Certified Community Behavioral Health Clinic (CCBHC) Overview and Discussion Mary Duffy, LCSW Bluebonnet Trails Community Services Jolene Rasmussen, MS Texas Council of Community Centers

Federal CCBHC Legislation Excellence in Mental Health Act (2013-2014) Purpose to increase Americans’ access to community mental health and substance use treatment services via CCBHCs while improving Medicaid reimbursement for these services Planning grant 1-year Demonstration program – 2-year; 8 states (Minnesota, Missouri, New Jersey, New York, Nevada, Oklahoma, Oregon and Pennsylvania) Excellence in Mental Health and Addiction Treatment Expansion Act (2017-2018) Expand and extend CCBHC pilot program 11 additional states that submitted applications in 2016 6 billion dollars total; 2 billion for CCBHC

CCBHC in Texas HHSC continues to promote CCBHC with implementation of Texas CCBHC Pilot Eight certified sites (Bluebonnet Trails, Burke, Helen Farabee, Integral Care, Montrose Center, StarCare, Tarrant MHMR and Tropical Texas) Currently, CCBHC model without associated CCBHC payment structure Beginning September 1, 2018, payment structure changes Statewide expansion Based on applications received during Planning Grant, the next group of sites eligible to pursue certification are the Center for Health Care Services, Community Healthcore, Emergence, Harris Center and Memorial Hermann Overall roll-out strategy is yet to be determined

CCBHC and Managed Care The language for CCBHC and VBP are in the cover pages for the 17 MCOs as part of the March 2018 amendment. MCOs participating in CCBHC must: Reimburse for CCBHC services (as designated by the State) using a value based payment methodology agreed upon by the MCO and the Center, and reported to HHSC in writing. Value based payments must begin no later than September 1, 2018; Continue monitoring and management of all potentially preventable event measures; Adjust prior authorization requirements for behavioral health services provided by pilot sites. These updates will be identified in CCBHC project documents; Engage with CCBHC pilot sites for care coordination, quality measure discussions, and development of a value based payment structure to be employed after the two-year demonstration period; and Comply with the requirements outlined in the CCBHC Operational Protocol.

Timing is Everything

CCBHC Statewide HHSC moves forward with CCBHC statewide expansion Based on applications received during the Planning Grant, the next group of sites eligible to pursue certification are the Center for Health Care Services, Community Healthcore, Emergence, Harris Center and Memorial Hermann Overall roll-out strategy is yet to be determined Open to entities able to meet CCBHC criteria CCBHC is one part of 1115 Waiver Adult Mental Health Amendment strategy under consideration by the Centers’ Executive Directors MCO-directed payments Provision that Centers are eligible to become a CCBHC, regardless of other CCBHCs in same service area

There are only two things I don’t like: Change and the way things are.

Why ccbhc? Benefits of and support for the CCBHC model of care: State certification Uniform services and evidenced-based practices Emphasis on care coordination Integration of mental health and substance use services Standardized quality measures Cost-based payment methodology Trauma-informed, person-centered, recovery oriented care Continued support by CMS and SAMHSA Aligns with HHSC’s Behavioral Health Strategic Plan

What are the Ccbhc services? Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization* Screening, assessment and diagnosis including risk assessment* Patient-Centered treatment planning or similar processes, including risk assessment and crisis planning* Outpatient mental health and substance use services* Outpatient clinic primary care screening and monitoring of key health indicators and health risk** Targeted case management** Psychiatric rehabilitation services** Peer support and counselor services and family supports** Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration** *CCBHC must directly provide **May be proved by CCBHC and/or DCO

Which Evidenced-based Practices? Texas includes the following EBPs: Cognitive Behavioral Therapy (CBT) Nurturing Parenting Cognitive Processing Therapy (CPT) Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Assertive Community Treatment (ACT) Team Intensive Case Management Using Wraparound Model Illness Management and Recovery (IMR) SAMHSA Supported Employment (Individual Placement and Support) Screening, Brief Intervention, and Referral to Treatment (SBIRT) Model SAMHSA Supported Housing Motivational Interviewing SAMHSA Integrated Treatment for Co-Occurring Disorders Person-Centered Recovery Planning Seeking Safety

Next Steps – New Incubator Strategy

Seven Centers began the CCBHC journey...

Panel questions Why did you decide to pursue the CCBHC model even without being part of the pilot? Benefits, long term goals? (Emergence Health Network) What are the most challenging aspects of the pilot? What changes have you implemented? (Burke) How does the CCBHC model support MH and SU integration and why is this important? What changes have you made? (Helen Farabee Centers) What are the financial implications for CCBHC VBP contracting with MCOs? (Integral Care) What operational efficiencies will be necessary related to staffing and service utilization? (Bluebonnet Trails Community Services) What changes will be necessary to meet the care coordination requirements including staffing? (Tropical Texas Behavioral Health) Do you anticipate changes to peer and/or recovery coach services as a CCBHC? (MHMR Tarrant) Are veteran’s services different for a CCBHC? (StarCare Specialty Health System)

The future…

Open questions and Discussion As your journey begins…