If you have been interested in leading your provider agency through becoming a Certified Community Behavioral Health Clinic (CCBHC), you likely already know about the SAMHSA “FY2023 Certified Community Behavioral Health Clinic Planning, Development, and Implementation Grant which is available now to all those who are eligible. The anticipated total available Funding is $61,800,000 for an anticipated 62 awards of up to $1,000,000 for up to 4 years with the application due date as May 22, 2023.
While the application process is rigorous, the benefits that becoming a CCBHC will bring to the people you serve, your community, and your agency are unparalleled. The application process can be daunting, as it is comprehensive, and the rules for submitting the application are very concise.
Tip 1: Thoroughly Read SAMHSA’s 2023 Updated CCBHC Criteria
The CCBHC treatment model is the model of the future, but completing the application process and opening CCBHC services, and tracking and reporting on them is a heavy lift. Your commitment must be informed by the clarity of knowing what you have to achieve and your plan for getting there.
Thoroughly read SAMHSA’s 2023 Updated CCBHC Criteria before starting the application process. You need a clear understanding of the organizational commitment required. Highlight text, write notes in the margins, jot down questions; whatever you need to do to align your multi-disciplinary application team around submitting the strongest application possible. Remember- these grants are very competitive.
Recommendation: You can contact the CCBHC program manager at Qualifacts, Mary Givens, via email at Mary.Givens@qualifacts.com for assistance with the CCBHC-PDI Grant as you build out your application.
Tip 2: Assemble a Multidisciplinary Team
The team you gather now for your application process will support you through the award process if you become a SAMHSA CCBHC grantee.
Recommendation: Employees can occupy more than one of the recommended roles, but each of the roles should be owned by a single person. Key starting points in identifying tasks, roles, and skills include:
| Recommended CCBHC Application Tasks | Recommended Roles and Skills |
| Design or modify job descriptions based on the staffing criteria for the PDI grant. | Human Resources, Compliance, Clinical Leadership |
| Analyze existing costs to build the CCBHC budget that you will submit | Billing Lead, Revenue Cycle Management experts, CFO, Report Writer |
| Document current clinical workflows and plan for new and expanded services and workflows | Clinical Director, Chief Medical Officer, Front Desk Manager, Peer Professional, Trainer |
| Designated CCBHC Project Director | Compliance Office, Quality Improvement Officer, Grant Manager |
| EHR evaluation, planning for a possible switch to an enterprise-level platform that supports CCBHCs | EHR System Administrator, Technical Team, CFO, COO, Clinical Director |
Tip 3: Identify and Designate Your CCBHC Project Director
The person who will have the role of your CCBHC Project Director should be identified immediately. If the right person for the job is not yet on staff, you can designate an intermediary person so all the tasks required to complete the proposal are coordinated and tracked against a formal project plan. Delegate tasks in the project plan to responsible persons with target due dates. You should also require status updates for tasks, to ensure that you meet the application submission deadline.
Recommendation: The project plan you build for your application process will also guide the team through the execution of the plan you committed to in your proposal. It will be your source of truth.
Tip 4: Identifying your Evidence-Based Practices
SAMHSA’s Evidence-Based Practice Resource Center and SAMHSA’s National Network to Eliminate Disparities in BH (NNED) resources can guide you through selecting evidence-informed and culturally appropriate MH and SUD treatment practices to implement in your CCBHC. You will need to tie these EBPs to your identified populations to demonstrate where these practices have been effective. Be prepared to pivot to other EBPs if the evidence of success is not there.
Recommendation: Convene a small clinical group to select the practices that best meet the needs of the populations you serve, map them to workflows, and integrate outcomes and reporting.
Tip 5: Identity Designating Collaborating Organizations (DCOs) Early
Determine early whether you will provide all the required CCBHC services or if you will partner with DCOs. There are pros and cons to both approaches:
A pro of partnering with DCOs is that established practices and providers can offer services and a level of experience that your agency currently does not have. A con of Partnering with DCOs would be the oversight responsibilities for DCO-provided services can be challenging and can become a pain point. Strong and well-established interoperability (exchange of data) among the CCBHC and DCO is the key to success.
Recommendation: If you decide to leverage DCOs, start with agencies you are already collaborating with whether formally or informally. Whether you find new partners or leverage existing ones, your CCBHC DCO relationship should be formalized with a written “memo of understanding” (MOU) that discusses and documents information sharing and interoperability for caseloads. Be sure to exchange direct addresses and discuss which HIEs both entities will share data with.
