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Service rates information

Medical Assistance rates for mental health services

The current fee-for-service (FFS) rates for mental health services are included in the below table and are updated to reflect the most current maximum allowed, FFS rate for the code. The table also explains when services are reimbursed at an adjusted rate in certain circumstances.

The chart is split between two different groups of providers. The right side of the chart is for providers who received legislated rate enhancements on 7/1/2007. The left side of the chart is for all other mental health providers. The chart does not include rates for evaluation and management (E&M) services that might be provided by mental health providers who are eligible to use these codes. The E&M rates can be found on the MHCP Fee Schedule webpage.

Mental Health Codes and Rates

Mental Health Critical Access Rate Increase

 

Medical Assistance payment for intensive rehabilitative services

Assertive Community Treatment (ACT), Intensive Residential Treatment Services (IRTS) and Residential Crisis Services (RCS)

These three mental health services utilize a prospective cost-based rate setting methodology to establish a per diem rate for individual service providers. The total per diem is the sum of the provider’s direct service costs, other program costs, and physical plant costs (for residential rehabilitation service providers only).

2019 Rate Setting Manual for existing and new programs

The Rate Setting Manual - ACT/IRTS/RCS manual is updated annually in September of each year

Current Program FY18 Actual Expenditures Worksheet

Spreadsheets are updated annually in August of each year to establish program rates for the following calendar year

NEW Program Expenditures Worksheet

Spreadsheets are updated annually in August of each year to establish program rates for the following calendar year

Settle-Up Process for ACT/IRTS/RCS

A settle-up process is utilizes for circumstances when there is a change in ownership of an ACT, IRTS, or RCS program.

  • Settle- up Spreadsheet – please contact the division.

More information

651-431-2225
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