CCBHC TIP SHEET Recommended Process for Living Within Your PPS Rate Why CCBHCs should monitor their PPS rate during Year 1 of the demonstration The CCBHC PPS rates were initially set based on historical data and adjusted for anticipated changes in services provided, costs and visits (daily or monthly). Some states will be re-basing the PPS rates based on performance in Year 1 while others will simply increase the initial rate by the Medicare Economic Index (MEI) Monitoring financial/operational performance throughout Year 1 is imperative for many reasons including: Ensuring that the CCBHC’s performance is financially sustainable given current and projected PPS rate-setting Preparing for adjustments to the PPS rate in Year 2 When monitoring the PPS rate, CCBHCs must focus on the key drivers of the PPS rate and how operations impact the rate, and thereby, revenue generated to support the program services Managing/monitoring the actual cost of the program costs of the CCBHC – program are impacted by many factors which should be measured throughout the year and compared to the same metrics used in preparing the initial cost report, including: Staffing profile (full-time equivalents, FTEs) and support staff ratios Salary levels Indirect costs both the amounts charged and amount allocated to the CCBHC – program (CCBHC direct cost as a % of total direct costs) new costs as well as unanticipated costs “Anticipated” Provider productivity/clinician capacity Managing/monitoring the actual visits since the counting of visits used in the – calculation of the PPS rates are new to most clinics and many states’ definitions continue to evolve, it is important to monitor the actual visits being billed as compared to those computed and included in the rate calculation. Items to consider would include: The actual definition of a visit used in preparing the cost report versus that used to bill The differences between the number of visits versus services (which include non-billable encounters or contacts with clients) Provider productivity/clinician capacity and staffing profiles Utilization of services (visits per patient) The impact of scheduling and patient flow on visit volume Managing/monitoring visit utilization - how many visits, on average, are provided to a patient/client is an important tool when evaluating total visit volume; increasing services provided to an existing patient is one method of improving care and volume. If the service utilization is flat and patients/clients are being effectively managed, visit growth would come from bringing in new patients through outreach and engagement efforts.
CCBHC TIP SHEET Recommended Process for Living Within Your PPS Rate Why CCBHCs should monitor their PPS rate during Year 1 of the demonstration The CCBHC PPS rates were initially set based on historical data and adjusted for anticipated changes in services provided, costs and visits (daily or monthly). Some states will be re-basing the PPS rates based on performance in Year 1 while others will simply increase the initial rate by the Medicare Economic Index (MEI) Monitoring financial/operational performance throughout Year 1 is imperative for many reasons including: Ensuring that the CCBHC’s performance is financially sustainable given current and projected PPS rate-setting Preparing for adjustments to the PPS rate in Year 2 When monitoring the PPS rate, CCBHCs must focus on the key drivers of the PPS rate and how operations impact the rate, and thereby, revenue generated to support the program services Managing/monitoring the actual cost of the program – costs of the CCBHC program are impacted by many factors which should be measured throughout the year and compared to the same metrics used in preparing the initial cost report, including: Staffing profile (full-time equivalents, FTEs) and support staff ratios Salary levels Indirect costs – both the amounts charged and amount allocated to the CCBHC program (CCBHC direct cost as a % of total direct costs) “Anticipated” new costs as well as unanticipated costs Provider productivity/clinician capacity Managing/monitoring the actual visits – since the counting of visits used in the calculation of the PPS rates are new to most clinics and many states’ definitions continue to evolve, it is important to monitor the actual visits being billed as compared to those computed and included in the rate calculation. Items to consider would include: The actual definition of a visit used in preparing the cost report versus that used to bill The differences between the number of visits versus services (which include non-billable encounters or contacts with clients) Provider productivity/clinician capacity and staffing profiles Utilization of services (visits per patient) The impact of scheduling and patient flow on visit volume Managing/monitoring visit utilization - how many visits, on average, are provided to a patient/client is an important tool when evaluating total visit volume; increasing services provided to an existing patient is one method of improving care and volume. If the service utilization is flat and patients/clients are being effectively managed, visit growth would come from bringing in new patients through outreach and engagement efforts.
Tip-Sheet-Living-Within-Your-PPS-Rate.docx