Agency Information Collection Activities: Submission for OMB Review; Comment Request, 61615-61620 [2012-24862]
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Federal Register / Vol. 77, No. 196 / Wednesday, October 10, 2012 / Notices
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Virtual Meeting).
Contact Person: Marie-Jose Belanger,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 5181,
MSC, Bethesda, MD 20892,
belangerm@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; Small
Business: Biological Chemistry, Biophysics,
and Drug Discovery.
Date: November 8, 2012.
Time: 8:30 a.m. to 6 p.m.
Agenda: To review and evaluate grant
applications.
Place: Doubletree Hotel Bethesda,
(Formerly Holiday Inn Select), 8120
Wisconsin Avenue, Bethesda, MD 20814.
Contact Person: Sergei Ruvinov, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 4158,
MSC 7806, Bethesda, MD 20892, 301–435–
1180, ruvinser@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; Small
Business: Biological Chemistry, Biophysics,
and Drug Discovery.
Date: November 8, 2012.
Time: 10 a.m. to 6 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892.
Contact Person: Dennis Hlasta, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 6185,
MSC, Bethesda, MD 20892, 301–435–1047,
dennis.hlasta@nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; PAR–11–
100: Alzheimer’s Disease Pilot Clinical
Trials.
Date: November 8, 2012.
Time: 1 p.m. to 4 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Virtual Meeting).
Contact Person: Mark Lindner, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 3182,
MSC 7770, Bethesda, MD 20892, 301–435–
0913, mark.lindner@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; AREA:
Endocrinology, Metabolism, Nutrition and
Reproduction.
Date: November 8, 2012.
Time: 1 p.m. to 5 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Virtual Meeting).
Contact Person: Dianne Hardy, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 6175,
Bethesda, MD 20892, 301–435–1154,
dianne.hardy@nih.gov.
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Name of Committee: Center for Scientific
Review Special Emphasis Panel; Member
Conflict: Neural Injury and
Neurodegeneration.
Date: November 8, 2012.
Time: 1:30 p.m. to 4 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Telephone Conference Call).
Contact Person: Seetha Bhagavan, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 5194,
MSC 7846, Bethesda, MD 20892, (301) 237–
9838, bhagavas@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; Member
Conflict: Language and Communication.
Date: November 8, 2012.
Time: 12 p.m. to 2:30 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Telephone Conference Call).
Contact Person: Serena Chu, Ph.D.,
Scientific Review Officer, BBBP IRG, Center
for Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 3178,
MSC 7848, Bethesda, MD 20892, 301–500–
5829, sechu@csr.nih.gov.
(Catalogue of Federal Domestic Assistance
Program Nos. 93.306, Comparative Medicine;
93.333, Clinical Research, 93.306, 93.333,
93.337, 93.393–93.396, 93.837–93.844,
93.846–93.878, 93.892, 93.893, National
Institutes of Health, HHS)
Dated: October 3, 2012.
David Clary,
Program Analyst, Office of Federal Advisory
Committee Policy.
[FR Doc. 2012–24877 Filed 10–9–12; 8:45 am]
BILLING CODE 4140–01–P
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 request a copy of these
documents, call the SAMHSA Reports
Clearance Officer on (240) 276–1243.
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61615
Project: Uniform Application for the
Mental Health Block Grant and
Substance Abuse Block Grant FY 2014–
2015 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 2014 and
2015 Community Mental Health
Services Block Grant (MHBG) and
Substance Abuse Prevention and
Treatment Block Grant (SABG)
Guidance and Instructions into a
uniform block grant application.
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
had 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.
In addition, between 2014 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
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Federal Register / Vol. 77, No. 196 / Wednesday, October 10, 2012 / Notices
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 will
have additional opportunities to be
insured. To ensure sufficient and
comprehensive preparation, SAMHSA
will use FY 2013 to continue 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 MHBG and SABG build
on ongoing efforts to reform health care,
ensure parity and provide states with
new tools, new flexibility, and state/
territory-specific plans for available
resources to provide their residents the
health care benefits they need. The
planning section of the block grant
application provides a process for states
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 will provide
information for SAMHSA and other
federal partners to use in working with
states to improve their behavioral health
systems over the next two years as
health care and economic conditions
evolve.
The FY 2014–2015 block grant
application provides states the
flexibility to submit one rather than two
separate block grant applications if they
choose. It also allows states 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 (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
in setting a clear direction for system
improvements over time, rather than as
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a simple effort to seek compliance with
minimal requirements.
Consistent with previous
applications, the FY 2014–2015
application has sections that are
required and other sections where
additional information is requested, but
not required. The FY 2014–2015
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, assurances, and
certifications. In addition, SAMHSA is
requesting information on key areas that
are critical to the state’s success in
addressing 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 SABG.
Therefore, as part of this block grant
planning process, SAMHSA is asking
states to identify their technical
assistance needs to implement the
strategies they identify in their plans for
FY 2014 and 2015.
To facilitate an efficient application
process for states in FY 2014–2015,
SAMHSA convened an internal
workgroup to develop 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. Comments were requested from
federal partners including the
Department of Health and Human
Services (HHS), the Office of
Management and Budget (OMB), the
Office of National Drug Control Policy
(ONDCP), and the Assistant Secretary
for Financial Resources (ASFR). Other
stakeholder groups consulted with
included NASADAD and NASMHPD.
Based on these discussions with states,
federal partners, and stakeholder
groups, SAMHSA is proposing the
following revisions to the block grant
application.
Changes to Assessment and Planning
Activities
SAMHSA has not made major
revisions to the FY 2014–2015
application. The proposed revisions are
based primarily on previous
instructions provided in the FY 2012–
2013 application guidance. In building
on the FY 2012–2013 guidance,
SAMHSA proposed revisions to expand
the areas of focus (environmental
factors) for states to describe their
comprehensive plans to provide
treatment, services, and supports for
individuals with behavioral health
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needs. These revisions will enable
SAMHSA to assess the extent to which
states plan for and implement
provisions of the Affordable Care Act
and determine whether block grants
funds are being directed toward the four
purposes of the grant.
