Alabama Department Of Mental Health And Mental Retardation — Billing Profile & Reimbursement Data

This entity is effectively a Medicaid-focused operator: there is no Medicare billing on file and reported lifetime Medicaid revenue is $2.26B, indicating near-exclusive dependence on Medicaid as its payer base. The provider’s NPI was enumerated 2007-01-18 (~19 years ago), consistent with a long-tenured presence in the Alabama behavioral health and developmental-disability service market.

Revenue is extremely concentrated in a small set of waiver and habilitation codes: the top three Medicaid codes (T2016, T2021, T1019) account for 96.6% of the provider’s total Medicaid revenue. Specifically, T2016 generates $1.83B (81.3% of Medicaid revenue), T2021 generates $204.5M (9.1%), and T1019 generates $141.7M (6.3%), so these three codes overwhelmingly drive financial performance.

The code mix signals an operational model built around residential and day habilitation plus personal care: T2016 is a per-diem residential habilitation waiver, T2021 is day habilitation (per 15 minutes), and T1019 is personal care services (per 15 minutes). High claim volumes—477.6K for T2016, 493.9K for T2021, and 681.5K for T1019—combined with the high dollar share of T2016, point to large-scale residential capacity and intensive day/home support programs rather than episodic clinic- or procedure-based care.

Competitive standing in-state is dominant or highly prominent for several core codes. The provider ranks #1 of 1 for T2016 (0th percentile, no peer comparison available), #1 of 2 for T2021 (100th percentile, typical state volume for that code), and #2 of 50 for T1019 (98th percentile, described as notably above typical state volume), indicating it is a leading statewide provider for residential habilitation and among the top personal-care vendors in Alabama.

Several secondary codes show above-typical or outlier status that expand the provider footprint beyond core residential/day services: T2028 (specialized supply) ranks #1 of 5 and is described as notably above typical, H2019 (therapeutic behavioral services) ranks #1 of 5 and is described as notably above typical, and 97535 (instruction) ranks #3 of 80 and is labeled an extreme outlier/far above typical state volume. These findings suggest the organization also bills for a range of habilitation, behavioral, and training supports that complement its residential and day services.

Unit-payment and claim-count patterns underline the service economics: T2016 has a very high average paid/claim ($3838) consistent with per-diem residential care, while T2021 ($414 avg paid/claim) and T1019 ($208 avg paid/claim) show lower per-unit rates but very large claim volumes. The combination of high unit cost for residential per diems and mass volume in day and personal-care minutes implies a business model with substantial fixed-capacity costs and ongoing operational staffing intensity.

From a payer and contracting perspective, Medicaid policy or rate changes for waiver habilitation codes would materially affect this provider because so much revenue is concentrated in a few waiver-specific codes. Given the provider’s effective single-payer exposure to Medicaid and the 96.6% revenue concentration in three codes, payers negotiating rates or managing utilization for T2016/T2021/T1019 can significantly influence the provider’s financial stability.

Operational scale and longevity support the likelihood that this is a system-level or state-contracted behavioral health/developmental-disability provider: the $2.26B Medicaid lifetime revenue, combined with nearly two decades since NPI enumeration, suggests sustained, large-scale delivery of residential habilitation, day habilitation, and personal-care services across Alabama. This profile is consistent with an institutionalized provider of waiver services rather than a small private practice or episodic service vendor.