Coordinator: Welcome to today's conference call.
Thank you all for standing by.
At this time, all lines are on listen only for today's conference until the question
and answer portion of our call at which time you will be prompted to press Star one on
your touchtone phone.
Please be sure to record your name when prompted so that I may introduce you to ask your question.
Our conference is being recorded and if you have any objections, you may disconnect at
this time.
I will now turn the conference over to our host, Ms. Joy Mobley.
Ma'am you may proceed.
Joy Mobley: Thank you.
Good afternoon everybody and welcome to the pre-applicant webinar for the FY'2018 Certified
Community Behavioral Health Clinic Expansion Grants.
Again my name is Lieutenant Commander Joy Mobley and I'll be walking you through some
information about this funding opportunity today and we will be taking questions at the
end.
So please hold your questions until the end.
And we do have a chat box function that we're kind of working on at the moment.
So please feel free to type those questions in there and we'll try to get that resolved.
And if we can't, we'll answer the questions during the verbal Q&A.
All right, so this award for the CCBHC expansion grants, the total award is up to $47 million
- over $47 million per grant year.
We anticipate making approximately up to 25 awards with the total anticipated award amount
being of up to $2 million per year.
So length of the project will be up to two years and the due date for this application
for this grant award is July 9.
All right so the purpose of this grant program is to increase access to and improve the quality
of community behavioral health services through the expansion of certified community behavioral
health clinics.
CCBHCs provide person and family centered services and are available in the 24 states
that participated in the FY'2016 planning grants for community behavioral health clinics.
This - CCBHC expansion announcement creates opportunities to support the expansion of
the CCBHC model in those states with participated in the 2016 planning grant program.
The CCBHC expansion grant program must provide access to services for individuals with serious
mental illness or substance use disorders including opioid disorders, children and adolescents
with serious emotional disturbance, and individuals with co-occurring disorders.
SAMHSA expects this program will improve the behavioral health of individuals across the
nation by providing comprehensive community-based middle and substance abuse services, treatment
of co-occurring disorders, advanced integration of behavioral health with physical healthcare,
assimilate and utilize evidence based practices on a more consistent basis, and promote improved
access to high quality care.
All right so let's talk a little bit about eligibility and certification.
Eligible applicants are certified community behavioral health clinics or community based
behavioral health clinics who may not yet be certified but meet the certification criteria
and can be certified within four months of the award in the following states.
Appendix M and the funding opportunity announcement, the CCBHC criteria compliance checklist, is
available to assist applicants in understanding their organization's readiness to become a
CCBHC.
And we've received a lot of questions about certification and at the moment we're asking
the applicants to review that Appendix M and SAMHSA will provide a certification process
upon award.
Okay.
So applicants must be either a certified CCBHC or can meet all of the CCBHC criteria and
become certified within four months of the award.
They also must have two years of experience as of the due date of the application in providing
these relevant services.
All right so some expectations: CCBHC expansion is one of SAMHSA's services grants programs.
SAMHSA intends the services programs result in the delivery of services as soon as possible
after the award.
At the latest, award recipients are expected to provide services to the populations of
focus by the fourth month of the grant.
Collaboration with the state and - state behavioral health authority and state Medicaid office
is expected.
And the key personnel for this grant which are those physicians that require prior approval
by SAMHSA are the project director, who should have the minimum level of effort of .5, and
the evaluator.
All right so next we'll talk about required activities.
You must use SAMHSA's services grant funds primarily to support direct services, provide
the following services in compliance with the CCBHC criteria listed in this uplink.
But those services are crisis mental health services including 24 hour mobile crisis teams,
emergency crisis intervention services and crisis stabilization, screening assessment
and diagnosis including risk assessment, patient center treatment planning or similar processes
including risk assessment and crisis planning, and comprehensive outpatient mental health
and substance abuse services.
All right some additional requirements, outpatient primary - I'm sorry.
So the following requirements must be provided directly or these services can be provided
through a designated collaborating organization.
And those services are outpatient primary care screening and monitoring of key health
indicators and health risk, clinical monitoring for adverse effects of medications including
monitoring for metabolic syndrome consistent with published guidelines, targeted case management,
psychiatric rehabilitation services, social support opportunities to establish models
such as clubhouses that provide therapeutic individual and group interactions, assistance
with employment, housing and other community recovery supports, development of comprehensive
community recovery supports including peer support, counselor services, and family support,
intensive community based mental healthcare for members of the armed forces and veterans,
and assertive community treatment.
In addition, applicants will need to establish cooperative relationships with judicial official
court systems and provide assisted outpatient treatment when ordered, establish an advisory
workgroup comprising of individuals with mental and substance abuse disorders and family members
to provide input and guidance to CCBHCs on implementation services and policies.
And finally develop and implement plans for sustainability to ensure delivery of services
once federal funding ends.
All right so we'll talk a little bit about the designated collaborating organizations.
