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KY to expand, improve behavioral health treatment services

Section 223 of the Protecting Access to Medicare Act (PAMA) helps establish certified community behavioral health clinics (CCBHCs)

By Susan Dunlap

Frankfort, KY - The Kentucky Cabinet for Health and Family Services (CHFS) today announced that Centers for Medicare and Medicaid Services (CMS) has selected Kentucky to create, evaluate and certify community behavioral health clinics through a two-year demonstration program. The clinics will treat children and adults, primarily those with mental illness, emotional disturbances and/or substance use disorders.

"Opioid-related deaths in Kentucky were up 5% in 2019, and on top of that, in 2020, the pandemic has made it harder for Kentuckians struggling with addiction or other behavioral health challenges to get the assistance they need," said Governor Andy Beshear. "This project will help save and improve the lives of Kentuckians who receive expanded treatment services, and in doing so, it will positively impact their families as well."

Certified community behavioral health clinics (CCBHCs) will be funded as part of Medicaid and must meet all required criteria for staffing, availability and accessibility of services, care coordination, scope of services, quality and other reporting and organizational authority.

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services, explains:

"The CCBHCs represent an opportunity for states to improve the behavioral health of their citizens by: providing community-based mental and substance use disorder services; advancing integration of behavioral health with physical health care; assimilating and utilizing evidence-based practices on a more consistent basis; and promoting improved access to high quality care. Care coordination is the linchpin holding these aspects of CCBHC care together and ensuring CCBHC care is, indeed, an improvement over existing services."

The demonstration program is a provision of the federal, bipartisan PAMA of 2014, which initially identified eight states for participation: Minnesota, Missouri, New Jersey, New York, Nevada, Oklahoma, Oregon and Pennsylvania.

Kentucky originally applied to join the CCBHC demonstration in 2016 and was awarded a planning grant from SAMHSA. As a result of the passage in March of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, two additional states could participate. Kentucky and Michigan were selected and CHFS' Department for Medicaid Services (DMS) was notified.

Medicaid is the single largest payer of behavioral health services, including mental health and substance use services, in Kentucky. By one estimate, more than a quarter of Kentucky adults with a serious mental illness (SMI) rely on Medicaid. SMIs or Severe Emotional Disturbances (SEDs) can have detrimental impacts on the lives of patients, as well as on these Kentuckians' families, caregivers and the community support system, including health care facilities, providers and law enforcement. Since these conditions often arise in adolescence or early adulthood and often go untreated for many years, individuals with SMI or SED are less likely to finish high school and attain higher education, disrupting education and employment goals. Negative impacts on individuals, families and communities tend to reverberate.

"In addition to a more efficient payment system, more treatment options for serious mental illness are needed, and that includes attention to opioid addiction," said CHFS Secretary Eric Friedlander.

CHFS Department for Behavioral Health, Developmental and Intellectual Disabilities Commissioner Wendy Morris said, "We are considering our participation in the CCBHC Demonstration as part of our Building Back Better plan. We view it as a way to improve our existing behavioral health safety network of providers who serve the most vulnerable individuals in the population and to have a more sustainable payment system in place."

The National Council for Behavioral Health, which advocates for national expansion of CCBHCs, highlights the clinics' effectiveness:

"In the states that currently have certified clinics, they provide an increased scope of services, including evidence-based outpatient mental health and substance use services, 24-hour crisis care, primary care screening and monitoring and care coordination across health care settings. They must work with law enforcement officers, criminal justice systems, veterans' organizations, child welfare agencies, schools and other community organizations to ensure no one falls through the cracks. Through outcome monitoring and quality bonus payments, clinics are held accountable for patients' improvement, while engaging patients wherever needed and leveraging technology for improved outcomes."

Results from an initial evaluation of the original eight states participating in the demonstration project have revealed positive outcomes with respect to recruiting and retaining more staff and better qualified staff, including those with specialized training in key areas of need, such as psychiatry and addiction specialties; an increased capacity to serve individuals in need; decreased wait times; expanded scope of addiction care, including increased access to medications for opioid use disorder; improved innovative partnerships with law enforcement and hospitals to improve care, reduce recidivism and prevent hospital readmissions; and improved integrated care practices with mental health, addiction and primary care.

All states participating in the demonstration project are required to submit clinic-based quality measures and state-based quality measures.

This story was posted on 2020-08-21 17:13:45
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