Service Expansion in Mental Health/Substance Services, Oral Health and Comprehensive Pharmacy Services




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U.S. Department of Health and Human Services

Health Resources and Services Administration
Bureau of Primary Health Care
Service Expansion Funding for the Health Center Program

Service Expansion in Mental Health/Substance Services, Oral Health and Comprehensive Pharmacy Services

Under the Health Center Program

New Competitive Supplemental Grants

HRSA 08-076, HRSA 08-107, HRSA 08-108

Catalog of Federal Domestic Assistance (CFDA) No. 93.224

PROGRAM GUIDANCE

Fiscal Year 2008


Application Due Dates in Grants.gov:

HRSA-08-076 (Mental Health/Substance Services): January 15, 2008

HRSA-08-107 (Oral Health Services): January 16, 2008

HRSA-08-108 (Comprehensive Pharmacy Services): January 17, 2008

Date of Issuance: November 15, 2007
Kristi Messer

Public Health Analyst

Bureau of Primary Health Care

Office of Policy and Program Development

Telephone: 301/594-4300

Fax: 301/480-7225

Email: kMesser@hrsa.gov

Technical Assistance Resources: www.hrsa.gov/grants/technicalassistance/se.htm
Authority: Public Health Service Act, Section 330, (42 U.S.C. 254b)

EXECUTIVE SUMMARY
This application guidance details the eligibility requirements, review criteria and awarding factors for section 330 funded health centers1 seeking supplemental grant support to establish access to mental health and substance abuse (MH/SA), oral health care, or pharmacy services in fiscal year (FY) 2008. The Health Resources and Services Administration’s Bureau of Primary Health Care has targeted $30 million to support supplemental awards for Service Expansion grant awards in FY 2008. Final action on the FY 2008 appropriation may impact the availability of funds for this opportunity.

Access to MH/SA services, oral health care and pharmacy services is critical in ensuring the overall health and well-being of the populations served by health centers funded under the Health Center Program. The goal of this funding opportunity is to increase the number of grantees that provide access to MH/SA, oral health and pharmacy services.
The Service Expansion supplemental grant opportunity is limited to organizations funded under the Health Center Program, including Community Health Centers (CHC), Migrant Health Centers (MHC), Health Care for the Homeless (HCH), and Public Housing Primary Care (PHPC) authorized under section 330 of the Public Health Service Act (PHS) as amended. There are three types of Service Expansion funding opportunities described in this guidance:


  1. HRSA-08-076: MENTAL HEALTH AND SUBSTANCE ABUSE (MH/SA) SERVICES (ONSITE ACCESS)– HRSA expects to award approximately 60 grants totaling $9,000,000 to increase access to MH/SA services by establishing onsite MH/SA services under a health center’s approved scope of services. Each supplemental application from a section 330 funded health center seeking support for MH/SA services may not exceed $150,000 in both Year 1 and Year 2 in requested grant funds.



  1. HRSA-08-107: ORAL HEALTH-SERVICES –HRSA expects to award approximately 60 grants totaling $15,000,000 to increase access to oral health services by establishing oral health services at a site(s) under a health center’s approved scope of project. Each supplemental application from an existing section 330 funded health center seeking support for oral health services may not exceed $250,000 in both Year 1 and Year 2 in requested grant funds.



  1. HRSA-08-108: PHARMACY SERVICES (ONSITE ACCESS) –HRSA expects to award approximately 60 grants totaling $6,000,000 to increase onsite access to pharmacy services by establishing onsite pharmacy services at health centers that do not provide onsite access to a licensed pharmacy under its approved scope of project (i.e., health centers providing onsite access to pharmacy services only through provider dispensing programs or by unpaid referral to a licensed pharmacy). Each supplemental application from a section 330 funded health center seeking support to provide onsite access to pharmacy services may not exceed $100,000 per year in both Year 1 and Year 2 in requested grant funds.


The estimated date of award is September 1, 2008. Applications must be submitted no later than January 15, 2008; January 16, 2008; and January 17, 2008 as required, in accordance with the chart found later in this section.

This application guidance supersedes Program Information Notice (PIN) 2005-04: Service Expansion for Mental Health and Substance Abuse and Oral Health in Programs Funded Under the Health Centers Consolidation Act of 1996 (HRSA 05-103) (SEXP). For FY 2008, the following differences should be noted:

  • There are three distinct types of Service Expansion funding opportunities; MH/SA, Oral Health, and Pharmacy Services. Please see the appropriate Purpose, Program Narrative and Review Criteria sections to apply for one of these Service Expansion grants.

  • The eligibility and review criteria have been updated.

  • Health centers that received funding under section 330 for the first time as a new start in FY 2006 and FY 2007 are not eligible to apply for FY 2008 Service Expansion grant.

