Over the past decade, Texas has made significant investments into the behavioral health delivery system. Policy revisions, infrastructure development, and technological innovations have been employed to allow people to have better access to the care they need. However, with multiple funding sources and services provided by various state agencies, gaps and fragmentation of care still continue to present significant barriers for populations with serious and persistent mental illness, emotional disturbances and substance use disorders.
To help address these gaps, the Texas Health and Human Services Commission (HHSC) applied for and was awarded a Substance Abuse and Mental Health Services Administration (SAMHSA) planning grant in October 2015 to develop certification and payment methodologies for the integration of targeted acute care services into behavioral health (mental health and substance use disorder services) community centers. This planning grant was the first of a 2-part SAMHSA initiative to assist states with planning, implementing and evaluating efforts to improve community health services.
Participation in the SAMHSA Certified Community Behavioral Health Clinic (CCBHC) planning grant provided Texas with a unique opportunity to partner with managed care organizations (MCOs), providers and stakeholders to certify clinics, develop an integrated service delivery framework and craft a prospective payment model supporting a robust integrated care approach for behavioral health.
Planning activities included:
- Developing state standards for pilot CCBHC centers based on SAMHSA criteria
- Identifying, preparing and certifying pilot CCBHCs
- Developing a prospective payment system (PPS) based on Centers for Medicare and Medicaid Services (CMS) cost report methodology
- Developing a proposal for participation in a 2-year national CCBHC demonstration project
While Texas was not selected as a national demonstration site, Texas Health and Human Services is continuing to explore this emerging national model to transform service delivery to improve the lives and healthcare outcomes of vulnerable populations by creating a more efficient and coordinated system.
Through a rigorous application process, HHS selected 8 sites that exhibited the highest levels of readiness to participate in the certification process. Over the course of the planning grant year, these organizations prepared to become CCBHCs through continued partnership with HHSC staff. The following tools were used to certify the centers and are based on the SAMHSA Criteria and state demonstration application. More information about this process can be found in the state demonstration narrative.
- CCBHC Reviewer Checklist – Tool used by HHSC staff to ensure that a center meets all of the components of the SAMHSA Criteria
- CCBHC Pilot Site Assessment – Completed by HHSC and distributed to the centers identifying areas that needed additional information, resources or technical assistance
Austin Travis County Integral Care
Austin Travis County Integral Care (ATCIC) is the largest community-based behavioral health provider in Travis County. ATCIC works with 6 Medicaid MCOs to provide services to a predominantly urban population of 1.2 million residents living within 1,000 square miles. Through Joint Commission on the Accreditation of Health Care Organizations (JCAHO) accreditation, ATCIC has evolved into an integrated health model and is able to provide services through its own service locations and co-locations with primary care partners and schools across the service delivery area.
Bluebonnet Trails Community Services
Bluebonnet Trails serves 8 counties in Central Texas which represent a mix of urban and rural populations surrounding the Austin and San Antonio metropolitan areas. Of the 8 counties, 4 are designated as rural and as health professional shortage areas (HPSAs). Bluebonnet serves a geographic area of 6,904 square miles, and has a population density of 130 individuals per square mile. As one of the larger centers, Bluebonnet Trails partners with 10 Medicaid MCOs to serve parts of 3 service areas.
Burke primarily operates in East Texas, providing services for approximately 400,000 people across a 12-county rural area that spans more than 10,000 square miles. All of the counties within Burke's service delivery area are federally designated as HSPAs for mental health. The center uses telemedicine to expand access to care across its region. In addition, Burke is the only CCBHC pilot site in Texas with a Native American tribe within its service delivery area. Burke works with 7 MCOs and has held JCAHO accreditation since 1980.
Helen Farabee Centers
Of the selected sites, Helen Farabee serves the largest geographic area, covering 16,655 square miles across 19 counties in north Texas, 10 of which have frontier designations. Helen Farabee Centers serve 17 counties federally designated as HPSAs for mental health and 10 counties which have a medically underserved area (MUA) designation. To address issues arising from distance between centers and lack of health professionals, Helen Farabee has a network of telehealth and telemedicine services to meet the needs of their consumers who may reside in counties with population densities as low as 2 people per square mile. The Center works with 7 Medicaid MCOs to cover parts of 3 service delivery areas in the northern and western regions of the state.
The Montrose Center
As an urban center, the Montrose Center is a nonprofit organization that primarily serves people who are LGBT and HIV positive in Harris County and the surrounding areas. In conjunction with local mental health authorities (LMHAs) and community centers, Montrose helps provide services for the diverse population of Harris County, which encompasses approximately 4.1 million individuals who live in more than 1,730 square miles. Because the Montrose Center is not an LMHA, it is not assigned to a specific service delivery area, but works with 8 MCOs to deliver services and provide behavioral health resources for approximately 5,000 people each year.
StarCare Specialty Health System
StarCare Specialty Health System is located in West Texas. It works with 4 Medicaid MCOs to provide services to approximately 317,000 people across 5 counties comprised of 4,375 square miles. Two of the counties within StarCare's service delivery area are designated as rural, and all of them are federally designated as HPSAs. StarCare addresses this professional shortage by identifying opportunities to use telehealth and telemedicine services, and works closely with higher education institutions in the area to help address health professional shortages and better serve the community.
MHMR of Tarrant County
MHMR of Tarrant County is one of the largest urban centers selected as a pilot site for the demonstration. Covering over 860 square miles in Tarrant County, MHMR Tarrant works with 4 Medicaid MCOs to provide services for a population of approximately 1.8 million. As one of the oldest centers in Texas, Tarrant has the largest network of locations and services available to residents.
Tropical Texas Behavioral Health
Tropical Texas serves the highest number of potential CCBHC consumers as the LMHA for the South Texas region. Spanning 3,100 square miles along the Gulf Coast and South Texas border, Tropical Texas works with 5 Medicaid MCOs to provide services for approximately 1.2 million residents across the 3 counties. Based on their location and proximity to the US-Mexico border, Tropical Texas presents unique opportunities in working across culturally diverse populations.
This site will evolve as the Texas approach to CCBHC services is piloted and refined. For more information on the project or on the tools used for certification, please email the CCBHC Coordination Team.