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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Excellence Act Demonstration Program: The Details

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With the enactment of the Excellence in Mental Health Act demonstration program this week, now the real work of implementation begins. So, what’s in the law? And how will it affect community mental health and substance use providers? Keep reading for the nitty-gritty details.

The Basics. The Excellence Act establishes a new federal definition and criteria for “Certified Community Behavioral Health Clinics” or CBHCs. It also provides for a 2-year, 8-state pilot project in which organizations that meet CBHC criteria will be eligible for an enhanced payment rate through Medicaid, under a Prospective Payment System developed by each participating state. The ultimate goal: improved access to comprehensive mental health and addiction treatment services.

The Timeline. This won’t all happen right away. First, the Department of Health and Human Services will have to provide concrete details on what it means to be certified as a CBHC and how the 8 states will be selected for the demonstration program. Initial guidance won’t come until September 2015.

The States. The 8 states will be selected through a competitive application process. But first, they must apply for a planning grant, to be awarded in January 2016. Only states that receive a planning grant may apply for and be selected to participate in the demonstration program. Although the full details of the selection process will be determined in future rulemaking, the law stipulates that preference will be given to states that provide the most complete scope of services, improve availability of, access to, and participation in treatment services under Medicaid, and demonstrate the potential to expand services without increasing net federal spending.

The Certification Process. Based on the CBHC criteria to be issued by HHS, states are in charge of developing a process to certify CBHCs. The planning grants will help states develop this process and assess their provider organizations’ readiness to meet CBHC standards.

The CBHC Criteria. The Excellence Act outlines – in broad terms – the criteria organizations must meet in order to be certified as CBHCs. These include (but are not limited to): crisis mental health services; outpatient mental health and substance use services; patient centered treatment planning; targeted case management; psychiatric rehabilitation; peer support; and services for veterans. CBHCs must also engage in care coordination with federally qualified health centers, inpatient psychiatric hospitals, Department of Veterans Affairs medical centers, and others. Finally, they must meet certain data reporting standards. Full details on how each of these requirements will be operationalized will be developed in the future rulemaking process, so stay tuned! You can also read a full list of the criteria in our Excellence Act fact sheet.

The Payment for CBHC Services. States that receive planning grants are tasked with developing a Prospective Payment System for the payment of CBHC services. While the exact payment details will vary by state, in general what this means is that services will be paid for at a rate that is based on their actual cost.

The Next Steps. For more details, visit our Excellence Act website. Stay tuned to National Council emails and Capitol Connector for the latest news and updates. If you’re coming to our conference May 5-7, check out the Town Hall meeting where we’ll discuss the implications of the Excellence Act for our field. And of course, don’t hesitate to contact the National Council’s Chuck Ingoglia or Rebecca Farley with any questions.