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Utah DHHS is applying for the Certified Community Behavioral Health Clinic (CCBHC) planning grant to develop the framework for the implementation of a state CCBHC certification program. Three agencies, Volunteers of America, Utah, Project Reality, and Valley Behavioral Health, will work as pilot sites. Within the Utah Medicaid program, behavioral health services are delivered primarily through 1115 waiver authority using capitation. Recent Utah Medicaid options have increased integration across mental health, substance use, and physical health services, and expanded funding mechanisms. This has opened the door for an integrated CCBHC model within the state. The following goals will build both the service capacity of the pilot sites, while addressing the CCBHC certification criteria, and appropriate collection and use of data for quality improvement. Goal 1. Completion of State and Community Needs Assessments Objective 1: Ongoing state-wide gaps and barriers in mental health and substance use treatment will be identified using the Kem Gardner state-wide mental health and preliminary substance use needs assessments. Objective 2: Local gaps and barriers in mental health and substance use treatment will be identified with local needs assessments for pilot site catchment areas, with an emphasis on Populations with the highest needs populations. Goal 2. Expand Capacity for Behavioral Health Services Meeting Certification Criteria Objective 1: Two outreach and engagement strategies for the population of focus will be implemented for each project site. Objective 2: Each project site will maintain SAMHSA grantee criteria and meet any additional Utah specific criteria. Objective 3: UDHHS will work with CCBHC sites to recruit and retain a workforce, reflective of the service population. This work will extend into the Demonstration phase. Goal 3. Facilitation of Procedural and Organizational Changes Objective 1: Local sites will work with Utah Medicaid for the development of sustainable PPSs for CCBHC services. Objective 2: Local sites will refine current governance boards to include individuals and family members with lived experience. Objective 3: UDHHS and pilot sites will work together to develop data collection and capacity for HHS reporting and quality improvement. This work will extend into the Demonstration phase. While these are aggressive goals for the short timeline of 12 months, the groundwork has been established to ensure that objectives will be completed unless otherwise noted. Lessons learned will be carried forward to assist other sites that are poised to transform to a certified CCBHC. Utah Medicaid and the Office of Substance Use and Mental Health (SUMH), both housed in the Division of Integrated Healthcare, will work together to address the objectives within the proposed project.

West Virginia CCBHC Planning Grant 2024 Project Abstract West Virginia's Department of Human Services, Bureau for Behavioral Health (BBH) and Bureau for Medical Services (BMS) developed this project, the West Virginia CCBHC Planning Grant 2024. BBH is the SAMHSA federally designated Single State Authority for the Mental Health and substance use disorder services, and the lead agency for Intellectual and Developmental Disabilities. The BMS is the designated Single State agency responsible for the administration of the State's Medicaid program. Together BBH and BMS will address four priorities through the planning grant to expand state and provider capacity, increase access and services, including: • Expand behavioral healthcare coverage statewide in all 55 counties • Prioritize reaching populations demonstrating significant need or who are traditionally under-served • Build additional state capacity to collect, analyze and report data • Develop and submit the application for the CCBHC Demonstration Program Statewide coverage West Virginia will work to expand coverage in 17 counties in the Eastern and Northern panhandles and an adjacent area, where almost 20% of residents reside. Objectives include: • Provide TA and other support for CBHCs that have made great strides towards CCBHC transformation. Prioritized populations The state has identified six priority populations for additional provider outreach and targeted partnership and best practice strategies for engaging: • Racial/ethnic groups that historically have experienced disparities • Returning/reentering citizens from incarceration • People experiencing homelessness • At risk children and youth • Veterans and active military service members • People who utilize the EDs and are admitted for inpatient care with a particular focus on survivors of overdose and suicide attempts or at risk for suicide. As a result of this outreach, providers will serve at least 10% more of each identified group. Expanded State capacity West Virginia has made significant progress towards CCBHC implementation to date. The state has fully final CCBHC criteria, a CCBHC provider manual, an established cost reporting process, and has finalized its full CCBHC certification process. The state is in the final stages of CMS review of its State Plan Amendment. This award will enable state leadership to establish the capacity to oversee and manage the CCBHC program, using two main strategies: 1) Leverage the state’s plan to evaluate CCBHC implementation to inform capacity building priorities; and 2) Review current data collection and performance measurement processes to identify any changes needed for CCBHCs. In the first six months the state will evaluate CCBHC implementation, identify gaps in capacity and data collection for quality measure reporting and in services for populations served. The BBH and BMS will incorporate evaluation findings, gather requirements, and write a detailed plan for ensuring CCBHC data capture and extraction for the data submission process. In the second six months, BBH and BMS will implement the plan.

