Baltimore Substance Abuse Systems, Inc
Baltimore Substance Abuse Systems, Inc.
G R A N T A P P L I C A T I O N P A C K E T
I N S T R U C T I O N M A N U A L
FY 2014
(Do not proceed before reading all instructions)
BALTIMORE SUBSTANCE ABUSE SYSTEMS, INC.
INSTRUCTIONS FOR GRANT APPLICATION PACKET
This package is a standard application to become a vendor for a health related human services program funded in whole or part by Baltimore Substance Abuse Systems, Inc. (BSAS).
You have received an invitation to submit an application for funding of a Cost Reimbursement, Fee-For-Service or Performance BasedContract from Baltimore Substance Abuse Systems, Inc. (BSAS).
Programs should submitone (1) original (please do not staple or bind the original)and six(6) copies of the program description and budget application. Only three (3) sets of the appendices need to be submitted.
Providers should also email the budget in Excel format and program narrative in Word format to the Contract Officer at . The subject line for the email should be: “XXXFY14BSAS Grant Application Submission”. Please substitute three letters of your organization’s name for the first three letters (XXX), e.g., the subject line for the FY 2014 grant application submission of the ACME COUNSELINGCENTER could be “ACCFY14BSAS Grant Application Submission”.
Providers can obtain electronic copies of budget forms and a sample organizational chart on the BSAS website at
The budget forms located on the BSAS website mustbe used in preparing the budget application.
I.GRANT APPLICATION OVERVIEW
A.Grant Application Cover Page – FORM (BSAS – CP)
Complete entire form. Do not leave any items blank.
- Name of Organization – Enter formal, corporate or agency name
- Program Title – Specific title indicating program.
- Fiscal Year – State Fiscal Year for which funds are requested – e.g., 2014
- Grant Name(s)– Enter the grant name(s) for which funds are requested
- Submission Date – Enter date you are submitting grant application to BSAS
B.Table of Contents
See Addendum I (pg. 22) for sample Table of Contents that must be used in all applications. All pages of the Program Narrative must be consecutively numberedand should include the Table of Contents. Consecutivelynumbering of the budget application is optional.
II.PROGRAM NARRATIVE
Applicants should complete the program narrative specific to the service for which funding is being requested. Instructions for the following types of services are contained below:
1.Treatment Services (ASAM Levels 0.5-Level III.7D and/or Continuing
Care
2.Threshold to Recovery Center Services
3.Recovery Support Services
4.Buprenorphine Services
5.Criminal Justice Assessment Services
6.Department of Human Resources (DHR) Assessment Services
7.Information and Referral, Case Management, Care Coordination.
8.Prevention
III.Treatment Services (ASAM Levels 0.5-Level III.7D and/or Continuing Care
Narrative Guidelines
A.Program Description (25 pages)
If your program receives more than one treatment grant award from BSAS, only one (1) Program Description is required. Please include the following:
1.Introduction
a)Outline the structure of the services provided including population(s) targeted for services. Describe which priority populations are served, and the specific services provided to these populations. Describe how the following populations are prioritized for screening, assessment, and placement into care.
(1)Pregnant women
(2)Women with children
(3)HIV positive
(4)IV drug users
(5)Homeless
(6)Non-English speaking
(7)Hearing impaired
b)Provide a service matrix listing each BSAS funded program with
grant number(s):
(1)ASAM Level (s) of Care and/or Continuing Care
(2)Address of the site where treatment services are provided and hours of operation
(3)Total number of BSAS funded treatment slots/beds
(4)Total number of non-BSAS funded treatment slots/beds
(5)Projected number of individuals served annually by BSAS funds for each level of care
(6)Projected number of individuals served annually by non-BSAS funds for each level of care.