If the applicant is - have designated collaborating organizations, a system providing services
to CCBHC patients, each DCO must be an organization for direct client substance use disorder treatment,
substance misuse prevention and/or mental health services appropriate to the grant.
More than one DCO can be used.
Each DCO must have two years of experience providing relevant services.
Official documents must establish that the organization has provided relevant services
for the last two years, comply with all applicable local and state licensing, accreditation and
certification requirements as of the due date of the application, and CCBHC formal agreements
with DCOs within the state make clear that the CCBHC retains ultimate clinical responsibility
for CCBHC services provided by DCOs.
And just a special note on this slide, a license from an individual clinician will not be accepted
in lieu of a provider organization's license.
All right so a little bit about evidence based practices.
SAMHSA services grants are intended to fund services or practices that have demonstrated
evidence base and that are appropriate for the populations of focus.
An EVP refers to approaches to prevention and treat - or treatment that are validated
by some form of documented research evidence.
In section C of your project narrative, you will need to identify the evidence based practices
you propose to implement for the specific populations of focus.
In addition, you must discuss the population's practices have been shown to be effective
and show that it is appropriate for your population of focus.
Applicants are encouraged to visit the SAMHSA evidence based practices resource center or
the National Institute of Health's Web site.
All right next we'll talk about data collection and performance measurements.
All SAMHSA recipients are required to collect and report certain data so that SAMHSA can
meet its obligations under the Government Performance and Results monitorization - Modernization
Act of 2010.
This information will be reported using SAMHSA's performance and accountability reporting systems
or SPARS.
It is expected that data collected will be collected and reported quarterly.
A national evaluation is required in order to collect outcome data and build the evidence
base for this program.
Recipients are required to participate fully in all aspects of the cross site evaluation.
This may include collection of additional client level data and participation by sub-recipients.
Details on the evaluation including type of evaluation and research questions will be
provided.
No more than 15% of the total grant award for each budget period may be used for data
collection, performance measurement and performance.
No more than 20% of total grant award for each budget period may be used for infrastructure
development.
Okay so in section five of the FOA, it describes the evaluation criteria.
Your application will be reviewed and scored according to the quality of your responses
in the following section.
Decisions to fund a grant are based on several things which include the strengths and weaknesses
of the application as identified by peer reviewers.
When the individual award is over $150,000 approval is required by the Center for Mental
Health Services National Advisory Council.
It also depends on the availability of funds, equitable distribution of awards in terms
of geography, and balance among populations of focus and program size, submissions of
any required documentation that must be submitted prior to making an award, and SAMHSA reserves
the right not to make an award to an entity if that entity does not meet the minimum qualification
standards to describe.
All right so the applications for this funding opportunity are due by 11:59 pm Eastern Standard
Time on July 9 -- oh I see a typo there -- 2018 not 1018.
All applicants must register with NIH's eRA Commons in order to submit an application.
This process takes up to six weeks.
If you believe you are interested in applying for this opportunity, start the registration
process immediately.
Do not wait to start this process.
If your organization is not registered and you do not have an active eRA Commons P.I.
account by the deadline, the application will not be accepted.
No exceptions will be made.
SAMHSA highly recommends that you submit your application 24 to 72 hours before the submission
deadline.
Many submission issues can be fixed within that time and you can attempt to resubmit.
SAMHSA will not accept paper applications except under very special circumstances.
So we want to take some time to go through some of the most frequently asked questions
that we've received thus far.
Currently we have a resource mailbox set up at CCBHC@samhsa.hhs.gov and we've received
lots of questions.
So regarding eligibility, eligible provider from planning states can apply directly to
SAMHSA.
This grant goes directly to clinics not to states.
FQHCs are eligible for the grant opportunity if they meet the certification criteria.
Certification criteria are outlined in Appendix M, CCBHC criteria compliance checklist on
page 85 of the funding opportunity announcement.
If the applicant is not already a CCBHC, they must meet the eligibility criteria within
four months of the grant award.
A little bit - lots of questions received about certification process.
So at the moment, we are asking potential applicants to review Appendix M, which is
the CCBHC criteria compliance checklist on page 85 of the FOA to self-assess their ability
to meet the requirements.
A certification process will be further clarified upon award.
And again we're just referring folks to the Appendix M to review those criteria.
And you can click on or copy the link provided to find out more information about the criteria.
As far as prospective payment system, I know we received a lot of questions about this
because the previous CCBHC grants were utilizing this payment model but for this grant the
prospective payment system or PPS will not be utilized.
So we've had some questions from folks who are already CCBHCs.
As a CCBHC you are eligible to apply for this grant program.
The FOA states that grant funds may not be used to supplant current funding of existing
activities.
So you could propose a new project or activity.
And this grant opportunity is not meant to be a continuation of your current grant project.
And as far as the national evaluation, details on the evaluation including the type of evaluation
and research questions will be provided upon award.
So there will be more to come upon award.
