April 11 – Governor signs AB 847 (Mullin) – Funding for Certified Community Behavioral Health Centers
- 30% increase in federal matching funds for outpatient behavioral health
- Improved and streamlined way to receive federal funds
- Counties must elect to participate and be certified by state
- State must be selected as a participating state; odds are good that this will happen
- Lots of work between now and October 31 Deadline for submittal of the state plan
AB 847 appropriates $1 million to enable DHCS to develop a California proposal to participate in the federal Certified Community Behavioral Health Centers (CCBHC) program.
California is one of 24 states receiving a planning grant in October 2015 to develop a proposal to submit in October of 2016. Under current federal law, eight states will be selected to begin a two year demonstration program. These programs will show that increased federal investment in outpatient behavioral health will pay for itself in reduced physical health and behavioral health inpatient and other costs.
The law increases the federal share of costs for outpatient Medicaid behavioral health services by 15% –from 50% to 65%.
In reality that is a 30% increase in the federal funding relative to county costs, calculated as follows: Under current law to fund $1 million in services there is a $500,000 county match required (for those not in the 100% federal share of costs expansion population of non disabled adults without dependent children).
Under this program the county match is reduced to $350,000 – freeing up 30% of the County funds currently being used for this purpose. Those funds could be used to expand care-generating additional federal funds so that the same $500,000 could now pay for nearly $1.5 million in services instead of $1 million. In addition, the way federal funds are paid is changed to a prospective payment model based upon estimated costs. There is no retroactive reconciliation of costs. The payment model reflects either a daily average for all who receive services or a series of monthly average costs based upon several categories of individuals – based on level of disability or function.
Counties need to become certified centers, with all of their contract network providers as participating organizations. Counties also need to demonstrate that they have relationships with other types of providers necessary to coordinate care for people with complex needs. For the most part these relationships already exist but additional work can enable us to have a stronger plan to show that we coordinate with education and physical health in better ways than happens now in most places.
Six months may seem like a long time to complete the plans but it really is not that long because the details of the certification process may take some time in each county to complete – especially getting all of the rates and agreements together.
The state has indicated in its preliminary plan that it will be contracting with California Institute for Behavioral Health Services (CIBHS) led by Sandra Naylor Goodwin, and with Harbage Consulting where Don Kingdon, formerly of the County Behavioral Health Directors Association (CBHDA), will be among the lead staff on fiscal issues. Harbage also consulted with the State on development of the most important MediCal waivers, such as the coordinated care initiative for people with Medicare and MediCal, and which included the concepts of integration of behavioral health and physical health that will be expanded to the rest of the MediCal population and be central to this initiative.
Several other new DHCS initiatives will complement this effort, notably the Whole Person Health Care Pilot, the Health Home Option and the Organized Delivery System for Substance Use Disorder services which are moving toward implementation, and the soon-to-be-announced plan for integration of physical health and behavioral health. It also complements the MHSA housing bond measure expected to be approved by the Legislature this Spring.
The potential additional funding will support the efforts of these initiatives to meet the behavioral health needs of the so called “frequent flyers,” the people who are most frequently hospitalized. 70% of that population has mental illness. Many of these are homeless and fit the pattern of the so-called revolving door group of people who go between homeless, hospitals and jail.
We have not had the resources to get very many into comprehensive programs such as the Mental Health Services Act full service partnerships. The new DHCS initiatives bring new federal funds and supports for other services such as outreach and engagement and care coordination. The bond measure can support housing and the CCBHC funding can create the capacity to enroll more people in comprehensive services. They also create more flexible funds that counties can use to expand care to other populations such as the dramatically underserved Latino and Asian communities.
Right now the most important actions are for everyone to get ready to participate.
Many counties have only minimal knowledge of this incredible opportunity and may have concerns about its feasibility that need to get addressed quickly so that they can join the dozen or so counties (representing about half of the state population) who are already committed to participation.
There are lots of questions that DHCS and its consultants will need to answer quickly. Some may be hesitant due to the shortened time line, uncertainty of getting the funding and the fact that it might only be for two years. However, the current situation about all of those factors is likely to change over the coming months.
- First of all the National Council is working to extend the application deadline from October 31st to a later date. (They have already been successful in getting the start-up date for services extended from January 1 to July 1st (at state option) which means that counties and contract providers do not have to do the work to adjust their contracts until the state finds out if it has been selected.
- Secondly there are several bi-partisan proposals pending in Congress and supported by the Obama administration to increase the number of states selected and to lengthen the program beyond two years.
- Finally California is fortunate to be in the state of Congresswoman Doris Matsui, one of the four Congressional co-authors of this legislation and who is in constant contact with federal officials to get answers to questions and working optimistically to expand this program.
We will all learn much more about this exciting program but it has the potential to become as big as the Mental Health Services Act in supporting expansion and transformation in behavioral health. That alone should be reason enough for everyone to want to learn everything they can and to make sure that every county participates.