This column was originally featured on Newportri.com.
Rhode Island is actively transforming its behavioral health system by adopting the Certified Community Behavioral Health Clinic (CCBHC) model and implementing the Prospective Payment System (PPS). This payment approach moves away from the limitations of fee-for-service, which only reimburses for coded, billable services and often leaves essential outreach and wraparound care uncoded and therefore unfunded.
Through the PPS, Rhode Island aims to provide bundled payments that cover the full spectrum of care for each client, ensuring CCBHCs like Newport Mental Health have the resources to deliver evidence-based, community-based, and integrated behavioral health services to all who need them, regardless of their ability to pay. The CCBHC bundled rates are set using a robust cost reporting process which is designed to ensure rates cover the costs of delivering all the services the clients need to stay in the community and out of higher levels of care. The CCBHCs are held to service quality and reporting standards.
The state’s commitment to improving the payment system is reflected in recent legislation and strategic planning, which prioritize equitable access, real-time service delivery, and partnerships across hospitals, community organizations, and insurers. By aligning payment with quality outcomes and investing in workforce development, Rhode Island is building a sustainable system that measures success by improved health, reduced emergency department use, and better community outcomes, rather than by the number of billable visits.
Why a true prospective payment system works
A true prospective payment system fundamentally shifts the focus from volume to value in behavioral healthcare. This approach incentivizes providers to prioritize quality outcomes, care coordination, and evidence-based practices rather than maximizing billable visits.
There are many reasons for its effectiveness:
- Alignment with Outcomes: Payments are tied to measurable improvements in client health, such as reduced emergency department use, lower hospital readmission rates, and increased independence for clients. This ensures that providers are rewarded for delivering care that truly benefits patients and communities.
- Reduced Administrative Burden: Providers no longer need to track every phone call or chase billing codes. Instead, they can focus on engaging with clients and measuring outcomes, which streamlines operations.
- Encourages Collaboration: By providing a bundled rate, PPS fosters collaboration among community organizations, hospitals, and insurers, building an integrated system that is easier for clients to navigate and reduces duplication of services.
- Supports Innovation and Flexibility: Providers can scale services based on what works, adapt to changing needs, and invest in workforce development, all while maintaining financial sustainability. CCBHCs conduct community needs assessments to guide program and staffing needs.
- Comprehensive Coverage: PPS covers services that are essential but often unfunded under fee-for-service, such as community engagements by our Rhode Island Outreach (RIO) teams, care coordination, and wraparound supports such as housing and food assistance. This enables CCHBCs to address social determinants of health and deliver holistic care.
Transition challenges in Rhode Island’s behavioral health payment reform
Newport Mental Health and the other Rhode Island CCBHCs are currently navigating a challenging transition to a fully implemented PPS. We are facing a dual burden: we must still comply with the State’s legacy reporting requirements from the fee-for-service model while also developing new systems to track and measure outcomes under PPS.
To truly embrace the transformation, Rhode Island must encourage a shift in focus from counting visits and billing codes, which lack evidence of improving outcomes, to measuring and rewarding meaningful, evidence-based results. This means investing in unified data systems, streamlining reporting, and aligning payment with quality metrics that reflect real improvements in client and community well-being.
Signs of improvement under CCBHC
Rhode Island’s adoption of the CCBHC model is already producing improved behavioral health outcomes, increased access, and expanded community engagement. Each month, 80 to 100 new people of all ages are coming through our doors. We’re collaborating with Newport Hospital, DCYF, Child & Family Services, the MLK Center, Edward King House, schools, colleges, Housing Authorities and more to ensure clients are getting the proper care for behavioral health, physical health, and social determinants of health. But we risk losing momentum if the payment model doesn’t evolve with us.
How outcomes are measured
CCBHC programs are evidence-based, meaning the services are based on scientific research and proven to deliver measurable outcomes. For example, our Assertive Community Treatment (ACT) program follows rigorously tested fidelity measures and uses clinical decision-making tools that have proven effective in improving mental health outcomes. It is also an example of how a PPS better supports the CCBHC in providing effective care.
ACT is for those with serious mental illness who require assistance with daily living. We help each client gain the skills and confidence needed to move toward a greater degree of independence, which includes securing and maintaining employment and housing. The client’s ACT team includes a psychiatrist, licensed clinician, RN, supportive employment specialist, peer specialist, case manager, substance abuse specialist, and therapist, all working together to help them achieve these goals. Client success is measured by remaining healthy, employed, and housed.
These outcomes are specific, trackable, and rooted in the question: Does the client improve? And when clients follow the CCBHC treatment plans, the evidence says yes, they do. This design removes the need for extensive manual tracking and micromanagement as providers don’t need to count every phone call or conversation, or chase billing codes. They engage with their clients and focus on outcomes. It’s a self-sustaining system built on evidence.
What’s possible with full transformation
As Rhode Island completes its first full year of CCBHC participation, it is critical to fully embrace the PPS transformation. States that adopted this model eight years ago have seen remarkable outcomes:
- Missouri achieved an 83% increase in patients served, a 76% reduction in emergency department visits, and a 70% reduction in law enforcement involvement for behavioral health crises.
- New York eliminated wait lists and increased Medicaid access by 21% in the first year.
- Oklahoma achieved a net savings of over $2 million annually, primarily through reductions in psychiatric inpatient hospitalization claims.
The enhanced capacity of CCBHCs allows providers to meet more needs on an outpatient basis, significantly decreasing the use of higher-cost levels of care. CCBHCs also report significant workforce growth. If you’d like to learn more about the nationwide results, you can find the annual reporting on CCBHC impact here: https://www.thenationalcouncil.org/resources/2024-ccbhc-impact-report/
Rhode Island must fully commit to the payment transformation it has already started
These results underscore the importance of Rhode Island’s commitment to the transformation, ensuring that payment reform leads to measurable improvements in health outcomes, access, and system sustainability. As other states have shown, success depends on sustained commitment, ongoing partnership, and a willingness to innovate and adapt the payment system to meet the needs of communities.
We are ready to focus all of our staff time on achieving and measuring outcomes. That means trusting the system we’ve invested in and leaving fee-for-service behind—for good. Please let your elected officials know that you support your CCBHC and perspective payment transformation.
The community also has a voice in ensuring that our services align with community needs. Newport Mental Health is currently partnering with the University of Rhode Island to conduct a community needs assessment, which Newport County residents can find here until Nov. 1, 2025: https://uri.co1.qualtrics.com/jfe/form/SV_5sE8XUn4p3CdRbw?Q_CHL=qr
Please take a few minutes to let us know how we can help you.