80_FR_16071 80 FR 16013 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

80 FR 16013 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

Federal Register Volume 80, Issue 58 (March 26, 2015)

Page Range16013-16016
FR Document2015-06915

Federal Register, Volume 80 Issue 58 (Thursday, March 26, 2015)
[Federal Register Volume 80, Number 58 (Thursday, March 26, 2015)]
[Notices]
[Pages 16013-16016]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-06915]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


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

    Periodically, the Substance Abuse and Mental Health Services 
Administration (SAMHSA) will publish a summary of information 
collection requests under OMB review, in compliance with the Paperwork 
Reduction Act (44 U.S.C. Chapter 35). To 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 2016-2017 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 and 2017 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, as many as six 
million people, will gain health insurance coverage in 2014 and will 
have various outpatient and other services covered through Medicaid, 
Medicare, or private insurance. However, these plans will not provide 
access to the full range of support services necessary to achieve and 
maintain recovery for most of these individuals and their families.
    Given these changes, SAMHSA has conveyed that block grant funds be 
directed toward four purposes: (1) To fund priority treatment and 
support services for individuals without insurance or who cycle in and 
out of health insurance coverage; (2) to fund those priority treatment 
and support services not covered by Medicaid, Medicare or private 
insurance offered through the exchanges and that demonstrate success in 
improving outcomes and/or supporting recovery; (3) to fund universal, 
selective and targeted prevention activities and services; and (4) to 
collect performance and outcome data to determine the ongoing 
effectiveness of behavioral health prevention, treatment and recovery 
support services and to plan the implementation of new services on a 
nationwide basis.
    To help states meet the challenges of 2016 and beyond, and to 
foster the implementation 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, and a shift in SAMHSA staff functions to 
support and provide technical assistance for states receiving block 
grant funds as they fully integrate behavioral health services into 
health care.
    Consistent with previous applications, the FY 2016-2017 application 
has sections that are required and other sections where additional 
information is requested. The FY 2016-2017 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 their technical assistance needs to implement 
the strategies they identify in their plans for FY 2016 and 2017.
    To facilitate an efficient application process for states in FY 
2016-2017, SAMHSA convened an internal workgroup to develop the 
application for the block grant planning section. In addition, SAMHSA 
consulted with representatives from SMHAs and SSAs to receive input 
regarding proposed changes to the block grant. Based on these 
discussions with states, SAMHSA is proposing several changes to the 
block grant programs, discussed in greater detail below.

Changes to Assessment and Planning Activities

    The revisions reflect changes within the planning section of the 
application. The most significant of these changes relate to evidenced 
based practice for early intervention for the MHBG, participant 
directed care, medication assisted treatment for the SABG, crisis 
services, pregnant women and women with dependent children, community 
living and the implementation of Olmstead, and quality and data 
readiness collection.
    The FY 2014-2015 application sections on the Affordable Care Act, 
health insurance marketplace,

[[Page 16014]]

