHCs to report on each of them; (2) provide examples of how to extract information and calculate measures from EHR data (for example, what queries to run; what numerators and denominators to use; etc. PDF Division of Mental Health Director Diana Knaebe States submitted the cost reports to CMS for all 66 CCBHCs in Excel format, and we obtained them from CMS and conducted the analysis using Excel. We then followed the procedure used by the state to combine information from the two reports to calculate a single cost estimate. For example, officials in all states reported using quality measures data to support ongoing monitoring and oversight of CCBHCs (for example, to assess compliance with certification criteria). Labor costs. We conducted three rounds of telephone interviews with state behavioral health and Medicaid officials involved in leading implementation of the demonstration in each state. In some cases, this was done when a clinic had zero cases in one of the categories during the year prior to DY1 (the year on which the rates were based). The vendors did some over promising and under delivering, particularly around the timelines and deadlines.". Second, as we described in a separate report, CCBHCs made efforts to increase access to services. As shown in Figure III.1, PPS-1 rates varied across clinics within states, as well as across states. The average blended rate in rural areas was $852 and the average blended rate in urban areas was $676. Second, states' initial PPS rate calculations may have assumed smaller caseloads, while CCBHCs increased their caseload size through efforts to increase access to care. Section 223 Demonstration Program to Improve Community - Medicaid For example, interviewees from a number of states reported that many clinics--particularly those with limited experience in preparing cost reports--had some initial difficulty in completing cost forms. > d f h y l We summarized interviewees' responses for each state and then identified cross-state themes in the findings. Similarly, the demonstration states lacked detailed historical information from which they could estimate the PPS rates, but the experience of DY1 and the cost report data provide a stronger basis for these rates for DY2. Finally, we summarize DY1 PPS rates relative to actual DY1 costs. In addition, participating CCBHCs and states must submit to HHS performance data for a core set of quality measures specified in the criteria. The evaluation team did not have access to the cost reports that CCBHCs completed during the rate-setting process. incorporated into a contract. Depending on the availability of data within each state, we expect that the impact analyses will use approximately four years of Medicaid claims/encounter data (up to a two-year pre-demonstration period and a two-year post-implementation period). Across all PPS-1 clinics, the average DY1 visit-day cost was $234 and ranged from $132 to $639. In the first two rounds of interviews, behavioral health and Medicaid officials in six states participated in the interviews together to reduce scheduling burden and provide comprehensive answers; we conducted two separate interviews with behavioral health and Medicaid officials in two states. While you won't be able to fill in the . This final chapter summarizes key findings. In contrast, multiple state officials noted that the reporting process itself and/or the types of CCBHC-reported measures collected were new to many CCBHCs. We conducted the third round toward the end of DY2--February to April 2019. The first model (PPS-1) provides CCBHCs with a fixed daily payment for each day that a Medicaid beneficiary receives services from the clinic (this is similar to the PPS model used by Federally Qualified Health Centers). In New York, the clinics have historically been required to submit detailed, audited cost reports to the state--the CMS rate-setting form was filled in using information from these reports. While interpreting the cost report information, we found some limitations of the data. This could happen, for example, if the CCBHC hired higher or lower salaried staff than anticipated or incorporated services that were more expensive to provide than anticipated. Rates may be lower in clinics with more visits due to economies of scale. However, for those clinics with rates that were not close, state officials were glad to re-base between DY1 and DY2. In interviews with state officials during DY1, all states reported that many clinics initially experienced challenges with their EHR/HIT systems, particularly with respect to collecting and aggregating data needed to generate quality measures (for example, querying databases to specify the correct numerators and denominators within a given timeframe; ensuring that fields were correctly specified in all records to allow for aggregate reports to be generated directly from the EHR/HIT system rather than having to transfer data to intermediate files to generate necessary metrics). Base Rate Update Factor Medicare Economic Index (MEI) adjustment or . To overcome these challenges CCBHCs relied upon ad hoc strategies to facilitate data collection and reporting, and these strategies were often laborious and time-consuming. DY1 rates varied across CCBHCs and states. In New Jersey Clinics 5, 6, and 7, two or more special populations were paid at the same rate, and the state set the rate for these special populations by calculating the weighted average of the costs for each special population based on pre-DY1 cost data. To be completed by CCBHCs. Quality measure reporting provided clinics and state officials with standardized metrics to monitor the quality of care and inform quality improvement efforts. Costs of treating consumers in the CCBHCs. Having fewer staff than anticipated would lower total operating costs. Cost-reporting was challenging for most CCBHCs. All local mental health authorities and local behavioral health authorities are certified as T-CCBHCs, in addition to a few other provider types. New York officials initially planned to only make an MEI adjustment