Pre-application Webinar for Primary and Behavioral Health Care Integration (PBHCI). Trina Dutta, MPP, MPH Center for Mental Health Services. Logistics Info. Agenda Importance of integrated care to SAMHSA History of PBHCI Overview of new funding opportunity Frequently Asked Questions
Trina Dutta, MPP, MPH
Center for Mental Health Services
Physical Health Conditions among Adults with Mental Illnesses—New SAMHSA Study*
Combined 2008 and 2009 data indicate that adults aged 18 or older with any mental illness (AMI) or major depressive episode (MDE) in the past year were more likely than adults without these mental illnesses to have high blood pressure, asthma, diabetes, heart disease, and stroke
Adults with serious mental illness (SMI) in the past year were more likely than adults without SMI to have high blood pressure, asthma, and stroke
Those with AMI, SMI, or MDE were more likely than adults without these mental illnesses to use an emergency room and to be hospitalized
*SAMHSA NSDUH Report, “Physical Health Conditions among Adults with Mental Illnesses,” 4/5/12
Past Year Emergency Room Use and Past Year Hospitalization among Persons Aged 18 or Older with and without Serious Mental Illness in the Past Year: 2008 and 2009
SAMHSA. (2010). Mental health and substance abuse services in Medicaid, 2003: Charts and state tables. HHS Publication No. (SMA) 10-4608.
What does this mean?
These results suggest a greater need for:
screening for and treating these physical conditions among persons with mental illnesses;
screening for and treating mental illnesses among persons with these physical conditions; and
promoting programs that integrate mental health screening, intervention, and treatment with primary care or primary care into specialty mental health care.
If it’s that obvious, what’s happening to address this?
AHRQ Evidence Report: Integration of Mental Health/Substance Abuse and Primary Care
We need to know more!
Both specialty behavioral health settings and primary care
(with a strong need for collaboration between the two)
health programs with linkages to primary care
Behavioral health risk/status
Primary care or in the medical
Physician with on-site behavioral health staff
Physical health risk/status
Milbank 2010--Adapted from Mauer 06
In partnership with HHS/Health Resources and Services Administration (HRSA)
Grantees are expected to serve at minimum 200 clients in Year 1, 375 clients in Year 2, 475 clients in Year 3, and 600 clients in Year 4. ( If you are unable to meet these goals, you may provide a detailed explanation of why along with your proposed goals of clients served.)
Body Mass Index—quarterly
Plasma Glucose (fasting) and/or HgbA1c—annually
Lipid profile (HDL, LDL, triglycerides)—annually
National Outcome Measures—every 6 months
Quarterly Performance Reports
A person-centered system of care that achieves improved outcomes and better services and value
Q: How does SAMHSA define a serious mental illness?
A: SAMHSA definition of SMI stipulated in PL 102-321 requires the person to have at least one 12-month DSM disorder, other than a substance use disorder, and to have "serious impairment." SAMHSA decided that "serious impairment" is defined as a Global Assessment of Functioning (GAF) score of less than 60).
Q: Is the required minimum clients served a duplicated or unduplicated count?
A: Grantees are expected to serve at minimum 200 clients in Year 1, 375 clients in Year 2, 475 clients in Year 3, and 600 clients in Year 4. These numbers are unduplicated (but SAMHSA encourages grantees to exceed these numbers when possible.)
Q: I am having trouble locating section 1913(b)(1) of the Public Health Service Act that defines “qualified community mental health programs.” Could you provide me with that definition or with a link to that section of the law?
A: Section 1913 of the PHS Act which is codified at 42 U.S.C. §300x-2 link: http://www.law.cornell.edu/uscode/text/42/300x-2. You will then need to scroll down to (b)(1) (see slide 20 for exact language)
Q: Could two separate independent community mental health centers write a single grant application for funding for the identical program to be implemented at both organizations?
A: The two separate independent community mental health centers must submit separate grant applications for funding. The two separate centers cannot submit a single grant application to implement the same program. That said, there could be one main fiduciary CMHC that subcontracts with a second CMHC.
Q: My question has to do with Section 3.2 Evidence of Experience and Credentials, bullet point 2 under the three requirements. Do we have to have two years experience providing primary care services AND mental health services, or just two years providing services in general?
A: Per the RFA, “each mental health/primary care treatment provider organization must have at least 2 years experience (as of the due date of the application).” This means that whomever will be providing the primary care services must have documents 2 years of experience. If you (the applicant) are planning on providing the primary care services, you would need 2 years of experience. If you plan on contracting with a local community provider, they would need 2 years experience.