The proposed revisions reflect
changes within the planning section of
the application. The most significant of
these changes relate to prevention,
particularly primary prevention; data
and quality; enrollment of individuals
and providers; and descriptions of good
and modern behavioral health services.
States are encouraged to address each of
the focus areas. SAMHSA has provided
a set of guiding questions to stimulate
and direct the dialogue that states may
engage in to determine the various
approaches used to develop their
responses to each of the focus areas.
The proposed revisions are described
below:
Areas of Focus/Environmental Factors
• Coverage for M/SUD Services—
Beginning in 2014, block grant dollars
should be used to pay for (1) people
who are uninsured, (2) services that are
not covered by insurance and Medicaid,
(3) prevention, and (4) the collection of
performance and outcome data.
Presumably, there will be similar
concerns at the state level that state
dollars are being used for people and/
or services not otherwise covered. States
(or the federal exchange) are currently
making plans to implement the
benchmark plan chosen for Qualified
Health Plans (QHPs) and their expanded
Medicaid program. States should begin
to develop strategies that will monitor
the implementation of the Act in their
states. States should begin to identify
whether people have better access to
mental health and substance use
disorder services. In particular, states
will need to determine if QHPs and
Medicaid are offering services for
mental and substance abuse disorders
and whether services are offered
consistent with provisions of MHPAEA.
• Affordable Insurance Exchanges—
Affordable Insurance Exchanges
(Exchanges) will be responsible for
performing a variety of critical functions
to ensure access to much needed
behavioral health services. Outreach
and education regarding enrollment in
QHPs or expanded Medicaid will be
critical. SMHAs and SSAs should
understand their state’s new eligibility
determination and enrollment system.
They should also understand how
insurers (commercial, Medicaid and
Medicare plans) will be making
decisions regarding their provider
networks. States should consider
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developing benchmarks regarding the
expected number of individuals in their
publicly funded behavioral health
system that should be insured by the
end of FY 2015. In addition, states
should set targets or recommendations
for the number of providers who will be
participating in insurers’ networks that
are currently not billing third party
insurance.
• Program Integrity —The Act directs
the Secretary of HHS to define EHBs.
Non-grandfathered plans in the
individual and small group markets
both inside and outside the Exchanges,
Medicaid benchmark and benchmark
equivalent plans, and basic health
programs must cover these EHBs. The
selected benchmark plan would serve as
a reference plan, reflecting both the
scope of services and limits offered by
a ‘‘typical employer plan’’ in a state as
required by the Act.
At this point in time, many states will
know which mental health and
substance abuse services are covered in
their benchmark plans offered by QHPs
and Medicaid programs. SMHAs and
SSAs should be focused on two main
areas related to EHBs: monitoring what
is covered and aligning block grants and
state funds for what is not covered.
These include: 1) ensuring that QHPs
and Medicaid programs are including
EHBs as per the state benchmark plan;
2) ensuring that individuals are aware of
the covered mental health and
substance abuse benefits; 3) ensuring
that people will utilize the benefits
despite concerns that employers will
learn of mental health and substance
abuse diagnosis of their employees; and
4) monitoring utilization of mental
health and substance abuse benefits in
light of utilization review, medical
necessity, etc.
SAMHSA expects states to implement
policies and procedures that are
designed to ensure that block grant
funds are used in accordance with the
four priority categories identified above.
Consequently, states may have to
reevaluate their current management
and oversight strategies to accommodate
the new priorities. They may also need
to become more proactive in ensuring
that state-funded providers are enrolled
in the Medicaid program and have the
ability to determine if clients are
enrolled or eligible to enroll in
Medicaid. Additionally, compliance
review and audit protocols may need to
be revised to provide for increased tests
of client eligibility and enrollment.
• Use of Evidence in Purchasing
Decisions—SAMHSA is interested in
whether or how states are using
evidence in their purchasing decisions,
educating policymakers or supporting
providers to offer high quality services.
In addition, SAMHSA is interested in
additional information that is needed by
SMHAs and SSAs in their efforts to
continue to shape their and other
purchasers decisions regarding mental
health and substance abuse services.
• Quality—Up to 25 data elements,
including those in the table below will
be available through the Behavioral
Health Barometer which SAMHSA will
prepare at least bi-annually to share
with states for purposes of informing the
planning process. Using this
information, states will select specific
priority areas. States will receive
feedback on an annual basis in terms of
national, regional and state performance
and will be expected to provide
information on the additional measures
they have identified outside of the core
measures and state barometer. Reports
on progress will serve to highlight the
impact of the block grant funded
services and thus allow SAMHSA to
collaborate with the states and other
HHS Operating Divisions in providing
technical assistance to improve
behavioral health and related outcomes.
Prevention
Health ....................
Home .....................
Community .............
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Purpose .................
Substance abuse
treatment
Youth and Adult Heavy Alcohol Use—
Past 30 Day.
Parental Disapproval Of Drug Use .......
Environmental Risk/Exposure to Prevention Messages And/or Friends
Disapproval.
Pro-Social
Connections-Community
Connections.
Reduction/No Change In substance
use past 30 days.
Stability in Housing ...............................
Involvement in Self-Help .......................
• Trauma—In order to better meet the
needs of those they serve, states should
take an active approach to addressing
trauma. Trauma screening matched with
trauma-specific therapies such as
exposure therapy or trauma-focused
cognitive behavioral approaches should
be adopted to ensure that treatments
meet the needs of those being served.
States should also consider adopting a
trauma informed care approach
consistent with SAMHSA’s trauma
informed care definition and principles.
