Apply for Addiction Treatment Starts Here: Primary Care, Wave 2

 

Before proceeding with the application, please read the Request for Applications to confirm your organization’s eligibility to apply. If you have any questions, please email us prior to the application due date, July 24, 2019.

How to Apply

Step 1: Attend Informational Webinar (Optional)

Interested organizations are encouraged to attend the informational webinar on July 12th (register here) or view the webinar recording that will be posted below afterward. The webinar will review program components and answer questions that attendees have.

Step 2: Submit Application Form

Applicant teams must apply via the online form below by Wednesday, July 24, 2019, at 5pm PT. Organizations must submit a separate application for each site that is applying (up to three sites from the same organization may apply). Upon reviewing applications, we may ask for follow-up information or a phone call with the applicant team lead or other leadership staff. We intend to select up to 20 qualified and strong primary care sites for this program. The program cohort will be announced via email by August 23, 2019.

Please ensure you include the following documents in addition to the completed online application form (if you have trouble downloading either template, please email Briana at [email protected]):

  1. Narrative responsedownload the narrative questions
  2. Budget proposal download CCI’s budget template
  3. Letter of support from your leadership – This letter should be from a senior leader that will be involved in your project (i.e.; CMO) and should be no more than 1 page.
  4. 501(c)3 tax status documentation

 

Addiction Treatment Starts Here: Primary Care, Wave 2 - Application Submission Form

A program of the Center for Care Innovations and funded by California Department of Health Care Services. 


Applications must be submitted by 5 pm PT on Wednesday, July 24, 2019. Please refer to the Addiction Treatment Starts Here: Primary Care, Wave 2 Request for Applications (RFA) for details about the program and application requirements. 


Organizations may apply in one of two ways:

  • Option 1: your organization could submit a single application for one $50,000 grant if you are: 
    • a single-site organization; or
    • a multi-site organization applying for just one site to participate; or 
    • a multi-site organization that intends to have a single MAT team that works across multiple sites
  • Option 2: your organization could submit multiple applications for different clinic sites (up to 3) if you are a multi-site organization that plans to have separate MAT programs and distinct MAT teams at each clinic site working with different patient populations. There can be some cross-over of team members, but each site must have their own prescriber and front-line team member. If you select this option, please complete a separate application form for each applying site and submit separate application materials.

Your Organization Information
















Fiscal Sponsor Information




Applying For This Grant

Site Information
Reminder: if you are applying for multiple grants, at the site level, you must complete separate applications for each clinic site. This includes a new application form and unique grant documents.

Please note that a separate application must be submitted for each site that is applying.








CEO Contact 




Program Team Lead Contact






Program Team Members

Please list the contact information for each member of your anticipated team at this site. At least 4 individuals are required to be committed to this project. Teams should include at minimum a program lead responsible for the day-to-day activities of the program, at least one x-waivered clinician, a clinical leader, and at least one other team member. See the RFA for more information about recommended team members.





Application Components



This letter should be from a senior leader that will be involved in your project (i.e.; CMO) and should be no more than 1 page.