BPHC HRSA-24-078 (H8N) FY 2024 Behavioral Health Service Expansion_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Bureau of Primary Health Care

Health Center Program

Fiscal Year 2024 Behavioral Health Service Expansion

Funding Opportunity Number: HRSA-24-078

Funding Opportunity Type: New

Assistance Listings Number: 93.224

PHASE 1: Application Due Date in Grants.gov: May 22, 2024 PHASE 2: Supplemental Information Due Date in EHBs: June 21, 2024

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: April 22, 2024

Casey Thomas Public Health Analyst, Office of Policy and Program Development Bureau of Primary Health Care Call: 301-594-4300 Contact: BPHC Contact Form BHSE Technical Assistance (TA) Webpage: https://bphc.hrsa.gov/funding/funding-opportunities/behavioral-health-service-expansion See Section VII. Agency Contacts for a list of agency contacts.

Authority: 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act) https://hrsa.force.com/support/s/ https://bphc.hrsa.gov/funding/funding-opportunities/behavioral-health-service-expansion http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim

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508 COMPLIANCE DISCLAIMER

Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII. Agency Contacts.

SUMMARY

Funding Opportunity Title: Behavioral Health Service Expansion (BHSE)

Funding Opportunity Number: HRSA-24-078

Assistance Listing Number: 93.224

Due Date for Applications – Grants.gov:

Phase 1: May 22, 2024 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA Electronic Handbooks (EHBs):

Phase 2: June 21, 2024 (5 p.m. ET)

Purpose: BHSE funding will support health centers to increase access to behavioral health services through starting or expanding mental health and substance use disorder (SUD) services.

Program Objectives: • Increase the number of patients receiving mental health services, and

• Increase the number of patients receiving SUD services, including treatment with medications for opioid use disorder (MOUD)

Eligible Applicants: Current Health Center Program operational (H80) grant award recipients. See Section III.

Eligibility for more information.

Anticipated FY 2024 Total Available Funding:

$240 million ($200 million in ongoing service expansion funding and $40 million in one-time, initial year funding)

Estimated Number and Type of Award(s):

400 new grants

Estimated Annual Award Amount: Up to $600,000 in year 1, and up to $500,000 in year 2

Cost Sharing or Matching Required: No

Estimated Notice of Award Date: September 1, 2024

Period of Performance: September 1, 2024, through August 31, 2026

(2 years)

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Agency Contacts:

Business, administrative, or fiscal issues:

Doris Layne-Sheffield Grants Management Specialist Division of Grants Management Operations, OFAM

Health Resources and Services Administration Call: 301-945-9881 Email: DLayne-Sheffield@hrsa.gov or

India Blankenship Grants Management Specialist Division of Grants Management Operations, OFAM

Health Resources and Services Administration Call: 301-443-0687 Email: IBlankenship@hrsa.gov

Program issues or technical assistance:

Casey Thomas Public Health Analyst, Office of Policy and Program Development Bureau of Primary Health Care Health Resources and Services Administration Call: 301-594-4300 Contact: BPHC Contact Form

• Under Funding, select Applications for Notice of Funding Opportunities, then Behavioral Health Service Expansion mailto:DLayne-Sheffield@hrsa.gov mailto:IBlankenship@hrsa.gov

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Application Guide You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this Notice of Funding Opportunity (NOFO) and the HRSA Two-Tier Application Guide. Visit HRSA's How to Prepare Your Application webpage for more information.

Technical Assistance The BHSE TA webpage includes:

• Application resources, such as forms and documents.

• Answers to frequently asked questions.

• Details about our pre-application TA webinar.

• Contact information for questions.

The HRSA-supported Health Center Resource Clearinghouse also provides training and TA resources for health centers nationwide.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-app-guide-2-tier.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.healthcenterinfo.org/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING OR MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Program-Specific Forms (Submit in EHBs)

vi. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PAGE LIMIT WORKSHEET

APPENDIX B: EQUIPMENT AND MINOR A/R REQUIREMENTS

APPENDIX C: EXAMPLE PARTNERS AND RESOURCES

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I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) announces the opportunity to apply for funding under the fiscal year (FY) 2024 Behavioral Health Service Expansion (BHSE) program. BHSE will support health centers to increase access to behavioral health services through starting or expanding mental health and substance use disorder (SUD) services.

Program Requirements

You must propose to use BHSE funds to achieve two objectives:

• Increase the number of patients receiving mental health services, and

• Increase the number of patients receiving SUD services, including treatment with medications for opioid use disorder (MOUD).

We will measure your progress using the following Uniform Data System (UDS) data:

• Table 5: Staffing and Utilization, Line 20, for mental health services.

