In April of 2014, Congress passed the Protecting Access to Medicare Act of 2014, which is also referred to as PAMA. Section 223 of this Act requires that the Department of Health and Human Services (HHS) create a process to certify Community Behavioral Health Clinics. Once a clinic receives certification, it becomes a Certified Community Behavioral Health Clinic (CCBHC).
The CCBHC Demonstration Program
In October of 2015, 24 states were awarded planning grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) within the HHS, to design a CCBHC program. All 24 states were given the opportunity to apply to participate in the CCBHC demonstration program. Many of the community behavioral health providers in these 24 states made operational and clinical changes in an attempt to fulfill the requirements set forth by the SAMHSA and obtain CCBHC status. However, under federal law, only eight (8) of the 24 states that were awarded a planning grant were selected to participate in the two-year demonstration.
The HHS chose eight (8) states to participate in its demonstration program.
The states that were chosen to participate in the CCBHC two-year demonstration program include:
- New Jersey
- New York
These states must begin their two-year demonstration programs no later than July 1, 2017.
CCBHC Demonstration Is Also Referred to as a Medicaid Demonstration Program
Although the CCBHC program changes the reimbursement a provider receives from Medicaid, the program will also impose new operational and clinical requirements; these new requirements will affect every consumer who receives behavioral health services, not just those consumers who are Medicaid beneficiaries.
Only Certain Behavioral Health Service Providers Are Eligible to Become a CCBHC
The statute that created the CCBHC program has set forth certain requirements that a clinic must meet to become certified. Some community behavioral health providers are already taking steps to become “CCBHC-ready.” These providers are creating new relationships as well as strengthening and formalizing their existing relationships with the social service agencies and other providers within their communities.
For-Profit Organizations and Clinics Are Not Eligible
Despite the fact that privately-owned, for-profit organizations and clinics are not eligible to become a CCBHC, these establishments can still participate by becoming a designated collaborating organization (DCO). To become a DCO, a formal agreement must be created between the for-profit establishment and the CCBHC. Even in the event that the Indian Health Services (IHS) or the local behavioral health authority pays for the services rendered at the clinic, a for-profit clinic is not eligible to become a CCBHC.
For-Profit Organizations and Clinics Can Become DCOs
For-profit organizations that want to become a DCO must meet certain requirements.
These requirements include:
- Scope of Services
The CCBHC criteria require CCBHCs to provide consumers a range of services. While many of the required services must be provided by the certified community behavioral health clinic itself, other services can be provided by a contracted DCO.
- A Formal Relationship Between the CCBHC and the DCO Must Be Created
The formal relationship between the DCO and the CCBHC is critical in that the certified community behavioral clinic is ultimately responsible for all of the care a consumer receives. This is true whether the services are provided by the CCBHC itself or by the DCO. The relationship between these two establishments is considered a contract.
- The CCBHC and DCO Formal Agreement
The formal agreement that is made between the DCO and CCBHC may also be referred to as a Memorandum of Understanding (MOU) or a Memorandum of Agreement (MOA). This agreement should describe the expectations of each party (the DCO and the CCBHC) as well as establish accountability for the services that will be provided. In addition, specifics related to the funding that will be sought and utilized need to be addressed when creating this contract.
Clinics Operated by the State
Since a state-operated clinic is considered a local government behavioral health authority, these clinics are eligible to become a CCBHC. That said, in order to be eligible, a county, locality, state or region must oversee the clinic’s substance use and/or mental health services and provide these services at the clinic itself. Clinics owned and operated by the local behavioral health authority can become a CCBHC as long as it meets the criteria necessary for certification.
A nonprofit organization that has multiple clinics may become a CCBHC. To do so, all of its components must meet the criteria set forth by the HHS. If all of the requirements are not met, the parent organization will not be a certified community behavioral health clinic.
A clinic that is part of a large nonprofit organization can become a CCBHC, and another faction of the same organization can become a DCO. Needless to say, the clinic must meet the requirements set forth by the HHS, and the other faction of the organization must meet the requirements to become a DCO.
For example, a nonprofit organization with only one certified community behavioral health clinic and a state-sanctioned, licensed or certified behavioral health crisis system may apply for the crisis system to become a DCO for its already existing CCBHC. Again, the requirements of this relationship must be satisfied.
Tribal Health Organizations
Tribal health organizations, health centers or clinics may become a CCBHC as long as the organization, center or clinic meets the requirements set forth by the HHS. Furthermore, the facility must be operated under the authority of an Indian tribe, a tribal organization or the IHS in accordance with a contract, cooperative agreement, grant or compact with the IHS (pursuant to the Indian Self-Determination Act). In addition, entities that are funded as Urban Indian Health Centers via a contract or grant from the IHS (under Title V of the Indian Health Care Improvement Act) can become a CCBHC or a DCO.
The CCBHC Contracting and Community Partnerships Toolkit
The National Council for Behavioral Health offers providers the CCBHC Contracting and Community Partnerships Toolkit to assist them as they determine their eligibility to become a CCBHC or DCO. Via this documentation, providers can also learn more about the goals of the CCBHC demonstration.