CCBHCs 101: Opportunities and Strategic Decisions Ahead3. Person and Family-centered treatment planning 4. Direct provision of outpatient mental health and substance use services 5.

Speaker NameTitle

Organization

CCBHCs 101: Opportunities and Strategic

Decisions Ahead

Rebecca C. Farley, MPHNational Council for Behavioral Health

It Passed!The largest federal investment in mental health and addiction treatment in a

generation.

Representatives Leonard Lance and

Doris Matsui

Senators Roy Blunt and Debbie Stabenow

“This is a B.F.D.”–Joe Biden

The Vision

• Improve overall health by bolstering community-based mental health and addiction treatment

• Advance behavioral health care to the next stage of integration with physical health care

• Assimilate and utilize evidence-based practices on a more consistent basis

Certified Community Behavioral Health Clinics

What makes CCBHCs so different?

• New provider type in Medicaid

• Distinct service delivery model: trauma-informed recovery outside the traditional four walls

• New prospective payment system (PPS) methodology

• Requirement to contract with other organizations

Why pursue CCBHC status?

• Improved care and enhanced access to care

• Potential for secure payment based on actual anticipated costs via a Prospective Payment System (PPS)

• Expansion of person-centered, family-centered, trauma-informed, and recovery oriented care that integrates physical and behavioral health care to serve the whole person

24 States Selected for Planning Grants

Decisions Ahead

• Under my state’s CCBHC certification process, do we have a shot?

• What changes to our service array are needed?

• What workforce education/training do we need to do?

• What capital investments do we need to make?

• Is it worth it to pursue these changes, even if our state isn’t picked for the demo?

Timeline

Jan 2017—Dec 2018

Demonstration Phase

Oct 2015—Oct 2016

Planning Phase

May‐Aug 5, 2015

Prepare Planning Grant Applications

SAMHSA has granted a 6-month extension for states that are selected to participate in the demonstration

• The demonstration start date may be between Jan. 1 and June 30, 2017

Do I have to be a CCBHC?

• DCOs augment or fill gaps in CCBHCs’ service array…

No! You could become a…

Designated Collaborating Organization

• …And can benefit from CCBHCs’ enhanced reimbursement

CCBHC Criteria

Scope of Services

9 Types of CCBHC Services1. Crisis mental health and addiction services2. Screening, assessment and diagnosis, including risk

assessment3. Person and Family-centered treatment planning4. Direct provision of outpatient mental health and substance use

services5. Outpatient primary care screening and monitoring of key health

indicators and health risk6. Targeted case management7. Psychiatric rehabilitation services8. Peer support and counselor services and family supports9. Intensive, community-based mental health care for members of

the armed forces and veterans, particularly those in rural areas

CCBHC Scope of Services

Must be delivered directly by CCBHCDelivered by CCBHC or a Designated Collaborating Organization (DCO)

Evidence-based practices

• Based on community needs assessment, states must establish a minimum set of required evidence based practices, such as:o Motivational Interviewingo Cognitive Behavioral individual, group, and on-line therapies (CBT)o Dialectical Behavioral Therapy (DBT)o First episode early intervention for psychosiso Multi-systemic therapyo Assertive Community Treatment (ACT)o Forensic Assertive Community Treatment (F-ACT)o Community wrap-around services for youth and children o And more…

Breaking through old limitations…

Think creatively!? In-home services for

newly placed foster youth

? Post-booking assessment in jails

? Outreach to homeless populations

Services are not confined to delivery within the 4 walls of a clinic

CCBHC Criteria

Staffing

Staffing Standards• Medicaid-enrolled providers • Credentialed, certified, and licensed

professionals• Individuals with expertise in addressing the

needs of children and adolescents Culturally and linguistically competent and appropriate

*Including for Veterans and members of the Armed Services

Staffing: Positions• Management team:

– Chief Executive Officer or Executive Director/Project Director– Psychiatrist as Medical Director

• States will specify disciplines required for certification, but must include:– Medically trained BH provider able to prescribe and manage

meds (i.e., opioid and alcohol treatment)– Credentialed substance abuse specialists– Individuals with trauma expertise able to promote recovery

of children with SED, adults with SMI, and those with SUD

CCBHC CriteriaAvailability and Accessibility of Services

Availability & Accessibility Standards

• Access required at times and places convenient for those served

• Prompt intake and engagement in services• Access regardless of ability to pay (sliding

scale fees) and place of residence • Crisis management services available 24

hours per day

CCBHC CriteriaCare Coordination

Care Coordination: The “Linchpin” of CCBHC

• CCBHC coordinates care across the spectrum of health services, including physical and behavioral health and other social services

• CCBHC establishes or maintains electronic health records (EHR)– Health IT system is used to conduct

population health management, quality improvement, reducing disparities, and for research and outreach