• Table 5: Staffing and Utilization, Line 21, and Appendix E: Other Data Elements, Question 1b, for SUD services. These capture patients receiving SUD services and patients receiving treatment with MOUD.1

See Program Recommendations for more details.

2. Background

The Health Center Program is authorized by 42 U.S.C. § 254b (Title III, § 330 of the Public Health Service (PHS) Act). For BHSE, health centers are those receiving Health Center Program operational funding under sections 330(e), (g), (h), and/or (i), also known as H80 funding.

In 2021, 82.5 million adults lived with a mental health condition or an SUD. However, less than half with a mental health condition received treatment. Among those with an SUD, just 1.5 percent received treatment.2 The number of teens with depression has more than doubled over the last decade, with nearly 1 in 3 teenage girls reporting suicidal thoughts in the last year. Left untreated, these conditions are debilitating and

1 As of June 27, 2023, a DATA-Waiver is not required to prescribe MOUD. See https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act.

2 The White House. (2023). Report on mental health research priorities. https://www.whitehouse.gov/wp-content/uploads/2023/02/White-House-Report-on-Mental-Health-Research-Priorities.pdf.

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act https://www.whitehouse.gov/wp-content/uploads/2023/02/White-House-Report-on-Mental-Health-Research-Priorities.pdf https://www.whitehouse.gov/wp-content/uploads/2023/02/White-House-Report-on-Mental-Health-Research-Priorities.pdf

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life-threatening. From 1999 to 2019, overdose fatalities increased by 250 percent, while suicide rates rose by 36 percent. The rates for each continue to rise.2

As the necessity for behavioral health services increases, it is important to leverage all opportunities to respond to patients’ mental health and SUD treatment needs. In fact, in 2022, the Department of Health and Human Services (HHS) released a Roadmap for Behavioral Health Integration. It provides a path to expand access to mental health and SUD treatment and recovery services by ensuring trusted primary care providers have the resources and tools they need to help respond to patients’ behavioral health needs.

However, in 2022, health centers were only meeting 27 percent of the estimated need for mental health services among their patients, and 6 percent of the estimated need for SUD services. Although mental health conditions comprised half of the six most common diagnoses among health center patients, fewer than 9 percent of patients accessed mental health services. Similarly, although an estimated 17 percent of health center patients could benefit from SUD services, fewer than 1 percent used them.3 There is enormous opportunity to increase access to vital health care services by supporting health centers in making mental health and SUD services part of primary care.

More than ever, underserved populations seek behavioral health services in primary care settings. For many communities, the health center is their first point of access for any health care need, and therefore it is well-positioned to address barriers to care and provide access to a continuum of behavioral health services that includes treatment and recovery support.4 By building on previous Health Center Program investments, BHSE funding will further the HHS strategic objective of integrating behavioral health into primary care and aid health centers in their response to the nation’s ongoing mental health and substance use crises.

II. Award Information

1. Type of Application and Award

Application type: New.

We will fund you via a grant.

3 Health Resources and Services Administration. (2022). 2022 health center data: National data.

https://data.hrsa.gov/tools/data-reporting/program-data/national.

4 Recovery support includes a range of social, educational, legal, and other services to support long-term recovery, wellness, and quality of life. See the HHS Overdose Prevention Strategy:

https://www.hhs.gov/overdose-prevention/.

https://aspe.hhs.gov/reports/hhs-roadmap-behavioral-health-integration https://aspe.hhs.gov/reports/hhs-roadmap-behavioral-health-integration https://data.hrsa.gov/tools/data-reporting/program-data/national https://www.hhs.gov/overdose-prevention/

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2. Summary of Funding

We estimate $240 million will be available in FY 2024 and $200 million will be available in FY 2025 to fund approximately 400 awards. The period of performance is September 1, 2024, to August 31, 2026 (2 years).

You may apply for:

• Year 1 – Up to $600,000 (reflecting direct and indirect costs).

• Year 2 – Up to $500,000 (reflecting direct and indirect costs).

We may adjust the final award amounts or number of awards based on the number of fundable applications and final FY 2024 appropriations.

Support beyond the first budget year will depend on future appropriations, satisfactory progress in meeting the project’s objectives, and a decision that continued funding is in the government’s best interest.

We will award BHSE funding as a new grant award, separate from your Health Center Program operational (H80) award. Under 45 CFR § 75.302, you must document use of BHSE funds separately and distinctly from other Health Center Program funds and other federal award funds. You must maintain your H80 award status throughout the 2-year period of performance to maintain your BHSE funding.

