[Federal Register Volume 76, Number 69 (Monday, April 11, 2011)]
[Notices]
[Pages 19999-20003]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-8520]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Agency Information Collection Activities: Proposed Collection;
Comment Request
In compliance with Section 3506(c)(2)(A) of the Paperwork Reduction
Act of 1995 concerning opportunity for public comment on proposed
collections of information, the Substance Abuse and Mental Health
Services Administration (SAMHSA) will publish periodic summaries of
proposed projects. To request more information on the proposed projects
or to obtain a copy of the information collection plans, call the
SAMHSA Reports Clearance Officer on (240) 276-1243.
Comments are invited on: (a) Whether the proposed collections of
information are necessary for the proper performance of the functions
of the agency, including whether the information shall have practical
utility; (b) the accuracy of the agency's estimate of the burden of the
proposed collection of information; (c) ways to enhance the quality,
utility, and clarity of the information to be collected; and (d) ways
to minimize the burden of the collection of information on respondents,
including through the use of automated collection techniques or other
forms of information technology.
Proposed Project: Unified Application for the Community Mental Health
Services Block Grant and Substance Abuse and Prevention Treatment Block
Grant FY 2012-2013 Application Guidance and Instructions (OMB No. 0930-
0168)--Revision
The Substance Abuse and Mental Health Services Administration
(SAMHSA), is requesting approval from the Office of Management and
Budget (OMB) for a revision of the 2012 and 2013 Community Mental
Health Services Block Grant (MHSBG) and Substance Abuse Prevention and
Treatment Block Grant (SAPTBG) Guidance and Instructions into one
unified block grant application. To minimize the burden, the two
separate clearances for the block grant applications will be merged
into one.
Currently, the SAPTBG and the MHSBG differ on a number of their
practices (e.g., data collection at individual or aggregate levels) and
statutory authorities (e.g., method of calculating MOE, stakeholder
input requirements for planning, set asides for specific populations or
programs, etc.). Historically, the Centers within SAMHSA that
administer these Block Grants have had different approaches to
application requirements and reporting. To compound this variation,
States have different structures for accepting, planning, and
accounting for the Block Grants and the Prevention Set Aside within the
SAPTBG. As a result, how these dollars are spent and what is known
about the services and clients that receive these funds varies by Block
Grant and by State.
In addition, between 2012 and 2015, 32 million individuals who are
uninsured will have the opportunity to enroll in Medicaid or private
health insurance. This expansion of health insurance coverage will have
a significant impact on how State Mental Health Authorities (SMHAs) and
State Substance Abuse Authorities (SSAs) use their limited resources.
Many individuals served by these authorities are funded through Federal
Block Grant funds. SAMHSA proposes that Block Grant funds be directed
toward four purposes: (1) To fund priority treatment and support
services for individuals without insurance or who cycle in and out of
health insurance coverage; (2) to fund those priority treatment and
support services not covered by Medicaid, Medicare or private insurance
offered through the exchanges and that demonstrate success in improving
outcomes and/or supporting recovery; (3) to fund universal, selective
and targeted prevention activities and
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services; and (4) to collect performance and outcome data to determine
the ongoing effectiveness of behavioral health prevention, treatment
and recovery support services and to plan the implementation of new
services on a nationwide basis.
States should begin planning now for FY 2014 when more individuals
are insured. To ensure sufficient and comprehensive preparation, SAMHSA
will use FY 2012 and 2013 to work with States to plan for and
transition the Block Grants to these four purposes. This transition
includes fully exercising SAMHSA's existing authority regarding States'
and Jurisdictions' (subsequently referred to as ``States'') use of
Block Grant funds, and a shift in SAMHSA staff functions to support and
provide technical assistance for States receiving Block Grant funds as
they move through these changes.
