CCBHC vs. DCO
Ongoing requirements for CCBHC certification
Part 6: Ongoing requirements for CCBHC certification
1. Service transition
Many groups are not large or diverse enough to provide the services required by Section 223 Demonstration Program for Certified Community Behavioral Health Clinics of the Protecting Access to Medicare Act (PAMA) to become a certified community behavioral health clinic (CCBHC). However, many groups want to grow to become a CCBHC due to the enhanced US Centers for Medicare & Medicaid Services (CMS) payments. To meet the four service requirements, organizations may need to expand their operations, or acquire or merge with other organizations to augment their service offerings.
2. Care coordination
Providers must ensure seamless transitions for patients across the full spectrum of health services, including acute, chronic, and behavioral health needs. Effective care coordination balances physical and behavioral care, supporting optimal outcomes, which providers can achieve by sharing comprehensive healthcare information.
Once the clinic achieves certification, they must solicit the input of their consumers and the consumers' families/caregivers to determine their staffing requirements. This feedback is used to update the staffing assessment at least every three years the clinic is certified. However, clinics may want to perform this analysis more often than every three years because changes will need to be factored into the prospective payment system (PPS) cost report to ensure PPS rates are sufficient to cover the cost of care.
CCBHCs have a high level of reporting requirements within two specific areas: quality metrics and cost metrics. Clinics need to generate cost information to support their PPS calculations for their revenue to cover their costs. Quality metrics are required to justify the CCBHC certification, and are necessary for recertification every five years. They will also be necessary for clinics to qualify for the quality bonus payments from the CMS.
5. Data sharing
Information exchange is critical to the success of any CCBHC. The services required for a CCBHC necessitate that providers share information among their peers in the clinic to ensure quality outcomes over the life of the consumer. If DCOs are used, the processes must also include sharing that information bidirectionally with one or more external entities. Current health IT solutions do not excel at this level of information exchange, so clinics need to start preparing early to ensure success.
Intelligent transitions with the right expertise and tools
Having both behavioral health and medical information in one record is not common, but it is possible. The comprehensive, integrated, and interoperable behavioral health EHR and practice management solution from NextGen Healthcare delivers this record on a single platform, with intuitive behavioral health content and workflow tools.
The NextGen® behavioral health solution can help your clinic improve care outcomes, streamline data sharing and access, reduce costs, and manage reporting more easily. With it, your clinic will have the foundation you need to become a CCBHC.
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