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Certified Community Behavioral Health Clinics (CCBHC) March 2014 Congress passed the Protecting Access to Medicare Act (H.R. 4302) Included Excellence in Mental Health Act – an eight state demonstration project and the single largest investment in community behavioral health in more than 50 years (approximately $1.1Billion)

Certified Community Behavioral Health Clinics (CCBHC) What does the act accomplish? Gave behavioral health clinics a federal definition with defined quality standards and reimbursement that reflects cost of care Created criteria for Certified Community Behavioral Health Clinics (CCBHCs) Provides $25,000,000 in planning grants for states to develop applications for 2-year demonstration pilot

Certified Community Behavioral Health Clinics (CCBHC) Texas House Bill 1, 84th Regular Session, Article II, HHSC: Rider 79. Excellence in Mental Health. Out of funds appropriated above, the Health and Human Services Commission shall develop and submit an application to Centers for Medicare and Medicaid Services for an Excellence in Mental Health planning grant as authorized in the Protecting Access to Medicare Act (H.R. 4302). It is the intent of the Legislature that applying for the grant and participation in a pilot will be cost neutral to the state and that the principles of the grant are consistent with Commission’s value based payment strategies.

Certified Community Behavioral Health Clinics (CCBHC): Planning Grant Phase I: One-Year Planning Grants Texas was one of 24 states awarded a planning grant ($982,373) Program proposal for Demonstration Grant due to SAMHSA by October 23, 2016

Certified Community Behavioral Health Clinics (CCBHC): Planning Grant Two Key Planning Grant Activities: CCBHC Readiness and Certification Development of a Prospective Payment System (PPS) for Medicaid Clients

Certified Community Behavioral Health Clinics (CCBHC): Planning Grant Texas will focus on four key populations who would benefit from CCBHC model: Children/youth with mental health issues Children/youth with substance use disorders Adults with mental health issues Adults with substance use disorders

Certified Community Behavioral Health Clinics (CCBHC): Planning Grant Activities Certification of Clinics: Must offer services to all clients – regardless of payer or age Must be not-for-profit, local mental health authorities or Indian Health Service Minimum of 2 clinics must be selected in Texas (at least 1 rural and 1 urban) Control group must be identified Must participate in data collection up to 3 years post demonstration

Certified Community Behavioral Health Clinics (CCBHC): Required Services CCBHC must directly provide the following: Crisis Mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization Screening, assessment and diagnosis including risk management Patient-centered treatment planning Outpatient mental health and substance use services

Certified Community Behavioral Health Clinics (CCBHC): Required Services CCBHC must provide either directly or through Designated Collaborating Organization(DCO) the following: Primary Care Screening & Monitoring Targeted Case Management Psychiatric Rehabilitation Services Peer support, counseling services, and family support services Services for members of the armed services and veterans Connections with other providers and systems

Certified Community Behavioral Health Clinics (CCBHC): Why Required Services Defined Comprehensive array necessary to create access, stabilize people in crisis, and provide the necessary treatment for those with the most serious, complex mental illnesses and addictions. Approach to health care that emphasizes recovery, wellness, trauma-informed care, and physical-behavioral health integration.

Certified Community Behavioral Health Clinics (CCBHC): Prospective Payment System (PPS) Certification of Clinics: Monthly payment rate – to be adopted by partnering MCOs Payment for different populations Service bundles will build off Texas Resiliency and Recovery model Outlier payments may be required Quality bonus payment is required – upside bonus

Certified Community Behavioral Health Clinics (CCBHC): Prospective Payment System (PPS) Certification of Clinics: Service are reimbursed to Texas at enhanced (CHIP) FMAP during the demonstrations phase Regular FMAP 2017 56.18% Enhanced FMAP 2017 69.33% Provides a waiver for Medicaid state plan authority to implement payment and services expansion

Certified Community Behavioral Health Clinics (CCBHC): Center Required Reporting Measures Measure or Other Reporting Requirement National Quality Forum Measure (# if endorsed) Number/Percent of clients requesting services who were determined to need routine care N/A Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients Mean number of days before the comprehensive person-centered and family centered diagnostic and treatment planning evaluation is performed for new clients Number of Suicide Deaths by Patients Engaged in Behavioral Health (CCBHC) Treatment Documentation of Current Medications in the Medical Records 0419 Patient experience of care survey Family experience of care survey Preventive Care and Screening:  Adult Body Mass (BMI) Screening and Follow-up 0421

Certified Community Behavioral Health Clinics (CCBHC): Center Required Reporting Measures Measure or Other Reporting Requirement National Quality Forum Measure (# if endorsed) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) 0024 Controlling High Blood Pressure - Adult 0018 Preventive Care & Screening:  Tobacco Use:  Screening & Cessation Intervention 0028 Preventive Care and Screening:  Unhealthy Alcohol Use:  Screening and Brief Counseling 2152 Initiation and engagement of alcohol and other drug dependence treatment - Adult 0004 Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment 1365 Adult major depressive disorder(MDD):  Suicide risk assessment 0104 Screening for Clinical Depression and Follow-Up Plan – Adult 0418 Depression Remission at 12 months 0710

Certified Community Behavioral Health Clinics (CCBHC): Potential Quality Bonus Measures Measure or Other Reporting Requirement National Quality Forum Measure (# if endorsed) Follow-Up After Hospitalization for Mental Illness (Adult NCQA/HEDIS Follow-Up After Hospitalization for Mental Illness (child/adolescents) Adherence to Antipsychotics for Individuals with Schizophrenia Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Adult Major Depressive Disorder (MDD):  Suicide Risk Assessment AMA-PCPI Child and Adolescent Major Depressive Disorder (MDD):  Suicide Risk Assessment Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication Screening for Clinical Depression and Follow-Up Plan CMS Antidepressant Medication Management

Certified Community Behavioral Health Clinics (CCBHC): Demonstration Grant Phase II: Selection of States SAMHSA will select up to eight states to carry out their CCBHC projects Demonstration project grants will fund the selected CCBHCs for at least two years Demonstration would begin Early 2017

The Principles of CCBHC Apply to All of the Behavioral Health Industry