The District of Columbia (DC) Department of Behavioral Health (DBH) and the DC Department of Health Care Finance (DHCF) intend to use the FY 2025 Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grant (NOFO No. SM-25-001) to expand access to comprehensive, low-barrier behavioral health services for all District residents through the adoption of CCBHCs. The subpopulations of focus for the Planning Grant and Demonstration will be individuals adversely affected by poverty or inequality, those with serious mental illness (SMI), children with severe emotional disturbance (SED), individuals with substance use disorders (SUD), and older adults with significant medical co-morbidities. DBH serves around 48,905 individuals, of these, 90% receive mental health treatment, 10% receive SUD treatment, and 6% receive both. In DC, 29% of adults have any mental illness, but 55% do not receive treatment. Among youth, 7% experience severe Major Depressive Episodes, with 41% not receiving treatment. For those 12 and older, 23% have a SUD, yet 75% do not receive treatment. DC also has the second-highest overdose rate in the country. Black/African American residents make up 41% of the population but 67% of DBH service recipients. Among DBH clients, 12% are under 18, 9% are over 65, and 98% of SUD clients are adults. Among mental health clients, 48% are male; among SUD clients, 64% are male. Additionally, 39% of DBH mental health clients are unemployed, with 17% experiencing homelessness. For those in SUD treatment, 58% are unemployed, and 50% are homeless. The District offers a wide range of behavioral health services but recognizes the need to expand access to comprehensive, person-centered, trauma-informed, and evidence-based care. If awarded the Planning Grant, DC will enhance its behavioral health infrastructure by preparing clinics to become CCBHCs, which will provide a single access point for services across all age groups, improve integration with primary care, and standardize evidence-based practices. During the Planning Grant period, DBH will prepare 4 prospective CCBHCs for the 2026 Demonstration, ensuring they are certified and ready to meet the CCBHC criteria and receive reimbursement before the Demonstration begins. The Planning Grant will enable DBH and DHCF to hire project staff who will establish a Steering Committee consisting of care recipients, families, providers, and other key stakeholders to guide the planning and implementation of CCBHCs in DC, including developing certification criteria and establishing Prospective Payment System (PPS) rates. CCBHC project staff will provide training, technical assistance, and sub-grant funding to help selected providers meet CCBHC certification requirements, including staffing, ensuring access to all nine required services either directly or through DCOs, care coordination and managing DCO partnerships, PPS cost reporting, data collection and quality reporting, and establishing board governance with participation from individuals with lived experience. The Planning Grant will also support providers in making cultural, procedural, and organizational changes, with an emphasis on improving workforce diversity and competence. CCBHCs will build provider capacity to deliver expanded services and ensure high-quality care for individuals with SMI, SUD, youth with SED, older adults with significant medical co-morbidities, and those affected by poverty or inequality. DBH and DHCF will work closely with selected CCBHCs to ensure accurate and timely performance measurement, utilizing the Behavioral Health Supplemental Data System (BHSD) for data management and reporting.

The Delaware Certified Community Behavioral Health Clinic (CCBHC) Planning Grant project is a collaboration among the Department of Health and Social Services' Division of Substance Abuse and Mental Health (DSAMH), Division of Medicaid and Medical Assistance (DMMA), Division of Developmental Disabilities Services (DDDS), and the Department of Services for Children, Youth and Families (DSCYF) Division of Prevention and Behavioral Health Services (DPBHS) to improve the system and ultimately the outcomes of those served. The activities under this grant will be continuously informed by consumer and constituent input through a dedicated Stakeholder Advisory Group. The Delaware CCBCH Planning Grant will focus efforts on adults with serious mental illness (SMI) as well as those with any mental illness (AMI), children with serious emotional disturbance (SED) as well as those with AMI, and youth and adults with SUD and co-occurring disorders (COD). Delaware will focus on the following special populations; pregnant and parenting people, justice- involved populations, transitioned aged youth, and families at risk of, or involved with the Division of Family Services including children in foster care who may need behavioral health support. Delaware views CCBHCs as a pathway to develop an organized framework that provides positive outcomes for behavioral health and physical health integration across the lifespan will addressing mental health, substance use, and co-occurring disorders. This models' focus on social determinants of health, which impacts behavioral health outcomes and financing model will support the achievement of these goals and will provide the necessary sustainability to ultimate help Delaware achieve outcomes it seeks.