This means providing care based on an
understanding of the vulnerabilities or
triggers of trauma survivors that
traditional service delivery approaches
may exacerbate, so that these services
and programs can be more supportive
and avoid re-traumatization.
• Justice—The SABG and MHBG may
be especially valuable in supporting
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Mental health services
Percent in TX employed, in school,
etc.—TEDS.
care coordination to promote pre-arrest,
pre-adjudication and pre-sentencing
diversion, providing care during gaps in
enrollment after incarceration, and
supporting other efforts related to
enrollment. Communities across the
United States have instituted problemsolving courts, including those for
defendants with mental and substance
use disorders. These courts seek to
prevent incarceration and facilitate
community-based treatment for
offenders, while at the same time
protecting public safety. There are two
types of problem-solving courts related
to behavioral health: Drug courts and
mental health courts. However, there are
a number of different types of problemsolving courts. In addition to drug
courts and mental health courts, some
jurisdictions, for example, operate
courts for DWI/DUI, veterans, family,
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Level of Functioning.
Stability in Housing.
Improvement/Increase in quality/number of supportive relationships
among SMI population.
Clients w/SMI or SED who are employed, or in school.
teen, reentry, as well as courts such as
gambling, domestic violence, truancy,
etc. States are also encouraged to work
with municipalities to determine
whether municipal mental health or
drug courts might be viable. Specialized
courts provide a forum in which the
adversarial process can be relaxed and
problem solving and treatment
processes can be emphasized. States
should place emphasis on screening,
assessment, and services provided prior
to arrest, adjudication and/or sentencing
to divert persons with mental and/or
substance use disorders from
correctional settings. Secondarily, states
should examine specific barriers such as
lack of identification needed for
enrollment, loss of eligibility resulting
from incarceration, and care
coordination for individuals with
chronic health conditions, housing
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instability, and employment challenges.
Secure custody rates decline when
community agencies are present to
advocate for alternatives for detention.
• Parity Education—SAMHSA
encourages states to take proactive steps
to improve consumer knowledge about
parity. As one plan of action, states can
develop communication plans to
provide and address key issues.
SAMHSA is in a unique position to
provide content expertise to assist
states, and is asking for input from
states to address this position.
• Primary and Behavioral Health
Care Integration Activities—Numerous
provisions in the Affordable Health Care
Act and elsewhere improve the
coordination of care for patients through
the creation of health homes, where
teams of health professionals will be
rewarded to coordinate care for patients
with chronic conditions. States that had
approved Medicaid State Plan
Amendments (SPAs) received 90
percent Federal Medicaid Assistance
Percentage (FMAP) for health home
services for eight quarters. At this
critical point in time, some states are
ending their two years of enhanced
FMAP and rolling back to their regular
state FMAP for health home services. In
addition, many states may be a year into
the implementation of their dual eligible
demonstration projects. States should
indicate how these changes and
opportunities affect their application.
• Health Disparities—In the block
grant application, states are asked to
define the populations they intend to
serve. Within these populations of focus
are subpopulations that may have
disparate access to, use of, or outcomes
from provided services. These
disparities may be the result of
differences in insurance coverage,
language, beliefs, norms, values, and/or
socioeconomic factors specific to that
subpopulation. For instance, Latino
adults with SMI may be at heightened
risk for metabolic disorder due to lack
of appropriate in-language primary care
services; American Indian/Alaska
Native youth may have an increased
Application
due
Application(s) for FY
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2014
2015
2016
2017
incidence of underage binge drinking
due to coping patterns related to
historical trauma within the American
Indian/Alaska Native community; and
African American women may be at
greater risk for contracting HIV/AIDS
due lack of access to education on risky
sexual behaviors in urban low-income
communities, etc. While these factors
might not be pervasive among the
general population served by the block
grant, they may be predominant among
subpopulations or groups vulnerable to
disparities. To address and ultimately
reduce disparities, it is important for
states to have a detailed understanding
of who is being served and not being
served within their communities,
including in what languages services are
provided, in order to implement
appropriate outreach and engagement
strategies for diverse populations. The
types of services provided, retention in
services and outcomes are critical
measures of quality and outcomes of
care for diverse groups. In order to
address the potentially disparate impact
for their block grant funded efforts,
states will be asked to address access,
use and outcomes for subpopulations,
which can be defined by the following
factors: race, ethnicity, language, gender
(including transgender), tribal
connection and sexual orientation (i.e.,
lesbian, gay, bisexual).
• Recovery—SAMHSA encourages
states to take proactive steps to
implement recovery support services.
SAMHSA is in a unique position to
provide content expertise to assist
states, and is asking for input from
states to address this position. SAMHSA
has launched Bringing Recovery
Supports to Scale Technical Assistance
Center Strategy (BRSS TACS). BRSS
TACS assists states and others to
promote adoption of recovery-oriented
supports, services, and systems for
people in recovery from mental or
substance use disorders.
• Children and Adolescents
Behavioral Health Services—Since
1993, SAMHSA has funded the
Children’s Mental Health Initiative
..............................................................
..............................................................
..............................................................
..............................................................
Summary of Changes as a Result of the
60-Day Federal Register Notice
SAMHSA received 232 comments
from 36 individuals or organizations.
The comments expressed general
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4/1/13
4/1/14
4/1/15
4/01/16
Plan due
Planning period
Yes ...............................................................
No .................................................................
Yes ...............................................................
No .................................................................
7/1/13–6/30/15
............................
7/1/15–6/30/17
............................
support for the option to submit a
combined plan for mental and substance
use disorders (M/SUD) for both block
grants, the movement to the behavioral
health barometer, the expressed four
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(CMHI) to build the System of Care
approach in states and communities
around the country. This has been an
ongoing program with over 160 grants
awarded to states and communities.