All uses of BHSE funds must align with your H80 scope of project. Your scope of project includes the approved service sites, services, providers, service area, and target population that are supported (wholly or in part) under your total approved health center budget. You may apply for this funding even if you do not currently offer behavioral health services and would need to submit a change in scope request. See page 17 “Scope of Project” for information on how to indicate if you need to change your Form 5A: Services Provided to support your proposed project. You must comply with all Health Center Program requirements as described in the Health Center Program Compliance Manual, and applicable law and regulations.5

We will use 2025 UDS data demonstrating increases in the number of visits and patients receiving mental health and SUD services, including patients receiving treatment with MOUD, to determine funding beyond year 2.

We anticipate that funding beyond the 2-year period of performance will be based on the year 2 funding amount. If HRSA continues your funding, we may supplement this initial award and/or make further funding available under your H80 award.

5 Requirements are stated in 42 USC § 254b (section 330 of the PHS Act), and in applicable program regulations (42 CFR parts 51c and 56, as appropriate), grants regulations (45 CFR part 75), and grants policy (HHS Grants Policy Statement).

https://www.ecfr.gov/current/title-45/section-75.302 https://bphc.hrsa.gov/compliance/scope-project https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.302

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45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

III. Eligibility Information

1. Eligible Applicants

You can apply if your organization is a Health Center Program award recipient6 with an active H80 grant award.

We encourage health centers that do not currently provide behavioral health services to apply.

2. Cost Sharing or Matching

Cost sharing or matching is not required for this program.

3. Other

We may consider your application ineligible for review if it:

• Requests more than $600,000 in year 1.

• Requests more than $500,000 in year 2.

• Does not include a Project Narrative.

• Fails to meet the deadlines in Section IV.4.

Multiple Applications

We will only review your first validated application under HRSA-24-078 in Grants.gov. If you wish to change attachments submitted in a Grants.gov application, you may do so in the HRSA EHBs application phase.

You may not submit multiple applications under the same Unique Entity Identifier (UEI).

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov and EHBs. Use the SF-424 workspace application package associated with this NOFO. You must use the two-phase submission process. Follow these directions: How to Apply for Grants and those in EHBs.

6 Funded under 42 USC § 254b(e), (g), (h), and/or (i).

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://grants.hrsa.gov/2010/WebEPSExternal/Interface/Common/AccessControl/Login.aspx https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update http://www.grants.gov/applicants/apply-for-grants.html

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• Phase 1 – Grants.gov – You must submit your application via Grants.gov by May 22, 2024, at 11:59 p.m. ET.

• Phase 2 – EHBs – You must submit supplemental information via EHBs by June 21, 2024, at 5 p.m. ET.

Only applicants who successfully submit the workspace application package associated with this NOFO in Grants.gov (Phase 1) by the due date may submit the additional required information in EHBs (Phase 2). If you wish to change information you submitted in EHBs, you may reopen and revise your application before the EHBs deadline. For more details, see Sections 3 and 4 of the Two-Tier Application Guide. Note: Grants.gov calls the NOFO, “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-078 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements

Follow the instructions in Sections 4 and 5 of the Two-Tier Application Guide and this NOFO. Write your application in English. Use U.S. dollars for your budget. There’s an Application Completeness Checklist in the Two-Tier Application Guide to help you.

In Grants.gov (Phase 1), submit your:

• Application for Federal Assistance (SF-424)

• Project Abstract Summary

• Project/Performance Site Locations

• Grants.gov Lobbying Form

• Key Contacts

In EHBs (Phase 2), submit your:

• Project Narrative

• SF-424A Budget Information Form

• Budget Narrative and Table of Personnel Paid with Federal Funds

• Program-Specific Forms

• Attachments, if applicable https://www.hrsa.gov/sites/default/files/hrsa/grants/sf-424-app-guide-2-tier.pdf#page=61

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Application Page Limit

The page limit for your application is 50 pages. We will not review any pages that exceed the page limit. Using the pages within the page limit, we will determine eligibility using the Section III. Eligibility Information of the NOFO.

These items do not count toward the page limit:

• Standard OMB-approved forms in the NOFO’s workspace application package and program-specific forms in EHBs

• Abstract (standard form (SF) “Project Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that do not count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that is not in the HRSA-24-078 workspace application package or EHBs application, it may count toward the page limit. Therefore, we recommend you only use Grants.gov and EHBs workspace forms for this NOFO to avoid exceeding the page limit.

It is important to ensure your application does not exceed the specified page limit. See Appendix A: Page Limit Worksheet for additional information.

Applications must be complete, validated by Grants.gov, and submitted under HRSA-24-078 before the Grants.gov and EHBs deadlines.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals7 (for example, program director) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take actions like those in 45 CFR § 75.371. This includes suspending or debarring you.8

• If you cannot certify this, you must explain why in Attachment 1: Other Relevant Documents.

See Section 5.1.viii – Certifications of the Two-Tier Application Guide.