enrollment and primary and behavioral health care integration have been 
consolidated into a Health Care System and Integration section moving 
the emphasis to implementation of health care systems rather than 
preparation of the Affordable Care Act. Additionally, the FY 2014-2015 
Quality, Data and Information Technology sections have been 
consolidated into one section in the FY 2016-2017 application. 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:
     Health Care System and Integration--This section is a 
consolidation of the FY 2014-2015 sections on the Affordable Care Act, 
health insurance marketplace, enrollment and primary and behavioral 
health care integration. It is vital that SMHAs and SSAs programming 
and planning reflect the strong connection between behavioral and 
physical health. Fragmented or discontinuous care may result in 
inadequate diagnosis and treatment of both physical and behavioral 
conditions, including co-occurring disorders. Health care 
professionals, consumers of mental, substance use disorders, co-
occurring mental, and substance use disorders treatment recognize the 
need for improved coordination of care and integration of primary and 
behavioral health care. Health information technology, including 
electronic health records (EHRs) and telehealth are examples of 
important strategies to promote integrated care. Use of EHRs--in full 
compliance with applicable legal requirements--may allow providers to 
share information, coordinate care and improve billing practices.
    Implementation by SMHAs, SSAs and their partners of the Affordable 
Care Act is an important part of efforts to ensure access to care and 
better integrate care. In a recent report, the Congressional Budget 
Office estimates that by 2018, 25 million persons will have enrolled in 
the Affordable Care Act Marketplace and 12 million in Medicaid and the 
State Children's Health Insurance Program (SCHIP). The Department of 
Health and Human Services Assistant Secretary for Planning and 
Evaluation (ASPE) estimates that 32 million Americans will acquire 
coverage for mental and substance use disorder treatment as a result of 
the Affordable Care Act, including both previously uninsured persons 
and those enrolled in plans that lacked adequate coverage. In 2014, 
non-grandfathered health plans sold in the individual or the small 
group health insurance markets offered coverage for mental and 
substance use disorders as an essential health benefit.
     Evidenced-Based Practices for Early Intervention for the 
MHBG--In its FY 2014 appropriation, SAMHSA was directed to require that 
states set aside 5 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 Institutes of Health, 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.
     Participant Directed Care--As states implement policies 
that support self-determination and improve person-centered service 
delivery, one option that states can consider is the role that vouchers 
may play in their overall financing strategy. Many states have 
implemented voucher and self-directed care programs to help individuals 
gain expanded access to care and to enable individuals to play a more 
significant role in the development of their prevention, treatment and 
recovery services. The major goal of a voucher program is to ensure 
individuals have a genuine, free, and independent choice among a 
network of eligible providers. The implementation of a voucher program 
expands mental and substance use disorder treatment capacity and 
promotes choice among clinical treatment and recovery support 
providers, providing individuals with the ability to secure the best 
treatment options available to meet their specific needs. A voucher 
program facilitates linking clinical treatment with critical recovery 
support services, such as care coordination, childcare, motivational 
development, early/brief intervention, outpatient treatment, medical 
services, housing support, employment/education support, peer 
resources, family/parenting services or transportation.
    States interested in utilizing a voucher system should create or 
maintain a voucher management system to support vouchering and the 
reporting of data to enhance accountability by measuring outcomes. 
Meeting these voucher program challenges by creating and coordinating a 
wide array of service providers, leading them though the innovations 
and inherent system change processes results in the building of an 
integrated system that provides holistic care to individuals recovering 
from mental and substance use disorders.
     Medication Assisted Treatment (MAT)--There is a voluminous 
literature on the efficacy of Food and Drug Administration (FDA)-
approved medications for the treatment of substance use disorders. 
However, many treatment programs in the U.S. still offer only 
abstinence-based treatment for these conditions. The evidence base for 
medication assisted treatment of these disorders is described in 
several of SAMHSA's Treatment Improvement Protocol Series (TIPS) 
publications numbered 40, 43, 45, and 49. SAMHSA strongly encourages 
the states to require that treatment facilities providing clinical care 
to those with substance use disorders be required to either have the 
capacity and staff expertise to utilize MAT or have collaborative 
relationships with other providers such that these MATs can be accessed 
as clinically indicated for patient need. Individuals with substance 
use disorders who have a disorder for which there is an FDA-approved 
medication treatment should have access to those treatments.
     Crisis Services--In the on-going development of efforts to 
build an evidence-based robust system of care for adults diagnosed with 
an SMI, children with a serious emotional disturbance (SED) and persons 
with addictive disorders and their families via a coordinated continuum 
of treatments, services and supports, growing attention is being paid 
across the country to how states and local communities identify and 
effectively respond to behavioral health crises. SAMHSA has taken a 
leadership role in deepening the understanding of what it means to be 
in crisis and how to effectively respond to crisis as experienced by 
people with behavioral health conditions.

[[Page 16015]]