The proposed Mental Health Block Grant and the Substance Abuse
Prevention and Treatment Block Grant build on ongoing efforts to reform
health care, ensure parity and provide States and Territories with new
tools, new flexibility, and state/territory-specific plans for
available resources to provide their residents the health care benefits
they need. The revised planning section of the Block Grant application
provides a process for States and Territories to identify priorities
for individuals who need behavioral health services in their
jurisdictions, develop strategies to address these needs, and decide
how to expend Block Grant Funds. In addition, the Planning Section of
the Block Grant requests additional information from States that could
be used to assist them in their reform efforts. The plan submitted by
each State and Territory will provide information for SAMHSA and other
federal partners to use in working with States and Territories to
improve their behavioral health systems over the next two years as
health care and economic conditions evolve.
Currently, States and Territories are asked to provide strategies
for seventeen areas that were developed almost twenty years ago. This
new Block Grant application guides and prompts States and Territories
to consider multiple populations and program areas that are likely to
be priorities for States and Territories today, and to consider how
changes in other funding streams that were not as relevant in prior
years might fit with Block Grant funds today and in the future.
In addition, the new Block Grant application provides States and
Territories the flexibility to submit one rather than two separate
Block Grant applications if they choose. It also allows States and
Territories to develop and submit a bi-annual rather than an annual
plan, recognizing that the demographics and epidemiology do not often
change on an annual basis. These options may decrease the number of
applications submitted from four in two years to one.
Over the next several months, SAMHSA will assist States and
Territories (individually and in smaller groups) as they develop their
Block Grant applications. While there are some specific statutory
requirements that SAMHSA will look for in each submitted application,
SAMHSA intends to approach this process with the goal of assisting
States and Territories in setting a clear direction for system
improvements over time, rather than as a simple effort to seek
compliance with minimal requirements.
Consistent with previous applications, the FY 2012-2013 application
has sections that are required and other sections where additional
information is requested, but not required. The FY 2012-2013
application requires States to submit a face sheet, a table of
contents, a behavioral health assessment and plan, reports of
expenditures and persons served, executive summary, and funding
agreements and certifications. In addition, SAMHSA is requesting
information on key areas that are critical to their success to address
health reform and parity. States will continue to receive their annual
grant funding if they only chose to submit the required section of
their State Plans or choose to submit separate plans for the MHBG or
SAPTBG. Therefore, as part of this Block Grant planning process, SAMHSA
is asking States and Territories to identify their technical assistance
needs to implement the strategies they identify in their plans for FY
2012 and 2013.
To facilitate an efficient application process for States in FY
2012-2013, SAMHSA convened an internal workgroup to develop the
application for the Block Grant planning section. In addition, SAMHSA
consulted with representatives from the state mental health and state
substance abuse authorities to receive input regarding proposed changes
to the Block Grant. Based on these discussions with States, SAMHSA is
proposing several changes to the Block Grant programs, discussed in
greater detail below.
Changes to Assessment and Planning Activities
Under the previous SAPTBG, States were requested to address
seventeen national goals. Some of these seventeen goals were population
specific (pregnant women), while others were service specific
(substance abuse prevention strategies). The MHSBG required States to
address a set of criterion for children with serious emotional
disturbances and adults with serious mental illness. While both Block
Grants required States to do an assessment and plan, they did not
always allow the State or SAMHSA to obtain an overall picture of the
State's behavioral health needs and to incorporate consistent
priorities and planning activities, especially for individuals with a
co-occurring mental and substance use disorder. States will be asked to
follow a four-step planning process which consists of: (1) Assessing
the strengths and needs of the service system; (2) identifying the
unmet service needs and critical gaps within the current system; (3)
prioritize the State planning activities, and; (4) develop goals,
strategies and performance indicators.
