CCBHCs will provide integrated care across the health care continuum, promoting a recovery-based focus to services. Substance use disorder treatment providers who are a part of the CCBHC treatment team will work collaboratively with primary care and other behavioral health service providers to address the holistic needs of individuals seeking care.
Providers with expertise in substance use disorder care are able to ensure that all services provided in the CCBHC include recovery-focused attention to substance use disorder prevention, assessment, and treatment. CCBHCs are required to make available a full range of substance use disorder services and ensure care coordination with inpatient psychiatric treatment, ambulatory and medical detoxification, post-detoxification step-down services, and residential programs.
Medications for Opioid Use Disorder (MOUD) Options
MOUD options are listed in the CCBHC certification criteria – 2016 (PDF | 755 KB) as one of the services that states might consider both in the “minimum set of evidence-based practices required of the CCBHCs” or as an additional service, as described under Outpatient Mental Health and Substance Use Services (criteria 4.f.2). Learn more about the use and effectiveness of MOUD..
If your needs assessment shows that a particular community has significant rates of opioid addition, the state should strongly consider adding MOUD services in that CCBHC’s continuum of services offered. If the community needs assessment results do not show a need for MOUD, but the state wants to ensure this type of treatment is available to CCBHC clients, the state can also add MOUD to the continuum. MOUD services can be provided directly by the CCBHC or through a designated collaborating organization (DCO) arrangement.
Ambulatory and Medical Detoxification Requirements
The revised American Society of Addiction Medicine (ASAM) criteria list five levels of Withdrawal Management for Adults. As part of the CCBHC criteria 4.c.1, it is required that CCHBCs have services for the first four levels readily available and accessible to people experiencing a crisis at the time of the crisis. The four levels include:
- 1-WM: Mild withdrawal with daily or less than daily outpatient supervision; likely to complete withdrawal management and to continue treatment or recovery. The CCBHC must directly provide 1-WM.
- 2-WM: Moderate withdrawal with all-day withdrawal management support and supervision; at night, has supportive family or living situation, likely to complete withdrawal management. The CCBHC is encouraged to directly provide 2-WM. While the CCBHC must have the 2-WM level of ambulatory withdrawal management available and accessible to eligible consumers, it is not a requirement that this service be provided directly, although it is encouraged.
- 3.2-WM: Moderate withdrawal, but needs 24-hour support to complete withdrawal management and increase likelihood of continuing treatment or recovery. May be provided directly either by the CCBHC or through a DCO relationship or by referral.
- 3.7-WM: Severe withdrawal and needs 24-hour nursing care and physician visits as necessary; unlikely to complete withdrawal management without medical, or nursing monitoring. May be provided directly either by the CCBHC or through a DCO relationship or by referral.
- SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)
- SAMHSA’s Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Requirements From the Criteria
The criteria include the following requirements related to substance use disorder treatment providers offering services through CCBHCs:
Program Requirement 1: Staffing
- 1.b.2. The CCBHC must have staff, either employed or available through formal arrangements, who are credentialed substance abuse specialists.
Program Requirement 3: Care Coordination
- 3.c.2. The CCBHC must have an agreement establishing care coordination expectations with programs that can provide inpatient psychiatric treatment, with ambulatory and medical detoxification, post-detoxification step-down services, and residential programs to provide those services for CCBHC consumers. The CCHBC is able to track when consumers are admitted to facilities providing the services listed above, as well as when they are discharged, unless there is a formal transfer of care to a non-CCBHC entity. The CCBHC has established protocols and procedures for transitioning individuals from EDs, inpatient psychiatric, detoxification, and residential settings to a safe community setting. This includes transfer of medical records of services received (e.g., prescriptions), active follow-up after discharge and, as appropriate, a plan for suicide prevention and safety, and provision for peer services.
Program Requirement 4: Scope of Services
- 4.c.1. Crisis behavioral health services must include services capable of addressing crises related to substance abuse and intoxication, including ambulatory and medical detoxification.
- 4.d.3. The initial evaluation must identify needs related to substance use disorders.
- 4.d.5. The comprehensive diagnostic and treatment planning evaluation must include a diagnostic assessment of substance use disorders (including tobacco, alcohol, and other drugs).
- 4.d.9. If screening identifies unsafe substance use, including problematic alcohol or other substance use, the CCBHC conducts a brief intervention and the consumer is provided or referred for a full assessment and treatment, if applicable.
- 4.f.1. The CCBHC directly provides outpatient mental and substance use disorder services that are evidence-based or best practices, consistent with the needs of individual consumers as identified in their individual treatment plan. In the event specialized services outside the expertise of the CCBHC are required for purposes of outpatient mental and substance use disorder treatment (e.g., treatment of sexual trauma, eating disorders, specialized medications for substance use disorders), the CCBHC makes them available through referral or other formal arrangement with other providers or, where necessary and appropriate, through use of telehealth/telemedicine services. The CCBHC also provides or makes available through formal arrangement traditional practices/treatment as appropriate for the consumers served in the CCBHC area.
- 4.f.2. Among the evidence-based practices the state may wish to establish are provision of evidence-based medication evaluation and management, including but not limited to medications for psychiatric conditions, medications for alcohol and opioid substance use disorders (e.g., buprenorphine, methadone, naltrexone [injectable and oral], acamprosate, disulfiram, naloxone), prescription long-acting injectable medications for both mental and substance use disorders, and smoking cessation medications.
- 4.f.4. Children and adolescents are treated using a family/caregiver-driven, youth-guided and developmentally appropriate approach that comprehensively addresses family/caregiver, school, medical, mental health, substance use, psychosocial, and environmental issues.
- 4.k.3. CCBHCs ensure there is integration or coordination between the care of substance use disorders and other mental health conditions for those veterans who experience both.
Program Requirement 5: Quality and Other Reporting
- 5.b.2. Among other things, the continuous quality improvement (CQI) plan must address CCBHC consumer 30-day hospital readmissions for psychiatric or substance use reasons.
Program Requirement 6: Governance
- 6.b.1. The CCBHC must incorporate meaningful participation on the governing board by adults recovering from substance use disorders.