CMS-10398 #45 Guidance on Addition of CCBHCs to Section 223 State Demo

Guidance on Addition of CCBHCs to Section 223 State Demonstration Programs
States 1 participating in the Section 223 Protecting Access to Medicare Act of 2014, Certified
Community Behavioral Health Clinic (CCBHC) Demonstration Program are permitted as of
February 21, 2023 to add new CCBHCs to their demonstration programs, subject to the
following guidance.
In order to be included in the Demonstration, new clinics must meet the certification criteria and
prospective payment system (PPS) guidance in effect and be certified as a CCBHC by the state at
the time they join the Demonstration.
In calendar year (CY) 2023, states will be able to allow CCBHCs to begin participating in the
Demonstration at any time during the year. States adding CCBHCs in 2023 should submit the
following materials to [email protected] for approval by the Substance Abuse and
Mental Health Services Administration (SAMHSA) and the Centers for Medicare & Medicaid
Services (CMS). Approval decisions will be made within 30 calendar days after receipt of a
complete submission that includes all of the elements listed below.
For states that are planning to add CCBHCs to their demonstration programs in CY 2024 or
after, states must align their participation in the Demonstration with the annual start of their
demonstration year (DY). 2 Therefore, states shall submit the following materials at least 30
calendar days prior to the beginning of the DY in which the state would like the CCBHCs to join
the Demonstration. As approval decisions will be made within 30 calendar days after receipt of a
complete submission, we encourage states to submit materials as early as possible to ensure that
their submissions are complete and able to be approved prior to the start of their DY.
The following materials must be included as part of the state’s submission in order for it to be
considered complete.
a. The list of new CCBHCs to be added, including the date when the state intends to add
the clinic(s) to the CCBHC Demonstration.
b. A timeline for conducting a needs assessment for each new CCBHC, as required in
the CCBHC Certification Criteria.
c. A timeline for certifying the clinics as CCBHCs that the state is planning to add to the
Demonstration. Note: States must verify that CCBHCs being added to their
Demonstration programs are certified by the state prior to joining the demonstration
program.
Including the District of Columbia, which is eligible to participate in the Demonstration.
For example: Oklahoma (OK) DY year starts April 1. In CY 2023, OK would be able to add new CCBHCs, pending
approval, anytime during CY 2023 subject to the timeframes detailed in this document. In CY 2024 and in future
years, OK would only be able to add new CCBHCs starting on April 1.

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d. A description of the certification process for new CCBHCs participating in the state
demonstration program, using the CCBHC Certification Criteria that are in effect
when the state intends to add the new CCBHCs to the Demonstration (note: states
may certify new CCBHCs being added to state demonstration programs using the
updated certification criteria being released in 2023 ahead of the other CCBHCs in
their demonstration program that are still operating under the existing Certification
Criteria). As part of this response the state should ensure their submission includes:
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The CCBHC Criteria Checklist (available at
https://www.samhsa.gov/sites/default/files/state-compliance-ccbhbc-criteriachecklist.pdf) with ratings of new CCBHCs in the state as “ready to
implement,” “mostly ready to implement,” “ready to implement with
remediation,” and “unready to implement.”
A description of the selection processes and review procedures that the state is
using to certify clinics including attention to quality of care, access, and
availability of services.
A description of how the state facilitated cultural, procedural, and
organizational changes to CCBHCs that will result in the delivery of high
quality, comprehensive, person‐centered, and evidence‐based services that are
accessible to the target population.
A description of how the CCBHC needs assessment process addresses the
following: (a) input from individuals with lived experience of mental health
and substance use challenges, and other stakeholders; (b) behavioral health
needs and resources in the service area; and (c) transportation, income,
culture, and other barriers.
A description of the guidance to CCBHCs regarding the CCBHC’s
organization governance that ensures meaningful input by clients, people with
lived experience of mental health and substance use conditions, and family
members.

e. A description of how the state is preparing new CCBHCs to use data to inform and
support continuous quality improvement processes, including fidelity to evidence‐
based practices; delivery of person‐centered, recovery‐oriented care; and tracking and
addressing health disparities during the Demonstration.
f. A description of how the state is assisting new CCBHCs with collection and reporting
of the CCBHC Behavioral Health Clinic Quality Measures to comply with the
existing state reporting schedules for these measures. While new CCBHCs are
expected to participate in collection and reporting of these measures during the
first full DY, they will not be expected to report on quality measures before their first
full DY if they join the demonstration program in calendar year 2023 out of
alignment with the state’s DY cycle.

g. A description of how the state is assisting new CCBHCs to ensure they are using
either CCBHC- or state-specific billing codes to identify CCBHC service level details
on claims.
h. A description of how the state is assisting new CCBHCs with the cost reporting
process and how the rates will be set.
i. Estimates of the clinic-specific rates for each new CCBHC to be added under the
state’s existing demonstration program and the timeframe in which these new
CCBHC’s initial PPS rates will be in effect.
j. States should submit final rates for the new clinic(s) one month prior to the date on
which the state intends to add them.
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CCBHCs may provide services in multiple locations and in community-based settings;
however, there is a restriction on satellite facilities in statute. If a facility meets the
definition of a satellite facility on SAMHSA’s website
(https://www.samhsa.gov/sites/default/files/section-223-satellite-facility.pdf), it cannot
receive payment as a part of the Demonstration if it was established after April 1, 2014.
New CCBHCs are expected to participate in all aspects of the existing state
demonstration program, including but not limited to quality measurement and reporting,
evaluation activities, and state CCBHC demonstration program requirements such as use
of state-specified evidence-based practices.
The state is the only entity that can certify CCBHCs; the SAMHSA attestation process
for the CCBHC expansion grants is not sufficient to constitute state certification.
The state must use the existing approved state demonstration PPS methodology for any
added CCBHCs. Reimbursement under the CCBHC Demonstration for new CCBHCs
will not be retroactive and will only start on the approved effective date for new clinics
being added to the CCBHC Demonstration.
The state must use the CMS CCBHC cost report
(https://www.medicaid.gov/medicaid/financial-management/section-223-demonstrationprogram-improve-community-mental-health-services/index.html) to set initial rates for
new CCBHCs, unless the state has a state-specific CCBHC cost report that has been
previously approved by CMS to use in the Demonstration.
The state is expected to follow the CMS PPS guidance related to updating and rebasing
PPS rates. States are expected to update the PPS rates for CCBHCs after their first full
DY using actual costs. These updated rates should be effective for the following DY.
Payments will only be made in alignment with Demonstration PPS guidance.