Vermont picks two agencies to begin CCBHC certification under federal demonstration

The Vermont Department of Mental Health told the House Appropriations Committee on Feb. 5 that it will begin implementing the certified community behavioral health clinic (CCBHC) model in two agencies as part of a federal demonstration that increases federal match for integrated mental health and substance use disorder services.

Commissioner Emily Hawes said the CCBHC model aims to expand access to evidence-based substance use disorder treatment, mental health services, 24/7 crisis response and medication assisted treatment for opioid use disorder. "This model requires agencies to meet a robust criteria regarding timeline of access, quality reporting, staffing, coordinating with local services and education systems," Deputy Commissioner Samantha Swee said.

Why it matters: The CCBHC model is a national approach designed to broaden access to integrated care and offer more predictable funding through a daily or per-capita rate under some demonstration arrangements. In Vermont's demonstration status, the department said it can access "an enhanced federal drawdown for those services delivered within the CCBHC model," Swee said.

Implementation timeline and sites: The department awarded planning grants beginning in 2021 and completed a competitive process to identify the first two agencies to certify. "Those two agencies are the Claire Martin Center and Rutland Mental Health Center. Those two agencies will begin operating under the CCBHC model in July 1," Swee told the committee. Howard Center, HCRS and Northeast Kingdom Human Services are planning to pursue certification as well, the department said.

Model details discussed during the hearing included the following points: - The CCBHC rate in Vermont's demonstration is not a per-encounter fee-for-service; Swee described it instead as a daily rate and part of a flexible funding approach negotiated with agencies during the demonstration. - The model is intended to increase access for veterans and to include peer services (people with lived experience) as part of the staffing mix. - The department emphasized that some services, such as residential programs, exist outside a CCBHC rate and may be billed separately.

Questions from committee members addressed scope and data: Representative Lohre asked what portion of mental health cases are co-occurring with substance misuse; Swee said adult clients commonly have co-occurring disorders and estimated "80, 90 percent" of adults interacting with the mental health system also use substances, acknowledging that that figure comes from billable-service data and primary diagnosis reporting. Representative Giacalone asked whether CCBHCs are similar to intensive wraparound services; the department clarified that CCBHCs are not limited to wraparound family programs and that residential services generally sit outside the CCBHC rate.

Ending: The department said two agencies will begin certification on July 1 under federal demonstration terms and that other designated agencies are actively preparing for certification; committee members pressed for additional details about the rate methodology and how residential and wraparound services will coordinate with CCBHC billing.