Every state has received at least one
CMHI grant. In 2007, SAMHSA awarded
State Substance Abuse Coordinator
grants to 16 states to build a state
infrastructure for substance use
disorders. This work has continued with
a focus on financing and workforce
development to support a recoveryoriented system of care that incorporates
established evidenced-based treatment
for youth with substance use disorders.
SAMHSA expects that states will
build on this well-documented, effective
system of care approach to serving
children and youth with behavioral
health needs. Given the multi-system
involvement of these children and
youth, the system of care approach
provides the infrastructure to improve
care coordination and outcomes,
manage costs and better invest
resources. The array of services and
supports in the system of care approach
includes non-residential (e.g.,
wraparound service planning, intensive
care management, outpatient therapy,
intensive home-based services,
substance use disorder intensive out
patient services, continuing care, mobile
crisis response, etc.), supportive
services (e.g., peer youth support, family
peer support, respite services, mental
health consultation, supported
education and employment, etc.), and
residential services (e.g., therapeutic
foster care, crisis stabilization services,
inpatient medical detoxification, etc.).
Although the statutory dates for
submitting the block grant application,
plan and annual report remain
unchanged, SAMHSA requests that the
MHBG and SABG applications be
submitted on the same date. In addition,
the dates for submitting the plans have
changed to better comport with most
states fiscal and planning years (July 1st
through June 30th of the following year).
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Reports due
12/1/13
12/1/14
12/1/15
12/1/16
priorities for the block grants, the twoyear planning cycle, and tribal
consultation. Many comments were
duplicative and include requests that
SAMHSA eliminate any reference to
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initiatives in the President’s budget
proposal and include a discussion of
only those initiatives that are
authorized; ask only for what is required
information and not include any areas
that are requested; clarify that SABG
dollars cannot be used for mental health
promotion; provide clear operational
definitions for each outcome measure;
simplify the data collected; reduce or
clarify the expanded area of focus;
change the acronym for the substance
abuse block grant back to SAPTBG;
address a concern from some states that
the April 1 deadline will be difficult
given other priority activities in the
states; emphasize older adults and
veterans; require substance abuse
representation on the planning council
for those states submitting a combined
application; and, address a concern that
the use of block grant funds are
becoming more prescriptive instead of
giving states maximum flexibility.
SAMHSA received some comments
about the ‘‘Behavioral Health Advisory
Council Composition by Member Type’’
table indicating that the reference to
members from diverse racial and
LGBTQ populations is potentially
confusing and creates a dilemma as to
which category members should be
ascribed, the term ‘leading state experts’
is also confusing and somewhat
arbitrary, and the membership
categorization for ‘‘Federally
Recognized Tribe Representatives’’
could be confused with council
members who happen to be tribal
members. SAMHSA agrees with the
recommendations that the request for a
number of individuals and providers
from diverse racial, ethnic, and LGBTQ
backgrounds in the table will skew the
calculation of the percentage of
consumers/state members. SAMHSA
has moved this information request, as
well as the request to identify any
member who is an individual in
recovery from SUD or advocating for
SUD services to the bottom of the table
and removed it from the calculation.
‘‘Leading state expert’’ is deleted.
Federally Recognized Tribal
Representatives are individuals who are
officially designated by the tribe to sit
on the Council.
SAMHSA added clarifying language
within the prevention section, that
clarifies that states will be allowed to
use some of their current Mental Health
Block Grant to support mental health
promotion and mental illness
prevention activities related to adults
with serious mental illnesses and
children with serious emotional
disturbances and their families. In
addition, the 20% set aside funds of the
Substance Abuse Block Grant must be
used for substance abuse primary
prevention activities by the state. Many
evidenced-based substance abuse
programs have a positive impact on the
prevention of substance use and abuse
as well as other health and social
outcomes such as education, juvenile
justice involvement, violence
prevention and mental health.
SAMHSA reduced the number of
questions in the prevention planning
section, in the Primary and Behavioral
Health Care Integration Activities
section, and in the Technical Assistance
needs section..
SAMHSA has renumbered and, in
some instances, renamed tables
throughout the document to eliminate
the redundancy in the table numbers
between the planning and reporting
sections and improve user navigation.
SAMHSA also revised the table entitled
‘Behavioral Health Advisory Council
Composition by Member Type.’ In
addition, SAMHSA enhanced the tables
of contents in the reporting sections to
facilitate user navigation.
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
Application element
Burden/
response
(hours)
Responses/
respondents
Number respondents
Total burden
Application Burden
Yr One Plan (separate submissions) ..............
1
282
16,920
Yr One Plan (combined submission) ..............
30 (CMHS) .....................................................
30 (SAPT)
30 ...................................................................
1
282
8,460
Application Sub-total ................................
60 ...................................................................
........................
........................
25,380
Reporting Burden
59 ...................................................................
59 ...................................................................
160 ..................................................................
215 ..................................................................
1
1
1
1
186
35
186
4
10,974
2,065
11,160
60
Reporting Subtotal ...................................
60 ...................................................................
........................
........................
24,259
Total .........................................................
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MHBG Report .................................................
URS Tables .....................................................
SABG Report ..................................................
Table 5 ............................................................
119 .................................................................
........................
........................
49,639
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.
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Federal Register / Vol. 77, No. 196 / Wednesday, October 10, 2012 / Notices
TABLE 2—ESTIMATES OF APPLICATION AND REPORTING BURDEN FOR YEAR 2
Application element
Burden/
response
(hours)
Responses/
respondents
Number respondents
Total burden
Application Burden
Yr Two Plan ....................................................
24 ...................................................................
1
40
960
Application Sub-total .......................................
24 ...................................................................
........................
........................
960
Reporting Burden
MHBG Report .................................................
URS Tables .....................................................
SABG Report ..................................................
Table 5 ............................................................
