What is a Prospective Payment System (PPS) Rate?

A specialized Medicaid reimbursement model in which clinics are paid a predetermined, fixed rate for services rather than billing separately for each service, and is designed to financially support the true, comprehensive cost of expanding behavioral health services.

To determine the PPS rate, the clinic prepares a detailed cost report that includes all allowable costs associated with delivering CCBHC-required services. PPS rates are calculated by taking the CCBHC's Total Annual Allowable Costs and dividing them by Total Annual Projected Daily Visits.

 

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Helpful Links

PPS Code Information

PPS Cheat Sheet

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Providers and PPS Rates Year-to-Year

CCBHCs are managed through State Section 223 CCBHC Demonstration Programs. They are certified by the state as compliant with the CCBHC Certification Criteria and are reimbursed through a PPS for PPS-eligible services.