New Federal Funding Will Help States Improve Behavioral Health Care

This piece is co-authored by Jessica Casebolt and Mindy Klowden

States have a historic opportunity to significantly increase access to high-quality behavioral health care. On October 18, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a new funding opportunity for cooperative agreements with states interested in planning to expand the Certified Community Behavioral Health Clinic (CCBHC) model. The purpose of the CCBHC Planning Grants is to support states develop certification systems for CCBHCs, establish a payment model that enables state Medicaid programs to pay behavioral health providers through a prospective payment system that is based on what it costs to care for a client, and prepare an application to participate in a four-year CCBHC demonstration program.

The CCBHC model was first introduced federally under Section 223 of the Protecting Access to Medicare Act (PAMA) of 2014 (Public Law 113-93) to provide a robust range of mental health and substance use disorder (SUD) services to vulnerable individuals. The CCBHC model was initially implemented in eight states through the Medicaid demonstration project and has since expanded to two additional states, with hundreds of other CCBHCs supported through SAMHSA grants. States participating in the demonstration receive an enhanced federal match for up to four years and can make their state certification process permanent through a State Plan Amendment.

Similar to federally qualified health centers (FQHCs), CCBHCs are required to provide a federally defined array of services, emphasizing the utilization of evidence-based practices. Additionally, CCBHCs must serve all clients regardless of their ability to pay and adhere to rigorous, uniform data collection requirements that demonstrate value.

An expansion of the CCBHC demonstration could not have come at a better time. The need for behavioral health services is greater now than ever before. Late last year U.S. Surgeon General Dr. Vivek Murthy issued an advisory on the youth mental health crisis exposed by the COVID-19 pandemic.

As discussed in the Washington Post, psychiatry wait lists are at record levels. Furthermore, drug overdose deaths in the U.S. reached record levels during the pandemic and remain near record levels. According to provisional data by the Centers for Disease Control and Prevention (CDC), more than 109,000 people died of a drug overdose in the 12 months ending March 2022 – a 44 percent jump from two years earlier, when there were about 76,000 deaths reported in the 12 months ending in March 2020.

The 2022 CCBHC Impact Report released by the National Council for Mental Wellbeing (National Council) provides essential data on how implementing the services required under CCBHC improves care delivery in behavioral health across the country.

The report found that CCBHCs are expanding access to care and reducing wait times for services. It cites that as of August 2022, an estimated 2.1 million people are served nationwide by all 450 CCBHCs and grantees, representing an increase of about 600,000 clients compared to the estimated total number of individuals served by all CCBHCs in 2021. On average, CCBHCs and grantees serve over 900 more individuals per clinic than before CCBHC implementation, a 23 percent increase.

The National Council report also found that almost 90 percent of CCBHCs report seeing patients for routine needs within ten days of the initial call or referral, with 71 percent offering access within one week or less. In contrast, the national average is 48 days between a client’s first outreach or referral before their first appointment.

CCBHCs’ ability to get people in need into care more quickly may be attributable to the fact that CCBHCs can attract and retain a qualified behavioral health workforce, given the enhanced funding. The National Council estimated 11,240 new staff positions were added across all 450 active CCBHCs and grantees active as of August 2022.

The report also describes other impacts of CCBHCs, including the expanded availability of Medication-Assisted Treatment for opioid use disorder, better coordination and integration with primary care, expansion of crisis response services, and reduced health disparities.

Through our consulting work with many CCBHCs across the country and as a subcontractor for the CCBHC-E Training and Technical Assistance Center, we have observed that the emphasis on quality and uniform data standards results in clinics becoming more data-informed in their clinical decision-making. We also found that the CCBHC model has an impact on organizational culture as clinics move towards being more integrated in terms of providing comprehensive mental health and SUD services and screening for chronic health conditions and connecting clients to primary care.

CCBHCs admittedly do not solve for all behavioral health needs. The CCBHC model is entirely an outpatient model of care and therefore does not replace the need for inpatient and residential services. Furthermore, while clinics are required to see all community members in need regardless of payer source, the CCBHC Demonstration is ultimately a Medicaid program. Hence, states and the federal government still need to bolster parity enforcement and ensure adequate payment models and provider networks within commercial insurance and Medicare. With that said, the CCBHC model is one of the most evidence-based approaches we have in the field today to help prevent people with mental health and SUD from needing higher levels of care and support the development and sustainability of services at the local community level. There is ample flexibility for states to align the CCBHC model with other state-led behavioral health and Medicaid initiatives while providing a federally defined scope of services and rigorous standards to achieve improved behavioral health outcomes.

We urge all states to apply for the planning grants and work with providers, associations, and consumers to design and implement CCBHC nationwide.