Form 1203, Texas Certified Community Behavioral Health Clinic (CCBHC) Application

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Documents

Effective Date: 1/2020

 

Instructions

Updated: 1/2020

 

Purpose

The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded Texas Health and Human Services Commission (HHSC) a planning grant in October 2015. The grant helped develop certification and payment methods for integrated mental health and substance abuse community centers. It was the first of a two-part SAMHSA initiative, designed 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 gave Texas the opportunity to partner with managed care organizations (MCOs), providers and stakeholders to certify clinics, establish standards, and develop an integrated service delivery framework.

Texas was not selected as a national demonstration state for the second part of the initiative, but HHSC continues to use the CCBHC model to transform service delivery to improve the lives and health outcomes of vulnerable populations.

Through a state-driven initiative that aligns the goals of CCBHCs with the current Medicaid and behavioral health environment in Texas, HHSC demonstrates a commitment to using CCBHCs as a best practice for service delivery in behavioral health settings. Starting in Fiscal Year 2020, and as an identified goal in the HHS Business Plan: Blueprint for a Healthy Texas, HHSC will begin increasing the number of CCBHCs statewide to expand capacity for community-based behavioral health services and enhance behavioral health care outcomes.

 

Procedure

When to Prepare

The CCBHC Application Form is required for interested organizations to begin the Texas CCBHC Certification process.

 

Transmittal

Completed application form and a signed copy of the HHSC and CCBHC Memorandum of Understanding (MOU) should be emailed to TexasCCBHCInitiative@hhsc.state.tx.us.

 

Instructions

Please fill out all sections of this application form completely and accurately. Incomplete forms will not be considered for the CCBHC certification process. The application form consists of the following sections:

  • Section A: Administrative Information
  • Section B: Service Provision
  • Section C: Electronic Health Records and Data Reporting
  • Section D: Organizational Authority, Governance, and Accreditation