County explains CCBHC billing changes and a shift to per‑service school contracts

Scott County officials told the board that certification as a Certified Community Behavioral Health Clinic (CCBHC) changes how school‑based therapists are billed and how school contracts must be structured.

Dr. Ward explained the CCBHC cost‑report methodology that aggregates clinical services and required nonbilled activities into a per‑service rate; the county's most recent rebased rate was about $421 per service. Staff said CCBHC certification increased insurance revenue and allowed the county to capture a larger share of clinic costs, but rebasing rules mean the rate may fall in the short term and then be readjusted in future years.

As a consequence, staff said school contracts cannot remain structured as a pay‑for‑nonbilled time model. Under CCBHC rules, the county must account for the full cost per clinical service and will bill schools for services not covered by insurance or grants up to a not‑to‑exceed amount. "As a CCBHC... the schools will be paying for every service that we do up to a point of making us whole, paying that $421 per cost of service," Dr. Ward said. Staff proposed 'not to exceed' figures for each district for 2027 and emphasized that the county will try to avoid sudden levy impacts.

School officials have already seen changes in contributions; staff said the new model likely produces a more predictable invoicing method for districts but could look different than historical hourly or 'availability' contracts. Staff will circulate detailed district figures, proceed with legal and contract revisions, and present a July authorization that would implement the new billing methodology while seeking to minimize levy impact.

Next steps: staff will engage districts on contract changes, finalize not‑to‑exceed figures for 2027, and monitor quarterly revenues and service counts as the CCBHC model settles.