Extensive training and technical assistance were provided on preparing EHR/health information technology (HIT) systems, facilitating information exchange between disparate data systems, and streamlining the reporting process. Neighborhood primary care clinics fill the health care gaps in many localities, delivering culturally-appropriate care on a no or low-cost basis. HHS has recently awarded $54.6 million dollars in Affordable Care Act mental health services funding to 221 health centers nationwide. A CCBHC must provide service to any individual who presents in their clinic, regardless of ability to pay or insurance. This webinar will introduce the audience to Certified Community Behavioral Health Clinics (CCBHC), Federally Qualified Health Centers (FQHC) and how their services can be considered separately or in tandem to improve population health in all communities. Seventeen percent used measures related to reducing time between intake and assessment to ensure timely care. Preventive Care & Screening: Body Mass Index Screening & Follow-Up, Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents, Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention, Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling, Child & Adolescent Major Depressive Disorder: Suicide Risk Assessment, Adult Major Depressive Disorder: Suicide Risk Assessment, Screening for Clinical Depression & Follow-Up Plan, Follow-up After Emergency Department for Mental Health, Follow-up After Emergency Department for Alcohol or Other Dependence, Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are Using Antipsychotic Medications, Adherence to Antipsychotic Medications for Individuals with Schizophrenia, Follow-up After Hospitalization for Mental Illness, ages 21+, Follow-up After Hospitalization for Mental Illness, ages 6-21, Follow-up care for children prescribed ADHD medication, Initiation and Engagement of Alcohol and Other Drug Dependence Treatment. Contemporary Clinical Trials, 37(2), 234-241. doi: 10.1016/j.cct.2014.01.005. At the start of the demonstration, New Jersey did not include MH/SUD services in most managed care contracts. Discussions occur with individual clinics regarding their data, as well as with all clinics regarding the overall results of the various evaluation findings. Now, it is an allowable service within the CCBHC's outpatient addiction treatment license, which has significantly increased access to this level of care. The remaining services may either be provided directly or by a designated collaborating organization (DCO). Connected to that are variations in the severity and acuity of individual needs and the level of care provided in response to need. He has not had any suicidal ideations in more than 6 months, nor exhibited any violent behavior since entering the program. Billing and claims/encounter data. Overview of key differences between DCO CCBHC demonstration and expansion grant program Demonstration Expansion Grant Eligibility States compete to participate in CCBHC demonstration (8 selected in 2016; 2 in 2020); states select and certify CCBHCs to carry out services For hospitals and health systems, an FQHC partner in community care offers opportunities to reduce avoidable emergency department (ED) admissions and better coordinate care for the most vulnerable patients. Nineteen percent more consistently used measures to screen for depression (especially the Patient Health Questionairre-9) and more regularly conducted follow-up with those served. Section 223 of PAMA authorized exploration of the extent to which states can improve mental health and substance use disorder (MH/SUD) services through the establishment and operation of CCBHCs. CCBHC reports on quality measure performanceand state impact measures are verified every 3 months. In implementing Section 223, HHS recognized that the current status quo is comprised of a patchwork of programs with tremendous variability in access and waiting lists as well as in the range and quality of services available, particularly for those with serious mental illness (SMI) and children with serious emotional disturbance (SED). In explaining why CCBHCs prefer to provide services directly rather than establish a formal relationship with a DCO, state officials cited CCBHCs' concerns about: (1) legal requirements for DCO agreements (preferring informal relationships and/or more flexible partnership arrangements that existed before the demonstration); (2) information sharing; and (3) lack of experience with the PPS. CMS Guidance Needed to Better Align Demonstration Payment Rates with Costs and Prevent Duplication. A hallmark of this demonstration program is its capacity to offer recipients a comprehensive range of high-quality services, delivered directly by the CCBHC or through DCOs. Documentation of client's military service. FQHCs can help fill these gaps by providing