Q: I am unclear if there is a licensing or other form of designation that also must be met to confirm that we meet these requirements and are officially considered a community mental health program.
A: There is no federal level accreditation for CMHCs, so we hold you to whatever it is you receive from your state to provide services. If you receive the award, SAMHSA reserves the right to request documentation of your state certification, etc. Many states have legislated definitions of CMHCs which your organization meets, and SAMHSA will defer to that definition.
Q: Is it a requirement for the co-located service to be physically located in the behavioral healthcare facility rather than the physical healthcare facility?
A: Yes, these services must be co-located WITHIN the mental health setting.
Q: Could you tell me when awards for this grant would occur. When does the first year funding start?
A: The awards would in all likelihood be awarded close to/before September 30, 2012, with funding starting October 1, 2012 (beginning of the federal fiscal year).
Q: We would like to apply to provide the primary care for SMI patients and contract with a behavioral health provider agency to provide these services at our primary care clinic sites. Is this within the scope of services that SAMHSA is interested in? Or do you require the primary care services be provided in a mental/behavioral healthcare setting?
A: The explicit focus of the project is the co-location of primary and specialty care medical services in community-based mental and behavioral health settings, so embedding mental health services into an FQHC would fall outside the scope of the project.
Q: On Page 21 of the RFA, it notes supporting information on Attachment 1-4, but then also mentions Attachment 5. Is this an error?
A: Yes, this is an error. This section should read:
Attachments 1 through 4 [change, if necessary] – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachment 2.
Q: We are the administrative unit that contracts for all community mental health programs in the County. Are we as the County office eligible to apply?
A: County operated community mental health centers are certainly eligible to apply. The county, itself, could not apply for its centers, though, and I would suggest the contracted community mental health programs in your County serve as the primary applicant.
Q: In terms of the specialty care services for uninsured people, how far is the grantee expected to go in paying for services? For example, if we make a referral to a cardiologist who does a procedure costing thousands, does the grant pay for that? Should the budget include funds to pay for prescription drugs?
A: The requirement is for provision of PC services and referral to specialty care. The budget can include payment for medicines, but again, in the name of sustainability you will have to discuss how this will be carried forward beyond the grant. Per the RFA (pp. 46), SAMHSA grant funds must be used for purposes supported by the program and may not be used to: Pay for pharmacologies for HIV antiretroviral therapy, sexually transmitted diseases (STD)/sexually transmitted illnesses (STI), TB, and hepatitis B and C, or for psychotropic drugs.
Q: As a CMHC, if we partnered with a private practitioner with 2 yrs experience in primary care, but they were not a non-profit, in other words they were in private practice is that acceptable under the provisions of the grant?
A: A grantee or grant applicant cannot contract or partner with a for-profit primary care organization for the programmatic health work. They could contract with individual doctors in a for-profit practice, but not with the practice itself. No HHS funds may be paid as profit (fees) per C45CFR Parts 74.81 and 92.22(2).
Q: Page 9 also includes a requirement that grantees participate in the Regional Extension Center program. However, this program is specifically targeted to primary care providers that practice in groups of 10 or fewer providers. Further, in some states, enrollment in the REC has been closed for some time. Can you clarify what is meant by this requirement?
A: While RECs receive federal dollars to support primary care, many will allow CMHCs to join for a small fee, and you can use your HIT dollars towards that (current PBHCI grantees are doing this with success). For RECs with “closed enrollment,” SAMHSA will work with the Office of the National Coordinator.
Q: Do the required number of individuals served need to be uninsured individuals?
A: You can serve whatever client mix of insured/uninsured exists in your community, but you can ONLY use SAMHSA grant dollars to cover services that aren’t billable via another vehicle (this goes for uninsured and insured folks).
Q: We are in a rural area and are considering proposing that a mobile unit be purchased/leased. The unit would be staffed with medical staff that can travel to our facilities where we provided behavioral health services in more rural areas as well as to assisted living facilities where we provide services. Can a mobile van/unit can be funded with grant dollars (for example out of the facility modifications allocation)?
A: You may use the grant funds to purchase/lease the van mobile. However, in order to determine what is more cost efficient, you should do a purchase/lease cost analysis and state it in the detailed budget justification.
For questions about program issues contact:
Public Health Analyst, Center for Mental Health Services
[email protected] (preferred)
For questions on grants management and budget issues contact:
Gwendolyn SimpsonOffice of Financial Resources, Division of Grants [email protected]