[Federal Register Volume 76, Number 117 (Friday, June 17, 2011)]
[Notices]
[Pages 35454-35459]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-15070]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

    Periodically, the Substance Abuse and Mental Health Services 
Administration (SAMHSA) will publish a summary of information 
collection requests under OMB review, in compliance with the Paperwork 
Reduction Act (44 U.S.C. Chapter 35). To obtain a copy of these 
documents, see the following link: http://www.samhsa.gov/grants/blockgrant/.

[[Page 35455]]

Project: Uniform 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 a uniform 
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 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

[[Page 35456]]

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 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

[[Page 35457]]

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.
     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 application 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 an assurance to confirm compliance.

Summary of Changes as a Result of the Federal Register Notice

    On April 11, 2011 a Federal Register Notice was posted to obtain 
comments on the proposed collection of information sought through the 
revised application for the SAPTBG and the MHSBG. In total, 772 
comments from 522 individuals or organizations were received. The 
comments were (1) Supportive of the changes proposed to the FY 2012-
2013 Block Grant Application, (2) requested clarification regarding 
certain areas or (3) requested specific changes to the Block Grant 
Application.
    The most frequent comments in support of the revised Block Grant 
application focused on the following areas:
     Allowing States to submit a bi-annual plan instead of an 
annual plan.
     Having a standard format for both the MHSBG and SAPTBG.
     SAMHSA's efforts to encourage States to use the revised 
Block Grant application process to be better prepared to respond to 
several major Federal initiatives.
     Focus on planning for populations that are uninsured and 
below 133% of the Federal poverty level that may become insured in FY 
2014.
     Inclusion of family involvement, tribal consultation and a 
focus on the provision of recovery support services.

[[Page 35458]]

     Commending SAMHSA on including adolescents as a target 
group that States can include in their needs assessment and State Plan.
    The most frequent comments seeking clarification in the revised 
Block Grant application focused on the following areas:
     Requesting clarification on the sections of the Block 
Grant application that were required versus requested.
     Requesting that SAMHSA provide States flexibility 
regarding the submission of Block Grant applications post the statutory 
submission given the compressed timeframes.
     Requesting assurances that SAMHSA will not disapprove a 
State Plan or payment that did not include the requested information in 
the block grant application.
     Clarification that SAMHSA is not consolidating the MHBG 
and SAPTBG funds.
     Requesting definitions and procedure codes for the 
services that are included in Table 5 of the State Plan document and 
the reporting sections.
     Additional clarification regarding the process to develop 
dashboard measures for States and the proposed incentive program.
     Additional clarification and technical assistance 
regarding strategies to perform formal Tribal consultation.
     Comments regarding SAMHSA's proposed FY 2012 budget and 
the creation of State Prevention Grants. The comments were not in 
support of the FY 2012 proposal. While these were important comments 
that were not relevant to the FRN regarding the changes in the Block 
grant application.
    During the 60 day review period SAMHSA conducted fourteen 
teleconferences to review the changes to the MHSBG and SAPTBG with 
State Substance Abuse authorities, State Mental Health Authorities and 
other stakeholders. SAMHSA also did a significant public outreach 
effort to solicit comments on the revised block grant application 
through announcements in various periodicals, trade association 
materials and prominently displayed the FRN and the application on the 
SAMHSA Web site.
    Based on the comments received through the Federal Register Notice, 
SAMHSA has made changes to the revised block grant application. These 
changes include:
     Clarifying which sections of the block grant application 
are required to be submitted as part of the State Plan and which 
sections SAMHSA is requesting, but not requiring States to submit. 
SAMHSA continues to strongly encourage States to submit this 
information. This will allow SAMHSA to understand the Applicant State's 
efforts and identify how it can assist the applicant State meet its 
goals in a changing environment. In addition, this information will 
identify States that are models and assist other States with areas of 
common concern.
     Clarify to States that not submitting this information 
will not change SAMHSA's approval of their Plan or payment, States are 
strongly encouraged to submit as much as they can so the nation as a 
whole will have a complete picture of needs of individuals with 
behavioral health conditions as well as the innovative approaches 
States are undertaking in these areas as well as the barriers they 
encounter to design and implement important policies and programs.
     Provided some additional clarity regarding specific 
sections of the plan in the following areas: Data and Information 
Technology, consultation with Tribes, Support of State Partners, and 
State behavioral Health Advisory Council.
     Provided additional clarification on specific sections of 
the reporting section for the MHBG and SABG.

Estimates of Annualized Hour Burden

    The estimated annualized burden for a uniform 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 uniform 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
----------------------------------------------------------------------------------------------------------------
                                                                                      Burden/
         Application element              Number  respondents       Responses/       response      Total burden
                                                                    respondents       (hours)
----------------------------------------------------------------------------------------------------------------
Application Burden:
    Yr One Plan (separate              30 (CMHS)................               1             282          16,920
     submissions).                     30 (SAPT)................
    Yr One Plan (combined submission)  30.......................               1             282           8,460
                                      --------------------------------------------------------------------------
        Application Sub-total........  60.......................  ..............  ..............          25,380
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
        Reporting Subtotal...........  60.......................  ..............  ..............          24,259
                                      --------------------------------------------------------------------------
            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
----------------------------------------------------------------------------------------------------------------
                                                                                      Burden/
               Application element                    Number        Responses/       response      Total burden
                                                    respondents     respondents       (hours)
----------------------------------------------------------------------------------------------------------------
Application Burden:
    Yr Two Plan.................................              24               1              40             960
    Application Sub-total.......................              24  ..............  ..............             960

[[Page 35459]]

 
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
    Reporting Subtotal..........................              60  ..............  ..............          24,259
                                                 ---------------------------------------------------------------
        Total...................................             119  ..............  ..............          25,219
----------------------------------------------------------------------------------------------------------------

    The total annualized burden for the application and reporting is 
37,429 hours (49,639 + 25,219 = 74,858/2 years = 37,429).
    Link for the application: http://www.samhsa.gov/grants/blockgrant/.
    Written comments and recommendations concerning the proposed 
information collection should be sent by July 18, 2011 to: SAMHSA Desk 
Officer, Human Resources and Housing Branch, Office of Management and 
Budget, New Executive Office Building, Room 10235, Washington, DC 
20503; due to potential delays in OMB's receipt and processing of mail 
sent through the U.S. Postal Service, respondents are encouraged to 
submit comments by fax to: 202-395-7285.

    Dated: June 13, 2011.
Elaine Parry,
Director, Office of Management, Technology and Operations.
[FR Doc. 2011-15070 Filed 6-16-11; 8:45 am]
BILLING CODE 4162-20-P