The Hawaii State Department of Health (HI DOH) is proud of its existing behavioral health services, but recognizes opportunities to expand comprehensive, patient-centered, trauma informed, and evidence-based care for individuals with significant behavioral health challenges. Through the Certified Community Behavioral Health Clinic (CCBHC) initiative, HI DOH aims to serve 1,500 individuals annually, focusing on those with Serious Mental Illness (SMI), youth with Serious Emotional Disturbance (SED), and co-occurring, mental health and substance use disorders (SUD). Over the four-year CCBHC Demonstration program, excluding the initial one year planning phase, the program is expected to serve a total of 6,000 people across the state. The initiative will prioritize underserved populations, including Native Hawaiians, Pacific Islanders, immigrants, low-income families, and rural residents on Neighbor Islands like Molokai and Kauai, where access to care is limited. Building on the success of the Maui CCBHC, which serves as a model for comprehensive, integrated behavioral health care, the program will expand statewide to benefit geographically isolated communities and historically underserved groups, such as individuals experiencing homelessness and Native Hawaiian and Pacific Islander populations facing cultural and language barriers. With CCBHC funding, the Hawaii Adult Mental Health Division (AMHD) in collaboration with the Hawaii Behavioral Health Administration (BHA), Med-Quest Division of the Hawaii Department of Human Services (DHS), and other key community stakeholders, will further integrate behavioral health services with the broader healthcare system, aligning Medicaid reimbursement through the Prospective Payment System (PPS-4) to ensure sustainable, standardized and crisis care. This will enhance system capacity to deliver evidence-based practices such as Cognitive Behavioral Therapy (CBT), Medication-Assisted Treatment (MAT), and trauma-informed care. The initiative will also focus on supporting providers throughout the transition from Community Mental Health Centers (CMHCs) to CCBHCs, offering training and resources to ensure compliance with the CCBHC model. Workforce recruitment will emphasize hiring professionals from underserved communities to reflect Hawaii's cultural diversity, with special efforts to recruit those fluent in Native Hawaiian and Pacific Islander dialects, Spanish, Ilocano, Tagalog, Japanese, Korean, and other languages spoken by immigrant populations. This will ensure culturally competent, responsive care. Additionally, expanding telehealth services and implementing myAvatar, a statewide electronic health record (EHR) system, will enhance care coordination and improve access to behavioral health services for rural and remote areas, ensuring equitable service delivery across the state. By 2025, HI DOH will have expanded the CCBHC model statewide, ensuring high-quality, culturally responsive health services to individuals with SMI, SUD, youth with SED, Native Hawaiians, Pacific Islanders, immigrants, and rural residents. A dedicated project management team will oversee the initiative, ensuring milestones are met and the CCBHC model is fully integrated into Hawaii's healthcare system, promoting long-term sustainability.

A proposal to expand CCBHC coverage to include 91% of Washingtonians within a 1-hour drive of a CCBHC, ensure coverage for vulnerable SED/SMI populations, and to develop and launch a Washington state CCBHC demonstration.

Louisiana is proposing to implement a Certified Community Behavioral Health Clinic (CCBHC) Planning Grant to develop and implement a state-specific certification program for CCBHCs, establish Prospective Payment Systems (PPS) for Medicaid reimbursable behavioral health services, and prepare an application to participate in a four-year CCBHC Demonstration program. Louisiana's CCBHC program will serve our statewide population of 4,590,241 residents with a special focus of adults and children who have Serious Mental Illness/Serious Emotional Disturbances (SMI/SED), substance use disorders (SUD), and co-occurring disorders (COD). Louisiana ranks higher than the national averages in several behavioral health prevalence indicators, including prevalence estimates of SMI among adults aged 18 and older at 6.24% (vs 5.86% nationally) and SUD prevalence at 20.6% among ages 18 and older (vs 17.8% nationally). Strategies & Intervention: As required by the Planning Grant, Louisiana will collect and report on Infrastructure Development, Prevention, and MH Promotion (IPP) Indicators. Each CCBHC will develop a Continuous Quality Improvement (CQI) plan, which must be reviewed and approved by the state in accordance with CCBHC requirements and will provide a framework for continuous quality improvement within each clinic. These plans will outline the development, implementation, and maintenance of effective, data-driven CQI processes for clinical services and management. The plans will also include a gap analysis to identify deficiencies in the existing performance measurement infrastructure and provide a clear, step-by-step process for addressing these gaps. Goals and objectives: Louisiana’s goal is to expand statewide behavioral healthcare capacity, access, and availability for residents of all ages. Key objectives of the Planning Grant are to (1) develop the Louisiana CCBHC Certification Program, (2) certify the six existing CCBHCs, and (3) recruit and prepare new CCBHCs to ensure statewide coverage. A key strategy for accomplishing the goal and objectives is partnering with the CCBHC Steering Committee, which is composed of consumers of both mental health and addiction services, family members of individuals with SMI/SED and SUD, behavioral health advocates, representatives from the state’s ten Regional Advisory Councils (RACs), and state agency employees. The CCBHC Steering Committee will include members with diverse backgrounds and ethnicities and representatives of special populations, including the elderly, federally recognized tribes, the homeless, transitional youth, veterans, and the LGBTQI+ population. The CCBHC Steering Committee will facilitate and enlist robust community level input from each region throughout the Planning Grant period to inform the Louisiana CCBHC certification criteria. Monthly meetings will focus on statewide population needs, additions to the national CCBHC criteria, and approaches to expanding capacity, access and availability based on state, regional, and local data.

