On March 31, 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. On May 20, 2015, two federal agencies released guidance on how they will be implementing this Act, the biggest federal investment in mental health and addiction services in a generation. The Excellence Act will increase Americans’ access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services. This legislation:
- Creates criteria for “Certified Community Behavioral Health Clinics” as entities designed to serve individuals with serious mental illnesses and substance use disorders that provide intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment, prevention, and wellness services. The Secretary of the Department of Health and Human Services recently released applications for planning grants directed to establish a process for selecting states to participate in a 2-year pilot program.
- Provides $24.6 million that will be available to states as planning grants to develop applications to participate in the 2-year pilot. SAMHSA will be funding up to 25 states for planning grants of up to $2 million to start to put together their certification processes and develop their payment methodologies. Only states that have received a planning grant will be eligible to apply to participate in the pilot.
- Stipulates that eight (8) states will be selected to participate in the 2-year pilot program. The match rate for Certified Community Behavioral Health Clinic services is either the Enhanced FMAP/CHIP rate or, for newly eligible “expansion” Medicaid beneficiaries, the current FMAP for that population – which is 100% now and moves down to 90% by 2020.
- Requires participating states to develop a Prospective Payment System (See Appendix III) for reimbursing Certified Community Behavioral Health Clinics for required services provided by these entities.
- Requires Certified Community Behavioral Health Clinics to engage in partnerships with a variety of health system partners, from primary care to hospitals, VA centers, and more. The emphasis on these partnerships reflects the need for health care organizations to work together to demonstrate concrete health outcomes and high-value care.
- Improves behavioral health resources for public safety by providing a much-needed infusion of funding into the addiction and mental health system, expanding treatment capacity and alleviating the burden on public safety officers.
May, 2015: The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS) released guidance on how they will be implementing the Excellence in Mental Health Act, including certification criteria, prospective payment guidance, and the planning grant applications.
August 5, 2015: Deadline for states to submit planning grant applications to SAMHSA. Only states that apply will be eligible to receive federal funding for planning grants. Only states that have received a planning grant are eligible to apply for and participate in the two-year demonstration program.
October 1, 2015: Deadline for the Secretary to award planning grants to states for the purpose of developing proposals to participate in the demonstration program. Planning grant funds can be used to support states as they determine how CCBHCs best fit within current system redesign efforts. States can leverage this opportunity plan and implement other delivery and payment reform efforts.
October, 2016: Deadline for states to submit their applications to participate in the demonstration. The demonstration program includes provisions that will provide CCBHCs with the financial footing to deliver these required services.
January, 2017: Deadline for the Secretary to select the states that will participate in the demonstration program. Only states that have received a planning grant are eligible to participate. The states will be selected through a competitive application process and must represent a diverse selection of geographic areas, including rural and underserved areas.
FOR MORE INFORMATION AND RESOURCES
- Read our comprehensive fact sheet, including a description of CCBHC criteria and the state planning process.
- Stay up to date on the latest Excellence Act news on our blog, Capitol Connector.
- Please don’t hesitate to contact Chuck Ingoglia, Nina Marshall or Rebecca Farley on our staff with questions about the Excellence Act and Certified Community Behavioral Health Clinics.
- Want to explore what it takes to be a CCBHC? Head over to our CCBHC Readiness page.