high quality, integrated primary care with these enabling services, such as care management, transportation and interpretation, to treat the full person. Explain how to complete the reporting template. New Jersey's Department of Human Services contracted with Rutgers University to assess and monitor the implementation of EBPs among CCBHC providers. Vocational Instruction Project Community Services, Inc. Mercy Behavioral Health, Pittsburgh Mercy, Resources for Human Development Lower Merion Counseling Center. Other CQI initiatives focus on safety planning and risk assessment, increasing use of MAT, and preventing unnecessary emergency department visits and hospitalizations. Improve availability of, access to, and participation in services to individuals eligible for medical assistance under the state Medicaid program. Eighty-four percent of CCBHCs made changes to the range of services they provide. CCBHCs also implemented new internal performance improvement processes to ensure better CQI, such as conducting more frequent measurement and reporting of data, holding regular review meetings, hiring dedicated quality assurance staff, providing staff trainings, and aligning demonstration-focused CQI initiatives with state and other reporting requirements and programs. [2] The 2017 report is based on information and data gathered from interviews with state Medicaid and behavioral health agencies, as well as program reports completed by all CCBHCs, as part of a comprehensive national evaluation of the demonstration managed by ASPE. State CCBHC staff review Department of Human Services Licensing Division's bi-weekly publications regarding agencies with violations and follow up when a CCBHC has a violation or receives a correction order. CCBHCs also reported hiring specific types of nurses (registered nurses with or without psychiatric experience, nurses with experience in SUDs or providing medication-assisted treatment (MAT) for SUDs, nurse practitioners, psychiatric mental health nurse practitioners, and licensed practical nurses) and other clinical staff (licensed professional counselors, qualified mental health professionals or licensed mental health counselors, and licensed clinical social workers). The criteria for CCBHC Certification Requirement 1 include specific staffing requirements, such as a psychiatrist serving in the role of medical director[4] and the following staff: A medically trained behavioral health care provider who can prescribe and manage medications independently under state law. Table 10 presents PPS rates for Demonstration Year One (DY1). The amount paid through the rate was also affected by the location of the individual clinics: urban, rural, or frontier areas. Toward this end, CCBHCs improved the capacity to share clinical information with DCOs and other external providers by changes to or adoption of new electronic health record (EHR)/health information technology systems. (2017). 7. 1396(y)), expenditures are matched at the newly eligible FMAP rate applicable under paragraph (1) of that section. Strengthened Treatment Planning and Teams. For example, more frequent and shorter appointments for high-need individuals is being tested as a strategy for reducing crises and use of emergency services among these populations. Evaluation: A Systemic Approach (3rd ed.). Ninety-one percent of CCBHCs reported employing a psychiatrist as a medical director. FIGURE F. Proportion of CCBHCs that Receive Notification about Treatment for Physical Conditions and MH/SUDs, TABLE 6. Moving to the PPS allowed the clinics to provide competitive salaries for key positions when warranted, thereby attracting more psychiatrists and other licensed professionals. CCBHCs are required to provide training to new staff that addresses cultural competence; person/family-centered, recovery-oriented, evidence-based and trauma-informed care; and primary care/behavioral health integration at orientation and at reasonable interval thereafter. Missouri also implemented Mental Health First Aid training which teaches members of the general public how to recognize and help someone experiencing a mental health crisis. DISCLAIMER: The opinions and views expressed in this report are those of the authors. HHS Office of the Assistant Secretary for Planning and Evaluation, Nevada Bureau of Health Care Quality and Compliance, Certified Clinic Prospective Payment System, Certified Community Behavioral Health Clinic, Nevada Center for Health Information Analysis, HHS Centers for Medicare & Medicaid Services, Nevada Division of Health Care Financing and Policy, Nevada Department of Health and Human Services, New Jersey Division of Mental Health and Addiction Services, Nevada Division of Public and Behavioral Health, Maternal and Child Health Integrated Program, Oklahoma Department of Mental Health and Substance Abuse Services, Pennsylvania Office of Mental Health and Substance Abuse Services, New Jersey Opioid Overdose Recovery Program, Protecting Access to Medicare Act (Public Law 113-93), Qualified Disabled and Working Individuals, HHS Substance Abuse and Mental Health Services Administration, Specified Low-Income Medicare Beneficiaries, Women, Infants and Child nutrition program. Fidelity to Assertive Community Treatment and client outcomes in the New Hampshire dual disorders study. The two clinics with the lowest rates are in areas with few other providers, which means they serve a broader range of people with varying severity and acuity levels. