My name is Tom Curtis. I'm director of state affairs here at NCQA. And for the next fifty eight minutes or so, we're going to... My my my colleagues and I are gonna walk through some information, about CCBHCs, and specifically the evolving role of accreditation when it comes to, implementing and monitoring CCBHC quality. So you'll be hearing from myself, from my colleague, Jenny Susie, and also, Reisa. There you are, Reisa. And they'll introduce themselves, as they jump into the conversation. So let's get going. Before, I get into the fun stuff, just a reminder, we do have a q and a box, at the bottom of the Zoom application, and we encourage you to put your questions in anytime, during the presentation. And we'll go ahead and try to answer those live, or type in a a response or both. You're also, welcome, and we encourage you to join in on the conversation. And so just do so by raising your hand, and we'll take you off mute, and we can, talk things through. And lastly, you will be getting, the slide material as well as a recording, and we'll have a question... A polling question later in the presentation on whether you wanna get in touch afterwards to continue the conversation. So, we like this to be engaging, and we need you all to be part of making this engaging for everybody. So we encourage you to to talk to us, through any of these means. Next slide. Alright. So I'm gonna start with, I think, three slides or so on federal updates to CCBHC program, specifically related to accreditation. And so I'm gonna talk through kind of the highlights of why accreditation is taking a more prominent role in the CCBHC program overall. Then we'll go through the NCQA CCBHC accreditation program. And lastly, kinda round things out with some of the customized solutions that we are, offering and working through with with states. Next slide. Alright. And you can just go to the next one. Okay. So I'm gonna start, with the SAMHSA RFI on CCBHC accreditation that was recently released back in June. And, NCQA did respond to this RFI, that we'll talk through here in a moment. What we can ascertain from this RFI are a couple things. One is that SAMHSA is moving away from self attestation in the context of, assuring that CCBHCs meet SAMHSA criteria. Two, we can predict that there will be multiple accrediting organizations that will be allowed to support CCBHCs and states. And lastly, that the federal government would oversee the accreditator... Accredit... Accreditors, but states would retain that central authority to certify CCBHCs. So kind of creating this parallel coordinated, oversight, federal state partnership. Some of the, signals about accreditor standards and scope align directly with how NCQA is approaching CCBHC accreditation. You'll hear about that in a moment. But we do have clear objective, surveyable standards that cover all SAMHSA criteria. We do provide oversight, and data monitoring when it comes to, looking at CCBHC quality and and ensuring that the CCBHCs are doing the best practices and meeting SAMHSA criteria. One of the cool things I'd say about our accreditation program is that we keep states in the center of the certification decision. And so SAMHSA's questions signaled that there may, at times, be conflict between an accreditor saying this organization has received accreditation and a state, essentially certifying that that organization. So it's all... Ultimately, always up to the state, and they may choose to certify an organization that may not have met accreditation criteria, or they may not... They may choose to not certify an organization that did meet accreditation criteria. And that is that is allowable. That can happen, and SAMHSA acknowledges that that is going to happen, at times. And we, our accreditation approach, honored that from the get go. So we, will survey the standards. We will provide a scorecard to the CCBHC and the state, as to where the organization met criteria, where the organization maybe needs improvement, and then ultimately, that that accreditation decision from NCQA. And then the rest is up to the state. We also have a method of allowing for interim or provisional accreditation, and you'll hear about that later too, which sort of weighs into how SAMHSA is trying to transition from attestation to, accreditation. Next slide. Alright. So what did SAMHSA hear in their RFI? Well, they received 34 responses, and all of this was presented by SAMHSA at a webinar that was about two weeks ago, October 14. They shared the theme... The general themes that they had heard. They did not announce any decisions. They did not announce any endorsements of accreditors, but they did sort of walk through some of the information that they received. So they received 34 responses. 17 of those half were from CCBHCs themselves. 12 were from states and advocacy groups. Four responses were from accrediting organizations, and they received one from IT... An IT system stakeholder. What they heard was, generally, there is broad support for independent accreditation. So generally speaking, all respondents said, yes. Independent accreditation is a good idea for strengthening accountability, providing consistency in care delivery, and remaining, retaining fidelity to the model. Predominantly, respondents said they wanna see accreditation that's measuring care, not paperwork. And so an accreditation that really focuses on how is this clinic delivering care, how are they improving and expanding access, how are they coordinating care, and, ultimately, what are the measures of performance looking like, that is what respondents are really interested in focusing on when it comes to accreditation. Reducing duplication. So the extent to which accreditors can look at already existing recognition or certification programs and building upon those, so that an organization is not submitting the same document, across multiple