[Federal Register Volume 81, Number 225 (Tuesday, November 22, 2016)]
[Notices]
[Pages 83859-83862]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-28043]


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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: Community Mental Health Services Block Grant and 
Substance Abuse and Prevention Treatment Block Grant FY 2018-2019 Plan 
and Report 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 2016-17 Community Mental Health 
Services Block Grant (MHBG) and Substance Abuse Prevention and 
Treatment Block Grant (SABG) Plan and Report Guidance and Instructions.
    Currently, the SABG and the MHBG 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 
SABG. 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.
    Increasingly, under the Affordable Care Act, more individuals are 
eligible for Medicaid and private insurance. This expansion of health 
insurance coverage will continue to have a significant impact on how 
State Mental Health Authorities (SMHAs) and Single State Agencies 
(SSAs) use their limited resources. In 2009, more than 39 percent of 
individuals with serious mental illnesses (SMI) or serious emotional 
disturbances (SED) were uninsured. Sixty percent of individuals with 
substance use disorders whose treatment and recovery support services 
were supported wholly or in part by SAMHSA block grant funds were also 
uninsured. A substantial proportion of this population has gained 
health insurance coverage since enactment of the Affordable Care Act 
and now has various outpatient and other services covered through 
Medicaid, Medicare, or private insurance. However, coverage provided by 
these plans and programs do not necessarily provide access to the full 
range of support services needed to achieve and maintain recovery for 
most of these individuals and their families.
    Given these changes, SAMHSA has conveyed 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.
    To help states meet the challenges of 2018 and beyond, and to 
foster the implementation and management of an integrated physical 
health and mental health and addiction service system, SAMHSA must 
establish standards and expectations that will lead to an improved 
system of care for individuals with or at risk of mental and substance 
use disorders. Therefore, this application package includes fully 
exercising SAMHSA's existing authority regarding states', territories' 
and the Red Lake Band of the Chippewa Tribe's (subsequently referred to 
as ``states'') use of block grant funds as they fully integrate 
behavioral health services into the broader health care continuum.
    Consistent with previous applications, the FY 2018-2019 application 
has sections that are required and other sections where additional 
information is requested. The FY 2018-2019 application requires states 
to submit a face sheet, a table of contents, a behavioral health 
assessment and plan, reports of expenditures and persons served, an 
executive summary, and funding agreements and certifications. In 
addition, SAMHSA is requesting information on key areas that are 
critical to the states success in addressing health care integration. 
Therefore, as part of this block grant planning process, SAMHSA is 
asking states to identify both their promising or effective strategies 
as well as their technical assistance needs to implement the strategies 
they identify in their plans for FYs 2018 and 2019.
    To facilitate an efficient application process for states in FYs 
2018-2019, SAMHSA convened an internal workgroup to review and modify 
the application for the block grant planning section. In addition, 
SAMHSA utilized the questions and requests for

[[Page 83860]]

clarification from representatives from SMHAs and SSAs to inform the 
proposed changes to the block grants. Based on these discussions with 
states, SAMHSA is proposing several changes to the block grant programs 
as discussed in greater detail below.

