Potential Applicants' Questions and Answers Now Available for Review

The Closing the Addiction Treatment Gap initiative thanks all participants in the February 25 Potential Applicant Question-and-Answer Conference Call. Answers to callers' questions, as well as email follow-up questions, are available below for review. Please continue to send any questions that have not yet been addressed to Lindsey Caruso at lcaruso@sorosny.org.

• Are proposals that, as a strategy, seek to engage those who need but do not want treatment acceptable?
• Must a jurisdiction be local in order to be eligible? Can you clarify what is constitutes a jurisdiction?
• Can funds from this grant be used to support legislation?
• Is a healthcare system an appropriate applicant and if so, can the service area of that system be considered a jurisdiction?
• In regard to the issue of appropriations, would a system that seeks to create a "safety net" for uninsured individuals in which providers donate a portion of their time be a fit for the type of appropriations increase this initiative is looking for?
• Because the Baltimore initiative was very urban, will preference be given to similar communities? What about rural areas?
• In our state, monetary resources for treatment are expanding mostly through the criminal justice system, but the overall pie of treatment resources is not expanding. This has led to a situation where increased access to treatment for the criminal justice population has essentially occurred at the expense of the general population in terms of not actual dollars but number of treatment ‘beds’ available . With this in mind, what is your response to a strategy of trying to expand the actual number of sites and beds? In other words, can we use funds to expand a particular type of service or for a specific population?
• It is clear that you are seeking proposals with one financing and one efficiency strategy. Would a good proposal address multiple advocacy and communications strategies or also focus on just one?
• In terms of the financing strategies, would an effort to get the state to turn on reimbursement codes be an effective financing strategy?
• A huge issue in our community has to do with transportation and people simply being unable to get to treatment. Would a strategy that seeks to identify resources to address this problem be appropriate to include in our proposal?
• Our interest lies in creating more collaboration among agencies treating co-occuring disorders so that we can increase capacity and deliver a more integrated service delivery system. Is this what you are looking for?
• What can be counted as matching funds? Can in-kind services be counted? How much match is required? Must we show evidence of it with out application or can it be a work in progress?
• Can money be used for start-up? For example, hiring a project coordinator, having necessary planning meeting, or setting up databases that we might need?
• What do you expect to see on July 1? What is a reasonable start-up time?
• Are there any communities that OSI would see as being in greater need?
• Will there be opportunities to apply for larger implementation grant once this three-year period is over?
  

Follow-Up Questions Received Via Email

• As we look at the RFP, we have noted that there is a requirement to give top priority to one of the financing strategies and one of the efficiency strategies. Given where our system is presently in our city, we wanted to know if our overall strategy could incorporate the blending of more than one strategy in a given category. For example, there are at least two efficiency strategies that we have given thought to implement, as they are consistent with our current internal strategic planning efforts. Is this permissible?
• On page nine, # 8, for the proposal format, we wanted to clarify if there was an expectation regarding how a public official is defined--elected, appointed, or some other requirement?
• Also on page 9, # 10, are we correct in understanding that you looking for a sustainability plan after two years even though we could continue to receive funding for a third year?
• As we proceed with the preparation of our application, if there are additional questions, is contacting you, as I have done today, the best mechanism for having questions answered?
• With respect to the “Expanding Insurance” option, can working on parity be an activity? I understand that parity is not the focus of this initiative; however it is not clear whether or not it is disallowed.
• With reference to the offset and redeploy activities, was criminal justice or corrections purposefully left out as an example? If it is a true increase and not a re-allocation of existing treatment dollars, is it allowed?
• Is it possible to have co-leads for the proposal? If it can be only one, is it better for that person to be in the location where the work will take place?
• Regarding the needs assessment, is there a minimum level of performance required to apply for funds?
• It is not clear whether applicants need to budget funds to participate in learning collaborative or annual meetings convened by the funders or if these are financed from other OSI funds. I am assuming that the allowable travel funds listed in p.12 of the announcement are for travel within the jurisdiction for specific activities connected to the proposed local strategies. Please clarify.
• If there are activities convened by the funders for grantees that require budgeting for travel to these events from the grant budget, what are OSI expectations regarding the number of individuals that should attend? Where would be meetings be held?
• Regarding the resources for technical assistance introduced in the teleconference, are these resources available to the projects or are this meant to be working with the OSI program staff?
• What information are you seeking under the category “Financing and Coverage” when referring to community/local philanthropy? If having to do with dollars or other resources secured from philanthropic organizations, are you interested in treatment dollars?
  

Are proposals that, as a strategy, seek to engage those who need but do not want treatment acceptable?

There are 23 million people who need treatment. About one-half of those are actually seeking treatment. Our system currently serves about 2 million people, or 1/5 of those who need and want treatment. We are looking for proposals that increase the resources for those who need and want treatment. If your proposal seeks first to address that gap and then secondly, addresses the issue of engagement as a means of making treatment more successful (thereby effectively increasing treatment capacity,) this is acceptable. Engagement should not be the primary strategy of your proposal. The primary strategy of all proposals should be to increase the resources available for treatment, whereas a secondary strategy may seek to increase efficiency.

