On April 1, 2014, Congress enacted the Protecting Access to Medicare Act (PAMA) of 2014. Section 223 of PAMA requires the U.S. Department of Health and Human Services (HHS) to establish a process for the certification of Certified Community Behavioral Health Centers (CCBHCs) under Medicaid. In October 2015, twenty-four states were awarded planning grants to design a CCBHC program. In 2016, CMS will select eight states to participate in a two-year (2017-2019) CCBHC demonstration.
States participating in the demonstration will be required to implement a “prospective payment system” (PPS) for the reimbursement of CCBHCs. PAMA required the Centers for Medicare and Medicaid Services (CMS) to issue guidance to states on the development of the CCBHC PPS. In addition, the law set forth a long list of program requirements for CCBHCs relating to the availability and accessibility of services, care coordination, the scope and quality of services, and CCBHC governance. The Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance interpreting and implementing the statutory program requirements for CCBHCs.
The CCBHC demonstration program might appear to be of limited relevance to many behavioral health providers since only eight states will be selected to participate in the two-year Medicaid demonstration and states may choose to certify as few as two CCBHCs. However, behavioral health advocates hope that the demonstration will bear out the effectiveness of the CCBHC model and that the CCBHC model will become the prevalent model for the provision of community-based behavioral health services for Medicaid programs in other states.
The new PPS will be a positive development for community-based behavioral health providers participating in the demonstration because, for the first time, they will be entitled to reimbursement under Medicaid that tracks, at least to some extent, their costs of serving Medicaid beneficiaries.
The new reimbursement methodology will also impose new and complex requirements on CCBHCs that will create legal risks for non-compliance. This series of articles will review the payment methodology and the risks associated with the establishment of a base year rate. Upcoming articles in this series will billing Medicaid for CCBHC services and for services provided under managed care, as well as “designated collaboration organization” arrangements. For questions about CCBHCs, please contact our Health Care practice group at Feldesman Tucker Leifer Fidell LLP, www.ftlf.com or 202-466-8960.
This article was originally published in Compliance Watch, a bimonthly newsletter for behavioral health organizations, which keeps you up-to-date on regulatory changes and best practices in corporate compliance, giving you the information and guidance needed to reduce and manage risk. To subscribe, please click here and keep in mind that the National Council, Feldesman Tucker and Compliance Watch will continue to provide information and resources to help organizations navigate this and other payment reform initiatives.
 Protecting Access to Medicare Act, Pub. L. No. 113-93 (Apr. 1, 2014) § 223, 128 Stat. 1079.
 Each state participating in the demonstration is, per federal guidance, required to certify at least two providers to participate as CCBHCs.