APA Bridge Payment - IPMH

This page is intended to be a resource for our provider network to find answers to critical questions during the COVID-19 crisis. As we receive more information, Community Care will be updating the site, so check back frequently for the most up-to-date information. As new questions are added, they will appear at the top of the list.

If we choose to “opt out,” how do we return the payment?

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
Attn: Kimberly Casciato, Director of Provider Reimbursement

What is the purpose of the Inpatient Mental Health gap APA payment?

Inpatient Mental Health providers may experience a decrease in utilization during the COVID-19 pandemic. This gap payment is to assist providers to sustain staff in order to continue to provide inpatient mental health services.

What is the Inpatient Mental Health gap APA payment to be used for?

Providers should use this APA to support paying and preserving provider staff and maintaining its current behavioral health bed capacity.

Will accepting the Inpatient Mental Health gap APA payment impact my ability to apply for and/or receive emergency funding such as that available through the CARES Act?

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

How are payments determined?

APA payments will be determined by a review of Provider’s average monthly revenue for HealthChoices members for the period July 2019 through February 2020 (“Average Monthly Revenue”). This Average Monthly Revenue will be the baseline with which a decrease in revenue, if any, is determined. Community Care will evaluate projected revenue for Inpatient mental health services based on authorizations (“Projected Revenue”) for March 2020. If provider Projected Revenue is more than 3% below the Average Monthly Revenue, a payment equal to the difference between the Average Monthly Revenue and the Projected Revenue for the designated month will be made. Community Care is committed two retrospective gap payments, one for March 2020 and one for April 2020. Community Care may decide to repeat the methodology for subsequent months based upon the ongoing impact of the COVID-19 crisis.

Do I have to provide any information to Community Care regarding this payment?

Providers should report the following: 1. IPMH bed capacity on March 1, 2020 and on the date of receipt of the IPMH Bridge payment APA Amendment to provide real time bed capacity tracking; 2. Timely advance notification to Community Care if Provider plans to change IPMH bed capacity. This information should be submitted to: CCBHsigncontract@ccbh.com. Providers should also notify respective counties of plans to change IPMH bed capacity.

Will I receive the Inpatient Mental Health gap APA payment electronically or by check?

Payments will be made in the manner in which providers receive reimbursement for claims.

What if I don’t want to participate in the Inpatient Mental Health gap APA payment initiative or if I have objections?

Providers may choose to ‘opt out’ of the inpatient gap APA. In addition, providers may object to language in the amendments. If so, providers should submit their objection or intent to opt-out to the following e-mail address: ccbhsigncontract@ccbh.com

What should I do if I have questions related to the Inpatient Mental Health gap payment APA?

Please first contact your Community Care Provider Relations Representative Community Care is available to discuss any questions related to the gap payment APA.

When will the Inpatient Mental Health gap APA payments be made?

The March 2020 gap payment will be included in payments to providers the week of May 4, 2020, with a second retrospective gap payment for April 2020 the week of June 1.

Are providers expected to continue to bill for Inpatient mental health services?

Yes, providers should continue to submit claims and receive reimbursement for all services, including inpatient mental health, delivered to HealthChoices eligible enrollees.

Is additional detail regarding provider-specific payments available?

Yes, the Community Care ePortal - Report Center will include provider-specific information. 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.

ePortal Report Center Downloads

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