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Rebecca Farley David

Vice President of Policy and Advocacy, National Council for Mental Wellbeing

CCBHCs are Reviving the Safety-net

November 28, 2017 | Population Health | Comments
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“We hear stories of people in tears when they realize they can get help.” – CCBHC survey respondent

Three years ago, we celebrated the passage of the Excellence in Mental Health Act demonstration, designed to expand Americans’ access to community-based addiction and mental health services. We hoped the initiative would provide sustainable footing to combat generations of funding cuts that have left the safety-net struggling to meet the mental health and substance use needs in our communities, while accelerating adoption of evidence-based practices and data-driven care.

Today, early results of the demonstration’s Certified Community Behavioral Health Clinics (CCBHCs) show our hope is being realized. They are: increasing access to mental health and addiction treatment; expanding capacity to address the opioid crisis; collaborating with partners in hospitals, jails, prisons and schools; and attracting and retaining qualified staff who offer science-based, trauma-informed services – often on the same day patients present for care.

CCBHCs are a new provider type in Medicaid, providing a comprehensive range of addiction and mental health services to vulnerable individuals while meeting additional requirements that address staffing, governance, reporting and more. In return, they receive a Medicaid reimbursement rate based on the anticipated costs of expanding services to meet the needs of these complex populations. Sixty-seven CCBHCs are currently in operation in the eight states selected for participation in the demonstration: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania.

Now a quarter of the way through the two-year demonstration program, the National Council surveyed CCBHCs to find how their participation has affected their capacity to expand and improve services. Survey results confirm that when community behavioral health clinics are incentivized to provide evidence-based care and provided compensation that adequately covers their cost of doing business, they can transform access to care in their communities. Since becoming CCBHCs, the organizations surveyed have:

  • Expanded treatment capacity by adding new staff. All 47 of the respondents have added new staff positions, hiring a total of 1,160 new staff since earlier this year. This includes 72 newly-hired psychiatrists and 212 newly-hired staff with an addiction specialty or focus, ensuring consumers’ expanded access to psychiatric services and addiction care. CCBHC status has transformed chronically underfunded organizations’ ability to recruit and hire, particularly in rural areas of the country. As one respondent put it, “we have an increased ability to hire at a wage that is comparable to our state/region, which allowed for increased workforce to more appropriately meet the needs in our rural area.”Because of these staffing expansions, 87 percent of clinics increased the number of patients they serve, representing up to a 25 percent increase for most organizations. Most new patients either have a mental illness or substance use disorder but were not receiving treatment, or were referred to treatment for the first time. Now, as a CCBHC, these organizations can meet these patients’ needs with an expanded array of timely, evidence-based services. In the words of one respondent, “we [now] offer a wider range of treatment options; hired more, better qualified staff to provide addiction services; and created new protocols to rapidly respond to need.”
  • Expanded opioid treatment capacity. All surveyed CCBHCs report increasing their capacity to provide addiction care, a critical need for our nation’s treatment infrastructure in the face of the ongoing opioid epidemic. CCBHCs’ addiction-focused activities include training staff and community partners in naloxone administration (62 percent), hiring peer recovery specialists (63 percent) and expanding access to medication-assisted treatment (MAT). More than 80 percent of CCBHCs initiated or expanded their MAT offerings. Other reported activities include establishing withdrawal and detoxification services along with screening protocols and intensive community outreach strategies to connect people in need with care.

The result has been a dramatic growth in the availability of opioid treatment services in CCBHCs’ communities. “Prior to becoming a CCBHC, we had no recovery services whatsoever,” one survey respondent reported. “We have opened addiction services and trained all mental health and chemical dependency providers in dual diagnosis care, integrated treatment planning, substance use screening and ASAM [American Society of Addiction Medicine] criteria.”

  • Expanded services, technology or other innovations. More than half of CCBHCs – 57 percent – began offering same-day access so all patients can be seen on the day they are referred for services. Three-quarters expanded their crisis care services and 72 percent adopted new technologies that support care delivery, including electronic health record (EHR) upgrades, mobile apps and telehealth. CCBHCs report that their new certification requirements and payment model have supported them in establishing new collaborative relationships with their partners in hospitals, schools and criminal justice agencies and offering expanded services to veterans. Many of these activities have not previously been possible due to low reimbursement rates that left clinics without the resources to implement innovative practices or take advantage of technology tools that support care. “Because we are now getting better results with our clients, our community values us more than ever,” one CCBHC respondent concluded.

A formal evaluation of the CCBHC demonstration by federal agencies is underway, with results expected in the coming years. Yet these current survey results clearly show the promise of CCBHCs just six to eight months in to the demonstration, CCBHCs are providing increased access to mental health and addiction treatment, care coordination and 24-hour crisis services.

Unfortunately, constraints on this program limit its potential to meet the need in every community, with participation limited to eight states over two years. The bipartisan Excellence in Mental Health and Addiction Treatment Expansion Act, co-authored by Sens. Debbie Stabenow (D-MI) and Roy Blunt (R-MO), and Reps. Doris Matsui (D-CA) and Leonard Lance (R-NJ), would extend CCBHC operations by an additional year in the current eight states and allow 11 additional states to join those that are up and running. “Each and every state that came forward with a plan to increase access to community mental health services should have the support they need,” said Sen. Stabenow.

One of the CCBHCs put it best when they described the impact of their program and the need to continue it into the future: “Our biggest impact to date as a CCBHC is that we are providing higher quality, evidence-based services to our patients. We have expanded our substance use services due to having new staff and new expertise. We have been able to reduce our waiting times for patients due to the increase in staff. Our patients can often be seen on the same day or scheduled within a couple of days. We have been very successful thus far, and have great hopes in continuing as a CCBHC. This demonstration to date has been a big success for our communities, and we hope that it continues to expand. I believe that in the long run it will save taxpayers. We will be able to serve more patients, reduce hospital readmission rates and save money.”

We encourage you to write your legislators urging them to support passage of the Excellence Act expansion.

To see the full survey results, click here.