Implementation Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration. NOTES

09/12/2020

  1. HHS Substance Abuse and Mental Health Services Administration (SAMHSA). "Criteria for the Demonstration Program to Improve Community Mental Health Centers and to Establish Certified Community Behavioral Health Clinics." Rockville, MD: SAMHSA, 2016.

  2. The nine types of services are: (1) crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization; (2) screening, assessment, and diagnosis, including risk assessment; (3) patient-centered treatment planning or similar processes, including risk assessment and crisis planning; (4) outpatient mental health and substance use services; (5) outpatient clinic primary care screening and monitoring of key health indicators and health risk; (6) targeted case management; (7) psychiatric rehabilitation services; (8) peer support and counselor services and family supports; and (9) intensive, community-based mental health care for members of the armed forces and veterans. CCBHCs must provide the first four services directly; the other service types may be provided by a DCO. In addition, crisis behavioral health services may be provided by a DCO if the DCO is an existing state-sanctioned, certified, or licensed system or network. DCOs may also provide ambulatory and medical detoxification in American Society of Addiction Medicine categories 3.2-WM and 3.7-WM.

  3. Nevada initially certified four clinics; however, one is no longer participating in the demonstration. In March 2018, that CCBHC withdrew from the demonstration after Nevada revoked its certification.

  4. CCBHCs submit cost reports within nine months following each demonstration year. CMS provided CCBHCs with a cost-reporting template. This report does not contain findings based on data from these cost reports, but, where noted, some of the definitions and terminology used in this report align with definitions and terms from the CMS cost-reporting template.

  5. HHS Substance Abuse and Mental Health Services Administration (SAMHSA). "Criteria for the Demonstration Program to Improve Community Mental Health Centers and to Establish Certified Community Behavioral Health Clinics." Rockville, MD: SAMHSA, 2016.

  6. The nine types of services are: (1) crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization; (2) screening, assessment, and diagnosis, including risk assessment; (3) patient-centered treatment planning or similar processes, including risk assessment and crisis planning; (4) outpatient mental health and substance use services; (5) outpatient clinic primary care screening and monitoring of key health indicators and health risk; (6) targeted case management (TCM); (7) psychiatric rehabilitation services; (8) peer support and counselor services and family supports; and (9) intensive, community-based mental health care for members of the armed forces and veterans. CCBHCs must provide the first four service types directly; a DCO may provide the other service types. In addition, crisis behavioral health services may be provided by a DCO if the DCO is an existing state-sanctioned, certified, or licensed system or network. DCOs may also provide ambulatory and medical detoxification in American Society of Addiction Medicine (ASAM) categories 3.2-WM and 3.7-WM.

  7. CCBHCs submit cost reports within nine months following each demonstration year. CMS provided CCBHCs with a cost-reporting template. This report does not contain findings based on data from these cost reports, but, where noted, some of the definitions and terminology used in this report align with definitions and terms from the CMS cost-reporting template.

  8. Nevada initially certified four clinics; however, one is no longer participating in the demonstration. In March 2018, shortly after we collected the first round of progress reports, this CCBHC withdrew from the demonstration after Nevada revoked its certification.

  9. In one state, we conducted separate interviews for each group of state officials--one with behavioral health officials and one with Medicaid officials per the state's preference.

  10. We selected these states based on their geographic diversity, use of different PPS options (i.e., PPS-1, PPS-1 with QBPs, and PPS-2), and because we are including these states in the evaluation's claims analysis.

  11. In cases in which a CCBHC is unable to employ a psychiatrist as medical director (e.g., because of a documented behavioral health professional shortage in its vicinity), the criteria specify that "a medically trained behavioral health care provider with appropriate education and licensure with prescriptive authority in psychopharmacology who can prescribe and manage medications independently pursuant to state law" may serve as a CCBHC medical director.

  12. HHS Substance Abuse and Mental Health Services Administration (SAMHSA). "Criteria for the Demonstration Program to Improve Community Mental Health Centers and to Establish Certified Community Behavioral Health Clinics." Rockville, MD: SAMHSA, 2016.

  13. To align with the terminology included in the CCBHC cost-reporting template, the mental health professional category in the progress report included only those trained and credentialed for psychological testing.

  14. The CCBHC PPS does not cover transportation services; rather, clinics may have worked to assist clients with obtaining and using the separate Medicaid transportation benefit if it was offered by the state and the client was eligible.

  15. States are unable to bill Medicaid for incarcerated or justice involved individuals, and services delivered to incarcerated individuals were not approved under this demonstration. However, clinics may have elected to provide telehealth services to incarcerated individuals without billing Medicaid.

  16. CCBHCs may engage DCOs to provide primary care screening and monitoring; TCM; psychiatric rehabilitation services; peer support services and family support services; and services for members of the armed services and veterans. In addition, a DCO may provide crisis behavioral health services if the DCO is an existing state-sanctioned, certified, or licensed system or network. DCOs may also provide ambulatory and medical detoxification in ASAM categories 3.2-WM and 3.7-WM.

  17. Community mental health liaisons, who are employed by clinics (including CCBHCs), work closely with the criminal justice system (including courts, police) to help direct consumers into behavioral health care.

  18. The ECHO model is a hub-and-spoke model that links expert specialist teams at a "hub" with providers and clinicians in local communities--the "spokes" of the model.

  19. High acuity typically refers to consumers with acute (active) disorders that require substantial amounts of care.

  20. This seemingly contradictory finding may reflect the fact that the questions in the progress reports about specific treatment team members capture information only at each time point rather than fluctuations in these specific team members over the past 12 months.