The revised Block Grant application requires States to identify and
analyze the strengths, needs, and priorities of their behavioral health
systems. One important change is that States will be requested to take
into account the priorities for the specific populations that are the
current focus of the Block Grants in the context of the changing health
care environment and SAMHSA's strategic initiatives. The focus of
SAMHSA's Block Grant programs has not changed significantly over the
past 20 years. While many of these populations originally targeted for
the Block Grants are still a priority, additional populations have
evolving needs that should be addressed. These include military
families, youth who need substance use disorder services, individuals
who experience trauma, increased numbers of individuals released from
correctional facilities, and lesbian, gay, bi-sexual, transgender and
questioning (LGBTQ) individuals. The uniform plan required in the Block
Grant application must address the statutory populations (as
appropriate for each Block Grant) and should address these other
populations.
One population of particular note in 2014 will be the newly-
insured. States should begin planning now for individuals with low-
incomes who are currently uninsured but will gain health coverage in
2014 when additional coverage options are available. Many of these
individuals will be covered by Medicaid or private insurance in FY
2014, and this will present new opportunities for behavioral health
systems to expand access and capacity. In addition, States should
identify who will not be covered after FY 2014, as well as whose
coverage is insufficient
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and how federal funds will be used to support these individuals who may
need treatment and supports.
SAMHSA is also encouraging SMHAs and SSAs to develop and submit a
combined plan to address a number of other common areas, including bi-
directional integration of behavioral health and primary care services,
provision of recovery support services and a combined plan for the
provision of services for individuals with co-occurring mental and
substance use disorders. These combined plans should be included in a
State's application (for those states submitting one Block Grant
application). For States that submit separate Block Grant applications,
these combined plans for these activities should be included in both
the State MHSBG and SAPTBG applications.
The new Block Grant application requires States to follow the
following planning steps:
Step One: Assess the strengths and needs of the service
system to address the specific populations. This will include a
description of the organization of the current public system, the roles
of the state, county, and localities in the provision of service and
the ability of the system to address diverse needs.
Step Two: Identify the unmet service needs and critical
gaps within the current system. Included in this step is the
identification of data sources used to determine the needs and gaps for
the populations identified as a priority.
Step Three: Prioritize State planning activities. Given
the information in Step 2, the States will prioritize the target
populations as appropriate for each Block Grant as well as other
priority populations as determined by the State.
Step Four: Develop goals, strategies and performance
indicators. For each of the priorities identified in Step 3, the state
will identify at least one goal, strategies to reach that goal, and the
performance indicators to be examined over the next two years.
In addition to the planning steps, States are requested to provide
the following information:
Information on the Use of Block Grant Dollars for Block
Grant Activities--States should project how Block Grant funds will be
used to provide services for the target populations or areas identified
in their plans for States that have a combined MHSBG and SAPTBG
application. SAMHSA encourages States to use MHSBG and SAPTBG funds to
support their or other agencies' efforts to develop reimbursement
strategies that support innovation. For example, States could use Block
Grant funds to support various demonstration projects through other
federal programs (Medicaid, HUD, Veterans Affairs). The new Block Grant
application asks States to describe their overall reimbursement
approach for services purchased with MHSBG and SAPTBG funds. States
must identify the reimbursement methodology proposed for each service,
prevention and emotional health development strategy, and system
improvement. States are requested to project their expenditures under
the MHSBG and the SAPTBG for treatment and support services.
Information on Activities that Support Individuals in
Directing the Services--In the new Block Grant application, States are
asked to provide information regarding policies and programs that allow
individuals with mental illness and/or substance use disorder to direct
their own care.
Information on Data and Information Technology--SAMHSA is
requesting States to provide unique client-level encounter data for
specific services that are purchased with Block Grant funds. States
will be requested to complete the service utilization table in the
Reporting Section of the Application. States should provide information
on the number of unduplicated individuals by each service purchased
with Block Grant Funds. If the State is currently unable to provide
unique client level data for any part of its behavioral health system,
the State is requested to describe in the Block Grant application their
plan, process, resources needed and timeline for developing such
capacity.
