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Office of Mental Health

Certified Community Behavioral Health Clinics (CCBHC)

CCBHC Demonstration Timeline | What is a CCBHC? | CCBHC Prospective Payment System | CCBHC Quality Data Reporting
CCBHC Data Sharing with Managed Care Organizations

New York State’s CCBHC Demonstration Timeline

On April 1st 2014 the Protecting Access to Medicare Act of 2014 (H.R. 4302) was enacted, laying the groundwork for the establishment of the Certified Community Behavioral Health Clinic (CCBHC). In October 2015, New York State was one of 23 states who were awarded a 1-year planning grant from SAMHSA & CMS to develop a proposal to detail how the CCBHC program model would be designed and implemented in New York State.

Under the planning grant, the State – through a triple partnership of NYS Department of Health (DOH), NYS Office of Alcoholism and Substance Abuse Services (OASAS), and NYS Office of Mental Health (OMH) - was charged with:

To ensure a strong initial foundation for the CCBHC demonstration, New York focused on engaging with existing providers within the State who had a demonstrated history of providing comprehensive high quality behavioral health services. Together OMH, OASAS and DOH selected a set of criteria - in addition to the SAMHSA criteria - that informed their selection of CCBHC providers. The criteria to be selected included:

In December 2016, NYS was one of 8 States chosen to implement CCBHC as a 2-year demonstration program - with a requirement to begin all CCBHC programs consistent with SAMSHA criteria no later than July 1st 2017. Of the 29 behavioral health clinics who had initially participated in the development of the CCBHC demonstration in New York State, 13 providers were ultimately included on the application. New York’s current participating CCBHC providers are:

A press release was released in January 2017 announcing NYS’ selection to participate in the CCBHC demonstration.

What is a CCBHC?

The purpose of a CCBHC is to:

CCBHCs are responsible for directly providing or contracting with Designated Collaborating Organizations (DCOs) to provide 9 required types of core services***:

*CCBHC must directly provide; **May be provided by CCBHC and/or DCO; ***CCBHC demonstration services must be provided to all clients regardless of their catchment area and/or ability to pay, both within and outside of the clinic setting

Full descriptions of the 9 core services can be found in the CCBHC Scope of Services Manual or in the CCBHC MCO Operations Manual on pages 3-52.*

Additional information about the CCBHC demonstration can also be found on The National Council for Behavioral Health website.

CCBHC Prospective Payment System (PPS)

The statute establishing criteria to participate in the CCBHC demonstration program required the use of a Prospective Payment System (PPS) to pay the participating clinics for the provision of CCBHC services. CMS issued guidance to states and clinics that outlined two potential PPS rate methodologies. New York State’s CCBHC demonstration program uses the first option (CC PPS-1) as defined in the CMS guidance, which provides reimbursement of cost by way of a daily rate. To create the rate for demonstration year 1 (DY1), NYS used cost and visit data from the demonstration planning phase, updated by the MEI. The DY1 rate will be updated again for demonstration year 2 (DY2) by the MEI. The methodology applies to all CCBHC participating providers and services, including those delivered by qualified satellite facilities established prior to April 1st 2014. New York also elected to include additional quality bonus payment for meeting certain defined quality metrics. The rate elements for CC PPS-1 include:

The CC PPS-1 rate is based on total annual allowable CCBHC costs divided by the total annual number of CCBHC daily visits and results in a uniform payment amount per day, regardless of the intensity of services or individual needs of clinic users on that day. The daily rate is a cost-based, per-clinic rate that is a fixed amount for all CCBHC services provided any given day to a Medicaid beneficiary. The daily rate applies to all services and conditions, there is no variation or carveout to the daily rate for specific services or specific conditions. CCBHCs bill for the daily rate when one or more CCBHC service has been provided on a specific day.

For additional information please see the SAMHSA Prospective Payment System (PPS) Reference Guide

CCBHC Quality Data Reporting

New York will be monitored over the course of the CCBHC demonstration through the collection of the following process measures which will be reported to SAMHSA yearly using the Common Data Platform:

New York State will also engage CCBHCs in the collection of encounter, clinical outcomes, and quality improvement data for annual reporting. The quality data collected will include: (1) access to community-based behavioral health services; (2) quality and scope of services provided by CCBHCs compared with non-CCBHC providers; and (3) federal and state costs of a full range of behavioral health services (including inpatient, emergency, and ambulatory services) (PAMA § 223(d)(7)(A)). New York State will also encourage the use of recipient and family led individual perception of care evaluations of the CCBHCs to ensure recipients and families are involved in this aspect of service design and delivery.

Each CCBHC will have a quality management program that will refer to the New York State Medicaid Managed Care Quality Strategy and the New York State Behavioral Health Quality Strategy as a framework to monitor and ensure quality of the data collected. Quality strategies will include monitoring access, quality, utilization and satisfaction with care using NCQA standards as well as the development of performance improvement projects specific to population health needs.

For additional information on CCBHC quality data reporting requirements please see the CCBHC Project Summary.

CCBHC Data Sharing with Managed Care Organizations (MCOs)

Prior to the start of New York’s CCBHC demonstration, NYS DOH approved the demonstration services to be carved-out of Managed Care and billed fee-for-service (FFS) to allow for increased State oversight. The FFS carve-out applies for the entirety of the 2-year CCBHC demonstration beginning on July 1st 2017. Although demonstration services are currently carved-out, Managed Care Organizations are still able to access client level CCBHC data for HEDIS and NCQA reporting purposes using the existing DOH monthly FFS Claims Data Report.

DOH’s FFS Claims Data Report is accessible to Managed Care Organizations through the Secure File Transfer Utility located on the MEDS III Home Page on the Health Commerce System (HCS) with the CCBHC rate code (1147) information located on the report in record position 216-219. Please see page 62 of the CCBHC MCO Operations Manual for information on the specific data elements included in the monthly report.

Further questions about data and oversight may be submitted to the NYS Office of Mental Health Bureau of Program and Policy Development.

* If you are having ADA accessibility issues with the previous documents, please contact Office of Diversity Management, or call (518) 473-4144.