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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) and Division of Medicaid and Medical Assistance (DMMA), and the Department of Services for Children, Youth and Families (DSCYF) to: (1) convene a cross-agency steering committee and engage stakeholders; (2) develop a CCBHC certification infrastructure and certify CCBHCs; (3) establish PPS; (4) conduct provider outreach/ education and engage stakeholders in implementation planning; (5) develop state and provider data collection and reporting capacity; and (6) prepare and submit a CCBHC Demonstration application. These activities will be continuously informed by consumer and constituent input through a dedicated Stakeholder Advisory Group. As one of the only four states in the country without this model, the CCBHC Planning Grant offers a critically needed organizational framework for Delaware to redesign and enhance its system of care statewide to improve service quality, accessibility, delivery, and outcomes for comprehensive behavioral health care services in an integrated, trauma-informed, person- centered manner across the lifespan. This initiative will address the needs of Delawareans with any mental illness and serious mental illness, children with serious emotional disturbance, and those with substance use disorder in all three counties, with additional focus on special populations, including pregnant and parenting people and justice-involved individuals. Delaware currently ranks 22nd out of 50 states in prevalence of mental health issues as compared to access to care, for both adult and youth measures. In Delaware, rates of depressive episodes in the past year for adults and youth are higher than the national averages. Delawareans also experience a significantly higher drug overdose death rate as compared to the national average per 100,000 populations. All three Delaware counties have drug overdose death rates higher than the national rate. Among youth aged 12-17 in Delaware, the annual average percentage of illicit drug use in the past month was above the national average. Delaware views CCBHCs as a system redesign effort that has the potential to positively impact 156,000 adults with mental health illness, and 10,000 youth ages 12-17 experiencing major depressive episode in the past year, through improved access to and quality of comprehensive behavioral health care services. Delaware views CCBHCs as a pathway to advance integrated and sustainably financed care coordination and delivery, thereby improving short and long-term outcomes for individuals while also improving the fiscal health of the behavioral health system. The proposed CCBHC planning process will effectively leverage and build upon major federal- and state -funded behavioral health system reform initiatives undertaken by Delaware, to enhance access to an integrated, coordinated, and person-centered behavioral health care system statewide. The Planning Grant will enable Delaware to launch a statewide CCBHC initiative, thereby expanding access to and availability of services in all three counties.

The Rhode Island Certified Community Behavioral Health Clinic (CCBHC) Planning grant activities will support action to improve access to and delivery of coordinated, comprehensive behavioral healthcare. Once CCBHCs are fully implemented, it will result in the transformation of services for an estimated 15,000 newly admitted individuals with Serious Mental Illness and Co-occurring Substance Use Disorders. The Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), the Executive Office of Health and Human Services (EOHHS) and the Department of Children, Youth and Families (DCYF) have been working closely together as the "CCBHC Interagency Team" in the planning for Rhode Island's implementation of CCBHC and mobile crisis services. This includes the oversight of a 30 million dollar infrastructure grant program to prepare behavioral health and equity focused agencies to become CCBHCs and Designated Collaborating Organizations (DCOs). This collaboration began in 2020 with the development of a Behavioral Health System Review. In cooperation with SAMHSA, our local partners, consumers, youth and family members, the CCBHC Planning Grant will allow us to continue this implementation work. We are creating certification systems for CCBHCs, establishing a Prospective Payment System (PPS) for Medicaid reimbursable services, and preparing to support our potential CCBHCs and DCOs with community engagement. Our goals for the planning period are to (1) have at least 50% of advisory committee members representative of consumers, (2) improve resource sharing and collaboration among partners, and (3) improve readiness of CCBHCs to change policies and practices to implement the nine core services. Specific planning activities include evaluating the feasibility of standardizing a biopsychosocial assessment tool, assessing the need for additional fidelity instruments to evaluate delivery of evidence-based programs, and outreach in catchment areas to build local governance structure inclusive of consumers.

The State of Montana is implementing the Montana Certified Community Behavioral Health Clinic (CCBHC) Planning Project in collaboration with the Montana Healthcare 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.

