Behavioral healthcare providers are about to go through a major change. Substance Abuse and Mental Health Services Administration (SAMHSA) has introduced new laws surrounding the coordination of behavioral health (BH) care. Beginning in 2018, anyone providing BH services will need to comply and adhere to these new standards of care.

SAMHSA 101: What you need to know

This new law creates additional revenue streams for the BH industry. Sounds great, but becoming eligible is challenging. In reality, only 15% of the BH market will be eligible for these new revenue opportunities as a Certified Community Behavioral Health Clinic (CCBHC). Those who don’t provide the required core nine services at their group will become known as a Designated Collaborating Organization (DCO).

The core services required to qualify as a CCBHC are:

  1. Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention, and crisis stabilization
  2. Screening, assessment, and diagnosis
  3. Patient-centered treatment planning
  4. Outpatient mental health and substance use disorder services
  5. Primary care screening and monitoring*
  6. Targeted case management*
  7. Psychiatric rehabilitation services*
  8. Peer support services and family support services*
  9. Services for members of the armed services and veterans*

CCBHCs in every state must provide these services regardless of whether they are independently covered under the Medicaid state plan. Services marked with an asterisk (*) above may be provided via DCO.

The service array is deliberate. CCBHCs provide the services needed to create access, stabilize people in crisis, and provide the necessary treatment for those with the most serious, complex mental illnesses and addictions. CCBHCs also integrate additional services to ensure an approach to healthcare that emphasizes recovery, wellness, trauma-informed care, and physical/behavioral health integration.

CCBHC vs DCO – how does each entity work?

The CCBHC coordinates the care and services provided by DCOs in accordance with the current treatment plan. A DCO is an entity that is not under the direct supervision of the CCBHC, but is engaged in a formal contractual relationship. Under the written contractual agreement, the parties should describe their mutual expectations and establish accountability for services provided, as well as the funding sought and utilized. Payment for DCO services is included within the scope of the CCBHC prospective payment system (PPS) per-visit rate. Because the CCBHC is paying the DCO to render services and the CCBHC bears financial responsibility for the services, the CCBHC/DCO relationship is necessarily contractual.

Interested in becoming a DCO? How to prepare

 Ask yourself the following questions:

  • What organizations in your service area are best situated to become CCBHCs? Are any of these organizations your current partners?
  • How will your organization identify and approach potential CCBHC partners?
  • What is the capacity of your organization to take on additional consumers?
  • What CCBHC services does your organization offer that a potential CCBHC partner may not be able to provide?
  • What costs are associated with the CCBHC services that you would provide?
  • How will your organization exchange information electronically with a CCBHC?

At NextGen Healthcare, we understand this is a major overhaul for the industry. We are ahead of the curve and can help you with this initiative. We’ll ensure your success through this SAMHSA change, as well as during future healthcare reform challenges.

For more information or if you have any questions, please reach out to ldonohue@nextgen.com.