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  5. BHSE Frequently Asked Questions

BHSE Frequently Asked Questions

Read this along with the Behavioral Health Service Expansion (BHSE) notice of funding opportunity and example forms. Find these and additional technical assistance resources on Apply for FY 2024 Behavioral Health Service Expansion.

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Work plan

Why do you require treatment services in the work plan?

For many communities, health centers are the first point of access to any health care service. To support more patients receiving behavioral health services, you must propose at least one mental health treatment activity and at least one substance use disorder (SUD) treatment activity in your BHSE work plan. 

(Added: 4/30/2024)

How can I use health center services to implement recovery and support activities in my project? 

Recovery and support can include enabling services, such as transportation or translation services. It can also be case management services, such as eligibility assistance to support patient access to programs for health-related social needs.

Examples include:

  • Working with street medicine groups, housing programs, drop-in centers, and emergency rooms to create a system for referrals to your health center for people who need behavioral health services
  • Making your pharmacy an authorized drug collection site for safe disposal of unused or expired medications
  • Hiring staff to provide family support such as parenting services, family therapy, or services for children of parents with a mental health condition or SUD
  • Developing programs to reduce stigma related to mental health conditions and SUDs

Visit Recovery and Recovery Support for more ideas.

(Added: 4/30/2024)

How can I use BHSE funds to increase patients’ access to treatment with medications for opioid use disorder? 

One way to do this is by expanding your pharmacy’s role in administering MOUD (formerly known as medication-assisted treatment or MAT). Your pharmacists may dispense buprenorphine, naltrexone, and naloxone without a prescription from another provider, in accordance with state law. In addition, you can offer patient education and resources to support patients’ consistent engagement in their treatment plans.

(Added: 4/30/2024)

Patient impact

Can I apply for BHSE funding if my health center’s 2023 UDS data does not include any mental health, SUD, or MOUD patients?

Yes. We encourage you to apply for BHSE funding to start providing mental health services, SUD services, and MOUD. Your baseline data on the Patient Impact form can be 0 for any or all of these services. 

(Added: 4/30/2024)

How will you measure my progress toward the BHSE objectives?

We’ll use UDS data. 

To decide funding beyond year 2, we’ll use 2025 UDS data showing increases in the number of visits and patients receiving mental health and SUD services, including patients receiving MOUD. 

See Apply for FY 2024 Behavioral Health Service Expansion for a sample Patient Impact Form.

(Added: 4/30/2024)

Do I need to project a minimum number of patients in my Patient Impact Form?

No. You should estimate patient increases that are realistic and achievable. 

Consider:

  • The number of mental health and SUD services patients in your 2023 UDS report
  • The need for services in your service area
  • Provider capacity
  • Patient increases based on previous service expansions
  • Your proposed BHSE activities

(Added: 4/30/2024)

Can BHSE affect my H80 patient target?

Yes. 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. 

(Added: 4/30/2024)

Do I need to increase both the number of patients receiving mental health services and the number of patients receiving SUD services?

Yes. You must propose activities that will increase both the number of patients receiving mental health services and SUD services, including patients receiving MOUD, even if you already provide one of these services.

(Added: 4/30/2024)

Budget requirements

How should I present my BHSE budget request on the SF-424A?

You can request up to $600,000 in BHSE funding for year 1 and up to $500,000 for year 2.

In Sections A, B, and C of your SF-424A, record information for year 1. 

In Section E, record information for year 2. 

Leave Section D blank. 

More details:

  • Section A: Request year 1 federal funding (up to $600,000) by subprogram: CHC, HCH, MHC, PHPC. List non-federal funding by subprogram, if applicable.
  • Section B: Break out year 1 federal (up to $600,000) and non-federal funding by object class category.
  • Section C: Break out year 1 non-federal funding by source.
  • Section E: Request year 2 federal funding (up to $500,000) in the “first” future year column by subprogram: CHC, HCH, MHC, PHPC. Leave other columns blank.

If funding continues beyond year 2, we’ll base it on your year 2 BHSE funding request (up to $500,000).

(Added: 4/30/2024)

What non-federal funding should I include in my BHSE budget?