for DY2, but they changed this plan after deciding to continue the CCBHC model beyond the two-year demonstration project. Many state officials reported having formally or informally shared information on clinic-specific performance on the quality measures relative to other CCBHCs in the state during collaborative meetings. There are separate thresholds set for the standard population and for each special population specified in the states' PPS-2 rate schedule. The PPS, which reflect the anticipated costs per visit-day or visit-month, tended to be lower than the actual costs per visit-day or visit-month as reported in the DY1 cost reports. The CCBHCs report on nine of the measures, based on clinical data typically derived from EHRs or other electronic administrative sources. For some states, such as Minnesota and Pennsylvania, rates varied widely across clinics, whereas in other states, such as Missouri and Nevada, the rates varied less across clinics. CMS required the use of six quality measures to trigger bonus payments to CCBHCs (two of the CCBHC-reported measures and four of the state-reported measures; see Table IV.4). During the planning grant year, states worked with clinics that were candidates for CCBHC certification to set visit-day rates for PPS-1 states or visit-month rates for PPS-2 states. Washington, D.C. 20201 The data collection and reporting challenges state officials identified generally pertained to the CCBHC-reported measures. For example, in DY1, 88 percent of CCBHCs reported providing emergency crisis services directly, suggesting that they provided these services to some consumers but also contracted with a DCO to supplement their crisis services (for example, to serve clients outside of regular office hours). Analyses of Medicaid payments to CMHCs prior to the CCBHC demonstration found that these payments were in most cases below the costs of providing care, and that the new PPS rates for CCBHCs would likely be higher than historical Medicaid payments for mental health services. Labor costs for professional staff comprised about 29 percent of costs, with psychiatrists and other medical doctor staff comprising 19 percent and other non-medical doctor professional staff (for example, psychologists) comprising the remaining 10 percent. Certified Community Behavioral Health Clinics Infrastructure Grant In October 2015, the U.S. Department of Health and Human Services (HHS) awarded planning grants to 24 states to begin certifying CMHCs to become CCBHCs, develop new prospective payment systems (PPS), and plan for the demonstration's implementation. In addition to the six required measures, Minnesota also used the CMS-optional measure Screening for Clinical Depression and Follow-Up Plan (CDF-A) in determining QBPs, and New York added two state-specific measures based on state data regarding suicide attempts and deaths from suicide. CCBHC Designated Collaborating Organizations (DCO) Requirements . Minnesota, Nevada, and New York also used the CMS-optional measure for Plan All-Cause Readmission Rate (PCR-AD) in addition to the six CMS-required measures. Proportion of Labor Costs by Staff Category Across All Clinics, FIGURE III.8. Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2019, Implementation Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration, Preliminary Cost and Quality Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration. This report answers the following evaluation questions: How did the states initially establish the CCBHC rates? Several states assessed performance on the quality measures during the first six months of the demonstration and used that information to set improvement goals for the remainder of DY1. The states provide this supplemental payment to a clinic when the costs of providing care for a consumer during a visit-month exceeds a pre-established cost threshold. In December 2016, HHS selected eight states to participate in the demonstration (listed in Table ES.1) from among the 24 states that received planning grants. We first describe the PPS rates and how they varied across CCBHCs within and across states. The state average visit-day cost ranged from $167 in Nevada to $336 in Minnesota. To date, the evaluation has focused on providing critical information to Congress and the larger behavioral health community about the implementation of the CCBHC model across the eight demonstration states. We asked interviewees' permission to audio record the discussions to ensure the accuracy and completeness of interview notes. As required by PAMA, HHS selected the states based on the ability of their CCBHCs to: (1) provide the complete scope of services described in the certification criteria; and (2) improve the availability of, access to, and engagement with a range of services (including assisted outpatient treatment). Development of infrastructure to report measures. Each report shall include assessments of: (1) access to community-based mental health services; (2) the quality and scope of services provided by Certified Community Behavioral Health Clinics (CCBHCs); and (3) the impact of the demonstration programs on the federal and state costs of a full range of mental health services. State-reported measures focus on CCBHC consumer characteristics (for example, housing status), screening and treatment of specific conditions, follow-up and readmission, and consumer and family experiences of care. As a condition of participation, all CMHCs participating in the program must allow for the following. Given that the adoption of electronic health records (EHRs) and other health information technology (HIT) has been slower among behavioral health providers than other sectors of the health care system (in part, because these providers did not historically receive the same incentives as medical providers to adopt such technologies), the evaluation examined how CCBHCs' made changes to their EHR/HIT systems to facilitate reporting the required quality measures and how both CCBHCs and states used performance on those measures to improve care and make QBPs to CCBHCs. 