CCBHC PPS-1 vs PPS-2 Reconciliation — 2026 State Rules
Every CCBHC state has different PPS reconciliation rules. Getting this right = predictable cash flow. Getting it wrong = 60-90 day cash-flow gaps and clawbacks.
PPS-1 (Daily Per-Visit)
Each CCBHC visit reimbursed at flat daily rate. Must track visits with strict encounter-level documentation.
PPS-2 (Monthly Per-Consumer)
Each active consumer generates monthly capitated payment. Must maintain active-consumer roster; disenroll appropriately.
State PPS Choice Table 2026
| State | PPS Model | Reconciliation Frequency |
|---|---|---|
| NY | PPS-1 daily | Quarterly |
| NJ | PPS-1 daily | Annually |
| MO | PPS-2 monthly | Quarterly |
| OK | PPS-1 daily | Annually |
| OR | PPS-1 daily | Annually |
| PA | PPS-1 daily | Quarterly |
| MN | PPS-1 daily | Annually |
| KY | PPS-1 daily | Annually |
Recovery Framework
Monthly encounter reconciliation vs PPS rate → identify variance → appeal underpayments within state-specific window.
Case Study
Free 30-day CCBHC audit · Pricing 4-8%
– KD, Revenant Care