A Certified Community Behavioral Health Clinic (CCBHC) is a specially designated clinic that receives flexible funding to expand the scope of mental health and substance use services available in the community to ensure health equity and high-quality care for underserved populations. Alabama is transitioning to this new, integrated business model of mental health care.
On March 31, 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. The legislation created criteria for “Certified Community Behavioral Health Clinics” (CCBHCs). As of March 2023, there are more than 500 CCBHCs are operating in 46 states, plus Puerto Rico, Washington D.C. and Guam.
Alabama does not currently certify CCBHCs but is in the process of developing certification criteria which will be in effect in 2024.
CCBHCs began in the state’s community mental health centers, with the awarding of a 2021 SAMHSA grant to AltaPointe Health and WellStone to implement the Certified Community Behavioral Health Clinic (CCBHC) model for care delivery. Over fiscal year 2023, Alabama’s Community Mental Health Centers and the ADMH completed assessments to determine their preparedness for the development and implementation of the CCBHC integrated behavioral healthcare business model with high-quality care, practices, and reporting measures. This model will ensure improved access to and delivery of coordinated, comprehensive behavioral healthcare to all Alabamians.
On March 16, 2023, the Substance Abuse and Mental Health Service Administration (SAMHSA) has awarded the Alabama Department of Mental Health (ADMH), a Certified Community Behavioral Health Clinic (CCBHC) Planning Grant in the amount of one million dollars to develop statewide certification criteria for CCBHCs. Within the year-long period of the grant, the ADMH will work with Alabama’s Community Mental Health Centers to plan a comprehensive behavioral healthcare business model to reduce disparities; improve access to care for marginalized communities; and develop a payment system that will reward quality over volume.
An important feature of the CCBHC model is that it requires crisis services that are available 24 hours a day, 7 days a week. The Alabama Crisis System of Care is a foundational component of the CCBHC model, as the state has established six state-funded Crisis Centers, which will be operational in 2023. The CCBHC model is designed to increase access to behavioral health services, including crisis services, that respond to local community needs, incorporate evidence-based practices, and establish care coordination to help people navigate behavioral healthcare, physical healthcare, and social services.
CCBHCs are responsible for providing all nine services, which can be provided directly or through formal relationships with Designated Collaborating Organizations (DCOs):
- 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 Services
CCBHCs are responsible for meeting criteria, which establish a basic level of service at which a CCBHC should operate, fall into six key program areas:
- Staffing – Staffing plan driven by local needs assessment, licensing, and training to support service delivery
- Availability and Accessibility of Services – 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 – Care coordinate agreements across services and providers (e.g., Federally Qualified Health Centers, inpatient and acute care), defining accountable treatment team, health information technology, and care transitions
- Scope of Services – Nine required services, as well as person-centered, family-centered, and recovery-oriented care
- Quality and Other Reporting – Required quality measures, a plan for quality improvement, and tracking of other program requirements
- Organizational Authority and Governance – Consumer representation in governance, appropriate state accreditation
CCBHCs must meet standards for the range of services they provide, and they are required to get people into care quickly. CCBHCs must provide care coordination to help people navigate behavioral health care, physical health care, social services, and the other systems they are involved in.
The CCBHC model will also improve integration, reduce silos and support a sustainable and well-trained behavioral health workforce. A transition to the Certified Community Behavioral Health Clinic business model will ensure statewide expansion of and access to mental healthcare for all Alabamians.