Description of State's Quality Improvement Reporting--
States have been reporting the program performance monitoring
activities to include the use of independent peer review to improve the
quality and appropriateness of treatment services delivered by
providers receiving funds from the block grant (See 42 U.S.C. 300x-
53(a) and 45 CFR 96.136), States are asked to attach their current
quality improvement plan to their Block Grant application.
Description of State's Consultation with Tribes--SAMHSA is
required by the 2009 Memorandum on Tribal Consultation to submit plans
on how it is to engage in regular and meaningful consultation and
collaboration with tribal officials in the development of Federal
policies that have Tribal implications. SAMHSA is requesting that
States provide a description of how they consulted with Tribes in their
State. This description should indicate how concerns of the Tribes were
addressed in the State Block Grant plan(s). States shall not require
any Tribe to waive its sovereign immunity in order to receive funds or
in order for services to be provided for Tribal members on Tribal
lands.
Description of State's Service Management Strategies--
SAMHSA, similar to other public and private payers of behavioral health
services, seeks to ensure that services purchased under the Block Grant
are provided to individuals in the right scope, amount and duration.
The Block Grant application asks States to describe the processes that
they will employ over the next planning period to identify trends in
over/underutilization of SAPTBG or MHSBG funded services. They must
also describe the strategies that they will deploy to address these
utilization issues. SAMHSA is also requesting the States to describe
the resources needed to implement utilization management strategies and
the timeframes for implementing these strategies.
Development of State Dashboards--An important change to
the administration of the MHSBG and SAPTBG is the creation of State
dashboards on key performance indicators. National dashboard indicators
will be based on outcome and performance measures that will be
developed by SAMHSA in FY 2011. For FY 2012, States will be requested
to identify a set of state-specific performance measures for this
incentive program. In addition, SAMHSA will identify several national
indicators to supplement the state-specific measures for the incentive
program. The State, in consultation with SAMHSA, will establish a
baseline in the first year of the planning cycle and identify the
thresholds for performance in the subsequent year. The State will also
propose the instrument used to measure the change in performance for
the subsequent year. The State dashboards will be used to determine if
States receive an incentive based on performance. SAMHSA is considering
a variety of incentive options for this dashboard program and will
solicit input from the States on the options.
Information of State's Suicide Prevention Plan--As an
attachment to the Block Grant application(s), States are requested to
provide the most recent copy of their suicide prevention plan. While
this is not a required plan, SAMHSA is interested in knowing the
strategies that State's are proposing to address suicide prevention. If
a State does not have a suicide prevention plan or if it has not been
updated in the past three years States are requested to describe when
they will create or update their plan.
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Identification of Technical Assistance Needs--States are
requested to describe the data and technical assistance needs
identified by the State during the process of developing this plan that
will be needed or helpful to implement the proposed plan.
Process for Comment on State Plan--Current statute
requires that, as a condition of the funding agreement for the grant,
States will provide opportunity for the public to comment on the State
plan. In the application, States are asked to describe their efforts
and procedures to obtain public comment on the State plan.
Description of Processes to Involve Individuals and
Families--In the Block Grant application States are requested to
describe their efforts to actively engage individuals and families in
developing, implementing and monitoring the State mental health and
substance abuse systems.
Description of the Use of Technology--Interactive
Communication Technologies (ICTs) are more frequently being used to
deliver various health care services. In the Block Grant application,
States are requested to provide information on their use or planned use
of ICTs.
Process for Obtaining Support of State Partners--The
success of a State's MHSBG and SAPTBG will rely heavily on the
strategic partnership that SMHAs and SSAs have or will develop with
other health, social services, education and other State and local
governmental entities. States are requested to identify these partners
in their Block Grant application and describe the roles they will play
in assisting the State to implement the priorities identified in the
plan. SAMHSA is requesting States to provide a letter of support
indicating agreement with the description of their role and
collaboration with the SSA and/or SMHA and other State agencies (e.g.
State education authorities, the State Medicaid agency, etc.)
