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Mental Health Rate Reform

The Department is in the process of reforming the mental health rate setting process. This reform is in response to the performance audit conducted by the Mercer Government Human Services Consulting on the Medicaid Mental Health Rates ("Mercer Audit"). The Mercer Audit provided the Department with recommendations for improvement after evaluating the current rate setting methodology.

 

To comply with the recommendations, the Department hired two contractors to develop or update three documents for the Behavioral Health Organizations (BHOs), Community Mental Health Centers (CMHCs), and the Department. The Department, the BHOs, and the CMHCs will use the documents for rate setting.

 

The two contractors invited feedback from the Department, the Office of Behavioral Health (OBH), and other stakeholders in order to develop the final documents. The Department anticipates that further changes will be made to the posted documents and will set up a working group to provide input when updating the documents. The links to the three documents are below for reference and use by the provider community, interested stakeholders, and the Department.

 

Mental Health Accounting and Auditing Guidelines 

BHO Supplementary Audit Schedules 

 

Annual Cost Reports

  1. Mental Health Only Providers Cost Report

  2. Mental Health/SUD Providers Cost Report

  3. SUD Only Providers Cost Report 

 

This document updates the billable costs to Medicaid and OBH. Additionally, this document requires the CMHCs and BHOs to report costs in greater detail. The FAQ provides answers to the questions and recommendations developed by the providers during the March 2010 cost trainings and the A&A Review Committee.

 

Resource-Based Relative Value Scale Narrative and Weights 

 

This document standardizes the price of services through the use of relative weights.

 

Uniform Service Coding Standards

 

This document sets forth the requirements of billing procedure codes for covered mental health services. The Department and DBH have updated the Uniform Coding Standards three times.

 

  1. 2009 edition 

  2. 2011 edition - the issues from the stakeholder community regarding the 2009 version and the updates implemented in the 2011 version can be found here.   

  3. 2012 edition - the issues from the stakeholder community regarding the2011 version and the updates implemented in the 2012 version can be found here.  

  4. 2013 edition - changes made to the code pages and code page appendices are identified in the 2013 version using blue font. 

  5. 2014 Edition - this is the draft edition of the 2014 version. The final version will be posted at a later date. Changes made to the code pages and code page appendices are identified in the 2014 draft version in blue font.

     

The Office of Behavioral Health has developed a 2014 manual specifically for SUD providers, which will be added to the upcoming edition of the USCS manual.  Please refer to this manual for SUD coding standards.

 

The USCS manual is a living document that is updated each year to maintain consistency between the BHO contract, the DBH contract, the State Plan Amendments, the (b)(3) waiver, and coding guidelines. Unless otherwise noted, the State (HCPF and DBH) has agreed that it will accept coding provided under all editions through June 30, 2012. Providers must implement the 2012 edition by July 1, 2012.

 

If there are implementation issues for the BHOs and CMHCs, please contact Sharon Liu, the Department's lead mental health rate analyst, at Sharon.Liu@state.co.us. If there are questions regarding the three documents, please email Sarah Campbell at Sarah.Campbell@state.co.us.