Changes to Assessment and Planning Activities

    The proposed revisions reflect changes within the planning section 
of the application. The most significant change involves a movement 
away from a request for multiple narrative descriptions of the state's 
activities in a variety of areas to a more quantitative response to 
specific questions, reflecting statutory or regulatory requirements 
where applicable, or reflecting specific uses of block grant funding. 
In addition, to respond to the requests from states, the required and 
requested sections have been clearly identified.
    The FY 2016-2017 application sections that gave states policy 
guidance on the planning and implementation of system issues which were 
not authorized services under either block grant have been eliminated 
to avoid confusion. In addition, the statutory criteria which govern 
the plan, report and application have been included in the document as 
references.
    Other specific proposed revisions are described below:
     Health Care System, Parity and Integration--This section 
is a consolidation of the FY 2016-2017 sections on the Affordable Care 
Act, health insurance marketplace, parity, enrollment and primary and 
behavioral health care integration. It is vital that SMHAs and SSAs 
programming and planning reflect the strong connection between 
behavioral and physical health. Fragmented or discontinuous care may 
result in inadequate diagnosis and treatment of both physical and 
behavioral conditions, including co-occurring disorders. Health care 
professionals, consumers of mental, substance use disorders, co-
occurring mental, and substance use disorders treatment recognize the 
need for improved coordination of care and integration of primary and 
behavioral health care. Health information technology, including 
electronic health records (EHRs), and telehealth are examples of 
important strategies to promote integrated care. Use of EHRs--in full 
compliance with applicable legal requirements--may allow providers to 
share information, coordinate care and improve billing practices.
     Evidenced-Based Practices for Early Intervention for the 
MHBG--In its FY 2016 appropriation, SAMHSA was directed to require that 
states set aside 10 percent of their MHBG allocation to support 
evidence-based programs that provide treatment to those with early SMI 
including but not limited to psychosis at any age. SAMHSA worked 
collaboratively with the National Institute on Mental Health (NIMH) to 
review evidence showing efficacy of specific practices in ameliorating 
SMI and promoting improved functioning. NIMH has released information 
on Components of Coordinated Specialty Care (CSC) for First Episode 
Psychosis. Results from the NIMH funded Recovery After an Initial 
Schizophrenia Episode (RAISE) initiative, a research project of the 
NIMH, suggest that mental health providers across multiple disciplines 
can learn the principles of CSC for First Episode of Psychosis (FEP), 
and apply these skills to engage and treat persons in the early stages 
of psychotic illness.
    States can implement models across a continuum, which have 
demonstrated efficacy, including the range of services and principles 
identified by NIMH. Utilizing these principles, regardless of the 
amount of investment, and with leveraging funds through inclusion of 
services reimbursed by Medicaid or private insurance, every state will 
be able to begin to move their system toward earlier intervention, or 
enhance the services already being implemented.

Other Changes

    While the statutory deadlines and block grant award periods remain 
unchanged, SAMHSA encourages states to turn in their application as 
early as possible to allow for a full discussion and review by SAMHSA. 
Applications for the MHBG-only is due no later than September 1, 2017. 
The application for SABG-only is due no later than October 1, 2017. A 
single application for MHBG and SABG is due no later than September 1, 
2017.

Estimates of Annualized Hour Burden

    The estimated annualized burden for the uniform application is 
33,374 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 recordkeeping 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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                               Substance Abuse Prevention and Treatment and Community Mental Health Services Block Grants
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                                                                                                                    Number of    Number of
       Authorizing legislation SABG        Authorizing legislation MHBG    Implementing regulation     Number of    responses    hours per   Total hours
                                                                                                       respondent    per year     response
--------------------------------------------------------------------------------------------------------------------------------------------------------
Reporting: Standard Form and Content--
    42 U.S.C. 300x-32(a).................
SABG:
    Annual Report                          ............................  ...........................  ...........  ...........  ...........       11,160
    42 U.S.C. 300x-52(a).................  ............................  45 CFR 96.122(f)...........           60            1
    42 U.S.C. 300x-30-b..................  ............................  ...........................            5            1
    42 U.S.C. 300x-30(d)(2)..............  ............................  45 CFR 96.134(d)...........           60            1
MHBG:
    Annual Report--                        ............................  ...........................  ...........  ...........  ...........       10,974
                                           42 USC Sec.   300x-6(a).....  ...........................           59            1
                                           42 U.S.C. 300x-52(a)........
                                           42 U.S.C. 300x-4(b)(3)B.....  ...........................           59            1
    State Plan (Covers 2 years)
SABG elements:
    42 U.S.C. 300x-22(b).................  ............................  45 CFR 96.124(c)()1).......           60            1
    42 U.S.C. 300x-23....................  ............................  45 CFR 96.126(f)...........           60            1

[[Page 83861]]

