Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2024
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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
- The number of CCBHCs across demonstration states expanded over time, and states planned to add more clinics in the future. The number of people CCBHCs served each year also increased steadily over time.
- The introduction of the CCBHC model affected the use of services differently across the three demonstration states included in impact analyses (Minnesota, Oklahoma, and Nevada). In some states, introduction of the CCBHC model was associated with reduced emergency department visits, and there was some evidence of positive impacts on hospitalization rates. The demonstration was also associated with increased behavioral health–related ambulatory visits.
- The demonstration was associated with increased total Medicaid costs in the two states for which cost impacts were assessed. Although the demonstration decreased inpatient costs for some populations, these decreases did not offset an increase in ambulatory behavioral health costs driven by increased behavioral health–related ambulatory visits. The increased costs, however, and particularly costs driven by increased costs for ambulatory behavioral health visits, might not be unexpected.
Section 223 of the Protecting Access to Medicare Act of 2014 (PAMA; Public Law 113-93) authorized the Certified Community Behavioral Health Clinic (CCBHC) demonstration, which allows states to test an innovative evidence-based strategy for delivering and reimbursing a comprehensive array of services provided in community behavioral health clinics. The demonstration aims to improve the availability, quality, and outcomes of outpatient services and also provides coordinated care that addresses both behavioral and physical health conditions provided in these clinics. The demonstration requires participating states to reimburse CCBHC services through a Medicaid prospective payment system (PPS) intended to cover the expected costs of CCBHC services for Medicaid beneficiaries. In 2016, the U.S. Department of Health and Human Services (HHS) selected 8 states to participate in the demonstration (Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania). The demonstration was originally authorized for two years, but Congress has extended it multiple times and it is currently authorized in the original states through September 2025. In August 2020, HHS announced that Kentucky and Michigan would begin participating in the demonstration as a result of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; Public Law 116-136) which allowed HHS to add two states from among the original 24 planning grant states. The Bipartisan Safer Communities Act (Public Law 117-159), enacted in June 2022, funded additional planning grants and authorized all states who received a planning grant to apply to participate in the demonstration beginning in 2024. Beginning July 1, 2024, and every two years thereafter, HHS may select up to 10 additional states to participate in the demonstration.
PAMA mandates that the HHS Secretary submit an annual report to Congress that assesses: (1) access to community-based mental health services under Medicaid; (2) the quality and scope of services provided by CCBHCs; and (3) the impact of the demonstration on federal and state costs of a full range of mental health services. This report describes findings related to the PAMA topics of access to care, quality of care, and the demonstration’s impact on costs. The report draws on Medicaid data, quality measure data, and interviews with state officials.
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