APA Bridge Payment - Ambulatory Services

Bridge payments will be delivered using the same vehicle used to deliver your claim payments.

The bridge payment will not hinder your eligibility for federal funding and/or other small business loans that may be available to you.

APA bridge payments from Community Care are to be used to keep behavioral health services accessible to HealthChoices members.

Providers may use their existing I&E statements or any other format that demonstrates that provider has met the goals of the APA: (i) stabilization of Provider’s workforce to continue to provide access to essential behavioral health service; and (ii) help members manage other social needs.

1. The first APA Bridge payment (3/15/2020-4/14/2020) was made on March 27, 2020, which reflected 75% of the average historical baseline reimbursement.
2. The week of April 20, a second payment is being made to reflect the remaining 25% (the decision was made to pay 100% of historical monthly baseline reimbursement).
3. The second APA Bridge payment will be made the week of April 27, 2020 (4/15/2020 – 5/14/2020). The total amount of the Bridge Payment will be 100% of the average historical monthly amount reduced by the amount of any claims that have been paid for services covered under the APA for the dates of service 3/15/2020-4/10/2020.
4. For any future APA payments after the second payment, only the additional claims for service dates beginning 3/15/2020 paid that have not already been offset against any APA payments will be subtracted from the current month’s APA payment.
5. Reconciliations will be made for each distinct HealthChoices contract as reflected on the remittance.
6. Claims payments will be monitored going forward to determine if provider was paid in excess of 100% of their normal volume for each contract in which it provided services. Once the crisis period is over, a full reconciliation will be completed.
7. The proposed reconciliation will then be sent to the provider for review and agreement.

Community Care and our Primary Contractors/county partners for HealthChoices received approval from OMHSAS to implement a Provider Bridge Payment APA. The purpose of this APA is to stabilize ambulatory service providers’ workforce to continue to provide essential behavioral health services and assist HealthChoices Members manage other social needs during the COVID-19 crisis.

The goal of the ambulatory bridge payment is to retain the behavioral health workforce in order to continue to provide access to essential behavioral health services to our Members. Community Care expects participating ambulatory providers to continue to sustain a workforce sufficient to meet the needs of our Members during this crisis. Routine outreach to members enrolled in services prior to the crisis, including assessment of behavioral health and social needs, is expected. Providers are expected to continue to provide – and bill for – services to Members. The bridge payment is designed to address anticipated reductions in services as a result of the crisis.

Providers may choose to ‘opt out’ of the bridge payment APA. For example, we have individual outpatient practitioners and group practices who have made this decision, because they have not seen a decline in utilization since offering telehealth as an option for Members.

Please send a check in the amount of the payment to the following address:

Community Care Behavioral Health Organization
339 Sixth Avenue, Suite 1300
Pittsburgh, PA 15222
Attention: Kimberly Casciato, Director of Provider Reimbursement

The monthly APA payment reflects approximately 100 percent of providers’ historical trend of paid claims for ambulatory services for HealthChoices members from July 1, 2018 through December 31, 2019. In most cases, the calculation of the payment, we:

• Calculated the average monthly spend for the following periods
  • July 2018 – June 2019 (FY19)
  • July 2019 – September 2019
  • October 2019 – December 2019
• We took the median monthly spend of the above 3 periods to use in our calculation and applied the 100% to that amount
• Newer providers with claims in the October 2019 – December 2019 period only, had their payment based on that time period

Provider must continue to appropriately document services and submit claims for services rendered to Members for payment during this time. Community Care will perform a reconciliation of the APA and claims payment to ensure Provider receives no more than 100% of the historical trend of services for HealthChoices members from July 1, 2018 to December 31, 2019, as appropriate. Community Care reserves the right to retract APA overpayments to Providers who are determined to have an income in excess of the 100% threshold. More information related to the reconciliation process will be provided in the near future.

Yes, providers should continue to submit claims for services delivered. A reconciliation will occur as noted above. More details will be forthcoming related to that process.

Yes, the payments are taxable and will be included in the 2020 1099 issued next January.

The bridge payment APA is considered a pre-payment for services which would have been delivered during March 15-April 15, had the COVID-19 crisis not occurred.

We anticipate there will be three total payments through June 2020. The first payment covers services from March 15- April 15, 2020. The second payment is scheduled to be released with claims payments on Friday, April 24 and received/posted for providers early the following week (April 27/28),for the next month (mid-April – mid May). Please make sure to complete and submit your survey response on ambulatory service operations during the crisis to Community Care as soon as possible. We will not release future payments to providers who have not completed and submitted their survey response to Community Care. We ask providers to submit responses by no later than COB on Wednesday, April 15, in order to prevent delays of future bridge payments. Instructions on completion of the survey were included in the email sent with participating provider contract amendments. These surveys should be submitted to: CCBHsigncontract@ccbh.com

Additional detail regarding provider-specific payments will be made available on the Community Care ePortal - Report Center by Monday, April 6, 2020. Below is a link to the user Guide for Report Center Downloads that can be used by Facility Administrators if they need help on how to grant permissions, as well as instructions on accessing the Downloads area and viewing files.

(Reminder: Practitioners who sign their own contracts with Community Care are the Facility Administrators for their ePortal accounts.)

ePortal Report Center Downloads

In order to identify the files, the files will be named: COVID19 Ambulatory Bridge Payment

There will be one payment made per Tax ID number.

For questions related to the Ambulatory Bridge Payment, please contact your Provider Relations Representative. Find your Provider Relations Representative contact information