Compliance considerations for your CCBHC’s DCO Agreement

The legislative act that created the Certified Community Behavioral Health Clinic (CCBHC) demonstration program requires clinics to perform an array of services for certification, but clinics do not have to perform all of those services directly.    

Many CCBHCs rely on other providers to step in as a Designated Collaborating Organization (DCO )to perform some of the required services through contractual agreements.

According to guidance from the Substance Abuse and Mental Health Administration (SAMHSA), as many as five specific services from the nine required services may be performed indirectly through contractual agreements.

The CCBHC itself must directly perform:

  • Screening, Assessment, and Diagnosis.
  • Person-Centered and Family-Centered Treatment Planning.
  • Outpatient Mental Health and Substance Use Services.

Crisis Behavioral Health Services. Note that even though CCBHCs are required to directly provide Crisis Behavioral Health Services, specific exceptions are allowed. The CCBHC may contract with a DCO to provide those services when “a state-sanctioned alternative acts as a DCO.” The CCBHC may also contract with a DCO to provide ambulatory and medical detoxification under specific ASAM categories. For details on this, read my previous article on CCBHC Crisis Management Services here.

Services that may be provided by a DCO are:

  • Outpatient Clinic Primary Care Screening and Monitoring.
  • Targeted Case Management Services.
  • Psychiatric Rehabilitation Services.
  • Peer Support, Peer Counseling, and Family/Caregiver Support.
  • Intensive, Community-Based Mental Health Care for Members of the Armed Forces and Veterans.

How the DCO relationship works for CCBHCs

When a CCBHC contracts with a DCO, it essentially purchases the DCO's services at a fair market value. Note that it does not simply pass on the fee for services; the rate is negotiated based on the market. A written agreement will be needed.

Under the arrangement, recipients of services provided by DCOs are still clients of the CCBHC. The CCBHC bills third-party payors, including Medicare, Medicaid, and commercial insurance companies, for the services provided under contract by the DCO.  Contracting costs associated with the services should be included on the cost report the CCBHC is required to submit.

Any nonprofit, for-profit, or governmental entity may function as a DCO. Usually, the DCO is a separate and distinct organization not affiliated with the CCBHC, but SAMHSA guidance does not prohibit separate clinics within a larger, non-profit organization from entering into a contractual DCO agreement. It is also acceptable for the DCO to be a subsidiary of the CCBHC.

Getting the DCO documentation right

Some of the most important and confusing components of a DCO relationship include getting the documentation right. The CCBHC must ensure that consumer fees and cost-sharing for services rendered by the DCO are collected.

SimiTree consultants work with CCBHCs to review records and documentation to ensure billing and certification compliance and provide targeted staff training when necessary. We make certain an effective system is in place for billing third parties. In some cases, it may be most effective to contractually obligate the DCO for the collection of consumer fees and cost-sharing at the point of service.

We also help CCBHCs determine the fair market value of the DCO cost, ensure that all certification criteria are being met, and suggest streamlined approaches for more efficient workflow.

Here are some of the top compliance considerations for any CCBHC considering a DCO arrangement.


Top Compliance Consideration for DCO Agreements

  1. Clinical responsibility. CCBHCs do not abdicate clinical responsibilities when they contract with a DCO to provide services on their behalf. The CCBHC retains responsibility for all services provided by the DCO, including all care coordination. This means the CCBHC must ensure that services are reflected in data reported under SAMHSA’s Uniform Reporting System.
  2. Accessibility of services. The DCO cannot limit or deny services based on the recipient’s ability to pay, insurance status, or residence. The CCBHC must ensure that the DCO meets all standards for the accessibility of services, including the application of a sliding fee.
  3. Person and family-centered care. The DCO must follow CCBHC requirements for person and family-centered, recovery-oriented care, being respectful of the individual person’s needs, preferences, and values, and ensuring involvement by the person being served and self-direction of services received. Services for children and youth must be family-centered, youth-guided, and developmentally appropriate.
  4. Certifications and licensure. The DCO must have the necessary certifications, licenses, and/or enrollments to provide the services. Terms of the contractual agreement should give the CCBHC the right to terminate if the DCO loses its license or certification necessary to perform services, fails to maintain insurance, or becomes listed on any applicable provider exclusion list. Staff providing CCBHC services must also have proper licensure.
  5. Cultural competency. The DCO must meet all CCBHC cultural competency and training requirements set by SAMHSA and/or the CCBHC. For example, the CCBHC must have in place a training plan for staff and DCOs that addresses cultural competence and person-centered, family-centered, recovery-oriented, evidence-based, and trauma-informed care.
  6. Confidentiality. The DCO must follow all federal, state, and CCBHC requirements for confidentiality and data privacy. The agreement should prohibit the unauthorized use or disclosure of PHI, including the requirements of the Health Insurance Portability and Accountability Act (HIPAA). In addition to meeting applicable laws and regulations, the DCO will need to follow the CCBHC’s policies regarding the use and disclosure of PHI.
  7. Grievance procedures. The DCO must follow the grievance procedures of the CCBHC.
  8. Payment safeguards. The CCBHC and the DCO must have safeguards in place to ensure that the DCO does not receive a duplicate payment for services that are included in the CCBHC’s PPS rate.

SimiTree helps with compliance

SimiTree offers services to help your organization ensure compliance with DOC requirements and all new CCBHC certification criteria. We help CCBHCs with data collection, calculation, quality reporting, and more.   

Reach out to us today to learn how we can help your organization comply with SAMSHA’s new CCBHC certification criteria, leverage quality data to improve care, streamline workflow, and drive optimal performance.

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J’non Griffin serves as Senior Vice President/Principal for the Compliance as well as Coding divisions at SimiTree. Her healthcare career spans three decades of clinical and leadership experience, and she has a track record of helping many provider types implement effective compliance programs. She is a certified ACHC and CHAP consultant and holds additional certifications in diagnosis coding and other healthcare specialties. As an AHIMA ambassador, she was instrumental in the implementation of ICD-10.