Summary
MDHHS set the operational requirements for the CMS Certified Community Behavioral Health Clinic (CCBHC) Demonstration, with an implementation start date of October 1, 2021. Each qualifying CCBHC service is paid at the site-specific PPS-1 rate, and it is recognized only when submitted with both the T1040 service encounter code and a CCBHC encounter code. CCBHCs must first bill applicable third-party payors, including Medicare, before submitting the encounter to the PIHP for the remaining amount.
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What to do
Action · 7 steps
01Already effective October 1, 2021: Submit each CCBHC service encounter to the PIHP with the T1040 service encounter code and the matching CCBHC Encounter Code from Appendix A of the CCBHC Demonstration Handbook, because omitting either code precludes the PPS-1 payment.
02Submit each encounter with the CCBHC as billing NPI, using the beneficiary's Medicaid ID for Medicaid beneficiaries or the PIHP Consumer ID for non-Medicaid recipients.
03Bill third-party payors, including Medicare, and any applicable federal or state grant funding, such as SAMHSA CCBHC Expansion grant funding for non-Medicaid recipients, before submitting the encounter to the PIHP for the difference.
04The combined reimbursement from all payor sources may not exceed the site's PPS-1 rate, and the PPS-1 payment may be paid only once per day regardless of the number of CCBHC encounters reported that day.
05Submit timely and complete CCBHC encounters under federal managed care rules and the CCBHC Demonstration Handbook.
06For services rendered through a designated collaborating organization, the CCBHC bills the CCBHC services rendered under contract by the DCO, except where a third-party payor does not allow the CCBHC to bill on behalf of a DCO, in which case the DCO must provide any payment received from that payor to the CCBHC.
07Check current applicability of these 2021 requirements before acting on them.
Codes mentioned
T1040
Original notice
MSA 21-34
michigan.gov · Always check the source before changing claims.
Related changes
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