Must a jurisdiction be local in order to be eligible? Can you clarify what is constitutes a jurisdiction?

We want applicants to be able to define the area that is most appropriate for the identified strategies. An entity—such as a state--would be appropriate provided the applicants submit a state-wide proposal. For others, a jurisdiction may be a local community, a county, or even a set of counties. We use the term “jurisdiction” loosely to mean a cohesive unit with an identifiable leadership component.

Can funds from this grant be used to support legislation?

Foundation funds cannot be used to support specific legislation. Funds can support information about issues, formulate strategies, inform, and educate, but cannot be used to sponsor or advocate for specific legislation, or do direct or grassroots lobbying with these grant funds.

Is a healthcare system an appropriate applicant and if so, can the service area of that system be considered a jurisdiction?

The basic eligibility criteria for an applicant is that it be a non-profit or governmental organization. Please carefully review the Self-Assessment Tool. The tool suggests that a successful applicant will represent a collaborative effort of advocacy organizations, provider organizations, consumer organizations, and political leadership. In that regard, almost any group can be the lead applicant. The key to a successful application is the involvement of all stakeholders needed to advance the strategy selected to increase resources.

In regard to the issue of appropriations, would a system that seeks to create a "safety net" for uninsured individuals in which providers donate a portion of their time be a fit for the type of appropriations increase this initiative is looking for?

We are looking to create systemic change that will make treatment more available over the long run that would include increased appropriations from federal, state or local sources. In-kind donations (e.g. providers donating time) may not result in increased appropriations or necessarily be sustainable long term.

Because the Baltimore initiative was very urban, will preference be given to similar communities? What about rural areas?

There is a very strong interest in geographic diversity. We would like to represent both rural and urban areas in this initiative.

In our state, monetary resources for treatment are expanding mostly through the criminal justice system, but the overall pie of treatment resources is not expanding. This has led to a situation where increased access to treatment for the criminal justice population has essentially occurred at the expense of the general population in terms of not actual dollars but number of treatment ‘beds’ available. With this in mind, what is your response to a strategy of trying to expand the actual number of sites and beds? In other words, can we use funds to expand a particular type of service or for a specific population?

The goal of the initiative is to make change in systems. If we approach this problem population by population, but the pie stays the same, increases for certain populations will happen at the expense of others. We want to increase awareness of the issue so that treatment is available for all who need it, especially those without insurance. With that in mind, an application that seeks just to increase one service, such as residential care, may be problematic, as opposed to one that works to increase the total pool. As stated in the RFP, at the end of this initiative, we hope to increase the dollars for treatment, to increase the total number of people seen in treatment, and to be able to identify, recommend and replicate models that have been successful making these results occur.

It is clear that you are seeking proposals with one financing and one efficiency strategy. Would a good proposal address multiple advocacy and communications strategies or also focus on just one?

We recognize that the advocacy and communications strategies are the engines that are going to drive this initiative. It would be impossible for us to prescribe these strategies because local situations will vary throughout the country. Most likely, multiple advocacy and communications strategies will be necessary at any one site and over a period of time, these strategies will need to adapt to change.

In terms of the financing strategies, would an effort to get the state to turn on reimbursement codes be an effective financing strategy?

No, because the resource has been made available; however getting new state and/or federal matching funds for new services is a financing strategy. These new services may result in the state developing a new definition, procedure code and reimbursement methodology as a result of this new financing strategy.

A huge issue in our community has to do with transportation and people simply being unable to get to treatment. Would a strategy that seeks to identify resources to address this problem be appropriate to include in our proposal?

It could be included as an item related to improving quality treatment and keeping people in treatment; however, it should not be a primary strategy. The primary strategy is what is key.

Our interest lies in creating more collaboration among agencies treating co-occuring disorders so that we can increase capacity and deliver a more integrated service delivery system. Is this what you are looking for?

This would be a strong and appropriate efficiency strategy to go along with a primary strategy to increase resources. This should not be a primary financing strategy.

What can be counted as matching funds? Can in-kind services be counted? How much match is required? Must we show evidence of it with out application or can it be a work in progress?

Applicants that receive actual cash contributions from a third party (e.g., a local foundation) to finance and/or sustain this project will be given preference in the selection process. While we recognize that in-kind contributions provide valuable support, proposals that rely primarily on these as their matching funds will not be given the same weight as proposals that obtain and commits specific funds for the operation of the project.

We understand that applicants may not have obtained a firm commitment from a third party prior to April 11th. These applicants should provide correspondence or other documentation from the third party that indicates some interest in their application.

Can money be used for start-up? For example, hiring a project coordinator, having necessary planning meeting, or setting up databases that we might need?

Yes.

What do you expect to see on July 1? What is a reasonable start-up time?

There should be a partnership that has met and has developed a work plan and finalized budget to implement their initiative. This is not a planning grant.

Are there any communities that OSI would see as being in greater need?

A. No. The application should describe the population that will be impacted by this grant and use the self assessment tool to identify the needs of that population to develop appropriate efficiency strategies.

