Your Questions on Getting CCBHC Certified Answered

Earlier this year, SAMHSA released a funding opportunity announcement (FOA) that allows clinics across the nation to apply for the Certified Community Behavioral Health Clinic (CCBHC) Expansion Grant. Clinics in all 50 states can apply, and if awarded would receive a two-year grant of up to $2 million per year.

The National Council has been a longtime advocate for increased funding and expansion of the program to clinics throughout the country.

We were very excited to partner with them in January to discuss the future of CCBHCs (including requirements to get certified in the FOA) and how clinics can leverage CCBHC status to further staff training and combat workforce shortages and development.

If you missed the webinar, you can watch it on demand here.

How to Get CCBHC Certified in the New FOA

In the new FOA, SAMHSA outlines specific eligibility, application, and submission information and requirements.

At a high level, to be awarded a CCBHC Expansion Grant and official CCBHC status you must:

1. Offer or contract with partner organizations to provide the nine required services

Crisis mental health services
Screening, assessment and diagnosis, including risk assessment
Patient-centered treatment planning
Outpatient mental health and substance use services
Primary care screening and monitoring of key health indicators/health risk
Targeted case management
Psychiatric rehabilitation services
Peer support and family supports
Intensive, community-based mental health care for members of the armed forces and veterans

2. Meet CCBHC criteria

Organizational authority
Staffing
Access to care
Scope of services
Care coordination
Quality reporting

3. Be able to meet CCBHC requirements within four months of receiving their award

In the Future of CCBHCs webinar, Rebecca Farley David, from The National Council, and Melissa Lewis-Stoner, from Relias, go over CCBHC services and criteria in detail. They even highlight the specific things staff training should address, like cultural competence, risk assessment, person-centered care, trauma-informed care, and more.

If your organization is applying for the grant or considering applying, keep the following dates in mind as you plan your CCBHC implementation.

Key dates to remember:

March 10, 2020—CCBHC Expansion Grant Application Due Date
End of April/Beginning of May—Award Announcement
August 30, 2020—CCBHC Program Begins

You can read the full CCBHC Expansion Grant FOA here.

Below are the most common questions we received regarding the CCBHC model and how to achieve CCBHC status:

CCBHC Model

CCBHC Funding

CCBHC Service Requirements

CCBHC and DCOs

CCBHC and Staff Training

Questions on the CCBHC Model and Grant Application

Have you been able to measure the impact on the cost of care from this model? How does that cost compare with what the market is willing or able to pay for the same outcomes?

Early results from the CCBHC program show promising reductions in hospitalizations, emergency department visits, and incarcerations. A formal evaluation from the federal government is forthcoming.

Are Medicare or dually eligible clients able to access CCBHC services, or is it only for Medicaid only clients?

CCBHCs must serve all clients regardless of coverage source or ability to pay.

Does that also include the intellectually and/or developmentally disabled population?

CCBHCs must serve all clients regardless of coverage source or ability to pay.

Does being a CCBHC require national accreditation by CARF, JCAHO, etc.?

Accreditation is encouraged but not required (Click here to see page 60 of the full CCBHC criteria)

Relias can also help you achieve and maintain CARF, Joint Commission and COA accreditations. Read more here.

How often would this opportunity to apply for the grant occur if we choose not to apply at this time?

There is no guarantee of future funding, but the National Council is advocating for continued appropriation of grant funds.

Does the number of anticipated clients provide a better chance for winning a grant? What about for the geographic area to be served?

See pages 18-21 of the FOA for a discussion of evaluation criteria and the selection process.

Questions on CCBHC Funding

Is the $25,000 in the current SAMHSA NOA for TA supposed to cover staff training and other TA needs?

The $25,000 is for TA needs related to your organization’s implementation of the CCBHC model. Consult the SAMHSA project officer with any questions about allowable use of TA funds.

What is supposed to happen after the two-year grant period? Would there be a shift to PPS payment?

Just like with any grant, there is no guarantee of funding beyond the grant term. The National Council encourages grantees to open conversations with your state Medicaid office about utilizing existing state authorities (waiver, SPA) to implement the CCBHC model and ensure sustainability. Contact us if you have questions about opening those conversations.

Does funding cover all medications for mental health, SUD and physical health?

CCBHCs are required to offer services inclusive of “appropriate psychotropic medication inclusive of long-acting injectable antipsychotic medication and FDA-approved medication treatments for substance use disorders including for tobacco, alcohol and opioid use disorders” (see page 8 of the FOA).

Have CCBHCs needed to use a lot of their grant money to pay for providing CCBHC services to uninsured individuals as well as “underinsured,” e.g., those with commercial insurance who don’t cover many of the CCBHC required services?

This depends on the unique payer mix of each agency and what portion of their clients are uninsured. We encourage you to think critically as you prepare your budget for the grant, and consider how any anticipated increase in your number of patients served would impact your ability to provide all required services using the amount of funds available.

