CCBHC Prospective Payment System Demonstration Project

In October, 2015, Missouri was one of 24 states that received a Planning Grant from the federal Substance Abuse Mental Health Services Administration (SAMHSA) to prepare for implementing a federal demonstration project designed to pilot implementation of a Medicaid prospective payment system for community behavioral health services provided by organizations meeting new national standards for community behavioral healthcare.

In October 2016, Missouri was one of only eight (8) states selected by SAMHSA and the Centers for Medicare/Medicare Services (CMS) to actually pilot the prospective payment system.

During the planning process, the Division of Behavioral Health (DBH) determined that 19 community behavioral healthcare organizations serving 25 of the state’s 28 behavioral health service areas were in substantial compliance with the new federal standards for “Certified Community Behavioral Health Clinics" (CCBHCs), and that they were eligible to participate in the Demonstration Project.  CCBHCs are required to provide:

  • Crisis Mental Health Services
  • Screening, Assessment and Diagnosis
  • Patient-centered Treatment Planning
  • Outpatient Mental Health and Substance Use Disorder Treatment Services
  • Screening and Monitoring of Health Risks and Status
  • Targeted Case Management
  • Psychiatric Rehabilitation
  • Peer and Family Support Services

The populations of focus for the Demonstration Project in Missouri include:

  • Adults with serious mental illness
  • Children and adolescents with serious emotional disorders
  • Children, adolescents and adults with moderate to severe substance use disorders
  • Children and adolescents in state custody who have behavioral health issues
  • Young adults with mental illness or substance use disorders identified as in need of treatment by the courts, law enforcement, or hospital emergency rooms.

CCBHCs are required to provide services to members of the armed forces and veterans consistent with guidelines set forth by the Veterans Administration.

The Demonstration Project (which begins on July 1, 2017, and runs through June 30, 2019) is designed to demonstrate the cost effectiveness of converting Medicaid reimbursement for community behavioral health services from a fee-for-service reimbursement system to a prospective payment system while improving the availability, accessibility, and quality of community behavioral healthcare.  An independent contractor has been selected by SAMHSA to conduct a national evaluation of the Demonstration Project across the eight (8) participating states.