Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2023

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 (HHS) selected eight 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 (CARES 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 with two rounds of planning grants to allow up to ten states to participate every two years starting in 2024. (Public Law 117-159). 

PAMA mandates that the HHS Secretary 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 describes findings as they relate to the PAMA topics of access to care and scope of services, focusing on care coordination services and activities. The report also provides information on changes in the quality of care during the first four years of the demonstration for states with available quality measures and quality bonus payments states made to CCBHCs based on quality measure performance. The report builds on detailed findings on demonstration implementation, quality improvement, and costs included in previous evaluation reports and focuses on qualitative and quantitative data collected through the evaluation since the spring of 2022.