CCBHC Prospective Payment System (PPS) Technical Assistance Session 11 Webinar: Coding for Demonstration Billing June 16, :30-4:00 pm ET

I.Welcome II.Webinar Goals III.Subject Matter Experts from CMS IV.Background V.Proposed Methods to Identify CCBHC- and DCO-specific Data  Summary of Proposed Methods to Identify Data  Example of How to Report a CCBHC encounter  Example of How to Report a DCO encounter  Discussion of Options  Coding Survey  Updated PPS Information and PPS Webinar Schedule VI.Questions and Discussion Webinar Agenda 2

1.Discuss CMS proposed methods for collecting CCBHC and DCO data. 2.Share ideas on how states may identify service level data specific for CCBHCs and DCOs. 3.Determine whether states would find codes for CCBHC daily encounter rates and CCBHC monthly encounter rates useful. 4.Determine which proposed method for collecting service level data specific for CCBHCs and DCOs states would prefer. II. Webinar Goals 3

III. Subject Matter Experts 4 PPS – Beverly Boston, Mary Cieslicki, Danielle Motley MMIS/Systems – Enitan Oduneye Coding – Frances Crystal Managed Care – Debbie Dombrowski, Lynn Sanetrik CMS Cynthia Kemp David Morrissette Joanna Barnes SAMHSA Judith Dey Emily Jones ASPE

IV. Background Importance of reporting CCBHC, DCO, and service-level data Facilitates assessment and improvement of program quality Allows states to meet requirement for state collection and reports on encounter, clinical outcomes, and quality improvement data, and demonstration participation Helps states in reporting annually to assess impact of demonstration 5

IV. Background – CCBHC Reported Measures Link to Quality Bonus Payments (pg. 9 of PPS Guidance) For the state to make QBP the CCBHC must demonstrate that it has achieved all of the required quality measures. 6 *Quality Measures were revised as of May 1, 2016 and are reduced from the list published in the RFA Measure or Other Reporting Requirement QBP Eligible Measures Required QBP Measures Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients No Preventive care and screening: Adult BMI screening and follow-up No Weight assessment and counseling for nutrition and physical activities for children/adolescents (WCC) No Preventive care and screening: Tobacco use: Screening and cessation intervention No Preventive care and screening: Unhealthy alcohol use: Screening and brief counseling No Child and adolescent major depressive disorder: Suicide risk assessment Yes Adult major depressive disorder: Suicide risk assessment Yes Screening for clinical depression and follow-up plan YesNo Depression remission at 12 months YesNo

IV. Background – State Reported Measures 7 *Quality Measures were revised as of May 1, 2016 and are reduced from the list published in the RFA Measure or Other Reporting Requirement QBP Eligible Measures Required QBP Measures Housing status No Follow-up after emergency department for mental health No Follow-up after emergency department for alcohol or other dependence No Plan all-cause readmission rate YesNo Diabetes screening for people with Schizophrenia or Bipolar disorder who are using antipsychotic medications No Adherence to antipsychotic medications for individuals with schizophrenia Yes Follow-up after hospitalization for mental illness, age 21+ Yes Follow-up after hospitalization for mental illness, age Yes Follow-up care for children prescribed ADHD medication YesNo Antidepressant medication management YesNo Initiation and engagement of alcohol and other drug dependence treatment Yes Patient and family experience of care survey No Link to Quality Bonus Payments (pg. 9 of PPS Guidance)

V. Proposed Methods to Identify CCBHC and DCO-Specific data 8 Methods to collect these data: Method to identify CCBHC claims Method to identify DCO claims Method to identify individual services

V. Proposed Methods to Identify CCBHC Data Use existing Place of Service (POS) codes o Community Mental Health Clinic #53 o Independent Clinic #49 PLUS Implement use of a CCBHC daily and CCBHC monthly rate o CMS will seek feedback from states on this proposal 9

V. Proposed Method to Identify DCO Services The DCO would provide to the CCBHC all data required for the CCBHC to bill for demonstration services. Require CCBHC to include the DCO’s rendering provider number for demonstration service claim 10

V. Proposed Method to Identify Individual Service Level Data Use of billing code modifiers for individual service CPT codes $0 amount for Medicaid demonstration services Implementing new codes may require MMIS modifications 11 Example: CCBHC modifier

V. CCBHC and DCO Services 12

V. Example of How to Report a CCBHC Encounter Example: CCBHC client receives a demonstration service that falls under screening, assessment, and diagnosis, including risk assessment (Section 223(a)(1)(D)(ii)). The CCBHC would bill for this demonstration service as indicated in the chart below. 13 Proposed Method A Proposed Method B Proposed Method C Place of Service Code #49 Independent Clinic or #53 Community MH Center ✓✓✓ CCBHC daily or monthly encounter rate – not yet established ✓✓ Billing CPT code + modifier (billed at $0 amount) – modifier not yet established ✓ ✓ Billing CPT code without modifier (billed at $0 amount) ✓

V. Example of How to Report a DCO Encounter Following the same example, client is then referred to a DCO by the CCBHC for psychiatric rehab services (Section 223(a)(1)(D)(vii)). The CCBHC would bill for the DCOs services as indicated in the chart below. 14 Proposed Method A Proposed Method B Proposed Method C Place of Service Code - #49 or #53 ✓✓✓ Rendering Provider Number ✓✓✓ CCBHC daily or monthly encounter rate – not yet established ✓✓ Billing CPT code + modifier (billed at $0 amount)- modifier not yet established ✓ ✓ Billing CPT code without modifier (billed at $0 amount) ✓

V. Discussion of Options Do states see any barriers to implementing any of the three options? Additional options for identifying service level data specific to CCBHCs or DCOs? Should CMS request a CCBHC daily encounter and a CCBHC monthly encounter rate code? Should CMS request a billing code modifier for individual services delivered as part of the 9 demonstration services? Will states require additional TA to implement any of the options? 15 Options for coding discussion prompt:

V. Coding Survey 1.States will receive a link to the Coding Survey by – survey will ask for state’s responses to questions on previous slide 2.Please consolidate comments and provide ONE respondent per state *survey results will inform CMS’ next steps 3.Responses due by June 15,

V. 223 PPS Updates Roadmap of Technical Assistance Resource o ed and posted on SharePoint beginning of June Additional TA Resources Survey o Each State should complete the brief Additional TA Resources Survey immediately if have not already done so Additional TA Resources Survey 17

V. PPS Webinar Topics & Schedule Additional webinars added: 18 Webinar Topic Date PPS TA Session 12: Case Study, Part 1Tues 7/26, 2:30-4pm ET PPS TA Session 13: Case Study, Part 2Thu 7/28, 2:30-4pm ET PPS TA Session 14: Open SessionThu 8/18, 2:30-4pm ET

VI. Questions and Discussion 19

Mailboxes – CMS mailbox for PPS guidance-related questions: – CMS mailbox for Quality Based Payment-related questions: 223 PPS TA SharePoint Site Link – Crosswalk template for State developed cost reports Q&As posted at the 223 Landing Page on Medicaid.gov 223 Landing Page on Medicaid.gov Collaboration Tools 20