Community Care Management (CCM)

Applies to:

Group Commercial HMO, EPO, POS and PPO plans 
Individual Commercial MyPriority® plans 
Medicare

CCM program description

Community Care Management is a program that offers Priority Health members critical, time-sensitive treatment when they need it most by offering intensive support to help avert a crisis or allow for a successful transition back home after a mental health hospitalization.  When the member is more stable, services move to a more traditional outpatient therapy model.

Community Care Management offers our members in need of urgent or more comprehensive behavioral health services access to the care they need to help them avoid inpatient admissions or readmissions. When the member is more stable, services move to a more traditional outpatient therapy model.

Download the CCM provider flyer

Who’s eligible?

CCM is available for adults and children who:

1. Are transitioning home from an inpatient or partial hospitalization stay.
2. Are experiencing moderate mental health symptoms that impact functioning and quality of life and require more than what traditional outpatient therapy can provide.
3. Have a history of limited improvement in outpatient therapy and/or have barriers to accessing outpatient therapy.

CCM goes beyond traditional outpatient behavioral health care

• Expedited access to a therapist and psychiatric medication provider who partner to provide intensive support.
• Visits with a therapist who provides intensive mental health support up to three times per week in a flexible location including home, office, community or virtually.
• Care coordination to help members organize their healthcare needs and share information between their providers.
• Connection to community resources and support.

CCM provider partners 

The providers listed below hold contracts with Priority Health to offer CCM services. Only the providers listed below can bill for CCM services. 

Provider availability is subject to change.

Easter Seals	Southeast Michigan
Integrated Services of Kalamazoo	Kalamazoo County
Reliance Community Care Partners	West Michigan
Samaritas	Statewide
Training and Treatment Innovations	Southeast Michigan
Wedgwood	West Michigan

How the program works

• When a referral is made to a provider partner, a coordinator will reach out to the member to schedule the intake. If a member is inpatient when the referral is made, a coordinator may set up a time for the therapist to visit them in the hospital.
• At intake, a therapist will work with the member to identify areas of need and develop a plan that may include visits up to three times per week.
• A therapist will also help coordinate appointments and services such as medical visits, transportation, housing and access to other community support.
• If a member is prescribed psychiatric medication, an appointment will be scheduled immediately with a psychiatrist, physician assistant or nurse practitioner that works alongside a therapist. The member may continue working with the medication prescriber after they’re discharged from the program.
• When a member is ready to start working with a traditional outpatient therapist, the CCM therapist will connect them to an outpatient therapist who will provide continued support.

Eligibility

Priority Health members with commercial group and individual and Medicare plans are eligible depending on geographic location. Geographic location may also impact whether members have access to in person and/or virtual services.

Members with Medicaid and Healthy Michigan plans aren’t eligible.

Coverage

CCM is a service that applies to the member’s mental health outpatient benefits. Some members have a mental health outpatient benefit that requires a co-pay per visit and others have a deductible to meet and then a percentage of the treatment that’s covered. 

Copays are waived for many plans to support access to this program. Waived co-pays don’t apply to self-funded plans. 

Referral process

If you have a patient who may benefit from this program, contact our Behavioral Health Department at 800.673.8043 and ask to speak with a clinician. The clinician will check eligibility to ensure CCM is the appropriate level of care.

Additional CCM resources
Updated February 2023