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The 5 Ws of CCBHC | Answering the Hard-Hitting Questions

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If you ask anyone to name the 5 Ws, most would be able to quickly return your question with “Who, what, when, where, and why.” The ‘5 Ws’ are yet another mnemonic imparted on grade school children to get them to remember something important. Just like we use acronyms like CCBHC in the behavioral health world to remember terms like Certified Community Behavioral Health Clinic. These five questions were the basis of short stories and of science reports-I still remember getting papers back where my teacher marked that I had forgotten to include ‘where’ or my ‘why’ wasn’t long enough.

Whether we realize it or not, these 5 Ws still guide our thought processes as adults. I have a lot of agencies asking me about CCBHC and a lot of their questions follow the 5 Ws:

  1. Who can receive CCBHC services?
  2. What is CCBHC?
  3. When did CCBHCs get started?
  4. Where are the selected states?
  5. Why is this a big deal?

I decided to answer their questions together and throw in a refresher on the 5 Ws.

  1. WHO can receive CCBHC services?

CCBHCs aim to serve individuals in need of care, regardless of their ability to pay. The National Council published a description of those eligible for CCBHC services. The list is not limited to but includes:

  • Those with
    • Serious mental illness
    • Serious emotional disturbance
    • Long-term chronic addiction
    • Mild or moderate mental illness and substance use disorders
  • Those who are underserved
  • Those with low incomes
  • Those who are insured, uninsured or on Medicaid
  • Those who are active duty military or veterans
  1. WHAT is CCBHC?

As I mentioned, a CCBHC is a Certified Community Behavioral Health Clinic. This federal program was designed and funded by SAMHSA. Authorized under Section 223 of the Protecting Access to Medicare Act (PAMA) (PL 113-93), the overarching goal of this program is to improve access to high-quality care for all people. These certified clinics will provide a range of services to people with complex needs. Many will be offered and paid for even if they’re not included in Medicaid.

These certified clinics provide a range of services to people with complex needs. There are nine different areas of service:

  • Crisis mental health services
  • Screening, assessment and diagnosis
  • Patient-center treatment planning
  • Outpatient mental health and substance abuse services
  • Primary care screening and monitoring
  • Targeted case management
  • Psychiatric rehabilitation services
  • Peer support, counseling and family support services
  • Services for veterans

These services are provided with the stipulation of 24-hour-crisis care, evidence-based practice, and integration with physical healthcare.

While these guidelines seem strict, it’s done purposefully to ensure that these providers are being held to a high standard. This initiative is the biggest investment in mental health and addiction care in decades and no one wants it to be a waste of time and resources. The federal government is trying to see if certifying behavioral health clinics and forcing them to measure results, provide services in a certain way, and report quarterly will result in improved positive outcomes. If positive outcomes improve, it could ultimately decrease Medicare and Medicaid spending.

  1. WHEN did CCBHCs get started?

The process to become a CCBHC is long and requires various submissions and documentation. The National Council discusses the timeline in a presentation entitled Tick Tock: The Countdown Is On for CCBHC State Planning Grant Applications to health management associates. The visual below breaks down the various steps:

Currently, the 8 selected states are amid their CCBHC demonstration period. They are consistently tracking their performance to be able to show that their program is successful and has positive outcomes. There is a lot of documentation and reporting during this process. For CCBHCs to be successful, they need to have a comprehensive electronic health record that works with them to submit their documentation on time.

  1. WHERE are the selected states?

24 states utilized a planning grant to develop CCBHCs. Once their project proposals were submitted, only eight were chosen to carry out their plan:

  • Minnesota
  • Missouri
  • New York
  • New Jersey
  • Nevada
  • Oklahoma
  • Oregon
  • Pennsylvania

For the 16 states whose project proposals were not selected, the National Council and others are consistently working to expand the program to accommodate more states.

  1. WHY is this a big deal?

A successful implementation of a CCBHC will improve health services for many. Some of the benefits of this program include easy access to a wide variety of services, 24/7/365 services, and services for military. With additional resources, they can fill a gap in unmet need and provide the flexibility to offer services beyond the four walls of a clinic.

But the most important reason why this is a big deal is that it’s successful. CCBHCs are able to do what they set out to do. Now that we’re partially through the two-year demonstration period, the National Council surveyed the eight states who implemented CCBHCs to see how they’re doing. The survey results were overwhelmingly positive. With incentives and adequate compensation, states are changing their community’s access to care for the better. They’re addressing the opioid crisis, hiring and retaining qualified staff, offering trauma informed care services on the same day they’re requested, and more.

But wait, don’t the 5 Ws have an H?

Those who preferred English class in school probably remembered that the 5 Ws are usually accompanied by an H…how. As in:

HOW do we pay for this?

To fund CCBHC, a prospective payment system (PPS) is utilized. This system is CCBHC specific and requires the organization to develop an annual cost report. There are two versions of PPS states can choose from, PPS-1 or PPS-2.

If states select PPS-1, they’ll receive a fixed daily reimbursement per visit which is the same no matter the intensity of the visit.

If PPS-2 is selected, states will receive a fixed monthly reimbursement for every individual who has at least one visit per month. The payment is the same regardless of the number of visits per month or the intensity of the visits.

It is up to the states to weigh the pros and cons of each option and see which works best for them.

It Only Takes 5 Ws and an H to Find Your Answers

Relying on the 5 Ws and an H helped me to expand my knowledge of CCBHC and its impact. But there’s always more to learn. If you’re looking for more information, check out the CCBHC page on the National Council’s website and its accompanying links.  

So it turns out my teachers were right about remembering the 5 Ws and an H. Makes me wonder what else they were right about…

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