FY 2014/2015 Behavioral Health Funding Opportunities

FY 2014/2015 Behavioral Health Funding Opportunities On July 31, 2014, $54.6 million were awarded to 221 health centers through the Behavioral Health Integration (BHI) Funding opportunity. The BHI funding was a competitive funding opportunity to improve and expand the delivery of behavioral health services through the establishment and/or enhancement of an integrated primary care behavioral health models at existing Health Center Program grantee sites. This will include bringing on behavioral health providers, and Plan for achieving or enhancing a fully-integrated primary care and behavioral health services model of care that includes the use of screening, brief intervention, and referral to treatment (SBIRT) and other evidence-based practices and the use of a team-based, integrated model of care.

Also, in early June 2014, HRSA released the FY 2014 Affordable Care Act Health Center Expanded Services (ES) supplemental funding opportunity. $14 million were release to 240 existing health centers looking to expand behavioral health services provided.

On November 6th, an additional $51.3 million in Affordable Care Act funding was released to support 210 health centers in behavioral health integration.  HRSA-14-110 ACA - Service Expansion in Behavioral Health Integration

 Expanding Behavioral Health Services to the Safety-Net Webinar

Behavioral Health Related Performance measures All HRSA-funded health centers are required to report Screening Brief Intervention and Referral to Treatment (SBIRT) services delivered via the Uniform Data System (UDS) on an annual basis. Currently, 17% of health center grantees are providing SBIRT services.

Additionally, the UDS 2014 also includes a new depression screening and follow-up clinical quality measure which will encourage health centers to implement routine depression screening for all patients age 12 and older using a standardized tool and documented follow-up.

Patient-Centered Medical Home and Behavioral Health Through supplemental funding opportunities under the ACA, HRSA has advanced the adoption and recognition of the patient-centered medical home (PCMH) model in health centers. In the PCMH model, enhanced access and continuity; planning and managing care; providing self-care and community support; and tracking and coordinating care are emphasized. All of these factors are important in successful behavioral health intervention and treatment as well as primary care.  Advancing Behavioral Health Integration within NCQA Recognized Patient-Centered Medical Homes reviews the National Committee for Quality Assurance's (NCQA) patient-centered medical home (PCMH) standards and how they relate to the integration of behavioral health into primary care. HRSA-supported safety-net providers who have integrated behavioral health services can use this resource as a guide when preparing to apply to be recognized as a PCMH with NCQA.  NCQA’s Patient-Centered Medical Home 2014 is an innovative program for improving primary care. The 2014 standards include heightened expectations that recognized practices support patients’ behavioral health, including via collaboration with “behavioral health care providers and communication of behavioral health care capabilities to patients.”  "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home." Published in the March, the new document complements the Joint Principles of the Patient- Centered Medical Home (PCMH) and was created to address bringing behavioral health into the PCMH model.

Integration Models  The Center for Integrated Health Solutions’ (CIHS) Standard Framework for Levels of Integrated Healthcare is a six-level framework that can be used for planning; creating a common language to discuss integration, progress, and financing; supporting assessment and benchmarking efforts; explaining integration efforts to stakeholders; and clarifying differences in vision between two or more partnering organizations.  Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.

Financing & Billing  The Business Case for the Integration of Behavioral Health and Primary Care addresses the business case for integration of behavioral health into primary care and provides guidance on how to evaluate this business case at an individual health center.  CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work.  Managed care and managed behavioral healthcare play a critical role in the delivery of behavioral healthcare services. Whether Medicaid, Medicare, or commercial insurance, primary care providers need to know how to effectively participate in managed care networks. How to do the Managed Care Dance – What You Need to Know to Participate in Networks shares how to effectively apply and gain acceptance on managed care provider panels.  Behavioral Health Homes for People with Mental Health & Substance Use Conditions: The Core Clinical Features helps prepares organizations to become health homes by outlining the essential clinical features.  The Center for Health Care Strategies state highlights map provides a state-by-state look at how state agencies, health plans, and other organizations are participating in Medicaid Health Homes.

Clinical Tools  As primary care providers integrate behavioral health into their clinical services, universally screening patients for mental health and substance use conditions is often the first step in the process. A variety of screening tools can be used as part of the collaborative care model for depression care and SBIRT model to address substance use.  Brief interventions are evidence-based practices design to motivate individuals at risk of substance abuse and related health problems to change their behavior by helping them understand how their substance use puts them at risk and to reduce or give up their substance use. CIHS offers several brief intervention resources that includes brief screening questions health practitioners can ask during brief intervention.  CIHS' 3-part webinar series — Helping People Embrace Behavior Change in Healthcare Settings provides primary and behavioral healthcare staff strategies to support individuals’ readiness for health-related behavior change using motivational interviewing.  Medication assisted treatment (MAT) is the use of pharmacological medications, in combination with counseling and behavioral therapies, to provide a ‘whole patient' approach to the treatment of substance use disorders. Research indicates that a combination of medication and behavioral therapies can successfully treat substance use disorders, and for some people struggling with addiction, MAT can help sustain recovery.

Operations Practices  AHRQ's new Care Coordination Measures Atlas lists existing measures of care coordination, with a focus on ambulatory care, and presents a framework for understanding care coordination measurement. The Atlas is useful for evaluators of projects aimed at improving care coordination and for quality improvement practitioners and researchers studying care coordination.  As community-based primary and behavioral health care providers come together to better meet patient needs by integrating services and sharing staff, there are practical considerations such as contracting and partnership agreements that will help community health organizations transform from clinical models of integration into truly integrated practices. Workforce Development  The CIHS Core Competencies for Integrated Behavioral Health and Primary Care provide organizations and individual professionals a “gold standard” for the skill set needed to deliver integrated care. They represent the long-term goal of workforce development for professionals with careers in integrated care.  In all disciplines there is supervision provided if required for licensure or practice requirements. However there is added focus on supervision in behavioral health for issues of self –care, clinical assistance, and professional development. As disciplines integrate and work as a single team, supervision models are shifting and having to blend cultures. CIHS has several resources to achieve successful integrated supervision.