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.
Due to SAMHSA’s guidance for additions of new CCBHCs into the state Demonstration program, this timeline reflects a 12-month readiness cycle for Alabama’s CMHCs (may vary based on CMHC readiness).
Alabama Path to CCBHC
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.
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 and unserved populations. Alabama’s transition to this new, integrated business model of behavioral health care began in March 2023 with the award of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) CCBHC Planning Grant. Through this funding, the Alabama Department of Mental Health (ADMH) spearheaded several planning and readiness activities that has positioned the state to be an optimal site for SAMHSA CCBHC Demonstration.
Understanding the severe gaps in Alabama’s Behavioral Health continuum, ADMH began preparing to become a CCBHC demonstration state prior to receipt of the planning grant, commissioning a needs assessment in early 2022 to gain a full and objective picture of the service gaps in the state. This needs assessment served to guide selection of our CCBHC impact goals and provided a roadmap for planning grant activities. ADMH has worked diligently over the past several years to identify gaps in services and to incrementally adjust the system toward supporting an integrated approach to mental health and substance use disorder (MH and SUD) treatment, thus establishing six state-funded Crisis Centers that serves as a foundational component of the CCBHC model. The CCBHC model will also improve integration, reduce silos and support a sustainable and well-trained behavioral health workforce.
ADMH sees the CCBHC model as a driving force that will assist in transforming our Behavioral Health Care continuum. Through anticipated participation in the SAMHSA Demonstration program (July 1, 2024), ADMH’s long-term goal is to have all 19 Community Mental Health Centers (CMHC) become CCBHCs that will support statewide access to high-quality, accessible, and integrated care for all. Understanding this is a major paradigm shift for our CMHCs, the ADMH has prepared a robust CCBHC certification process that will help to develop the readiness capacity of CMHCs statewide.
Required Services
CCBHCs are responsible for providing all nine services, which can be provided directly or through formal relationships with Designated Collaborating Organizations (DCOs).
PAMA makes clear that, regardless of condition, CCBHCs must provide services to anyone seeking help for a mental health or substance use condition, regardless of their place of residence, ability to pay, or age. This includes any individual with a mental or substance use disorder who seeks care, including those with serious mental illness (SMI); substance use disorder (SUD) including opioid use disorder and severe SUD; children and adolescents with serious emotional disturbance (SED); individuals with co- occurring mental and substance disorders (COD); and individuals experiencing a mental health or substance use-related crisis. It also specifies that CCBHCs provide nine required services.
CCBHC
crisis response providing 24/7/365 access to help stabilize an individual in the least restrictive and the most clinically appropriate manner.
Screening, diagnosis, and risk assessment for behavioral health care conditions and primary care needs that are conducted in a timeframe responsive to the needs of the individual.
Evidence based rehabilitation services and recovery support that helps individuals develop skills and functioning to facilitate community living.
ongoing primary care monitoring of health conditions to ensure individuals have access to primary care services and promotion of a healthy lifestyle through care coordination with primary care and specialty health providers.
providing an intensive level of support that goes beyond care coordination by assisting people receiving services in sustaining recovery and gaining access to needed medical, social, legal, educational, housing, vocational and other services and supports.
peer support including wellness and recovery services, peer education, leadership development, self-help groups and family/caregiver support.
tailored community based behavioral health care for U.S. Armed Forces and veterans.
comprehensive, customized treatment planning based upon a shared decision-making approach.
evidenced based practices for treating mental health and substance use disorders across the lifespan while ensuring accessibility and availability of services regardless of one’s ability to pay or location of residence.
Federal Program Distinction
- 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 CMHCs through self-attestation that the awarded clinic meets the baseline CCBHC criteria. States do not have any direct role in these grants.
- 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 CCBHC certification, payment to the CCBHCs and development of PPS rates, and compliance with federal reporting requirements.