On April 16, 2015, President Obama signed MACRA (the Medicare Access and Chip Reauthorization Act) into law without much fanfare. Yet, this patient-centered approach to healthcare is quietly changing the face of medicine in America. The new legislation effectively repeals the Sustainable Growth Rate (SGR) formula for determining Medicare Part B payments.
In place of the SGR, we now have two new reimbursement systems: MIPS (the Merit-Based Incentive Payments System) and APMs (Alternative Payment Models). With MACRA, healthcare reimbursements are based on quality, rather than quantity of care.
So, what does MACRA have to do with FQHCs, CCBHCs, and CMHCs? Plenty. In 2018, all three are at the forefront of efforts to deliver value-based care to America’s distressed populations. To date, eight states have been chosen to participate in 2-year CCBHC demonstration programs.
These eight states are Missouri, New York, New Jersey, Nevada, Oregon, Minnesota, Pennsylvania, and Oklahoma.
How FQHCs and CMHCs Represent a New Care Paradigm For America
FQHCs, CCBHCs, and CMHCs basically provide care to disadvantaged or distressed populations, regardless of their ability to pay.
FQHCs (federally qualified health centers) frequently serve the homeless, migrant, and tribal communities. To improve the quality of care for Medicare patients, FQHCs also provide CCMs (chronic care management services). According to the CMS (the Centers for Medicare & Medicaid Services), nurse practitioners (NPs), physicians assistants (PAs), clinical nurse specialists, and certified nurse midwives may provide and bill for CCM services.
With comprehensive electronic care management plans and 24/7 care continuity, FQHCs that provide CCMs are delivering on MACRA’s definition of value-based healthcare. Meanwhile, CMHCs (community mental health centers) provide similar but specialized services for children, the disabled, and the elderly.
With the emphasis on quality care (and the shortage of primary care physicians in distressed areas), CMHCs and FQHCs are quietly hiring increasing numbers of nurse practitioners and physicians assistants. Additionally, many NPs and PAs also live in the distressed regions, adding to their ability to provide value-based care in these areas.
The Centerpiece of MACRA: CCBHCs (Certified Community Behavioral Health Clinics)
CBBHCs were created through the Protecting Access to Medicare Act (PAMA) in 2014. In 2018, the alignment of PAMA and MACRA initiatives represents the crown jewel of patient-centered care.
Each of the eight states in the CCBHC demonstration program will provide nine services that cater to disadvantaged populations:
- Peer and family-support services.
- Primary care screening and monitoring.
- Psychiatric rehabilitation services.
- Services tailored to the needs of veterans and active-duty military.
- Targeted case management.
- Patient-centered treatment planning.
- Outpatient mental health and substance abuse services.
- 24-hr crisis healthcare.
- Screening, assessment, and diagnosis services.
What Does This Mean for New Jersey?
As one of the 8 states, New Jersey is a trailblazer in the Northeast region. To date, New Jersey CCBHCs are collaborating with participating DCOs (designated collaborating organizations) and FQHCs. They are delivering on a major plank of the CCBHC program: care coordination. Such collaboration has increased patient access to all nine of the required CCBHC program services.
Since the program premiere, nine New Jersey CCBHCs have seen an increase in the number of patients served. Certainly, the federally-funded 2-year program has made a crucial difference to marginalized communities. By extension, New Jersey has also seen the demand for healthcare professionals skyrocket. CCBHCs and DCOs are seeing an increased need for nurses (especially those from diverse cultural and linguistic backgrounds), psychiatrists, and health professionals with diversified addiction specialties.
To date, any FQHC or CMHC can potentially qualify to become a DCO. Also, there are benefits to receiving DCO status: organizations will be reimbursed for critical behavioral health services that they previously provided for free. In New Jersey, increasing numbers of healthcare organizations have qualified for DCO or CCBHC status. These organizations report an increased ability to implement opioid treatment initiatives. These initiatives include expanded medication-treatment programs and screening protocols for opioid disorders.
Certainly, 2018 will be an exciting year. So, if you have questions about qualifying for CCBHC status or if you’re a CCBHC looking for trained healthcare professionals, contact us. At Vitalis, our priority is your satisfaction: we’re results-oriented and committed to healthcare excellence.
1) The New Jersey CCBHC Initiative.