The 2023-2024 Ohio Certified Community Behavioral Health (CCBHC) Planning Grant effort will be led by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) in collaboration with the Ohio Department of Medicaid (ODM), people with lived experience and family members, healthcare providers and payers, and with support from community and academic partners. This project will advance initiatives underway in Ohio, the 7th most populous state where 60 of its 88 counties are rural or rural Appalachian, to provide accessible, effective, person-centered integrated healthcare to Ohio residents with Behavioral Health (BH) conditions using approaches that are disparity- and trauma-informed. This project will benefit work currently underway by 23 SAMHSA CCBHC grantees that served 35,000 Ohioans in the past year in 41 of Ohio's 88 counties, and by the fact that ODM has existing state plan authority to accommodate all six CCBHC program requirements and cover all nine required services. This project will focus on a) building a CCBHC-certification system which fully encompasses SAMHSA's CCBHC criteria and incorporates existing state plan requirements aligned with the model; b) defining and refining a prospective payment system based on sound actuarial principles and valid empirical data; and c) selecting CCBHCs in rural and urban communities to participate in the demonstration. Ohio looks forward to achieving these objectives and working with SAMHSA and the national CCBHC evaluation team, with the goal of taking part in the national CCBHC demonstration project, for the benefit of all Ohioans who deserve access to high-quality integrated healthcare (IHC). Ohio has a strong history of supporting SAMHSA and CMS integrated care models (CCBHC, PBHCI, PIPBHC, Medicaid Health Homes) and engaging Ohio's colleges of medicine and public universities to improve healthcare provider capacity and workforce to deliver best practices. Ohio has several recent policy initiatives that strengthened the infrastructure for integrated care. For example, a BH benefit package established in 2018 expanded coverage for evidence-based treatment models (e.g., ACT, IHBT), enhanced care coordination and management, developed a system for peer-led services and primary healthcare (E&M services). Ohio's substance use disorder 1115 waiver led to system changes that improve access and coordination of all American Society for Addiction Medicine (ASAM) levels of care. Ohio's Next Generation of Medicaid Managed Care will enhance collaboration across multiple systems of care to achieve a seamless service delivery system for individuals, providers, and system partners. This project will have broad reach across Ohio. Past year prevalence estimates for Ohio based on the National Survey on Drug Use and Health (NSDUH) were 24.32% for any mental illness (AMI), 6.85% for serious mental illness (SMI) in 2019 and 2020 - higher than Midwest regional and national estimates. Past month estimates were 24.62% for binge drinking, 11.72% for marijuana, and 3.32% for illicit drug use, similar to regional and national estimates. Within Ohio's Medicaid population ages 19-64, 29% had a primary diagnosis of AMI; nearly 16% had a diagnosis indicating a severe mental illness (SMI); about 10% had a primary diagnosis of substance use disorder (SUD). Among youth with Medicaid coverage, ages 5 to 18, about 25% had a primary behavioral health diagnosis; about 12% had a diagnosis and utilization pattern consistent with serious emotional disturbance. The impact of social and economic factors, including employment, financial security, and loneliness is the most observable in the state's Appalachian region, yet opportunities to improve the quality of care and address workforce shortages are nearly a statewide concern. Finally, the opioid crisis continues to impact Ohio, currently 4th in drug overdose deaths. Grant funding will allow Ohio to provide access to high-quality integrated care.

The West Virginia Bureau for Behavioral Health (BBH) Cooperative Agreement for Certified Community Behavioral Health Clinic (CCBHC) Planning Grant will enhance the current efforts the state of WV is currently pursuing to develop CCBHC infrastructure to serve people of all ages, across the state. BBH and the WV Department of Health and Human Resources' Bureau for Medical Services have worked closely with other cross systems agencies to prioritize efforts to establish CCBHCs as supported by the Substance Abuse and Mental Health Services Administration and 2022 state legislation. This proposal seeks planning funds to: 1. Establish certification infrastructure for providers participating in the CCBHC Demonstration Program, ensuring compliance with WV CCBHC Certification Criteria. 2. Establish a Prospective Payment System (PPS) for behavioral health services furnished by a CCBHC in accordance with CMS guidelines. 3. Identify providers with the capacity to serve as CCBHCs and develop an implementation plan that will enable CBHC services statewide in WV. 4. Develop and enhance the state data collection and reporting capacity necessary to participate in the CCBHC Demonstration Program and provide technical assistance to clinics to build data collection infrastructure and capacity to participate in the CCBHC program. 5. Develop the state's CCBHC Demonstration Program application for submission by March 2024 to participate in the 4 year Demonstration Program, complying with all SAMHSA and CMS requirements related to criteria, PPS, and other essential components of the program.

