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September 15, 2023
Certified Community Behavioral Health Clinics (CCBHCs)
Since the 1960s, when Congress authorized the first federal
Table 1. CCBHC Medicaid Demonstration Program
grants to establish outpatient mental health clinics, the
States and Dates
federal government has supported states’ provision of
Date Planning
Date
Demonstration
community-based behavioral health services. In 2014,
Grant
States
Period End
Certified Community Behavioral Health Clinics (CCBHCs)
States
Awarded
Selected
Date
were developed to improve community behavioral health
services by supporting certain outpatient mental health
MO, NV, NJ, October 19,
December September 30,
clinics that meet specified federally designated criteria. A
NY, OK, OR 2015
21, 2016
2025
CCBHC is a federally designated model of care. CCBHCs
KY and MI
October 19,
August 5,
Six years after
can be supported by a Medicaid demonstration program for
2015
2020
implementation
states and/or discretionary grant funding for clinics from the
(MI: September
Substance Abuse and Mental Health Services
30, 2027, and KY:
Administration (SAMHSA).
December 31,
What Is a CCBHC?
2027)
Up to 10
March 16, 2023 On or after Four years after
CCBHCs are community-based outpatient facilities
states
July 1, 2024 implementation
operated by nonprofit, governmental, or tribal entities that
offer a comprehensive range of behavioral health services.
Source: U.S. Department of Health and Human Services (HHS),
HHS awards up to $22.9 mil ion in Planning Grants for Certified
Federal criteria related to access and quality of mental
Community Behavioral Health Clinics, October 19, 2015, 42 U.S.C.
health care are used to certify outpatient behavioral health
§1396a notes; Center for Medicaid and CHIP Services, CMS and
clinics that meet these standards. The criteria require
SAMHSA announce new participants of the Certified Community
CCBHCs to provide specified services, such as risk
Behavioral Health Clinic Demonstration, August 5, 2020; HHS, HHS
assessment, outpatient mental health and substance use
Awards CCBHC Planning Grants to 15 States to Help Address Ongoing
treatment, case management, psychiatric rehabilitation
Mental Health Crisis, March 16, 2023.
services, peer and family supports, 24-hour crisis
Notes: CCBHC=Certified Community Behavioral Health Clinic.
management, primary care screening, and care coordination
Pennsylvania and Minnesota were among the original eight states
(among others), on site or through partnerships with other
selected to participate in the demonstration program, but both states
health and social service providers. CCBHCs must provide
have since withdrawn from the demonstration.
services to individuals with mental health and substance use
In October 2015, HHS awarded $23 million in planning
disorders seeking care regardless of ability to pay or place
grants to 24 states to develop proposals to participate in the
of residence. CCBHCs can serve patients covered by
CCBHC demonstration program. In December 2016, HHS
Medicare, Medicaid, and private health insurance, as well
selected eight states to participate: Minnesota, Missouri,
as those who are uninsured. CCBHCs may receive state
Nevada, New Jersey, New York, Oklahoma, Oregon, and
funds or funding from other federal discretionary grant
Pennsylvania. (Pennsylvania and Minnesota have since
programs.
withdrawn from the demonstration.) For the six original
CCBHC Medicaid
states that continue to participate in the Medicaid
Demonstration Program
demonstration program, the current expiration date of the
Section 223 of the Protecting Access to Medicare Act of
demonstration is September 30, 2025. In 2020, HHS
2014 (P.L. 113-93) authorized the Medicaid demonstration
selected two additional states (Kentucky and Michigan) to
program for community behavioral health clinics that meet
join the demonstration program, as authorized by the
the federally designated CCBHC criteria specified in the
Coronavirus Aid, Relief, and Economic Security Act of
law. For states participating in the demonstration program,
2020 (P.L. 116-136). Kentucky’s demonstration expires
the federal government pays a higher share of Medicaid
December 31, 2027, and Michigan’s demonstration expires
expenditures through the enhanced federal medical
September 30, 2027.
assistance percentage (E-FMAP) for services provided to
The Bipartisan Safer Communities Act of 2022 (P.L. 117-
Medicaid enrollees at CCBHCs. In addition, CCBHCs in
159) authorizes the HHS Secretary to select up to 10
these states, through a prospective payment system (PPS)
additional states for the Medicaid demonstration program
methodology, receive greater Medicaid payment rates than
beginning July 1, 2024, and every two years after that. The
what the state pays other mental health outpatient clinics.
demonstration program for this new group of states is
Eight states are currently participating in the demonstration
authorized to last four years from the date the state
(Table 1).
implements the demonstration. On March 16, 2023, HHS
awarded planning grants to 15 states: Alabama, Delaware,
Georgia, Iowa, Kansas, Maine, Mississippi, Montana, North
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Certified Community Behavioral Health Clinics (CCBHCs)
Carolina, New Hampshire, New Mexico, Ohio, Rhode
Figure 2. CCBHC Expansion Grant Appropriations
Island, Vermont, and West Virginia.
