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Four Steps to Becoming a CCBHC

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You have been thinking about becoming a CCBHC but are not sure this is the right direction for your agency. We have made it a bit easier by compiling the requirements you will need to meet to make this change. The following lists four areas your application will need to address, including agency requirements, services required, use of Designated Collaborating Organizations (DCO), and data collection and CQI.

1. Agency Requirements

Staffing

The first step is the completion of a needs assessment. The needs assessment must include the cultural, linguistic, treatment, and staffing needs of the area you intend to serve. It also must include how you intend to address staffing shortages.

The CCBHC must consult with consumers, family members, and community members during the assessment development. Based on the current needs assessment and staffing plan, the Chief Executive Officer must maintain a fully staffed management team. The CCBHC must update the assessment every three years.

Once you conclude your assessment, you apply the findings to your staff and ask the following questions.

  • Is your CCBHC staff (both clinical and non-clinical) appropriate to meet the needs of the population you intend to serve? If not, you need to hire.
  • Does your consumer population include veterans or active duty armed forces? If yes, you have staff ready to serve veterans
  • Do you have c credentialed substance abuse specialists, individuals with expertise in addressing trauma? If not, you will need to hire.
  • Do you have individuals with experience working with children with serious emotional disturbance (SED) and individuals trained to work with adults with serious mental illness (SMI)? If not, you will need to hire
  • Do you have a psychiatrist as Medical Director on staff? Or do you have psychiatric consultation and prescribing provisions established? If not, you will need to hire.
  • Do you have appropriate liability and malpractice insurance, and do you have established procedures to maintain the licensure and credentials of your staff?

Once you have addressed staffing shortages, you must implement a training plan. Your training plan must incorporate cultural competency. In addition, the training plan must include risk assessment, suicide prevention, suicide response, and the role of families and peers. If the CCBHC area includes active duty military or veterans, cultural competency must include information related to military culture. As part of orientation, you agree to train staff as follows:

  • Cultural competency
  • Person-centered and family-centered care
  • Recovery-oriented care
  • Trauma-informed care
  • Integration of behavioral health and primary care
  • Continuity plan

You must ensure the competency of the identified trainers and trainees. The staff record must keep track of completed training. Training should occur at orientation and after that as needed. As a CCBHC, you must have written policies and procedures that indicate how you assess the competencies of your staff. You agree to provide in-service training and education programs. You should maintain a list of training and educational programs for the prior year.

You must provide services to consumers with Limited English Proficiency (LEP) in a manner that works for those consumers. In addition, you must provide interpretation and translation services as required by your consumers. All persons working with consumers and data must adhere to the privacy requirements of 42 CFR Part 2.

Management Team

To be a CCBHC, you must have a management staffing that meets the needs of the CCBHC, the needs assessment, and the staffing plan. If the management team is not complete, you will need to hire.

Board of Directors

Families, consumers, or people recovering from behavioral health conditions must constitute 51% of your board of directors.

2. Services

Access and Availability

You must provide a safe, clean, and welcoming environment for consumers and staff. You must comply with relevant federal, state, and local laws and regulations regarding client and staff safety, cleanliness, and accessibility.

CCBHCs may not deny services due to the inability to pay and should have a sliding scale that provides discounts if the consumer can afford something. The CCBHC may not deny services based on residence. CCBHCs should have a policy to address services provided to those that live out of state. For those living outside the CCBHC catchment area, the CCBHC should provide crisis and other required services and then coordinate and follow up with the providers in the appropriate catchment area.

The clinic hours must include some evening and weekend hours to meet the needs of the consumers. The location is accessible to the consumers, and if not, you use transportation and transportation vouchers to assist consumers. You use mobile in-home, telehealth, and online treatment services and have prior experience in doing so effectively. You engage in outreach to assist consumers and families in accessing benefits and services. You have a disaster plan in place to ensure continuity of operations. Finally, you have available the services identified in the needs assessment.

If a consumer presents for an initial screening that identifies an urgent need. The CCBHC must provide clinical services and initial evaluation in not more than one business day from the initial request. If the initial screening identifies routine needs? In that case, the CCBHC must provide clinical services and screen within ten days. The comprehensive family-centered diagnostic and treatment planning evaluation must occur within sixty days of the first service request. Policies must also ensure immediate action if the evaluation identifies an emergency or crisis need. The initial evaluation for crisis may occur telephonically, but the next encounter must be face to face.