     A crisis response system will have the capacity to 
recognize and respond to crises across a continuum, from crisis 
planning, to early stages of support and respite, to crisis 
stabilization and intervention, to post-crisis follow-up and support 
for the individual and their family. SAMHSA expects that states will 
build on the emerging and growing body of evidence for effective 
community-based crisis response systems. Given the multi-system 
involvement of many individuals with behavioral health issues, the 
crisis response system approach provides the infrastructure to improve 
care coordination and outcomes, manage costs and better invest 
resources.
     Pregnant Women and Women With Dependent Children--
Substance-abusing pregnant women have been a leading priority 
population throughout the history of the SABG (Section 1922(b) of Title 
XIX, Part B, Subpart II, of the PHS Act (42 U.S.C. 300x-22(b)). The 
authorizing legislation required states to expend not less than 5 
percent of the FY 1993 and FY 1994 SABG to increase the availability of 
treatment services designed for pregnant women and women with dependent 
children. The purpose of these programs is to expand the availability 
of comprehensive, residential substance use disorder treatment, and 
recovery support services for pregnant and postpartum women and their 
minor children, including services for non-residential family members. 
This population continues to be of utmost concern, since by helping 
such women along their recovery journey, additional benefits may 
result: Fetal alcohol spectrum disorder may be prevented; a normal 
birth-weight may be achieved; and intergenerational transmission of 
addiction may be interrupted. Women with dependent children are also 
identified as a priority for specialized treatment (as opposed to 
treatment as usual) in the implementing regulations governing the SABG. 
In 1995 and subsequent fiscal years states are required to expend no 
less than an amount equal to that spent by the state in prior fiscal 
years for treatment services designed for pregnant women and women with 
dependent children.
     Community Living and the Implementation of Olmstead--The 
community living and Olmsted section was included in the environmental 
factors/background section of the FY 2014-2015 application and has been 
added to the planning section of the FY 2016-2017 application. The 
integration mandate in Title II of the Americans with Disabilities Act 
(ADA) and the Supreme Court's decision in Olmstead v. L.C., 527 U.S. 
581 (1999), provide legal requirements that are consistent with 
SAMHSA's mission to reduce the impact of substance abuse and mental 
illness on America's communities. Being an active member of a community 
is an important part of recovery for persons with behavioral health 
conditions. Title II of the ADA and the regulations promulgated for its 
enforcement require that states provide services in the most integrated 
arrangement appropriate and prohibit needless institutionalization and 
segregation in work, living, and other settings. In response to the 
tenth anniversary of the Supreme Court's Olmstead decision, then HHS 
Secretary Sebelius directed the creation of the Coordinating Council on 
Community Living at the HHS. SAMHSA has been a key member of the 
Coordinating Council on Community Living and has funded a number of 
technical assistance opportunities to promote integrated services for 
people with behavioral health needs, including a policy academy to 
share effective practices with states.
    Community living has been a priority across the federal government 
with recent changes to Section 811 and other housing programs operated 
by the Department of Housing and Urban Development (HUD). HUD and HHS 
collaborate to support housing opportunities for persons with 
disabilities, including persons with mental/substance use disorders. 
The Department of Justice (DOJ) and HHS Office of Civil Rights (OCR) 
cooperate on enforcement and compliance measures. DOJ and HHS OCR have 
expressed concern about some aspects of state mental health systems 
including use of traditional institutions and other settings that have 
institutional characteristics to serve persons whose needs could be 
better met in community settings. More recently, there has been 
litigation regarding certain employment services such as sheltered 
workshops. States should ensure Block Grant funds are allocated to 
support treatment and recovery services in community settings whenever 
feasible and remain committed, as SAMHSA is, to ensuring services are 
implemented in accordance with Olmstead and Title II of the ADA.
     Quality and Data Collection--The FY 2014-2015 Quality, 
Data and Information Technology sections have been consolidated into 
one section in the FY 2016-2017 application and is part of the planning 
section. SAMHSA is moving forward on the task of advancing a system for 
the collection of client level substance abuse and mental health 
treatment data. As such, SAMHSA is undertaking a series of efforts 
designed to develop a set of common core performance, quality, and cost 
measures to demonstrate the impact of SAMHSA's discretionary and block 
grant programs and guide SAMHSA's evaluation activities.
    The foundation of this effort is National Quality Behavioral Health 
Framework, which derives from the National Quality Strategy and seeks 
to improve the delivery of health care services, individual patient 
health outcomes, and the overall health of the population. The 
overarching goals are to ensure that services are evidence-based and 
effective; that they are person/family-centered; that care is 
coordinated across systems; that services promote healthy living; and 
that they are safe, accessible and affordable.
    For the FY 2016-2017 MHBG and SABG reports, achieving these goals 
will result in a more coordinated behavioral health data collection 
program that complements other existing systems (e.g., Medicaid 
administrative and billing data systems; and state mental health and 
substance abuse data systems), ensures consistency in the use of 
measures that are harmonized across various agencies and reporting 
systems, and provides a more complete understanding of the delivery of 
mental health and substance abuse services. Both goals can only be 
achieved through continuous collaboration with and feedback from 
SAMHSA's state partners.
    SAMHSA anticipates this movement is consistent with the current 
state authority's movement toward system integration and will minimize 
challenges associated with changing operational logistics of data 
collection and reporting. SAMHSA understands some modifications to data 
collection systems may be necessary, but will work with the states to 
minimize the impact of these changes.

Other Changes

    The overall format has been streamlined to integrate the 
environmental factors throughout the behavioral health assessment and 
plan narrative. This has reduced the length of the application by 10 
pages.
    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, 2015.
    The application for SABG-only is due no later than October 1, 2015. 
A single application for MHBG and SABG is due no later than September 
1, 2015.

[[Page 16016]]

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
SAPTBG Report.........................  60 \1\..................               1             186          11,160
Table 5...............................  15 \2\..................               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.


