Certified Community Behavioral Health Clinic (CCBHC)

Revised: January 25, 2023

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Billing Expanded CCBHC Covered Services

· Additional CCBHC Billing and Payment Provisions

· Legal References

Overview

CCBHC is an integrated community behavioral health model of care that aims to improve service quality and accessibility. CCBHCs do the following:

· Provide integrated, evidence-based, trauma-informed, recovery-oriented and person-and-family-centered care

· Offer the full array of CCBHC-required mental health, substance use disorder (SUD) and primary care screening services

· Have established collaborative relationships with other providers and health care systems to ensure coordination of care

Visit the Certified Community Behavioral Health Clinics webpage for more detailed information about CCBHC certification, services, payment and evaluation policy.

Eligible Providers

Participating CCBHCs are enrolled Minnesota Health Care Programs (MHCP) service providers for all CCBHC services and have been certified by the state. Visit the Certified Community Behavioral Health Clinics webpage for a list of current CCBHCs and certification information.

State-certified CCBHCs in Minnesota receive one of the following:

· Demonstration CCBHCs receive an approved Medicaid Prospective Payment System (PPS) rate under the federal Section 223 demonstration

· SPA CCBHCs receive an approved Medicaid CCBHC daily bundled rate under Minnesota’s Medicaid State Plan

Additionally, organizations within Minnesota receive Substance Abuse and Mental Health Services Administration (SAMHSA) CCBHC expansion federal grant funds.

The CCBHC section of the MHCP Provider Manual only applies to payment for services delivered by state-certified CCBHC providers, and does not apply to the SAMHSA grant-funded services. Only CCBHC providers who are enrolled in the Section 223 demonstration or state certified as a SPA CCBHC will receive a PPS rate or daily bundled rate payment.

Designated Collaborating Organizations (DCO) are entities that have a formal agreement with CCBHCs to furnish CCBHC services. DCOs furnishing services under an agreement with CCBHCs must observe the same service standards and provider requirements as CCBHCs. CCBHCs maintain responsibility for coordinating care and are clinically responsible for services provided by DCOs. Refer to the CCBHC DCO Requirements on the Certified Community Behavioral Health Clinics webpage.

Eligible Members

All MHCP members who have not been served by the clinic in the six months before the current service and meet one of the following requirements are eligible for CCBHC services:

· Received a preliminary screening and risk assessment and one CCBHC service, or

· Received a crisis assessment

Covered Services

CCBHC covered services include the following existing and expanded services.

Existing Minnesota Health Care Programs (MHCP) services billed according to current MHCP requirements:

· Adult crisis response services

· Adult day treatment

· Adult rehabilitative mental health services (ARMHS)

· Children’s mental health crisis response services

· Children’s therapeutic services and supports (CTSS)

· Comprehensive substance use disorder assessment

· Diagnostic assessment

· Dialectical behavior therapy (DBT)

· Mental health provider travel time

· Neuropsychological services

· Psychological testing

· Psychotherapy

· Psychotherapy for crisis

· Substance use disorder treatment coordination

Expanded MHCP services only for CCBHC providers who have an approved PPS rate or CCBHC daily bundled rate:

· Initial evaluation

· Certified peer recovery support specialist

· Comprehensive evaluation

· Comprehensive evaluation update

· Integrated treatment plan

· Integrated treatment plan update

· Family psychoeducation

· Mental health certified family peer specialist

· Mental health certified peer specialist

· Mental health targeted case management for adults

· Mental health targeted case management for children

· Functional assessment and level-of-care determination

· Outpatient (Ambulatory) withdrawal management (2-WM)

CCBHC required activities but not billable as a CCBHC encounter (review the Billing section for detailed billing and payment information):

· Preliminary screening and risk assessment

· Care coordination

· Additional CCBHC Billing and Payment Provisions

Note that under state plan authority, the following two activities pay at the posted fee-for-service rates. They are not billable as a CCBHC encounter:

· Clinical care consultation

· Psychiatric consultation to primary care providers

Initial Evaluation

The initial evaluation must:

· Include the reason the person wants assistance, a preliminary diagnosis, referrals to services within the CCBHC (specifically: outpatient SUD services, ARMHS, TCM, CTSS, peer services and psychotherapy) and medical necessity for those services

· Fulfill the evaluation requirements for CCBHC published on the CCBHC webpage.

