Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2022
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Associated Project
Evaluation of the Certified Community Behavioral Health Clinic Demonstration
Prepared for:
U.S. Department of Health and Human Services
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Key Findings
- State officials in original Certified Community Behavioral Health Clinic (CCBHC) demonstration states reported transitioning past planning and launch activities by the second demonstration year and generally reported that states and CCBHCs have implemented the demonstration consistently since that time.
- The initial implementation experiences of new demonstration states (Kentucky and Michigan) appeared consistent with early experiences from the original states.
- State officials perceived that several demonstration features, such as telehealth requirements and the prospective payment system, helped CCBHCs maintain service access during the national emergency related to the COVID-19 pandemic.
- Total costs of clinic operations reported in cost reports remained relatively stable across the first four demonstration years in Oregon and Minnesota but increased more than 25 percent in Missouri, New York, and Oklahoma. The most consistent contributor to changes in total costs across states was the change in the cost per client served and not in the number of clients served or cost per visit.
Section 223 of the Protecting Access to Medicare Act of 2014 (PAMA; Public Law 113-93) authorized the Certified Community Behavioral Health Clinic (CCBHC) demonstration to allow states to test a new strategy for delivering and reimbursing a comprehensive array of services provided in community behavioral health clinics. The demonstration aims to improve the availability, quality, and outcomes of outpatient services provided in these clinics. The demonstration requires participating states to reimburse CCBHC services through a Medicaid prospective payment system intended to cover the full costs of CCBHC services for Medicaid beneficiaries. In 2016, the U.S. Department of Health and Human Services selected 8 states to participate in the demonstration (Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania). The demonstration was originally authorized for two years, but Congress has extended it multiple times and it is currently authorized in the original states through September 2025. In August 2020, the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116-136) expanded the demonstration to two new states (Kentucky and Michigan). The Bipartisan Safer Communities Act, enacted in June 2022, authorizes all states to apply to participate in the demonstration beginning in 2024 (Public Law No: 117-159).
PAMA mandates the HHS Secretary to submit an annual report to Congress that assesses: (1) access to community-based mental health services under Medicaid; (2) the quality and scope of services provided by CCBHCs; and (3) the impact of the demonstration on federal and state costs of a full range of mental health services. This report presents findings from an ongoing evaluation of the CCBHC demonstration conducted by Mathematica and the RAND Corporation on behalf of the Office of the Assistant Secretary for Planning and Evaluation. Building on previous evaluation findings of the initial two years of the demonstration, the report assesses the implementation and outcomes of the demonstration beyond its first two years for the seven original states participating as of spring 2022. The report describes findings on state demonstration oversight and expansion of the model since the end of the second demonstration year (DY) and early implementation experiences in the two new states. It then describes specific findings as they relate to the PAMA topics of access to care and scope of services. Finally, the report provides information on demonstration payment rates and costs for the first four DYs for states with available data.
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