CCBHCs provide, in a manner reflecting person-centered care, the following services:
CCBHCs also provide directly, or through referral with DCOs, the following services:
A hallmark of this demonstration program is its capacity to offer recipients a comprehensive range of high-quality services, delivered directly by the CCBHC or through DCOs. Recognizing the inherent complexity of providing such a range, states were permitted flexibility in aligning the scope of services with their Medicaid State Plans and other state regulations. Requirement 4 also calls for the continuous integration of evidence-based practices (EBPs).
|Demonstrating the spectrum of whole-person health care, clients participate in services at Grand Lake Mental Health Center, Inc., a CCBHC serving rural populations of Oklahoma.|
Eighty-four percent of CCBHCs made changes to the range of services they provide. They most often added services within the categories of outpatient MH/SUD services, psychiatric rehabilitation services, and crisis behavioral health services. (See Figure G.) Responding to a write-in question on the progress report, CCBHCs reported providing "other" CCBHC services, including emergency room enhancement services, CMHLs, and withdrawal management services.
|FIGURE G. Proportion of CCBHCs that added Services within Each Service Category as a Result of Certification|
|NOTE: CCBHCs may have provided services within each of the service categories illustrated in Figure G prior to CCBHC certification. For example, all CCBHCs provided some type of outpatient mental health and/or SUD treatment prior to certification. However, 63 percent of CCBHCs added some type of outpatient mental health and/or SUD treatment as a result of certification. The service categories illustrated in this figure correspond to the service categories described in the CCBHC certification criteria.|
Table 7 presents the availability of services in CCBHCs and DCOs. 24-hour mobile crisis teams and MAT for alcohol and opioid use are the services most often added as a result of CCBHC certification. Eighty-four percent of CCBHCs provide MAT for alcohol and opioid use; among the 11 CCBHCs that did not provide MAT either directly or through a DCO, nine had either a formal (four) or informal (five) relationship with a MAT provider.
In addition to MAT, other services frequently added because of certification include targeted case management (40 percent) and illness management and recovery (31 percent). State officials attributed variability in the proportion of CCBHCs providing certain EBPs (e.g., MAT, multi-systemic therapy, assertive community treatment, supported education) to a combination of perceived population needs, state priorities and ongoing state initiatives, and workforce shortages.
|TABLE 7. Required Services Provided by CCBHCs and/or DCOs|
|DCO Provided Service||Either CCBHC and/or
DCO Provided Service[a]
|Added as a Result
of CCBHC Certification
|Crisis behavioral health services|
|24-hour mobile crisis teams||49||73||23||34||65||97||31||46|
|Emergency crisis intervention||59||88||20||30||67||100||21||31|
|Screening, assessment, and diagnosis|
|Person/family-centered treatment planning services||66||99||5||7||66||99||12||18|
|Outpatient mental health and/or SUD services|
|First episode/early intervention for psychosis||40||60||0||0||40||60||9||13|
|MAT for alcohol and opioid use[b]||55||82||2||3||56||84||31||46|
|Outpatient SUD treatment||67||100||0||0||67||100||13||19|
|Specialty MH/SUD services for children and youth||58||87||0||0||58||87||15||22|
|Community wraparound services for youth/children[b]||50||75||2||3||51||76||10||15|
|Psychiatric rehabilitation services|
|Illness management and recovery||62||93||4||6||65||97||21||31|
|Wellness education services (diet, nutrition, exercise, tobacco cessation, etc.)||65||97||6||9||67||100||24||36|
|Peer support services|
|Targeted case management||62||93||1||1||63||94||27||40|
|Primary care screening and monitoring||63||94||3||4||65||97||28||42|
|Community-based mental health care for armed forces and veterans||47||70||1||1||48||72||30||45|
To facilitate crisis planning, CCBHCs used best practices such as psychiatric advance directives, and safety/crisis plans, as presented in Table 8. "Other" strategies listed include suicide assessments such as the Columbia Suicide Severity Rating Scale (C-SSRS), relapse prevention and planning, critical intervention planning, and working with external partners and stakeholders to provide patient-centered services in crisis planning.
|TABLE 8. Number and Proportion of CCBHCs using Specific Crisis Planning Strategies|
|Wellness recovery action plan||49||73|
|Psychiatric advance directives||46||69|
|Develop a safety or crisis plan||29||43|
State officials described overcoming the following initial barriers to implementing a full scope of services:
State credentialing and licensure requirements. State officials worked with state licensure offices and CCBHCs to obtain licensure for certain required services (e.g., ambulatory withdrawal management [AWM]) or hiring staff with the credentials necessary to provide required services (e.g., peer support).
Workforce shortages. As noted previously, several states experienced challenges in recruiting and hiring certain types of staff, such as peer support staff in rural areas. Strategies to attract and retain employees included offering competitive salaries and leveraging professional networks within the state to advertise CCBHC positions.
Inexperience in providing specific services to certain populations. CCBHCs in some states were required to add new service lines, to fulfill demonstration criteria. CCBHCs in other states needed to expand certain services to new populations, such as youth in order to become a CCBHC.
Billing and claims/encounter data. States supported CCBHCs in administering PPS claims and recording encounters during the planning phase and the initial months of the demonstration. In the March 2018 interviews, officials from all states reported that the CCBHCs were using the systems they had put in place, the payment and encounter information was being appropriately recorded and submitted, and the PPS claims were being paid. However, most state officials also noted that they have not yet conducted detailed audits, so early impressions are subject to change. For instance, detailed audits of the data would be required to identify gaps in the encounter data or systematic errors in PPS claims.