The New Hampshire (NH) Department of Health and Human Services (DHHS) aims to expand access to high quality, evidence-based and trauma-informed mental health and substance use disorder (behavioral health) services by broadly implementing Certified Community Behavioral Health Clinics (CCBHC) across all rural and urban areas of the state for people with serious mental illness, serious emotional disturbance, any other mental illness and substance use disorders. The program will emphasize access for populations with evidence of disparity or high need including: youth and young adults, Native American and other racial and ethnic minorities, refugees, veterans and members of the armed services, and people who identify as LGBTQ. Community behavioral health workers who identify as members of these special populations will work in concert with CCBHC teams who have been trained in skills for cultural and linguistic appropriate policies and practices for service delivery and data collection. NH DHHS will utilize an expert engagement coordinator to conduct extensive engagement activities through a stakeholder advisory council and statewide outreach and listening sessions to obtain input from consumer, family and other stakeholders into the developing NH CCBHC model. DHHS will complete its statewide self-assessment of needs and behavioral health capacity. The state is utilizing four workgroups, with expert partners, to finalize the NH CCBHC scope of services as well as to develop and expand infrastructure and capacity for state-level CCBHC certification, quality monitoring, data reporting and payment model development. NH DHHS will complete evaluations of cost estimates, conduct actuarial analyses and develop a prospective payment system with unique payments for each CCBHC based on cost estimates. DHHS will support the community mental health centers (CMHCs) to expand infrastructure at the CMHC level through advanced training, learning communities, consultation and technical assistance. By the end of the planning year, three CMHCs will have completed their community assessment, expanded services according to local need as well as to meet the NH CCBHC criteria, completed their cost estimate, provided exemplar data and quality reports, and completed certification. DHHS will support all other NH CCMHCs in developing CCBHC knowledge and capacity through similar supports geared to their introductory needs: learning communities, consultation and technical assistance. Through these year-long state-level and CMHC-level activities, NH will be prepared to implement a CCBHC service system and participate in a national demonstration project. In summary, the proposed CCBHC planning year will enable NH DHHS to obtain stakeholder input into the NH CCBHC model, to develop infrastructure to support CMHCs for becoming and maintaining certification, to develop a Prospective Payment System, to track CCBHC activities, and to establish new processes to improve collection and tracking of all necessary data, including quality metrics, for the national evaluation of the CCBHC model.

Vermont will build on its innovative delivery system for publicly funded mental health and substance use disorder (SUD) services and certify CCBHCs to expand access to timely, integrated, and high quality care across all regions of the state. Today, Vermont has a network of ten designated agencies (DAs), community based mental health and SUD providers located in all regions of Vermont that serve a predominantly low income population. The DAs provide a comprehensive suite of mental health and SUD services including many of the CCBHC required services. The State anticipates that with technical assistance, DAs will be able to achieve CCBHC certification to provide more integrated mental health and SUD services to Vermonters with mental illness, SUD, and co occurring conditions. See attached documents for the remainder.