Include the non-federal funds that will support your BHSE project. Do not duplicate non-federal resources included on your H80 award or any other Health Center Program award. 

Enter non-federal funds in both your SF-424A Budget Information Form and Budget Narrative attachment.

(Added: 4/30/2024)

Allowable uses of funds

What are examples of allowable uses of BHSE funds?

You may use BHSE funds to support a variety of costs for your project. 

Examples include:

  • Hiring licensed providers, community health workers, peer recovery specialists (PDF - 1 MB), or case managers to provide counseling and care coordination
  • Contracting with a specialist to provide your staff training and technical assistance in evidence-based approaches for treatment with MOUD
  • Providing group counseling for patients with post-partum depression.
  • Developing a tobacco cessation program for patients receiving MOUD
  • Supporting certification, training programs, continuing education, and mentorship opportunities to improve your providers’ capacity to care for patients accessing behavioral health services

(Added: 4/30/2024)

May I use BHSE funding to increase the FTE of a staff member who is currently less than 1.0 FTE?

Yes. You may use BHSE funds to increase the FTE of a staff member if the staff member does not exceed 1.0 FTE across all awards. Personnel compensation must align with your existing written policies and procedures and 45 Code of Federal Regulations C.F.R. § 75.430. 

(Added: 4/30/2024)

Can I use BHSE funding for recruitment incentives?

Yes. You may include recruitment incentives in a salary package that you support with BHSE funding. You should cover incentives through your indirect cost rate, if applicable. If you do not have an indirect cost rate agreement, you may charge recruitment incentives as direct costs.

(Added: 4/30/2024)

Can I use BHSE funding to pay recruitment agency fees?

Yes. You may use BHSE funding to pay costs or fees for an outside recruitment agency to hire personnel for your BHSE project.

(Added: 4/30/2024)

Do I need to add a certain type or number of personnel as part of my BHSE project?

No. We do not require you to add a specific type or number of personnel. You may use BHSE funding to support a range of personnel that will contribute to increasing the number of patients receiving mental health and SUD services, including MOUD.

(Added: 4/30/2024)

Can I use BHSE funding for patient incentives?

Yes. You may use BHSE funds for incentives if you need them to meet your project goals.

You must:

  • Have written policies and procedures for using funds for incentive costs
  • Document that you’re following your policies and procedures
  • Describe the types of incentives in detail in your budget narrative
  • Explain how the cost is reasonable and necessary to encourage patient participation in your BHSE project activities
  • Maintain appropriate records and cost documentation as 45 CFR §75.302 requires

You cannot use BHSE funds:

  • For cash gift cards, food, or other costs prohibited under 45 CFR 75 or other federal regulations
  • To persuade people to select your health center as their provider

You may also use non-grant funds, leverage partnerships with other community organizations, or use donations from local businesses to offer small rewards as incentives. For example, you may offer a nominal gift card to a local store, food, a meal, or a free admission voucher to a local event or attraction.

For questions about the potential impact of incentives and the federal anti-kickback statute, email the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) at OIGComplianceSuggestions@oig.hhs.gov. 

(Added: 4/30/2024)

Can I use BHSE funding to support contingency management, such as vouchers or prizes?

HHS considers contingency management an evidence-based intervention for SUDs. You may include contingency management activities and expenses in your BHSE application if you have established policies and procedures and follows all rules and regulations related to incentives. 

Clearly describe the activities and costs in your application. If awarded, you must submit a prior approval request to your Grants Management Specialist before you start your contingency management activity or program.

Follow this guidance:

  • You may use incentives to reward treatment compliance.
  • The maximum value of each contingency management incentive is $15.
  • The maximum value of contingency management incentives per patient per year is $75.

(Added: 4/30/2024)

Minor alteration and renovation (A/R) and equipment

What types of minor A/R projects or equipment purchases align with BHSE funding?

Examples of minor A/R projects include:

  • Converting an underused area to a group visit space
  • Enhancing exam rooms to optimize privacy and safety
  • Adapting a space to help integrate primary care and behavioral health teams

Examples of equipment purchases include:

  • Virtual reality headsets and software to help patients change their behavior, develop coping skills, and manage cravings
  • Point of care testing systems, such as options to test for stimulants
  • Audio-visual systems to support virtual group visits with remotely located patients

(Added: 4/30/2024)

If I propose to use BHSE funding for minor A/R, do I have to submit a Landlord Letter of Consent? 

