Certified Community Behavioral Health Clinics Provide Enhanced Access to Integrated Health Services

Helio Health, a nonprofit health system in New York, is one of 13 Certified Community Behavioral Health Clinics, or CCBHCs, in the state. Helio Health implemented the CCBHC model in 2017 upon participation selection by the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), and focuses on a person-centered approach to care.

What is a Certified Community Behavioral Health Clinic (CCBHC)?

CCBHC Definition and Model

The National Council for Behavioral Health defines a CCBHC as an “entity designed to provide a comprehensive range of mental health and substance use disorder services to vulnerable populations.”

A CCBHC covers the needs of these populations in one place—directly and through partnerships with designated collaborating organizations (DCOs)—regardless of their location and ability to pay. Its care and scope of services generally include: screening, assessment, and diagnosis; crisis intervention and stabilization; targeted case management; outpatient mental health, drug and alcohol counseling; psychiatric rehabilitation and medication support; family and peer support; treatment planning; non-residential withdrawal management; care coordination.

Legislation and Creation

Legislation led to the creation of CCBHCs. In 2014, Congress passed the Excellence in Mental Health Act, S. 264, first introduced by U. S. Senator Debbie Stabenow (D-MI) in 2013.

“Our goal was to have a system where mental health and addiction services are treated from a funding standpoint as comprehensive healthcare: Treating healthcare above the neck, as well as health care below the neck,” Stabenow told The Detroit News in March.

This Act established federal certification criteria for community-based mental and behavioral healthcare—to be developed by SAMHSA—and invested $1 billion into the pilot program. Based on this Act, to improve these services, Section 223 of the Protecting Access to Medicare Act (PAMA) of 2014 assisted eight states with the creation and evaluation of two-year CCBHC demonstration programs, funded by enhanced Medicaid reimbursements through a Prospective Payment System (PPS).

Success and Expansion Grants

An intention of the CCBHC model has been to improve individual health outcomes in urban and rural communities. And it has proven promising. The program served an estimated 381,346 individuals at 372 locations in its first year, SAMHSA reported.

Based on state quality measures, CCBHCs have also been reporting their results. Helio Health, for example, has reduced both emergency room visits (32%) and inpatient admissions (approximately 41%), according to its May 2019 RecoveryToday publication.

This success resulted in CCBHC expansion grants. These grants do not guarantee PPS payments, but they allow agencies and organizations in 24 states to increase access to behavioral services for persons with serious mental illness (SMI), substance use disorders (SUD), serious emotional disturbance (SED), and co-occurring disorders (COD).

Stanley Street Treatment and Resources (SSTAR) is one organization to receive grant money. In February 2019, SSTAR, a nonprofit health care and social services agency in Massachusetts, received a two-year, $3.8 million grant from SAMHSA, The Herald News reported. SSTAR implemented the CCBHC model this spring and has expanded its services.

Expiration and Funding Extension Issues

Dubbed “one-stop shops,” these Medicaid demonstration programs launched in 2017 with the following expiration dates: March 31, 2019 (Oklahoma and Oregon) and June 30, 2019 (Minnesota, Missouri, Nevada, New Jersey, New York, and Pennsylvania). In April of this year, however, Congress extended the program in Oklahoma and Oregon by three months, so all eight states were funded through June.

CCBHC states now risk the loss of federal funding to sustain integrated healthcare, mental health, and addiction services. For this reason, Senator Stabenow (D-MI) introduced the Excellence in Mental Health and Addiction Treatment Expansion Act, S. 824/H.R. 1767—co-sponsored by Senator Roy Blunt (R-MO), Representative Doris Matsui (D-CA), and Representative Markwayne Mullin (R-OK), among others—to renew participating state programs for two additional years and expand CCBHCs to 11 more eligible states.

“About one in five people worldwide is affected by mental illness, and drug overdoses are now the leading cause of death for Americans under 50,” Senator Stabenow said in a press release. “These disorders do not discriminate – they affect our parents, our veterans, our friends, and our children.”

Support for Extension

There has been much support to extend funding for the CCBHC program because it provides uniform standards for addressing mental illness and addiction in communities. Without them, patients usually must navigate between multiple providers and social services agencies, among others—and wait months for available appointments.

Congress has yet to act on the Excellence in Mental Health and Addiction Treatment Expansion Act, but the good news?

The House of Representatives recently passed the Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019, H.R. 3253, introduced by Representative Debbie Dingell (D-MI) this month. If also passed by the Senate, this act would extend the program in participating states for another two and a half years.

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