Overview|Consulting & Resource Hub | DCOs & Care Coordination|Getting Paid as a CCBHC|Guidance Documents
What is a CCBHC?
CCBHCs were created through Section 223 of the Protecting Access to Medicare Act (PAMA), which established a demonstration program based on the Excellence in Mental Health Act. The Excellence in Mental Health Act demonstration program—also known as the Excellence Act or the Section 223 demonstration program—is a two-year, 8-state initiative to expand Americans’ access to mental health and addiction care in community-based settings.
The Excellence Act established a federal definition and criteria for Certified Community Behavioral Health Clinics (CCBHCs) and stipulated that CCBHCs may receive an enhanced Medicaid reimbursement rate based on their anticipated costs of care. CCBHCs are responsible for directly providing (or contracting with partner organizations to provide) nine required types of services, with an emphasis on the provision of 24-hour crisis care, utilization of evidence-based practices, care coordination, and integration with physical health care. Ultimately, the demonstration program is expected to infuse more than $1.1 billion into community-based services, making it the largest investment in mental health and addiction care in generations.
In December 2016 the Substance Abuse and Mental Health Services Administration announced the selection of the eight participating states: 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. 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. Click each state to see its impact: Minnesota, Missouri, New Jersey, New York, Oklahoma, Oregon and Pennsylvania. Early results also indicate CCBHCs are making great strides in addressing the opioid epidemic.
Unfortunately, sixteen states that had also gone through a year of planning and implementation activities were not selected because under language in the demonstration law that limits participation to just eight states. The National Council remains committed to expanding the Excellence Act to all interested states and will continue working with congressional champions in the coming year to expand the scope of this important program
To learn more, check out these resources:
A CCBHC isn’t just business as usual by a different name: CCBHCs are a new provider type in Medicaid. This means that they are subject to a host of new opportunities and requirements:
- CCBHCs are eligible for enhanced payment through a Prospective Payment System (PPS), a methodology used to reimburse providers based on their anticipated costs of serving individuals in their communities. This means CCBHCs will have access to a rate that supports numerous activities not typically funded through current funding streams, from services provided outside the four wall of the clinic, to telehealth, peer services, care coordination activities, and much more.
- CCBHCs are subject to unique requirements with respect to their partnerships in the health and social service sectors. They maintain clinical and financial liability for CCBHC services furnished under contract by partners known as Designated Collaborating Organizations. Additionally, they are required to institute care coordination agreements with numerous entities such as primary care clinics, child welfare agencies, justice systems, and more.
- CCBHCs service delivery is based on the concept of trauma-informed recovery, with services provided outside the traditional four walls of a clinic in settings where providers can better connect with target populations to engage them in care.
For states participating in the Excellence Act demonstration, CCBHCs have the opportunity to fundamentally transform the delivery of behavioral health services for high-needs populations. For more on the implications of CCBHCs, see our fact sheet: “Why is the Excellence in Mental Health Act a Game-Changer?”
The Excellence in Mental Health Act outlined requirements for CCBHCs across six core areas: staffing; availability and accessibility of services; care coordination; scope of services; quality and other reporting; and organizational authority, governance, and accreditation. Subsequent guidance from SAMHSA delineated specific standards in each of the core areas. In turn, states are responsible for operationalizing those standards and establishing their own certification process for potential CCBHCs. CCBHCs must be certified before the October deadline for states to submit their applications to participate in the demonstration program.
CCBHCs must offer the following services either directly or through a formal contract with a Designated Collaborating Organization (DCO). These services must be offered and will be paid for even if they are not included in a state’s Medicaid plan:
- Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization*
- Screening, assessment and diagnosis including risk assessment*
- Patient-Centered treatment planning or similar processes, including risk assessment and crisis planning*
- Outpatient mental health and substance use services*
- Outpatient clinic primary care screening and monitoring of key health indicators and health risk**
- Targeted case management**
- Psychiatric rehabilitation services**
- Peer support and counselor services and family supports**
- Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration**
*CCBHC must directly provide
**May be proved by CCBHC and/or DCO
For a detailed description of the required CCBHC services, see p. 33-52 of the SAMHSA CCBHC Certification Criteria.
Explore our Contracting and Community Partnership toolkit to learn more about contracting with DCOs for the provision of required CCBHC services!
No! You can continue operating as you are, or you could become a Designated Collaborating Organization (DCO) to a CCBHC in your community. DCO’s may provide the following services:
- Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration
- Psychiatric rehabilitation services
- Peer support and counselor services and family supports
- Targeted Case Management
- Outpatient clinic primary care screening and monitoring of key health indicators and health risk
Explore our Contracting and Community Partnership toolkit to find out more about the CCBHC-DCO relationship!
CCBHCs are paid through a Prospective Payment System similar to that used by Federally Qualified Health Centers and other types of providers. States may select from two options for their PPS: a daily rate, or a monthly rate. Based on this selection, CCBHCs in that state will be paid either a single daily rate for each Medicaid patient who receives services at the clinic (or DCO) during that day, or a single monthly rate for each Medicaid patient that receives services at the clinic (or DCO) during the month. PPS rates are CCBHC specific, and the same rate is paid regardless of the intensity of services (note that under the monthly PPS rate, clinics may subdivide patient populations in order to draw down different rates for populations with different levels of need).
In establishing PPS rates, CCBHCs must create a cost report that includes the cost of providing all services to all patients in order to establish the per-day or per-month cost of serving patients in that clinic (however, note that the PPS rate is only paid for Medicaid patients). The cost report may include estimated costs related to new services or new costs which will be provided or incurred during the demonstration phase. The cost of DCO services is included in the CCBHC prospective payment rate, and DCO encounters are treated as CCBHC encounters for purposes of the prospective payment system.
For more details, check out these resources:
- CMS guidance on CCBHC Prospective Payment System
- SAMHSA PPS Reference Guide
- The National Council’s webinar series on PPS: Establishing a Base Year Rate, Billing Medicaid, and Care Coordination and Arrangements with Designated Collaborating Organizations
Currently, 24 states are planning their participation in the demonstration; unfortunately, SAMHSA can only fund 8 of the 24 states in this initial program. At the National Council, we are working hard to secure funding for all the 24 states who have drafted proposals. Let your Member of Congress know you support funding all 24 states!
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