Certified Community Behavioral Health Clinics: Model Overview and Virginia Adaptation

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CCBHC Model Overview

Kedar Dange, B.A.
ILPPP Research Assistant
MPH Candidate, Class of 2019

Context

Following enactment of the Protecting Access to Medicare Act in 2014,** new mental health treatment programs were developed. Eight states across the US have adopted Certified Community Behavioral Health Clinics (CCBHCs) in order to reform the structure of their behavioral health systems. Virginia has begun implementing an adaptation of the CCBHC structure in its STEP-VA program.

Certified Community Behavioral Health Clinics

CCBHCs are centers designed to provide a variety of mental health and substance-use disorder services using the framework of a trauma-informed approach to mental health. This concept revolves around empowerment, fostering trust and transparency, and recognizing social factors in the treatment of mental illness. These programs were defined in the Protecting Access to Medicare Act, and in 2016 the Substance Abuse and Mental Health Services Administration (SAMHSA) selected eight states to participate in the program. (1)

Oversight of these operations is done by Designated Collaborating Organizations (DCO). These are external providers, private or public, which are contracted by the CCBHC to ensure that all nine essential services are provided and paid for, several of which may be provided by the overseeing DCO itself:

  • Emergency mental health services, including 24-hour mobile support, intervention, and stabilization*

  • Screening, assessment, and diagnosis*

  • Treatment planning*

  • Outpatient care for mental health and substance use patients*

  • Primary care screening and monitoring

  • Case-management

  • Psychiatric rehab

  • Peer and family counseling/support services

  • Services for members or veterans of the Armed Services

  • Connection with other providers and systems (hospitals, criminal justice, child welfare, etc.) via partnerships and collaborations
    *Must be provided by CCBHC itself, not contracted from DCO

Emphasis is put on rehabilitation, outpatient care, and behavioral elements of health, as well as offering early and cost-irrelevant care to vulnerable populations (particularly military members) without interruption (24/7/365). (2)

As a provider under Medicaid, CCBHCs are eligible for unique payment plans, covering a range of addiction and mental health services. The Prospective Payment System (PPS) allows CCBHCs to receive Medicaid reimbursements based on anticipated costs of the expanded service range, guided by SAMHSA-issued quality measures and the CCBHC cost report template released by the Center for Medicare and Medicaid Services (CMS). (3) This allows CCBHCs additional funding to invest in new hires, additional programs, and new technologies that were previously ineligible for reimbursement. (4)

Seven of the eight CCBHC states have reported results: New York, Minnesota, Missouri, New Jersey, Oklahoma, Oregon, and Pennsylvania. Each CCBHC was surveyed to measure how well service capacity and quality has improved. Metrics of success range from hiring new employees, particularly psychiatrists and other specialized staff members, to services offered, such as Medication-Assisted Treatment, opioid recovery initiatives, and screening programs. An extended glossary of quality measures was released by SAMHSA and can be found below. (5,6)

Table 1: Quality Measures for measuring CCBHC effectiveness (5)

Table 1: Quality Measures for measuring CCBHC effectiveness (5)

Individual states, such as Pennsylvania and Minnesota, report successes in providing better and more integrated care, hiring qualified medical professionals, facilitating communication between CCBHCs and hospitals, and providing same-day care access to consumers. (1)

Benefits

The primary benefit of this style of program is its designation as a special provider under Medicaid, which enables qualifying programs to receive additional funding to cover expanded services via PPS, which is defined by anticipatory cost reports provided by the CCBHCs themselves. Oversight by DCOs enables participating organizations to be uniform in services offered and streamlines communication, particularly billing, for CCBHCs, and provides flexibility for states that have pre-existing CCBHC-like programs to integrate into the new framework without having to completely restructure. All CCBHC services, and by extension DCO-provided services, report through SAMHSA’s Uniform Reporting System, which collects information on a large variety of demographic and service usage information.7 These report National Outcome Measures (NOM) which have been developed by SAMHSA in collaboration with NRI. (8)

STEP-VA

Virginia’s analogous program, launched by the Virginia Department of Behavioral Health and Development Services (DBHDS) called STEP-VA (System Transformation Excellence and Performance) is built on the same framework. STEP-VA will provide a more comprehensive and standardized array of services at all 40 CSBs, and is slated to be implemented in phases over the next several years. To date, DBHDS has funded and begun to implement the first two phases: same-day access and primary care screening. (9) The goals of STEP-VA are largely similar to those of the national program, using the same essential services. (10) Once STEP-VA is fully implemented, the following services will be provided at all 40 CSBs (11):

