Excellence in Mental Health Act and CalMHSA Statewide Prevention and Early Intervention Project

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This pub tells you about the “Excellence in Mental Health Act”. This Act allows states have “Certified Community Behavioral Health Clinics.” These health clinics have mental health services. This pub also tells you about the “California Mental Health Services Authority.” The pub tells you about their projects to improve mental health.

1. What is the Excellence in Mental Health Act?

The Excellence in Mental Health Act (the Excellence Act) is a federal law passed in 2014. It is part of the Protecting Access to Medicare Act. The point of the Excellence Act is to increase quality community mental health and substance use treatment services. It allows states to create Certified Community Behavioral Health Clinics (CCBHCs) during a two-phase Demonstration Program. It helps states create a prospective payment system to improve CCBHC provider reimbursements. The Excellence Act will put about $1.1 billion into the mental health system through mid 2019, when the Demonstration Program is slated to end. This makes it the biggest federal investment in mental health and substance use treatment services in generations.

2. What is a Certified Community Behavioral Health Clinic?

A Certified Community Behavioral Health Clinic (CCBHC) is a type of health clinic. The law requires that these clinics have a broad range of services for people with mental health disabilities and substance use disorders.

CCBHCs must have these mental health services:

  • Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention, and crisis stabilization
  • Screening, assessment, and diagnosis, including risk management
  • Patient-centered treatment planning
  • Outpatient mental health and substance use services
  • Primary care screening and monitoring
  • Targeted case-management
  • Psychiatric rehabilitation services
  • Peer support, counseling services, and family support services
  • Services for members of the armed forces and veterans
  • Connections with other providers and systems (primary care, education, child welfare, criminal justice, foster care, hospitals, etc.)

CCBHCs must follow strict standards of care, staffing, and accountability.  For example, CCBHCs must be staffed with licensed people who are trained in person-centered, recovery-oriented, and culturally competent care. They must provide services at convenient times and places.  They must offer services even if a person cannot pay.

3. What is the Excellence Act’s Demonstration Program?

A demonstration program is a special project to test the law. The Excellence Act’s Demonstration Program allows states to have CCBHCs that follow the new criteria and test how well CCBHC services work. The Demonstration Program has two parts:

  • Phase I – Planning Grant Phase: Grants were awarded to 24 states. These 24 states used their grants to develop CCBHC clinics and created plans for how they would run.
  • Phase II – Two-Year Demonstration Program: Eight of the 24 states were selected for Phase II. During Phase II, CCBHCs in eight states are providing mental health and substance use treatment services and are paid using a prospective payment system. During the second phase, CCBHCs are funded to give services for two years.

4. Did California get an Excellence Act Planning Grant?

Yes. California was awarded $982,373 for Phase I. California used its grant to develop CCBHC clinics in accordance with the law’s criteria. California applied for Phase II funding, but was not one of the eight states selected for the next phase of the Demonstration Program. Congress introduced legislation to expand the Excellence in Mental Health Act to more states, which could include California.

5. What is a Prospective Payment System?

A Prospective Payment System (PPS) is a way to figure out how much to pay CCBHC providers. Under this system, their pay is decided in advance and is a fixed price. The Excellence Act allows states to pick one of two PPS rate systems depending on what works best for the state. This means for the first time ever, CCBHC providers can be paid the real cost of mental health, substance use, and basic primary care services.

6. Is the Excellence Act a step toward mental health parity?

Yes. Mental health parity means equal coverage for both physical and mental health care. For many years, Federally Qualified Health Centers received federal funds for physical health care services. Mental health centers did not get the same federal funds—until now. The Excellence Act makes sure mental health centers are more -- equal to physical health centers. It improves standards and expands access so more people can get the care they need. Building on the success of Federally Qualified Health Centers, the Excellence Act is a step towards mental health parity.

7. CalMHSA Statewide Prevention and Early Intervention (PEI) Project

The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families and communities. Prevention and Early Intervention Programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop 63).

The PEI Statewide Project is a collection of Prop. 63-funded programs, which together aim at preventing suicides, reducing stigma and discrimination, and improving student mental health throughout the state.

Phase I of the PEI Statewide Project, from 2011 to 2015, implemented programs through three initiatives: suicide prevention, stigma and discrimination reduction, and student mental health.

Phase II of the PEI Statewide Project, from 2015 to 2017, continued the three initiative efforts with an added focus around four wellness areas (diverse communities, schools, healthcare, and workplace) to achieve broad activities that reflect a public health/population based approach for advancing community change.

Phase III of the PEI program, from 2017 to 2020, builds upon the initiatives of Phases I and II with an emphasis on reaching Hispanic communities throughout the state. Actions include the creation of a more culturally relevant outreach and education campaigns, with the aims of promoting awareness of mental health issues in Hispanic communities and encouraging both prevention and treatment.  

Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California’s diverse communities.