· Be administered to any person new to receiving CCBHC services age 5 and older

· Include a *face-to-face interview with the person receiving CCBHC services and a written evaluation completed by a mental health professional or a clinical trainee

A mental health professional and an alcohol and drug abuse counselor may assess an individual’s substance use disorder diagnosis and determination of medical necessity for SUD treatment. Include SUD assessment results within the initial evaluation.

It is allowable for CCBHC providers to gather required initial evaluation information from internal staff, existing documentation, and other providers from whom the CCBHC has obtained a release of information, if the documentation is less than one year old.

Comprehensive Evaluation

The comprehensive evaluation must meet these requirements:

· Include a review and combination of existing information obtained from external sources, internal staff, preliminary screening and risk assessment, crisis assessment, initial evaluation or other service received at the CCBHC

· Fulfill the evaluation requirements for CCBHC published on the Certified Community Behavioral Health Clinics webpage

· Include a *face-to-face interview with the MHCP member and written evaluation completed by a mental health professional or a clinical trainee

· Complete a new comprehensive evaluation or update under time frames established for completion of a new or updated diagnostic assessment within existing service standards (for example, annually for children receiving CTSS, every three years for an adult receiving TCM services)

· Complete a comprehensive evaluation for people served in the CCBHC in the six months before CCBHC certification when that person’s current diagnostic assessment expires

A comprehensive evaluation for children under 5 years old must utilize the current version of the DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood published by Zero to Three which may consist of up to four separate billable encounters including:

· An initial session as a family psychotherapy session without the member present and may include providing treatment to the parents or guardians along with inquiring about the child. Bill the initial session as a family psychotherapy session (90846). If possible, defer billing until completion of assessment with encounter date as date of service.

· Three separate sessions follow the initial session; one session must include face-to-face contact with the child.

· Bill the three to four completed assessment sessions as a comprehensive evaluation (90791 Q2).

· The level of care tool (ECSII) must be incorporated into the comprehensive evaluation for it to be considered complete.

· The comprehensive evaluation must be completed before recommending additional CCBHC services.

· In the event patient or family participation stops before all sessions are completed, CCBHCs may bill for the sessions completed.

It is allowable for CCBHC providers to gather information for each required assessment component from internal staff, existing documentation or external providers from whom the CCBHC has obtained a release of information and if the documentation is less than one year old.

Comprehensive Evaluation Update

The comprehensive evaluation update must meet these requirements:

· Be completed with adults only (age 18 and over)

· Include a review and synthesis of existing information obtained from external sources, internal staff, preliminary screening and risk assessment, crisis assessment, initial evaluation, previous comprehensive evaluations or other services the person receives at the CCBHC

· Include a *face-to-face interview with the MHCP member and written evaluation by a mental health professional or a clinical trainee

· Fulfill the evaluation requirements for CCBHC published on the Certified Community Behavioral Health Clinics webpage.

· Be completed according to time frames established for completion of a new or updated diagnostic assessment within existing service standards

Integrated Treatment Plan

The integrated treatment plan (ITP) must meet these requirements:

· It is the result of a person and family-centered planning process in which the person receiving CCBHC services, any family or natural supports (defined by the person served), CCBHC service providers, external service providers as appropriate and care coordination staff are engaged in creation of the integrated treatment plan

· It should include the person receiving CCBHC services and all interested parties; however, at minimum, the ITP must be completed in a *face-to-face interaction with the person

· Fulfill the integrated treatment plan requirements for CCBHC published on the Certified Community Behavioral Health Clinics webpage

· It must be approved by a mental health professional.

Integrated Treatment Plan Update

The integrated treatment plan (ITP) must meet these requirements:

· Providers must update the ITP at least every 6 months and anytime there is significant change in the member’s situation, functioning, service methods or at the request of the member or the member’s legal guardian

· ITP updates require the member receiving CCBHC services be present and include engagement of any family or other natural supports (defined by the member served), CCBHC service providers, external service providers, as appropriate, and care coordination staff

· Fulfill the integrated treatment plan requirements for CCBHC published on the Certified Community Behavioral Health Clinics webpage

*Face-to-face means two-way, real-time, interactive and visual communication between a client and a treatment service provider and includes services delivered in person or via telehealth.

