Request for Applications Practice Transformation Small Grants Fund Open to Practices Participating in the First SIM Practice Transformation Cohort

Supported with Funds from The Colorado Health Foundation and the Center for Medicaid and Medicare Innovation

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Contents Request for Applications .................................................................................. 1 Practice Transformation Small Grants Fund ............................................................ 1 Summary .................................................................................................. 3 Available Funding ........................................................................................ 4 Use of Funds .............................................................................................. 4 Unallowable Use of Funds .............................................................................. 5 Applicant Mandatory Qualifications ................................................................... 6 Application Process ...................................................................................... 6 Application Evaluation .................................................................................. 6 Application Timeline .................................................................................... 7 Expectations of Awardees .............................................................................. 7 Payment ................................................................................................... 8

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Summary The Colorado SIM Office has established a Practice Transformation Fund to support SIMparticipating primary care practices in implementing innovative strategies that advance integration of physical and behavioral health care. The Practice Transformation Fund currently totals $6.125 million, including $3.125 million of SIM funds from the Center for Medicare & Medicaid Innovation (CMMI) and an additional $3 million from a grant by The Colorado Health Foundation (TCHF). Primary care practices participating in the first SIM practice transformation cohort may apply for competitive small grants from either the SIM Funding Stream or the TCHF Funding Stream – applicants may not apply to both funding streams. Small grants from the SIM Practice Transformation Fund are intended to assist practices in achieving the goals and milestones outlined in their practice improvement plan, developed in collaboration with their supporting Practice Transformation Organizations. Examples of the potential uses of these funds include, but are not limited to, the following: Awards from the SIM Funding Stream may be used for:    

Training and onboarding of clinical staff; Upgrades and customizations to existing technology to support integrated care; Methods to foster patient and family engagement in integrated care; and/or Methods to foster better coordination and referral to specialty mental health settings.

Awards from the TCHF Funding Stream may be used for:  Capital costs to support renovations of clinical and/or team space that foster integrated, collaborative care;  Seed funding to support the hiring (or contracting) and initial salary expenses for behavioral health clinicians; and/or  Technological solutions to support systematic screening for behavioral health problems. Primary care practices participating in a SIM practice transformation cohort may apply for competitive small 2-year grants of up to $40,000 total. The request can be made from the SIM funding stream or the TCHF funding stream, but not both. A practice may apply for funds that exceed $40,000 dollars, but such grants will only be made in exceptional circumstances, or may be recommended for funding at a reduced amount. Small grants will be made in addition to SIM participation payments of up to $5,000 that practices will be eligible to earn separately. Grant funds are intended to cover start-up costs of resources and activities that advance integration and cannot be funded through practice participation payments or enhanced payments from health plans alone. Applicants will be selected through a competitive process based on the overall quality of the application, the likelihood that the project will help the practice achieve the practice transformation milestones, and practice need, including the needs of the practice’s target population and the demonstrated need for the project. As the designated recipient and administrator of SIM funds, The Colorado Department of Health Care Policy & Financing (the Department) will administer grants made through the Practice Transformation Fund.

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Available Funding The SIM Office anticipates awarding a total of $2 million during the first round of applications, with approximately $1 million available for applicants to the SIM Funding Stream and $1 million available for applicants to the TCHF funding stream. It is anticipated that a greater number of applicants may apply to the TCHF funding stream, potentially making this application pool more competitive than the SIM application pool. Aside from a small proportion of funds that will be used to cover administrative costs associated with grant management, the SIM Office plans to disburse the remainder of the Practice Transformation Fund through two additional funding opportunities in 2017 and 2018 that coincide with the onboarding of second and third cohort SIM practices. Practices in the first SIM cohort will not be eligible to apply for the 2017 or 2018 funding opportunities. Primary care practices participating in a SIM practice transformation cohort may apply for competitive small 2-year grants of up to $40,000 total. The request can be made from the SIM funding stream or the TCHF funding stream, but not both. A practice may apply for funds that exceed $40,000 dollars, but such grants will only be made in exceptional circumstances, or may be recommended for funding at a reduced amount. Small grants will be made in addition to practice participation payments ($5,000) that all SIMparticipating primary care practices will receive upon completion of the required activities outlined in their Practice Participation Agreement, signed with the University of Colorado in order to participate in SIM. However, failure to complete these requirements may result in the practice’s forfeiture of any small grants awarded through the Practice Transformation Fund, in addition to forfeiture of the associated participation payments.