2.Treatment
a)Provide a detailed description of the program’s counseling and therapeutic approach to serving people seeking recovery. Include individual, group and family counseling approaches in your description.
b)Describe and outline a typical program week for a client accessing services. A program schedule must be submitted with this grant application. The schedule of activities/menu of services submitted with this application must indicate the following: hours of operation, range of the menu of services provided (clinical services, peer and recovery support services), group schedule which lists the names of all groups provided, the time the group is held, and a brief overview of the content covered within the group. Medication Assisted (Methadone, Buprenorphine& Vivitrol) programs should specify medication dosing hours. (Include all schedules with attachments)
c)Discuss how you propose to enhance, implement, and/or maintain recovery-oriented intake, screening, and assessment processes. Discuss how you will integrate the values of recovery into your screening and/or assessment tools.
d)Describe how your organization proposes to transition from the basic concepts of treatment planning to recovery-focused treatment planning. For instance, please include a discussion of how individualized plans are developed, the role of the person in recovery in that planning, and the process for reviewing and updating the plan.
e)List evidence-based, evidence-informed, and/or promising practices that yourprogram currently implements, and/or that yourprogram plans to implement in as part of service delivery. Tell us how you propose to ensure these practices will be or are being used appropriately and effectively.
f)Please describe your program’s system for communicating with the criminal justice court personnel, supervision agents and other officials regarding patient referral, treatment attendance, patient progress, and discharge planning.
g)Discuss one area in which you propose to focus your efforts in terms of including families in an ongoing meaningful way in the care and follow-up care with individuals served by your agency.
h)Describe the frequency of supervision and availability of clinical training for all direct service staff. Include any support and/or training provided to your current supervisors. Discuss support for any paid or volunteer peer support positions, including supervision and professional development opportunities.
i)All providers are required to form and facilitate a peer government/advisory board for patients and families to provide input/feedback for program planning and service delivery. Discuss two additional areas related to peer culture that your program will create or enhance in the upcoming fiscal year.
j)If your agency is accredited by a behavioral health accreditation body, please provide the name of the accrediting body. If your agency is not accredited, please describe your agency’s timeline and work plan for moving towards accreditation by July 2014.
3.Evaluation and Outcomes
a)Discuss three evaluation and/or quality improvement measures that you have implemented or propose to implement in your program.
b)Briefly discuss your program’s capability of tracking and reporting outcomes.
4.Community Involvement
a)Describe any recent efforts to enhance your program’s knowledge and understanding of the community in which you provide services.
5.Entitlement and Fiscal Management
a)Describe how patients are assessed and assisted with applying for entitlement eligibility at admission and throughout treatment.
b)Describe the program’s processes for checking entitlement status via the EVS service and subsequently ensuring payment sources are correct in Utilization Program (UP) and SMART.
c)Provide a brief description of fee collection policy to include: 1) procedures for billing and collection of charges and fees; 2) safeguarding of patient monies; 3) maintenance of required reports and patient records such as financial assessment forms; and 4) usage of sliding fee scale.
d)Include your Fee Collection Policy with attachments.
6.Organizational Chart (see attached sample)
a)Include with attachments your organizational chart showing all BSAS and non-BSAS funded positions by service funded and/or level of care.
b)List name of staff, position title, and credentials (certification or licensure if applicable).
c)For BSAS funded positions:
(1)Use plus sign (+) for any BSAS funded positions within the
same grant which are split between Levels of Care.
(2)Use the asterisk (*) for any BSAS funded positions which
are funded in more than one BSAS grant.
d)For 100% non-BSAS funded positions:
(1)List the funding source only.
B.Information Technology
1.General Data Requirements
a)Please discuss how the State data requirements listed below will be implemented in your program for all publically funded (Medicaid, HealthChoice, PAC, MCHIP, uninsured) patients in SMART. What specific strategies are used to verify data accuracy and timeliness of data entry?
(1)A complete intake, profile, admission, enrollment for every patient who has entered treatment.
(2)A complete disenrollment and new enrollment for every patient who has changed levels of care within a program.
(3)A complete disenrollment and discharge for any patient who has completely left treatment.