Family Psychoeducation

Family psychoeducation is expanded to adult MHCP members (21 years old and over) only for CCBHC providers. Refer to the MHCP Provider Manual for Family Psychoeducation for a definition of the covered service.

Mental Health Targeted Case Management for Adults and Mental Health Targeted Case Management for Children

Mental health targeted case management (MH-TCM) for adults and children is a covered CCBHC service for MHCP members. Refer to the Mental Health Targeted Case Management MHCP Provider Manual section for a definition of the covered service.

For CCBHC providers only, in addition to current state eligibility criteria, MH-TCM supports and services may be provided to both children and adults who do not meet the current criteria who are deemed at high risk of suicide by a mental health professional, particularly during times of transitions from acute care and residential settings. The mental health professional can establish medical necessity for MH-TCM utilizing an evidence-based tool to determine risk of suicide or determine risk based on clinical judgment.

Functional Assessment and Level of Care Determination

Functional assessment (FA) and the level-of-care determination must meet these requirements:

· The FA is a covered CCBHC service for all persons served in a CCBHC regardless of services rendered

· Administer functional assessment and level-of-care determination instruments according to established service and instrument schedules

· Fulfill the functional assessment requirements for CCBHC published on the Certified Community Behavioral Health Clinics webpage

Certified Peer Services

Mental health certified peer specialist services are covered CCBHC services for adult MHCP members (18 years old and older) if determined medically necessary by a qualified mental health professional. CCBHC certified peer specialist services are subject to the same standards outlined in the Certified Peer Specialist Services section of the MHCP Provider Manual with the exception of limiting services to rehabilitation and crisis service recipients. MHCP members may receive mental health certified peer specialist services from a CCBHC regardless of other service eligibility or service provision.

Mental health certified family peer specialist services are allowable within a CCBHC if determined medically necessary by a qualified mental health professional. CCBHC mental health certified family peer specialist services are subject to the same standards outlined in the Certified Family Peer Specialist section of the MHCP Provider Manual.

Certified peer recovery support specialist services are covered CCBHC services if determined medically necessary by a licensed professional. Certified peer recovery services are subject to the same standards outlined in the Substance Use Disorder (SUD) Services section of the MHCP Provider Manual with the exception of limiting services to SUD treatment recipients. MHCP members may receive certified peer recovery support specialist services from a CCBHC regardless of other service eligibility or service provision.

Outpatient (Ambulatory) Withdrawal Management (2-WM)

Outpatient Withdrawal Management level 2 (2-WM) is a time-limited service delivered in an office setting, an outpatient behavioral health clinic or in a member’s home by staff who provide medically supervised evaluation and detoxification services to achieve safe and comfortable withdrawal from substances and to facilitate the member’s transition into ongoing treatment and recovery. It also includes trained observation of withdrawal symptoms and supportive services to encourage the person’s recovery.

MHCP members experiencing acute intoxication or mild to moderate or persistent withdrawal symptoms who do not need residential or inpatient withdrawal management are eligible for outpatient withdrawal management.

The staff within an interdisciplinary care team provide outpatient withdrawal management services. Each staff person operates based on their own scope of practice and competency area to observe and monitor symptoms; provide assessment, planning and supportive services and according to the outpatient withdrawal management requirements published on the Certified Community Behavioral Health Clinics webpage.

Noncovered Services for outpatient withdrawal management (2-WM)

· Lab work, urine screens

· CCBHC staff, while providing other services, could observe withdrawal symptoms

Additional Required Activities

Participating CCBHCs must provide additional activities to receive a PPS rate or daily bundled rate payment. These activities are not directly reimbursable through MHCP fee-for-service (FFS) billing, but are required and the costs for which are factored into the PPS rate or daily bundled rate payment.

Preliminary Screening and Risk Assessment

CCBHC providers must complete a preliminary screening and risk assessment for all persons requesting services from a CCBHC who have not received services in the six months before they fulfill the evaluation requirements published on the Certified Community Behavioral Health Clinics webpage.

Care Coordination

CCBHC providers must provide required care coordination tasks, which include:

· Developing a person or family-centered plan of care

· Assisting with obtaining appointments and confirming the appointments were kept

· Creating a crisis plan

· Tracking member’s medications

· Establishing a health IT system that contains the required elements.

