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CCBHC vs. DCO

Bundled rate calculations for CCBHCs

Part 5: Bundled rate calculations for CCBHCs

Daily bundled rate

To calculate the daily bundled rate, each community behavioral health clinic (CCBHC) first determines their allowable costs and nonallowable costs, and then creates a base year cost. Once the clinic is certain all costs have been included, they must determine the annual number of visits they receive from consumers.

The Substance Abuse and Mental Health Services Administration (SAMHSA) advises that this number can include these three visit types:

  1. Daily visits from patients receiving CCBHC services provided directly by staff
  2. Daily visits from patients receiving CCBHC services directly by a designated collaborating organization (DCO) (not included above)
  3. Additional anticipated daily visits from patients receiving CCBHC services

Monthly bundled rate

The monthly bundled rate is calculated very differently than the daily rate. Clinics must divide annual costs by 12 to determine an average monthly cost. Next, they must determine how many unique clients they serve each month. A client must visit at least once per month to be counted, but they still count as a single client even if they visit multiple times that month. The clinic then divides the average monthly cost by the number of unique clients seen in a month to determine the monthly rate.

This rate is paid to the clinic for each unique consumer who has visited at least once in a month, but is only paid once per month regardless of the number of visits during the month.

The CCBHC monthly bundled rate has provisions for these five specific consumer populations with higher costs:

  • Adults with serious mental illness (SMI)
  • Adults with significant substance abuse disorders (SUDs)
  • Adults with SMI and co-occurring substance abuse disorders (SMI/SUDs)
  • Children or adolescents with serious emotional disturbance (SED)
  • Consumers with a recent history of frequent hospitalizations related to behavioral health conditions