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Key Terms and Definitions

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Learn how to interpret key terms and phrases used in the clinic certification process and the Section 223 demonstration program.

Terms are listed alphabetically. This list is updated periodically as states request more definitions.

Additional definitions are provided on page three of the Certified Community Behavioral Health Clinic (CCBHC) certification criteria – 2016 (PDF | 755 KB).

Background From the Statute: The Protecting Access to Medicare Act (PAMA), Section 223, which authorized the CCBHC Demonstration, stipulates that no payment shall be made under the demonstration program to satellite facilities of Certified Community Behavioral Health Clinics (CCBHCs)1 if such facilities were established after April 1, 2014.

Care coordination partner: Care coordination partners coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services, including acute, chronic, and behavioral health needs.

To learn more about the entities involved in care coordination and how to coordinate care, review Care Coordination for CCBHCs. For additional information on care coordination in the demonstration program, review Section 223 (a)(2)(C) of the Protecting Access to Medicare Act (PAMA) (PL 113-93).

Differences Between Satellite Facilities and Designated Collaborating Organizations (DCOs): A Designated Collaborating Organization (DCO)2 is distinct from a satellite facility and is an entity that is not under the direct supervision of the CCBHC but is engaged in a formal relationship with a CCBHC and delivers services under the same requirements as the CCBHC. Payment for DCO services is included within the scope of the CCBHC PPS, and the DCO encounters will be treated as CCBHC encounters for purposes of the PPS. DCOs are not considered to be satellite facilities. For a full definition of a DCO, please refer to the Criteria.

“Directly provides”: When the term “directly provides” is used in the criteria, it means employees or contract employees deliver the service within the management structure and under the direct supervision of the CCBHC.

Evidence-based Practice (EBP): The criteria list multiple examples of EBPs. In addition, each state proposed a number of EBPs in its planning grant applications. States must establish a minimum set of EBPs to be used in every CCBHC within the state. Some communities may require EBPs that have been adapted to best meet the populations that CCBHCs serve. Applications to participate in the demonstration program will be evaluated on their “description and justification of the evidence-based practices that the state has required.”

“Formal arrangements”: The criteria state, “The CCBHC must have staff, either employed or available through formal arrangements, who are credentialed substance abuse specialists.” This means that the CCBHC has the flexibility to enter into a “formal arrangement,” such as a contract, with credentialed substance abuse specialists to provide services within the management structure and under the direct supervision of the CCBHC. Learn about working with a designated collaborating organization (DCO) to provide certain services.

“Minimum set”: As stated in the criteria, the CCBHC must directly provide a “minimum set” of substance abuse outpatient treatment services. This minimum set will be determined through the needs assessment. Learn how to conduct a needs assessment.

This minimum set of outpatient services cannot be provided by a DCO. Therefore, the state must determine what minimum set of evidenced-based outpatient treatment practices all CCBHCs in the state will directly provide in their outpatient services. In addition, states have the flexibility to determine whether additional services beyond the minimum set should be offered. These may vary by CCBHC based on the needs of the consumers served. These additional evidence-based practices can either be provided directly by the CCBHC or by establishing a DCO arrangement.

Other Service Modalities: Criterion 2.a.5 permits CCBHCs to utilize telehealth/telemedicine and video conferencing (to the extent possible within the state Medicaid program and as allowed by state law) to ensure consumers have access to all required services.

Renovated, Expanded, and/or Replaced Facilities: A behavioral health facility established before April 1, 2014, may be certified by the state as a CCBHC and may receive payment under the demonstration program and as such is permitted to renovate, expand, and/or replace facilities after April 1, 2014, based on the needs determined in the state-prepared needs assessment without jeopardizing their certification or the prospective payment system (PPS) payment.

Rural and urban: Under the Notice of Funding Opportunity (NOFO), states determine the definitions of rural and urban. Each state was asked to describe how it would certify clinics in both rural and urban areas. Some states used various definitions to distinguish between the two. States may use any of the federal definitions to distinguish the two. For additional guidance, review information on defining rural from the Department of Agriculture’s National Agricultural Library.

Satellite and other facilities: To provide clarity on the roles of various facilities in the demonstration program, SAMHSA and its federal partners have released definitions of satellite and other facilities – 2023 (PDF | 111 KB).

Satellite Facility Definition: For the purposes of this demonstration, a satellite facility of a CCBHC is a facility that:

  1. Was established by the behavioral health agency that is certified by the state as a CCBHC,
  2. Operated under the governance and financial control of that CCBHC, and
  3. Provides the following services: crisis services; screening, diagnosis, and risk assessment; person and family centered treatment planning; and outpatient mental health and substance use services as defined in the CCBHC Certification Criteria (PDF | 1.3 MB).

Per the statute, no payment shall be made under this demonstration to a satellite facility of a CCBHC established after April 1, 2014. This definition does not limit the provision of services in non-clinic settings such as shelters and schools. Consistent with Criteria 2.a.3, CCBHCs may also provide services at other locations managed by the CCBHC that do not meet the definition of a satellite facility.

Severe substance abuse disorder: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer uses the terms substance abuse and substance dependence. Rather, it refers to substance use disorders, which are classified as mild, moderate, or severe. The level of severity is determined by the number of diagnostic criteria met by an individual. The NOFO defines individuals with severe substance abuse disorders as a target group. For facts on common substance use disorders, review substance use disorder information from SAMHSA.

State-sanctioned crisis service system: CCBHCs are required to directly provide crisis behavioral health services unless there is a state-sanctioned, certified or licensed system or network for the provision of crisis behavioral health services that dictates otherwise. The state will determine whether any of the crisis services in the areas served by the CCBHCs meet these criteria and will detail this in its application to be part of the demonstration program.

1A CCBHC is an organization certified by states in accordance with the Criteria and with the requirements of PAMA. A CCBHC may offer services in different locations. For multi-site organizations, however, only clinics eligible pursuant to these criteria and PAMA may be certified as CCBHCs.

2A DCO is an entity that is not under the direct supervision of the CCBHC but is engaged in a formal relationship with the CCBHC and delivers services under the same requirements as the CCBHC. Payment for DCO services is included within the scope of the CCBHC PPS, and DCO encounters will be treated as CCBHC encounters for purposes of the PPS. The CCBHC maintains clinical responsibility for the services provided for CCBHC consumers by the DCO. To the extent that services are required that cannot be provided by either the CCBHC directly or by a DCO, referrals may be made to other providers or entities. The CCBHC retains responsibility for care coordination including services to which it refers consumers. Payment for those referred services is not through the PPS but is made through other payment methodologies within Medicaid or through other sources outside of Medicaid.

Last Updated

Last Updated: 09/01/2023