If you do not own the property where the site is located, you must provide a Landlord Letter of Consent signed by the property owner. See the Landlord Letter of Consent Sample on Apply for FY 2024 Behavioral Health Service Expansion.

(Added: 4/30/2024)

If I propose to use BHSE funding for minor A/R, what are the environmental and historic preservation requirements?

For information on these requirements, see Environmental and Historic Preservation Technical Assistance. Minor A/R projects typically do not require a full Environmental Assessment under the National Environmental Policy Act (NEPA). 

But you may need to comply with other requirements as applicable:

  • If your project involves exterior work (for example, windows or signage) or work on a building that is over 50 years old, it may require State Historic Preservation Office (SHPO) consultation under Section 106 of NEPA.
  • For buildings constructed before 1985, you may need to submit a hazmat study and abatement plan.
  • If your site is in a coastal state, your project may require you to comply with the Coastal Zone Management Act.
  • If your project is in a 100- or 500-year floodplain, it may require you to comply with E.O. 11988, Floodplain Management.

(Added: 4/30/2024)

If I use BHSE funds to purchase a mobile unit, can I also use the mobile unit for other purposes?

Yes. But the primary purpose of the mobile unit must be to provide mental health and SUD services, including MOUD. 

(Added: 4/30/2024)

Scope of project

How do I know if my BHSE project will require a change in scope?

Use the materials on Scope of Project to assess your scope of project (Form 5A: Services Provided and Form 5B: Service Sites). Contact your H80 program specialist for additional guidance. 

(Added: 4/30/2024)

Can I make changes to my scope of project through the BHSE application?

No. However, you may submit a change in scope (CIS) or scope adjustment request through the Electronic Handbooks (EHBs). We recommend that you submit such requests 60 days before making the change. You may submit a CIS before receiving your BHSE award.

(Added: 4/30/2024)

General application

Will my application be competitive if I do not currently provide behavioral health services?

Yes. We encourage health centers that do not currently provide behavioral health services to apply. In fact, the review criteria support health centers that propose to use BHSE funds to start providing one or more behavioral health services for the first time.

Your application will receive 5 points if your 2023 UDS report included 0 mental health patients, 0 SUD patients, or 0 patients who received MOUD. Applicants with numbers greater than 0 in all of these categories will not receive these points.

(Added: 4/30/2024)

How do I complete the Application for Federal Assistance (SF-424)?

For detailed instructions, see Section 5.1 of the Two-Tier Application Guide (PDF - 704 KB). This table includes information on how to respond to specific sections.

Box Number Field Response
1 Type of Submission Application
2 Type of Application New
3 Date Received Leave blank (completed automatically in Grants.gov)
4 Applicant Identifier Enter your H80 number
5a,5b Federal Entity Identifier, Federal Award Identifier Leave blank
12 Funding Opportunity Number HRSA-24-078
14 Areas Affected by Project List the main site for your BSHE project
15 Descriptive Title of Applicant’s Project Behavioral Health Service Expansion
16 Congressional Districts  Include the congressional district for your main site (we do not require an attachment) 
17 Proposed Project The period of performance is September 1, 2024, to August 31, 2026
18 Estimated Funding ($) Enter amount of BHSE funding requested for year 1 in the a. Federal box (up to $600,000)
19 Is Application Subject to Review Under Executive Order 12372 Process?

Select a. if your state is on the list of State Points of Contact (SPOC list (PDF - 332 KB)).

If not, select b. Program is subject to E.O. 12372 but has not been selected by the State for review.

(Added: 4/30/2024)

How do I make changes to my application once I submit in EHBs?

Your authorizing official (AO) can reopen and edit your application any time before the EHBs deadline. For additional details and step-by-step instructions, refer to Reopen Submitted Applications. The AO must resubmit the reopened application in EHBs by 5 p.m. ET on the EHBs due date for us to consider your application.

(Added: 4/30/2024)

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