Will there be opportunities to apply for larger implementation grant once this three-year period is over?

At this point, there is no plan for this. This is the implementation grant.

Follow-Up Questions Received Via Email

As we look at the RFP, we have noted that there is a requirement to give top priority to one of the financing strategies and one of the efficiency strategies. Given where our system is presently in our city, we wanted to know if our overall strategy could incorporate the blending of more than one strategy in a given category. For example, there are at least two efficiency strategies that we have given thought to implement, as they are consistent with our current internal strategic planning efforts. Is this permissible?

Yes, an application could include more than one financing and efficiency strategy. However it is important that any financing strategy(s) proposed increase the resources available for treatment. An efficiency strategy must also be included. An application that blends more than one of these strategies in each category should include a strong rationale for this approach.

On page 9, #8, for the proposal format, we wanted to clarify if there was an expectation regarding how a public official is defined--elected, appointed, or some other requirement?

"Public official" was meant to indicate a recognized leader and authority figure for the jurisdiction who would publicly "champion" the issue of expanding treatment.

Also on page 9, #10, are we correct in understanding that you looking for a sustainability plan after two years even though we could continue to receive funding for a third year?

The intent of the question is to demonstrate how the applicant is thinking about sustaining the effort after the grant period ends. Sustainability should be considered from the project beginning.

As we proceed with the preparation of our application, if there are additional questions, is contacting you, as I have done today, the best mechanism for having questions answered?

Questions can be addressed via email to Lindsey Caruso at lcaruso@sorosny.org.

With respect to the “Expanding Insurance” option, can working on parity be an activity? I understand that parity is not the focus of this initiative; however it is not clear whether or not it is disallowed.

The initiative seeks to expand resources needed to make treatment available for those who cannot access treatment because the demand for treatment is greater than the capacity of the treatment system to respond. This occurs primarily because there are inadequate resources to pay for treatment. Insurance coverage must exist in order for parity to be an issue. Parity addresses an often arbitrary decision by purchasers and insurers to eliminate or restrict coverage for certain health conditions or types of treatment. This is fundamentally a different issue that affecting a different population than those that are uninsured and otherwise dependent on "safety net" resources to get care. A proposal that focuses on adding resources for those who lack coverage as a primary goal would likely receive more favorable review than one that focused on the issue of parity alone. Having said that, parity may well be a reasonable secondary strategy to accompany a strategy that seeks to have basic coverage for all citizens that includes a basic benefit for addiction disorders.

With reference to the offset and redeploy activities, was criminal justice or corrections purposefully left out as an example? If it is a true increase and not a re-allocation of existing treatment dollars, is it allowed?

Offsets from the criminal justice system that are real dollars are recognized and allowed.

Is it possible to have co-leads for the proposal? If it can be only one, is it better for that person to be in the location where the work will take place?

The term "lead organization" refers to the organization that will have the fiduciary and ultimate program accountability to receive, manage, and execute the grant agreement. The RFP is clear that coalitions, networks, or other forms of inter-organizational collaboration are welcomed and encouraged to engage in this initiative.

Regarding the needs assessment, is there a minimum level of performance required to apply for funds?

We expect that the partnership for this project will meet several times prior to submitting a proposal and have provided the self-assessment as a tool to assist applicants while they develop the proposal. (We do not expect the self-assessment to be included in the submitted proposal.) We would expect, however, that the partnership will identify what steps will be taken to improve areas they recognize need additional work as a result of the self-assessment process.

It is not clear whether applicants need to budget funds to participate in learning collaborative or annual meetings convened by the funders or if these are financed from other OSI funds. I am assuming that the allowable travel funds listed in p.12 of the announcement are for travel within the jurisdiction for specific activities connected to the proposed local strategies. Please clarify.

The applicant’s budget should include funding to participate in one mid-point meeting (out of state) during the three years as well as in jurisdiction travel for project meetings, coaching visits, etc.

If there are activities convened by the funders for grantees that require budgeting for travel to these events from the grant budget, what are OSI expectations regarding the number of individuals that should attend? Where would be meetings be held?

At a minimum one member from each of the organizations in the applicant’s partnership should attend the one mid-point meeting that is currently planned. The site of this mid-point meeting is yet to be determined.

Regarding the resources for technical assistance introduced in the teleconference, are these resources available to the projects or are this meant to be working with the OSI program staff?

There are several possibilities for technical assistance. The sites can purchase technical assistance through their grants. OSI will make other technical assistance on topical and strategic areas available on a regular basis during the grant period. In addition, each site will work with a coach from the Legal Advocacy Center (LAC) who will provide technical assistance and coordinate other technical assistance from a pool managed by LAC. Furthermore, the national communications firm, Laufer, Green, Issac (LGI), will provide assistance to sites regarding their communication plan.

What information are you seeking under the category “Financing and Coverage” when referring to community/local philanthropy? If having to do with dollars or other resources secured from philanthropic organizations, are you interested in treatment dollars?

No, we are not seeking treatment dollars; rather, we are seeking dollars that will support the advocacy and communication needed to increase insurance or appropriation resources.