CCBHC DCO Requirements
It is allowable for participating CCBHCs to enter into formal agreements with Designated Collaborating Organizations (DCOs) that provide certain CCBHC services under the same requirements as the CCBHC. The CCBHC is paid a PPS rate for all CCBHC services provided by the CCBHC and its DCOs. Since the PPS rate reflects the average cost per day for all CCBHC services, the amount that the CCBHC pays to the DCO will typically be different from the PPS rate. Instead, the CCBHC payment to the DCO should reflect an objective, arm’s length estimation of fair market value of the specific service provided by the DCO. Documentation of the fair market value basis for the consideration should be retained in the CCBHC’s files. The estimation of fair market value could be based on salary surveys, fee schedules, or the historic costs to the DCO of furnishing the type of services rendered under the contract. The CCBHC and the DCO must exclude the DCO costs from the CCBHC PPS rate if those costs have already been included in the DCO’s own Medicaid cost-based rate. For example, if the DCO is also a CCBHC, the cost of those services have already been included in that CCBHC’s PPS rate.
A formal relationship is evidenced by a contract, Memorandum of Agreement (MOA), Memorandum of Understanding (MOU), or such other formal arrangements describing the parties’ mutual expectations and establishing accountability for services to be provided and funding to be sought and utilized. The formal agreement must be submitted during the certification process and must include expectations regarding:
- The CCBHC maintains clinical responsibility for services provided by the DCO,
- The CCBHC retains responsibility for care coordination,
- The DCO must have the necessary certifications, licenses and/or enrollments to provide the services,
- The staff providing CCBHC services within the DCO must have the proper licensure for the service provided
- The DCO meets CCBHC cultural competency and training requirements,
- The DCO must follow all federal, state and CCBHC requirements for confidentiality and data privacy,
- The DCO must follow the grievance procedures of the CCBHC,
- The DCO must follow the CCBHC requirements for person and family-centered, recovery-oriented care, being respectful of the individual person’s needs, preferences, and values, and ensuring involvement by the person being served and self-direction of services received. Services for children and youth are family-centered, youth-guided, and developmentally appropriate,
- People seeking services must have freedom of choice of providers,
- The DCO must be part of the CCBHC’s health IT system,
- The CCBHC must arrange for DHS to access data about the DCO where access to data outside the CCBHC is required (such as claims data), and
- The CCBHC and the DCO must have safeguards in place to ensure that the DCO does not receive a duplicate payment for services that are included in the CCBHC’s PPS rate.