· Implementing care coordination agreements according to required standards.

Authorization Requirements

For Substance Use Disorder (SUD) services, SUD treatment services are required to be entered into in DAANES for each admission episode before billing.

For mental health services, CCBHCs:

· Use existing systems and timelines for those services that require prior authorization or ongoing authorization

· Can provide the initial and comprehensive evaluations in place of the diagnostic assessment

· Can provide the functional assessment as described here in place of the current functional assessment

· Can provide the integrated treatment plan in place of the individual treatment plan

Billing Expanded CCBHC Services

Only Demonstration CCBHCs and SPA CCBHCs are eligible to use the billing guidelines in the following tables.

General Billing Guidelines

· CCBHC billing is subject to the same standards outlined in the Billing Policy Overview section of the Provider Manual. · Bill all mental health CCBHC services as a professional claim using the MN–ITS 837P electronic claim format. · Bill outpatient substance use disorder service claims as an institutional (MN–ITS 837I electronic format) or a professional claim (MN–ITS 837P electronic claim format). · Submit any non-CCBHC services delivered by CCBHC providers separately from CCBHC service claims.

Initial Evaluation

Code	Modifier	Description	Unit
90791	Q2 52	Initial evaluation	1 session
90791	Q2 52 HN	Initial evaluation completed by a clinical trainee	1 session
90792	Q2 52	Initial evaluation with medical services	1 session

Comprehensive Evaluation

Code	Modifier	Description	Unit
90791	Q2	Comprehensive evaluation	1 session
90792	Q2	Comprehensive evaluation completed with medical services	1 session
90791	Q2 HN	Comprehensive evaluation completed by a clinical trainee	1 session
90791	Q2 TS	Comprehensive evaluation update	1 session
90792	Q2 TS	Comprehensive evaluation update completed with medical services	1 session
90791	Q2 TS HN	Comprehensive evaluation update completed by a clinical trainee	1 session
· Utilize the current version of the DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood published by Zero to Three for children up to 5 years old and bill as comprehensive evaluation.

Integrated Treatment Plan

Code	Mod	Brief Description	Units
H0032	Q2	Service plan development by non-physician	Per session
H0032	Q2 TS	Service plan development by non-physician update	Per session

CCBHCs cannot bill for service plan development using (H0032) for an individual or family community support plan (ICSP or ICFSP) completed by a CCBHC targeted case manager. This does not preclude billing for an integrated treatment plan (service plan development or service plan update) by qualified CCBHC staff. This assumes that qualified staff are not duplicating the targeted case manager’s work, but coordinating with the targeted case manager and approaching development of the integrated treatment plan from an integrated perspective, incorporating other service lines and care coordination.

Family Psychoeducation Benefits for Adults 21 Years Old and Older

Proc. Code	Modifier	Brief Description	Unit
H2027	Q2	Family psychoeducation individual (with a single member)	15 minutes
	Q2 HQ	Family psychoeducation member group (with multiple members)
	Q2 HR	Family psychoeducation member and family (with a single member and his or her family)
	Q2 HS	Family psychoeducation family (with a single family individual not present)
	Q2 HQ HR	Family psychoeducation family group (with multiple families with individuals present)
	Q2 HQ HS	Family psychoeducation family group (with multiple families individuals not present)

· Follow the billing guidance specifics in the MHCP Provider Manual section for Family Psychoeducation along with the Q2 modifier above.

Functional Assessment

Code	Mod	Brief Description	Units
H0031		Mental health assessment, by non-physician	Per session
H0031	TS	Mental health assessment, by non-physician, follow-up service (review or update)	Per session
H0031	UA	Administering and reporting standardized measures	Per session

· When completed by a targeted case manager, functional assessment (H0031) is not billable by the CCBHC.

