24 Feb The Growing Trend of CCBHCs in the Behavioral Health Industry

Our country faces a crisis. Communities across the nation are stricken with substance abuse and mental illness. Data from the Substance Abuse and Mental Health Services Association (SAMHSA) reveal nearly 58 million Americans have mental illnesses or substance use disorders, with 9 million adults having co-occurring disorders. While effective treatment exists, access is limited. The Excellence in Mental Health Act received broad bi-partisan support in 2014. The legislation paved the way for better access to community-based mental health services by establishing Certified Community Behavioral Health Clinics (CCBHCs). 

Growing Trends

The behavioral healthcare field is changing. CCBHCs are a way to increase access to quality care for Americans across the country. As the way we deliver services evolves, we are seeing two major trends in the industry—growing awareness of the need for behavioral health services and value-based purchasing.

1. Increased Awareness – To rectify major societal problems such as opioid addiction, we must first address the underlying issues. More and more people are becoming aware of the urgent need for behavioral healthcare. Despite this growing recognition, access to behavioral healthcare is still limited.
2. Value-based Purchasing – Payers have developed an intense focus of examining the value they get for the dollar amount invested in particular services. States and commercial payers are exploring different ways to invest in health systems to maximize value and improve outcomes.

Both these trends indicate continued funding for behavioral healthcare in the future. By offering higher reimbursement rates to CCBHCs, Medicaid is covering the real cost of improved outcomes, including non-billable activities such as outreach and care coordination. The CCBHC model allows clinics to invest in an increased service capacity, data infrastructure, and EHRs.

Expansion of CCBHCs

CCBHCs started small. In 2016, section 223 of the Protecting Access to Medicare Act (PAMA) established demonstration programs in 8 states—Minnesota, Missouri, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania. Then, in 2018, congress appropriated funding for CCBHC expansion grants. Now there are 113 such clinics in 21 states. As of January, all states are now eligible for the expansion grant program. The 2020 congressional budget saw a $50 million funding increase for such grants. With expanded federal funding, more clinics have a chance to fulfill the needs of their community. To be eligible for the awards, clinics must meet the prerequisite requirements for CCBHCs.

Six Program Criteria

SAMHSA established criteria for certifying community-based behavioral health clinics with the desired goal of extending services and improving outcomes, and encouraging further development of services and best practices. These six standards are likely to lead to high-quality, person-centered care across the nation. 

1. Staffing – According to Section 223 of PAMA, CCBHC staff “have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic’s patient population.” In general, this means states need to assess the needs of the target population, including cultural and linguistic needs. The assessment will determine the appropriate staffing plan for each facility.
2. Availability and Accessibility – PAMA is clear that CCBHCs must provide services to everyone who seeks help. Requirements include 24/7 crisis management services, sliding scales, a no reaction, or limiting of services based on the patient’s ability to pay. Facilities need to have working relationships with emergency services to provide crisis care coordination, discharge, and follow-up.
3. Care Coordination – Integrated and coordinated care strive to meet all aspects of a person’s health. Agencies must implement person-centered care that aligns with state and federal regulations. CCBHCs need to have adequate communication and collaboration between medical and other service providers. 
4. Scope of Services– Regulations require CCBHCs to provide certain services. Agencies who do not directly offer these must establish formal relationships with other providers who do. The nine required services, as outlined in PAMA section 223, are as follows.
   1. Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.
   2. Screening, assessment, and diagnosis, including risk assessment.
   3. Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.
   4. Outpatient mental health and substance use services.
   5. Outpatient clinic primary care screening and monitoring of key health indicators and health risks.
   6. Targeted case management.
   7. Psychiatric rehabilitation services.
   8. Peer support and counselor services and family supports.
   9. Intensive, community-based mental health care for members of the armed forces and veterans.
5. Reporting – Data collection is vital for assessment and program improvement. The law requires participating states to gather and report data regarding encounters, clinical outcomes, and quality improvement. Specific reporting entails access to community-based behavioral health services, the quality and scope of services, and federal and state costs for all behavioral health services. 
6. Organizational Authority – SAMHSA envisions organizations that provide comprehensive, evidence-based care that follows best practices in the field. CCBHCs are part of a local government behavioral health authority and must adhere to requirements at the local, state, and federal levels. Additionally, facilities need to stay up-to-date on accreditations, certifications, and licensing requirements. 

 
Resources for CCBHCs

As the CCBHC model expands, new resources are becoming available that let providers and clinicians carry out the mission of providing quality care to those in need. Federal grants (up to $2 million annually) are available for CCBHCs. SAMHSA is accepting applications for the funding expansion until March 10, 2020. This funding can help facilities expand staffing, outreach, and technology. For example, an investment in Electronic Health Records (EHRs) would dramatically help clinics streamline care coordination, assist in data collection, and automate billing. Due to CCBHCs’ unique requirements, they need an EHR specifically designated for Behavioral Healthcare Facilities. With the right resources, CCBHCs are poised to satisfy the needs of their communities.