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Click here to learn moreWhat is a CCBHC?
A Certified Community Behavioral Health Clinic is a specially designated clinic that provides a comprehensive range of mental health and addiction services and be in compliance with the state’s criteria, developed by the Division of Mental Health and Addiction. CCBHCs serve all that walk through their door, regardless of their diagnosis, insurance status, place of residence or age. The CCBHC model is a proven outpatient model that:
- Ensures access to high quality behavioral health care, including 24/7 crisis response.
- Meets strict criteria regarding access, quality reporting, staffing, and coordination with social services, justice, and education systems.
- Receives funding to support the real costs of expanding services to fully meet the need for care in communities.
For more information on CCBHCs, please visit the SAMHSA CCBHC webpage.
Background
The Protecting Access to Medicare Act of 2014 was enacted in 2014. Section 223 of the Act provides for the creation and evaluation of a demonstration program to improve community mental health services. Section 223 authorized the U.S. Department of Health and Human Services to establish the federal CCBHC criteria for the demonstration program and for clinics to be certified by a state as a Certified Community Behavioral Health Clinic.
CCBHC in Indiana
In 2022, House Enroll Act 1222 directed the Division of Mental Health and Addiction to develop a plan to strengthen the use of Certified Community Behavioral Health Clinics (CCBHCs) statewide by implementing the CCBHC model at the state level. The CCBHC model is an outpatient model that ensures evidence-based mental health and addiction care for any individual’s needs within its community. State level implementation of the CCBHC model is the key to building the comprehensive behavioral health system that Hoosiers deserve.
In 2023, Senate Enrolled Act 1 allowed the Division of Mental Health and Addiction to apply for participation in the expansion of a community mental health services demonstration program. The legislation provided DMHA $100 million, $50 million each year in SFY24 and 25, through the state biennium budget to establish the next step for improving the state’s mental health care system.
In June 2024, the U.S. Department of Health and Human Services named Indiana as one of 10 states selected to participate in the Certified Community Behavioral Health Clinic Medicaid Demonstration Program. The state competitively selected eight CCBHC Demonstration Pilot Sites, with services beginning in early 2025.
Indiana's CCBHC Demonstration Application
*In light of significant progress since March 2024, please note some details of the state’s plan have evolved since this application was written and submitted.
Criteria and Services:
The following Certification Criteria are Indiana’s initial requirements for CCBHCs, built and expands upon the SAMHSA guidelines, and will be continuously refined in collaboration with stakeholders, including all prospective CCBHCs.
Indiana’s CCBHC Certification Criteria can be found here.
The CCBHC criteria falls into six key program areas:
- Staffing
Staffing plans are developed and driven by first performing a local needs assessment to determine needs of the community served by the CCBHC. Each CCBHC develops a staffing plan from such needs assessments that inform the required the staffing levels, licensing and training to support service delivery.
- Available and Accessibility of Services
CCBHCs have described standards for timely and meaningful access to services, outreach and engagement, 24/7 access to crisis services, treatment planning, and acceptance of all patients regardless of ability to pay or place of residence.
- Care Coordination
CCBHCs are required to develop care coordination agreements across services and providers (e.g., Federally Qualified Health Centers, inpatient and acute care), defining accountable treatment team, health information technology, and care transition guidelines and practices.
- Scope of Services
CCBHCs are required to provide nine required services. CCBHC services are to be provided in a manner that is person-centered, family-centered, and recovery-oriented care. The nine required services are to be provided directly by the CCBHC but may also be provided through a formal relationship by establishing partnering agencies as Designated Collaborating Organization.
Required CCBHC Services:
- Crisis Services
- Treatment Planning
- Screening, Assessment, Diagnosis & Risk Assessment
- Outpatient Mental Health & Substance Use Services
- Targeted Case Management
- Outpatient Primary Care Screening and Monitoring
- Community-Based Mental Health Care for Veterans
- Peer, Family Support & Counselor Services
- Psychiatric Rehabilitation Service
- Quality and Other Reporting
CCBHCs have site specific required quality measures that must be collected and reported. CCBHCs must also develop a plan for quality improvement and tracking of other program requirements. In addition to site specific required quality measures, states that certify CCBHCs have state specific quality measures that must be collected and reported in addition to the site-specific measures.
- Organizational Authority and Governance
CCBHCs are required to incorporate consumer representation in the governance of the CCBHC. CCBHCs certified by their state are required to have undergone the appropriate state accreditation process of CCBHCs.
CCBHC Demonstration and Expansion Grant Locations
Federal Program Distinctions:
There are two different federal programs that support CCBHCs, the CMS CCBHC Demonstration and the Substance Abuse and Mental Health Administration CCBHC Expansion Grant (discretionary grant awards).