Okay.
So we've reached sort of the end of our presentation and we are ready to - oh okay.
So I'm hearing that we have quite a few questions in the mailbox.
And so I think we're going to start with answering those questions.
(David Devorney): Sure.
Hi my name is (David Devorney) and I work with Joy here in our - in the Center for Mental
Health Services and we did get quite a few questions in from the mailbox already and
we'll try and run through those quickly.
So thank you for submitting those.
So our first question in the mailbox was will receiving CCBHC status prohibit an organization
from taking FQHC status?
And the answer is no.
Those are completely separate processes.
Second question we received is the CCBHC site/office specific, county specific or organization
specific?
The CCBHC is how you define it.
You know, there are different configurations of organizations that can apply to be CCBHCs.
The important part is that you meet the eligibility criteria that Joy has already outlined which
is to be in the 24 states to be a clinic that can meet the certification criteria with four
months of award.
Thanks.
Next question is if a CCBHC in one county is wholly - is a wholly owned satellite offices
in other counties are they still considered part of the CCBHC?
Again it's how you define the CCBHC.
The important part is that however your organization is configured, it can meet the certification
requirements.
Does a CCBHC have to accept patients without payer sources for inpatient psychiatric services?
CCBHCs have to serve anybody who walks through the door.
That is a condition of participating in the grant.
So I'm sorry.
Our colleague (Dave Morrissette's) going to jump in here.
(Dave Morrissette): Yes.
Yes in the criteria they talk about making services both available to anyone based on
their ability.
You can't exclude people based on their ability to pay or where they live.
So the criteria in the (unintelligible) here.
(David Devorney): Does the budget have to include all expenses and revenue for the CCBHC
reflecting all services?
No.
I think the budget we'd be looking for along with the grant would be the - about how you're
going to use these grant funds.
We understand that there is probably a significant portion of the operations of your clinic that
would not be included within the budget.
The announcement - there's a question about the announcement.
The announcement means 25 clinics or do they mean individual clinics or agency organizations
and do we apply by site or by agency?
Is it $2 million per site or agency?
So again it's however you define the CCBHC that meet the eligibility criteria.
And each CCBHC that you define is - can apply as long as they meet that eligibility criteria.
And it is $2 million per CCBHC application and that's $2 million per year for two years.
And it's up to $2 million.
So you don't have to apply for that full amount if you don't want to.
Next question, if you are not yet a CCBHC would you only begin seeing clients after
the fourth year and certification or would you be expected to see clients right away
while you're working toward certification?
(Dave Morrissette): I think they meant fourth month.
(David Devorney): Oh fourth month.
Did I say?
Okay sorry.
Fourth month.
The, you know, we anticipate that these would be operating clinics already.
And so you probably would be providing services to clients.
We'd like to see the grantees ramp up their activities to be able to meet certification
and within four months.
But, you know, we don't expect that you, you know, provide the CCBHC services before the
four months but it probably from an operational standpoint would make sense to get things
online as quickly as you can to meet that certification requirement.
Please elaborate on the required service of assertive community treatment.
Does an applicant need to have an ACT team in place prior to the grant?
Can grant funds be used to develop an ACT team?
So you can develop your capacity for ACT team in house.
You can also contract out through a direct collaborating organizations to provide ACT
team services.
If three CCBHCs wish to submit a joint application, can all three be primary applicants or do
we need a lead CCBHC with DCO?
So, you know, as I said before it's one award per applicant and if you want to take three
clinics and have them band together to provide the comprehensive set of services laid out,
I think that's an okay approach but there would be one award.
(Dave Morrissette): Yes and what I would also have to say that that - there has to be a
sole organization…
(David Devorney): Right.
(Dave Morrissette): …that's providing all of these services.
So they'd have to within that four months become certified and become a single organization
from three clinics.
If they were independent to begin with, that's a lot to do in four months.
I don't know how they could become a single organization within four months.
(David Devorney): Right.
And I think if they want to arrange it and so there's one clinic that is the lead and
then they have the other two clinics participating as DCOs as long as they meet the certification
requirements in that arrangement.
(Dave Morrissette): Yes but you - the single organization remember under the criteria has
to provide the…
(David Devorney): Core services.
(Dave Morrissette): …the core services.
So that can't be opted out to DCOs.
(David Devorney): Right and so it - there's more detail on what's in the list of core
services, you know, on - under the expectations section of the FOA, page eight and nine and
then also within the certification criteria as well.
Okay.
You mentioned you must have two years of experience providing the services.
Does that mean that all of the expected services must have been delivered in the past two years?
Joy Mobley: You should (unintelligible).
So in terms of the applicant must having two years of experience of providing those services
as of the due date of the application.
So if it's due July 9, you should have been already providing mental health services for
the past two years up until July 9.
If you started a year ago providing mental health services or substance abuse services,
then you do not meet that criteria.