                        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
SAPTBG Report.........................  60......................               1             186          11,160
Table 5...............................  15......................               1               4              60
                                       -------------------------------------------------------------------------
    Reporting Subtotal................  60......................  ..............  ..............          24,259
                                       -------------------------------------------------------------------------
        Total.........................  119.....................  ..............  ..............          25,219
----------------------------------------------------------------------------------------------------------------

    The total annualized burden for the application and reporting is 
37,429 hours (49,639 + 25,219 = 74,858/2 years = 37,429).
    Link for the application: http://www.samhsa.gov/grants/block-grants.
    Written comments and recommendations concerning the proposed 
information collection should be sent by April 27, 2015 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. 2015-06915 Filed 3-25-15; 8:45 am]
 BILLING CODE 4162-20-P



                                                                               Federal Register / Vol. 80, No. 58 / Thursday, March 26, 2015 / Notices                                             16013

                                                  vehicle sold by respondent. Part V                      for planning, set asides for specific                 addiction service system, SAMHSA
                                                  requires dissemination of the order, now                populations or programs, etc.).                       must establish standards and
                                                  and in the future, to persons with                      Historically, the Centers within                      expectations that will lead to an
                                                  responsibilities relating to the MINI                   SAMHSA that administer these block                    improved system of care for individuals
                                                  Division and the subject matter of the                  grants have had different approaches to               with or at risk of mental and substance
                                                  order. Part VI ensures notification to the              application requirements and reporting.               use disorders. Therefore, this
                                                  FTC of changes in corporate status. Part                To compound this variation, states have               application package includes fully
                                                  VII mandates that respondent submit an                  different structures for accepting,                   exercising SAMHSA’s existing authority
                                                  initial compliance report to the FTC,                   planning, and accounting for the block                regarding states’, territories’ and the Red
                                                  and make subsequent reports available                   grants and the prevention set aside                   Lake Band of the Chippewa Tribe’s
                                                  to the FTC, upon request. Part VIII is a                within the SABG. As a result, how these               (subsequently referred to as ‘‘states’’)
                                                  provision ‘‘sunsetting’’ the order after                dollars are spent and what is known                   use of block grant funds, and a shift in
                                                  twenty (20) years, within certain                       about the services and clients that                   SAMHSA staff functions to support and
                                                  exceptions.                                             receive these funds varies by block grant             provide technical assistance for states
                                                    The purpose of this analysis is to                    and by state.                                         receiving block grant funds as they fully
                                                  facilitate public comment on the                           Increasingly, under the Affordable                 integrate behavioral health services into
                                                  proposed order. It is not intended to                   Care Act, more individuals are eligible               health care.
                                                  constitute an official interpretation of                for Medicaid and private insurance.                      Consistent with previous
                                                  the proposed order or to modify its                     This expansion of health insurance                    applications, the FY 2016–2017
                                                  terms in any way.                                       coverage will continue to have a                      application has sections that are
                                                    By direction of the Commission.                       significant impact on how State Mental                required and other sections where
                                                  Donald S. Clark,                                        Health Authorities (SMHAs) and Single                 additional information is requested. The
                                                                                                          State Agencies (SSAs) use their limited               FY 2016–2017 application requires
                                                  Secretary.
                                                                                                          resources. In 2009, more than 39 percent              states to submit a face sheet, a table of
                                                  [FR Doc. 2015–06903 Filed 3–25–15; 8:45 am]
                                                                                                          of individuals with serious mental                    contents, a behavioral health assessment
                                                  BILLING CODE 6750–01–P
                                                                                                          illnesses (SMI) or serious emotional                  and plan, reports of expenditures and
                                                                                                          disturbances (SED) were uninsured.                    persons served, an executive summary,
                                                                                                          Sixty percent of individuals with                     and funding agreements and
                                                  DEPARTMENT OF HEALTH AND                                substance use disorders whose                         certifications. In addition, SAMHSA is
                                                  HUMAN SERVICES                                          treatment and recovery support services               requesting information on key areas that
                                                                                                          were supported wholly or in part by                   are critical to the states success in
                                                  Substance Abuse and Mental Health                       SAMHSA block grant funds were also                    addressing health care integration.
                                                  Services Administration                                 uninsured. A substantial proportion of                Therefore, as part of this block grant
                                                  Agency Information Collection                           this population, as many as six million               planning process, SAMHSA is asking
                                                  Activities: Submission for OMB                          people, will gain health insurance                    states to identify their technical
                                                  Review; Comment Request                                 coverage in 2014 and will have various                assistance needs to implement the
                                                                                                          outpatient and other services covered                 strategies they identify in their plans for
                                                    Periodically, the Substance Abuse and                 through Medicaid, Medicare, or private                FY 2016 and 2017.
                                                  Mental Health Services Administration                   insurance. However, these plans will                     To facilitate an efficient application
                                                  (SAMHSA) will publish a summary of                      not provide access to the full range of               process for states in FY 2016–2017,
                                                  information collection requests under                   support services necessary to achieve                 SAMHSA convened an internal
                                                  OMB review, in compliance with the                      and maintain recovery for most of these               workgroup to develop the application
                                                  Paperwork Reduction Act (44 U.S.C.                      individuals and their families.                       for the block grant planning section. In
                                                  Chapter 35). To request a copy of these                    Given these changes, SAMHSA has                    addition, SAMHSA consulted with
                                                  documents, call the SAMHSA Reports                      conveyed that block grant funds be                    representatives from SMHAs and SSAs
                                                  Clearance Officer on (240) 276–1243.                    directed toward four purposes: (1) To                 to receive input regarding proposed
                                                                                                          fund priority treatment and support                   changes to the block grant. Based on
                                                  Project: Community Mental Health                        services for individuals without                      these discussions with states, SAMHSA
                                                  Services Block Grant and Substance                      insurance or who cycle in and out of                  is proposing several changes to the
                                                  Abuse and Prevention Treatment Block                    health insurance coverage; (2) to fund                block grant programs, discussed in
                                                  Grant FY 2016–2017 Plan and Report                      those priority treatment and support                  greater detail below.
                                                  Guidance and Instructions (OMB No.                      services not covered by Medicaid,
                                                  0930–0168)—Revision                                     Medicare or private insurance offered                 Changes to Assessment and Planning
                                                     The Substance Abuse and Mental                       through the exchanges and that                        Activities
                                                  Health Services Administration                          demonstrate success in improving                         The revisions reflect changes within
                                                  (SAMHSA), is requesting approval from                   outcomes and/or supporting recovery;                  the planning section of the application.
                                                  the Office of Management and Budget                     (3) to fund universal, selective and                  The most significant of these changes
                                                  (OMB) for a revision of the 2016 and                    targeted prevention activities and                    relate to evidenced based practice for
                                                  2017 Community Mental Health                            services; and (4) to collect performance              early intervention for the MHBG,
                                                  Services Block Grant (MHBG) and                         and outcome data to determine the                     participant directed care, medication
                                                  Substance Abuse Prevention and                          ongoing effectiveness of behavioral                   assisted treatment for the SABG, crisis
mstockstill on DSK4VPTVN1PROD with NOTICES




