The Certified Community Behavioral Health Clinic (CCBHC) model – one of the nation’s biggest investments in expanding and sustaining behavioral health services, according to some experts – is at a critical chapter in its story.
Broadly, a CCBHC is a specially designated clinic that offers a range of behavioral health services, from mental health crisis teams and screenings, to substance use disorder (SUD) treatment and psychiatric rehabilitation. The Protecting Access to Medicare Act of 2014 paved the way for CCBHCs to launch in eight demonstration states in 2017, and, now, the recently passed Bipartisan Safer Communities Act is enabling its nationwide expansion.
“That act expanded the existing CCBHC Medicaid demonstration program and allowed the opportunity for new states to sign on, as well as extended the demonstration program for existing states who are currently working within that model,” Kristan McIntosh, a principal at the research and consulting firm Health Management Associates (HMA), said during a Thursday webinar. “So [that’s] very exciting.”
Among CCBHCs, there are the original demonstration programs plus other state-run CCBHC programs. A third bucket are those operated by nonprofit providers via CCBHC expansion grants.
Starting this fall as part of a competitive two-step process, states that weren’t part of the initial eight-state demo can apply for a planning grant. If selected, those states can then apply to join a separate 10-state CCBHC demonstration that starts in July 2024.
While current demo states aren’t eligible for the new planning grants, officials from both the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as the U.S. Centers for Medicare & Medicaid Services (CMS) have suggested they’ll be able to add new CCBHCs to their existing initiatives, according to Rebecca Farley-David, a senior advisor at the National Council for Mental Wellbeing.
The bottom line: The increasingly popular CCBHC concept is about to get even more momentum behind it.
“This program began as an eight-state demonstration in 2017 with 66 certified clinics,” Farley-David said during the webinar. “And based on the very early outcomes, the very quick outcomes that program started to achieve, the interest in CCBHCs has absolutely ballooned over time – and become a true national movement, I would say.”
By the numbers: CCBHC growth
In many ways, the growth of the CCBHC model in the U.S. is truly staggering.
In 2017, there were just 66 CCBHCs scattered across the initial state participants. Over the next two years, that number climbed to 101 in 2018 and 113 in 2019.
That’s when CCBHCs really began to take off.
In 2020, the number of clinics in the U.S. jumped to 224 – nearly doubling over the prior year. That pace kept up going into 2021, with the group of CCBHCs hitting 430.
This year, there are more than 500 CCBHCs operating across the country, with the only states lacking programs being North Dakota, South Dakota, South Carolina and Virginia. Puerto Rico and Washington, D.C., both have a CCBHC presence as well.
“Nearly every state around the nation either has at least one CCBHC grantee, or has implemented or is considering implementing the model as part of their state Medicaid program,” Farley-David explained.
The number of CCBHCs is destined to climb in 2023, again, partly thanks to the Bipartisan Safer Communities Act. With promising results from existing programs and policy support, one of the only factors slowing growth is the overarching staffing shortages that plague all of health care.
“The workforce shortages – I’m sure everybody, you know, can speak to that,” CCBHC expert Amy Kanouse said during the webinar. “But it’s really kind of hindered the growth, and universally, that’s the biggest challenge that we hear from the clinics, too, that they are just having a terrible time recruiting and retaining staff. And it’s really kind of impacting their ability to grow, serve and provide the services the CCBHC [model] requires.”
An inside look: Michigan and New York
Kanouse has been working with the Michigan Department of Health and Human Services to grow the state’s CCBHC efforts. During the webinar, she was joined by behavioral health innovation specialist Lindsey Naeyaert, who also works within Michigan’s health department.
Meanwhile, New York’s CCBHC scene was represented by Bob Blaauw, program manager for New York’s CCBHC project team, and Nicole Haggerty, an official with the state’s Office of Mental Health.
Collectively, the CCBHC leaders provided an inside look at the trends, challenges and opportunities associated with growing the model from the ground up.
Michigan – which boasts a senator that helped write CCBHC legislation in Sen. Debbie Stabenow, a Democrat – applied to be an original CCBHC demonstration state back in 2016, but it wasn’t selected. It was added and authorized in August 2020.
New York launched its demo in July 2017.
During its CCBHC experience, New York has seen improvements in integrated and rapid-response care. Additionally, it has seen CCBHC’s value in addressing comorbid physical health conditions, Haggerty said.
“CCBHC really aligns with our overall efforts to improve integrated care. That is a very intentional aspect of this model that we’ve learned a lot about,” she noted. “Also, improving rapid access to care, so that individuals get what they need, when they need it – right away. I think that’s critical and something we’ve been continuing to work towards.”
Although it’s newer to CCBHC, Michigan has made similar observations. In particular, CCBHC has helped with integrated care and “expanding access to everybody,” Kanouse described.
“In a lot of ways, the CCBHC model … layered on top of some areas that had been really focused on within our behavioral health systems,” she said. “So the emphasis on peer-led services, on patient-driven care, youth-and-family voice. It kind of elevates those components that have been really central to our system for a long time.”
As far as non-workforce challenges, the leaders said it can be difficult to get programs up and running in a relatively short period of time. Integrating CCBHCs within a state’s existing Medicaid system can likewise be challenging.
“We had to really expand our team and connect the dots into every single aspect of Medicaid contracting,” Naeyaert said.
Blaauw echoed some of those points and said that determining provider rates under a new model can be a major undertaking.
“Working with the provider to develop the information, the cost and the service, the visit volume, and all that kind of stuff, to come up with a reasonable rate for that beginning period was a much bigger challenge, I think, then all of us truly understood it would be,” he said.