Mississippi’s Certified Community Behavioral Health Clinic (CCBHC) program will support the redesign of the state’s behavioral health (BH) delivery system to meet the needs of all Mississippians. Our focus is adults who have serious mental illness (SMI), children and youth with serious emotional disturbance (SED), and people with substance use disorders (SUD) and co-occurring disorders (COD), with priority for access to rural and minority populations. Mississippi is one of the most rural U.S. states-- 60.0% of 2.9 million residents reside in rural areas. Ranked 49th in the U.S. for poverty, 19.4% (vs. 12.8% nationally) of Mississippi households live below the federal poverty line.i. Rural populations experience poverty rates higher than their urban counterparts (20.5% vs. 16.7%, respectivelyii). African American (31.3%) and Native American (36.1%) populations experience higher rates of poverty compared to Whites (12.1%)iii and African Americans predominate in rural Mississippi's regions, which are some of the most impoverished areas in the country.iv Children and youth experience higher rates of poverty (28%) vs. adults aged 18 to 64 (17.6%) and those aged 65 years and older (13.8%).v In 2021, nearly half the adult population (42.7%) reported experiencing symptoms of anxiety and depression,vi however more than half (59.3%) of adults with any mental illness report not receiving treatmentvii and 70.0% of Mississippi children with major depression are not receiving treatment vs. 60.3% nationally.viii 80% of Mississippians live in a health professional shortage areaix and gaps are particularly acute in rural areas.x Mississippi’s goal for the Planning Grant is to transition its statewide network of 12 CMHCs to adopt the CCBHC model for integrated care delivery during the Demonstration. This will be informed by robust stakeholder engagement and begin with two CMHCs that serve Mississippi’s most underserved rural and urban populations: the Delta and Gulf Coast regions. CMHCs already provide CCBHC services but must expand their workforce, enhance their practice, and increase their community access points by adopting a common set of tools, approaches, and organizational commitments. DMH will engage CCBHC consumers, youth, family members and communities in its Steering Committee, supporting Workgroups, and an Advisory Council to ensure they solicit meaningful feedback in the development, implementation, and ongoing monitoring of the Planning Grant. The CCBHC Planning team will: 1) expand telehealth; 2) optimize a new certification process to credential unlicensed mental health professionals to create a more sustainable and diverse workforce within the BH system; 3) establish a Prospective Payment System (PPS-1); 4) prepare an application to participate in the CCBHC Demonstration Program; 5) enhance the data collection and reporting capacity to support the evaluation of impact on access, quality, scope of services, and cost of BH services; and 6) train providers on continuous quality improvement. We will serve approximately 13,000 people during the Planning Grant period.

Maine Department of Health and Human Services (DHHS) aims to improve Maine’s behavioral health system to expand access to behavioral health services, meet individual and community needs, improve quality of care, and deliver interdisciplinary, integrated behavioral healthcare to any person regardless of diagnosis or ability to pay. To achieve this aim, Maine DHHS will work collaboratively with behavioral health providers, people with lived experience with behavioral health conditions, and state and community partners to design Maine’s Certified Community Behavioral Health Clinic (CCBHC) model. The developed model will be responsive to current and future recipients of care, will strengthen Maine’s behavioral health workforce to meet community needs, and will have an innovative system for payment and quality measurement. This Planning Grant will allow Maine DHHS to fully prepare for the Demonstration Grant opportunity, with the intention of expanding capacity, accessibility of behavioral health outpatient services and rehabilitation, recovery, and peer supports for individuals living with Serious and Persistent Mental Illness (SPMI) and Substance Use Disorders (SUD) and for children living with Social Emotional Disturbance (SED). The priority populations for Maine to identify supportive and connected care within the CCBHC model include service members and veterans, children and adults with SPMI/SED or SUD and co-occurring Intellectual and Developmental Disabilities (IDD), and justice-involved youth and adults; Maine seeks to identify the most appropriate evidence-based practices (EBP) to best meet the behavioral health needs of these populations. The selection of CCBHC services, activities, and EBPs will be informed by a statewide Community Needs Assessment. The selected services and activities will direct the development of a Maine CCBHC cost report, prospective payment system (PPS) methodology, and a CCBHC certification process. Maine DHHS will use its experience and knowledge of value-based and alternative payment models to develop a monthly PPS-2 rate methodology and quality measurement to incentivize high-quality care. In preparation for the Demonstration Grant, Maine will use an application process to identify behavioral health organizations with the greatest readiness to meet the certification requirements. Through the implementation of CCBHCs, Maine intends to develop a statewide CCBHC model and Medicaid PPS that will transform behavioral healthcare delivery in the communities they serve.

