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.
Annual Cost Report
Mental Health and/or SUD 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 behavioral health services covered by the Department and the Office of Behavioral Health.
Uniform Service Coding Standards Addendum March 2017
Uniform Service Coding Standards January 2017
Uniform Service Coding Standards October 2016
Uniform Service Coding Standards July 2016
Uniform Service Coding Standards 2015
The USCS manual is a living document that is updated periodically to maintain consistency between the BHO contract, 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