59
59
60
15
...................................................................
...................................................................
...................................................................
...................................................................
1
1
1
1
186
35
186
4
10,974
2,065
11,160
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:
www.samhsa.gov/grants/blockgrant.
Written comments and
recommendations concerning the
proposed information collection should
be sent by November 9, 2012 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:
OIRA_Submission@omb.eop.gov.
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. 2012–24862 Filed 10–9–12; 8:45 am]
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BILLING CODE 4162–20–P
VerDate Mar<15>2010
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DEPARTMENT OF HOMELAND
SECURITY
Federal Emergency Management
Agency
[Internal Agency Docket No. FEMA–4078–
DR; Docket ID FEMA–2012–0002]
Oklahoma; Amendment No. 2 to Notice
of a Major Disaster Declaration
Federal Emergency
Management Agency, DHS.
ACTION: Notice.
AGENCY:
W. Craig Fugate,
Administrator, Federal Emergency
Management Agency.
[FR Doc. 2012–24718 Filed 10–9–12; 8:45 am]
BILLING CODE 9111–23–P
This notice amends the notice
of a major disaster declaration for the
State of Oklahoma (FEMA–4078–DR),
dated August 22, 2012, and related
determinations.
DATES: Effective Date: September 27,
2012.
FOR FURTHER INFORMATION CONTACT:
Peggy Miller, Office of Response and
Recovery, Federal Emergency
Management Agency, 500 C Street SW.,
Washington, DC 20472, (202) 646–3886.
SUPPLEMENTARY INFORMATION: The notice
of a major disaster declaration for the
State of Oklahoma is hereby amended to
include the following area among those
areas determined to have been adversely
affected by the event declared a major
disaster by the President in his
declaration of August 22, 2012.
SUMMARY:
Cleveland County for Individual
Assistance.
(The following Catalog of Federal Domestic
Assistance Numbers (CFDA) are to be used
for reporting and drawing funds: 97.030,
Community Disaster Loans; 97.031, Cora
Brown Fund; 97.032, Crisis Counseling;
97.033, Disaster Legal Services; 97.034,
Disaster Unemployment Assistance (DUA);
97.046, Fire Management Assistance Grant;
97.048, Disaster Housing Assistance to
Individuals and Households in Presidentially
Jkt 229001
Declared Disaster Areas; 97.049,
Presidentially Declared Disaster Assistance—
Disaster Housing Operations for Individuals
and Households; 97.050, Presidentially
Declared Disaster Assistance to Individuals
and Households—Other Needs; 97.036,
Disaster Grants—Public Assistance
(Presidentially Declared Disasters); 97.039,
Hazard Mitigation Grant.)
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DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT
[Docket No. FR–5613–N–10]
Privacy Act of 1974; Home Equity
Reverse Mortgage Information
Technology (HERMIT)—Notice of
Modification to, and Deletion of HUD/
HS–10, Home Equity Conversion
Mortgage System
Office of the Chief Information
Officer HUD.
ACTION: Notification of modification to,
and deletion of existing system of
records notification.
AGENCY:
Pursuant to the provision of
the Privacy Act of 1974, as amended (5
U.S.C. 552a), the Department of Housing
and Urban Development (HUD) is
providing notice of its intent to modify
and delete one of its system of records
notifications, the HUD/HS–10, Home
Equity Conversion Mortgage (HECM)
system. HUD/HS–10, HECM is being
modified and replaced by the new
HECM program system, Home Equity
Reverse Mortgage Information
Technology (HERMIT). The
modifications for the existing system of
SUMMARY:
E:\FR\FM\10OCN1.SGM
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Agencies
[Federal Register Volume 77, Number 196 (Wednesday, October 10, 2012)]
[Notices]
[Pages 61615-61620]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-24862]
-----------------------------------------------------------------------
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 request a copy of these
documents, call the SAMHSA Reports Clearance Officer on (240) 276-1243.
Project: Uniform Application for the Mental Health Block Grant and
Substance Abuse Block Grant FY 2014-2015 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 2014 and 2015 Community Mental
Health Services Block Grant (MHBG) and Substance Abuse Prevention and
Treatment Block Grant (SABG) Guidance and Instructions into a uniform
block grant application.
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 had 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.
In addition, between 2014 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
[[Page 61616]]
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
will have additional opportunities to be insured. To ensure sufficient
and comprehensive preparation, SAMHSA will use FY 2013 to continue 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 MHBG and SABG build on ongoing efforts to reform
health care, ensure parity and provide states with new tools, new
flexibility, and state/territory-specific plans for available resources
to provide their residents the health care benefits they need. The
planning section of the block grant application provides a process for
states 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 will provide information for SAMHSA
and other federal partners to use in working with states to improve
their behavioral health systems over the next two years as health care
and economic conditions evolve.
The FY 2014-2015 block grant application provides states the
flexibility to submit one rather than two separate block grant
applications if they choose. It also allows states 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
(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 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 2014-2015 application
has sections that are required and other sections where additional
information is requested, but not required. The FY 2014-2015
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, assurances, and certifications. In addition, SAMHSA is
requesting information on key areas that are critical to the state's
success in addressing 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 SABG. Therefore, as part of this block grant
planning process, SAMHSA is asking states to identify their technical
assistance needs to implement the strategies they identify in their
plans for FY 2014 and 2015.
To facilitate an efficient application process for states in FY
2014-2015, SAMHSA convened an internal workgroup to develop 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. Comments were requested from federal partners including the
Department of Health and Human Services (HHS), the Office of Management
and Budget (OMB), the Office of National Drug Control Policy (ONDCP),
and the Assistant Secretary for Financial Resources (ASFR). Other
stakeholder groups consulted with included NASADAD and NASMHPD. Based
on these discussions with states, federal partners, and stakeholder
groups, SAMHSA is proposing the following revisions to the block grant
application.