The Iowa Department of Health and Human Services (Iowa HHS) is proud of the behavioral health (BH) services offered to our residents, but we recognize the need to expand comprehensive, person-centered, trauma-informed, and evidence-based care to Iowans who experience BH conditions, particularly those with the most serious BH needs. Under our project titled the Iowa Certified Community Behavioral Health Clinic (CCBHC) Planning Grant, and through our participation in the CCBHC Demonstration Program, Iowa will certify and reimburse eligible clinics that serve individuals with BH conditions, including individuals with Serious Emotional Disturbance (SED), Serious Mental Illness (SMI), and significant Substance Use Disorders (SUD). Certified CCBHC will be available to serve Iowa’s residents who have a BH need, including an estimated 573,500 with Any Mental Illness and 248,000 with a SUD. Iowa HHS is committed to ensuring access to culturally competent services for members of historically underserved and marginalized groups, as well as members of groups experiencing poor behavioral health outcomes, including youth and adolescents experiencing SED and substance use (SU) conditions, adults with SMI and/or significant SUD, pregnant and parenting women, and veterans. While Iowa HHS is very proud of the service delivery systems we have built, and our success in weaving those service delivery systems together, we recognize that significant barriers remain that prevent Iowans from achieving optimal health outcomes. Both stakeholders and data analyses point us to vulnerable communities and priority populations that have the greatest needs for increased capacity and access. Iowa HHS will leverage the CCBHC initiative to promote further integration and alignment with the healthcare delivery system, increase the system’s capacity to offer evidence-based practices, and standardize service delivery. The CCBHC stakeholder engagement, technical assistance, learning community, and certification readiness activities will aid in improving outcomes for CCBHCs and their Designated Collaborative Organizations. We will support our provider community as they implement the cultural, procedural, and organizational changes necessary to become CCBHCs and deliver high quality, comprehensive, person-centered, and evidence-based services that are accessible to the populations of focus. This will require us to assist CCBHCs with improving the cultural diversity and competence of their workforce by recruiting from the populations of focus and providing evidence-based resources and supports to promote their skills and build career ladders. The process of developing the initiative and preparing providers to participate in it will make it possible for Iowa HHS to build the capacity of our providers, and the accountability CCBHC funding will make it possible for Iowa HHS to ensure that the additional capacity is targeted at the needs of our priority populations. In doing so, CCBHC will enable Iowa HHS to ensure that people with SMI, youth with SED, people with significant SUD, pregnant and parenting women, veterans, adolescents with depression and/or SUD, and historically underserved minority communities can access high quality services. Iowa HHS will collaborate with potential CCBHCs and other state-level partners to ensure consistent, accurate, and timely collection, monitoring, and interpretation of required performance measures. The Iowa Behavioral Health Reporting System (IBHRS) will act as the primary information infrastructure for the BH data needed to report measures.