(4)The prescription, dispensing, and/or use of pharmaco-therapies as part of the patient’s treatment plan, entered into the medication module.
(5)Use of the electronic consent and referral when referring a patient to another agency in SMART for ongoing treatment.
(6)The first page of the SMART encounter note for all admitted patients including the type of service provided at the time of patient visit (assessment, individual, group), the length of the service (15 minutes, hour, etc.), and the funding source of that service (grant, MA, PAC, etc.). This requirement does not apply to physician or nurse visits in which a patient is receiving a medical service or visits where only methadone medication or buprenorphine is received.
2.Criminal Justice Data Requirements
a)Describe your process for ensuring Drug Court casemanagement summary notesfor all patients who are Drug Courtparticipants are entered into SMART by the 15th day and 30th day of each month at least 72-hours prior to the patient’s drug court status hearing.
C.Progress Report on FY 12 and FY 13 Goals
FY2012
List your goals and objectives for FY 2012 and describe the level of achievement for each.
FY 2013
List your goals and objectives for the first six (6) months of this year and describe the level of achievement for each. Describe your programs progress, changes and challenges to date. Include activities of your Governing and/or Advisory Board.
D.Managing for Results/ Program Goals and Objectives
FY 2014
List your goals and objectives for upcoming year for which funding is being requested. Providers should include the applicable ADAA MFR goals (see next page).
IV.THRESHOLD TO RECOVERY CENTERS NARRATIVE GUIDELINES
Proposals should be no more than 8 pages. Please use single spacing, Times Roman,
12 pitch.
A.Description of Services
1.Describe location, hours of operation, staffing, and services including days/times when specific services are offered. Please include monthly schedule of activities.
2.Describe parent organization, if applicable, and other non-Threshold to Recovery services co-located at or adjacent to Threshold to Recovery Centers.
3.List and briefly describe organizations with whom the center collaborates, services provided on-site by outside organizations, and referral arrangements for clients to obtain various services such as medical care, mental health treatment, housing, employment, etc.
4.Describe relationships and collaborative activities with the community associations and/or community members in which the center is located.
5.Describe the role of the Recovery Coach and Vocational Specialist within your Threshold program.
B.Program Highlights for Previous and Current Fiscal Years
1.Describe program highlights during FY12 and FY13 (first 6 months) including, but not limited to, the number of clients served in various services, new or redesigned services, special events, media coverage of program, and outside events that had a positive or negative impact on Threshold Center operations.
2.Describe how feedback from clients and clients’ families was incorporated into program development and services.
3.Describe collaborative activities with other Threshold to Recovery Centers.
C.Plans for Upcoming Fiscal Year
1.Describe any new services or changes to existing services planned for the remainder of FY13 or FY14.
2.Describe any planned changes in program infrastructure such as program administration, funding, staffing, facility, etc.
D.Barriers/Solutions for Clients
1.Describe outreach activities conducted to inform the public about Threshold services and to encourage more people to attend the program.
2.Describe ongoing barriers experienced by your clients that hinder recovery.
3.Describe program’s attempts to address these barriers, and available community resources or lack thereof.
E.Program Needs
1.Describe program needs in areas such as facility, staffing, training, etc. that would enable the program to better serve your clients.
F.Evaluation
1.Discuss any evaluation and/or quality improvement measures that you have implemented or propose to implement in your program.
V.RECOVERY SUPPORT SERVICES NARRATIVE GUIDELINES
Proposals should be no more than 10 pages. Please use single spacing, Times Roman, 12 pitch.
A.Description of Services
1.Outline the structure of the recovery support services provided.
2.Describe location, hours of operation, staffing, and services including days/times when specific services are offered.
3.Describe parent organization, if applicable, and other recovery services provided by your agency.
4.List and briefly describe organizations with whom the center collaborates, services provided on-site by outside organizations, and referral arrangements for clients to obtain various services such as medical care, mental health treatment, housing, employment, etc.
5.Describe relationships and collaborative activities with the community associations and/or community members in which the program is located.
