Certified Community Behavioral Health Clinics

(CCBHC)

IDD Consortium Presentation

September 14, 2018

Jolene Rasmussen, MS

Director of Adult Behavioral Health

Texas Council of Community Centers

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Catalysts for Action (Select)

Mental Health Parity Act (1996)

U.S. Surgeon General (1999)

Rider Directed: SUD Treatment Medicaid Benefit (2009)

HB 2303: Expanded Center Scope (2009)

HB 2196: Integrated Care Study (2009)

Patient Protection & Affordable Care Act (2010)

1115 Waiver (2011)

SB 58: MH Rehab and TCM into Managed Care (2013)

Federal Mental Health Excellence Act (2014)

Rider Directed BH Strategic Plan (2015)

Rider Directed CCBHC Grant (2015)

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CCBHC Model of Care

Why CCBHC?•Aligns with Texas HHSC Behavioral Health Strategic Plan

•Receives State certification

• Integrates MH and SUD services

• Includes required services and evidenced-based practices

•Emphasizes care coordination

•Provides community-based, trauma-informed, person-

centered and recovery-oriented care

•Reports standardized quality measures

•Uses cost-based payment methodology

an amount of time or a situation in which something can be done

a favorable juncture or circumstance

a good chance for advancement or progress

Where Are We Now?

HHSC and CCBHC

HHSC states CCBHC is a vehicle to transform service

delivery, creating a more efficient and coordinated

system. Ultimately, improving the lives and healthcare

outcomes of vulnerable populations in Texas.

HHSC Reviewer Checklist:

http://www.txcouncil-intranet.com/wp-

content/uploads/2016/09/CCBHC-Texas-Pilot-Reviewer-

Checklist_UpdatedCleanv2.pdf

Texas CCBHC Next StepsTexas CCBHC Pilot

• 8 certified sites (Bluebonnet Trails, Burke, Helen Farabee, Integral Care,

Montrose Center, StarCare, MHMR Tarrant and Tropical Texas)

• Currently, without associated CCBHC cost-based payment structure

• Beginning September 1, 2018, MCOs to implement APMs with CCBHC

pilot sites

Statewide expansion

• Next group eligible to pursue certification‒The Center for Health Care

Services, Community Healthcore, Emergence and Harris Center

• Certification open to entities able to meet CCBHC criteria

• Overall roll-out strategy TBD

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is everything

Timing…

Our System and CCBHCCCBHC is one component of the 1115 Waiver AMH

Amendment strategy approved unanimously by

Center leadership includes:

•Centers certified over the next two years

•HHCS-directed payments from MCOs (alternative

payment methodology)

•Provision/protection that Centers are eligible to

become a CCBHC, regardless of other CCBHCs in same

service area

What Are the CCBHC Services?• Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis

stabilization*

• Screening, assessment and diagnosis including risk assessment*

• Patient-Centered treatment planning or similar processes, including risk assessment and crisis planning*

• Outpatient mental health and substance use services*

• Outpatient clinic primary care screening and monitoring of key health indicators and health risk**

• Targeted case management**

• Psychiatric rehabilitation services**

• Peer support and counselor services and family supports**

• Intensive, community-based mental health care for members of the armed forces and veterans, particularly

those members and veterans located in rural areas, provided the care is consistent with minimum clinical

mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines

contained in the Uniform Mental Health Services Handbook of such Administration**

*CCBHC must directly provide

**May be proved by CCBHC and/or DCO

Texas Evidenced-Based PracticesAdult Specific:

• SAMHSA Assertive Community Treatment (ACT)

• Cognitive Behavioral Therapy (CBT) and Cognitive Processing Therapy (CPT)

• SAMHSA Illness Management and Recovery (IMR)

• SAMHSA Integrated Treatment for Co-occurring Disorders

• SAMHSA Supported Employment and Permanent Supportive Housing

Child/Adolescent Specific:

• Nurturing Parent Training

• Trauma Focused CBT

• Case Management using the NWIC Wraparound model, when indicated

Applicable to all populations:

• Screening, Brief Intervention, and Referral to Treatment (SBIRT) model

• Motivational Interviewing

• Person-Centered Recovery Planning

• Seeking Safety

Are We Ready?

First Steps

√ All 39 Centers completed the

CCBHC Integrated Certification

Criteria Feasibility and Readiness

Tool (I-CCFRT)

√ Texas Council analyzed and

presented the results during

CCBHC-Pre-Conference Session

√ Identified system-wide needs

I-CCFRT: Feasibility and Readiness Assessment

The I-CCFRT provides a system for

gauging:

•Level of concern among staff

•Level of change management that

may be needed

New Incubator Strategy

Multi-pronged approach to prepare

Centers for CCBHC model of care

•Determine readiness

•Identify gaps & barriers

•Prioritize needs

•Provide learning/training

opportunities

When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.

Alexander Graham

Bell

Identified Focus Areas

1) Cultural competency

2) Triple Aim

3) Trauma-informed care

4) Ready access

5) PPS/APM

6) Population health

7) Care coordination agreements

8) Health IT/EHRs

9) Veteran services

10) Physical health data

11) Data exchange/MOUs

12) Change management

System Opportunities

1) Training

2) Resources available

3) In process – TICTOC 27 Centers

4) Resources available

5) Delta Center opportunities

6) Resources available

7) Resources available

8) No system-wide action

9) No system-wide action

10) No system-wide action

11) Resources available

12) Training; Delta Center opportunities

Next Steps

Current System-Level Training

• TICTOC Trauma-Informed Care, Time for Organizational System– TICTOC 1.0

• 7 Centers

– TICTOC 2.0• 21 Centers

• Beginning year-long process

• Change Management– October 31, 2018

– Supported by Delta Center Grant

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Alternative Payment Methodology (APM) Development

• Contracting with Community Oriented Correctional Health Services (COCHS) – Steve Rosenberg and team

• 9-month project

• APM workgroup, hybrid of Fiscal Imperative and DEW

• Center survey to be completed in October

• Kick-Off Meeting November 29, 2018

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Title slide

CCBHC Model of Care