Allowable Activities/Use of Funds:

Grant applicants must use funds to support evidence-based models of integrated care listed below. If an applicant is requesting funding for a model not listed below, additional documentation of appropriate evidence to support their selected model will be required. Grant funding may support launching an entire model, or it may support the addition, expansion, or improvement of a particular aspect of a selected evidence based model.

Accepted Evidence-Based Integrated Behavioral Health Models:

Collaborative Care Models (CoCM):

These models for integrated health care employ a care team that includes 1) a primary care provider, 2) a behavioral health care manager/specialist, and 3) a consulting psychiatrist.2 These collections of models are supported by an extensive research base.

In these models, the primary care provider identifies a patient in need often through the systematic use of screening tools, and the behavioral health care manager coordinates treatment, tracks patient follow up and outcomes, supports communication with the consulting psychiatrist, and offers brief counseling. Depending on the needs of the practice, this care manager may have either generalist or focused behavioral health training (i.e. certified addictions counselor or pediatric behavioral health specialist). The behavioral health care manager stays involved with the patient for short courses of care or until connection to specialty referral can be made. The behavioral health care manager may add to the team through motivational interviewing, behavioral health education, parent coaching, addictions counseling, harm reduction counseling, and/or community referrals for patients requiring more intensive care outside the primary care practice. The primary care provider prescribes psychiatric medications and/or medications to treat substance use disorders (MAT).

The consulting psychiatrist is available for diagnostic support or treatment recommendations. In this model, the psychiatrist typically provides ad hoc consultation and participates in regular case conferences with the behavioral health care manager, though they can also directly see patients to co-manage with a primary care provider.

Efficient use of technology plays a key role in these models, and all members of the team typically use the same electronic medical record. Some team members may also be virtual and use telehealth services to see patients or to communicate with other members of the care team.

Follow-up and progress tracking is done systematically often with an electronic patient registry. Many practices using this model use their electronic registries to track a defined group of patients being treated within the model and track progress on validated monitoring tools like the PHQ-9. Most models include universal screening tools to identify mental health and substance use needs. Examples of such tools include systematic use of PHQ-4s, SBIRT, and/or AHCH’s HRSN tool during check-in. This model can be adopted to serve a general primary care population, pediatric or geriatric populations, or can be tailored to focus on those with severe mental illness and/or substance use disorders.

Models that fit in this category will be represented roughly by the psychiatry and advanced coordination and care management components of the Building Blocks Of Behavioral Health Integration. Using the Integrated Practice Assessment Tool (iPAT), these models correspond roughly to Level 6.

Primary Care Behavioral Health (PCBH)

Similar to the CoCM models, these models for integrated health care include 1) a primary care provider and 2) a behavioral health clinician or manager. This behavioral health clinician or provider may see all patients or can have more specialist training (i.e. substance use counselor, early childhood mental health specialist, or pediatric behavioral health specialist) depending on the needs of the practice. The behavioral health clinician is able to see patients for a variety of needs including for short term therapy for behavioral health conditions, episodic stressors, medically unexplained symptoms, lifestyle change support, mental health promotion, early interventions for mental health concerns, or pediatric developmental concerns. They are generally available for warm hand-offs at the time of the patient visit and curbside consultations. These types of models do not usually have an integrated psychiatry provider and rely more heavily on outside referrals and care coordination for complex cases. The PCBH may employ many of the same electronic tools for shared record keeping, screening, and referral tracking. These types of models can be adopted to serve a general primary care population or can be tailored to focus on those with severe mental illness, substance use disorders, or young children. A common example of this model is the Healthy Steps Program designed for pediatric populations.

Models that fit in this category will be represented roughly by the integrated behavioral health professional component of the Building Blocks Of Behavioral Health Integration.7 Using the Integrated Practice Assessment Tool (iPAT), these models correspond roughly to Levels 3-5.

Integrated Care for Substance Use Disorders/Medication Assisted Therapies for Addiction (MAT) in Primary Care

These models for integrated care specifically focus on providing treatment for substance use disorders in primary care settings. The primary care provider can provide counseling and medication assisted treatments for addiction (MAT) for substance use disorders as appropriate. Support for the patient and primary care provider may be provided by a behavioral health care manager, a certified or licensed addictions counselor, generalist behavioral health clinician, peer support specialist, or other professional to provide support, harm reduction counseling, coordination, follow-up, and/or referrals to community resources. Most practices use universal screening protocols to identify patients at risk for substance use disorders.

These models correspond to the Advanced Care of Substance Use Disorders component of the Building Blocks Of Behavioral Health Integration.

Remote Psychiatry Support and Behavioral Health E-Consults

In these models, behavioral health care is provided by a medical provider using psychiatry consult services to support expansion of that provider’s skills and resources. Consult services are available via telephone, e-mail, or e-consult to aid providers in diagnosis and management decisions including medication recommendations. The psychiatry consult provider gives advice and counsel, but does not typically see the patient on their own or provide ongoing care. The medical provider is ultimately responsible for the provision of behavioral health care and appropriate follow-up.

Bidirectional Integration

These models facilitate access to mental and physical health services for people with severe mental health needs with medical and psychiatry providers in the same location providing care for patients as part of one fully integrated team. Visits for patients often include seeing medical, psychology, and psychiatry providers at each visit. Care plans for the patient are developed together often in meetings or case reviews during or before/after visits for a patient.

Other

Applications for projects that do not fit within one of the above approved evidence based models will be considered. Applicants must prepare a supplemental document to describe their model and provide supplementary information that details the peer reviewed evidence and clinical best practices that support their choice of another model for integrated behavioral health care.

Award Details

There is $29,500,000 in available grant funding. The maximum award for this grant is $400,000 per award over the life of the grant. Larger grants will only be available if necessary for larger practices that can demonstrate potential for broad impact. HCPF estimates the average grant amount will be $200,000 per award. Award amounts will depend on the scope of Medicaid members served through allowable services and the number and quality of the applications. HCPF anticipates awarding up to 150 sites. Final award amounts will be determined by HCPF.  HCPF reserves the right to adjust the award amount depending on the number of applicants and award readiness.

Cost Sharing

Per the legislation, if a grant recipient is a hospital-owned or hospital-affiliated practice and reports less than 10 percent total profit, the grant recipient shall provide a 25 percent match for the awarded amount. If the grant recipient is a hospital-owned or hospital-affiliated practice that is part of a hospital system or has 10 percent or more total profit, the recipient will provide a 50 percent match for the awarded amount. If a grant recipient is a critical access hospital, the recipient will provide a 10 percent match for the awarded amount.

For more information, read House Bill 22-1302 RFA