(Dave Morrissette): You know, I was wondering if they were speaking specifically about sub-categories
like ACT as well…
(David Devorney): I think that's a good question.
(Dave Morrissette): So I'm thinking…
(David Devorney): I think we may have to have some internal conversation about this and
then get back to you on it.
So please if you have this question, submit a question to the mailbox at CCBHC@samhsa.hhs.gov
and we'll provide you more specifics on that question.
If my state only participated in the planning grant without implementing, through what entity
would seek to certify us as a CCBHC within sort of four months?
SAMHSA will be providing additional information about this CCBHC certification process on
award.
For now, we are asking that folks take a look at the checklist included in the appendices
of the FOA to ensure that they will have the ability to meet those certification criteria
should they be awarded.
With regards to the DCO, we have a CCBHC DCO for primary healthcare monitoring with a local
mental health - medical clinic that is not a behavioral health substance abuse provider.
According to DCO guidance, are there onsite nurses and physician oversight excluded as
DCO providers?
(Dave Morrissette): Oh so is the question if you have a nurse onsite at the CCBHC like
as a - who's a kind of a contracted DCO…
(David Devorney): Right.
(Dave Morrissette): …does that…
(David Devorney): Within the DCO…
(Dave Morrissette): …exclude the DCOs somehow.
(David Devorney): I don't believe so.
I think it's fairly common to have DCOs providing services in a number of sites.
This is a fairly specific question, so it might be worthwhile you following up and emailing
the mailbox and we can try and make sure that we're getting to the heart of what your question
is.
I see people have been sending in questions also on the mailbox while we've been.
So we're not sure we're catching up to questions in time to.
Please give an example to clarify the bullet titled see a certified CCBHC already.
Can you go back to the last slide?
Joy Mobley: Oh sure.
(David Devorney): So I think this is if an applicant - you're talking about that fourth
bullet under eligibility if an applicant is not already a CCBHC.
So there are eight pilot states that were included in the Medicaid pilot and some of
those states already have clinics which have been certified as CCBHCs by a state.
That's what we mean when we talk about already a CCBHC.
What is the state's role in reporting?
What is the state's role going to be overall?
Can providers report out all requirements without state assistance?
We anticipate that there will be minimal involvement by states with the CCBHC expansion grants.
States aren't - we don't anticipate that states will be involved in certification and, you
know, we don't involve - we don't expect that states will also be involved in reporting.
So we're not anticipated a major in certification or reporting.
We've been including questions about a PPS rate.
Will it be made available at a later date?
And also if a FQHC has become a CCBHC how the two PPS rates would coincide?
I need to be 100% clear about this.
This grant has nothing to do with eligibility for the PPS rate or for the enhanced match
that applies to the Medicaid pilot.
Participating in this expansion grant, you know, the CCBHC expansion grant it has - there's
no relationship and it doesn't in any way make you eligible for those Medicaid services
- for those Medicaid benefits.
Can you comment on this part of the certification process?
Will a grantee go through its existing state process or a different federal process?
As I said, we're still - we'll make more details about that process available upon award and
don't anticipate that states will be involved significantly.
Are providers and non-designated CCBHC able to apply for this opportunity, for example,
Illinois?
So there's a list of the 24 states that are eligible to apply under the eligibility criteria.
I'll refer you to that list.
(Dave Morrissette): And Illinois is one of them.
(David Devorney): And Illinois is one of them, yes…
Joy Mobley: (Unintelligible) state.
(David Devorney): Are providers in non-designated CCBHC - oh sorry I just read that one.
Can the provide - sorry.
Can the program evaluator also be a data analyst employee?
I'm not sure what a data analyst employee is.
You may want to email us that question and we'll try and answer it specifically.
(Dave Morrissette): So another interpretation is does the person who is evaluating the effort
locally, can they also be an employee within the CCBHC?
(David Devorney): I believe yes.
There's no…
(Dave Morrissette): There's no exclusion.
(David Devorney): …exclusion for that.
Do FQHCs gain any benefits by obtaining the CCBHC designation?
Not in terms of your FQHC status.
We do think the $4 million that you would be eligible for should you, you know, get
this grant is a significant benefit and hopefully will enable you to provide more comprehensive
services to a greater population of people.
So yes I hope you take that into consideration.
The FOA states that collaboration with the state behavioral health and Medicaid authorities
is expected.
What are the roles, functions, expectations of the state agencies?
Again we would like to see these clinics work with their state to address issues such as
sustainability and, you know, ensure that their public programs are coordinated and
are part of a - as a part of the broader health system.
But we don't expect, you know, we don't have strong expectations for state participation
because we don't - aren't providing specific funding to states as a part of this opportunity.
(David Devorney): Do we need to add costs for the site approval process?
I'm not sure.
Maybe you can follow-up with the CCBHC mailbox.
We just need a little bit more detail on what you mean by your question.
Regarding certification is the state required to provide certification or is all attested
to by the organization?