The State of Georgia is pursuing SAMHSA CCBHC State Planning Grant funding to support its efforts to transition the publicly funded behavior health service delivery system to include statewide access to Certified Community Behavioral Health Clinics. This transition will expand service capacity and improve access to needed services for individual in Georgia. It is intended that these efforts will significantly impact currently unmet needs in the state. The Department of Behavioral Health and Developmental Disabilities (DBHDD) is Georgia’s Mental Health Authority (O.C.G.A. 37-1-20 (2010)). DBHDD is responsible for all components of the state public behavioral health and intellectual and developmental disability systems. Over the last eight (8) years DBHDD has strategically prioritized its preparedness for growing the CCBHC model and network to provide direct support to its contracted providers through the CCBHC Project. Designed to help qualified Community Service Boards (CSBs) achieve Certified Community Behavioral Health Clinic status, the CCBHC Project has supported providers to integrate additional services to ensure an approach to health care that emphasizes recovery, person-centered wellness, trauma-informed care, and physical-behavioral health integration. The state of Georgia has identified significant unmet need for behavioral health services, particularly among the population intended to be served by the “safety net” of Tier 1 providers (CSBs). The CSBs currently serve approximately 108,000 individuals each year. It is expected that this will remain consistent during the planning grant period. The currently unserved and underserved population is the primary intended population to be served by this project. By Race and Ethnicity, the current service population is 54.6% White/Caucasian, and 38.6% Black/African American, with no other race constituting more than 2% of the population. Currently, 4.2% of the population is Hispanic/Latino. This is fairly consistent with the racial/ethnic composition of the population of Georgia and is expected to be consistent with the intended service population of this project. The population includes adults and youth with mental illness and/or substance use disorders. It also includes those individuals with co-occurring mental illness and developmental disabilities. Veterans, active military, and their families are also part of the intended service population. The primary goal of this project is to complete application for, and be selected as, a CCBHC Demonstration State. This includes successfully completing all required activities: including soliciting and using stakeholder input; finalizing the application, review and certification process for initial CCBHCs with diverse geographic areas; establishing processes for expanding CCBHCs during the demonstration period; supporting providers to become Tier 1+ providers and certified CCBHCs with cultural, procedural and organizational changes resulting in expanded, high quality, person-centered, trauma-informed services; address workforce issues; developing, testing and implementing a PPS system with specific PPS rate for each CCBHC provider with appropriate cost reporting and verification; and enhancing data collection, analysis and reporting capacities.

The New Mexico Certified Behavioral health Clinics planning grant initiative (NMCCBHC) will improve the behavioral health of its citizens living in rural and urban areas by providing community-based mental health and substance use treatment, advancing to the next stage of integration with physical health care, assimilating and utilizing Evidence Based Practices (EBPs) on a more consistent basis, and providing improved access to high quality care. NMCCBHC will serve adults with SMI, children with SED, and those with long term and serious substance use disorders (SUDS), as well as others with mental illness and substance abuse. In essence, this includes American Indians and Hispanic populations. In 2021, 31.9% of adults in NM reported symptoms of anxiety and/or disorder. In 2018-2019 21.4% of adults in NM reported at least one mental illness, while nationally it was 19.9% (USCB HPS, 2021). Suicide rate of 24.2 or 100,000 individuals (CDC 2020). Substance use disorder (SUD) causes serious negative effects on emotional and behavioral aspects on the inception of the family resulting in poor outcomes for the children and adults (Lander et al,2013). Since 1997, alcohol-related death rate in NM has been the highest among all the states in the UB (NM DOH, 2019). From 1990-2020, over 43,000 of NM's citizens died from drug overdose or alcohol related causes. The deaths reached highest in a single year in 2020 when NM reported 766 deaths due to drug overdose and 1,770 form alcohol related causes (NM LFC,2021) The prevalence of alcohol or drug dependence for most age groups is considerably higher that the national average (6.5% in NM vs. 4.8% Nationally). The six pilot sites for the NMCCBHC initiative are Eddy County (rural), Curry County (rural), Dona Ana County (rural and urban) Sandoval County (rural and urban), Santa Fe County (urban), Bernalillo County (urban). Prevalence rates for SMI and SED in all sites are comparable with the state. Since this is a planning grant, the number of persons served will be all persons who obtain behavioral health services in these sites. The NMCCBHC planning grant will help ensure services are expanded to include the array of services required toward certification. Expansion of services will be based on a needs assessment to determine capacity, access, and availability of services in the community. NMCCBHC will create a flexible payment and reimbursement plan so that no consumers are denied behavioral health services because of their inability to pay or because of place of residence, homelessness, or lack of permanent residence. The majority or these services are currently in place so efforts will be made to expand services that are limited and to certify a minimum of 2 agencies as CCBHCs within the grant year. Staff training will also be a majority priority with CCBHC project staff assisting clinics with meeting certification standards by expansion of behavioral health services. Performance assessment will be conducted to ensure successful accomplishments of the above certification related objectives, as well as process evaluation and collection of infrastructure outcome measures to determine any needed ways to alter or improve certification process and full preparation for sites to serve as CCBHCs for the Demonstration Project and beyond.