different surveying processes or, or in some cases, modifying slightly documents for different survey processes. But reduce that duplication and that burden on the on the provider level. And then lastly, keeping state central. And this is... I've already spoke to this, but making sure that there are delineated roles, responsibilities between states and accreditors, so that accreditation is not kinda usurping the authority of the state in the context of deciding who's a CCBHC and who isn't. And that is one thing our accreditation really, really does. The other, thing that you'll hear about here in a moment from Jenny is we we saw the signals, NCQA saw the signals kind of early on that CCBHC funding was at some point gonna transition to Medicaid. And we knew that the, we've had a lot of experience working with Medicaid agencies over the years, and we knew the the level of quality assurance and the level of accountability needed to align with what Medicaid would expect, should they be the the funder of this. So we we built the accreditation with that in mind. So let's go to the... My last slide, and then I'll turn it over with, hopefully, plenty of time from my colleagues. The only other federal update that I wanted to make you all aware of was that there was a new Medicaid director letter that was published three weeks ago now, that, the first two things you see here aren't new, added CCBHC's state plans authorized, and then the Consolidated Appropriations Act, and covers CCBHCs that are certified by the state, requires a community health needs assessment. Those aren't new, but it did reemphasize those in the letter. What is new is that states may rely on recognized accrediting organizations that have specific accreditation programs for CCBHCs as part of their certification process. So states are being encouraged through this letter to consider accrediting organizations and their accreditation programs to support the overall state certification process. And I I left the link to the letter there at this... On the slide for you all to go ahead and take a look for yourselves. And those are the federal updates on this, and I do see a question in the q and a box. What is the guidance for a state who certifies three of seven providers applying to be a CCBHC due to budget restrictions when all applicants met all requirements? So I know you submitted this anonymously, and you may not want to, identify yourself. If you're... If you have reconsidered and you're fine with that, you can go ahead and raise your hand because I could use some clarification. If not, then I'm gonna turn it over to Jenny, and I will think through this question and see if I can give you a good answer. To give you a third option too, you can also put additional information back into the q and a or, anonymously. I don't know if you can do the chat anonymously, but that might be an option too if you wanna Oh. More information, but do it anonymously. That's a great idea. Yeah. You could do that too. Well, with that, hey, everyone. It's great to see you all. My name is Jenny Soucy. I'm a senior product manager here at NCQA, and I'm really excited to talk to you all about our CCBHC accreditation program. So if we go ahead to the next slide. So I wanna start by just getting a sense of the room and how familiar folks are with the various accreditations, not just around CCBHCs, but behavioral health as a whole. So we'll launch this poll. And if you all wanna just acknowledge, what provider accreditations, if any, you all are using within your state Medicaid programs, as a way to assess quality of, specific initiatives and providers. And, Marilena or Amy, when we have a a... Enough votes, if you could close that out, and then we'll see if I'm able to see those results or if I'm gonna need you to read those for me. Oh, here we go. Perfect. Alright. So of those we have on the phone today, it looks like two out of four organizations that are using PCMH or two out of four respondents. We have another two out of four who are using CARF, and then one person whose offices are using social current CCBHC accreditation. Thank you all so much. That's really helpful as we think about the mix of folks we have in the room today and how your state is leveraging those programs. I will pause here just for a second. No pressure, and I I won't call on anybody or put anyone on the spot. But if there are folks who are using one of... One or more of those programs and you wanna tell us about your experience with them, you should be able to raise your hand and come off mute because I'd be curious to see about what prompted you to use one of these programs and what your experience has been so far. Alright. Well, hearing none, I will keep going, but that offer stands. If anyone wants to share more, you can also put that in the chat or in the q and a if you wanna do it anonymously. Alright. We can go ahead to the next slide. Alright. So I wanna talk a little bit about our CCBHC accreditation. So we launched this program in July 2024, and Tom talked to you a little bit about the reasons why we opted to get into this space. You know, we saw that this was going to eventually likely transition to a Medicaid run program, and we saw an opportunity for us to leverage the work that we had already done with our PCMH program in helping practices transform and really transition all of that knowledge and expertise into the CCBHC space. And so what we were able to do is take SAMHSA's 113 criteria and whittle that down to 44 standards plus policies and procedures while still keeping that one to one match for the SAMHSA criteria. Also, there are up to 25 quality measures that are asked to be reported through this work. 15 of those are HEDIS measures, which NCQA owns and stewards, which makes us, you know, well positioned to support that measurement process. You can see here that we kept the program areas