Behavioral Health
Accounting, tax, and advisory for behavioral health and human services providers — so you can focus on care, not compliance.
Overview
Behavioral health providers run on layered funding, thin margins, and heavy reporting obligations — a mix of Medicaid, federal grants, and private payors that few accounting firms fully understand. From our Cleveland, Ohio headquarters and serving clients in all 50 states, Pease Bell CPAs works with substance use disorder programs, mental health agencies, IDD providers, and community mental health centers across the nonprofit and for-profit spectrum. We handle financial statement and Single Audits, Medicaid cost reports, SAMHSA and HRSA grant compliance, tax, transactions, and outsourced accounting — so leadership can spend less time on compliance and more time on the people you serve.
How we help behavioral health providers
End-to-end accounting, audit, and advisory support tailored to the funding and reporting realities of behavioral health.
Financial statement & Single Audits
Financial statement audits, reviews, and Uniform Guidance Single Audits for organizations expending federal awards — with a clear plan to prevent and resolve recurring compliance findings.
Medicaid cost reports & reimbursement
Preparation and review of Medicaid and other program cost reports, plus reimbursement analysis, so allowable costs are captured accurately and rate filings stand up to scrutiny.
SAMHSA & grant compliance
Grant accounting and compliance support for SAMHSA, HRSA, and other federal awards under 2 CFR 200, including allowability, eligibility, cash management, and reporting requirements.
Tax planning & compliance
Tax strategy and filings for both nonprofit and for-profit providers — including Form 990, unrelated business income questions, and entity structuring across affiliated organizations.
Transaction & affiliation advisory
Diligence, quality of earnings, and structuring support for mergers, affiliations, and acquisitions as behavioral health providers consolidate to gain scale and stability.
Outsourced accounting & CFO support
Client accounting services and fractional CFO support — from monthly close and grant tracking to board reporting — for organizations that need finance depth without the full-time cost.
Contact Us
Tell us about your organization and a member of our behavioral health team will be in touch.
The pressures we help you manage
Behavioral health finance leaders juggle overlapping funding streams and rulebooks that change constantly. We help you get ahead of the issues that most often threaten compliance, reimbursement, and margins.
- ✓Single Audit findings — recurring problems in eligibility, cash management, and reporting that put future SAMHSA and federal funding at risk.
- ✓Medicaid reimbursement complexity — cost reporting, rate methodologies, and payor rules that determine whether allowable costs are actually recovered.
- ✓Grant compliance under 2 CFR 200 — allowability, documentation, and time-and-effort requirements across multiple federal awards.
- ✓Revenue cycle and payor mix — reconciling Medicaid, grant, and commercial revenue against thin operating margins and delayed payments.
- ✓Mergers and affiliations — the accounting, diligence, and integration work that comes with consolidating programs and organizations.
Why behavioral health providers choose Pease Bell
Deep federal funding fluency
We work in Single Audits, SAMHSA and HRSA grants, and 2 CFR 200 every day. That fluency means fewer surprises, cleaner audits, and practical guidance on findings before they jeopardize your funding.
Nonprofit and for-profit under one roof
Behavioral health spans tax-exempt agencies and investor-backed providers. We serve both, so we can advise on structure, tax, and reporting across affiliated entities without handing you off between firms.
Full service, boutique touch
As a Top 200 U.S. CPA firm with 150+ professionals serving all 50 states, we bring real depth — delivered by a partner-led team that knows your organization and answers the phone.
Behavioral Health Team
Featured Insights
Behavioral health insights from our team
Practical guidance on the funding, reimbursement, and compliance issues behavioral health providers face.
- Grant compliance
Top Single Audit findings for SAMHSA-funded organizationsThe recurring audit findings that most often put SAMHSA funding at risk.
- Federal awards
Single Audit threshold rises to $1 millionWhether your organization still triggers a Single Audit under the higher threshold.
- Grant accounting
SAMHSA grants and 2 CFR 200 complianceAllowability, eligibility, and reporting rules for SAMHSA awards.
- CCBHC
CCBHC cost reportingCost reporting considerations for Certified Community Behavioral Health Clinics.
- Policy
CCBHC demonstration expansionWhat the CCBHC demonstration expansion means for providers.
- FQHCs
FQHC financial pressures in 2026Funding and margin pressures facing federally qualified health centers.
- 340B
340B audit readinessPreparing for 340B program compliance and audit scrutiny.
Behavioral health accounting FAQs
Does Pease Bell perform Single Audits for behavioral health organizations?
Yes. Pease Bell performs Uniform Guidance Single Audits for behavioral health and human services providers that expend federal awards. We audit programs funded by SAMHSA, HRSA, and other federal sources, testing eligibility, allowability, cash management, and reporting. Because we work in these audits regularly, we also help clients understand and resolve recurring findings before they threaten future funding.
When is a behavioral health provider required to have a Single Audit?
A Single Audit is generally required when an organization expends federal awards above the Uniform Guidance threshold in a fiscal year, which rose to $1 million. The trigger is based on federal funds expended — across all programs combined — not revenue or the size of any single grant. Because behavioral health providers often draw from multiple federal sources, we help you total awards correctly and confirm whether an audit applies.
Can you help with Medicaid cost reports and reimbursement?
Yes. We prepare and review Medicaid and program cost reports and provide reimbursement analysis for behavioral health providers, including community mental health centers and CCBHCs. Our goal is to capture allowable costs accurately, support defensible rate filings, and identify reimbursement that organizations often leave uncaptured under complex cost-based methodologies.
Do you work with both nonprofit and for-profit behavioral health providers?
Yes. We serve tax-exempt agencies and for-profit and investor-backed providers alike. That includes Form 990 and nonprofit compliance work as well as corporate tax, entity structuring, and transaction support across affiliated organizations — so providers operating in both models can work with one firm rather than several.
What SAMHSA and federal grant compliance support do you provide?
We provide grant accounting and compliance support under 2 CFR 200, covering allowability, eligibility, cash management, time-and-effort documentation, and financial reporting for SAMHSA, HRSA, and other federal awards. We also help organizations build the internal controls and documentation that stand up to Single Audit testing and reduce the risk of repeat findings.
Where is Pease Bell located, and do you serve behavioral health clients outside Ohio?
Pease Bell CPAs is headquartered in Cleveland, Ohio, and serves clients in all 50 states. As a Top 200 U.S. CPA firm with 150+ professionals and 12,000+ clients, we support single-site Ohio agencies and multi-state behavioral health organizations alike, with experience across the federal grant and Medicaid rules that apply nationwide.