Community Mental Health Center (CMHC)

On this page, view the below information.

All information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10 Section 4.1.1 and the CMS IOM, Publication 100-07, State Operations Manual, Chapter 2. A CMHC is a facility that provides mental health services.

Must perform "core services" to qualify. These are:

  • Outpatient Services
    • This includes services for children, elderly, persons who are chronically mentally ill and those who have been discharged from a mental health facility for inpatient treatment
  • 24-hour-a-day emergency psychiatric services
  • Day Treatment or other Partial Hospitalization (PH) services, or Psychosocial Rehab services
  • Screening for patients being considered for admission to State mental health facilities

Billing for CMHC

  • For more information regarding billing, go to the billing portion of the website.

Application Requirements

  • Only one location per application may be reported in Section 4
  • Must have the following attachments
    • A CMHC must provide at least 40 percent of its items and services to individuals who are not eligible for benefits under title XVIII of the Social Security Act. The document must have the following criteria:
      • Must be on the letter head of an independent entity who has reviewed the CMHC's client care data
      • Appropriate official of the certifying entity must sign the document such persons may include accounting technician, Chief Executive Officer (CEO), officers, directors - of the accounting agency
        • Noridian sends this to the state agency
      • Must have the audit completed for 3 months prior to the enrollment for an initial enrollment - revalidation needs for each of the intervening 12-month periods between initial enrollment and revalidation
        • Noridian sends this to the state agency
  • The MAC will order a site visit
Application Tips
PECOS application
  • "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
  • Complete questionnaire to ensure correct applications (CMS-855A and CMS 588-EFT) populate.
CMS-855A
  • Complete all form sections
  • Attach all supporting documentation such as IRS documents
  • List all directors, board members, and contracted or W-2 managing employee
  • Visit the Application Fee webpage to access CMS link to pay application fee
CMS-588 EFT
  • Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field

 

Application Time Frame

  • Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the state agency and the CMS Survey & Operations Group. Below are the time frames in which Noridian has to review the application
Application Type Processing Time
PECOS On average, it can take 15 calendar days before application is sent to the state and CMS for approval for clean applications
PECOS On average, it can take 50 days before application is sent to the state and CMS for approval if request for information, site visits or fingerprints are required
Paper On average, it can take 30 calendar days before application is sent to the state and CMS for approval for clean applications
Paper On average, it can take 65 days before application is sent to the state and CMS for approval if request for information, site visits or fingerprints are required

 

  • The state agency and the CMS Survey & Operations Group (SOG) Locations (formerly CMS Regional Offices and hereafter referenced as “SOG Locations.”) work together on the approval process. Once the SOG Locations have all the required information, they will issue the approval letter. This is sent to the provider and to Noridian.
  • After receiving the tie-in Noridian has 21 days to complete the application.
  • If a site visit is needed, Noridian will have 45 days to complete the application.

 

Last Updated Mon, 24 May 2021 18:46:46 +0000