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Certified Community Behavioral Health Clinics (CCBHC) Demonstration Program

Publication Date

Per Section 223(d)(7)(A) of the Protecting Access to Medicare Act (PAMA) of 2014 (Public Law 113-93), the HHS Secretary must submit to Congress an annual report on the use of funds provided under all demonstration programs conducted under this subsection, not later than one year after the date on which the first state is selected for a demonstration program under this subsection, and annually thereafter. Each report shall include assessments of: (1) access to community-based mental health services; (2) the quality and scope of services provided by Certified Community Behavioral Health Clinics (CCBHCs); and (3) the impact of the demonstration programs on the federal and state costs of a full range of mental health services.

This research was conducted under contract #HHSP233201600017 between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) with Mathematica Policy Research and the RAND Corporation. Please also visit the ASPE Behavioral Health page for additional research in this area.

Available Yearly Reports to Congress:

  • Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2022 (2023). This report to Congress report summarizes describes state demonstration oversight and expansion of the CCBHC model since the end of the second demonstration year as well as early implementation experiences of two new states, Kentucky and Michigan, that were added to the demonstration as part of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116-136). The report describes specific findings related to the topics of access to care and scope of services and describes how states and CCBHCs adapted during the COVID-19 public health emergency. Finally, the report provides information on demonstration payment rates and costs for the first four demonstration years for states with available data.
  • Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2021 (2022). This fifth report to Congress report summarizes key findings for each of the areas related to the PAMA requirements and provides information on the implementation experiences of states and CCBHCs with the model. This report builds on interim evaluation reports, which provide detailed information on implementation progress and the costs and quality of care.
  • Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2020 (2021). This fourth report to Congress describes results from the evaluation of the CCBHC demonstration program. This report summarizes changes in CCBHC rates and costs from demonstration year one (DY1) to DY2, performance on quality measures in DY1, and the extent to which states provided quality bonus payments (QBPs) to CCBHCs for DY1. Results indicated that total costs, visit days/months, and per visit day/month costs increased from DY1 to DY2, but results varied considerably within and across states. Likewise, performance on the quality measures varied considerably across CCBHCs and across states, with no discernable patterns of consistently higher or lower performance in certain states. In DY1, all demonstration states except Oregon offered QBPs, and 4 states distributed bonus payments to 26 of 31 eligible CCBHCs for meeting the quality measure performance thresholds. Across states, the amount of QBP funding distributed in DY1 varied, ranging from approximately $500,000 to more than $17,000,000.
  • Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2019 (2020). This third report to Congress highlights participating states’ CCBHC activities that have been associated with improving access to a comprehensive range of treatment and recovery support services. The range of services includes delivery of mental health, addiction, and either screening for general medical conditions or onsite access to primary care during DY1. It draws on qualitative findings gathered from interviews at the state level and data from surveys of CCBHCs. The report also details how states have been reporting and utilizing the required quality measures for quality improvement. Finally, the report assesses the costs to CCBHCs for providing the required services and compares the demonstration payment rates to actual costs. [HTML version also available]
  • Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2018 (2019). This second report to Congress highlights participating states’ CCBHC activities that have been associated with improving access to a comprehensive range of treatment and recovery support services. The range of services includes delivery of mental health, addiction, and either screening for general medical conditions or onsite access to primary care during DY1. It draws on qualitative findings gathered from interviews at the state level and preliminary data from CCBHCs. The report also details how the 8 states that were selected to participate in the demonstration are monitoring the CCBHCs for compliance to the certification criteria. Each of the 8 demonstration states, Minnesota, Missouri, Nevada, New Jersey, New York, Oregon, Oklahoma, and Pennsylvania is profiled in the report to understand their compliance efforts. Subsequent annual reports to Congress on this demonstration will include data now being collected and reported by CCBHCs in each of the 8 demonstration states as required. [HTML version also available]

Additional Available Reports:

  • Implementation and Impacts of the Certified Community Behavioral Health Clinic Demonstration: Findings from the National Evaluation (2022). This report summarizes findings from ASPE’s evaluation of the CCBHC demonstration program. This final evaluation report provides detailed results related to implementation and program impacts during the first 2 years of the demonstration. During the first 2 years of the demonstration, CCBHCs implemented a range of activities to improve access to care; increased the number of clients they served; expanded services to include various evidence-based practices, crisis services, and rehabilitative services; hired and trained staff; developed partnerships with external providers; enhanced their data systems; and changed many of their care processes. Overall, the quality of care provided to CCBHC clients was comparable to available benchmarks, and performance on some measures improved over time. However, there was some room for improvement on several measures. Results indicated that states experienced some initial challenges setting PPS rates, but over time these rates came into greater alignment with CCBHC costs in all but one state. Average costs of CCBHC services varied widely by state, likely due to regional differences in costs and differences across states in the use of CCBHC services.
  • Interim Cost and Quality Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration (2021). This report outlines interim findings from the CCBHC evaluation. This report describes: (1) changes in Certified Community Behavioral Health Clinic rates and costs from DY1 to DY2; (2) performance on quality measures in DY1; and (3) the extent to which states provided QBPs to CCBHCs for DY1. Results indicated that total costs, visit days/months, and per visit day/month costs increased from DY1 to DY2, but results varied considerably within and across states. Performance on DY1 quality measures also varied considerably across measures and states, with no clearly discernable patterns of consistently higher or lower performing states. Four states distributed quality bonus payments to a total of 26 of 31 participating CCBHCs.
  • Implementation Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration (2020). This 2019 report informs the third annual Report to Congress and details highlights participating states’ CCBHC activities that have been associated with improving access to a comprehensive range of treatment and recovery support services. The range of services includes delivery of mental health, addiction, and either screening for general medical conditions or onsite access to primary care during DY1. It draws on qualitative findings gathered from interviews at the state level and data from surveys of CCBHCs. [HTML version also available]
  • Preliminary Cost and Quality Findings from the National Evaluation of the Certified Community Behavioral Health Clinic Demonstration (2020). This 2019 report informs the third annual report to Congress and details how states have been reporting and utilizing the required quality measures for quality improvement. This report also assesses the costs to CCBHCs for providing the required services, and compares the demonstration payment rates to actual costs. [HTML version also available]