CCBHC Prospective Payment System (PPS) & Quality Bonus Payments (QBPs)

CCBHC PPS

Under the CCBHC Demonstration, participating states must select from among four PPS rate methodologies to reimburse CCBHC providers a clinic-specific rate that pays the expected cost of delivering CCBHC services. The four PPS methodologies that can be used under the Demonstration are:

• PPS-1:  Pays the expected cost of providing CCBHC services on a daily basis with optional QBPs.
• PPS-2:  Pays the expected cost of providing CCBHC services on a monthly basis, with required outlier payments and QBPs, and optional special population rates.
• PPS-3: Pays the expected cost of providing CCBHC services on a daily basis with required Special Crisis Services (SCS) PPS rates and optional QBPs. SCS rates may be set for one or more of the following categories of crisis services:
  1. Mobile crisis services that meet the criteria as authorized under section 9813 of the American Rescue Plan (ARP) Act of 2021,
  2. Mobile crisis CCBHC services that do not meet the qualifying criteria of 9813 ARP, and
  3. On-site crisis stabilization services
• PPS-4: Pays the expected cost of providing CCBHC services on a monthly basis (similar to CC PPS-2), with required SCS PPS rates, outlier payments and QBPs, and optional special population rates.

States should submit their questions about the CCBHC PPS methodologies and related technical assistance to: CCBHC-Demonstration@cms.hhs.gov 

CCBHC QBPs

The CCBHC QBP measures included in the PPS Guidance are a subset of the Behavioral Health Clinic Quality Measures included in Appendix B of SAMHSA’s CCBHC Certification Criteria.  CCBHC Demonstration states have flexibility to use the full set of QBP measures outlined in Table 6 of the PPS Guidance; however, CMS only requires CCBHC states that implement QBPs to use the first seven, or “comparative” measures as part of their CCBHC QBP program to support annual evaluation and analysis of outcomes across CCBHC Demonstration states. QBPs are optional under the daily PPS-1 and PPS-3 rate options but required under monthly PPS-2 and PPS-4. States have flexibility to design the CCBHC QBP program in their state; however, for a state to make a QBP to a CCBHC provider, the clinic must first demonstrate that it has attained or exceeded the state-defined threshold assigned to the quality measure in accordance with the state’s written quality measurement guidelines for payment. The technical specifications, data reporting template, and additional guidance can be found here on SAMHSA’s website.