7 See definitions at 2 CFR § 180.995 -- Principal and 2 CFR § 376.995 -- Principal.

8 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.371 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.371 https://www.ecfr.gov/current/title-2/section-180.995 https://www.ecfr.gov/current/title-2/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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Program Recommendations

When designing your project, consider:

• The extent to which rural populations, racial and ethnic minorities, people who are uninsured, people experiencing homelessness, and other underserved groups experience higher rates of mental health conditions and SUDs and unique barriers to accessing treatment.

• The impact of stigma and discrimination on patients seeking and accessing treatment.

• Creating a comprehensive approach to behavioral health services that helps more patients access treatment and recovery and support services that address their underlying needs.

• Increasing your primary care providers’ role in use of FDA-approved medications for treatment of opioid use disorder, such as buprenorphine.

• Social risk factors like food insecurity, unstable housing, lack of or limited health insurance, linguistic barriers, financial strain, broadband issues, and limited access to transportation.9

• The existing treatment and recovery and support services in your service area, including Certified Community Behavioral Health Clinics (CCBHCs) and opioid treatment programs (OTPs), and how your proposed project will coordinate with or complement those services.

If you use broadband or telecommunications services to provide health care, discounts are available through the Federal Communication Commission’s Universal Service Program. For more information, see the Rural Health Care Program. The Affordable Connectivity Program (ACP) and Lifeline are federal programs that help eligible households pay for internet services and internet connected devices. Patients living on tribal lands may be eligible for additional benefits through ACP.

Program-Specific Instructions

Include application requirements and instructions from Sections 4 and 5 of the Two-Tier Application Guide (budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract). Also include the following:

i. Project Abstract

Use the Standard OMB-approved Project Abstract Summary Form in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information on what you must include in the Project Abstract

9 See the 2023 UDS Manual for additional information.

https://www.samhsa.gov/certified-community-behavioral-health-clinics https://www.hhs.gov/opioids/treatment/resources-opioid-treatment-providers/index.html https://www.hhs.gov/opioids/treatment/resources-opioid-treatment-providers/index.html https://www.usac.org/rural-health-care/ https://www.affordableconnectivity.gov/ https://www.affordableconnectivity.gov/ https://www.lifelinesupport.org/ https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf

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Summary Form, see Section 5.1.ix of the Two-Tier Application Guide. In addition, provide your Health Center Program grant number (H80CSXXXXX) and a summary of how your proposed project will:

• Increase the number of patients receiving mental health services, and

• Increase the number of patients receiving SUD services, including patients receiving treatment with MOUD.

NARRATIVE GUIDANCE

The following table is a crosswalk between the narrative language and where each section falls within the review criteria. Make sure you address everything. We will consider any forms or attachments you reference in your narrative during the merit review.

Narrative Section, Forms, Attachments Review Criteria

Need section Criterion 1: Need

Response section Project Overview Form: Work Plan Criterion 2: Response

Collaboration section Criterion 3: Collaboration

Resources/Capabilities section Budget Narrative Staffing Impact Form

Criterion 4: Resources/Capabilities

Impact section Project Overview Form: Work Plan Patient Impact Form

Criterion 5: Impact

Budget Narrative SF-424A Budget Information Form Equipment List Form Minor A/R Budget Justification Form

Criterion 6: Support Requested

ii. Project Narrative

This section must describe all aspects of your proposed project. Make it brief and clear.

Provide the following information in the following order. Use the section headers. This ensures reviewers can understand your proposed project.

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NEED – Corresponds to Section V. Review Criterion 1: Need

Using data, describe the following about your patient population and/or service area:10

1. The prevalence of mental health conditions and SUDs.

2. The number of people without access to mental health and SUD services.

3. The most significant barriers to accessing mental health and SUD services, including:

a. Gaps in currently available behavioral health services, for example, fragmented systems of care or workforce shortages,

b. Health-related social needs,11 and

c. Stigma and discrimination.

Example sources of needs data may include community health needs assessments, such as those from a local hospital, state or local health department, or community-based organization. The National Survey on Drug Use and Health (NSDUH) is a source for state-level data. You may also find the resources on HRSA’s How We Know Which Areas Need Health Center Services webpage helpful.

RESPONSE – Corresponds to Section V. Review Criterion 2: Response

For items 1 and 2 below, reviewers will assess your work plan in the Project Overview Form. Do not write a narrative response for these items. For instructions, see Section IV. Program-Specific Forms.