  • Service Expansion is not an opportunity to add a new target population or request support under a new section 330 subpart (CHC, MHC, HCH, or PHPC). Applicants may not submit a project plan proposing to serve a target population and/or service area outside its existing approved scope of project.

  • The service delivery plan must demonstrate the ability to provide access to services within 120 days of receipt of the notice of grant award (NGA).

  • Applicants will be required to submit a healthcare plan specific to the Service Expansion describing goals which include improvement of patient health outcomes and a business plan describing goals for improving access to care; quality of care; and cost efficiency/effectiveness.


PLEASE NOTE: Applicants may apply for more than one Service Expansion funding opportunity under this announcement. Each application must stand alone. All applicants are expected to demonstrate compliance with the requirements of section 330 of the PHS Act, as amended and applicable regulations. Applicants are encouraged to review Appendix D for additional information on program requirements and expectations.
HRSA is requiring applicants for this funding opportunity to apply electronically through Grants.gov, http://www.grants.gov/. All applicants must submit in this manner unless the applicant is granted a written exemption from this requirement in advance by the Director of HRSA’s Division of Grants Policy. Applicants must request an exemption in writing from DGPWaivers@hrsa.gov, and provide details as to why they are technologically unable to submit electronically though the Grants.gov portal. Make sure you specify the announcement number for which you are seeking relief. HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval. Applicants technologically unable to scan the signed face sheet should also contact the DGPWaivers mailbox to provide information and request further instructions. However, the application must still be submitted under the appropriate deadline.
The Grants.gov registration process involves three basic steps:

  1. Register your organization

  2. Register yourself as an Authorized Organization Representative (AOR)

  3. Get authorized as an AOR by your organization


Please visit the Grants.gov Web site at http://www.grants.gov/applicants/get_registered.jsp or call the Grant.gov Contact Center at 1.800.518.4726 between 7am and 9 pm ET for additional technical assistance on the registration process. 
The registration process can take up to one month. Please refer to Appendix B for information on registering, and Appendix A, Section 3 for information on applying through Grants.gov. If you do not complete the registration process, you will be unable to submit an application. Applicants are strongly encouraged to register multiple authorizing organization representatives.
Applications must be submitted by 8:00 P.M. ET by the due date listed. To ensure that you have adequate time to follow procedures and successfully submit the application, we recommend that you register immediately in Grants.gov and complete the forms as soon as possible.
It is the responsibility of the applicant to ensure that the complete application is submitted electronically by the published due date and time. Applications will be considered on time if successfully submitted electronically by the due date and time, as shown only by the electronic submission record. Applications which do not meet the criteria above are considered late applications. The Health Resources and Services Administration (HRSA) shall notify each late applicant that its application will not be considered in the current competition. Please indicate that you are responding to HRSA-08-076 (Mental Health/Substance Abuse Services), HRSA 08-107 (Oral Health Services) or HRSA 08-108 (Pharmacy Services).
Per section 330(k)(3)(H) of the PHS Act (42 U.S.C. 254b), the health center governing board must approve the health center’s annual budget and approve applications for subsequent grants for the health center.  In addition, the SF-424 face page, included in the required PHS 5161 Grant Application and which must be signed by the applicant’s authorized representative (most often the Executive Director, Program Director, or Board Chair), certifies that all data in the application are true and correct and that the document has been duly authorized by the governing body of the applicant.  It also certifies that the applicant will comply with the attached assurances if the assistance is awarded. Selection of the responsible person should be consistent with responsibilities authorized by the organization’s bylaws.
Authorized representatives that sign the SF-424 are reminded that a copy of the governing body’s authorization for them to sign the application as official representative must be on file in the applicant’s office and that their signature also assures that the governing board has reviewed and approved ALL content of the application, including the program specific forms.
All applicants requesting Service Expansion funds in FY 2008 must use this guidance. The guidance should be reviewed thoroughly prior to making a decision to apply. Additional instructions and specific requirements for each Service Expansion opportunity are detailed throughout the application guidance.
If you have questions regarding the FY 2008 Service Expansion application and/or the review process described in this application guidance, please call Kristi Messer in the Bureau of Primary Health Care’s Office of Policy and Program Development at 301-594-4300 or kMesser@hrsa.gov.
The Bureau of Primary Health Care will announce a pre-applicant teleconference conference call shortly after the guidance release date. Please visit www.hrsa.gov/grants/technicalassistance/se.htm for the call date and additional resources.
For your convenience, application deadlines for projects are provided below. Please review the online HRSA Preview or Grants.gov for more current information.


