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Certified Community Behavioral Health Clinic (CCBHC)

The Excellence in Mental Health Act demonstration established a federal definition and criteria for Certified Community Behavioral Health Clinics (CCBHCs). These entities, a new provider type in Medicaid, are designed to provide a comprehensive range of mental health and substance use disorder services to vulnerable individuals. In return, CCBHCs receive an enhanced Medicaid reimbursement rate based on their costs of expanding services to meet the needs of these complex populations.

CCBHCs represent an opportunity for states to improve the behavioral health of their citizens by: providing community-based mental and substance use disorder services; advancing integration of behavioral health with physical health care; assimilating and utilizing evidence-based practices on a more consistent basis; and promoting improved access to high quality care. Care coordination is the linchpin holding these aspects of CCBHC care together and ensuring high quality care and improved outcomes.

Overview

The Excellence in Mental Health Act demonstration established a federal definition and criteria for Certified Community Behavioral Health Clinics (CCBHCs). These entities, a new provider type in Medicaid, are designed to provide a comprehensive range of mental health and substance use disorder services to vulnerable individuals. In return, CCBHCs receive an enhanced Medicaid reimbursement rate based on their costs of expanding services to meet the needs of these complex populations.

On April 1, 2014 the Protecting Access to Medicare Act of 2014 (H.R. 4302) was enacted, laying the groundwork for the establishment of Certified Community Behavioral Health Clinics or CCBHCs. CCBHCs are a comprehensive community behavioral health provider that provides an opportunity to improve the behavioral health system by increasing access to high quality, integrated care.

In October of 2016 the State of Oklahoma was awarded a one-year planning grant from SAMHSA and CMS to develop a proposal and program demonstration for the provision of CCBHC. The State of Oklahoma was successful in the planning grant period. Oklahoma submitted a proposal and was one of eight states awarded a two-year demonstration grant starting in 2017. Oklahoma began CCBHC with three providers as part of the demonstration. As the end of the demonstration drew near, Oklahoma was able to obtain a State Plan Amendment (SPA) through CMS in 2019 to continue to expand CCBHC services in the state.

CCBHC represent an opportunity for states to improve the behavioral health of their citizens by: providing community-based mental and substance use disorder services; advancing integration of behavioral health with physical health care; assimilating and utilizing evidence-based practices on a more consistent basis; and promoting improved access to high quality care. Care coordination is the linchpin holding these aspects of CCBHC care together and ensuring high quality care and improved outcomes.

CCBHCs must provide a broad array of services and care coordination across settings and providers on a full spectrum of health, including acute, chronic, and behavioral health needs. The CCBHC model of care requires integrating mental health, substance use disorder, and physical health.

 

 The purpose of Oklahoma CCBHCs is to:

  1. provide easy access to integrated services for all individuals regardless of pay source or ability to pay;
  2. provide a full array of mental health and substance use disorder services available in every certified location, and provide, or coordinate with, primary care services;
  3. provide quality driven services as demonstrated through data reports and outcomes reports generated by the ODMHSAS or its contractor; and
  4. provide enhanced integration and coordination of mental health, primary, and substance use disorder services and supports for persons across the lifespan. Services and supports will be delivered utilizing an interdisciplinary, team-based approach.

To ensure enhancement of current behavioral health system, CCBHCs must adhere to the following values and core principles of services.

  • Coordination and Collaboration 
  • Accessible and Available 
  • Evidenced Based 
  • Person Centered Care 
  • Family Driven Care 
  • Recovery Oriented 
  • Trauma Informed 
  • Data Driven

Services

CCBHCs provide a comprehensive collection of services needed to create access, stabilize people in crisis and provide the necessary treatment for those with the most serious, complex mental illnesses and substance use disorders. CCBHCs integrate additional services to ensure an approach to health care that emphasizes recovery, wellness, trauma-informed care and physical-behavioral health integration. Comprehensive care includes, but is not limited to, the following required services:

  1. Crisis Services
  2. Screening, Assessment and Diagnosis
  3. Physical Healthcare Screening and Monitoring
  4. Comprehensive Integrated Care Planning
  5. Mental Health and Substance Use Outpatient Services
  6. Targeted Case Management
  7. Psychiatric Rehabilitation
  8. Peer & Family Support Services
  9. Veterans Services

 

Required Activities:

  1. Care Coordination
  2. Outreach
  3. Integrated Care
  4. Health Promotion
  5. Housing & Employment

Prospective Payment System (PPS)

The State uses a Prospective Payment System (PPS) for services delivered by a CCBHC. PPS is a cost-based, per clinic monthly rate that applies uniformly to all CCBHC services rendered by a certified clinic. CCBHC payment is based on an individual clinic’s expected cost of care. The PPS is paid when a CCBHC delivers at least one (1) CCBHC covered service, and when a valid individual procedure code is reported for the calendar month.

Rate Updates 

Provider specific monthly rates will be updated annually by the Medicare Economic Index to reflect changes due to inflation. ODMHSAS will review cost reports bi-annually to determine rate adequacy.

Providers

Quality Measures

Time to Initial Evaluation

Preventive Care: Body Mass Index Screening & Follow Up 

Body Mass Index Assessment for Children/Adolescents

Preventive Care: Tobacco Use: Screening & Cessation Intervention 

Preventive Care: Unhealthy Alcohol Use: Screening & Brief Counseling

Screening for Clinical Depression and Follow-Up Plan 

Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

Adult Major Depressive Disorder : Suicide Risk Assessment 

Depression Remission at Twelve Months

Patient Experience of Care Survey 

Youth/Family Experience of Care Survey

Follow-up After Emergency Department Visit for Mental Illness 

Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence

Plan All-Cause Readmissions Rate 

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications 

Adherence to Antipsychotic Medications for Individuals with Schizophrenia

Follow-Up After Hospitalization for Mental Illness 

Follow-Up after Hospitalization for Mental Illness

Follow-Up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder Medication 

Antidepressant Medication Management


Contact Us

Malissa McEntire

Manager of Integrated Care

Last Modified on Aug 14, 2019