- CMS CCBHC Demonstration – CCBHCs are funded by using a Prospective Payment System rate for qualifying services provided to Medicaid beneficiaries. States are responsible for oversight of the demonstration program which includes clinic certification, payment to the CCBHCs and development of PPS rates, and compliance with federal reporting requirements. The CMS CCBHC Demonstration also provides a four-year enhanced federal match for developed PPS rates approved in the demonstration.
- SAMHSA CCBHC Expansion Grants – CCBHC Expansion Awardees are funded for generally a grant period of two years, and funded directly by SAMHSA to their local clinic through self-attestation that the awarded clinic meets the baseline CCBHC criteria. States do not have any direct role in these grants. There have been 18 CMHC sites that have been awarded the CCBHC Expansion Grant
Questions and Answers CCBHC in Indiana
Direct questions may be answered through email at CCBHCQuestions@fssa.in.gov.
- Why is the CCBHC model important to Hoosiers?
Increased access to care.
Establishing the CCBHC model at the state level will ensure complete transparency into the effectiveness of the behavioral health system, link behavioral health care services with other community pillars such as education, justice and housing system, and provide the opportunity to build in tailored treatment pathways for individuals, rather than fit complex individuals into a one-size fits all approach.
- Who is eligible to receive care at a CCBHC?
CCBHCs are required to serve anyone who requests care for mental health or addiction, regardless of their ability to pay, place of residence, or age - including developmentally appropriate care for children and youth.
- How will expansion to the CCBHCs model be funded?
CCBHCs will be funded and supported by a prospective payment system or PPS, which provides a sustainable and flexible funding model to support the CCBHC. For more information, view the SAMHSA Prospective Payment System Reference Guide.
- How does the CCBHC model address financing barriers when seeking access to behavioral healthcare?
The CCBHC model addresses financing shortfalls by paying clinics a Medicaid rate inclusive of their anticipated costs of expanding service lines and serving new consumers. Under the PPS model, each CCBHC receives a fixed, clinic-specific rate for each qualifying visit, regardless of the intensity or quantity of service provided. Through a prospective payment system, the model supports:
- Expanded access to care through an enhanced workforce. CCBHCs’ Medicaid rates cover costs associated with hiring new staff such as licensed counselors or peer support specialists, paying employees a competitive wage in the local market, and training staff in required competencies such as care coordination and evidence-based practices.
- A stronger response to the addiction crisis. Addiction care is embedded throughout the CCBHC range of services, including screening for substance use disorders, detoxification, outpatient addiction services, peer support services, and other addiction recovery services at state discretion. Importantly, most states participating in the CCBHC program have also made medication-assisted treatment (MAT) a required service.
- Enhanced patient outreach, education and engagement. CCBHCs’ Medicaid rates include the cost of activities that have traditionally been near-impossible to reimburse yet play a critical role in behavioral health services.
- Care where people live, work, and play. CCBHCs may receive Medicaid payment for services provided outside the four walls of their clinic; for example, via mobile crisis teams, home visits, outreach workers and, emergency or jail diversion programs.
- Electronic exchange of health information for care coordination purposes. CCBHCs’ Medicaid rates include the cost of purchasing or upgrading electronic systems to support electronic information exchange. The 2014 Excellence in Mental Health Act prioritizes improving the adoption of technological innovations for care, including data collection, quality reporting, and other activities that bolster providers’ ability to care for individuals with co-occurring disorders.
- Sustainable funding for the costs of meeting the community’s needs as they change over time. CCBHC clinic-specific rates are reviewed every three years by first reviewing the community’s needs and then reviewing the cost report template of CCBHC’s costs to meet these needs and adjusting the clinic specific rates accordingly.
- How does the CCBHC model fit into Indiana's developing crisis system?
Crisis services are a core service requirement for CCBHCs. CCBHCs can provide crisis services directly or through a formal partnership. The developing crisis continuum in the state will interoperate and support the CCBHC crisis services.
Currently, Indiana will be the FIRST STATE to include alignment across the crisis continuum with the 988 Suicide and Crisis Lifeline, creating one unified, 24-hour system of care from a call or text to treatment and recovery. This approach can also create an interconnected system to support the existing not-for profit and faith-based groups that are working to address these issues on a community level.
- What effect does the CCBHC model have on the current behavioral health workforce shortage?
CCBHCs’ Medicaid rates cover costs associated with hiring new staff such as licensed counselors or peer support specialists, paying employees a competitive wage in the local market, and training staff in required competencies such as care coordination and evidence-based practices.
Since adopting the CCBHC model, clinics report on average hiring 27 new staff per clinic.
The most common strategies CCBHCs are using to recruit and retain staff include:
- Raising salaries or offering bonuses (92%)
- Engaging in staff wellbeing efforts or revamping employee benefits (86%)
- Partnerships with clinician training programs (62%)
- Revising roles and scope of practice (59%)
- Participation in loan repayment programs such as National Health Service Corps (46%)
For questions, or more information, please contact us at CCBHCQuestions@fssa.in.gov.