In your work plan on the Project Overview Form, propose activities that you will conduct to achieve the BHSE objectives to:

1. Increase the number of patients receiving mental health services, and

2. Increase the number of patients receiving SUD services.

For items 3, 4, 5, 6, and 7 below, write a narrative that clearly explains how your activities will:

3. Address barriers to mental health and SUD services that you described in your Need section, including:

10 One source of data is the Service Area Status at: https://bphc.hrsa.gov/funding/health-center-service-area-needs.

11 Health-related social needs are social and economic needs that individuals experience that affect their ability to maintain their health and well-being. These include needs such as employment, affordable and stable housing, healthy food, personal safety, transportation, and affordable utilities. See the HHS Call to Action: Addressing Health-Related Social Needs in Communities Across the Nation.

https://www.samhsa.gov/data/nsduh/state-reports https://bphc.hrsa.gov/funding/health-center-service-area-needs https://bphc.hrsa.gov/funding/health-center-service-area-needs https://bphc.hrsa.gov/funding/health-center-service-area-needs https://bphc.hrsa.gov/funding/health-center-service-area-needs https://aspe.hhs.gov/reports/hhs-call-action https://aspe.hhs.gov/reports/hhs-call-action

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a. Gaps in currently available behavioral health services, for example, fragmented systems of care or workforce shortages,

b. Health-related social needs, and

c. Stigma and discrimination.

4. Provide culturally responsive, patient-centered, and coordinated care to support equitable access to mental health and SUD services.

5. Serve patients who may not be able to receive care outside of your health center, for example, those who lack or have limited health insurance, those who are experiencing homelessness, or those who might otherwise not seek behavioral health care in a setting other than primary care.

6. Ensure providers are able to prescribe and manage MOUD for individuals experiencing opioid use disorder.

7. Result in improved patient outcomes, for example, UDS measures related to mental health and SUD services, and address underlying patient needs, for example, housing stability, food security, or transportation.

COLLABORATION – Corresponds to Section V. Review Criterion 3: Collaboration

Describe how you will partner with other organizations to:

1. Receive referrals for individuals who need mental health and/or SUD services.

2. Refer patients with complex needs to inpatient care and supportive community-based programs, such as Certified Community Behavioral Health Clinics, as needed.

3. Train and support your personnel to provide or expand access to treatment with MOUD, for example, through collaborations with addiction medicine experts and fellows, providers who support access to opioid use disorder treatment, and others.

4. Establish agreements, workflows, and health IT supports to facilitate timely and secure communication of patient information between provider teams and care settings.

5. Link patients to navigators or community health workers that provide care management services should they need to move through different care settings.

See Appendix C: Example Partners and Resources for a list of potential partners who may support your project.

RESOURCES/CAPABILITIES – Corresponds to Section V. Review Criterion 4:

Resources/Capabilities

Based on your Response section and Budget Narrative, describe:

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1. How you will apply your health center’s experience with either starting a new line of service or providing mental health and/or SUD services to successfully implement your proposed BHSE project.

2. The skills and expertise of the personnel you describe in your work plan and budget narrative, including their capability to provide operational and clinical oversight for the BHSE project.

3. Training and TA resources external to your health center that you will use to support your proposed project.

See Appendix C: Example Partners and Resources for a list of training and TA resource examples.

IMPACT – Corresponds to Section V. Review Criterion 5: Impact

Patient Impact

1. In your Patient Impact Form in EHBs, provide your baseline patient data, including if it is zero and you are proposing starting services in your application, for the following:

a. 2023 Mental Health Services Patients (UDS Table 5, Row 20)

b. 2023 SUD Services Patients (UDS Table 5, Row 21)

c. 2023 Patients Receiving Treatment with MOUD (UDS Appendix E, Question 1b)

2. In your Patient Impact form in EHBs, estimate how many additional patients will receive mental health services, SUD services, and treatment with MOUD as a result of BHSE funding in calendar year 2025. For instructions, see Section IV.

Program-Specific Forms.

3. In your Project Narrative, explain how you determined your 2025 additional mental health, SUD, and MOUD patient estimates and how your calendar year 2025 estimates are achievable by December 31, 2025.

Quality Improvement

4. Describe how you will use your Quality Improvement/Quality Assurance (QI/QA) program to support the changing mental health and/or SUD services needs of your patients and service area.

5. Describe how you will incorporate improving patient outcomes into your QI/QA program. Examples of outcomes include UDS measures related to mental health conditions and SUDs12 or other relevant outcomes based on identified needs.

12 See Table 6B: Quality of Care Measures in the 2023 UDS Manual for more information.

https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf#page=93

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SUPPORT REQUESTED – Corresponds to Section V. Review Criterion 6: Support Requested

For a list of forms and documents that reviewers will evaluate for this section, see the Narrative Guidance table. Ensure your request is consistent between all forms and documents. Do not include a Support Requested section in your Project Narrative.

iii. Budget

Follow the instructions in Section 5.1.iv Budget of the Two-Tier Application Guide and any specific instructions listed in this section. Your budget should show a well-organized plan.