the same as the SAMHSA program areas for that, again, continued alignment. And so if we go ahead to the next slide, you can see an example here of what I mean when I say that we keep the program, the same while whittling down that criteria. So one of NCQA standards, for example, safe access to care is, you know, eight SAMHSA criteria. So being able to make it a little bit easier to submit documentation and acknowledge the work that you're doing without having to attest to each and every one of those standards. We'll go ahead to the next slide. The way our program is set up too, we broke out those standards, into two very original categories, core and noncore standards. The noncore standards are recognizing that there are some standards such as getting agreements set up with the v... The local VA, or things of that nature may take a little more time. And you could still be doing work with that entity, and you just may not have signed on the dotted line. And we wanna recognize that those things take time and that transformation takes time. And so by making those noncore standards and have those standards be something that can be not met in that instance, unlike the core standards that must be fully or partially met, it offers, again, that flexibility to support everybody throughout that journey. And then you can see the core standards. There are six of them that must be fully met. Those are standards that, you know, include things like staffing that we feel are just so important or access that are just so central to being a CCBHC that you cannot not fully meet those standards. And then 16 standards where we recognize that you must be at least on that journey, so at least partially met, again, because that work is so central to patient safety and to being a CCBHC. If we go ahead to the next slide. So what are the outcomes of this program? And Tom talked a little bit about this. But the program, you can look at this, in three different ways. You can either be an accredited organization, meaning you met all of those core standards we just talked about, and you scored a 70% across both the core and noncore standards, in that case, your organization receives a seal, a status, and a scorecard. And I'm gonna come back and talk about that scorecard in just a moment. We also offer what we call provisional status, and that's for organizations who meet all of those core standards but maybe score, you know, a little bit lower, so between 5069%. Those organizations receive what we call provisional status for eighteen months and then have to be resurveyed and moved to accredited after those eighteen months. And the reason we thought that was so important to include was because we recognize that this is... Again, I keep saying it. This is really a journey, and we wanna support organizations through that transformation and to say, you know, if you don't meet this high bar the first time around, you know, because we recognize for many organizations, this may be the first time they're coming through accreditation. We want it to really be a supportive process. And then last but not least, we have what we call no status issued, and that is what the outcome is when an organization is unable to meet those core standards or receives less than a 50%. And what's unique about this program is that we offer, I mentioned it, a scorecard. And that scorecard is really designed so that the organizations have something that they can take back to either the state or to SAMHSA so that they're able to say, hey. These are the areas where I'm excelling, and these are the areas where I may need some additional TA training support so that it facilitates that conversation. It's also important too because it allows the state or for SAMHSA to, at a glance, understand what NCQA has assessed, where organizations are strong, and where there's that opportunity for improvement. And so to Tom's point earlier, NCQA is not looking to get into the business of certification. We believe that that fully belongs with the state. And so we we view this scorecard as a tool to help in those certification decisions and to help reduce the amount of due diligence needed to be done as you're working towards that decision. We'll go ahead to the next slide. For those of you who go through PCMH, this should look familiar. You'll see our our lovely Q Pass system. But this is an example of the scorecard that an organization would receive, and it shows, you know, what it would look like for an organization where they've met or, in some cases, have not fully met a standard. And what you can't see here that you would see if you click down a few more times are some of the notes around why something was not met. And, again, this is really designed to help support that conversation between the CCBHC and the state and or SAMHSA as we think about where are those areas where organizations can use additional support so that they're able to provide, again, those best services to the the communities they serve. We'll go ahead to the next slide. And so last but not least, you know, why use NCQA's accreditation? You know, there are... We recognize we are not the only ones in the space doing this work. But where I think we truly have unique offerings is that ability to provide that clear ongoing standard review through our three year accreditation process, our ability to have streamlined the standards from that 113 criteria down to 44 standards, and our ability to really partner with both the CCBHC and the state. So we just talked a little bit about the scorecard and how that helps us partner with both the state and the CCBHC to understand what opportunities there are for improvement. But that's also an ongoing conversation throughout the accreditation process. And so when CCBHCs come through, similar to PCMH for those who are familiar, they get those three check ins to meet with our our experts as