 
    42 U.S.C. 300x-24....................  ............................  45 CFR 96.127(b)...........           60            1
    42 U.S.C. 300x-27....................  ............................  45 CFR 96.131(f)...........           60            1
    42 U.S.C. 300x-29....................  ............................  45 CFR 96.133(a)...........           60            1
    42 U.S.C. 300x-32(b).................  ............................  45 CFR 96.122(g)...........           60            1          120        7,200
MHBG elements:
                                           42 U.S.C. 300x-1(b).........  ...........................           59            1          120        7,080
                                           42 U.S.C. 300x-1(b)(11).....  ...........................           59            1
                                           42 U.S.C. 300x-2(a).........  ...........................           59            1
    Waivers..............................  ............................  ...........................  ...........  ...........  ...........        3,240
    42 U.S.C. 300x-24(b)(5)(B)...........  ............................  ...........................           20            1
    42 U.S.C. 300x-28(d).................  ............................  45 CFR 96.132(d)...........            5            1
    42 U.S.C. 300x-30(c).................  ............................  45 CFR 96.134(b)...........           10            1
    42 U.S.C. 300x-31(c).................  ............................  ...........................            1            1
    42 U.S.C. 300x-32(c).................  ............................  ...........................            7            1
    42 U.S.C. 300x-32(e).................  ............................  ...........................           10
                                           300x-2(a)(2)................  ...........................           10
                                           300x-4(b)(3)................  ...........................           10
                                           300x-6(b)...................  ...........................            7
Recordkeeping--
    42 U.S.C. 300x-23....................  42 U.S.C. 300x-3............  45 CFR 96.126(c)...........        60/59            1           20        1,200
    42 U.S.C. 300x-25....................  ............................  45 CFR 96.129(a)(13).......           10            1           20          200
    42 U.S.C 300x-65.....................  ............................  42 CFR Part 54.............           60            1           20        1,200
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Combined Burden..........................  ............................  ...........................  ...........  ...........  ...........       42,254
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Report
300x-52(a)--Report.
300x-30(b)--Exclusion of Certain Funds (SABG).
300x-30(d)(2)--Maintenance of Effort (SABG).
300x-4(b)(3)B--Maintenance of Effort (MHBG).
State Plan--SABG
300x-22(b)--Allocations for Women.
300x-23--Intravenous Substance Abuse.
300x-24--Requirements Regarding TB and HIV.
300x-27--Priority in Admissions to Treatment.
300x-29--Statewide Assessment of Need.
300x-32(b)--State Plan.
State Plan--MHBG
42 U.S.C. 300x-1(b)--Criteria for Plan.
42 U.S.C. 300x-1(b)(11)--Incidence and prevalence in the state adults with SMI and Children with SED.
42 U.S.C. 300x-2(a)--Allocations for Systems Integrated Services for Children.
 
Waivers--SABG
300x-24(b)(5)(B)--Rural requirement regarding EIS/HIV.
300x-28(d)--Additional Agreements.
300x-30(c)--Maintenance of Effort.
300x-31(c)--Construction.
300x-32(c)--Certain Territories.
300x-32(e)--Waiver amendment for 1922, 1923, 1924 and 1927.
Waivers--MHBG
300x-2(a)(2)--Allocations for Systems Integrated Services for Children.
300x-4(b)(3)--Waiver of Statewide Maintenance of Effort.
300x-6(b)--Waiver for Certain Territories.
 
Recordkeeping
300x-23--Waiting list.
300x-25--Revolving loan fund.
300x-65--Charitable Choice.


                        Table 2--Estimates of Application and Reporting Burden for Year 2
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                                                                            Number of    Number of
                                                Number of respondents       responses    hours per   Total hours
                                                                             per year     response
----------------------------------------------------------------------------------------------------------------
Reporting:
    SABG..................................  60...........................            1          186       11.160
    MHBG..................................  59...........................            1          186       10,974
Recordkeeping.............................  60/59........................            1           40        2,360
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Combined Burden...........................  .............................  ...........  ...........       24,494
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The total annualized burden for the application and reporting is 33,374 hours (42,254 + 24,494 = 66,748/2 years
  = 33,374).
Link for the application: http://www.samhsa.gov/grants/block-grants.


[[Page 83862]]

    Send all comments via email to [email protected]. Comments 
should be received by January 23, 2017.

Summer King,
Statistician.
[FR Doc. 2016-28043 Filed 11-21-16; 8:45 am]
 BILLING CODE 4162-20-P