Reminder: The total project or program costs are all allowable (direct and indirect) costs13 used for the HRSA activity or project. This includes costs charged to the award and non-federal funds.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 5.1.v Budget Narrative in the Two-Tier Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

You may use up to $250,000 in year 1 for the following costs:

• Minor alteration/renovation (as defined in Appendix B: Equipment and Minor A/R Requirements, the total federal and non-federal cost of the alteration/renovation project must be less than $1,000,000, excluding the cost of moveable equipment), and/or

• Moveable equipment that costs $5,000 or more.

You may also want to consider how non-recurring costs such as professional development and consultants would support your project since you may request more funding in year 1 than in year 2.

Your total budget must:

• Include the amount of BHSE funds to be awarded (up to $600,000 in year 1, and up to $500,000 in year 2).

• Include all non-federal funds that will support your proposed project.

13 For details on allowable costs, see 45 CFR part 75 at https://www.ecfr.gov/current/title-45/part-75.

https://www.ecfr.gov/current/title-45/part-75

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• Comply with all related HHS policies and other federal requirements.14

• BHSE funding may support eligible syringe services programs (SSPs) costs.

SSPs are an effective public health approach to reduce the spread of infectious diseases and to link individuals to SUD services. Under federal law and policy, federal funds may not be used to purchase sterile needles or syringes for the hypodermic injection of any illegal drug. For guidance on using federal funding to support SSPs, see Department of Health and Human Services Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016 and the HRSA-Specific Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016. See Attachment 1: Other Relevant Documents for additional requirements.

All activities must be carried out consistent with Health Center Program requirements as described in the Health Center Program Compliance Manual, including those associated with Chapter 9: Sliding Fee Discount Program and Chapter 17: Budget.

Program Income

The non-federal share of the project budget includes all program income sources such as fees, premiums, third party reimbursements, and payments that are generated from the delivery of services, and from other revenue sources such as state, local, or other federal grants or contracts; private support; and income generated from fundraising, and donations/contributions.

In accordance with Section 330(e)(5)(D) of the PHS Act relating to the use of non-grant funds, health centers shall use non-grant funds, including funds in excess of those originally expected, “as permitted under this section [§ 330],” and may use such funds “for such other purposes as are not specifically prohibited under this section [§ 330] if such use furthers the objectives of the project.”

Specific Instructions

As required by the Further Consolidated Appropriations Act, 2024 (P.L. 118-47), Division D, Title II, § 202 As required by the, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Effective January 2024, the salary rate limitation is $221,900. As required by law, salary rate limitations may apply in future years and will be updated.

14 See Chapter 17: Budget of the Compliance Manual.

https://www.cdc.gov/hiv/pdf/risk/hhs-ssp-guidance.pdf https://www.cdc.gov/hiv/pdf/risk/hhs-ssp-guidance.pdf https://files.hiv.gov/s3fs-public/hhs-ssp-hrsa-guidance.pdf https://files.hiv.gov/s3fs-public/hhs-ssp-hrsa-guidance.pdf https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-9.html#titletop https://bphc.hrsa.gov/compliance/compliance-manual/chapter17 https://bphc.hrsa.gov/compliance/compliance-manual/chapter17

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Budget Information Form (SF-424A)

Complete the Budget Information Form in EHBs. The budget information in these sections must match the total cost of your BHSE project for year 1, except Section E, which records year 2.

• Section A – Budget Summary: Under New or Revised Budget, in the Federal column, enter the federal funding requested for year 1 (up to $600,000) for each type of Section 330 funding that you currently receive. The types are:

o Section 330(e) Community Health Center o Section 330(g) Migrant Health Center o Section 330(h) Health Care for the Homeless o Section 330(i) Public Housing Primary Care

We will award funding based on your current H80 award proportions. Enter all other project costs in the Non-Federal column. Leave the Estimate Obligated Funds column blank.

• Section B – Budget Categories: Enter an object class category (line item) budget for year 1, broken out by federal and non-federal funding. The amounts for each category in the Federal and Non-Federal columns, as well as the totals, should align with your Budget Narrative. You may request up to $250,000 for equipment and/or minor A/R. If you request funds for equipment, include the amount on the equipment line. If you request funds for minor A/R, include the amount on the construction line.

• Section C – Non-Federal Resources: Enter all sources of funding for year 1 except for the federal funding request. The total in Section C must be consistent with the Non-Federal Total in Section A. When providing Non-Federal Resources by funding source, include other federal funds supporting the proposed project in the “other” category.

• Section D – Forecasted Cash Needs: Leave this section blank.

• Section E – Budget Estimates of Federal Funds Needed for Balance of the Project: Enter the federal funding request (up to $500,000) for year 2 in the First column. The other columns must remain $0.

