What GAO Found
The Protecting Access to Medicare Act of 2014 (PAMA) established the Certified Community Behavioral Health Clinics (CCBHC) demonstration and tasked the Department of Health and Human Services (HHS) with its implementation. CCBHCs aim to improve the behavioral health services they provide, particularly for Medicaid beneficiaries. Initially established for a 2-year period, the demonstration has been extended by law a number of times; most recently, it was extended to September 2023. States participating in the demonstration can receive Medicaid payments, consistent with federal requirements, for CCBHC services provided to beneficiaries.
PAMA also required HHS to assess the effect of the demonstration on service access, costs, and quality. HHS’s preliminary assessments of the demonstration in eight states, with 66 participating CCBHCs, found the following:
- Access. CCBHCs commonly added services related to mental and behavioral health, such as medication-assisted treatment, and took actions to provide services outside the clinic setting, such as through telehealth.
- Costs. States’ average payments to CCBHCs typically exceeded CCBHC costs for the first 2 years of the demonstration. CCBHC payments and costs were more closely aligned in the second year for most states, better reflecting the payment methods prescribed under the demonstration.
- Quality. States and CCBHCs took steps, such as implementing electronic health records systems, to report performance on 21 quality measures.
GAO found data limitations complicated—and will continue to affect—HHS’s efforts to assess the effectiveness of the demonstration. For example:
- Lack of baseline data. PAMA requires HHS to assess the quality of services provided by CCBHCs compared with non-participating areas or states. The demonstration marked the first time these clinics reported performance on quality measures, so no historical baseline data exist. HHS officials noted that with time, additional data may provide insight on the quality of services.
- Lack of comparison groups. PAMA requires HHS to compare CCBHCs’ efforts to increase access and improve quality with non-participating clinics and states. HHS was unable to identify comparable clinics or states due to significant differences among the communities.
- Lack of detail on Medicaid encounters. PAMA requires HHS to assess the effect of the demonstration on federal and state costs and on Medicaid beneficiaries’ access to services. HHS plans to use Medicaid claims and encounter data to assess such changes. However, GAO has previously identified concerns with the accuracy and completeness of Medicaid data and has made numerous recommendations aimed at improving their quality.
HHS’s decisions in implementing the demonstration also complicated its assessment efforts. HHS allowed states to identify different program goals and target populations, and to cover different services. HHS also did not require states to use standard billing codes and billing code modifiers it developed. The lack of standardization across states limited HHS’s ability to assess changes in a uniform way.
Why GAO Did This Study
Behavioral health conditions—mental health issues and substance use disorders—affect millions of people. HHS estimates that 61 million adults had at least one behavioral health condition in 2019—41 million of whom did not receive any related treatment in the prior year.
Many individuals with behavioral health conditions rely on community mental health centers for treatment, but the scope and quality of these services vary. To improve community-based behavioral health services, PAMA created the CCBHC demonstration and provided HHS with $25 million to support its implementation.
PAMA directed HHS to assess the demonstration and to provide recommendations for its continuation, modification, or termination. To date, HHS has issued three annual reports assessing the initial demonstration period, which ran from 2017 to 2019. HHS plans to issue a fourth annual report and a final report by December 2021.
This report describes HHS’s assessment of the demonstration regarding access, costs, and quality. Under the CARES Act, GAO is to issue another report on states’ experiences by September 2021.
GAO reviewed federal laws and regulations; HHS guidance; and HHS’s assessments of the demonstration, including three issued reports, interim reports, and the analysis plan for future reports. GAO also interviewed HHS officials and officials from organizations familiar with community health clinics.
HHS provided technical comments, which GAO incorporated as appropriate.
For more information, contact Carolyn L. Yocom (202) 512-7114 or firstname.lastname@example.org.
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Reviewed select GAO documents, including Designing Evaluations (GAO-12-208G), published GAO TAs, select GAO products using policy analysis approaches to present policy options, and other GAO reports Reviewed select Office of Technology Assessment reports Reviewed select Congressional Research Service reports Reviewed select English-language literature regarding TAs and related to development and analysis of policy options Consulted with external experts and performed outreach, including holding an expert meeting to gather input on TA design, soliciting comments from external experts who contributed to GAO TAs published since 2015, and soliciting comments from the public Reviewed experiences of GAO teams that have successfully assessed and incorporated policy options into GAO products and TA design, including challenges to TA design and implementation and possible solutions GAO is not making any recommendations. For more information, contact Timothy M. Persons or Karen L. 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- 2020 Census: Census Bureau Needs to Ensure Transparency over Data QualityBy Sam NewsDecember 3, 2020This 2020 Census was taken under extraordinary circumstances. In response to the Coronavirus Disease 2019 (COVID-19) pandemic and related executive branch decisions, the Bureau made a series of late changes to the design of the census. The report GAO is releasing today discusses a number of concerns regarding how late changes to the census design could affect data quality. The Bureau has numerous planned assessments and evaluations of operations which, in conjunction with its post-enumeration survey (PES)—a survey conducted independently of each census to determine how many people were missed or counted more than once—help determine the overall quality of the census and document lessons for future censuses. As the 2020 Census continues, GAO will continue to monitor the Bureau's response processing operations. GAO was asked to testify on the Census Bureau's progress to deliver apportionment counts for the 2020 Decennial Census. This testimony summarizes information contained in GAO's December 2020 report, entitled 2020 Census: Census Bureau Needs to Assess Data Quality Concerns Stemming from Recent Design Changes and discusses key quality indicators the Bureau can share, as it releases apportionment counts and redistricting data. These key indicators discussed are consistent with those recommended by the American Statistical Association and Census Scientific Advisory Committee for the Bureau. In the accompanying report being issued today, GAO is recommending that the Bureau update and implement its assessments to address data quality concerns identified in this report, as well as any operational benefits. In its comments, the Department of Commerce agreed with GAO's findings and recommendation. For more information, contact J. Christopher Mihm at (202) 512-6806 or firstname.lastname@example.org.[Read More…]
- United States Joins Intergovernmental Forum on MiningBy Sam NewsJune 7, 2021
- Brazil Can Join the Growing Clean Network by Banning HuaweiBy Sam NewsSeptember 27, 2020Keith Krach, Under [Read More…]
- Secretary Pompeo’s Meeting with Japanese Prime Minister SugaBy Sam NewsOctober 6, 2020
- Secretary Blinken’s Call with Ukrainian Foreign Minister Dmytro KulebaBy Sam NewsFebruary 2, 2021
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- International Day of United Nations PeacekeepersBy Sam NewsMay 28, 2021