CCBHC Peer Specialist Services

Code	Mod	Brief Description	Units
H0038		MH peer services by level I certified peer specialist	15 minutes
	U5	MH peer services by level II certified peer specialist
	HQ	MH peer services in a group setting
H0038	U8	Certified peer recovery specialist	15 minutes
H0038	HA	Certified family peer specialist services	15 minutes
H0038	HA HQ	Certified family peer specialist services in a group setting

Code	Mod	Brief Description	Units
H0014		Outpatient Withdrawal Management - Level 2	Per Diem

· Outpatient withdrawal management claims for MA fee for service are covered through FFS MHCP. Outpatient withdrawal management claims for MCO enrollees are covered by the MCOs beginning July 1, 2021. Submit H0014 claims for MCO enrollees to MCOs. (Note – before July 1, 2021, MCO enrollee claims for H0014 were “carved-out” of MCO coverage. The contractual change took effect July 1, 2021.)

Additional CCBHC Billing and Payment Provisions

Demonstration CCBHCs are eligible to receive the following MA payments for CCBHC services:

· As enrolled providers of statewide covered CCBHC services outlined in the Scope of Services - Federal 223 Demonstration, CCBHCs receive payment at the approved CCBHC PPS rate and within the same claims processing methodology and restrictions as other similarly enrolled providers. If the member is in managed care, the managed care organization (MCO) continues to pay these claims.

· CCBHCs can receive payment for new and expanded services described previously (refer to notes on Scope of Services table and MHCP Provider Manual sections pertaining to each of these services). If the member is in managed care, these claims are paid by the MCO.

· During the transition of demonstration CCBHCs over to state plan authority and MMIS CCBHC daily bundled rate payment, full PPS payment is achieved through use of an alternative payment mechanism — a supplemental wrap payment that trues up eligible CCBHC claims to the PPS rate. Review Supplemental Wrap Payment System.

· CCBHCs are eligible to receive quality bonus payments averaging up to 5% of the other payments previously described. DHS and the MCOs will make quality bonus payments based on each CCBHC’s performance on outcome measures.

· Demonstration CCBHCs receive the PPS rate for Medicare-covered CCBHC services.

SPA CCBHCs are eligible to receive the following MA payments for CCBHC services:

· As enrolled providers of statewide covered CCBHC services outlined in the Scope of Services CCBHC - State Plan Authority. CCBHCs receive payment at the approved CCBHC daily bundled rate and within the same claims processing methodology and restrictions as other similarly enrolled providers. If the member is in managed care, the managed care organization (MCO) continues to pay these claims.

· CCBHCs can receive payment for new and expanded services described previously (refer to notes on Scope of Services table and MHCP Provider Manual sections pertaining to each of these services). If the member is in managed care, these claims are paid by the MCO.

· CCBHCs are eligible to receive quality bonus payments averaging up to 5 percent of the other payments previously described. DHS and the MCOs will make quality bonus payments based on each CCBHC’s performance on outcome measures.

· CCBHCs should follow general behavioral health billing policies relating to billing for clients who are dually eligible for MA and Medicare. Review the “Medicare Enrollment Denials” in the Mental Health Services section of the MHCP Provider Manual. CCBHC policy does not change how the claim is submitted, or whether it is paid. If Medicare is not the primary payer of a specific claim, CCBHC policy affects the rate that is paid. If Medicare is not primary, the CCBHC daily bundled rate is paid. If Medicare is primary, SPA CCBHCs are not eligible for CCBHC daily bundled rate payment. Medicare crossover claims are not eligible for PPS payment. Instead of CCBHC daily bundled rate payment, MA pays the copays and deductibles that would normally apply to a Medicare crossover.

Members on the following major programs are eligible and determined for MHCP payment:

· Demonstration CCBHCs receive an approved Medicaid Prospective Payment System (PPS) rate under the federal Section 223 demonstration for major programs MA or QM (when the service is billable to Medicare).

· SPA CCBHCS receive an approved Medicaid CCBHC daily bundled rate under Minnesota’s Medicaid State Plan Amendment, effective date of Oct. 1, 2020, for major programs MA, IM, NM, RM and EH. QM is not applicable under the SPA, Medicare duals are not eligible for a Medicaid CCBHC daily bundled rate. When Medicare is primary, MA pays the copays and deductibles that would normally apply to a Medicare crossover.

Legal References

Minnesota Rule 245.735, Excellence in Mental Health Demonstration Project
Minnesota Statute 245I.20, Mental Health Uniform Service Standards Act
Minnesota Statute 256B.0625, subdivision 5m, Covered services provides the medical assistance coverage authority for CCBHC
Federal Public Law 113-93, Protecting Access to Medicare Act (PAMA) of 2014