Request for Applications
Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS), a Project of the Substance Abuse and Mental Health Services Administration (SAMHSA)
Request for Applications
2014 Peer Awards for Health Reform Education
Application Deadlines:
Optional Letter of Intent: January 24, 2014 5:00 pm EST
Complete Application: February 19, 2014 5:00 pm EST
Schedule
January 2, 2014 / Request for Applications (RFA) AnnouncedJanuary 24, 2014 / Written Intent to Apply (Optional)
February 19, 2014 / Applications Must be Received by 5:00 p.m. EST
March 14, 2014 / Awardees Notified
March 28 – September 29, 2014 / Award Period
SUMMARY
The Substance Abuse and Mental Health Services Administration (SAMHSA)’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) is currently accepting applications for 2014 BRSS TACS Peer Awards for Health Reform Education. BRSS TACS is a SAMHSA project operated under a contract with the Center for Social Innovation.
The purpose of the 2014 BRSS TACS Peer Awards for Health Reform Education is to enable Peer-Run Organizations/Recovery Community Organizations in the states, District of Columbia, territories, and tribal jurisdictions located in states that have expanded Medicaid eligibility in 2014 to build and/or engage with existing statewide networks among Peer-Run Organizations/Recovery Community Organizations with the goals of:
1. Creating and disseminating among the members of these networks state or territory-specific educational materials on health reform initiated by the Patient Protection and Affordable Care Act (ACA) of 2010. This includes providing information on the state, territorial, or tribal jurisdiction’s affordable insurance exchange, expanded Medicaid program, Navigator programs, and other outreach, enrollment and treatment access services.
2. Soliciting informal information about the experiences of the providers and recipients of outreach and enrollment services during the affordable insurance exchange open enrollment period (October 1, 2013–March 31, 2014), and the year-round rolling enrollment for the state or territory’s Medicaid program. Informal information may also be gathered about the experiences of those who meet qualifying life event exemption criteria and are permitted to enroll for private coverage through the health insurance exchange outside the open enrollment period. This information will assist with collaborative efforts to identify and overcome barriers to effective outreach and enrollment services and to develop strategies to support those who are newly insured and Medicaid-eligible access treatment. The findings of these collaborative efforts will be shared as appropriate with behavioral health authorities in the state, territory or tribal jurisdiction (i.e., Single State Agency (SSA) for Substance Abuse Services, Mental Health Commissioner, or Behavioral Health Commissioner), as well as Peer-Run Organizations/Recovery Community Organizations.
Within this initiative, Peer-Run Organizations/Recovery Community Organizations are required to educate people with behavioral health conditions on the implementation of health reform in their state or territory and to understand how best to facilitate their enrollment in programs for which they eligible. This Request for Applications (RFA) invites Peer-Run Organizations/Recovery Community Organizations in the states, District of Columbia, territories, and tribal jurisdictions located in states that have expanded Medicaid eligibility in 2014 to propose activities that develop learning networks to increase peer organizations’ awareness of health reform programs and to provide effective outreach, enrollment, and treatment access assistance to individuals with mental health and substance use needs. Awardees must tailor their education activities to peer audiences.
Please Note: (1) Applications will only be accepted from Peer-Run Organizations and Recovery Community Organizations located in one of the states, District of Columbia, territories, and tribal jurisdictions in a state(s) that have expanded Medicaid eligibility in 2014. [To determine if your state or the District of Columbia, or the state(s) in which your tribal jurisdiction is located, has/have expanded Medicaid, see the listing of states at this URL: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. Territories should check the official website of the territory or contact the Medicaid Director in the territory]; (2) Organizations that received subcontract awards under the 2012 and 2013 BRSS TACS RFA for Peer Awards for Health Reform Education are eligible for the 2014 awards and are encouraged to apply.
Successful applicants will receive subcontract awards of $25,000 from the Center for Social Innovation. SAMHSA intends to fund twenty-two (22) BRSS TACS Peer Awards for Health Reform Education in 2014.