Tip 6: Assess Your Technology Needs
Now is the right time to seriously evaluate your current technology against the CCBHC criteria. This includes your EHR. Some of the technology capabilities you will want to ask your EHR vendor about are:
- How strong are the reporting and analytics tools of your current EHR? Can you easily pull clinical quality outcomes data and operational outcomes data?
- How well is the new NOMS supported? Does the technology include your ability to upload the NOMS data to the SPARS system or will your staff have to manually enter the NOMS data into SPARS?
- How flexible are clinical workflows? Your frontline staff will need to capture data for new clinical quality outcomes. How efficient is this to do in your current EHR?
- Does the case management workflow include alerts and reminders for a follow-up?
- Does the treatment plan support integrated care?
- Is there functionality that allows you to easily screen and monitor primary care symptoms and conditions?
- How strong are your EHR’s interoperability capabilities? Are the workflows for exchanging C-CDAs efficient? Can your EHR be integrated to exchange data with the local HIE? Critical data such as admissions and discharges to the emergency department or hospital.
- Does your EHR include integrated telehealth capabilities?
- How robust is the patient portal for ensuring the client can stay closely engaged?
- Does your EHR include patient appointment reminders?
Recommendation: Consider including the purchase of some new technologies in your award application under the rule that says “25% of the total award allowable in each year 1 and 2 and no more than 20 percent of the total award for the budget period in each of Year 3 and Year 4” can be used for infrastructure.
Tip 7: Document Current Clinical Workflows – Assess Gaps and Next Steps
Becoming a CCBHC will require your front-line staff to capture new outcomes data. Greater accessibility may require a change in workflows as well. If your current workflows are documented accurately, it will be easier for you to re-engineer them to meet the CCBHC certification criteria. Knowing how services are being delivered now from the front desk to the point of discharge will also aid you in training on any workflows that need to change.
Recommendation: Documenting these workflows does not need to be formal or fancy. It can be as easy as a bulleted step-by-step list or a simple diagram. Documenting the current workflows with ownership by those who know them best is your starting point for what you want to keep, change, and augment.
Tip 8: Submitting Your Budget
In developing your CCBHC budget, take advantage of Appendix B in the Notice of Funding Opportunity (NOFO) for the SAMHSA CCBHC-PDI grant to review the list of common errors agencies make in completing the budget information. This information is invaluable. SAMHSA also recommends you use the SAMHSA Budget Template referred to in Appendix L and found on the SAMHSA Forms and Resources webpage. Scroll down to the “SAMHSA Budget Template” section.
Recommendation: Whenever there are templates, agencies are encouraged to use them, to ensure that the information is complete and compliant with the requirements.
Tip 9: The Disparity Impact Statement (DIS)
The “Disparity Impact Statement “(combined with your Community Assessment) is an important tool for your CCBHC. It will greatly impact your outreach efforts, staffing, training, and service delivery. Knowing the make-up of your community and ensuring fair representation in your CCBHC and equal access to CCBHC services is key to the success of your CCBHC.
Recommendation: Be sure to utilize SAMHSA’s “Disparity Impact Statement” worksheet to assist you in preparing your DIS. You will be implementing your DIS throughout the life of your CCBHC. Take careful consideration when creating it, to ensure that it is comprehensive and actionable.
Tip 10: Continuous Quality Improvement
As a CCBHC, your organization is moving toward becoming an entity of Continuous Quality Improvement (CQI). Consider adopting the PLAN, DO, STUDY, ACT (PDSA) Process for CQI. You will need a formal CQI plan that you will update and maintain throughout the life of the CCBHC and implement on many levels.
Start with workflows and training to gather data so you can track, analyze, and report on your Clinical Quality Outcomes.
Recommendations: Once your data collection and workflows are in place, you will need to be able to easily run reports within your EHR so that you have great transparency into your quality outcomes performance. You will want to make changes to improve these early outcomes. PDSA is a tool that will enable you to analyze current workflows and adjust or change them to drive better outcomes.
Your CCBHC will also be tracking operational outcomes like “no-shows” for CCBHC clients. If the “no show” count is significant, you can use the PDSA process to analyze changes you can make to possibly decrease the no show such as the implementation of appointment reminders.