Care Coordination: The “Linchpin” of CCBHC

• Partnerships or care coordination agreements required with:– FQHCs/rural health clinics– Inpatient psychiatry and detoxification– Post-detoxification step-down services– Residential programs– Other social services providers, including

• Schools• Child welfare agencies• Juvenile and criminal justice agencies and facilities• Indian Health Service youth regional treatment centers• Child placing agencies for therapeutic foster care service

– Department of Veterans Affairs facilities– Inpatient acute care hospitals and hospital outpatient clinics

CCBHC CriteriaQuality and Other Reporting

Quality and Other Reporting Standards

• Standardized data elements modeled on the FQHC Uniform Data System:– Encounter data

• Consumer demographics• Staffing• Service usage• Service access• Care coordination

– Clinical outcomes data– Quality data– Other data as requested

Quality MeasuresRequired Measures for

Quality Bonus Payments1. Follow-Up after Hospitalization for Mental Illness (adult

age groups) 2. Follow-Up after Hospitalization for Mental Illness

(child/adolescents)3. Adherence to Antipsychotics for Individuals with

Schizophrenia4. Initiation and Engagement of Alcohol and Other Drug

Dependence Treatment5. Adult Major Depressive Disorder (MDD): Suicide Risk

Assessment6. Child and Adolescent Major Depressive Disorder

(MDD): Suicide Risk Assessment

Quality MeasuresEligibility Measures for

Quality Bonus Payments1. Follow-Up Care for Children Prescribed

Attention Deficit Hyperactivity Disorder (ADHD) Medication

2. Screening for Clinical Depression and Follow-Up Plan

3. Antidepressant Medication Management4. Plan All-Cause Readmission Rate5. Depression Remission at Twelve Months-

Adults

CCBHC Criteria

Organizational Authority, Governance, and Accreditation

Organizational Authority Governance and Accreditation

• CCBHCs must be: – Nonprofits– Part of local government behavioral health authority– Under the authority of Indian Health Service, Indian

Tribe or Tribal organization• Governing board members “reasonably represent”

those served • States are encouraged to require national accreditation

(e.g. CARF, COA, JCAHO)

CCBHC PaymentEstablishment of a Prospective

Payment System

Prospective Payment System• CMS Guidelines

– PPS rates are CCBHC-specific

– CCBHCs will be required to develop annual cost reports

– 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.

– States have two options to choose from: PPS-1 vs. PPS-2

PPS-1 Guidelines• CCBHC’s receive a fixed daily reimbursement

per visit– Based on the FQHC PPS approach used nationally

• Payment is the same regardless of intensity of services

Total allowable costs of providing services

Total number of daily visits per year

Daily per‐visit rate

PPS-1• Pros

– Methodology and requirements familiar from the FQHC experience

– Completion & review of cost report less complex– Implementation of one payment rate per CCBHC less complex– Data/system requirements may be more likely to be currently

available at CMHCs– Option to include quality bonus payments to CCBHCs

• Cons– One payment rate per visit

• Does not account for matching payment to disparate consumer conditions• Errors in predicting patient mix more problematic

PPS-2 Guidelines• CCBHCs receive a fixed monthly reimbursement for every 

individual who has at least one visit in the month• Payment is the same regardless of number of visits per month or 

intensity of services• CCBHCs do NOT get paid in months when the patient does not 

receive any services• Allows CCBHCs to establish separate reimbursement rates for 

distinct populations in addition to a base rate– adults with serious mental illness – children and youth with serious emotional disorders, – individuals with serious substance use disorders, – individuals with a recent history of frequent hospitalizations due 

to behavioral health conditions

PPS-2• Pros

– Includes a process to address outlier costs– Allows for more ability to match payment to patient

condition– Requires quality bonus payments to CCBHCs

• Cons– Completion of cost report more complex– Data/system requirements are complex to produce

required cost report elements by condition level– Difficult for State to review and validate payment rates– Administratively more complex for State to make

payments to CCBHCs when factoring in condition level, outliers and quality bonus payments

Special Considerations for DCOs

• What required services do you provide that CCBHCs in your community lack?

• Can you collect the required data and communicate electronically with your local CCBHC?

• What payment arrangement will you negotiate with the CCBHC?

NatCon16: CCBHC Track

• Monday:– 12:00: Becoming Best Friends: CCBHCs and

DCOs– 3:00: Getting Paid as a CCBHC: Cost

Reporting Principles• Tuesday:

– 10:00: Quality Reporting and CCBHCs– 10:00: The Role of CCBHCs in Monitoring &

Managing Chronic Illness

Visit our resource hub!

http://www.thenationalcouncil.org/topics/certified-community-behavioral-health-clinics/

What happens after 2 years?

Questions?Rebecca Farley

Director, Policy and [email protected]