Changes to Assessment and Planning Activities
SAMHSA has not made major revisions to the FY 2014-2015
application. The proposed revisions are based primarily on previous
instructions provided in the FY 2012-2013 application guidance. In
building on the FY 2012-2013 guidance, SAMHSA proposed revisions to
expand the areas of focus (environmental factors) for states to
describe their comprehensive plans to provide treatment, services, and
supports for individuals with behavioral health needs. These revisions
will enable SAMHSA to assess the extent to which states plan for and
implement provisions of the Affordable Care Act and determine whether
block grants funds are being directed toward the four purposes of the
grant.
The proposed revisions reflect changes within the planning section
of the application. The most significant of these changes relate to
prevention, particularly primary prevention; data and quality;
enrollment of individuals and providers; and descriptions of good and
modern behavioral health services. States are encouraged to address
each of the focus areas. SAMHSA has provided a set of guiding questions
to stimulate and direct the dialogue that states may engage in to
determine the various approaches used to develop their responses to
each of the focus areas.
The proposed revisions are described below:
Areas of Focus/Environmental Factors
Coverage for M/SUD Services--Beginning in 2014, block grant
dollars should be used to pay for (1) people who are uninsured, (2)
services that are not covered by insurance and Medicaid, (3)
prevention, and (4) the collection of performance and outcome data.
Presumably, there will be similar concerns at the state level that
state dollars are being used for people and/or services not otherwise
covered. States (or the federal exchange) are currently making plans to
implement the benchmark plan chosen for Qualified Health Plans (QHPs)
and their expanded Medicaid program. States should begin to develop
strategies that will monitor the implementation of the Act in their
states. States should begin to identify whether people have better
access to mental health and substance use disorder services. In
particular, states will need to determine if QHPs and Medicaid are
offering services for mental and substance abuse disorders and whether
services are offered consistent with provisions of MHPAEA.
Affordable Insurance Exchanges--Affordable Insurance
Exchanges (Exchanges) will be responsible for performing a variety of
critical functions to ensure access to much needed behavioral health
services. Outreach and education regarding enrollment in QHPs or
expanded Medicaid will be critical. SMHAs and SSAs should understand
their state's new eligibility determination and enrollment system. They
should also understand how insurers (commercial, Medicaid and Medicare
plans) will be making decisions regarding their provider networks.
States should consider
[[Page 61617]]
developing benchmarks regarding the expected number of individuals in
their publicly funded behavioral health system that should be insured
by the end of FY 2015. In addition, states should set targets or
recommendations for the number of providers who will be participating
in insurers' networks that are currently not billing third party
insurance.
Program Integrity --The Act directs the Secretary of HHS to
define EHBs. Non-grandfathered plans in the individual and small group
markets both inside and outside the Exchanges, Medicaid benchmark and
benchmark equivalent plans, and basic health programs must cover these
EHBs. The selected benchmark plan would serve as a reference plan,
reflecting both the scope of services and limits offered by a ``typical
employer plan'' in a state as required by the Act.
At this point in time, many states will know which mental health
and substance abuse services are covered in their benchmark plans
offered by QHPs and Medicaid programs. SMHAs and SSAs should be focused
on two main areas related to EHBs: monitoring what is covered and
aligning block grants and state funds for what is not covered. These
include: 1) ensuring that QHPs and Medicaid programs are including EHBs
as per the state benchmark plan; 2) ensuring that individuals are aware
of the covered mental health and substance abuse benefits; 3) ensuring
that people will utilize the benefits despite concerns that employers
will learn of mental health and substance abuse diagnosis of their
employees; and 4) monitoring utilization of mental health and substance
abuse benefits in light of utilization review, medical necessity, etc.
SAMHSA expects states to implement policies and procedures that are
designed to ensure that block grant funds are used in accordance with
the four priority categories identified above. Consequently, states may
have to reevaluate their current management and oversight strategies to
accommodate the new priorities. They may also need to become more
proactive in ensuring that state-funded providers are enrolled in the
Medicaid program and have the ability to determine if clients are
enrolled or eligible to enroll in Medicaid. Additionally, compliance
review and audit protocols may need to be revised to provide for
increased tests of client eligibility and enrollment.
Use of Evidence in Purchasing Decisions--SAMHSA is
interested in whether or how states are using evidence in their
purchasing decisions, educating policymakers or supporting providers to
offer high quality services. In addition, SAMHSA is interested in
additional information that is needed by SMHAs and SSAs in their
efforts to continue to shape their and other purchasers decisions
regarding mental health and substance abuse services.
Quality--Up to 25 data elements, including those in the
table below will be available through the Behavioral Health Barometer
which SAMHSA will prepare at least bi-annually to share with states for
purposes of informing the planning process. Using this information,
states will select specific priority areas. States will receive
feedback on an annual basis in terms of national, regional and state
performance and will be expected to provide information on the
additional measures they have identified outside of the core measures
and state barometer. Reports on progress will serve to highlight the
impact of the block grant funded services and thus allow SAMHSA to
collaborate with the states and other HHS Operating Divisions in
providing technical assistance to improve behavioral health and related
outcomes.
----------------------------------------------------------------------------------------------------------------
Substance abuse
Prevention treatment Mental health services
----------------------------------------------------------------------------------------------------------------
Health............................... Youth and Adult Heavy Reduction/No Change In Level of Functioning.
Alcohol Use--Past 30 substance use past 30
Day. days.
Home................................. Parental Disapproval Of Stability in Housing... Stability in Housing.
Drug Use.
Community............................ Environmental Risk/ Involvement in Self- Improvement/Increase in
Exposure to Prevention Help. quality/number of
Messages And/or supportive
Friends Disapproval. relationships among
SMI population.