HRSA Announcement Number


Funding Opportunity

Grants.gov Application Deadline



HRSA 08-076




Mental Health & Substance Abuse Services

January 15, 2008 at 8:00 PM ET

HRSA 08-107


Oral Health Services

January 16, 2008 at 8:00 PM ET

HRSA-08-108


Pharmacy Services

January 17, 2008 at 8:00 PM ET


Guidance Table of Contents



ORAL HEALTH SERVICES 10

PHARMACY SERVICES 11

Pre-Application Conference Call 17

APPENDIX A: HRSA’s Electronic Submission User Guide 56

1. Introduction 58

1.1 Document Purpose and Scope 58

1.2 Document Organization and Version Control 58

2. Noncompeting Continuation Application 58

2.1 Process Overview 58

2.2 Grantee Organization Needs to Register with Grants.gov (if not already registered) – See Appendix B 59

2.3 Project Director and Authorizing Official Need to Register with HRSA EHBs (if not already registered) 59

2.4 Apply through Grants.gov 60

2.5 Verify in HRSA Electronic Handbooks 62

3. Competing Application 63

3.1 Process Overview 63

3.2 Grantee Organization Needs to Register With Grants.gov (if not already registered) – See Appendix B 63

3.3 Apply through Grants.gov 64

4. General Instructions for Application Submission 65

4.1 Narrative Attachment Guidelines 66

4.2 Application Content Order (Table of Contents) 67

4.3 Page Limit 67

5. Customer Support Information 67

6. FAQs 68

6.1 Software 68

6.2 Application Receipt 69

6.3 Application Submission 71

6.4 Grants.gov 71

Appendix B – Registering and Applying Through Grants.gov 72

APPENDIX C: 77

PROGRAM SPECIFIC FORMS, BUDGET PRESENTATION, HEALTH CARE PLAN AND BUSINESS PLAN INSTRUCTIONS 77

AND 77

SERVICE EXPANSION DEFINITIONS 77

Instructions For The Completion Of Form 3: Income Analysis 79

PROJECTED FEE FOR SERVICE INCOME 79

PROJECTED CAPITATED MANAGED CARE INCOME 81

GUIDELINES FOR COMPLETION OF THE BUDGET PRESENTATION 82

SAMPLE BUDGET JUSTIFICATION 85

DEVELOPING THE HEALTH CARE PLAN AND BUSINESS PLAN 89

SERVICE EXPANSION DEFINITIONS 92

Role of the MH/SA Provider in Integrated Primary MH/SA care is to develop, deliver, and supervise comprehensive onsite integrated primary MH/SA programs, including patient education classes on self-management skills for at risk populations; group care clinics provided collaboratively with members of primary care teams, coordination and collaboration with outreach staff and lay health workers/promotoras de salud; consultation and co-management of patients with clinically significant mh/sa problems with the goal of improving the patient’s health outcomes; and improving the primary care provider’s skills in using psychosocial interventions. 97

APPENDIX D: 101

Summary of Program requirements and expectations 101

APPENDIX E: 104

PRIMARY CARE ASSOCIATION, 104

PRIMARY CARE OFFICE AND 104

NATIONAL ORGANIZATION CONTACTS 104

ALASKA 105

FORM 1 – PART A:GENERAL INFORMATION WORKSHEET 113

FORM 1 - PART B: BPHC FUNDING REQUEST SUMMARY 114


PUBLIC BURDEN STATEMENT: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 285. Public reporting burden for the applicant for this collection of information is estimated to average 100 hours, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14-45, Rockville, Maryland, 20857.

I. Funding Opportunity Description
Purpose

The goal of the Service Expansion funding opportunity is to increase access to mental health/substance abuse (MH/SA), oral health and pharmacy services at health centers funded under section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Existing Health Center Program grantees are those health centers that currently receive funding under the Health Center Program:

  • Community Health Centers (CHC) – section 330(e)

  • Migrant Health Centers (MHC) – section 330(g)

  • Health Care for the Homeless (HCH) – section 330(h)

  • Public Housing Primary Care (PHPC) – section 330(i)


Access to MH/SA, oral health care and pharmacy services is critical in ensuring the overall health and well-being of the populations served by the Health Center Program. MH/SA disorders, such as depression and abuse of alcohol, are prevalent among underserved populations and treatment for these disorders is not accessible in many communities. Lack of access to oral health care services is the primary reason for significant disparities in oral health status in vulnerable population groups. Inadequate access to pharmacy services often leads to problems related to drug interactions, inappropriate dosages and failure to adhere to prescribed therapy. Many of these disabling conditions can be prevented or managed through access to MH/SA, oral health and pharmacy services in health centers. The goal of the FY 2008 Service Expansion funding opportunity is to increase the number of grantees that provide access to MH/SA, oral health and pharmacy services. The availability of these essential health care services enhances the ability of health centers to provide comprehensive primary care, increases access to essential health care services at existing service sites, and continues to improve the health status of those served.
The three types of funding opportunities for Service Expansion in FY 2008 are:


  1. Mental Health and Substance Abuse (MH/SA) Services (Onsite Access) (HRSA 08-076) – HRSA expects to award approximately 60 grants totaling $9,000,000 to increase onsite access to MH/SA services by establishing onsite MH/SA services at a health center site under its approved scope of services. Each supplemental application from a 330 funded health center seeking support for MH/SA services may not exceed $150,000 in both Year 1 and Year 2 in requested grant funds.



