Certified Community Behavioral Health Clinics: Increasing Access to Behavioral Health Care

Three of the biggest challenges facing behavioral health care right now are cost, access and coordination. Individuals often don’t receive the treatment they need because of the high cost, the lack of accessibility and the lack of coordination between health care providers.

In 2014, the bipartisan Excellence in Mental Health Act was enacted in an attempt to level these barriers. It laid the groundwork for “largest single investment in community-based metal health in well over a generation,” according to the National Council for Behavioral Health.

The Excellence in Mental Health Act essentially did three things. First, it established federal status and criteria for certified community behavioral health clinics (CCBHCs), which provide comprehensive behavioral health services for individuals who need it most. Second, it requires CCBHCs to partner with other health services, such as law enforcement, hospitals and V.A. centers, creating a coordinated delivery system of health care. Finally, it requires states to develop a prospective payment system (PPS), which would reimburse CCBHCs for their services based on providers’ actual costs. This means that the services provided by CCBHCs come at no cost to individuals, even if they are not included in the state’s Medicare plan (National Council for Behavioral Health).

Right now, 24 states have been awarded $22.9 million in federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) under the Excellence in Mental Health Act. These states are currently in a one-year planning period. When the planning period ends in October 2016, eight of these states will have the opportunity to apply to participate in a two-year demonstration program, which will begin in January 2017 (National Council for Behavioral Health).

According to the Excellence in Mental Health Act, CCBHCs are “designed to provide a comprehensive range of mental health and substance use disorder services, particularly to vulnerable individuals with the most complex needs during a federal demonstration program with participating states.”

CCBHCs are required to directly provide screening, assessment and diagnosis, patient-centered treatment planning, outpatient mental health and substance use services, as well as crisis mental health services, including but not limited to 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization.

CCBHCs are also required to provide, either directly or through a designated collaborating organization (DCO), primary care screening and monitoring, targeted case-management, psychiatric rehabilitation services, peer support, counseling services, family support services, services for veterans and members of the armed services and connection with other providers and systems, such as the criminal justice and foster care systems (National Council for Behavioral Health).

During the two-year demonstration, CCBHCs will be reimbursed for all of these services through the state’s prospective payment system (National Council for Behavioral Health).

According to the Protecting Access to Medicare Act (PAMA), only certain organizations can become a CCBHC. According to SAMHSA, in order to become a CCBHC, an organization must be one of the following:

  • A nonprofit
  • Part of a local government behavioral health authority
  • An “entity operated under authority of the Indian Health Service (IHS), an Indian tribe, or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the IHS pursuant to the Indian Self-Determination Act”
  • An “entity that is an urban Indian organization pursuant to a grant or contract with the IHS under Title V of the Indian Health Care Improvement Act”

Private, for-profit clinics or organizations cannot be a CCBHC, but they can become designated collaborating organizations (DCOs), in which they would enter into a formal agreement with a CCBHC to provide certain services (SAMHSA).

According to SAMHSA, CCBHCs “are encouraged to use telemedicine to expand access to services and alleviate workforce shortages.”

Telemedicine and CCBHCs

The purpose of CCBHCs—and the Excellence in Mental Health Act, at large—is to make behavioral health more accessible to those who most need it. Telemedicine can help bring more qualified behavioral health care providers to individuals.

Telemedicine practices cannot become a CCBHC, because most are private practices that do not offer the wide range of services required of CCBHCs. However, telemedicine practices can enter into a contract with a CCBHC to offer certain services, such as counseling, and become a DCO.

By becoming a DCO in partnership with a CCBHC, telemedicine practices can help alleviate the stress on staff in a CCBHC and provide quality care to more patients.

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