Abstract: Alabama CCBHC Planning Grant The state of Alabama will utilize Certified Community Behavioral Health Clinic (CCBHC) Planning Grant funds to develop a state-wide comprehensive behavioral health system that will reduce disparities; improve access to care for marginalized communities; and develop a payment system that will reward quality over volume, improve integration, reduce siloes and support a sustainable and well-trained behavioral health workforce. Our populations of focus are all ages, races, ethnicities, genders, disability statuses, sexual orientations, and gender identities with SED, SMI, SUD, opioid use disorder (OUD), and co-occurring mental and substance disorders (COD), and those with or at risk of HIV and Hepatitis C due to injection drug use. Alabama currently faces an unprecedented and growing need for high quality mental health (MH) and substance use disorder (SUD) services. The state experiences a significantly higher prevalence of MH and SUD than the national average with 90.5% SMI prevalence in persons served compared to the national average of 71.6% and 97.1% prevalence of SED in persons served compared to the national average of 71.1%. 1. Similarly, Alabama experiences a higher rate of suicide deaths with 16 suicide deaths per 100,000 annually compared to 13.42 per 100,000 nationally. 2. Since 2019, Alabama has experienced a 36.8% increase in overdose deaths. 3. With one of the highest poverty rates in the country, Alabamans experience significantly more health-related social challenges than the rest of the nation. Ninety-four percent of counties in Alabama fall below the median national average household income. 4. Alabama experiences the second highest rate of gun violence in the US. This rate continues to grow with a 37% increase in 2019 (compared to 17% nationally). 5. Further disparities exist in access to treatment. While 16% of overdose deaths in Alabama are among African American members of the community, 95% of admissions to Opioid Treatment Programs (OTPs) are Caucasian. 6. ADMH and Alabama Medicaid Agency (AMA) work closely on planning and engaged with national experts, MTM services to implement their plan. This process includes a steering committee, robust stakeholder engagement and diversity, equity, inclusion and belonging (DEIB) activities. Through this partnership, the State is developing a strategy to ensure geographic access across the state. There are currently 19 Community Mental Health Centers (CMHCs) operating through non-profit regional mental health boards. Eighteen of the 19 CMHCs have been actively involved in the ongoing planning and feasibility work. ADMH is confident that at least 70% of the existing CMHCs will be early adopters of the CCBHC model. ADMH will transition CMHCs to ensure expansion of services to cover the state. We will engage 19 providers who served a total of 96,494 individuals in the MI community programs in FY21. Due to significant racial disparities in the state, ADMH has prioritized DEIB efforts and building a culturally responsive workforce. Their CCBHC planning includes a DEIB subcommittee to center these efforts. ADMH plans to build upon existing partnerships with Historically Black Colleges and Universities (HBCUs) and the Alabama Chapter of the National Association of Black Social Workers improve representative workforce recruitment and retention. ADMH and AMA have selected the PPS-1 model of payment and plans to explore quality incentives for providers. ADMH and AMA will use the planning period to align Medicaid authorities to prepare for the Demonstration period. Finally, ADMH plans robust improvements to its HIE and performance management systems and extensive support for CCBHCs in collecting and reporting on performance and using data to drive improvements.

The North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS), the State Mental Health Authority and the Single State Agency for substance use, in collaboration with the Division Health Benefits (DHB), the State Medicaid Program, proposes to develop a plan to strengthen and sustain the 13 existing certified community behavioral health clinics (CCBHCs) in the state. CCBHCs are specially-designated clinics that receive flexible funding to expand the scope of mental health and substance use services available in their community to ensure health equity and high-quality care for underserved populations, including children and youth with Serious Emotional Disturbances, adults with serious mental illness, individuals with long-term and serious substance use disorders and those with mental illness and substance use disorders. CCBHCs provide a wide array of integrated community- based services and provide serve everyone regardless of insurance status or diagnosis. Over the course of the planning year, the proposed project will (1) certify community behavioral clinics using the Department of Health and Human Services criteria, (2) establish prospective payment systems for Medicaid reimbursable services, (3) enhance data collection and reporting capabilities of CCBHCs, and (4) develop an application for a four-year CCBHC Demonstration program. Building upon lessons learned by working with the existing eight Substance Abuse and Mental Health Services Administration (SAMHA)- funded and five state- funded CCBHCs, the state will certify clinics based on the required criteria (staffing, availability and access to services, care coordination, scope of services, quality and other reporting, and organizational authority) developed by SAMHSA in response to Section 223 of the Protecting Access to Medicare Act of 2014 (HR 4302). Based on guidance from the Centers for Medicare & Medicaid Services (CMS) to states and clinics, the proposed project will develop, refine, and establish a prospective payment system to be used for the demonstration that will follow the planning year. The applicant agency intends to develop an application for a four-year demonstration program based on the results of planning efforts in the first year. The applicant agency will involve consumers with mental health and substance use disorders and their families at all levels of activities for the proposed project, ensuring that their representation and meaningful input during the planning year.