As I said, it's a separate federal process for certification for the expansion grants,
this opportunity.
So the state is not required to participate in that process.
One second.
Are current CCBHC clinics in PA required to have access grant factors not required currently?
Yes.
The current CCBHC doesn't wave the requirements that are included in this FOA.
In the absence of the PPS, will the payment model be for this round of funding?
As I said, this is a grant funded opportunity.
You know, the benefit of applying is the ability to provide expanded services as a result of
receiving these grant funds.
What section of the narrative should include the sustainability plan?
Sorry we're flipping through that part - portion of the FOA.
I'm just glancing at the page here.
I'm not seeing exactly what the reference in the question is to.
If you could email us that question offline, I would really appreciate it.
Can the funding for services be used to subsidize Medicare funding for OMHC services or office
(unintelligible)?
I am not sure.
I don't know but we would like to go back and explore this question further.
So please email the mailbox about it.
(Dave Morrissette): So long as it doesn't - I mean so what does that mean to - so are
they sort of asking if they can add it to their existing Medicaid funding to provide
a specific service do you think?
(David Devorney): It's a - Medicare is what they referenced.
(Dave Morrissette): Oh Medicare?
(David Devorney): So I'm not - again I'm not 100% sure but I think this is one route we
may want to make sure we're getting this right.
So I'd ask you to email the mailbox.
Our state was awarded a planning grant but then pulled out as a provider in the state.
Can we still apply?
So I - just so we're clear, it's the 24 states that participated in the planning grant that
are listed in the FOA that are eligible to apply.
What is the state's role if any in this grant for your post award?
You know, we certainly want to see strong relationships between states and these clinics
and we expect the clinics to work with the state as part of the expectations in the grant.
But there aren't specific expectations of the state related to the program.
Will the GPRA adult collection tool be required to be collected at baseline six months in
discharge or is it every six months and just a six month post baseline?
So the GPRA adult collection tool will be collected at baseline at six months and every
six months until discharge - and at discharge.
Is the funding inclusive of the CCBHC certification?
If you're asking if we expect you to spend separate - a pot of money on CCBHC certification
out of the dollars provided to the grant award, the answer is that at this moment no we don't
anticipate that but further details about the certification process will be provided
post award.
Does the CCBHC designation make organizations eligible for any special grant funds?
Well there are the grant funds that are available through this award.
So again I'll refer you back to the $4 million over to here.
(Dave Morrissette): You know, sort of going back to that question.
(David Devorney): Sure.
(Dave Morrissette): I think what my understanding is that the applicants or the grantees actually,
you know, once they're awarded the grantees are going to certify themselves.
And some - probably the federal government, SAMHSA, will be verifying that they've certified
properly.
Would that be the correct way to put it?
It would be verifying the certification.
So we're expecting the clinics to certify themselves by those - by that four month period.
(David Devorney): Yes.
So we expect that clinics will review that checklist and the certification criteria and
make sure that you are eligible - you are able to meet all of those criteria by four
months of award.
(Dave Morrissette): Right.
(David Devorney): And so we do expect you to do, you know, a thorough review to make
sure you meet the criteria.
That's the expectation that if you apply and receive this award.
(Dave Morrissette): So four months ago you will have met all of the - you could go down
that list and check every one of those boxes.
(David Devorney): Exactly.
You know, we are trying - we are right now thinking about our review process to confirm
that certification, so…
(Dave Morrissette): Right.
But should we come two months after that, that's too late.
They need to meet those certification standards four months.
(David Devorney): Right.
Exactly.
So the expectation is that if we sent a team of folks out to your clinic, you know, four
months from award you'd be ready to walk through that checklist with them and check up all
the boxes.
Does the CCBHC designation make organizations eligible for any - oh sorry I just read that
one.
Oh sorry.
Can these funds be used for integrated onsite medical care that Medicaid cannot be billed
for?
So one of the services provided for is outpatient primary screening and monitoring are key health
indicators and health risk.
There is more detail on the different services included in the certification criteria.
I'd refer you to those about the kind of scope of services that we'd expect you to use grant
funds to pay for.
So and if you have specific questions, of course we'd always appreciate if you can follow
up on the mailbox if that doesn't answer your question.
Another question, if not PPS what funding mechanism?
Again this is an opportunity to apply for the $2 million a year for two years of grant
funding - up to $2 million a year.
Is a top to bottom organization transfer required - transformation required if awarded funding?
We expect you to meet the certification criteria and whatever you need to do to do that is,
you know, what our expectation is for this opportunity.
I will say there is that two year service requirement.
And so if you are trying to stand up all these services at once and you are, you know, a
provider that's trying to do that, that may be a little bit ambitious.
So I anticipate the folks will do the best with this opportunity.
It will be people who already have a fairly robust set of services available and are,
you know, filling in some gaps with the grant funds, sure DCOs or other methods to meet
the CCBHC requirement - certification criteria requirement.