  1. Oral Health Services (HRSA 08-107) – HRSA expects to award approximately 60 grants totaling $15,000,000 to increase access to oral health services at a site(s) under a health center’s approved scope of project.. Each supplemental application from a section 330 funded health center seeking support for oral health services may not exceed $250,000 in both Year 1 and Year 2 in requested grant funds.



  1. Pharmacy Services (Onsite Access) (HRSA 08-108) –HRSA expects to award approximately 60 grants totaling $6,000,000 to increase access to pharmacy services by establishing onsite pharmacy services at health centers that do not provide onsite access to pharmacy services (see definition below) under its approved scope of project (i.e., health centers providing access to pharmacy services only through provider dispensing programs or by unpaid referral to a licensed pharmacy). Each supplemental application from a section 330 health center seeking support to provide onsite access to pharmacy services may not exceed $100,000 per year in both Year 1 and Year 2 in requested grant funds.

Background

MENTAL HEALTH/SUBSTANCE ABUSE SERVICES


Research has shown that underlying MH/SA problems account for up to 70 percent of all primary care visits. Depression, in particular, is predicted to be the second leading cause of disability in the United States by 2020. Depression can occur as a primary MH/SA problem, as a co-morbid condition with other MH/SA problems (e.g., ADHD, substance abuse) or as a co-morbid condition with other medical problems (e.g., chronic diseases, such as diabetes or arthritis). Although evidence-based treatments exist for depression, many individuals in need of services are never identified, and fewer than half of those identified as needing treatment actually receive it. (Institute of Medicine (1997). Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC. National Academy Press; Institute of Medicine (1996). Primary Care: America's Health in a New Era. Washington, DC. National Academy Press)
Substance abuse is one of the Nation’s most prevalent health problems, and alcohol is the drug of choice among both adolescents and adults. Health care costs of general medical patients with alcohol-related disorders are about twice those of patients without alcohol-related disorders. Alcohol-related disorders are frequently implicated in cancer, stroke, cirrhosis of the liver, cardiovascular disease, depression, falls, burns, and other unintentional injuries. In addition, alcohol use can exacerbate symptoms and complicate treatment compliance for any health problem. Patients are often reluctant to seek treatment in the community. Compounding this problem is the fact that many communities have little if any treatment capacity, particularly for the uninsured.
Onsite MH/SA services can be delivered either directly by the health center or through an established arrangement with another provider to provide services at the health center. Locating MH/SA services in the health center improves patient access to, and their acceptance of these services, where they are better able to screen, counsel and treat patients with emotional problems, mental illness, and addictive disorders. Locating MH/SA services with a primary care setting can improve a primary care provider’s access to MH/SA expertise, which can improve the patient’s health outcomes; facilitate treatment of co-occurring MH/SA conditions; and improve the clinic’s overall efficiency. Ideally, MH/SA services should be integrated into all aspects of the health center’s clinical operations (pediatric, adolescent, adult, and geriatric life cycles) and services (prenatal, gynecological, family planning, chronic disease, etc.).
HRSA has made access to onsite MH/SA services for underserved populations a priority for FY 2008, and is offering this opportunity to establish onsite MH/SA services. Applicants must propose to provide MH/SA services onsite at a minimum of one location by licensed MH/SA staff (i.e., must hire directly or to provide onsite services) that are appropriate to meeting the needs of the target population. All MH/SA programs are expected to include the following components:


  • Onsite access to services;

  • Licensed MH/SA staff;

  • Healthcare plan goals and objectives to improve patients’ health outcomes by reducing the rate and improving the management of alcohol and drug dependence; depression and other mood disorders; anxiety disorders; attention deficit and disruptive behavior disorders; and other mental disorders among the target population;

  • Application of exemplary practices and lessons learned;

  • Effective risk management practices;

  • Incorporation of program activities into the health center quality plan; and

  • Access to MH/SA services within 120 days of award.


Applicants are strongly encouraged to utilize an integrated primary MH/SA care model/approach in developing the MH/SA service delivery plan. Integrated primary MH/SA care involves the delivery of brief patient-centered MH/SA consultations and co-management of certain patients by MH/SA providers and medical providers. Through this model, services are provided by licensed MH/SA staff that will be members of the primary care provider team, are physically located in the clinic area, and are immediately available to the primary care provider as he/she is seeing patients.

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