Purpose.............................. Pro-Social Connections- Percent in TX employed, Clients w/SMI or SED
Community Connections. in school, etc.--TEDS. who are employed, or
in school.
----------------------------------------------------------------------------------------------------------------
Trauma--In order to better meet the needs of those they
serve, states should take an active approach to addressing trauma.
Trauma screening matched with trauma-specific therapies such as
exposure therapy or trauma-focused cognitive behavioral approaches
should be adopted to ensure that treatments meet the needs of those
being served. States should also consider adopting a trauma informed
care approach consistent with SAMHSA's trauma informed care definition
and principles. This means providing care based on an understanding of
the vulnerabilities or triggers of trauma survivors that traditional
service delivery approaches may exacerbate, so that these services and
programs can be more supportive and avoid re-traumatization.
Justice--The SABG and MHBG may be especially valuable in
supporting care coordination to promote pre-arrest, pre-adjudication
and pre-sentencing diversion, providing care during gaps in enrollment
after incarceration, and supporting other efforts related to
enrollment. Communities across the United States have instituted
problem-solving courts, including those for defendants with mental and
substance use disorders. These courts seek to prevent incarceration and
facilitate community-based treatment for offenders, while at the same
time protecting public safety. There are two types of problem-solving
courts related to behavioral health: Drug courts and mental health
courts. However, there are a number of different types of problem-
solving courts. In addition to drug courts and mental health courts,
some jurisdictions, for example, operate courts for DWI/DUI, veterans,
family, teen, reentry, as well as courts such as gambling, domestic
violence, truancy, etc. States are also encouraged to work with
municipalities to determine whether municipal mental health or drug
courts might be viable. Specialized courts provide a forum in which the
adversarial process can be relaxed and problem solving and treatment
processes can be emphasized. States should place emphasis on screening,
assessment, and services provided prior to arrest, adjudication and/or
sentencing to divert persons with mental and/or substance use disorders
from correctional settings. Secondarily, states should examine specific
barriers such as lack of identification needed for enrollment, loss of
eligibility resulting from incarceration, and care coordination for
individuals with chronic health conditions, housing
[[Page 61618]]
instability, and employment challenges. Secure custody rates decline
when community agencies are present to advocate for alternatives for
detention.
Parity Education--SAMHSA encourages states to take
proactive steps to improve consumer knowledge about parity. As one plan
of action, states can develop communication plans to provide and
address key issues. SAMHSA is in a unique position to provide content
expertise to assist states, and is asking for input from states to
address this position.
Primary and Behavioral Health Care Integration
Activities--Numerous provisions in the Affordable Health Care Act and
elsewhere improve the coordination of care for patients through the
creation of health homes, where teams of health professionals will be
rewarded to coordinate care for patients with chronic conditions.
States that had approved Medicaid State Plan Amendments (SPAs) received
90 percent Federal Medicaid Assistance Percentage (FMAP) for health
home services for eight quarters. At this critical point in time, some
states are ending their two years of enhanced FMAP and rolling back to
their regular state FMAP for health home services. In addition, many
states may be a year into the implementation of their dual eligible
demonstration projects. States should indicate how these changes and
opportunities affect their application.
Health Disparities--In the block grant application, states
are asked to define the populations they intend to serve. Within these
populations of focus are subpopulations that may have disparate access
to, use of, or outcomes from provided services. These disparities may
be the result of differences in insurance coverage, language, beliefs,
norms, values, and/or socioeconomic factors specific to that
subpopulation. For instance, Latino adults with SMI may be at
heightened risk for metabolic disorder due to lack of appropriate in-
language primary care services; American Indian/Alaska Native youth may
have an increased incidence of underage binge drinking due to coping
patterns related to historical trauma within the American Indian/Alaska
Native community; and African American women may be at greater risk for
contracting HIV/AIDS due lack of access to education on risky sexual
behaviors in urban low-income communities, etc. While these factors
might not be pervasive among the general population served by the block
grant, they may be predominant among subpopulations or groups
vulnerable to disparities. To address and ultimately reduce
disparities, it is important for states to have a detailed
understanding of who is being served and not being served within their
communities, including in what languages services are provided, in
order to implement appropriate outreach and engagement strategies for
diverse populations. The types of services provided, retention in
services and outcomes are critical measures of quality and outcomes of
care for diverse groups. In order to address the potentially disparate
impact for their block grant funded efforts, states will be asked to
address access, use and outcomes for subpopulations, which can be
defined by the following factors: race, ethnicity, language, gender
(including transgender), tribal connection and sexual orientation
(i.e., lesbian, gay, bisexual).
Recovery--SAMHSA encourages states to take proactive steps
to implement recovery support services. SAMHSA is in a unique position
to provide content expertise to assist states, and is asking for input
from states to address this position. SAMHSA has launched Bringing
Recovery Supports to Scale Technical Assistance Center Strategy (BRSS
TACS). BRSS TACS assists states and others to promote adoption of
recovery-oriented supports, services, and systems for people in
recovery from mental or substance use disorders.
Children and Adolescents Behavioral Health Services--Since
1993, SAMHSA has funded the Children's Mental Health Initiative (CMHI)
to build the System of Care approach in states and communities around
the country. This has been an ongoing program with over 160 grants
awarded to states and communities. Every state has received at least
one CMHI grant. In 2007, SAMHSA awarded State Substance Abuse
Coordinator grants to 16 states to build a state infrastructure for
substance use disorders. This work has continued with a focus on
financing and workforce development to support a recovery-oriented
system of care that incorporates established evidenced-based treatment
for youth with substance use disorders.
