OK SPA 21-0041 Certified Community Behavioral Health (CCBH) Reimbursement
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) seeks to update and clarify language regarding the reimbursement methodology for the Prospective Payment System (PPS) rates for Certified Community Behavioral Health (CCBH) services. Changes will update and clarify the method, timing, and frequency for the establishment of initial and subsequent provider-specific PPS rates. Language also clarifies that interim rates for new providers of CCBH services are based on both rural and urban existing rates, and clarifies the reimbursement of crisis intervention services when furnished by a provider of CCBH services.
Please view the circulation document here: OK SPA 21-0041 and submit feedback via the comment box below.
60-Day Tribal Consultation Period: 8/24/21 – 10/23/21
Tribal Consultation Meeting: 9/7/21
Circulation Date: 9/7/21
Comment Due Date: 10/7/2021
The proposed new “Methods and Standards for Establishing Payment Rates” for CCBH providers indicates that CCBH providers may only “request a rate adjustment for changes in scope expected to change provider payment rates by 5 percent or more”. Oklahoma allows Federally Qualified Health Centers to request a change in scope when FQHCs expect payment rates to change by 2.5 percent or more. A CCBH is the behavioral health equivalent of an FQHC and as such should have the same standard. Setting the expected payment rate change for behavioral health at twice the standard for FQHCs is not equitable.
Thank you for your comment. The State will explore making a change to lower the percentage threshold for changes in scope.