Community Behavioural Health (Philadelphia) Provider outcome requirements.
What is Community Behavioural Health?
Community Behavioural Health (CBH) is a nonprofit 501(c)(3) behavioural health managed care organization contracted by the City of Philadelphia to administer Medicaid behavioural health services for Philadelphia County residents. CBH is overseen by the Department of Behavioural Health and Intellectual disAbility Services (DBHIDS) and operates under Pennsylvania's HealthChoices program.
CBH provider obligations are set out in the CBH Provider Manual and related clinical practice guidelines. At the highest level, CBH requires three layers of outcome measurement: pay-for-performance system metrics, individualized treatment plan documentation, and use of evidence-based clinical tools aligned with CBH's Clinical Practice Guidelines.
Layer 1: Pay-for-Performance and Value-Based Purchasing metrics
CBH's Pay-for-Performance (P4P) and Value-Based Purchasing (VBP) programs are where outcome reporting is most explicitly required. These metrics track access, continuity, and retention in treatment, not symptom change, and are reported by level of care (inpatient, ASAM 3.5 residential, children's inpatient, etc.).
| Metric | Target | Primary data |
|---|---|---|
| 7-day follow-up after discharge | Contact within 7 days of inpatient discharge | Claims + clinic contact record |
| 30-day follow-up after discharge | Contact within 30 days of inpatient discharge | Claims + clinic contact record |
| 30-day readmission | Reduced 30-day rehospitalization rate | Claims |
| 90-day no-readmission | Increased 90-day no-rehospitalization rate | Claims |
| MOUD initiation | Medication for opioid use disorder initiated within defined window | Clinic + pharmacy claims |
| Engagement in care post-discharge | Multiple contacts in 30 days post-discharge | Claims + clinic |
For each P4P metric, HiBoop captures the clinic-side event (scheduled follow-up appointment, completed contact, scale score at that contact) and stamps it with a structured date so that when the metric is computed later, the clinic's data lines up cleanly with the claims-derived side.
Layer 2: Individualized treatment plan requirements
At the individual patient level, the CBH Provider Manual requires each client to have an individualized treatment plan containing:
- Short-term goals that can be measured – the manual uses this phrase directly
- Interventions tied to each goal
- Progress documentation against each goal on a defined cadence
HiBoop's scale library is how most clinics satisfy the "measurable" requirement. A depression goal ("reduce PHQ-9 from 18 to under 10 by session 8") is objectively measurable because the score is captured automatically at every contact. The alternative, clinician-rated progress notes, is harder to audit and less actionable for CBH's pattern recognition.
Layer 3: Evidence-based tools aligned with CBH Clinical Practice Guidelines
CBH does not mandate a single universal scale. Providers choose validated tools appropriate to the population and condition, so long as the choice aligns with CBH's Clinical Practice Guidelines. Those guidelines draw on SAMHSA and American Psychiatric Association recommendations and reference these commonly used scales:
- PHQ-9 for depression
- GAD-7 for generalized anxiety
- C-SSRS for suicide risk
- AUDIT for alcohol use
- DAST-10 for drug use
- PCL-5 for PTSD symptoms
- CANS / ANSA (Child / Adult Needs and Strengths) for population-specific level-of-care decisions
- ASAM multidimensional criteria for substance use placement and continued service
For substance use services specifically, CBH frames outcomes around ASAM-style multidimensional domains: substance use severity, biomedical conditions, emotional and behavioural conditions, readiness for change, relapse risk, and recovery environment. These domains guide both placement and ongoing outcome evaluation.