That being said, the eligibility criteria is fairly clear.
And so, you know, I'd refer you back to that criteria as far as eligibility.
But try to - I hope that answers your question about, you know, whether a transformation
would be required.
Is money available for rental assistance and respite beds along with staff to support housing
projects?
(Dave Morrissette): I think typically SAMHSA grants have prohibited funding for housing
services.
(David Devorney): Yes.
(Dave Morrissette): I'll have to see if they do in this - in the new FOAs.
(David Devorney): I think, you know, for the actual housing, you know, as far as kind of
the supportive housing services that go along with it.
(Dave Morrissette): Support housing services, yes.
Right.
That would be allowed…
(David Devorney): Allowed, right.
That would be allowed.
You state that the P.I. and evaluator are key staff members.
Do we need to have an evaluator identified prior to being awarded a grant or is an evaluation
strategy acceptable?
Joy Mobley: The evaluator is key staff.
So they would need to be included in the application.
(Dave Morrissette): Yes section D of the evaluation criteria asks them to provide a complete list
of staff positions including key personnel, project director, and evaluator.
Joy Mobley: Right.
(Dave Morrissette): So they wouldn't score very well if they didn't include that…
Joy Mobley: Right.
Exactly.
(David Devorney): Next question, in Oregon the state requires 20 hours of primary care
per week.
This service is not covered by current CCBHC funding.
So can this funding be used to cover these medical costs initially?
You know what?
It sounds like outpatient primary care, you know, on page nine of the FOA is says that,
you know, one of the services outpatient primary care screening and monitoring of key health
indicators and health risk.
So if that is what you're describing, you know, that is an acceptable use of the grant
funds.
And also I'll just refer you to the certification criteria, which has a little bit more detail.
(Dave Morrissette): The treatment is not considered a - is not a CCBHC service but the screening
is.
(David Devorney): Right.
(Dave Morrissette): The monitoring and the connecting.
(David Devorney): Right.
(Dave Morrissette): The medical.
(David Devorney): For new CCBHC, does the non-federal amount in the budget template
equal to service dollars received for services?
Can this be used for underfunded services?
We're a little unclear on exactly what the question is.
Just one thing I'll say on this and Joy covered this in the presentation.
There's not a matching requirement for this opportunity.
And if you could follow up with the question to mailbox, we'll try and answer your question
more specifically.
Do you consider providers that were certified by which - by a planning grant state that
was not selected for the demonstrated - considered to be a CCBHC for the purpose of this grant
opportunity?
No.
You know, all programs participating in this opportunity whether they have been certified
or not previously are expected to meet the certification criteria within four months
or to be able to meet those within four months of award.
Are we allowed to need a primary care partner or a mobile primary care service at an outlying
clinic?
Yes.
In Los Angeles, the Department of Mental Health has a 24/7 crisis response team which have
cleared for after hour crisis service call to them.
Does that count as the state certified crisis system in required services?
(Dave Morrissette): They should ask the state that question.
Joy Mobley: Yes.
(David Devorney): Yes.
Please check with your state.
(Dave Morrissette): Yes likely - yes but likely.
(David Devorney): It's likely but please check with your state.
Do you anticipate this opportunity being available in FY'18 or FY'19?
You know, honestly we don't have any information about future linear awards for this type of
opportunity.
Can grant funds be used to cover services not reimbursed by Medicare or services not
served - not services not especially covered by an individual's health insurance plan,
in other words services paid for by Medicare and Medicaid but not sufficiently covered?
So in general I think, you know, we do prefer that our grants cover services that are not
paid for by other methods, other third party payment systems.
And so, you know, I think it would be appropriate to use this opportunity to fund services within
the scope of services included in the FOA that are not covered by other payment sources.
If you have a specific service or question that you'd like us to address, again please
email the mailbox.
Thank you very much.
(Dave Morrissette): Well if somebody were eligible for Medicaid, if you - if they were
seeing somebody who was eligible for Medicaid we expect them to enroll them in Medicaid.
(David Devorney): Absolutely and, you know, just to follow that example a little bit further,
if their Medicaid benefits package covers some but not all of the services included
in the required services under the CCBHC, you know, we would expect that you would use
the dollars from this grant to perhaps cover those services that they were eligible to,
you know, for under their Medicaid package.
The idea is this should wrap around existing funding streams.
Can you cap the consumers served based on funding availability?
Right, you can cap the consumer served based on funding availability, right?
(Dave Morrissette): You know, I think what that means…
(David Devorney): I think
(Dave Morrissette): (Unintelligible)…
(David Devorney): One second.
We're going to have a little conference.
(Dave Morrissette): During the…
(David Devorney): So we prefer if you could email the email box with that question at
CCBHC@samhsa.hhs.gov.
Can grantees collect data on required performance measures using any assessment they would like
or is there a standard assessment you must use like SPARS?
We will expect that folks use the SAMHSA anonymous documents for collecting their information.
