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The Department is in the process of reforming the behavioral health rate-setting process.
The Department hires contractors to assist in the development and updating of documents for the Behavioral Health Capitated Entities Organizations (BH RAEs), Community Mental Health Centers (CMHCs), and the Department. The Department, the BH RAEs, and the CMHCs will use the documents for rate-setting.
The final documents are a collaboration of feedback from the Department, the Office of Behavioral Health (OBH), and other stakeholders. 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 these documents are below for reference and use by the provider community, interested stakeholders, and the Department.
FY19 Cost Report Template
This document updates the billable costs to Medicaid and OBH. Additionally, this document requires the CMHCs and RAEs report costs in greater detail. The FAQ provides answers to the questions and recommendations developed by the providers during the March 2010 cost training and the A&A Review Committee.
Third-Party Report Template
RAEs are to report any Third Party Liability (TPL) collected associated with Behavioral Health sub-contractor encounters in the tab “Post Pay Adj Pre Paid Ent”, and summarize the total amount collected in the “Post-Pay Adjudication for Pre-Paid Entities” row on the “Reporting Template FY2019” tab. The RAEs must submit the FY2019 report to the Department by January 31, 2020.
This document sets forth the requirements of billing procedure codes for behavioral health services covered by the Department and the Office of Behavioral Health.
The USCS manual is a living document that is updated periodically to maintain consistency between the BH RAE contracts, the OBH Contract, the State Plan Amendments, the 1915(b)(3) waiver, and coding guidelines. If you have any questions regarding any of these documents please contact John Doherty at email@example.com