The HHS Secretary is required to submit annual reports to
Congress about the demonstration program. In addition, the
HHS Secretary is required to issue recommendations by
September 30, 2025, regarding whether the CCBHC
demonstration program should be continued, expanded,
modified, or terminated.
Figure 1. CCBHCs in the United States
States Participating in the CCBHC Medicaid Demonstration
and States with CCBHC Expansion Grant Recipients
Source: CRS analysis.
Notes: ARPA=American Rescue Plan Act of 2021 (P.L. 117-2);
COVID-19=Coronavirus Disease 2019; LHHS=Labor, Health, and
Human Services. COVID-19 supplemental appropriations were in P.L.
116-136 and P.L. 116-260. ARPA funding is available until expended.
Medicaid demonstration planning grant funding is not included here.
Program Differences
While all CCBHCs are required to provide certain specified
services, some differences exist between facilities in states
participating in the Medicaid demonstration and facilities
receiving CCBHC Expansion grants directly. For instance,
Source: Substance Abuse and Mental Health Services Administration
while all CCBHCs provide the required scope of services,
(SAMHSA).
CCBHCs in states participating in the Medicaid
Notes: CCBHC=Certified Community Behavioral Health Clinic.
demonstration must collect, track, and report on a range of
SAMHSA CCBHC Expansion Grants
encounter, outcome, cost, and quality data. Medicaid
demonstration states certify CCBHCs through state entities
The Consolidated Appropriations Act of 2018 (P.L. 115-
or independent accrediting bodies, whereas not all CCBHCs
141) authorized a CCBHC Expansion grant program and
receiving CCBHC Expansion grants are formally certified
provided $100 million in expansion grant funding for
by their state (CCBHCs not formally certified attest to
FY2018. Grants awarded under the initial CCBHC
SAMHSA that they meet CCBHC criteria). States that are
Expansion grant program provided up to $2 million
not part of the CCBHC Medicaid demonstration program
annually for two years to CCBHCs (or comparable
are not required to pay CCBHCs through a PPS, but those
community-based behavioral health facilities that met the
states could use a PPS model. Nonetheless, only states
federal certification criteria) to increase access and improve
participating in the Medicaid demonstration program are
the quality of their behavioral health services. In 2018,
eligible for the E-FMAP for CCBHC services.
SAMHSA awarded the first CCBHC Expansion grants
directly to facilities that met the CCBHC criteria.
CCBHC Outcomes
(SAMHSA also administers the Medicaid demonstration
Reports from HHS agencies and partner organizations on
planning grants.) The CCBHC Expansion grant program
the Medicaid demonstration associate CCBHCs with
received further funding through the COVID-19
improved access to a range of behavioral health services.
supplemental appropriation laws (P.L. 116-136 and P.L.
Reports to Congress suggest that CCBHCs have increased
116-260), the American Rescue Plan Act of 2021 (P.L. 117-
the number of people served per clinic, augmented staffing
2), and subsequent annual Labor-HHS appropriations laws
of credentialed providers, improved care coordination, and
(Figure 2). Beginning in FY2022, SAMHSA awarded up to
expanded provider networks, among other outcomes. Initial
$1 million annually for four years to clinics to establish new
findings on costs and quality of care at CCBHCs show that
CCBHCs or support existing ones. Since 2018, SAMHSA
providing more comprehensive services is generally
has awarded grants to over 350 clinics across 46 states and
associated with higher costs, and that quality of outcomes
the District of Columbia (Figure 1).
varies among clinics and states.
Megan B. Houston, Analyst in Health Care Financing
Johnathan H. Duff, Analyst in Health Policy
IF12494
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Certified Community Behavioral Health Clinics (CCBHCs)
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