Public Comment z9dd

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As of: 1/23/24, 5:21 PM
Received: January 23, 2024
Status: Draft
Tracking No. lrq-t2w5-z9dd
Comments Due: January 23, 2024
Submission Type: Web

PUBLIC SUBMISSION
Docket: CMS-2024-0001
CMS-10398 #43 (Certified Community Behavioral Health Clinic (CCBHC) Cost Report)

Comment On: CMS-2024-0001-0001
Agency Information Collection Activities; Proposals, Submissions, and Approvals: Medicaid and Children's Health Insurance Program
Document: CMS-2024-0001-DRAFT-0005
Comment on CMS-2024-0001-0001

Submitter Information
Name: Daniel Kindler
Address:
Lexington,  KY,  40515
Email: [email protected]

General Comment
Utilizing a Federal Indirect Rate to calculate indirect costs is unique compared to other cost reports used by Medicaid programs or the
Medicare program. Has CMS considered allowing CCBHCs that are able to specifically identify their indirect cost on the trial balance tab
utilize their actual cost in the calculation of their PPS rate rather than requiring use of the Federal Indirect Rate?
Proposing the updated guidance dated May 2023 stated: “In addition to annual trending by the MEI or rebasing using cost reports, states
must also rebase rates for CCBHCs with actual cost data for demonstration year two (DY2) and at least every three years thereafter.” The
Application and Guidance to Participate in the Section 223 CCBHC Demonstration Program document indicates the first rebasing year is
DY3.
-- Can CMS confirm that the draft guidance issued requiring rebasing of DY2 has been changed?
-- If a state elects to rebase after DY1 for DY2, must they also still rebase DY3? Or can they rebase 3 years after DY2?
So, can states choose to rebase a DY using the most recent available cost report, to avoid using an interim rate with mass adjustments? For
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example, utilize DY1 actual costs to rebase DY3, with applicable MEI applied?
The General Instructions section of the cost report instructions appears to remove the reference to 42 CFR 413. 42 CFR §413 is utilized by
the Medicare program and many state Medicaid programs for cost reports for numerous other health care provider types. Can CMS confirm
that states and providers should not use the principles of 42 CFR §413?
It appears that amounts from column 9 of the Trial Balance schedule of the cost report should agree to amounts in column 5 of the Trial
Balance Crisis schedule. Has CMS considered making cells in column 4 of the Trial Balance Crisis schedule formula driven and locked? The
formula could pull in the amounts from the corresponding line on the Trial Balance schedule (column 9) and then subtract the sum of
amounts entered in columns 1-3 of the line. Ensuring the amounts for each line agree between the two trial balances would create less
confusion for providers when completing the cost report, while also reducing risk for errors in the cost report.
CMS might consider updating the description, row labels, and references for the Trial Balance, Trial Balance Crisis and Daily Visits PPS-1 or
Daily Visits PPS-3 schedules to correct for revisions made for proper cell referencing/labeling.
-- E.g. line 1 of CC PPS-3 Rate schedule should reference “Trial Balance Crisis, columns 1-4, line 29” and line 2 of the CC PPS-3 Rate
schedule should explain it is the amount from line 16 of the Indirect Cost Allocation schedule multiplied the percentage calculated on Trial
Balance Crisis schedule (No line number listed for calculation percentage).

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