In 2014, the Protecting Access to Medicare Act of 2014 (“PAMA”) was signed into law authorizing the Department of Health and Human Services (“HHS”) to select up to eight states to participate in a 2-year Demonstration program aimed at improving the availability, quality, and outcomes of ambulatory behavioral health services by establishing a standard definition and criteria for CCBHCs and developing new PPS that accounts for the expected cost of providing comprehensive behavioral health services to all individuals who seek care. The Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) signed into law on March 27, 2020, added two additional Demonstration states to the program. Most recently in June 2022, the Demonstration was extended and expanded under the Bipartisan Safer Communities Act to include up to an additional ten states starting in 2024, and every two years thereafter. 

CCBHCs are required to provide nine core services and requires CMS to issue Guidance to states and clinics on the development of the PPS to be used Demonstration-wide. The CCBHC PPS applies to services delivered either directly by a CCBHC or through a formal relationship between a CCBHC and Designated Collaborating Organizations (“DCOs”).  Here are some highlights of the changes:  

1. New Payment Rates. The updated guidance includes two new rate options, PPS-3 and PPS-4.  
2. DCOs. Softens the requirements on CCBHCs for services rendered by DCOs. 
3. Dually certified entities. clarifies payment treatment when a CCBHC is certified as another facility type, such as a federally qualified health center (FQHC), a clinic, or a tribal entity.  
4. Dual eligible beneficiaries. For individuals entitled both to Medicare and Medicaid benefits, guidance ensures CCBHCs should not receive lesser payment for serving Medicaid clients solely because those clients also have coverage under the Medicare program. 
5. Medicaid Managed Care Organizations (“MCOs”). The updated guidance includes more clarifications and protections surrounding CCBHCs’ arrangements with Medicaid managed care organizations.