Grantees will receive technical assistance (TA) and training on:
· How the Affordable Care Act affects access to recovery support services
· Changes in eligibility criteria and enrollment procedures for affordable health insurance exchanges, Medicaid, and other programs
· Strategies for developing learning networks that can efficiently and effectively circulate and act on new information
· Best practices in outreach, eligibility, and enrollment assistance
· Strategies for building the capacity of recovery support service providers – including Peer-Run/Recovery Community Organizations – to participate in health reform activities
· Approaches to gathering, reviewing and reporting on the experiences of individuals and organizations actively engaged in outreach, enrollment, and treatment access activities
Ongoing TA—including consultation sessions, training, webinars, and an online learning community—will support organizations as they implement their projects throughout the award period.
INFORMATION ABOUT THE AWARD & HOW TO APPLY
Background 4
About BRSS TACS 4
About the Patient Protection & Affordable Care Act of 2010 5
The 2014 BRSS TACS Peer Awards for Health Reform Education 7
About the Grant Awards 9
Award Administration 9
Schedule 9
How Funds May Be Used 10
Expectations of Awardees 12
Application Guidelines 13
Evaluation Criteria 14
Eligibility 16
Intent to Apply (Optional) 16
Instructions for Submitting Applications 17
Review Process 17
Contact Information 18
Additional Resources 19
Attachment A: Cover Sheet 20
Attachment B: Certificate of Eligibility 21
Attachment C: Budget Instructions 22
Attachment D: Interim Report Template 23
Background
SAMHSA was established in 1992. In the years since, SAMHSA has demonstrated that 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 support services provides a cost-effective opportunity to advance and protect the nation’s health.
SAMHSA’s mission is to reduce the impact of mental and substance use disorders on America’s communities. To achieve this mission, SAMHSA has identified the following eight Strategic Initiatives, which focus its resources on areas of urgency and emerging opportunities:
o Health Reform
o Prevention of Substance Abuse and Mental Illness
o Trauma and Justice
o Military Families
o Recovery Support
o Health Information Technology
o Data, Outcomes, and Quality
o Public Awareness and Support
Projects carried out under this RFA will support SAMHSA’s Health Reform and Recovery Support Strategic Initiatives.
ABOUT BRSS TACS
In 2011, SAMHSA funded the Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) to promote the widespread adoption of recovery concepts and practices throughout the United States. BRSS TACS serves as a coordinated effort to facilitate the adoption and implementation of recovery concepts, policies, practices, and services, leveraging previous and current accomplishments by SAMHSA and other leaders in the behavioral health recovery movement.
Widespread adoption of recovery supports and services requires the participation of Peer-Run Organizations/Recovery Community Organizations across the country in developing and implementing new approaches to policy development, funding, infrastructure, service design and delivery, and workforce development. To this end, the 2014 BRSS TACS Peer Awards for Health Reform Education will support Peer-Run Organizations/Recovery Community Organizations create and disseminate state/territory/tribal jurisdiction-specific educational materials on health reform to Peer-Run Organization/Recovery Community Organization networks, and solicit informal information on outreach, enrollment, and treatment access experiences in order to learn about barriers to and successful strategies for providing outreach, enrollment, and treatment access support to newly insured and Medicaid enrollees with behavioral health needs, including family members and children. Findings regarding barriers to and effective strategies for providing outreach, enrollment, and treatment access support will be shared with behavioral health authorities in the state, territory and/or tribal jurisdiction as well as Peer-Run Organizations/Recovery Community Organizations. BRSS TACS and its partners will provide technical assistance support relevant to these initiatives. BRSS TACS will also convene online forums and learning communities, along with regular discussions among awardees regarding strategies and lessons learned.
ABOUT THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010
The Patient Protection and Affordable Care Act—often referred to as health reform—is changing how Americans access health care. In the coming years, these changes will affect many in previously marginalized groups, including people with substance use and mental health conditions. Key provisions of the Affordable Care Act include:
Ø Establishment of Affordable Insurance Exchanges where people who are not covered through employers or other insurance affordability programs (e.g., Medicaid) can compare insurance policies and rates and purchase coverage;
Ø Assurance that health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, offer a comprehensive package of items and services known as essential health benefits (EHB);
Ø Subsidies to low- and middle-income Americans to help cover the costs of health insurance premiums;
Ø Elimination of the practice of refusing insurance coverage based on patients’ medical histories (e.g., pre-existing conditions) and charging different rates based on medical history or gender;
Ø Expansion of eligibility for restricted eligibility programs such as Medicaid, which will enable many more low-income Americans to enroll.