• Section F – Other Budget Information: If applicable, explain amounts for individual object class categories that may appear to be out of the ordinary in Direct Charges. Enter the type of indirect rate (provisional, predetermined, final, fixed, or de minimis) that will be in effect during the period of performance.

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iv. Budget Narrative

BHSE requires a detailed budget narrative that outlines federal and non-federal costs by object class category for each requested 12-month period (budget year) of the 2-year period of performance. The sum of line-item costs for each category must align with those you present in your SF-424A Budget Information Form. See Section 5.1.v of the Two-Tier Application Guide.

For year 2, the narrative should highlight the changes from year 1 or clearly indicate that there are no substantive changes. See the BHSE TA webpage for an example Budget Narrative.

Your budget narrative must:

• Show that you will use BHSE funds to meet the BHSE objectives.

• Clearly detail proposed costs for each line item on your SF-424A Budget Information Form, Section B, with calculations for how you estimated each cost.

• Not include ineligible costs.

• Not exceed $250,000 in equipment and/or minor A/R costs.

• Provide us with enough information to determine that you will use BHSE funds separately and distinctly from other Health Center Program support (for example, H80 awards).

• Include a Table of Personnel to be Paid with Federal Funds, as shown in the Two-Tier Application Guide.

• Align with your minor A/R project budget justification and Equipment List Form if such funding is requested. See Appendix B: Equipment and Minor A/R Requirements for details.

All contractual arrangements must be appropriate for health center oversight of the proposed project and include any contractors and sub-recipients.

Format the budget narrative to have all columns fit on an 8.5 x 11” page when printed.

v. Program-Specific Forms (Submit in EHBs)

For Phase 1, you will submit the required SF-424 information through Grants.gov. For Phase 2, you will submit supplemental information through EHBs.

Project Overview Form (Required)

Work Plan

You must complete the work plan to outline your proposed 2-year project. A sample work plan is available on the BHSE TA webpage.

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The work plan includes the following fields:

BHSE Objective – Select the BHSE objective that each activity will address. You must propose at least two activities for each objective.

Focus Area Field – Select one focus area for each activity you propose:

• Access and Affordability

• Quality, Patient Care, Safety, and Integrated Services

• Workforce

• Patient Experience

Activity Category Field – Select one activity category for each activity you propose.

You must propose at least one Treatment activity for each objective.

• Treatment

• Recovery and Support

Activity Field – You must write in at least one activity for each activity category you select. There is no maximum number of activities you can propose.

Health Center Program Operational Grant Number

Enter your Health Center Program grant number where indicated (H80CSXXXXX). This is an eligibility requirement.

Scope of Project

Evaluate your current scope of project in light of your proposed project.15 Use the TA materials on our Scope of Project webpage and contact your H80 program specialist to determine if a scope adjustment or change in scope is necessary.

To evaluate your scope, review the following:

• Form 5A – Services Provided: Consider if your work plan may require a change in service delivery methods. For example, if you will need to add SUD services for the first time.

• Form 5B – Service Sites: You will need to add a site if you propose to use BHSE funds to purchase a mobile unit. You must request a change in scope to add the new mobile site to Form 5B. You cannot add a site other than a mobile unit.

15 You can view your scope of project in the Approved Scope section of your H80 grant folder in EHBs.

https://bphc.hrsa.gov/programrequirements/scope.html

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To complete this section of the form:

• Indicate if you need to change your Form 5A: Services Provided or Form 5B:

Service Sites.

• Provide an overview of the change(s) along with a timeline for making the necessary request(s).

• Submit your scope adjustment and change in scope requests outside of your BHSE application, and obtain approval before adding a new service, service delivery method, or site. Allow 60 days for HRSA to review your request.

Once we approve your new service or site, you may use BHSE funds to support it. You may submit your scope adjustment or change in scope while your application is under review.

Staffing Impact Form (Required)

A sample Staffing Impact Form is available on our BHSE TA webpage.

List only personnel you will support with BHSE funds on this form. Enter all direct hire personnel and/or contractor FTEs that will support increasing the number of mental health and SUD patients. You will allocate all personnel time by function among the positions listed.

Patient Impact Form (Required)

See the BHSE TA webpage for a sample Patient Impact Form and the 2023 UDS Manual Instructions for Table 5: Staffing and Utilization and Appendix E: Other Data Elements.

2023 Baseline Behavioral Health Services Patients

Instruction: Enter your calendar year 2023 UDS data for the following:

1. Mental Health Services Patients (UDS Table 5, Line 20)

2. SUD Services Patients (UDS Table 5, Line 21)

3. Patients Receiving Treatment with MOUD (UDS Appendix E, Question 1b) https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf#page=55 https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-manual.pdf#page=55

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New Behavioral Health Services Patients

Instruction: Estimate your increases in patients as a result of BHSE funding. Your estimates should be the number of patients you expect to receive services in 2025 who were not receiving the services in 2023.

