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Linda Rosenberg

President and CEO

It’s a Big Day for Behavioral Health: Excellence Act Implementation Begins

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By: Linda Rosenberg

It’s a big day for our nation’s community behavioral health providers.

Yesterday, two federal agencies released guidance on how they will be implementing the Excellence in Mental Health Act, the biggest federal investment in mental health and addiction services in generations.

For decades, behavioral health and the health care system as a whole have been grappling with the difficult questions of how best to provide care to complex populations living with mental illness or addictions, how to ensure every American in need can access this care, and how to pay for it. For too long, we have failed to provide the federal infrastructure and support needed to sustain a strong behavioral health safety net. With the Excellence Act, that all changes.

The Excellence Act answers the question of what it means to provide comprehensive, high-quality behavioral health care. It establishes federal status and criteria for Certified Community Behavioral Health Clinics (CCHBCs) that provide comprehensive mental health and addiction outpatient services. CCBHCs are also responsible for basic primary care screenings and services to address the chronic comorbidities that drive high costs and poor health outcomes among patients living with behavioral health disorders. The CCBHC criteria highlight the critical role that crisis services play in de-escalating otherwise catastrophic situations and diverting individuals into care. They recognize the role of peer support in sharing a path toward recovery. And they emphasize the special needs of populations like veterans, who have served our country with honor but whose health needs we as a country have shamefully failed to meet.

The Excellence Act answers the question of what a coordinated delivery system looks like for the safety net. It requires CCBHCs to engage in partnerships with a variety of health system partners, from primary care to hospitals, VA centers, and more. The agencies’ emphasis on these partnerships reflects the fact that in the health care world of the future, policymakers and stakeholders will have little to no patience with siloed systems that cannot work together to demonstrate concrete health outcomes and high-value care. Behavioral health providers around the country are already engaging in these partnerships; with the advent of the Excellence Act, they will become part and parcel of the usual scope of care.

And the Excellence Act answers the question of how this care should be paid for, in a way that supports and incentives high-value care. Recognizing that current payment models are insufficient to support the kind of comprehensive and coordinated care envisioned by Excellence Act, the law requires states to establish a payment system based on CCBHCs’ anticipated costs – a giant step forward in a health system that until now has drastically underfunded community mental health and addiction services. It also puts behavioral health on the cutting edge of health care, by instituting a system of bundled payments that will either require or incentivize (depending on which model participating states select) value-based payments that allow providers to share in the cost savings their clinical care produces. National Council member organizations have been telling me for years that they want to be ahead of the curve in payment and service delivery redesign. With this new payment guidance, we have the opportunity to be leaders not just in our field, but in the health care system as a whole.

Don’t be fooled by the fact that this is an eight-state, two-year demonstration program. The Excellence Act is – to borrow words from Vice President Joe Biden – a BFD.

The bottom line is this: when someone walks through a CCBHC’s door, they will know what they’re getting. They know they will be linked to the services they need in the broader health care system. And they know they will receive better care coordination from a trained and competent team of providers. States will know what they’re paying for and have measurable ways to demonstrate value.

Here’s what’s coming next: 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 receive planning grant funding will be eligible to be a demonstration state – so don’t miss out! We need you to make the case to your state about why it should apply to participate. SAMHSA is offering two webinars to help states apply for planning grants; one will be held June 8 from 2:00-3:30 eastern, and the other will be held June 10 from 2:00-3:30 eastern. Click here for more details.

Planning grant applications are due by August 5, 2015, and grants will be awarded in October of this year. States will then have a year (until October 2016) to complete their planning and submit their application to participate in the demonstration, and the demonstration states will be selected in January 2017.

Now, the hard work turns to you – but we are on hand to help. We need you to start the process of evaluating your organization’s services to see where you already meet the CCBHC criteria – and where you need to build new service lines or partnerships. And we need you to spread the word. The National Council is ready to be a resource to you at every stage of the process. Please don’t hesitate to contact Chuck Ingoglia, Nina Marshall or Rebecca Farley on our staff with questions about the Excellence Act, advice on how to craft your planning grant application, tips on assessing your organization’s readiness to participate, and much more.