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CMS CCBHC Demonstration Versus SAMHSA CCBHC Expansion Grant

There are two federal programs that contain "CCBHC" in the name - the CMS CCBHC Demonstration and the Substance Abuse and Mental Health Services Administration (SAMHSA) CCBHC Expansion Grant. These are two different opportunities, as outlined below:

CMS CCBHC Demonstration - operationalized by the State and uses a Prospective Payment System (PPS) methodology for qualifying encounters provided to Medicaid beneficiaries. The State is responsible for overseeing the demonstration program, including clinic certification, payment, and compliance with federal reporting requirements.

SAMHSA CCBHC Expansion Grants - funded directly from SAMHSA to local clinics with self-attestation that they meet baseline CCBHC criteria - the State does not have any direct role in these grants. Michigan has SAMHSA CCBHC Expansion Grantees that are also included in the CMS CCBHC demonstration.

 

Certification

CCBHC demonstration clinics must complete the MDHHS certification process to become a CCBHC under the CMS CCBHC Demonstration. During the certification process, CCBHC clinics will provide justification of meeting CCBHC criteria defined by SAMHSA and MDHHS by submitting supporting documentation verifying that standards have are met. Certification criteria address the following elements:

  1. Staffing Requirements
  2. Availability and Accessibility of Services
  3. Care Coordination across the full spectrum of health services
  4. Scope of Services
  5. Quality and Other Reporting
  6. Organizational Authority, Governance, and Accreditation

Currently, MDHHS is responsible for selecting eligible applicants to apply to join the CCBHC Demonstration for budget and expansion opportunities.

For more information, please visit the  CCBHC Demonstration Handbook.  Or contact us – mdhhs-ccbhc@michigan.gov

Payment

MDHHS utilizes the prospective payment system (PPS-1) methodology in which CCBHC clinics receive an enhanced daily clinic-specific rate based on the average expected daily cost to deliver core CCBHC services to persons served. As the demonstration continues, MDHHS will rebase the CCBHC clinic specific rate according to the actual costs of providing the nine core CCBHC services, including costs of serving the uninsured and underinsured. 

A list of current CCBHC clinics PPS-1 rates can be found here: PPS-1 Rates FY24 Handout

Evaluation

Unlike traditional service organizations that operate differently in each state or community, CCBHCs are required to meet established criteria related to care coordination, crisis response and service delivery, and be evaluated by a common set of quality measures.

Reporting Requirements

CMS has defined reporting requirements and guidance for the CCBHC demonstration. MDHHS must report all measures to CMS on an annual basis. There are two broad sets of requirements – CCBHC Reported Measures and State Reported Measures. A state-lead measure is calculated by the state for each CCBHC, usually relying on administrative data. A CCBHC-lead measure is calculated by the CCBHC and sent to the state. The measures are not aggregated by the state. To the extent necessary to fulfill these requirements, providers must agree to share all CCBHC clinical and cost data with MDHHS. 

 

Resources

For questions, concerns or more information, contact us - mdhhs-ccbhc@michigan.gov