NYS Council in Today’s Crain’s Health Pulse

July 21, 2023

The NYS Council and our work to compel state leaders to expand the CCBHC federal Demonstration Program in NY, is once again in the news.  Many thanks to all of the NYS Council members who spoke to the reporter and added substance and perspective to the conversation.

Honestly?  I would have preferred the reporter include my comment in response her question about the possibility that (if Congress were to fail to re-authorize the Demo at some point in the future) services might have to move into the Medicaid Program and thus, payment would be managed by MCOs (I believe my response was ‘over my dead body’).  Some states are doing this but I have spoken with many representatives from these states and they do NOT have the same level of difficulty working with MCOs as is the case in NY.

All in all it’s a good article that allows us to highlight an important NYS Council advocacy win for all New Yorkers.

State expansion of federal behavioral health clinics could broaden cost-effective care, experts say

Crain’s Health Pulse, 7/21AMANDA D’AMBROSIO 

New York’s worsening mental health and substance use disorder crises have pushed providers to the brink as they struggle with long waiting lists, workforce shortages and low reimbursement rates that they say make it difficult for them to meet the state’s behavioral health needs.

But the state’s move to expand a federal program known as certified community behavioral health clinics—or CCBHCs—may be a critical part of a patchwork of solutions that adequately fund community-based health clinics, and invest in mental health services that keep patients out of the hospital, experts say.

Last week, Gov. Kathy Hochul announced that New York state would make $3.5 million available to create 13 additional CCBHCs across the state. New York already has 13 clinics—the recent funding is a part of its efforts to triple the number of CCBHCs across the state in the coming years.

CCBHCs, open 24/7, provide a range of mental health and substance use disorder treatment including psychiatric rehab, round-the-clock crisis services, case management and primary care. The clinics allow New Yorkers to receive care for a spectrum of services—including mental health care, substance use treatment and primary care—all in one place, and are required to treat all patients despite their ability to pay.

What makes the clinics unique is that they are not funded the same way as other behavioral health outpatient facilities. The program allows clinics to have a say in setting Medicaid reimbursement rates that actually cover the costs of their services, as opposed to receiving rates from Medicaid managed care organizations and private payers that they say make it a struggle to sustain services. These rates are called prospective payment system rates.

Lauri Cole, executive director of the NYS Council of Community Behavioral Healthcare, said payments made available by the program markedly improve access to care across the state. Becoming a CCBHC allows clinics to get paid more for the services they provide—ultimately helping them hire more workers, address growing waiting lists and meet the needs of the communities they serve.

“It allows them to get more boots on the ground,” said Cole, who advocated to include the expansion of the program in the enacted executive budget.

In 2015, New York became one of 23 states to participate in a one-year grant program with the Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services to plan certified community behavioral health clinics. After that planning grant, New York joined seven other states to participate in a two-year federal demonstration program to actually implement the facilities.

The demonstration program was set to end in 2019—however, the federal government has extended it several times since then, and it is now set to go through 2025.

People who received care from CCBHCs in the first two years of the demo program had lower average monthly costs of behavioral health and medical inpatient and emergency care, according to data from the state.

Some reports also show that the program could save the state money. An actuarial report commissioned by the NYS Council on Community Behavioral Healthcare at the end of last year found that expanding CCBHC clinics is budget neutral if the state receives a one-to-one federal match, but would save money if New York received enhanced federal funding.

The state did, however, include significant investments for the program in the recent budget. Between now and 2025, it allocated nearly $20 million for the expansion of CCBHCs, and an additional $34 million to establish an indigent care pool to provide services to people without insurance.

CCBHCs do have to generate savings to offset the state’s investments. By 2025, New York will increase the number of CCBHCs to 39.

Jeffrey Friedman, executive director of Central Nassau Guidance and Counseling on Long Island, which participates in the CCBHC program, said that the program allows his clinic to provide walk-in mental health services, crisis services and other programs to people who have typically had challenges accessing care. Because the payment rates are more sustainable, the clinic can pay for necessary staff and other expenditures that come with providing more services.

The biggest benefit to expanding these clinics, Friedman said, “is that people have access to care.”

If the federal government does not continue to renew the funding for the demo program after it ends in 2025, Cole said that the state may need to pay participating clinics through Medicaid managed care organizations.

But for now, Cole said her main concern is to ensure access to care for New Yorkers who have been on waiting lists for a long time to receive mental health services. “This improves those odds, dramatically,” she said. —Amanda D’Ambrosio