A crucial feature of the Affordable Care Act is ensuring access to a core set of Essential Health Benefits (EHB) regardless of whether the patient accesses care through the Affordable Insurance Exchanges or individual and small group plans outside the Exchanges. As described in the Affordable Care Act, EHB must include items and services within at least the following ten categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental and substance use disorders services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
The benefits and services included in the benchmark health insurance plan selected by each state is the essential health benefits package for that state. Plans could modify coverage within a benefit category as long as they do not reduce the value of coverage. This approach provides maximum flexibility to states, employers, and issuers while providing comprehensive, quality coverage for consumers.
Behavioral health, including mental and substance use disorder services, is one of the ten Essential Health Benefits (EHB). The Affordable Care Act requires that covered mental and substance use disorder services must be offered in a manner consistent with the 2008 Mental Health Parity and Addiction Equity Act, which requires that the financial requirements (such as co-pays and deductibles) or treatment limitations for mental and substance use disorder benefits be no more restrictive than those for medical and surgical benefits.
The Affordable Care Act greatly expands eligibility for federal and state programs. In the case of Medicaid, the legislation fills in gaps in coverage for the poorest Americans by creating minimum Medicaid income eligibility levels and expanding access to all individuals under 65 years of age with income at or below 133% of the federal poverty level. Provided that the individual meets certain non-financial eligibility criteria, such as citizenship and immigration status, they will be eligible for benefits beginning on January 1, 2014. These criteria will replace a wide variety of Medicaid categorical groupings and limitations. The decision to expand Medicaid eligibility is a decision made at the state level. Legislative requirements to implement Medicaid expansion vary across states with some requiring authorizing language and/or budgetary authority to implement the expansion. It is important to note that according to the Centers for Medicare and Medicaid Services (CMS) guidelines, there is no deadline for states to implement the Medicaid expansion.
Individuals who do not meet Medicaid eligibility criteria may be eligible for premium tax credits to purchase coverage in a qualified health plan sold within an Affordable Insurance Exchange. To qualify, one must be an uninsured adult, 18 to 64 years old, with an income at or below 399% of the federal poverty level (FPL). In addition, many individuals under 250% of the FPL who are also eligible for premium tax credits will be eligible for additional help through the reduction in their cost-sharing (e.g., co-pay, co-insurance) responsibilities. These provisions will result in new pathways to care for those not yet in care, and will change the costs of and access to treatment for many already enrolled.
As health reform is implemented, states face the significant task of helping newly eligible people understand their options for services, enroll in health care coverage programs, purchase insurance through Affordable Insurance Exchanges, and apply for premium tax subsidies and cost-sharing reductions. States also need to address eligibility recertification and the difficulties of “churning,” and “non-seamless transitions.” “Churning” occurs when an individual is disenrolled from a program and later re-enrolls in the same program following a gap in coverage of one to six months. “Non-seamless transitions” occur when an individual is disenrolled from a program and later enrolled in a different program following a gap in public coverage of one to six months.
A specific set of innovations implemented at the state level concern consumer enrollment assistance activities, especially for individuals who will enroll in Medicaid or through Affordable Insurance Exchanges. By 2019, an estimated 29 million people will enroll in a health insurance plan through Affordable Insurance Exchanges, including employees of small businesses, self-employed people, or those who do not have access to insurance through their employers.
People who purchase coverage within plans in the Affordable Insurance Exchanges must have access to reliable information to help them compare, choose, and apply to health insurance plans. The selection of an insurance plan is facilitated by a single application for the Exchanges, Medicaid, Children’s Health Insurance Program (CHIP), and the optional Basic Health Plan. To assist in this process, the Affordable Care Act requires states to establish Affordable Insurance Exchange-funded Navigator programs. The Exchange Navigator’s job is to provide individuals and families with fair and impartial information about available insurance plans in a manner that is culturally and linguistically appropriate. Exchange Navigators also help individuals and families enroll in the health plan they select and provide referrals to an office of health insurance consumer assistance or any other appropriate agency for enrollees with complaints, coverage appeals, or other questions regarding their health plan.