B.Program Highlights for Previous and Current Fiscal Years
1.Describe program highlights during FY12 and FY13(first 6 months) including, but not limited to, the number of clients served in various services, new or redesigned services, special events, media coverage of program, and outside events that had a positive or negative impact recovery support services.
2.Describe how feedback from clients was incorporated into program development and services.
3.Describe collaborative activities with other recovery support services.
C.Plans for Upcoming Fiscal Year
1.Describe any new services or changes to existing services planned for the remainder of FY13 or FY14.
2.Describe any planned changes in program infrastructure such as program administration, funding, staffing, facility, etc.
D.Barriers for Clients
1.Describe outreach activities conducted to inform clients about the recovery support services.
2.Describe ongoing barriers experienced by your clients that hinder recovery.
3.Describe program’s attempts to address these barriers, and available community resources or lack thereof.
E.Program Needs
1.Describe program needs in areas such as facility, staffing, training, etc. that would enable the program to better serve your clients.
F.Evaluation and Outcomes
1.Discuss any evaluation and/or quality improvement measures that you have implemented or propose to implement in your program.
2.Briefly discuss your program’s capability of tracking and reporting outcomes.
VI.BUPRENORPHINE INITIATIVE PROGRAMS NARRATIVE GUIDELINES
For Existing Baltimore Buprenorphine Initiative Programs Only –
A.Description of Services - Maximum 5 pages
1.Provide a brief description of how the buprenorphine services are delivered in a manner consistent with the Baltimore Buprenorphine Initiative Clinical Guidelines (such as first dose within 48-hours of patient’s first visit, use of BBI induction protocol, integration with HealthCare Access of Maryland services, working towards transition to continuing care within 150 days, responding to patients with continued opioid or other drug use, etc.)
2.List the days and hours for buprenorphine dosing.
3.Submit a copy of your program’s most recent plan for Integrated Team-Based Treatment. Briefly describe how the program has implemented its plan, and describe any planned changes or enhancements to the plan.
4.Briefly describe your program’s procedures for helping patients to independently manage their buprenorphine prescriptions and to transition to continuing care within 120-150 days following admission to treatment.
5.Briefly describe the program’s procedures and the responsible staff who ensure accurate and timely data entry of buprenorphine patients into BSAS’s Utilization Program and SMART’s Medication Module.
VII.BUDGET
Providers are asked to submit two cost reimbursement budget packets for buprenorphine services in FY14, including (1) Buprenorphine-dedicated funds budget, and (2) Treatment block grant budget.
A.Buprenorphine-Dedicated Funds Budget - Allowable line items include:
1.Personnel
a)Physician and/or Nurse Practitioner and/or Physician’s Assistant at a level of effort equivalent to a ratio of 0.2 FTE for 75 patients annually. Maximum rate allowed for physician salary and fringe is $120 per hour. Maximum rate allowed for NP or PA salary and fringe is $90 per hour.
b)Nurse at a level of effort equivalent to a ratio of 0.5 FTE for 75 patients annually. The maximum rate allowed for a registered nurse salary and fringe is the equivalent of $94,000 per year. The maximum rate allowed for a licensed practical nurse (LPN) salary and fringe is the equivalent of $60,000 per year.
2.Fringe
3.Medication – Suboxone Translingual Film only
a)Non-Federally Qualified Health Center programs may leave blank the medication line item and line item narrative.
b)FQHC programs should include Suboxone Translingual Film in their budgets at the current 340B prices.
4.Clinical supplies – Estimated actual costs up to a maximum of $45 per patient.
5.Laboratory/Urinalysis – Estimated actual costs for uninsured clients. Required testing includes pregnancy tests for female patients, liver function tests, and point-of-care buprenorphine dip tests at a rate up to $2 per test with up to 17 tests per patient.
B.Treatment Block Grant Budget - Allowable line items include:
1.Insurance – Professional liability insurance for medical services only. The amount should be the actual cost up to a maximum of $53 per patient.