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Primary and Behavioral Health Care Integration

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Short Title: PBHCI
Initial Announcement Back to the Grants Dashboard

Notice of Funding Opportunity (NOFO)

NOFO Number: SM-15-005

Posted on Grants.gov: Monday, December 22, 2014

Application Due Date: Friday, February 27, 2015

Catalog of Federal Domestic Assistance (CFDA) Number: 93.243

Intergovernmental Review (E.O. 12372): Applicants must comply with E.O. 12372 if their state(s) participates. Review process recommendations from the State Single Point of Contact (SPOC) are due no later than 60 days after application deadline.

Public Health System Impact Statement (PHSIS) / Single State Agency Coordination: Applicants must send the PHSIS to appropriate State and local health agencies by application deadline. Comments from Single State Agency are due no later than 60 days after application deadline.

Description

The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, is accepting applications for fiscal year (FY) 2015 Primary and Behavioral Health Care Integration (Short Title: PBHCI) grants.  The purpose of this program is to establish projects for the provision of coordinated and integrated services through the co-location of primary and specialty care medical services in community-based behavioral health settings.  The goal is to improve the physical health status of adults with serious mental illnesses (SMI) [1]and those with co-occurring substance use disorders who have or are at risk for co-morbid primary care conditions and chronic diseases. The program’s objective is to support the triple aim of improving the health of individuals with SMI; enhancing the consumer experience of care (including quality, access, and reliability); and reducing/controlling the per capita cost of care.

SAMHSA launched the PBHCI program in FY 2009 with the knowledge that adults with serious mental illness experience heightened morbidity and mortality, in large part due to elevated incidence and prevalence of obesity, diabetes, hypertension, and dyslipidemia.  This increased morbidity and mortality can be attributed to a number of issues, including inadequate physical activity and poor nutrition; smoking; side effects from atypical antipsychotic medications; and lack of access to health care services. Emerging research has documented the relationships among exposure to traumatic events, impaired neurodevelopmental and immune systems responses and subsequent health risk behaviors resulting in chronic physical or behavioral health disorders.[2] Unaddressed trauma significantly increases the risk of mental and substance use disorders and chronic physical illnesses.  Many of these health conditions are preventable through routine health promotion activities, primary care screening, monitoring, treatment and care management /coordination strategies and/or other outreach programs.  Much of the national effort towards achieving the triple aim of improved health, enhanced care, and reduced costs are associated with developing person-centered systems of care that address an individual’s holistic health and wellness.

The PBHCI grant program supports the goals of the Million Hearts™ Initiative in that people with behavioral health disorders are disproportionally impacted by many chronic primary care health conditions, including heart disease and hypertension.

The Million Hearts™ initiative supports cardiovascular disease prevention activities across the public and private sectors in an unprecedented effort to prevent 1 million heart attacks and strokes over five years and demonstrate to the American people that improving the health system can save lives. Million Hearts™ will scale-up proven clinical and community strategies to prevent heart disease and stroke across the nation by empowering people to make healthy choices such as preventing tobacco use and reducing sodium and trans fat consumption and by improving care for people who do need treatment by encouraging a targeted focus on the "ABCS" - aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation.

Million Hearts™ brings together existing efforts and new programs to improve health across communities and help Americans live longer, healthier, more productive lives. The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services are the co-leaders of Million Hearts within the U.S. Department of Health and Human Services, working alongside other federal agencies including the Administration on Aging, National Institutes of Health, the Agency for Healthcare Research and Quality, and the Food and Drug Administration, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration, the Office of the National Coordinator, and the Veterans Administration. Key private-sector partners include the American Heart Association, and YMCA, among many others.

In FY2015, SAMHSA builds on previous PBHCI funding opportunities by capitalizing on lessons learned from previous PBHCI grantees and the field at large, in order to further develop the coordination and integration of primary care and behavioral health care services.  Grantees will be expected to achieve this by strengthening their focus on integrated treatment teams, evidence-based and promising wellness interventions, program structures (e.g., primary care access, information sharing, and treatment planning, etc.), performance monitoring and continuous quality improvement, and sustainability. 

SAMHSA has demonstrated that behavioral health is essential to health, prevention works, treatment is effective, and people recover from mental and substance use disorders.  Behavioral health services improve health status and reduce health care and other costs to society.  Continued improvement in the delivery and financing of prevention, treatment and recovery provides a cost savings.  SAMHSA has identified six Strategic Initiatives to focus the Agency’s work on people and emerging opportunities.  More information is available at the SAMHSA website: www.samhsa.gov/about-us.

The PBHCI grant program supports SAMHSA’s Strategic Initiative on Health Care and Health Systems Integration, as well as aligns with Prevention of Substance Abuse and Mental Illness; Recovery Support; and Health Information Technology.  The PBHCI grant program seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use and outcomes among the racial and ethnic minority populations served.  (See PART II: Appendix G – Addressing Behavioral Health Disparities.)

PBHCI is one of SAMHSA’s services grant programs. SAMHSA intends that its services grants result in the delivery of services as soon as possible after award. Service delivery should begin by the 4th month of the project at the latest.

PBHCI grants are authorized under 520K of the Public Health Service Act, as amended. This announcement addresses Healthy People Mental Health and Mental Disorders Topic Area HP 2020-MHMD and/or Substance Abuse Topic Area HP 2020-SA.

 

[1] Adults with a serious mental illness (SMI) are defined by SAMHSA as persons age 18 and over, who currently or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the [DSM-IV], resulting in functional impairment which substan­tially interferes with or limits one or more major life activi­ties.  SAMHSA will defer to state definitions of SMI and/or serious and persistent mental illness (SPMI).

[2] Anda, R.F., Brown, D.W., Dube, S.R., Bremner, J.D., Felitti, V.J, & Giles, W.H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34(5), 396-403.

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.

Award Information

Funding Mechanism: Cooperative Agreement

Anticipated Total Available Funding: $40,897,330

Anticipated Number of Awards: 102

Anticipated Award Amount: Up to $400,000 per year

Length of Project: Up to 4 years

Cost Sharing/Match Required?: No

Proposed budgets cannot exceed $400,000 in total costs (direct and indirect) in any year of the proposed project.  Annual continuation awards will depend on the availability of funds, grantee progress in meeting project goals and objectives, timely submission of required data and reports, and compliance with all terms and conditions of award.

Contact Information

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