How HiBoop maps to CBH expectations
HiBoop ships every CPG-aligned symptom scale CBH providers commonly use. CANS, ANSA, and ASAM multidimensional assessments are specialized level-of-care tools, they're population- or service-specific rather than universal symptom measures, and are typically captured in level-of-care or ASAM-specific workflows outside HiBoop.
| CBH expectation | In HiBoop |
|---|---|
| PHQ-9 for depression | ✓ Includedcbh.match.row1.note |
| GAD-7 for anxiety | ✓ Includedcbh.match.row2.note |
| C-SSRS for suicide risk | ✓ Includedcbh.match.row3.note |
| AUDIT for alcohol use | ✓ Includedcbh.match.row4.note |
| DAST-10 for drug use | ✓ Includedcbh.match.row5.note |
| PCL-5 for PTSD symptoms | ✓ Includedcbh.match.row6.note |
| Measurable treatment plan goals tied to scale scores | ✓ Includedcbh.match.row7.note |
| Structured export of 7-day / 30-day follow-up contacts | ✓ IncludedCSV with discharge date, contact date, interval |
| CANS / ANSA level-of-care assessment | Outside HiBoopSpecialized tool, outside HiBoop |
| ASAM multidimensional criteria | Outside HiBoopSpecialized tool, outside HiBoop |
| Readmission / claims-derived outcome metrics | Outside HiBoopComputed by CBH from claims |
For CCBHC providers
Pennsylvania is a CCBHC demonstration state, and many Philadelphia community providers hold both a CBH network contract and federal CCBHC certification. The two requirement sets overlap substantially but are not identical:
- PHQ-9 satisfies both CBH's depression monitoring expectation and the CCBHC depression screening + remission measure
- C-SSRS satisfies both CBH's suicide screening guideline and the CCBHC suicide risk assessment measure
- CBH's 7-day and 30-day post-discharge follow-up metrics align with CCBHC's Follow-Up after Hospitalization (FUH) measure, though CBH's windows are tighter
- CCBHC's BMI and tobacco measures are not core CBH mandates but are still reported separately for CCBHC submission
For the federal CCBHC measure set and scale-to-measure mapping, see the CCBHC quality measures guide.
Frequently asked questions
What outcome measures does CBH Philadelphia require?
CBH Philadelphia requires three layers of outcome measurement. First, system-level Pay-for-Performance metrics: 7-day and 30-day follow-up after discharge, 30-day readmission, 90-day no-readmission, and MOUD initiation within defined windows. Second, individualized treatment plans with measurable short-term goals and interventions tied to each goal. Third, use of evidence-based clinical tools aligned with CBH's Clinical Practice Guidelines, commonly PHQ-9, GAD-7, C-SSRS, AUDIT, DAST-10, PCL-5, CANS / ANSA, and ASAM multidimensional criteria. CBH does not mandate one specific scale; it mandates alignment with the guidelines.
Is CBH Philadelphia the same as CCBH or Community Care Behavioural Health?
No. CBH (Community Behavioural Health) is a nonprofit 501(c)(3) contracted by the City of Philadelphia to administer Medicaid behavioural health for Philadelphia residents only. CCBH (Community Care Behavioural Health) is a separate UPMC-owned behavioural health organization that serves other Pennsylvania regions and several additional states. The two have different provider networks, contracts, and reporting requirements.
What format does CBH accept for outcomes data?
CBH outcomes submissions follow the structure defined in its P4P and VBP program specifications: metrics are reported by level of care with discharge dates, contact dates, and the interval between them. For clinic-side outcome data, a row-per-event CSV with patient identifier, scale name, completion date, score, and severity band aligns with what CBH's reporting system expects. HiBoop exports in this format directly.
Does CBH require PHQ-9 specifically?
No single scale is mandated. CBH expects alignment with its Clinical Practice Guidelines, which reference PHQ-9 as a commonly used depression measure but do not require it exclusively. PHQ-9 is the most widely adopted choice because it is brief, validated, available in multiple languages, and aligns with CCBHC reporting for clinics that hold both credentials.
Do Philadelphia CCBHCs also have to meet CBH requirements?
Yes. A Philadelphia community clinic that is both CCBHC-certified and a CBH network provider must meet both sets of requirements simultaneously. The overlap is substantial: PHQ-9 satisfies both depression measures, C-SSRS satisfies both suicide-risk measures. CBH's P4P follow-up windows are tighter than CCBHC's FUH measure, and CCBHC's BMI and tobacco measures are not core CBH expectations.