  • Same Day Access

  • Outpatient Services (including MAT and improved in-home services for children)

  • Primary Care Integration

  • Detoxification

  • Care Coordination

  • Peer and Family Support

  • Psychosocial rehabilitation/Skill Building

  • Targeted Case Management

  • Veterans Services

  • Person-Centered Treatment

  • Mobile Crisis Services

STEP-VA will build off of the current set of services already being provided by CSBs while adding new services to in an effort in increase access, quality, consistency and accountability. (12)

CCS 3 Outcomes Data

Beginning in July, 2017, CSBs have been submitting the following six outcome measures to DBHDS as part of regular CCS 3 reporting. (13) Most of these outcomes map onto similar CCBHC quality measures that are reported by the CCBHCs as part of the CCBHC demonstration program. The CCBHC demonstration program also requires that a number of other quality measures are tracked, most of which do not appear to be tracked by DBHDS. ILPPP staff do not currently know if DBHDS plans to adopt more of the CCBHC quality measures as part of implementing STEP-VA and plan to research this further.

* Denotes 1 of the 9 required measures to be reported by the CCBHCs as part of the CCBHC demonstration program.

* Denotes 1 of the 9 required measures to be reported by the CCBHCs as part of the CCBHC demonstration program.

** The Protecting Access to Medicare Act was an expansion bill signed in April 2014 to extend expiring programs implemented in several previous bills, notably preventing a 24% reduction in reimbursement rates for physicians through Medicare. Among the extension of Medicare programs, grant provisions were created, allocating $27 million to new programs to improve community mental health, which became the test runs for the CCBHC model. (14)

References

  1. “Certified Community Behavioral Health Clinics.” National Council, www.thenationalcouncil.org/topics/certified-community-behavioral-health-clinics/

  2. Miskowiec, Don, and Linda Rosenberg. CCBHC Demonstration. CCBHC Demonstration, National Council for Behavioral Health, 2017.

  3. “Section 223 Demonstration Program to Improve Community Mental Health Services.” Medicaid.gov, 2017, www.medicaid.gov/medicaid/finance/223-demonstration/index.html.

  4. “Getting Paid as a CCBHC” National Council, https://www.thenationalcouncil.org/topics-a-z/getting-paid-ccbhc/

  5. “Glossary of CCBHC-Related Quality Measure s and Acronym.” SAMHSA, 17 Apr. 2017. https://www.samhsa.gov/sites/default/files/programs_campaigns/ccbhc-glossary.pdf

  6. “Questions-Clarifications-about-Qms-Ccbhcs.pdf.” SAMHSA, 2016. https://www.samhsa.gov/sites/default/files/questions-clarifications-about-qms-ccbhcs.pdf

  7. “2016 URS Output Tables.” SAMSHA: Uniform Reporting Service, 2016. https://wwwdasis.samhsa.gov/dasis2/urs.htm

  8. “Uniform Reporting System and Mental Health Client-Level Data.” Uniform Reporting System and Mental Health Client-Level Data | NRI: No Person's Life Will Be Limited by Mental Illness or Addiction, NRI, 2017, www.nri-inc.org/our-work/projects/uniform-reporting-system-and-mental-health-client-level-data/

  9. “Joint Subcommittee to Study Mental Health Services in the 21st Century Adopts Final Recommendations for 2017.” VACO, 2017. http://www.vaco.org/joint-subcommittee-study-mental-health-services-21st-century-adopts-final-recommendations-2017/

  10. Herr, Daniel. “DBHDS Updates and STEP-VA: System Transformation, Excellence and Performance in Virginia.” 2015. http://dls.virginia.gov/groups/mhs/Step_VA.pdf

  11. “DBHDS Comprehensive State Plan (2016-2022).” DBHDS, 2016. http://www.dbhds.virginia.gov/library/quality%20risk%20management/dbhds-comprehensive-state-plan-2016-2022.pdf

  12. Barber, Jack. “DBHDS Budget and Policy Overview.” 2017. http://hac.state.va.us/subcommittee/health_human_resources/files/1-24-17/DBHDS%20Presentation.pdf

  13. Gilding, P. “Community Consumer Submission 3 Extract Specifications: Version 7.3.3” Virginia Department of Behavioral Health & Developmental Services, 1 July, 2017. http://www.dbhds.virginia.gov/library/community%20contracting/ccs3extractspecificationsversion733may2017finalver4.pdf

  14. Wilson, Joy Johnson. “The Protecting Access to Medicare Act: In Brief.” NCSL, National Conference of State Legislature, 15 Apr. 2014, www.ncsl.org/research/health/protecting-access-to-medicare-act-of-2014.aspx.