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/ccbhc-criteria.pdf. Nationwide, staff offer a wide range of services to a variety of populations at nearly 400 locations. This webinar will introduce the audience to Certified Community Behavioral Health Clinics (CCBHC), Federally Qualified Health Centers (FQHC) and how their services can be considered separately or in tandem to improve population health in all communities. Fiscal year 2014 marked the start of a multi-year investment in Missouri's Strengthening Mental Health Initiative,[c] which featured several innovations: CCBHCs in Missouri are able to employ Community Mental Health Liaisons (CMHLs) who work exclusively with law enforcement and courts to link people with MH/SUD needs to treatment. FQHCs and FQHC Look-Alikes receive enhanced reimbursement through a cost based Prospective Payment System (PPS)2. (See Appendix A for a list of CCBHCs.). Criteria for the Demonstration Program to Improve Community Mental Health Centers and to Establish Certified Community Behavioral Health Clinics. The range of services includes delivery of mental health, addiction, and either screening for general medical conditions or on-site access to primary care during the first year of the demonstration. CMS added new lines to the budget and expenditure reporting forms (CMS-37 and CMS-64) to support states in reporting demonstration cost data at the various federal matching rates. Council of Economic Advisers. Learn which organizations are eligible to be certified community behavioral health clinics (CCBHCs) and how they work with other organizations. Recognizing the inherent complexity of providing such a range, states were permitted flexibility in aligning the scope of services with their Medicaid State Plans and other state regulations. The demonstration allows payment to be made through FFS or managed care. States also leveraged external support to facilitate training. Reflecting 2 percent of its population, this percentage is ten times greater than many of the other demonstration states' projections. 2023 by National Conference of State Legislatures. As authorized by PAMA, eight states are participating in two-year demonstration programs to improve community behavioral health. Oklahoma does not currently have managed care arrangements in its Medicaid program. These community health centers can play a critical role in managing population health and achieving success in value-based contracts. Dr. Robert Eilers, DMHAS Medical Director and CCBHC Project Director, explains, "Several years ago, Rutgers' Center for State Health Policy secured a Center for Medicare and Medicaid Innovation State Innovation Model (SIM) design award for New Jersey. In order to incentivize enhanced health care quality for impacted Medi-Cal members, the new APM methodology will be linked to specific quality metrics that must be satisfied by the participating FQHC as a condition of continued participation in the APM program. of whether they have received SAMHSA CCBHC grant funding, must meet the CCBHC Certification Criteria through the state-based certification process in order to participate in the Medicaid Demonstration. The clinic reports encounter data, clinical outcomes data, quality data, and such other data as the Secretary requires. Patient-centered treatment planning or similar processes, including risk assessment and crisis planning. Nevada FQHC/CCBHC Allowable Services October 1, 2021 The allowable services listed on this grid are intended to address the 9 core service areas as defined by SAMHSA and CMS for the CCBHC Program. As stated in Appendix C of both the CCBHC-PDI (SM-22-002) and CCCBHC-IA (SM-22-012) NOFOs, "For-profit organizations and foreign entities are not eligible to apply for SAMHSA grants." Are Federally Qualified Health Centers (FQHCs) eligible to apply? "All of our CCBHCs were already serving as Health Homes. The core team provides technical assistance through learning communities to support CCBHCs in maintaining and reporting fidelity to specific EBPs. During Missouri's CCBHC planning process, individuals with lived experience, their family members, and stakeholders from social service and related support organizations expressed a need for additional peer