How does HiBoop help with CBH's 7-day and 30-day follow-up metrics?
HiBoop timestamps every patient contact with a structured date field. When a patient is discharged from an inpatient level of care, clinics schedule the 7-day and 30-day follow-up contacts inside HiBoop against the discharge date. The exported contact record matches cleanly with CBH's P4P metric definition: the interval between discharge date and contact date is computed directly, with no manual reconciliation at reporting time.
Does HiBoop support CANS / ANSA or ASAM multidimensional assessments?
CANS, ANSA, and ASAM multidimensional criteria are specialized level-of-care tools used for population- or service-specific placement decisions. HiBoop focuses on the symptom-based validated scales CBH's Clinical Practice Guidelines reference (PHQ-9, GAD-7, C-SSRS, AUDIT, DAST-10, PCL-5). Level-of-care tools typically live in dedicated ASAM or children's-system workflows outside HiBoop.
What is Community Behavioural Health (CBH)?
Community Behavioural Health (CBH) is a nonprofit 501(c)(3) corporation contracted by the City of Philadelphia to administer Medicaid behavioural health benefits for Philadelphia residents enrolled in HealthChoices. CBH manages the provider network, sets clinical practice guidelines, runs Pay-for-Performance and Value-Based Purchasing programs, and oversees outcomes reporting for mental health and substance use services across the city. CBH is distinct from CCBH (Community Care Behavioural Health), which is a separate UPMC-affiliated managed care organization serving other Pennsylvania regions.
Who is eligible to be a CBH provider?
Providers serving Philadelphia residents on HealthChoices Medicaid must be credentialed by CBH. Eligible organizations include outpatient mental health and substance use clinics, psychiatric hospitals, residential treatment facilities, IOP and PHP programs, and crisis services. Credentialing requires Pennsylvania licensure for the relevant level of care, agreement to CBH's clinical practice guidelines, ability to report Pay-for-Performance metrics, and capacity to participate in Value-Based Purchasing arrangements over time.
How does CBH measure clinical outcomes?
CBH measures outcomes across three layers: system-level Pay-for-Performance metrics covering 7-day and 30-day follow-up after discharge, 30-day readmission, 90-day no-readmission, and MOUD initiation; individual treatment plan outcomes tied to short-term measurable goals; and population health outcomes derived from claims and patient-reported scales. Providers are expected to use evidence-based scales aligned with CBH Clinical Practice Guidelines and to submit structured outcomes data on the cadence defined in their contract.
Can a Philadelphia clinic be both a CCBHC and a CBH provider?
Yes, and many are. A Philadelphia community clinic that is both CCBHC-certified and a CBH network provider must satisfy both sets of measures simultaneously. The overlap is substantial: PHQ-9 satisfies both depression measures; C-SSRS satisfies both suicide risk measures; AUDIT and DAST cover the substance use domain. CBH's P4P follow-up windows are tighter than CCBHC's FUH measure, and CCBHC's BMI and tobacco measures are not core CBH expectations, so dual-credentialed clinics need data systems that report against both rule sets.
Sources & Citations
Primary CBH & DBHIDS documents
- D1.Community Behavioral Health. CBH Provider Manual (2025-04-25 revision).cbhphilly.org (PDF)
- D2.Community Behavioral Health. Clinical Practice Guidelines.cbhphilly.org/cpg
- D3.Community Behavioral Health. Substance Use Services.cbhphilly.org/substance-use-services
- D4.DBHIDS. Division of Community Behavioral Health.dbhids.org
Peer-reviewed literature
- P1.Last BS, Johnson C, Dallard N, et al. Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation. Implementation Research and Practice 2023.PMID 37790185
- P2.Dodge KA, Prinstein MJ, Evans AC, et al. Population mental health science: Guiding principles and initial agenda. American Psychologist 2024;79(6):805-823.doi:10.1037/amp0001334