If an individual will be a new patient for more than one behavioral health service, count the patient for each service. For example, record a new mental health services patient who is also a new SUD services patient in both items 4 and 5, respectively.

4. New Mental Health Services Patients (UDS Table 5, Line 20)

5. New SUD Services Patients (UDS Table 5, Line 21)

6. New Patients Receiving Treatment with MOUD (UDS Appendix E, Question

1b)

We will measure increases in the number of patients receiving SUD services by adding together the SUD services patients and patients receiving treatment with MOUD.

We’ll use patient increases to assess your achievement of the BHSE objectives when we determine funding beyond the 2-year period of performance.

2025 Behavioral Health Services Patients

Instruction: Using your baseline and new patient data, EHBs will calculate the following:

7. Mental Health Services Patients

8. SUD Services Patients

9. Patients Receiving Treatment with MOUD

Patient Target Impact

Instruction: Enter the number of estimated unduplicated new patients (new to your health center) you will serve in 2025 as a result of BHSE funding.

Count each estimated new patient only once, even if some new patients are expected to receive more than one service (for example, mental health and SUD services).

10. Unduplicated Estimated New Patients

Note: We may add your estimated new, unduplicated health center patients to your H80 patient target if your BHSE award continues beyond the 2-year period of performance.

See the SAC TA webpage for patient target resources.

https://bphc.hrsa.gov/funding/funding-opportunities/service-area-competition

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Form 1B: Funding Request Summary (Required)

Before you complete Form 1B, complete your SF-424A: Budget Information Form. See Section IV.2.iii Budget.

BHSE Federal Funding Request

Form 1B prepopulates your BHSE funding request from Section A of your SF-424A Budget Information Form.

• You may apply for up to $600,000 in year 1.

• If you need to change the amount, edit the Total Federal Funds requested for year 1 in Section A of your SF-424A.

Equipment and Minor A/R Funding

• You may request to use up to $250,000 of your year 1 federal request for equipment and/or minor A/R.

• If you need to change the amount, edit the Total Federal Funds requested for equipment and construction (minor A/R) in Section B of your SF-424A.

• Select if you will use such funds for:

o Equipment purchases (no minor A/R) o Minor A/R with equipment o Minor A/R without equipment o Not applicable (no equipment or minor A/R funding request)

• If you select equipment, the Equipment List Form will be available for you to complete.

• If you select minor A/R, the Minor A/R Project Cover Page and Other Requirements for Sites Forms will be available for you to complete.

Note: If you change your selected funding option, EHBs will delete information from all funding forms that no longer apply.

Equipment List and Minor A/R Forms (if applicable)

Equipment and minor A/R forms will only display if you selected them under Equipment and Minor A/R Funding in your Form 1B: Funding Request Summary. See Appendix B:

Equipment and Minor A/R Requirements.

vi. Attachments

Provide the following attachments in the order we list them.

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Most attachments count toward the application page limit. Indirect cost rate agreement and proof of non-profit status (if it applies) are the only exceptions. They will not count toward the page limit.

Clearly label each attachment. Upload attachments into the application. Reviewers will not open any attachments you link to.

Attachment 1: Other Relevant Documents (as applicable)

• Upload your indirect cost rate agreement.

• If you propose to use BHSE funds to support an SSP, you must submit supporting documentation. For more information, see the Health Center Program Compliance Frequently Asked Questions.

• Include other relevant documents to support your proposed project.

• Do not upload more than five files.

3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

A UEI is required to apply for this funding. You must register in the SAM.gov to receive your UEI.

You cannot use a Data Universal Numbering System (DUNS) number to apply. For more details, visit the General Service Administration’s UEI Update webpage.

After you register with SAM, maintain it. Keep your information updated when you have:

• An active federal award,

• An application, or

• A plan that an agency is considering.16

When you register, you must submit a notarized letter naming the authorized Entity Administrator.

We will not make an award until you comply with all relevant SAM requirements. If you have not met the requirements by the time we’re ready to make an award, we will deem you unqualified and award another applicant.

If you already registered on Grants.gov, confirm that the registration is active and that your Authorized Organization Representative (AOR) has been approved.

To register in Grants.gov, submit information two systems:

16 Unless 2 CFR § 25.110(b) or (c) exempts you from those requirements or the agency approved an exemption for you under 2 CFR § 25.110(d)).

https://bphc.hrsa.gov/compliance/health-center-program-compliance-faqs?categories=All&keywords=ssp https://www.gsa.gov/entityid

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• System for Award Management (SAM) | (SAM Knowledge Base)

• Grants.gov

Effective March 3, 2023,…