Certified Community Behavioral Health Clinic
What is a CCBHC?
A Certified Community Behavioral Health Clinic is a specially designated clinic that provides a comprehensive range of mental health and addiction services. CCBHCs serve all that walk through their door, regardless of their diagnosis, insurance status, place of residence or age. The CCBHC model is a proven outpatient model that:
- Ensures access to integrated services including 24/7 crisis response and medication-assisted treatment.
- Meets strict criteria regarding access, quality reporting, staffing, and coordination with social services, justice, and education systems.
- Receives funding to support the real costs of expanding services to fully meet the need for care in communities.
CCBHCs are required to provide a comprehensive range of mental health and addiction services and to be in compliance with criteria developed by SAMHSA. For more information on CCBHCs, please visit the SAMHSA CCBHC webpage.
Background
The Protecting Access to Medicare Act of 2014 was enacted in 2014. Section 223 of the Act provides for the creation and evaluation of a demonstration program to improve community mental health services. Section 223 authorized the U.S. Department of Health and Human Services to establish the federal CCBHC criteria for the demonstration program and for clinics to be certified by a state as a Certified Community Behavioral Health Clinic.
Indiana's Pathway to CCBHC
House Enroll Act 1222 directed the Division of Mental Health and Addiction to develop a plan to strengthen the use of Certified Community Behavioral Health Clinics (CCBHCs) statewide by implementing the CCBHC model at the state level. The CCBHC model is an outpatient model that ensures evidence-based mental health and addiction care for any individual’s needs within its community. State level implementation of the CCBHC model is the key to building the comprehensive behavioral health system that Hoosiers deserve. Click here to view Indiana’s plan for expanding the use of Certified Community Behavioral Health Clinics.
Request for Information Issued
Indiana Family and Social Services Administration’s Division of Mental Health and Addiction has issued a Request for Information, available here, regarding the upcoming statewide expansion to the federally supported Certified Community Behavioral Health Clinic model. In this RFI, DMHA shares its preliminary thoughts regarding CCBHC implementation in Indiana for reaction and community input. DMHA invites interested stakeholders and providers to respond to this RFI with questions, inquiries and suggestions. The feedback and information gathered will be used to inform and strengthen the state’s CCBHC program design and upcoming demonstration program application.
While responses to this RFI will not result in a contract or award, DMHA plans to issue a Request for Services in the fall 2023. The upcoming RFS will allow current Community Mental Health Centers and other applicable providers the opportunity to apply for the state’s demonstration program. It is important to note that DMHA may limit eligibility for the state’s demonstration program to only those who respond to the RFI.
If an entity does not wish to submit a formal response at this time, DMHA is still interested in hearing any and all input - please submit questions and inquiries related to the CCBHC expansion to the following email: CCBHCQuestions@fssa.in.gov.
CCBHC Criteria and Services:
CCBHC’s are currently not yet defined or certified by the State of Indiana. However, SAMHSA’s criteria does describe the basic level of criteria and services that a CCBHC should operate. The CCBHC criteria falls into six key program areas:
- Staffing – Staffing plans are developed and driven by first performing a local needs assessment to determine needs of the community served by the CCBHC. Each CCBHC develops a staffing plan from such needs assessments that inform the required the staffing levels, licensing, and training to support service delivery.
- Availability and Accessibility of Services – CCBHCs have described standards for timely and meaningful access to services, outreach and engagement, 24/7 access to crisis services, treatment planning, and acceptance of all patients regardless of ability to pay or place of residence.
- Care Coordination – CCBHCs are required to develop care coordination agreements across services and providers (e.g., Federally Qualified Health Centers, inpatient and acute care), defining accountable treatment team, health information technology, and care transition guidelines and practices.
- Scope of Services – CCBHCs are required to provide nine required services. CCBHC services are to be provided in a manner that is person-centered, family-centered, and recovery-oriented care. The nine required services are to be provided directly by the CCBHC but may also be provided through a formal relationship by establishing partnering agencies as Designated Collaborating Organization.
Required CCBHC Services:- Crisis Services
- Treatment Planning
- Screening, Assessment, Diagnosis & Risk Assessment
- Outpatient Mental Health & Substance Use Services
- Targeted Case Management
- Outpatient Primary Care Screening and Monitoring
- Community-Based Mental Health Care for Veterans
- Peer, Family Support & Counselor Services
- Psychiatric Rehabilitation Service
- Quality and Other Reporting – CCBHCs have site specific required quality measures that must be collected and reported. CCBHCs must also develop a plan for quality improvement and tracking of other program requirements. In addition to site specific required quality measures, states that certify CCBHCs have state specific quality measures that must be collected and reported in addition to the site-specific measures.
- Organizational Authority and Governance – CCBHCs are required to incorporate consumer representation in the governance of the CCBHC. CCBHCs certified by their state are required to have undergone the appropriate state accreditation process of CCBHCs.
Federal Program Distinctions:
There are two different federal programs that support CCBHCs, the CMS CCBHC Demonstration and the Substance Abuse and Mental Health Administration CCBHC Expansion Grant (discretionary grant awards).
- CMS CCBHC Demonstration – CCBHCs are funded by using a Prospective Payment System rate for qualifying services provided to Medicaid beneficiaries. States are responsible for oversight of the demonstration program which includes clinic certification, payment to the CCBHCs and development of PPS rates, and compliance with federal reporting requirements. Indiana has not yet joined the CMS CCBHC Demonstration, but plans to apply in spring 2024. The CMS CCBHC Demonstration also provides a four year enhanced federal match for developed PPS rates approved in the demonstration.