Use of Funds Small grants from the SIM Practice Transformation Fund may be used to support activities that foster integration via one or more of the focus areas listed below. Please note that the following project examples are meant to provide general guidance on activities and are not inclusive of all activities that may be funded under a given focus area. Practices may apply for grants to support activities under multiple focus areas, but can only apply to funds from one funding stream. All proposed activities must fit within at least one focus area.

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SIM FUNDING STREAM Focus Area Potential Project Example Training and onboarding of new and/or Sending new or existing staff to training to existing clinical staff. learn new skills, such as motivational interviewing, Screening, Brief Intervention, and Referral to Treatment (SBIRT). Upgrades and customizations to existing Adding custom templates to an existing EHR technology to support integrated care. to improve documentation and workflow for depression care. Methods to foster patient and family Creating and sustaining a Patient and Family engagement in integrated care. Advisory Council that informs the practice’s efforts related to integrated care. Methods to foster better coordination and Creating better linkages (personal and referral to specialty mental health settings. technological) with medical neighborhood partners, such as Mental Health Centers, psychiatrists, and substance use treatment centers to successfully refer patients that require specialty mental health services. OR TCHF Funding Stream Focus Area Potential Project Example Seed funding to support the hiring (or Hiring a behavioral health provider to contracting) and initial salary expenses for provide services to patients on site. behavioral health clinicians Capital costs to support renovations of Refitting an existing space to serve as a clinical and/or team space that foster private location for behavioral health integrated, collaborative care consultations. Refitting existing space to promote team-based care. Technological solutions to support Purchasing tablets for patients to complete systematic screening for behavioral health behavioral health screenings in the waiting problems. room.

Unallowable Use of Funds Funds cannot be used for the following activities: 

To lobby or advocate for changes in Federal and/or state law.

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For “political expenditures” as defined in Section 4955 of the Tax Code.

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To conduct research.

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To provide services, equipment, or support that are the legal responsibility of another party under Federal or state law (e.g., vocational rehabilitation, criminal justice, or foster care) or under any civil rights laws. Such legal responsibilities include, but are not limited to, modifications of a workplace or other reasonable accommodations that are a specific obligation of the employer or other party. Page 5 of 8

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To pay for the use of specific components, devices, equipment, or personnel that are not integrated into the entire service delivery and payment model proposal.

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For any activities that are not legal under federal and/or state law.

Funds from the SIM funding stream must comply with all rules and regulations outlined in the SIM Funding Opportunity Announcement (pay special attention to page 40), the HHS Grants Policy Statement, and 2 CFR Part 200. In particular, funds from the SIM Funding Stream cannot be used to cover food of any sort, be it for meeting expenses or otherwise, and cannot be used to fund FTE, renovations, or direct services.

Applicant Mandatory Qualifications 1. The applicant will be a primary care practice that has a signed practice agreement in place indicating the practice’s participation in SIM practice transformation activities. 2. The applicant must be up to date on completing any practice assessments or activities expected of them at the time of the application, as indicated on the SPLIT dashboard. 3. Applicants who receive funds from the $3 million component of the Practice Transformation Fund provided by TCHF must demonstrate that they serve Medicaid and/or Medicare clients.

Application Process Each applicant must submit all required application materials in order to be considered for an award. Completed applications must include the following: 1. Application Packet: a. Cover Sheet b. Application Narrative c. Completed Project Plan 2. Completed Budget: a. Year one budget b. Year two budget 3. W-9 Applications should be submitted to [email protected] by May 31, 2016. Each email should have three attachments: the Application Packet, Completed Budget, and W-9. The Application Packet MUST be attached as a PDF and the budget MUST be attached as an Excel document. Scanned application packets or budgets will NOT be accepted.