they check-in their evidence and walk through that so that they, by the time they go in for that decision, they have a sense of where they land and know that they have gotten some of that support along the way. And last but not least, I wanna highlight the templates. And so that, I believe, is another really unique aspect of this program. When we set out to start doing this work, we talked to a lot of CCBHCs. We talked to a lot of states. And one thing we heard over and over again is that the community needs assessment is a challenge for a lot of organizations. You know? We hear it being a challenging, a challenging task for large health systems and health plans. And so, you know, we recognize the the burden that can create for a small community health center. And so we set out and built a template that helps organizations be able to meet the criteria specifically set out in the CCBHC accreditation that much easier through the use of that tool by providing, you know, resources to look at, to pull data from, and sample formats that will help complete the the task that much easier. We go ahead. I believe I have one more slide. And so the reason we've been talking about PCMH today, you all may be wondering how that fits in with a conversation about CCBHCs, but something we've been exploring is this idea of creating additional alignment between our CCBHC program and our PCMH criteria. And I'm really excited to hear that we have a couple of states on the line who are currently using the PCMH program, as we're... And thinking about CCBHCs. There are a significant amount of overlap between the CCBHC program and the PCMH criteria. And so as we think about how we wanna evolve the CCBHC program as we're getting additional guidance from SAMHSA around meeting intent rather than the letter of the standard, would it be of value for organizations to receive that auto credit between PCMH and our CCBHC program so that when they go for accreditation, it reduces that much more burden, and it helps the state have that much more insight into the quality of the work that the CCBHC is performing. We also know, too, that a lot of PCMHs are exploring CCBHC accreditation. And so, again, we view this as an opportunity to really support them in that transformation, especially knowing that those organizations will be familiar with the accreditation process and with that transformation process. So I wanna pause here. I have a polling question that'll pop up in a minute. But before I do that, I'm curious if there's anybody brave enough to come off mute and, especially those folks who, again, are using PCMH, if you have any thoughts about the idea of creating that additional alignment and if that would be a benefit to you at the state or if you see that being a benefit to the CCBHCs that you serve. I saw Tom put his camera back on, which means you all may be... He may start calling on people. Well, I was going to... I I I like the question, and it is because we are trying to, a, make this, opportunity of integrating behavioral health and primary care more accessible to providers, and, b, to reduce burden on your providers, in particular providers who are already, you know, serving a lot of Medicaid folks or, in the case of this CCBHC program, serving, folks with, you know, mental illness and substance use disorder. And so, you know, just to sort of remind us all who who we're talking about helping here, and the the rationale behind the question. So your... Any of your input would be really, really valuable in this moment if we can, if we can hear from from one of you so that we better understand the state perspective on on making this CCBHC PCMH connection. Alright. Jenny, I'm not seeing anybody. We tried. Well, the good news can put it in the chat too, guys. We would take that as well. I'll also... Again, you can use the q and a. I will take the feedback anonymously too. If folks wanna stay anonymous, I appreciate that. But if not, I would really appreciate your participation in the next polling question to gauge, the value of leveraging a program like CCBHC and PCMH as you think about how to, reduce oversight and burden while monitoring and ensuring quality in your state. And Amy and Maralina, I'm not able to see the the response rates. So once you guys think we've reached a critical mass, just let me know. So I see three out of five that say yes, and that is fantastic. And then I have two responses for unsure but would like to explore this option further. And so that's really heartening to hear, and I know at the end of the webinar, folks will... Tom or another will share a way to contact us at the end. So if you would like to continue the conversation, please feel free to reach out. I'll also put my email in the chat if you wanna reach out to me directly. But thank you all for your time today. And with that, I am gonna hand it over to my colleague, Raisa. Thanks so much, Jenny. Good afternoon, everyone, or I guess it's morning in some parts of the country. So my name is, and I'm so happy to be here with you all. I'm gonna spend a few minutes talking about how NCQA can support states beyond accreditation. You can go ahead and move to the next slide. Particularly, I I just wanna cover a few items including quality oversight, measurement and reporting, and technical assistance. So as I stated, so support for states goes beyond just individual accreditation for the community based clinics. We can support states with planning and advancing implementation statewide across the clinics, strengthening statewide quality oversight and program performance, providing guidance to support quality measurement and reporting. We can also provide training and technical assistance and peer learning opportunities to sort of build shared knowledge across participating clinics. So that would look like a statewide learning collaborative where, you know, organizations