How often are you paid by SAMSHA? How much of an outlay of funds is it for an agency before we are reimbursed?

Contact the project officer with any questions about how grant funds will be disbursed and remember that grant funds may not supplant any other sources of payment for your services (such as Medicaid).

Our agency is one of many that has managed care organizations administering the Medicaid program. Would funding via CCBHC replace MCO contracts? Please discuss how funding works in these situations.

The expansion grants are not intended to supplant any other existing funding source for services. With respect to all payers, grantees continue receiving payment as usual.

Questions on CCBHC Service Requirements

Do we need to manage substance use treatment and the CFR42?

Yes, see the full CCBHC criteria for a description of required SUD treatment services.

Does psychiatric rehabilitation include clubhouse services?

Grantees must provide access directly or through a DCO to “social support opportunities.” On page 8 of the FOA, clubhouses are listed as one example.

Does an organization have to already provide intensive substance use treatment services to be eligible for CCBHC funding? We meet all of the behavioral health conditions but are still working on expanding into substance use treatment. We currently do peer recovery support and therapy, but no medication-assisted treatment or detoxification services.

You must be able to meet all required criteria within four months of the date of the award.

Questions on CCBHC Certification

How to you become certified? What steps or who provides certification?

Clinics have to demonstrate through completion of the checklist in Appendix M that they are ready or will be ready within four months to meet all certification criteria, but formal certification by the state is not required.

Can you apply to be a CCBHC without support of the state?

Your state does not have to sign off on the grant application; however, SAMHSA encourages collaboration with the state behavioral health authority and state Medicaid office. Support from both will help with sustainability.

Is it required you have some kind of agreement with a FQHC?

Yes, FQHCs are listed as required care coordination partners.

How does an organization get licensure for a CCBHC when we meet the requirements?

Many of the services and components of this model are aligned with that of FQHCs. Are FQHCs eligible to become CCBHCs?

Yes, FQHCs are eligible to become CCBHCs if they can meet all the criteria. Click here to see a full description of the criteria.

Questions About CCBHCs and DCOs

How does a group become a DCO?

For organizations interested in becoming a DCO, we encourage you to reach out to local groups that may be applying for the CCBHC expansion grant and open conversations about how your services may fill any gaps in their service array.

Do services provided by DCOs need to be provided at the CCBHC facility? Or, can they be provided at the DCO?

They can be provided at the DCO.

Can you define a “formal agreement” with other providers for services we may not provide? Is that an MOU or formal contract?

For all DCOs, the CCBHC applicant must submit a letter of commitment at the time of the applications. Please consult the SAMHSA project officer with any additional questions about formal contracts.

In Massachusetts, all crisis services are contracted with the state by region. Our organization doesn’t and can’t offer crisis services. What are our options?

You can contract with the local crisis services provider as a DCO (see page 8 of the FOA).

I understand we must establish a formal DCO if we are delegating a required service to another provider. Do we need to establish a DCO if we are going to collaborate with another provider to offer just a small component of a required service? For example, we will provide OP mental health and SUD services, but we will work with another provider to offer methadone maintenance. Does that provider need to be a DCO, or can that be considered a referral relationship?

Please contact the SAMHSA project officer for any questions about whether a particular type of partnership would be considered to meet the CCBHC criteria and the extent to which a formal relationship must be established.

Questions on CCBHC and Staff Training

Does Relias currently provide training that suffices for the types of “CCBHC required training” that have been discussed in this webinar?

Relias offers training topics covering the CCBHC “required services.” We also offer staff training topics such as person-centered care, trauma-informed care, substance use and recovery, and culturally and linguistically competent care.

From the Tools to Aid Training page, do we need to add these specific courses for staff?

The CCBHC crosswalk provides a guide for provider organizations to identify how Relias training modules might be incorporated into a provider-specific staff training plan that meets CCBHC criteria. The courses listed are a representative sample of courses available in Relias libraries.

It may not be necessary to choose all courses listed for a specific training standard; it is recommended that courses are chosen that closely align with the mission and services offered and the specific needs of the persons served.

What is the relationship between Relias and SAMHSA?

We do not have a relationship with SAMHSA other than aligning our content with the CCHC criteria outlined by SAMHSA.

How can Relias help me with staff training and workforce development?

Relias provides online compliance and CE training across the health service continuum of care.

Additionally, we offer personnel assessments for job roles within healthcare. These assessments help ensure the person has the technical knowledge to complete required job tasks. We also have assessments that explore critical success factors for one’s job such as empathy, compassion, judgment, and reliability.

Finally, we offer a population health management solution that helps organizations effectively manage defined populations with data insights, risk stratification, and targeted interventions. The solution helps organizations prove clinical outcomes, measure quality and improve care.