[Federal Register Volume 82, Number 49 (Wednesday, March 15, 2017)]
[Notices]
[Pages 13826-13828]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-05063]



[[Page 13826]]

-----------------------------------------------------------------------

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. To request a copy of these documents, call the SAMHSA 
Reports Clearance Officer on (240) 276-1243.

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 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 indicated 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 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 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

[[Page 13827]]

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 Serious Mental Illness 
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.
     Statutory changes required by the 21st Century CURES Act--
The CURES Act required several language changes, to include: A change 
from Administrator of SAMHSA to Assistant Secretary for Mental Health 
and Substance Use; a change from ``Substance Misuse Prevention'' to 
``Substance Use Disorder Prevention'' and others. In addition, the Act 
eliminated section 1929 governing the annual treatment needs assessment 
and changed the specific requirements for the state determination of 
need to include estimates on the number of individuals who need 
treatment, who are pregnant women, women with dependent children, 
individuals with a co-occurring mental health and substance use 
disorder, persons who inject drugs, and persons who are experiencing 
homelessness.

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
--------------------------------------------------------------------------------------------------------------------------------------------------------
                               Substance Abuse Prevention and Treatment and Community Mental Health Services Block Grants
---------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                    Number of    Number of
                                         Authorizing           Authorizing          Implementing       Number of    responses    hours per   Total hours
                                      legislation SABG      legislation MHBG         regulation        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-       ....................  45 CFR 96.134(d)....           60            1
                                     30(d)(2).
MHBG..............................  Annual Report.......  ....................  ....................  ...........  ...........  ...........       10,974
                                                          42 U.S.C. 300x-6(a).  ....................           59            1
                                                          42 U.S.C. 300x-52(a)
                                                          42 U.S.C. 300x-       ....................           59            1
                                                           4(b)(3)B.
                                    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
                                    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-       ....................           59            1
                                                           1(b)(11).
                                                          42 U.S.C. 300x-2(a).  ....................           59            1
                                    Waivers.............  ....................  ....................  ...........  ...........  ...........        3,240
                                    42 U.S.C. 300x-       ....................  ....................           20            1
                                     24(b)(5)(B).
                                    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

[[Page 13828]]

 
                                    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
Combined Burden...................  ....................  ....................  ....................  ...........  ...........  ...........       42,254
--------------------------------------------------------------------------------------------------------------------------------------------------------

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
----------------------------------------------------------------------------------------------------------------
                                                                     Number of       Number of
                                                     Number of     responses per     hours per      Total hours
                                                    respondent         year          response
----------------------------------------------------------------------------------------------------------------
Reporting:
    SABG........................................              60               1             186          11,160
    MHBG........................................              59               1             186          10,974
Recordkeeping...................................           60/59               1              40           2,360
                                                 ---------------------------------------------------------------
        Combined Burden.........................              60  ..............  ..............          24,494
----------------------------------------------------------------------------------------------------------------

    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.
    Written comments and recommendations concerning the proposed 
information collection should be sent by April 14, 2017 to the SAMHSA 
Desk Officer at the Office of Information and Regulatory Affairs, 
Office of Management and Budget (OMB). To ensure timely receipt of 
comments, and to avoid potential delays in OMB's receipt and processing 
of mail sent through the U.S. Postal Service, commenters are encouraged 
to submit their comments to OMB via email to: 
[email protected]. Although commenters are encouraged to send 
their comments via email, commenters may also fax their comments to: 
202-395-7285. Commenters may also mail them to: Office of Management 
and Budget, Office of Information and Regulatory Affairs, New Executive 
Office Building, Room 10102, Washington, DC 20503.

Summer King,
Statistician.
[FR Doc. 2017-05063 Filed 3-14-17; 8:45 am]
 BILLING CODE 4162-20-P