SAMHSA expects that states will build on this well-documented,
effective system of care approach to serving children and youth with
behavioral health needs. Given the multi-system involvement of these
children and youth, the system of care approach provides the
infrastructure to improve care coordination and outcomes, manage costs
and better invest resources. The array of services and supports in the
system of care approach includes non-residential (e.g., wraparound
service planning, intensive care management, outpatient therapy,
intensive home-based services, substance use disorder intensive out
patient services, continuing care, mobile crisis response, etc.),
supportive services (e.g., peer youth support, family peer support,
respite services, mental health consultation, supported education and
employment, etc.), and residential services (e.g., therapeutic foster
care, crisis stabilization services, inpatient medical detoxification,
etc.).
Although the statutory dates for submitting the block grant
application, plan and annual report remain unchanged, SAMHSA requests
that the MHBG and SABG applications be submitted on the same date. In
addition, the dates for submitting the plans have changed to better
comport with most states fiscal and planning years (July 1st through
June 30th of the following year).
----------------------------------------------------------------------------------------------------------------
Application
Application(s) for FY due Plan due Planning period Reports due
----------------------------------------------------------------------------------------------------------------
2014................................. 4/1/13 Yes.................... 7/1/13-6/30/15 12/1/13
2015................................. 4/1/14 No..................... ................ 12/1/14
2016................................. 4/1/15 Yes.................... 7/1/15-6/30/17 12/1/15
2017................................. 4/01/16 No..................... ................ 12/1/16
----------------------------------------------------------------------------------------------------------------
Summary of Changes as a Result of the 60-Day Federal Register Notice
SAMHSA received 232 comments from 36 individuals or organizations.
The comments expressed general support for the option to submit a
combined plan for mental and substance use disorders (M/SUD) for both
block grants, the movement to the behavioral health barometer, the
expressed four priorities for the block grants, the two-year planning
cycle, and tribal consultation. Many comments were duplicative and
include requests that SAMHSA eliminate any reference to
[[Page 61619]]
initiatives in the President's budget proposal and include a discussion
of only those initiatives that are authorized; ask only for what is
required information and not include any areas that are requested;
clarify that SABG dollars cannot be used for mental health promotion;
provide clear operational definitions for each outcome measure;
simplify the data collected; reduce or clarify the expanded area of
focus; change the acronym for the substance abuse block grant back to
SAPTBG; address a concern from some states that the April 1 deadline
will be difficult given other priority activities in the states;
emphasize older adults and veterans; require substance abuse
representation on the planning council for those states submitting a
combined application; and, address a concern that the use of block
grant funds are becoming more prescriptive instead of giving states
maximum flexibility.
SAMHSA received some comments about the ``Behavioral Health
Advisory Council Composition by Member Type'' table indicating that the
reference to members from diverse racial and LGBTQ populations is
potentially confusing and creates a dilemma as to which category
members should be ascribed, the term `leading state experts' is also
confusing and somewhat arbitrary, and the membership categorization for
``Federally Recognized Tribe Representatives'' could be confused with
council members who happen to be tribal members. SAMHSA agrees with the
recommendations that the request for a number of individuals and
providers from diverse racial, ethnic, and LGBTQ backgrounds in the
table will skew the calculation of the percentage of consumers/state
members. SAMHSA has moved this information request, as well as the
request to identify any member who is an individual in recovery from
SUD or advocating for SUD services to the bottom of the table and
removed it from the calculation. ``Leading state expert'' is deleted.
Federally Recognized Tribal Representatives are individuals who are
officially designated by the tribe to sit on the Council.
SAMHSA added clarifying language within the prevention section,
that clarifies that states will be allowed to use some of their current
Mental Health Block Grant to support mental health promotion and mental
illness prevention activities related to adults with serious mental
illnesses and children with serious emotional disturbances and their
families. In addition, the 20% set aside funds of the Substance Abuse
Block Grant must be used for substance abuse primary prevention
activities by the state. Many evidenced-based substance abuse programs
have a positive impact on the prevention of substance use and abuse as
well as other health and social outcomes such as education, juvenile
justice involvement, violence prevention and mental health.
SAMHSA reduced the number of questions in the prevention planning
section, in the Primary and Behavioral Health Care Integration
Activities section, and in the Technical Assistance needs section..
SAMHSA has renumbered and, in some instances, renamed tables
throughout the document to eliminate the redundancy in the table
numbers between the planning and reporting sections and improve user
navigation. SAMHSA also revised the table entitled `Behavioral Health
Advisory Council Composition by Member Type.' In addition, SAMHSA
enhanced the tables of contents in the reporting sections to facilitate
user navigation.
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 submissions).... 30 (CMHS)............... 1 282 16,920
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
SABG Report........................... \1\60................... 1 186 11,160
Table 5............................... \2\15................... 1 4 60
-------------------------------------------------------------------------
Reporting Subtotal................ 60...................... .............. .............. 24,259
-------------------------------------------------------------------------
Total............................. 119..................... .............. .............. 49,639
----------------------------------------------------------------------------------------------------------------
\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.
[[Page 61620]]
Table 2--Estimates of Application and Reporting Burden for Year 2
----------------------------------------------------------------------------------------------------------------
Burden/
Application element Number respondents Responses/ response Total burden
respondents (hours)
----------------------------------------------------------------------------------------------------------------
Application Burden
----------------------------------------------------------------------------------------------------------------
Yr Two Plan........................... 24...................... 1 40 960
-------------------------------------------------------------------------
Application Sub-total................. 24...................... .............. .............. 960
----------------------------------------------------------------------------------------------------------------
Reporting Burden
----------------------------------------------------------------------------------------------------------------
MHBG Report........................... 59...................... 1 186 10,974
URS Tables............................ 59...................... 1 35 2,065
SABG 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: www.samhsa.gov/grants/blockgrant.
Written comments and recommendations concerning the proposed
information collection should be sent by November 9, 2012 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: OIRA_Submission@omb.eop.gov. 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. 2012-24862 Filed 10-9-12; 8:45 am]
BILLING CODE 4162-20-P