And we have our own data system, SPARS which we'll use to collect that information.
What type of involvement from the state Medicaid agency is required?
Again there is no specific requirement on state or state agencies for this announcement
but we would like to see cooperation with the state if possible.
I understand that anybody can be served by a clinic, but does the individual also have
to be required to meet our existing mental health and substance use disorder criteria?
(Dave Morrissette): Hey (unintelligible).
(David Devorney): So, you know, the funds should be used to provide the services under
the CCBHC criteria.
Those are services designed to help people mental and substance use disorders.
And so these are - we would expect that those folks would likely have - meet criteria for
having mental or substance use disorders or be at 3H risk of having something that requires
behavioral health services.
Can we use telepsychiatry for an ACT team and request funding for telepsychiatry?
(Dave Morrissette): Is that part of - is that an ACT component that we know of?
Is telepsychiatry currently used in ACT programs?
(David Devorney): I think it's typical.
(Dave Morrissette): Yes.
I don't think that would fulfill its fidelity to the ACT model.
(David Devorney): So we'd have to refer you back to the ACT model.
There's an ACT toolkit on the SAMHSA Web site.
If you go to SAMHSA Web site, go under publications and search for A-C-T toolkit.
There's more detail about, you know, what is included under the ACT model.
Will the physical health measures such as cholesterol be collected every 6 or 12 months?
Do they get entered into the IPP indicators or along with individual participant baseline
and follow-up interviews?
This is a pretty specific question.
I think we, you know, would prefer if you'd ask these kind of specific data collection
issues to the CCBHC mailbox.
And I will also say, you know, we require people to participate in the data collection
activities that are part of SAMHSA's non-SPARS efforts.
And those are kind of subject to change over the years.
And so no, you know, we might be able to provide you with some specifics of how the system
is now but those requirements do change from time to time.
Are we allowed to utilize a partner as a DCO who specializes in veteran services to meet
the eligibility criteria?
Yes.
Can CCBHC's funding be used to supplement existing program funding, for example, not
being able to scale a continuum of services currently funded but not funded adequately
for 24/7 model?
Yes you can use these funds to scale the continuing of services to meet the CCBHC certification
criteria.
Were all the state entities and behavioral health managed care organizations notified
of this opportunity for providers and their states?
If so, were they on the board for the expansion - were they onboard for the expansion?
(Dave Morrissette): Not this one.
(David Devorney): They were not consulted specifically.
You know, we are providing the information for this opportunity on our Web site and also
through activities such as this webinar.
(Dave Morrissette): We followed the statute.
(David Devorney): We attempted to follow the statute as closely as possible in implementing
this program.
For an FQHC that is not yet a CCBHC in California, are we eligible to apply to become such?
Will SAMHSA assist in the certification process?
So once again, this is - this clarification is only for this grant opportunity, the CCBHC
expansion grant.
And certification under this opportunity, you know, is just for your participation in
this grant opportunity.
It does not assist you in becoming certified as CCBHC for the purposes of the CCBHC Medicaid
pilot.
Can the funds be used to expand and enhance CCBHC services to specific populations or
to include those services not covered under the CCBHC payment?
Yes.
You can use the service to expand services and enhanced services to specific populations
and to kind of fill in gaps in your services however they're paid for to meet the certification
criteria services for the population that you're serving.
Does the applicant need to include dollars in the budget to pay for the national evaluation
or will that be provided by SAMHSA?
SAMHSA is separately funding the national evaluations although you all need the support
data collection and quality - and program - sorry and performance measurement activities
as a part of your grant funds as outlined in the funding opportunity announcement.
And as a part of that, you may be required to cooperate with the national evaluation.
After the two year grant program, what are SAMHSA's expectations related to how grant
services will be sustained?
That is an extremely broad question.
You know, there's a lot of answers to that.
It's part of the reason we think it is important for clinics to reach out to the states as
a part of this opportunity.
I'm sure that'll be a topic of intense conversation over the next two years.
And I wish we had time to go into a more full conversation around that.
But I'm glad that you are thinking about sustainability at this point because it's important to think
about that as a part of the application process and through the life of the grant.
Will certification have to be granted by the state or will there be an alternative?
We are going to be providing more details about the certification process after award.
We don't anticipate that the state will be significantly involved.
What documentation is necessary to demonstrate a state-sanctioned designated crisis behavioral
health or the designed CCBHC area?
(Dave Morrissette): They should look at the checklist and criteria.
(David Devorney): So please check the CCBHC criteria.
It has more detail on that issue.
(Dave Morrissette): If they have more questions, they can email that in…
(David Devorney): If you have any questions, please email the CCBHC mailbox.
If it's required that anybody seeking care be served by - oh sorry - served by the CCBHC
doesn't the individual need to often meet our existing criteria for mental health substitute
disorders diagnosis?
Yes…
Joy Mobley: Yes.
(David Devorney): Yes.