specialists and family support providers. States set clinic-specific rates based on the expected cost of providing demonstration services divided by the expected total number of demonstration visits, regardless of payer. Ninety-six percent of the CCBHCs provided translation services, usually through an external interpreter contract. The CCBHC program worked with Marcus in an open-minded, empathetic, and non-judgmental manner, helping him creatively overcome obstacles that prior traditional treatment programs were unable to help him circumvent. . More than three-quarters of CCBHCs reported that treatment teams have changed because of the certification process. Reduced cost drug access from the 340(b) program is offered. Staff of the CCBHC at AtlantiCare Regional Health Services in New Jersey, depicting "kindness." Reporting freestanding Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) on the CMS 2552-10. . As illustrated in Table 4, almost all CCBHCs reported offering a sliding fee schedule, providing services to people with Medicare and private insurance, and serving people not residing in their catchment area. MAT is but one of the several outpatient mental health and SUD (MH/SUD) services that were added by CCBHCs as they became certified. Psychiatric Services (Washington, DC), 66(6), 578-584. doi: 10.1176/appi.ps.201400248. Even more to the point of the CCBHC demonstration program, clients are benefitting from improved access to and a higher quality of community-based mental health services and from the enhanced capability of CCBHCs to coordinate care. ", Extensive technical assistance and training have paid off, helping providers adjust to significant changes in practice that ranged from adjusting to a new funding methodology--the CCBHC PPS-2--to connecting with emergency departments and other providers through a health information exchange. In accordance with Section 223 of PAMA, CMS developed guidance for states on how to determine rates when using a PPS methodology. See https://www.samhsa.gov/sites/default/files/ccbh_clinicdemonstrationprogram_071118.pdf. At the time of the March 2018 interviews, the remaining three states (Minnesota, New Jersey, and Pennsylvania) had not decided about rebasing their rates. At the end of April, the Substance Abuse and Mental Health Services Administration (SAMHSA) released details of new grants designed to increase access to behavioral health services and improve the quality of care. As presented in Table 1, CCBHCs have been diligent in providing the required training. CCBHCs have made services more convenient by introducing same-day or next-day appointments and accepting walk-in appointments. They have tailored services to the needs of specific populations, such as veterans, school-aged youth, and people experiencing homelessness. Percentage of urgent contacts in which an initial evaluation was completed within 1 business day. "Other" strategies listed include suicide assessments such as the Columbia Suicide Severity Rating Scale (C-SSRS), relapse prevention and planning, critical intervention planning, and working with external partners and stakeholders to provide patient-centered services in crisis planning. In the March 2018 interviews, officials from all states reported that the CCBHCs were using the systems they had put in place, the payment and encounter information was being appropriately recorded and submitted, and the PPS claims were being paid. Advances in fidelity measurement for mental health services research: Four measures. For example, a SFDS with discount pay classes of 101% to 125% of the FPG, 126% to 150% of the FPG, 151% to 175% of the FPG, 176% to 200% of the FPG, and over 200% of the FPG would have four discount pay classes between 101% and 200% of the FPG. . There is no restriction on FQHCs applying to either NOFO. Retrieved from https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/. Public officials, health care providers, and families are searching for effective responses to serious and complex problems, such as the opioid epidemic that kills an average of 130 people per day in the United States, (HHS, 2019), and in 2015 alone, cost the country $504 billion dollars (Council of Economic Advisers, 2017). Reporting will only affect the Maternal and Child Health Integrated Program (CMS-64.21) for CHIP. He embarked on MAT for long-term opioid dependence under the guidance of an outpatient psychiatrist and a therapist trained in PTSD and veteran's issues. Changes included creating dedicated space for ambulatory detoxification services, adding physical health exam rooms, improving the space for child and adolescent's receiving services, and expanding office space for new staff such as peers and case managers. Inexperience in providing specific services to certain populations. Building on the success of the CCBHCs, the state is creating a buprenorphine