learn from one another. So the overall goal of our offerings is really to help states monitor progress and and promote greater consistencies across the clinics in the state and support shared learning while also allowing for that local flexibility that you have within your states. So these four areas that you see on the screen translate into sort of a portfolio of flexible services that can be tailored to your state. Next slide, please. So as I noted, we can really tailor our services based on the state's priorities, the current capabilities, both at the state level for monitoring oversight and support, you know, the capabilities of clinics on the ground level at various stages of CCBHC implementation. So this support might look like readiness assist... Assessments and implementation roadmaps that align with both state and federal requirements. As I noted before, you know, a lot of the the oversight around quality assurance, frameworks, reviewing monitoring approaches and gap analysis, we provide through both the services capabilities and through our CCBHC accreditation program. So for the measurement and reporting component, we can help states with understanding data readiness considerations among the clinics and reporting approaches to further support their their quality measurement requirements. Capacity voting for for clinics would, again, look like the the pure learning opportunities that we offer for for clinics, trainings, webinars, office hours, and, of course, customized toolkits and templates that, you know, your your state can... Or we can adapt for your state. So we can engage with states in specific services through a phased approach that evolves with with your needs. Next slide. This again just reinforces, some of the items that I've already discussed. Really, we have a flexible way of working with states and approaching implementation in a way that works best for your level of readiness or your your client's level of readiness. So we begin by assessing that readiness, data capabilities, reporting processes, and oversight approaches at the at the state level. We've done work with states to design appropriate all environment reporting and technical assistance frameworks. From there, we can support implementation through a lot of those learning opportunities for individual clinics in a peer based environment, and we provide guidance to help states monitor performance and strengthen quality assurance and really refine the approach to CCBC implementation as as as clinic readiness and sophistication evolves over time. So together, these services are meant to complement the accreditation program by helping states strengthen, you know, the overall readiness implementation in a phased approach. So with that, I will go ahead and and pass it back to Tom, and we can take any questions. Thank you, Risa. And at this point, I don't see additional questions in the Q and A, but I do want to give folks a chance to do so. And you all are welcome also to raise your hand, and we can take you off mute, and you can ask, any questions. Alright. Well, you still have a chance to put questions in the q and a box, and we'll go ahead and keep moving to the next slide. So this, for this question, I don't know that we're gonna show results, but it is our way of keeping track of, attendees who came and would like to speak further about some of the information that you all heard or if you have questions sort of after you leave and you're thinking through what you heard, follow-up questions sometimes helps. So if you're interested in us reaching out, just let us know by clicking yes there, and we will be able to, circle back with you. Alright. Can probably go ahead and close that and move on. The next slide. So when I look at the attendee list, I see a lot of newer names to... For me, that I hadn't haven't seen from states previously, which is really, really fantastic. And one thing I want you all to know is that we do a quarterly newsletter called public policy notes. And so if you're interested, excuse me, in receiving that, that quarterly publication... Oh, okay. Jackie Griffin says we're already in touch. Alright. Oh, that was just to the panelists. I'm so sorry, Jackie. I shouldn't have announced that. But go ahead and, subscribe to the newsletter and get ahold of us, and we can we can put you on the list, and you'll be able to receive that quarterly. Next slide. Alright. In case you all are also working in this space in your state or if you know a colleague that's working in this spate... Space, we are doing a state spotlight on data quality and interoperability and action lessons from Rhode Island. So Rhode Island has done some pretty incredible work, I'll say, in, ushering in, an interoperability, champion for their for their state who's, transmitting clinical data around and and collecting it for them and also procuring for a measure vendor who is taking those data. Well, I don't wanna steal all the thunder here, but, essentially, moving in the direction of implementing digital quality measurement. So if that's a a term that you're hearing or that you're in... That you're involved in, then we really encourage you to attend that state spotlight. It's it's going to be all Rhode Island talking through their approach to data quality and interoperability, so you'll wanna come see that. Next slide. Alright. At this time, I still don't see any further questions in the q and a, and we've wrapped up all of our slides. So, thank you all for coming. I hope, you had, an expectation or a desire to hear certain things and that you heard what, some of what you came, looking for. And we are here and available if you wanna reach out, and we can continue talking about, CCBHCs and how NCQA can support you in your state and your CCBHCs and and changing the way care is delivered for some, the people that you're all serving. So thanks again.