Certified Community Behavioral Health Clinics (CCBHC) Demonstration Program

Background

Section 223 of the Protecting Access to Medicare Act (PAMA) established certified community behavioral health clinics (CCBHCs) by evaluating a two-year demonstration program for approved demonstration states. Section 223 authorized the U.S. Department of Health and Human Services (DHHS) to establish federal criteria for the demonstration program and for clinics to become certified by a state as a Certified Community Behavioral Health Clinic (CCBHC).

On August 5, 2020, Michigan was approved to become a CCBHC Demonstration state by the Centers for Medicare and Medicaid Services (CMS) and the federal CARES Act of 2020. Michigan’s CCBHC Demonstration launched on October 1, 2021.

The Bipartisan Safer Communities Act of 2022 extended states eligibility to participate in the demonstration for an additional four years resulting in a total six-year long demonstration. In February 2023, states participating in the Section 223 PAMA Act of 2014, were permitted to expand the opportunity for eligible providers to join the demonstration for an October 1, 2023, start date. CCBHC Demonstration Sites are selected by the state in accordance with federal requirements, including the attainment of state based CCBHC certification, and available funding. At the end of the demonstration, the Michigan Department of Health and Human Services (MDHHS) will evaluate the CCBHC Demonstration’s impact on Michigan’s behavioral health system and communities.

In March 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the updated 2023 Community Behavioral Health Clinics Certification Criteria (PDF | 1.3 MB) in compliance with statutory requirements outlined under Section 223 of PAMA. In Michigan, CCBHC Demonstration clinics are required to comply with the updated 2023 criteria beginning October 1, 2024. 

Program Overview

The CCBHC demonstration aims to improve the behavioral health for all Michiganders by:

• increasing access to high-quality care,
• coordinating integrated behavioral health with physical health care,
• promoting the use of evidence-based practices, and
• establishing standardization and consistency with a set criterion for all certified clinics to follow.

The CCBHC model requires access to 24/7/365 crisis response services, along with other critical elements including strong financial and quality metric reporting; formal coordination with primary and other care settings to provide intensive care management and transitions of care; linkage to social services, criminal justice/law enforcement, and educational systems.

CCBHC clinics are designed to provide a broad array of mental health and substance use disorder services to persons of all ages, regardless of ability to pay, including those who are underserved, have low incomes, have Medicaid, are privately insured or uninsured, and are active-duty military or veterans.

National Council for Mental Wellbeing video- What is a CCBHC? 

Services

CCBHC clinics are required to provide a set of nine comprehensive services, in accordance with the federal criteria provided by SAMHSA to facilitate access, stabilize crises, address complex mental illness and addiction, and emphasize physical/behavioral health integration. 

All the following services must be made available to all individuals, either directly provided by a CCBHC clinic, or through contracted designated collaborating organizations (DCOs):

1. Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.
2. Screening, assessment, and diagnosis, including risk assessment.
3. Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.
4. Outpatient mental health and substance use services.
5. Outpatient clinic primary care screening and monitoring of key health indicators and health risk.
6. Targeted case management.
7. Psychiatric rehabilitation services.
8. Peer support and counselor services and family supports.
9. Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas.

Eligibility

CCBHC services are available to any person in need, including but not limited to those with serious mental illness, serious emotional disturbances, long-term chronic addiction, mild or moderate mental illness, and substance use disorders.

• Any person with a behavioral health diagnosis, as cited in Appendix B of the CCBHC Demonstration Handbook, is eligible for CCBHC services. All persons are entitled to walk into CCBHC clinics and be screened for service eligibility.

CCBHC clinics must service all individuals regardless of residency or ability to pay. For individuals residing out of state, CCBHC clinics are responsible for providing, at a minimum, crisis response, evaluation, and stabilization services and should have protocols developed for coordinating care across state lines. CCBHCs offer a sliding fee scale for individuals who are uninsured or underinsured.

Evaluation and Outcomes

MDHHS is working with the University of Michigan Center for Health and Research Transformation (CHRT) to conduct an evaluation of the CCBHC demonstration in Michigan. Using a mixed methods approach, the evaluation seeks to understand how the CCBHC model is being implemented at the demonstration sites and measure the impact of the demonstration, particularly in expanding access to and participating of behavioral health services for underserved populations. Certified CCBHC clinics must participate in demonstration evaluation activities lead by CHRT. Evaluation findings will be shared and published to our website, when available.

MDHHS publishes annual progress reports summarizing CCBHC demonstration activity for each demonstration year. 

Demonstration Year 1:  FY21 CCBHC Annual Report

Demonstration Year 2: FY22 CCBHC Annual Report (Coming Soon)

CCBHC Demonstration Handbook

MDHHS developed the CCBHC Demonstration Handbook which is comprised of MDHHS’s operational requirements of Pre-Paid Inpatient Health Plans (PIHPs) and CCBHC Clinics, program requirements, and clinical and financial requirements. The CCBHC Handbook can be accessed here: CCBHC Demonstration Handbook

MDHHS will publish and post the FY2025 CCBHC Demonstration Handbook, in alignment with the 2023 SAMHSA criteria, prior to October 1, 2024. 

Locations & Contact Information

For CCBHC clinic locations and contact information, please navigate to the Persons Served Resources link: Persons Served Resources.

Resources

• FY25 CCBHC Demonstration Handbook (Coming Soon)
• CCBHC Demonstration Handbook
• Final Bulletin MMP 23-56-CCBHC
• MI CCBHC Sites- October 2023
• MI CCBHC Demonstration Overview
• CCBHC - Michigan Strategic Initiatives
• Section 223 Demonstration Program to Improve  Community Mental Health Services | Medicaid
• Section 223 Demonstration Program for Certified Community Behavioral Health Clinics | SAMHSA
• Certified Community Behavioral Health Clinic (CCBHC) Success Center (thenationalcouncil.org)

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