3. Clinics also focused their efforts on readying data systems during the certification process. Criteria In March 2023, SAMHSA released the updated criteria (PDF | 1.3 MB) for certifying community behavioral health clinics in compliance with the statutory requirements outlined under Section 223 of PAMA. In many instances, interviewees reported that similar screening tools had been used prior to the CCBHC demonstration period to assess key outcomes of interest. For example, if the clinic increased the number of visit-days or visit-months beyond the expected number, while their total costs remain constant, their actual cost per visit-day or visit-month would be lower than anticipated. The PPS-2 model has multiple rate levels--a standard rate and separate monthly rates for special populations defined by state-specified clinical conditions. In addition, quality measure reporting has an important role in the context of the PPS through which the CCBHCs are reimbursed for services. Payments could be higher for improvement greater than 1 percent. PDF CCBHC Cost Report This top section is for Medicaid ID, NPI, reporting In the early stages of the demonstration, many clinics relied upon ad hoc strategies to overcome these challenges and facilitate data collection and reporting. In June 2019, Mathematica and RAND submitted a second report, "Implementation Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration,"[5] which provided updated information on the demonstration's implementation through April 2019 (approximately the first 22 months of the demonstration for six states and 24 months for the remaining two states). States varied in the criteria they used to award QBPs. PDF CCBHC Planning Grant - Illinois Department of Human Services The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. For example, the Cost Report form (Step 9) has a section for entering data from your trial balance for a recent year and a separate section for entering Anticipated FTEs and costs. An official website of the United States government. For example, Oregon state officials said that one of the CCBHCs noticed numbers were very low for one of their population health measures (note: officials did not specify which measure) and, subsequently, hired a consultant to address the issue indicated by the quality data. The second model (PPS-2) provides CCBHCs with a fixed monthly payment for each month in which a Medicaid beneficiary receives services from the clinic. Nevada clinics were eligible to receive QBPs just for submitting data on all measures in DY1, which the state used to establish a benchmark by which to assess progress and make DY2 QBPs. Appendix B provides information about outlier payments. State officials in Pennsylvania instituted a "dry run" of the cost reports, which covered the first six months of the demonstration. However, for several states, there was wide variation across clinics in the proportion of costs allocated to direct labor, with clinics in Minnesota showing the widest range. Total costs. Wherever we noticed data omissions, errors, or inconsistent reporting methods, we requested via email supplemental information from states and clinics, and states and clinics were highly responsive to our questions. Behavioral Health System Review | Executive Office of Health and Human The range across clinics in the blended rates was wider in New Jersey than in Oklahoma, which is not surprising given the larger number of CCBHCs in that state. States that adopted the PPS-1 model also had the option of including a quality bonus payment (QBP) mechanism--a payment above the standard PPS rate based on performance on quality measures. Format developed by CMS. vi. ); and (3) explain how to complete the reporting template. Specifically, Section 223 of PAMA mandates that HHS's reports to Congress must include: (1) an assessment of access to community-based mental health services under Medicaid in the area or areas of a state targeted by a demonstration program as compared to other areas of the state; (2) an assessment of the quality and scope of services provided by CCBHCs as compared to community-based mental health services provided in states not participating in a demonstration program and in areas of a demonstration state not participating in the demonstration; and (3) an assessment of the impact of the demonstration on the federal and state costs of a full range of mental health services (including inpatient, emergency, and ambulatory services). However, state officials indicated in our interviews that they were aware of these data limitations and expected the rates to be inaccurate to a certain degree during DY1. Changes to rates for the second demonstration year (DY2). Establishment of PPS rates. In addition to technical assistance, some states established learning networks so that CCBHCs could learn from each other as they collected data for the quality measures. CCBHCs represent an opportunity for states to improve the behavioral health of their citizens by: providing community-based mental and substance use disorder services; advancing integration of behavioral health with physical health care; assimilating and utilizing evidence-based practices on a more consistent basis; and promoting improved access. The following acronyms are mentioned in this report and/or appendices. CCBHCs encountered challenges with quality measure data collection and reporting. Working with these federal partners, Mathematica and RAND designed a mixed-methods evaluation to examine the implementation and outcomes of the demonstration and to provide information for HHS to include in its reports to Congress. HHS selected Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania to participate in the demonstration. Use of quality measures to inform quality improvement. Figure 1 24 states received CCBHC planning grants in 2015. vii. The average blended PPS-2 rate was $714 in New Jersey and $704 in Oklahoma. Guidance for: This document provides guidance to CCBHCs on how to use the Certified Community Behavioral Health Clinic (CCBHC) cost