CCBHCs must offer crisis services 24/7 and deliver crisis management services within three hours of notification of the crisis. The CCBHC must notify the public of the availability of crisis services. To further provide crisis management, the CCBHC must have procedures when a consumer goes to the emergency department and gets involved with law enforcement to reduce delays in the start of services. The CCBCH must create and follow a crisis plan in response to the psychiatric emergency.

Established consumers with a routing need require an appointment in ten business days, and if the need is urgent, the appointment must occur in one business day. In addition, the CCBHC has policies to provide immediate and appropriate action to consumers in crisis.

Treatment Teams

The CCBHC treatment team includes the consumer, the family (if the consumer is a child), the adult consumer’s family (if requested by the consumer), or others designated by the consumer. All treatment planning and care coordination is person and family-centered. The CCBHC is responsible for coordinating all care wherever provided. The CCBHC designates an interdisciplinary treatment team composed of individuals who work together to coordinate the consumers’ medical, psychosocial, emotional, therapeutic, and recovery needs. Care must also be culturally appropriate.

CCBHC  Services

The CCBHC must provide the following four services:

  • Crisis mental health services include 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization(unless an existing state network exists).
  • The CCBHC completes a behavioral health screening, assessment, diagnosis, and risk assessment.
  • The CCBHC completes patient-centered treatment planning or similar processes, including risk assessment and crisis planning.
  • Outpatient mental health and substance use services.

The CCBHC or the DCO may perform the following services.

  • Outpatient clinic primary care screening and monitoring of key health indicators and health risks (e.g., BMI, blood pressure, tobacco use, HIV/Viral Hepatitis).
  • Targeted case management services that assist in sustaining recovery.
  • Psychiatric rehabilitation services.
  • The CCBHC or DCO provides support for peer support, peer counseling services, and family support services.
  • Intensive, community-based mental health for members of the armed forces and veterans’ care must be consistent with minimum guidelines issued by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook.

The CCBHC treatment teams are responsible for the treatment planning process; CCBHCs may not contract with DCOs for this. The treatment team must update the treatment planning evaluation based on an agreement with the consumer and with the consultation of the primary care provider. The treatment team should also update the treatment planning and evaluation when the response to treatment changes or the consumer reaches a treatment goal. In addition, the CCBHC treatment team must update the treatment planning evaluation every ninety calendar days.

Care Coordination

The CCBHC must coordinate care across all health services, including physical health, behavioral care, social services, housing, educational systems, and employment opportunities to facilitate the recovery of the whole person. The CCBHC will assist the consumer in getting and attending services provided by other providers outside of the CCHBC. The CCBHC will manage medication reconciliation with all providers.

The CCBHC must have an EHR that captures demographic information, provides clinical decision support, and electronically prescribes medications. The system must support reporting on data and quality measures. The CCBHC must have plans to conduct population health, quality improvement, disparity reduction, outreach, and research. The CCBHC must also manage care coordination with DCOs using health information technology (HIT). The coordination must include data exchange to improve the transition of care between the DCO and CCBHC.

3.  DCO

The CCBHC must have written agreements with all third parties, including DCOs, FQHCs, and primary care providers. The CCBHC must have written agreements with inpatient mental health and substance abuse facilities, and the agreement must include methods for tracking clients on intake and discharge. The CCBHC must develop written agreements with emergency departments, community or regional services, supports, and providers. Each agreement must indicate how clients access services and how the CCBHC maintains data regarding each of the services to maintain a complete integrated record.

All DCOs must follow the same requirements as the CCBHC regarding staff training, cultural competency, and limited language proficiency.

4. Data Collection and Continuous Quality Improvement (CQI)

The CCBHC must collect, track and report data and quality metrics as the statute requires. CCBHCs must include in the DCO agreement the ability to obtain the necessary data for reporting; this includes consent required by 42 CFR Part 2. The CCBHC must have a written CQI plan that addresses consumer suicide attempts and deaths, 30-day hospital readmissions, and quality of care issues, including monitoring for metabolic syndrome, movement disorder, and other medical side effects of psychotropic drugs.

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