History and Background

The Certified Community Behavioral Health Clinic (CCBHC) model was developed to improve access to comprehensive and coordinated mental health and substance use care. Since 2017, CCBHCs have transformed care in hundreds of communities across the United States. This webpage provides a timeline of major milestones in the CCBHC initiative to date.

2014-2015: Laying the Foundation

2014: Congress Passes PAMA

• Congress enacts the Protecting Access to Medicare Act (PAMA), including Section 223, which establishes the CCBHC Medicaid Demonstration and authorizes the creation of the CCBHC Certification Criteria by HHS.

2015: CCBHC Certification Criteria Established

• SAMHSA and CMS release the CCBHC Certification Criteria and Prospective Payment System (PPS) Guidance.
• SAMHSA awards planning grants to 24 states to prepare for the Section 223 CCBHC Medicaid Demonstration.

2016-2018: Expansion and Assessment

2016: Demonstration States Selected

• In December, SAMHSA announces the selection of eight states for the Section 223 CCBHC Medicaid Demonstration: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania.
• Texas initiates a state-led effort to establish and certify CCBHCs across the state.

2017: Demonstration Period Begins

• The eight selected states launch their CCBHC demonstrations, implementing the model and showcasing its effectiveness.
• ASPE begins evaluation of the CCBHC Medicaid Demonstration.

2018: Launch of the CCBHC Expansion Grants

• $100 million is appropriated through SAMHSA to establish the CCBHC Expansion Grant Program to directly fund behavioral health providers.
• The first 64 expansion grants are awarded. These grants provided each recipient up to $2 million per year in funding over a two-year grant period.

2019-2024: Moving Toward Sustainability

2019: First Federal Evaluation

• ASPE publishes the first annual evaluation report on the CCBHC Medicaid Demonstration.
• Congress makes the first extension of the original eight-state demonstration time frame.
• Congress appropriated $150 million for SAMHSA to support additional CCBHC expansion grants and continue funding for previous grantee cohorts.
• CMS approves first CCBHC Medicaid State Plan Amendment for Missouri, ensuring sustainability of the model beyond the demonstration.

2020: Demonstration and Grant Expansion

• Congress approves expansion of the CCBHC Medicaid Demonstration to Michigan and Kentucky.
• Congress appropriated $450 million through SAMHSA and the Coronavirus Aid, Relief and Economic Security (CARES) Act to award additional expansion grants.

2021: Independent CCBHC Implementation and Further Grant Expansion

• Several states adopt legislation to pursue the CCBHC model. (Learn more about CCBHC legislation in Kansas (PDF | 228 KB) and CCBHC legislation in Illinois (PDF | 471 KB).)
• SAMHSA awards more CCBHC expansion grants and continues funding for previous cohorts, using over $1.2 billion in COVID-19 Relief, American Rescue Plan and annual appropriations funds.

2022: Nationwide Demonstration Expansion

• CMS approves Kansas’ CCBHC Medicaid State Plan Amendment outside the demonstration.
• Congress passes the Bipartisan Safer Communities Act, adding up to 10 states to the CCBHC Medicaid Demonstration every two years.
• The CCBHC expansion grant period is extended to four years, and SAMHSA creates two expansion grant tracks: 1) Planning, Development and Implementation (PDI) to establish new CCBHCs, and 2) Improvement and Advancement (IA) to grow existing CCBHCs. The expansion grants also shift from being two-year grants funded at up to $2 million per year, to four-year grants funded at up to $1 million per year.
• $315 million is appropriated to SAMHSA for the CCBHC Expansion Grant Program.

2023: Updated CCBHC Criteria

• SAMHSA updates the CCBHC Certification Criteria (PDF | 1.3 MB).
• $385 million is appropriated through SAMHSA to support the CCBHC Expansion Grant Program.

2024: Demonstration Expansion and Medicaid Option

• Ten more states are accepted into the CCBHC Medicaid Demonstration: Alabama, Illinois, Iowa, Indiana, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont.
• CMS releases updated payment guidance (PDF | 970 KB), and the Consolidated Appropriations Act establishes a permanent state option for CCBHC services in Medicaid.
• Compliance with the updated CCBHC criteria is required by July 1 for all CCBHC expansion grants and most demonstration clinics.
• In 2024, Congress appropriated additional $385 million to SAMHSA for the CCBHC Expansion Grant Program.

Federal Partners

At the federal level, the model is jointly implemented within the U.S. Department of Health and Human Services by the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare and Medicaid Services (CMS), and Office of the Assistant Secretary for Planning and Evaluation (ASPE).

• SAMHSA is responsible for administration of the 1-year CCBHC planning grants for the purpose of developing proposals to participate in a time-limited Demonstration program, development and oversight of the CCBHC program criteria including clinic certification requirements, and CCBHC quality measure development and reporting. Also, SAMHSA administers the CCBHC-Expansion Grants.
• CMS is responsible for development and oversight of the CCBHC Prospective Payment System (PPS) requirements, development and oversight of the CCBHC cost-report to support PPS rate development, and Federal Medical Assistance Percentage (FMAP) claimed expenditures under the Demonstration.
• The Office of the Assistant Secretary for Planning and Evaluation develops reports on data collected by the CCBHC programs. ASPE is responsible for conducting an independent national evaluation of the CCBHC Demonstration. Evaluation activities are used to generate annual CCBHC Reports to Congress and Evaluation reports as required by Statute.