This page provides basic information about being certified as a Medicare and/or Medicaid Community Mental Health Care provider and includes links to applicable laws, regulations, and compliance information.

Although a CMHC does not have Conditions of Participation, it must provide the core services described in the Public Health Service Act.  Thus an applicant CMHC, in addition to enrolling, must reasonably demonstrate to CMS that it is providing the core PHSA services.  The RO will not approve an entity as a CMHC until the CMHC has reasonably demonstrated that it has provided each of the core services to a sufficient number of patients.

 A CMHC--

1.      Is an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located; and

2.      Must provide all of the following core services to meet the statutory definition of a CMHC.  However, effective March 1, 2001, in the case of an entity operating in a State that by law precludes the entity from providing the screening services, the entity may provide for such service by contract with an approved organization or entity (as determined by the Secretary) that, among other things, meets applicable licensure or certification requirements for CMHCs in the State in which it is located.  A CMHC may receive Medicare reimbursement for partial hospitalization services only if it demonstrates that it provides such services.  The core services include:

• Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of the CMHC’s mental health service area who have been discharged from inpatient treatment at a mental health facility;
• 24 hour-a-day emergency care services;
• Day treatment, or other partial hospitalization services, or psychosocial rehabilitation services; and
• Screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission.

Downloads
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Related Links Inside CMS
State Operations Manual, Chapter 2, Section 2250 Guidance For Laws and Regulations for CMHCs Survey and Certification General Enforcement Information
Related Links Outside CMS
Section 1832(a)(2)(J) of the Social Security Act Section 1861(ff)(3)(A) and (ff)(3)(B)(i) and (ii) of the Social Security Act Section 1866(e)(2) of the Social Security Act 42 CFR 410.172

Page Last Modified: 05/31/2006 2:00:00 PM
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