The Kansas Certified Community Behavioral Health Clinic (CCBHC) Planning Grant project is a collaboration between the Kansas Department for Aging and Disability Services (KDADS), the Kansas Department of Health and Environment (KDHE), and the State's 26 Community Mental Health Centers (CMHCs) - which are eligible under state statute to become certified as CCBHCs - to support the development and preparation for statewide implementation of the Centers for Medicare & Medicaid Services' (CMS) CCBHC Demonstration. Kansas will utilize the CCBHC Planning Grant to prepare for the CMS CCBHC Demonstration to further the transformative potential of the CCBHC initiative to increase access to quality of behavioral health services for all person with any behavioral health need, including adults with serious mental illness (SMI), children and youth with serious emotional disturbance (SED), persons with substance use disorder (SUD), and all other behavioral health conditions. To ensure CMS CCBHC Demonstration readiness, the main activities to be performed under the grant to include: bolstering State staff to provide intensive outreach and engagement to current and prospective CCBHCs and their communities; providing training and technical assistance to CMHCs, MCOs, and other key partners with regards to financial, policy, and systems operations; modifying State policies and regulations related to CCBHC payment and certification; finalizing the prospective payment system (PPS) section upon review of the new federal guidance; and submitting a proposal to participate in the CMS CCBHC Demonstration following the planning grant period. The need in Kansas for quality mental health services has grown through the COVID-19 public health emergency. Mental Health America ranked Kansas 51st for both adults and overall categories recently in their 2023 report. The rankings show a high prevalence of youth with substance use disorder in the past year (9.0 %), adults with any mental illness (26.0 %), and adults with serious thoughts of suicide (6.4%). For overall prevalence of mental illness, Kansas ranked 50th out of all states. Moreover, Kansas ranked 49th of all states in terms of access to care. The MHA report used CDC data, showing Kansas had the 12th highest age-adjusted rate for death by suicide in the nation at 18.4% in 2020 as part of its ranking criteria. For youth, Kansas ranked 50th out of 51 states and DC in terms of mental health. Kansas also ranked in the second worst quartile for the prevalence of youth with a major depressive episode (17.9%), higher than the national average of 16.4%. Unfortunately, the access to care response is not commensurate with the preceding needs. Nationally, 28% of youth with severe depression receive consistent treatment, whereas only 6.5% of you with severe depression in Kansas receive consistent treatment. The pandemic has taken a similar toll on Kansans in terms of substance use. Kansas is one of just five states to rank in the bottom ten of all states for prevalence of youth and adult substance use disorder (SUD) at 9.1% and 18.4%, respectively. The youth prevalence of SUD ranks last of all states and DC. Kansas also had the 4th highest rate nationally for both adults and children needing, but not receiving, treatment at a specialty facility for SUD. The CCBHC Planning Grant will be used to help carry out the State's commitment to statewide implementation of the CCBHC model. Codified in State Law and implemented under Kansas' Medicaid State Plan authority, the State has currently certified 9 CMHCs as CCBHCs and will certify the remaining 17 CMHCs by July 1, 2024, in accordance with State Statute. In doing so, the centers will address the prevalence of need among all Kansans with behavioral health issues exacerbated by the COVID-19 pandemic, including individuals in urban, rural, and frontier counties, with a specific focus on populations which experience health disparities related to behavioral health care.