Application Evaluation All applications will be evaluated in the following manner: 1. A review will occur to confirm that the applicant meets the mandatory qualifications stated in the “Applicant Mandatory Qualifications” section above and that the applicant has included all components necessary to deem the application complete. Applicants that do not meet the mandatory qualifications will be disqualified and the remainder of the application will not be evaluated. 2. An application evaluation committee will be established by the SIM Office to review and evaluate all proposed projects. No parties other than the application evaluation Page 6 of 8

committee, the SIM Office, and the Department will be involved in evaluating application responses, recommending awards or finalizing awards. 3. Each proposed project will undergo a thorough evaluation process. Applications will be scored based on the following criteria: a. The demonstrated need for the project (e.g. does the project serve a population in high need of the intervention?). b. Likelihood that the funding will help the practice achieve the practice transformation milestones. c. Overall quality of the application. Please note that the Colorado Procurement Code does not apply to this grant and therefore the decision of the evaluation committee is final.

Application Timeline The following table summarizes the schedule for this application. KEY ACTIVITIES

TARGET DATE1

Application Form Issued

April 25

Questions From Applicants Due via Email

May 6

Applicant Webinar

May 10 at 12:00 p.m.

Applications Due

May 31

Award Notification

June 30

Anticipated Contract Start Date

August, 2016

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Dates may be revised at the discretion of the Department.

Questions from Applicants: All applicants are encouraged to submit questions regarding any aspect of the application or grant funding. Questions should be submitted via the following form no later than Friday, May 6, 2016: https://docs.google.com/forms/d/1k6yfNQBGlXnS6QlwZYfhHHypLx1Jx8gT0_ihu1q4STI/viewfo rm?usp=send_form. Questions and responses will be posted by the SIM Office to www.colorado.gov/healthinnovation/sim-pt-fund no later than Friday, May 13, 2016. Applicant Webinar: All applicants are encouraged to attend an informational webinar on https://cc.readytalk.com/r/cgkmd2swv3kk&eom. Please register for the webinar through the aforementioned link by May 9. Applications Due: A complete application must be submitted via email by May 31, 2016. Late applications will not be considered. It is the responsibility of the applicant to ensure that applications are completed in the manner described in the “Application Process” section on or before the application due date and time. Award Notifications: All practices will be notified via email of their award status by June 30, 2016.

Expectations of Awardees All awardees will be expected to submit an annual report outlining their progress toward the milestones outlined in the project plan. Page 7 of 8

Certain awardees may be asked to present information regarding their project at Collaborative Learning Sessions or during other events. In order to maintain grant funding, all practices must be in good standing and complete all activities necessary to receive practice participation payments, as stated in the Practice Participation Agreement in a timely manner. These activities include: 

Participation of two attendees at all biannual Collaborative Learning Sessions.

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Quarterly submission of Clinical Quality Measures.

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Participation in the SIM Evaluation process, including completion of all required assessments.

Payment The Department will issue a purchase order for the work to award recipients. The purchase order contains terms and conditions that may not be modified by the recipient and the Department will not enter into negotiations with recipients regarding the terms and conditions. Terms and conditions of the purchase order are available for review online at: https://www.colorado.gov/pacific/osc/purchase-order-terms-conditions. The Department will reimburse the submission of an invoice that coincides with the budget as stated in the purchase order. The Department will not reimburse any expenses incurred before the date the agreement is fully executed. All grant funds must be expended by January 31, 2018, and reported to the Department by February 15, 2018. Carry over of unspent funds cannot be guaranteed from year one to year two. Therefore, applicants must budget as accurately as possible for year one and year two funds. The applicant should only include the amount the practice intends to spend between August, 2016 and January, 2017 in the year one budget, as the SIM Office cannot guarantee that unspent funds can be carried into the following year. Payments in year two are dependent on the renewal of the SIM cooperative agreement with the Center for Medicare and Medicaid Innovation. Awardees must submit an updated budget in order to receive second year funds.

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