The Certified Community Behavioral Health Clinic (CCBHC) demonstration program has long been heralded as a transformative model in community-based mental health and substance use disorder treatment. Its purpose is to improve access to behavioral health services, expand the range of services offered, and promote higher-quality care for individuals struggling with mental health and addiction issues. Recently, significant news regarding the program has emerged with the extension of its funding, but the future of CCBHCs remains uncertain as advocates and industry leaders continue to push for more permanent solutions.
On December 20, 2019, President Donald Trump signed the fiscal year 2020 funding package, which included an extension of the CCBHC demonstration program through May 2020. This move, passed by Congress earlier that week, was vital for ensuring that the program could continue to operate in the eight states currently participating. The package also includes an additional $50 million in funding for CCBHCs through the Substance Abuse and Mental Health Services Administration (SAMHSA), which provides grants to support the program.
While this extension is a welcome victory for community behavioral health providers, the broader behavioral health community is left with lingering questions about the long-term future of the program. Many advocates had hoped that the fiscal year 2020 funding package would bring a more permanent solution to the CCBHC program’s uncertain future, including further expansion of the program to additional states. However, such provisions did not make it into the final spending package, leaving advocates hopeful but cautious.
What is the CCBHC Demonstration Program?
The CCBHC program was created as part of the 2014 Protecting Access to Medicare Act (PAMA), which authorized the demonstration program to test the effectiveness of community-based behavioral health clinics in providing comprehensive, integrated services. The goal of the program is to provide high-quality, accessible, and affordable behavioral health services for individuals with mental health and substance use disorders, particularly those in underserved communities.
Under the demonstration program, participating states receive federal funding to support the creation and operation of CCBHCs, which must meet specific criteria, including providing a comprehensive range of services such as:
- Outpatient mental health and substance use disorder treatment
- 24/7 crisis services
- Screening and assessment
- Care coordination
- Integration with primary care services
CCBHCs are required to offer evidence-based, person-centered care to individuals of all ages, and they must also use data to track patient outcomes and improve service delivery. The program aims to ensure that individuals can access the care they need when they need it, without unnecessary barriers or delays.
Currently, the CCBHC program is operating in a select number of states: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania. These states were chosen for the demonstration based on their ability to implement the program and their commitment to improving community-based behavioral health services. CCBHCs in these states have had the opportunity to provide more comprehensive care, improve treatment outcomes, and increase access to behavioral health services for vulnerable populations.
Why Was the Extension of the CCBHC Program Necessary?
The CCBHC demonstration program has proven to be successful in improving access to behavioral health services, particularly for people who have traditionally had difficulty accessing care. By providing a range of services in a single, coordinated setting, CCBHCs help individuals with mental health and substance use disorders receive timely and effective treatment, often before their conditions become more severe.
However, the program has faced funding uncertainty since its inception. While the program has shown promise in the states where it has been implemented, it has not been permanently authorized or funded by Congress. The initial demonstration phase was set to run for two years, but funding for the program has been extended multiple times through short-term measures, like the December 2019 funding package. Without the extension included in this latest package, funding for the program would have run out immediately, leaving participating states and providers in a difficult position.
The extension through May 2020 was essential for ensuring that CCBHCs could continue to operate without disruption. The additional $50 million in funding for the program, provided through SAMHSA grants, also helps to ensure that the clinics can continue to meet the needs of their communities, expanding access to behavioral health services and improving care for individuals with mental health and substance use disorders.
What’s Next for the CCBHC Program?
While the extension of the CCBHC program through May 2020 was a critical step in maintaining access to care, advocates for the program were hoping for a more permanent solution. The National Council for Behavioral Health, a leading advocacy organization for community behavioral health providers, expressed disappointment that the funding package did not include a longer-term extension or broader expansion of the program.
The National Council has been pushing for an extension of the CCBHC program for at least two more years, along with the inclusion of additional states in the demonstration program. Earlier in December 2019, the Senate Finance Committee had reached an agreement to extend the program by two years and add 11 new states to the program. However, these provisions were not included in the final funding package.
Despite the setback, the National Council remains optimistic about the future of the program. “CCBHCs have been packaged with other health care program extensions, with the expectation that spending on these policies must be offset by cuts elsewhere,” the National Council wrote in a press release. “Unfortunately, Congress has not yet reached agreement on the offset, meaning that the whole package of extenders has been pushed to May to give negotiators time to work out a deal.”
This delay means that there is still a possibility that a more permanent solution could be reached before the May 2020 deadline. Advocates are hopeful that Congress will find a way to extend the program for a longer period of time and expand it to additional states, ensuring that more communities have access to the high-quality behavioral health services offered by CCBHCs.
Additional Funding for Behavioral Health Services
In addition to the extension of the CCBHC program, the fiscal year 2020 funding package also includes other provisions aimed at supporting behavioral health services. These include:
- Expansion of state opioid response grants to cover stimulants, in addition to opioids, in recognition of the growing crisis of stimulant use in the U.S.
- Funding for a loan repayment program for substance use treatment professionals, which will help to address the shortage of trained professionals in the behavioral health workforce.
- Increased funding for SAMHSA, the Centers for Medicare and Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC), all of which play a key role in supporting and overseeing behavioral health programs across the country.
These provisions are part of a broader effort to address the growing behavioral health crisis in the United States, including the opioid epidemic and rising rates of mental health conditions. While the extension of the CCBHC program is one of the most important aspects of the funding package, these additional measures also represent critical steps in ensuring that individuals can access the care they need to recover from mental health and substance use challenges.
Conclusion: A Step in the Right Direction, but More Work to Be Done
The extension of the CCBHC demonstration program through May 2020 is a positive development for community behavioral health providers and individuals who rely on these services. The program has proven to be an effective model for improving access to care, increasing the quality of behavioral health services, and integrating care for individuals with mental health and substance use disorders.
However, the uncertainty surrounding the future of the program highlights the ongoing challenges in securing long-term funding and support for behavioral health services. While the extension provides some relief, it is not a permanent solution. Advocates for CCBHCs continue to push for a more comprehensive, long-term extension of the program, including expanding it to additional states. The hope is that this will ensure more communities have access to the critical behavioral health services that CCBHCs provide.
As policymakers continue to negotiate solutions to the behavioral health crisis, the CCBHC program will likely remain a key part of the conversation. For now, providers and advocates will continue to work toward securing a future for CCBHCs that ensures all individuals, regardless of their location or background, can access the care they need to live healthier, more fulfilling lives.
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