Primary and Behavioral Health Care Integration

(PBHCI) Request for Application (RFA)

No. SM-15-005

January 15, 2015Tenly Pau Biggs, Roxanne Castaneda,

& Marian ScheinholtzCenter for Mental Health Services

Overview of PBHCI

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•Purpose: to establish projects for the provision of coordinated and integrated services through the co-location of primary and specialty care services in community-based mental and behavioral health settings.

•Goal: to improve the physical health status of adults with serious mental illnesses (SMI) and those with co-occurring substance use disorders who have or are at risk for co-occurring primary care conditions and chronic diseases

•Objective: to support the triple aim of improving the health of individuals with SMI; enhancing the consumer’s experience of care (including quality, access, and reliability); and reducing/controlling the per capita cost of care.

PBHCI Requirements

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Eligibility

•Eligibility for this program is statutorily limited to qualified community mental health programs, as defined under section 1913(b)(1) of the Public Health Service Act, as amended.

•The statutory authority for this program prohibits grants to for-profit agencies.

PBHCI Requirements

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SAMHSA believes that only existing, experienced, and appropriately credentialed organizations with demonstrated infrastructure and expertise will be able to provide required services quickly and effectively. You must meet three additional requirements related to the provision of services.

The three requirements are:•A provider organization for direct client mental health services appropriate to the grant must be involved in the proposed project. The provider may be the applicant or another organization committed to the project. More than one provider organization may be involved;•Each treatment provider (including partnering primary care) organization must have at least 2 years’ experience (as of the due date of the application) providing relevant services in the geographic area(s) in which services are to be provided (official documents must establish that the organization has provided relevant services for the last 2 years); and•Each treatment provider (including partnering primary care) organization must comply with all applicable local (city, county) and state licensing, accreditation and certification requirements, as of the due date of the application.•[Note: The above requirements apply to all service provider organizations. A license from an individual clinician will not be accepted in lieu of a provider organization’s license. Eligible tribes and tribal organization mental health/substance abuse treatment providers must comply with all applicable tribal licensing, accreditation, and certification requirements, as of the due date of the application.

PBHCI Requirements

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Core Requirements•Provide, by qualified primary care professionals, on site primary care services and •Provide, by qualified specialty care professionals or other coordinators of care, medically necessary referrals

Must serve as a client’s health home where grantees provide the following services:•Comprehensive care management •Care coordination •Health promotion•Comprehensive transitional care from inpatient to other settings, including appropriate follow-up•Individual and family support, which includes authorized representatives•Referral to community and social support services, including appropriate follow-up

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PBHCI Requirements

Establish PBHCI Coordination Teams, which at minimum includes:•Chief Executive Officer•Chief Financial Officer•Chief Medical Director•Primary Care Lead•PBHCI Project Director•PBHCI consumerAnd provide details on their roles in Attachment 5.

Integration treatment team (at minimum includes):•Primary care provider (e.g., doctor, nurse practitioner, physician assistant, medical assistant, etc.•Nurse care coordinator•Integrated care manager•Peer wellness coach•Co-occurring substance use disorder counselor•Other: pharmacist, nutritionist/dietician, dentist, occupational therapist, etc.

PBHCI Requirements

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•Health Information Technology (HIT): Grantees must achieve Meaningful Use Standards, as defined by CMS, by the end of the grant period;

•Prevention & Health Promotion: Grantees are expected to implement evidence-based tobacco cessation and nutrition/exercise interventions, in addition to other health promotion programs (e.g. wellness consultation, health education and literacy, self-help/ management programs). These programs should incorporate recovery principles and peer leadership and support, and must be included in the integrated person-centered care plan.

•Sustainability: Grantees must submit a sustainability plan in the beginning of Year 2 of their grant, detailing how expanded Medicaid eligibility, available CMS/3rd party billing, and other strategies will be utilized to sustain services post-grant. 

PBHCI Requirements

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•HHS/CMS Million Hearts Initiative ™: Supports cardiovascular disease prevention activities across the public and private sectors to prevent 1 million heart attacks and strokes by 2017. The targeted focus is on the “ABCS” – aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation.

•Data collection: Grantees are expected to collect and report on the following health outcomes: blood pressure, body mass index (BMI), waist circumference, breath CO (carbon monoxide), plasma glucose (fasting) and/or HgbA1c, and the lipid profile (HDL, LDL, triglycerides). Grantees will be expected to use one of the four hypertension protocols recommended by the CDC. Grantees are also expected to collect the National Outcomes Measures (NOMS).

Agency Contacts

For questions about program issues contact: Tenly Pau Biggs, MSW, LGSWCenter for Mental Health Services, Community Support Programs BranchSubstance Abuse and Mental Health Services Administration1 Choke Cherry RoadRoom 6-1008Rockville, Maryland 20857(240) 276-2411Tenly.Biggs@samhsa.hhs.gov  For questions on grants management and budget issues contact: Gwendolyn SimpsonOffice of Financial Resources, Division of Grants ManagementSubstance Abuse and Mental Health Services Administration1 Choke Cherry RoadRoom 7-1091Rockville, Maryland 20857(240) 276-1408gwendolyn.simpson@samhsa.hhs.gov

Questions?