Overview of Proposed Rates and Fiscal Data Modeling in Behavioral Health Payment Reform
This presentation covers the implementation of CPT coding transition under CalAIM Behavioral Health Payment Reform by the State DHCS. It includes details on outpatient service rates, use of CPT codes for clinical services, HCPCs for non-clinical services, fee-for-service rates, and taxonomy coding guidelines. The fiscal data modeling tool and next steps for counties are also outlined for estimating gross Medi-Cal billings.
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Presentation Transcript
Fiscal Data Modeling of Proposed Rates 101 November 10, 2022
Agenda Overview of Outpatient Services Rates Fiscal Data Modeling Tool Next Steps 1 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Rates Under CalAIM Behavioral Health Payment Reform Outpatient services Plan UR/QA Administration (SMH and DMC) 24 hour services Inpatient psych services Day Rehab/DTI (residential) Crisis Therapeutic Foster Care NTP services Stabilization Partnership Regional Model DMC-ODS Inpatient 2 Mobile Crisis *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Overview of Outpatient Services Rates State DHCS is implementing CPT coding transition under CalAIM Behavioral Health Payment Reform In general, CPT codes will be used for clinical services provided by licensed professionals providing services in their scope of practice DHCS is planning to continue to use HCPCs for non-clinical services (e.g., rehabilitation) and services provided by non-licensed staff Prospectively determined Fee-for-Service rates will be applied to all services Separate outpatient service rates for each CPT/HCPC code and each practitioner type Pre-defined minutes are assigned to all CPT/HCPC codes 3 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Overview of Outpatient Services Rates Minutes associated with each code are based on direct patient care time Excludes travel and documentation time Taxonomy code that is registered with the providers NPI number should be used for billing Taxonomy coding becomes extremely important 4 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Next Steps Counties can compile unit data to populate Units tab in Fiscal Impact Model DHCS to provide outpatient rates to counties Individual county rates Overview of methodology Counties can insert rates into model to estimate gross Medi-Cal billings Register for the November 17th Best Practices for System Shifts Related to Payment Reform webinar 6 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Questions & Answers Please type your questions in the chat 7 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
Thank You THANK YOU FOR ATTENDING THIS WEBINAR! THE RECORDING AND SLIDES WILL BE AVAILABLE ON OUR WEBSITE ON THE FOLLOWING DAY. PLEASE SEND YOUR QUESTIONS/COMMENTS TO PAYMENTREFORM@CALMHSA.ORG. 8 *Information in this presentation is pre-decisional (DHCS policy still in development as of 11.09.22).