The Maryland Certified Community Behavioral Health Clinic (CCBHC) Planning Grant project is an initiative of the Maryland Department of Health (the Department) to establish uniform requirements for Medicaid covered services and payments provided by CCBHCs. In recent years, Maryland’s behavioral health delivery system has made significant strides in becoming more recovery-oriented and person-centered. The Department has also advanced regulatory reforms by moving away from discrete program types, each with separate regulatory standards, to a model in which national accreditation plays a role in licensing providers. Most recently, to further build out the behavioral health continuum of care, the Department has been investing in statewide crisis stabilization, mobile crisis units, and the scaling up of 988. Despite advances, the Department recognizes that service gaps remain that inhibit Marylanders with serious behavioral health challenges from accessing the comprehensive, coordinated quality care they need to maintain their overall health. This initiative will enable the Department to expand and enhance care coordination, including the expansion of peer-driven care navigation; provide technical assistance to improve the quality of peer and family support; offer enhanced services for youth, families, individuals with developmental disabilities, and veterans; enrich linkages between justice involved individuals and community-based systems; improve access to crisis support and more substantial crisis follow-up services; and more effectively reach out to individuals and families who have either not engaged with the system or are utilizing only emergency room services. The CCBHC Planning Grant Project will also provide opportunities for the Department to develop and extend service capacity, including in rural areas, and address service gaps related to the delivery of care. This includes: Supported Employment (SE) and Assertive Community Treatment (ACT), which is currently limited to certain geographical areas where supply has never been sufficient to meet demand; Targeted Mental Health Case Management (TCM) which, although available in all jurisdictions, is underused; and Medications for Opioid Use Disorder (MOUD), an evidence-based practice (EBP) for individuals with opioid addictions that is underutilized due in part to stigma. The Department is also in the process of implementing Assisted Outpatient Treatment (AOT), which will serve as another tool to build out the continuum and linkage to services within a CCBHC. The Department will use the one-year planning period to develop a payment system for CCBHCs following the Certified Clinic Prospective Payment System 3 (CC PPS-3) model. CC PPS-3 will allow for a daily rate for all non-Special Crisis Services (SCS), as well as a separate SCS daily rate, enabling a broad range of possible providers to pursue CCBHC designation, particularly in rural areas of the state. CC PPS-3 will also ensure that sufficient funding is available to providers to provide the high-quality coordinated service envisioned by the CCBHC initiative. At the end of the planning year, up to ten CCBHCs will be selected and certified around the state.

Montana is implementing the Montana Certified Community Behavioral Health Clinic (CCBHC) Planning Project in collaboration with the Montana Health Foundation, the Montana Primary Care Association, and the Behavioral Health Alliance of Montana. The project is aimed to transform how behavioral health in the state of Montana is delivered, accessed, and measured by implementing high-quality programs, practices, and policies that are recovery-oriented, trauma-informed, and equity-based. The project aims to address complex challenges, from rising levels of drug overdoses and suicide to longstanding issues with the fragmentation of behavioral health and substance use from primary care systems. This initiative will address the needs of individuals in urban, rural, and frontier communities, focusing on those with health disparities by providing access to prevention, early intervention, treatment, and recovery services. For the first year of implementation post the planning grant year, the goal is to begin the operation of three of the eleven planned CCBHCs, serving an estimated 8,751 individuals and roughly 14,585 individuals by year two. The Montana CCBHC Planning Project is critical to addressing the behavioral health crisis and improving the health and well-being of Montanans. The state of Montana, in partnership with stakeholders, will design and implement a three-pronged stakeholder engagement approach and will develop a CCBHC Planning Methodology and Strategy that will be used to support the development, implementation, and expansion of CCBHCs. The CCBHC Planning Methodology and Strategy will be built on the foundation of improving access to and delivery of coordinated, comprehensive behavioral health care through recovery-oriented, trauma-informed, and equity-based policies. The CCBHC Planning Methodology and Strategy will prepare providers to 1) provide behavioral health services that meet the certification criteria, 2) serve their communities, including those most in need of coordinated, integrated, accessible, quality care, with no denial of services based on inability to pay, 3) and promote recovery while fostering resilience and addressing social determinants of health. In addition, the state’s goal is that the services provided are family and person-centered, strength-based, trauma-informed, culturally and linguistically competent, and coordinated across providers, agencies, levels of care, behavioral health, and primary care, as preferred by the person or family.