Preliminary Cost and Quality Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration
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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
- Demonstration states could select from two prospective payment system (PPS) models. Six demonstration states selected the first model (PPS-1) which provides a fixed daily payment for each day that a Medicaid beneficiary receives demonstration services. Two states selected the second model (PPS-2) which provides a fixed monthly payment for each month in which a Medicaid beneficiary receives demonstration services.
- Daily and monthly CCBHC payment rates set by states before the demonstration varied considerably within and across states in the first demonstration year. Similarly, actual costs per visit-day and visit-month varied considerably within and across states in the first demonstration year.
- In seven of the eight demonstration states, the payment rate per visit-day or per visit-month was higher, on average, than the actual cost per visit-day or visit-month.
- States and clinics developed and enhanced the infrastructure needed to report required quality measures. Although CCBHCs and states were not required to use quality measure data to monitor or improve the quality of care, state officials and clinics reported using quality measure data to support a wide range of quality improvement efforts.
Section 223 of the Protecting Access to Medicare Act, enacted in April 2014, authorized the Certified Community Behavioral Health Clinic (CCBHC) demonstration to allow states to test new strategies for delivering and reimbursing services provided by community behavioral health clinics. The demonstration aims to improve the availability, quality, and outcomes of ambulatory behavioral health services by establishing a standard definition and criteria for CCBHCs and developing new prospective payment systems (PPS) that account for the total cost of providing comprehensive services to all individuals who seek care. CCBHCs and demonstration states must report a common set of quality measures and report their costs as a condition of participating in the demonstration.
In September 2016, the HHS Office of the Assistant Secretary for Planning and Evaluation contracted with Mathematica and its subcontractor, the RAND Corporation, to conduct a comprehensive national evaluation of the demonstration. This report presents preliminary evaluation findings regarding payment rates and the costs of providing care during the first demonstration year and the experiences of states and CCBHCs reporting the required quality measures. The findings in this report draw on data collected from: (1) interviews with state Medicaid and behavioral health officials; (2) progress reports submitted by CCBHCs; (3) cost reports submitted by CCBHCs; and (4) site visits to select CCBHCs.
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