West Virginia’s road to statewide community behavioral health clinic certification

Last month, Health Affairs Institute began work on a new contract with the West Virginia Department of Human Services (DoHS) Bureau for Medical Services (BMS) that will strengthen the state’s network of community behavioral health centers (CMHCs). From January 2025 through December 2027, HAI will partner with BMS and the Bureau for Behavioral Health (BBH) to evaluate the process and progress of West Virginia’s 13 CBHCs and other licensed behavioral healthcare providers as they move toward becoming Certified Community Behavioral Health Clinics (CCBHCs).

A CCBHC is a specially-designated clinic that provides a comprehensive range of mental health and substance use services. The Excellence in Mental Health and Addiction Treatment Act established a federal definition and criteria for CCBHCs, which receive an enhanced Medicaid reimbursement rate based on their anticipated costs of expanding services to meet the needs of vulnerable populations.

CCBHCs create access, stabilize people in crisis, and provide the necessary treatment for those with the most serious, complex mental illnesses and substance use disorders. CCBHCs integrate additional services to ensure an approach to healthcare that emphasizes recovery, wellness, trauma-informed care, and physical behavioral health integration. These services include, but are not limited to: provision of 24/7/365 crisis care, on-site care coordination, integrated healthcare, and tailored care for active-duty military and veterans

In 2017, the first CCBHCs were funded under Medicaid, with 67 operating in eight states. Today, there are more than 500 CCBHCs, in 46 states, the District of Columbia, Guam, and Puerto Rico.

West Virginia passed legislation in 2022 (SB247) that directed BMS, in partnership with BBH, to establish a state certification process and payment system for CCBHCs. BMS submitted a revision to their state plan amendment in 2024 to modify WV’s state Medicaid plan to allow for the Prospective Payment System (PPS) for CCBHCs. Applications for the full certification process opened on Oct. 1, 2024.

BBH and BMS are partnering with Quality Insights, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Pennsylvania and West Virginia, to provide guidance and technical assistance during the certification process. According to Quality Insights, West Virginia CCBHCs will:

• Provide integrated healthcare services that are evidence-based, trauma-informed, recovery-oriented, and person and family-centered across a continuum of care and throughout the lifespan of the individual.
• Increase access to services by offering a comprehensive range of mental health, substance use disorder (SUD), and primary care screening services through systems integration and monitoring.
• Maintain and expand upon established collaborative relationships with other service providers and healthcare systems to promote effective coordination of care.

BMS is interested in evaluating the effectiveness of the CCBHC initiative to determine changes in costs, access to behavioral health services, quality of care, and other select priority outcomes. As data availability allows, evaluation measures may include assessment of the following:

• utilization of certain services (e.g., emergency room use, psychiatric hospitalization use, follow-up care after hospitalizations and emergency room encounters),
• services delivered to priority populations (e.g., Veterans, persons experiencing homelessness, children with serious emotional disorders),
• access to care including new locations of service delivery that may address ‘behavioral health service deserts,’ time to treatment measures, etc.,
• collaboration with community entities (e.g., law enforcement, primary care providers),
• changes in workforce retention and recruitment,
• and other outcomes of interest to be determined during the planning period.

As part of the Evaluation of Certified Community Behavioral Health Clinics (CCBHC), HAI will complete a scan of the WV CCBHC environment to determine existing CCBHC data sources, CCBHC data reporting requirements and content, data availability and requirements needed to access information (e.g., data use agreements), documentation of data integrity and fidelity issues, and any other CCBHC data source details that need to be considered to develop the evaluation plan.

Learn more about the certification progress on the BBH website.

West Virginia’s public health institute, West Virginia University (WVU) Health Affairs Institute is a nonpartisan organization that provides expert services in progressive health data analytics, public impact research, and program implementation and evaluation in collaboration with government agencies, foundations, and nonprofits to inform the advancement of health at the local, state, and national levels.