report for the two Certified Clinic Prospective Payment System (CCPPS) rate methodologiesCC PPS-1 and CC PPS-2. For example, some CCBHCs produce internal reports of performance on quality measures to examine trends over time, determine areas for improvements, and monitor the impact of quality improvement efforts. A. Proportion of Clinic Costs Allocated to Direct Labor in DY1 by State, FIGURE III.7. CCBHC Cost Report. The CC PPS2 methodology is implemented as a fixed monthly rate that reflects the expected cost of all CCBHC visits provided within any given month to a Medicaid beneficiary. By the end of DY2, officials in all states reported that the majority of issues surrounding CCBHC-reported quality measures had been resolved. Clinics in seven of the eight participating states did not have experience in collecting and reporting their operating costs prior to the demonstration. The cost-based rate gives clinics the flexibility to structure their services and financial management systems in a way that enables them to provide the full scope of services without having to bill for each of these services individually. We also highlight potential reasons that the rates differed from the DY1 costs. The evaluation team did not have access to the data nor the calculations used to set the DY1 rates. Since the clinics would be broadening their scope of services to meet the criteria, they would generally be increasing their total operating costs. Visit-days are unique days on which a consumer received at least one service, and visit-months are months in which a consumer received at least one service. Appendix Table B.1 summarizes the thresholds for triggering an outlier payment for each special population group. ASPE is overseeing the evaluation in collaboration with CMS. Certified Community Behavioral Health Clinics Demonstration - ASPE If the number of consumer visits increased, while the costs were relatively constant, the actual costs per visit-day or visit-month would be lower than had been anticipated. The blended rates were lower on average in clinics with higher numbers of visit-months, similar to the finding with respect to rates and visit-days in the PPS-1 clinics. DY1 Blended Cost Per Visit-Month for PPS-2 Clinics by State, FIGURE III.5. Number of CCBHCs, Demonstration Start Date, and PPS, FIGURE ES.1. Costs also varied widely across CCBHCs within states. DY1 Rates as Percent Above or Below DY1 Costs Per Visit-Day or Per Visit-Month for Clinics by State, TABLE ES.2. The state made a total of 2,574 outlier payments to CCBHCs during DY1. Similarly, staff turnover at a CCBHC during the year could reduce CCBHC costs, since they would not be paying staff costs for positions that were unfilled. We calculated an average blended rate by weighting each rate by the number of visit-months in that category in DY1 according to the cost reports and then calculated the average for the clinic. For example, officials in New York conducted a webinar to review the process for reporting CCBHC-level quality measures using the reporting template and created and distributed a list of frequently asked questions to all CCBHCs in the state. Less than 10 percent of costs were for staff with less than a BA degree. In addition, CCBHCs receive PPS payments based on anticipated daily or monthly per-patient cost rather than the cost of specific services provided during any particular patient visit. During CCBHC site visits, nearly all sites reported using standardized screening tools to assess key metrics. Due to these efforts, they could anticipate that the number of visit-days or visit-months would be quite different during the demonstration than they had been historically. To What Extent did CCBHCs Succeed in Collecting and Reporting Information Requested in the Cost Reporting Templates? In addition, four CCBHCs in New Jersey and one in Oklahoma applied the same rate to more than one special population. This is not surprising, as data on symptoms of depression (for example, the PHQ-9) are used for the depression remission at 12 months quality measure. Table IV.2 shows the number and percentage of CCBHCs that reported having various EHR/HIT system features in place in DY2 progress reports. Four of the state-specified improvement goals are based on Healthcare Effectiveness Data and Information Set (HEDIS) National Medicaid averages. If the number of consumer visits increased, while the costs were relatively constant, the actual costs per visit-day or visit-month would be lower than had been anticipated. Payments would be triggered if a clinic performed above the threshold or showed improvement over its own prior year rate during the DY. The cost reports were not audited, but the commonwealth performed a desk review . B. XLS CCBHC Cost Report Sample - Oregon.gov Historically, Medicaid has reimbursed CMHCs through negotiated fee-for-service or managed care rates, and there is some evidence that these rates did not cover the full cost of CMHC services. This chapter describes these data sources and our analytic methods. State officials were aware of the limitations of the data available to set rates and expected that the rates would vary from costs during the demonstration, with stabilization over time as more accurate data become available. (2016). Nineteen percent (n = 10) reported increasing the consistency with which they used measures to screen for depression (especially the PHQ-9) and the frequency with which they conducted follow-up assessments using such measures. DY1 Average Blended Visit-Month Rates for PPS-2 Clinics by State, FIGURE III.3. They planned to use a similar process to establish thresholds for DY2 using DY1 data. Therefore, we were unable to identify specific data limitations that may have led to inaccuracy in the rate-setting. Certified Community Behavioral Health Clinic - Cost Reports EOHHS, BHDDH, and DCYF drafted technical guidance to support provider completion of the CCBHC Cost Report.

1523 Riley Ave, Orlando, Fl, Elkins Park Swim Club, Homes For Sale Near Arden, Nc, Blue Marsh Lake Hp Limit, Articles C