- SAMHSA CCBHC Expansion Grants – CCBHC Expansion Awardees are funded for generally a grant period of two years, and funded directly by SAMHSA to their local clinic through self-attestation that the awarded clinic meets the baseline CCBHC criteria. States do not have any direct role in these grants. There have been 18 CMHC sites that have been awarded the CCBHC Expansion Grant.
Questions and answers about Indiana’s pathway to the CCBHC model
Indiana’s pathway to CCBHC is still being defined. Additional FAQs will be available as the state continues to build towards the CCBHC demonstration program and statewide expansion of the model. Direct questions may be answered through email at CCBHCQuestions@fssa.in.gov.
- Why is the CCBHC model important to Hoosiers?
Increased access to care.
Establishing the CCBHC model at the state level will ensure complete transparency into the effectiveness of the behavioral health system, link behavioral health care services with other community pillars such as education, justice and housing system, and provide the opportunity to build in tailored treatment pathways for individuals, rather than fit complex individuals into a one-size fits all approach.
- Who is eligible to receive care at a CCBHC?
CCBHCs are required to serve anyone who requests care for mental health or addiction, regardless of their ability to pay, place of residence, or age - including developmentally appropriate care for children and youth.
- How will expansion to the CCBHCs model be funded?
CCBHCs will be funded and supported by a prospective payment system or PPS, which provides a sustainable and flexible funding model to support the CCBHC. For more information, view the SAMHSA Prospective Payment System Reference Guide.
- How does the CCBHC model address financing barriers when seeking access to behavioral healthcare?
The CCBHC model addresses financing shortfalls by paying clinics a Medicaid rate inclusive of their anticipated costs of expanding service lines and serving new consumers. Under the PPS model, each CCBHC receives a fixed, clinic-specific rate for each qualifying visit, regardless of the intensity or quantity of service provided. Through a prospective payment system, the model supports:
- Expanded access to care through an enhanced workforce. CCBHCs’ Medicaid rates cover costs associated with hiring new staff such as licensed counselors or peer support specialists, paying employees a competitive wage in the local market, and training staff in required competencies such as care coordination and evidence-based practices.
- A stronger response to the addiction crisis. Addiction care is embedded throughout the CCBHC range of services, including screening for substance use disorders, detoxification, outpatient addiction services, peer support services, and other addiction recovery services at state discretion. Importantly, most states participating in the CCBHC program have also made medication-assisted treatment (MAT) a required service.
- Enhanced patient outreach, education and engagement. CCBHCs’ Medicaid rates include the cost of activities that have traditionally been near-impossible to reimburse yet play a critical role in behavioral health services.
- Care where people live, work, and play. CCBHCs may receive Medicaid payment for services provided outside the four walls of their clinic; for example, via mobile crisis teams, home visits, outreach workers and, emergency or jail diversion programs.
- Electronic exchange of health information for care coordination purposes. CCBHCs’ Medicaid rates include the cost of purchasing or upgrading electronic systems to support electronic information exchange. The 2014 Excellence in Mental Health Act prioritizes improving the adoption of technological innovations for care, including data collection, quality reporting, and other activities that bolster providers’ ability to care for individuals with co-occurring disorders.
- Sustainable funding for the costs of meeting the community’s needs as they change over time. CCBHC clinic-specific rates are reviewed every three years by first reviewing the community’s needs and then reviewing the cost report template of CCBHC’s costs to meet these needs and adjusting the clinic specific rates accordingly.
- What are the hours of a Certified Community Behavioral Health Clinic?
CCBHCs are required to provide services during times that facilitate accessibility and meet the needs of the population served, including outside of standard business hours, such as some evening and weekend hours. In addition, CCBHC crisis response services must be available 24 hours per day, 7 days a week.
- How does the CCBHC model fit into Indiana's developing crisis system?
Crisis services are a core service requirement for CCBHCs. CCBHCs can provide crisis services directly or through a formal partnership. The developing crisis continuum in the state will interoperate and support the CCBHC crisis services.
Currently, Indiana will be the FIRST STATE to include alignment across the crisis continuum with the 988 Suicide and Crisis Lifeline, creating one unified, 24-hour system of care from a call or text to treatment and recovery. This approach can also create an interconnected system to support the existing not-for profit and faith-based groups that are working to address these issues on a community level.
- What is Indiana's timeline for transitioning to a CCBHC model?
* If Indiana is not selected, the state will still have the opportunity to expand the CCBHC model through another application to enter the Demonstration program in 2026, through a State Plan Amendment, or 1115 Medicaid Waiver.
- What effect does the CCBHC model have on the current behavioral health workforce shortage?
CCBHCs’ Medicaid rates cover costs associated with hiring new staff such as licensed counselors or peer support specialists, paying employees a competitive wage in the local market, and training staff in required competencies such as care coordination and evidence-based practices.
Since adopting the CCBHC model, clinics report on average hiring 27 new staff per clinic.
The most common strategies CCBHCs are using to recruit and retain staff include:
- Raising salaries or offering bonuses (92%)
- Engaging in staff wellbeing efforts or revamping employee benefits (86%)
- Partnerships with clinician training programs (62%)
- Revising roles and scope of practice (59%)
- Participation in loan repayment programs such as National Health Service Corps (46%)
Resources:
National Council for Mental Wellbeing’s CCBHC Success Center: The CCBHC Success Center is the National Council’s hub for data, implementation support, and advocacy to support the Certified Community Behavioral Health Clinic initiative across the United States. On top of support and advocacy, the CCBHC Success Center also releases CCBHC Impact Reports on the progress made by CCBHCs, which may be viewed by clicking here.