Description of State Behavioral Health Advisory Council--
Each State is required to establish and maintain a State advisory
council for services for individuals with a mental disorder. SAMHSA
strongly encourages States to expand and use the same council to advise
and consult regarding issues and services for persons with or at risk
of substance abuse and substance use disorders as well.
Other Changes
States will be allowed to submit a joint plan for the Mental Health
Services Block Grant and the Substance Abuse and Prevention and
Treatment Block Grant.
States will no longer be required to submit an annual plan. The new
application allows States to submit a two-year plan for FY 2012 and
2014.
Although the statutory dates for submitting the Block Grant
application, plan and annual report remain unchanged, SAMHSA requests
that the MHSBG and SAPTBG applications be submitted on the same date.
In addition, the dates for submitting the plans have been changed to
better comport with most States fiscal and planning years (July 1st
through June 30th of the following year). More information can be found
in the application overview.
Also, the dates States are requested to submit the annual reports
have been changed for the SAPTBG. These annual reports will be due on
the same date as the reports for the MHSBG, December 1st. Opting not to
submit the block grant application, plan and annual report on the same
date for the SAPTBG as the MHSBG will not affect State funding in any
way (amount or timeliness of payment).
Various reporting requirements for narrative descriptions have been
deleted and included as a table or as an assurance to confirm
compliance. In addition SAMHSA is requesting States to provide more
detailed information on block grant expenditures (Table 5 in the
reporting section).
Estimates of Annualized Hour Burden
The estimated annualized burden for the unified application is
37,429 hours. Burden estimates are broken out in the following tables
showing burden separately for Year 1 and Year 2. Year 1 includes the
estimates of burden for the unified application and annual reporting.
Year 2 includes the estimates of burden for the application update and
annual reporting. The reporting burden remains constant for both years.
Table 1--Estimates of Application and Reporting Burden for Year 1
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Burden/
Application element Number respondents Responses/ response Total burden
respondents (hours)
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Application Burden:
Yr One Plan (separate submissions) 30 (CMHS); 30 (SAPT).... 1 282 16,920
Yr One Plan (combined submission.. 30...................... 1 282 8,460
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Application Sub-total......... 60...................... .............. .............. 25,380
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Reporting Burden:
MHBG Report....................... 59...................... 1 186 10,974
URS Tables........................ 59...................... 1 35 2,065
SAPTBG Report..................... 60 \1\.................. 1 186 11,160
Table 5........................... 15 \2\.................. 1 4 60
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Reporting Subtotal............ 60...................... .............. .............. 24,259
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Total..................... 119..................... .............. .............. 49,639
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\1\ Redlake Band of the Chippewa Indians from MN receives a grant.
\2\ Only 15 States have a management information system to complete Table 5.
Table 2--Estimates of Application and Reporting Burden for Year 2
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Burden/
Application element Number Responses/ response Total burden
respondents respondents (hours)
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Application Burden:
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Yr Two Plan................................. 24 1 40 960
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Application Sub-total................... 24 .............. .............. 960
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Reporting Burden:
MHBG Report................................. 59 1 186 10,974
URS Tables.................................. 59 1 35 2,065
SAPTBG Report............................... 60 1 186 11,160
Table 5..................................... 15 1 4 60
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Reporting Subtotal...................... 60 .............. .............. 24,259
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Total............................... 119 .............. .............. 25,219
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The total annualized burden for the application and reporting is
37,429 hours (49,639 + 25,219 = 74,858/2 years = 37,429).
The link to access the block grant application is http://www.Samhsa.gov/grants/blockgrant.
Send comments to Summer King, SAMHSA Reports Clearance Officer,
Room 8-1099, One Choke Cherry Road, Rockville, MD 20857 or e-mail a
copy to [email protected]. Written comments should be received
within 60 days of this notice.
Dated: April 5, 2011.
Elaine Parry,
Director, Office of Management, Technology and Operations.
[FR Doc. 2011-8520 Filed 4-8-11; 8:45 am]
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