network through which all outpatient settings can offer MAT and counseling. For instance, detailed audits of the data would be required to identify gaps in the encounter data or systematic errors in PPS claims. Multiple CCBHCs provided training on specific evidence-based and best practices, including motivational interviewing, cognitive behavioral therapy, and MAT for SUDs. Psychiatric rehabilitation services such as supported employment and supported housing. The program monitor is available to provide training or technical assistance when deemed appropriate. Lake Oswego, OR 97035. CCBHCs are designed to provide whole-person care by integrating physical health with a comprehensive range of mental health and substance use disorder services to vulnerable . Other locations included primary care offices and federally qualified health centers (FQHCs), homeless shelters, public spaces, and on the street. Lesa Peterson. Rutgers University's School of Social Work (SSW) rounds out the CCBHC project team. 200 Independence Avenue, SW Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (61 PDF pages). CCBHC staff participate 2-3 times per month in Department of Human Services-facilitated learning collaboratives focusing on CCBHC-specific billing policies, quality measures, and service standards. Rockville, MD: Substance Abuse and Mental Health Services Administration. (For more information on the evaluation process, see CCBHC Report to Congress, 2017.[3]). The potential for effecting positive change attracted New Jersey to the CCBHC demonstration program. Under federal rules, the CCBHC rate can include the cost of certain activities that are not billable services, but are necessary to provide billable CCBHC services according to federal CCBHC standards. Based on deliverables within these various SOWs, ODMHSAS works with contracted agencies to improve the access and quality of services. Establishing partnerships with external providers and support services in the community has been another important strategy for improving care coordination. The Certified Community Behavioral Health Clinics Demonstration Program, Report to Congress, 2017 (CCBHC Report to Congress, 2017),[1] the precursor to this report, presented the statutory requirements of Section 223 and its implementation. In addition to a detailed accounting of federal funds provided under Section 223, subsequent reports will provide an assessment of the following: Access to community-based mental health services under the state Medicaid program in the area or areas of a state targeted by a demonstration program compared to other areas of the state. Specific examples include: Twenty-six percent of these CCBHCs used suicide risk assessment and prevention measures, such as the C-SSRS, in routine practice and provided staff training on the measures. As communities weigh the promise and practicalities of an FQHC or FQHC Look-Alike, many strategic and practical evaluations ensue. GAO is making two recommendations, including that CMS issue clear and consistent written guidance to help states (1) better align payment rates with clinics' costs; and (2) avoid potential duplication between CCBHC and other Medicaid payments. CCBHCs play a significant role in New Jersey's Opioid Overdose Recovery Program (OORP), as well. For example, a CCBHC may provide crisis services for two other CCBHCs within the same service area. Connections were made between OORP . Value-based and Risk Transfer Payment Arrangements, Managed Care / Risk Readiness Gap Assessment, Managed Care Contract Revenue Optimization, Post-Acute Network Assessment and Optimization, Primary Care Provider Network Empanelment Assessment and Optimization, Quality and Provider Performance Improvement, Care Management Assessment, Optimization and Implementation, Managed Services Organization (MSO) Development and Optimization, Analytics for Risk Contracting (ARC) Suite, Value-Based and Risk Transfer Payment Arrangements, FQHCs and FQHC Look-Alikes are great partners for health systems, independent practice associations (IPAs), Aligned missions in better serving the community, Enhanced Medicaid and Medicare reimbursement, Eligible for quality incentive dollars based quality indicators, Increased enabling services (e.g., interpretation, transportation, care management, health education), Sliding fee scale providing services to patients no matter their ability to pay, Provide an additional option for physician alignment, Strengthen the referral network for post-inpatient discharge and ED patients in need of follow-up care, Integrate Adventist Health White Memorials teaching programs, Improve access to specialty care in a medically underserved community, Provide high need dental and behavioral health services.
California Certified Residential Manager,
Scheier And Carver Theory Of Optimism,
Falkensteiner Nassfeld,
Articles D