Thank you.
If a provider cannot meet the criteria in four months or cannot offer all the required
services, what is your take on the future expansion opportunity to legislative process?
So, you know, I don't have a crystal ball into the legislative process at the national
level.
I know there's a lot of interest in this program, but there's just not much I can say about
that.
I will say I really hope people try and be realistic about whether they can meet these
criteria.
It is a very ambitious undertaking and I think we want to see these awards go to people who
can really meet this certification criteria.
So sorry, I just don't have any insight into the future - the developments in - legislative
developments related to CCBHCs.
Can you provide additional information about the requirements to serve better in?
If you go to the CCBHC certification criteria, there is a more full description of what we
mean by that than what's included in the FOA on page nine and so I'd refer you to that
language.
If you still have questions, please feel free to email the mailbox.
Does your state have to collaborate in the CCBHC process?
That is, can an agency apply without any involvement by their state?
Yes.
The application process is direct from the clinic level.
You don't have to have any involvement from the state.
That being said, we would appreciate any FRQ can before it's once awarded to work with
your state around issues like sustainability.
Can a CCBHC contract with a DCO to provide 24/7 crisis services?
There is detail about that in the certification criteria.
So…
Joy Mobley: Is it a core service?
(David Devorney): It's a core service but there are some places where there is an established
crisis services…
(Dave Morrissette): Right.
(David Devorney): …process that's been established by the state…
(Dave Morrissette): By the state, right.
(David Devorney): And in those areas, it is possible for the CCBHC to use a DCO or another
organization to do that.
But they have to make sure that it's certified by the state.
And there is more detail about that in the certification checklist.
(Dave Morrissette): Yes and consulting the state I think would be very smart.
(David Devorney): Yes.
If your agency has one office in its five county offices in a state that is not one
of the 24, can your agency certification allow you to offer CCBHC services in a non-24 state?
I'm sorry this opportunity is only available to the 24 states who participated in the planning
grants for CCBHCs.
Can grant funds be used to offset losses for services performed, i.e. revenues that do
not cover costs or commercial insurance, doesn't cover services such as peers, i.e. such as
peers sort of community treatment, etcetera.
Yes.
You know, this is to support the operation of those types of services that are included
in the certification criteria.
When you stated clubhouse under social support, is that the clubhouse international model?
Tenly Biggs: Yes.
This will be the clubhouse model that was first founded by the one in New York City.
(David Devorney): Fountain House?
Tenly Biggs: Yes.
Fountain House.
Thank you (David).
(David Devorney): And, you know, again for these types of specific questions, I think,
you know, the safest thing to do is to go back and look at the certification criteria.
Next.
Are providers in Illinois able to participate in this?
Yes.
Illinois is among the 24 states eligible to apply.
Must the CCBHC provide or contract with a DCO for residential or inpatient substance
abuse treatment or detox?
(Dave Morrissette): I - that's a - I know that's one of the more difficult crisis response
kinds of questions.
I think there's more detail in the criteria and that would be a mail it into the mailbox
question as well.
(David Devorney): Yes.
Thanks.
If it has to do ACM and ACM levels.
Where is the list of the CCBHCs now?
I think you're referring to the CCBHCs participating in the Medicaid pilot.
There isn't an online list currently published of those CCBHCs, the 56 clinics that are participating
in this program.
(Dave Morrissette): They're also eligible to participate in this program, but it's not
limited to those 66 clinics.
(David Devorney): Exactly.
If you are experiencing for - if you have experience for two plus years providing clinical
services to populations but adding any of these that you have less than two years of
experience providing is that a problem?
We don't believe so but I think and this question came up earlier.
We thought that we would want to double check our rules around that.
And so please send a - that same question to the mailbox.
(Dave Morrissette): Can I sort of - can we go offline for a moment?
(David Devorney): Sure.
One second.
(Dave Morrissette): All right.
Hold on everybody.
(David Devorney): We're going to hold on for one second, sorry.
(Dave Morrissette): All right.
(David Devorney): Just for the sense is that, you know, it's really the requirement is that
they'd be in - be providing services for two years.
But there are - you can expand your scope of services under this program.
(Dave Morrissette): To a new EBP.
(David Devorney): Especially, you know, around filling the requirements of the certification
criteria.
So I'm sorry.
We did anticipate that we would be answering questions over the phone during the webinar.
We still have - we've been through about half the questions that were submitted through
the online system and we are at the end of our time for the webinar.
All I can do is, you know, thank you for your time and, you know, we will attempt to answer
further questions through the CCBHC mailbox.
Once again that's CCBHC@samhsa.hhs.gov.
And please submit any remaining questions that you might have to the mailbox.
I hope this has been helpful and, you know, we really appreciate your interest in this
program.
And thank you for your time and attention.
We know it's a difficult process to get through these applications.
And, you know, we really appreciate your interest.
So thanks very much.
Joy Mobley: Thank you.
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