                                                  Treatment Block Grant (SABG) Plan and                   health prevention, treatment and                      services, pregnant women and women
                                                  Report Guidance and Instructions.                       recovery support services and to plan                 with dependent children, community
                                                     Currently, the SABG and the MHBG                     the implementation of new services on                 living and the implementation of
                                                  differ on a number of their practices                   a nationwide basis.                                   Olmstead, and quality and data
                                                  (e.g., data collection at individual or                    To help states meet the challenges of              readiness collection.
                                                  aggregate levels) and statutory                         2016 and beyond, and to foster the                       The FY 2014–2015 application
                                                  authorities (e.g., method of calculating                implementation of an integrated                       sections on the Affordable Care Act,
                                                  MOE, stakeholder input requirements                     physical health and mental health and                 health insurance marketplace,


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                                                  16014                        Federal Register / Vol. 80, No. 58 / Thursday, March 26, 2015 / Notices

                                                  enrollment and primary and behavioral                   2014, non-grandfathered health plans                  needs. A voucher program facilitates
                                                  health care integration have been                       sold in the individual or the small group             linking clinical treatment with critical
                                                  consolidated into a Health Care System                  health insurance markets offered                      recovery support services, such as care
                                                  and Integration section moving the                      coverage for mental and substance use                 coordination, childcare, motivational
                                                  emphasis to implementation of health                    disorders as an essential health benefit.             development, early/brief intervention,
                                                  care systems rather than preparation of                    • Evidenced-Based Practices for Early              outpatient treatment, medical services,
                                                  the Affordable Care Act. Additionally,                  Intervention for the MHBG—In its FY                   housing support, employment/
                                                  the FY 2014–2015 Quality, Data and                      2014 appropriation, SAMHSA was                        education support, peer resources,
                                                  Information Technology sections have                    directed to require that states set aside             family/parenting services or
                                                  been consolidated into one section in                   5 percent of their MHBG allocation to                 transportation.
                                                  the FY 2016–2017 application.                           support evidence-based programs that                     States interested in utilizing a
                                                  SAMHSA has provided a set of guiding                    provide treatment to those with early                 voucher system should create or
                                                  questions to stimulate and direct the                   SMI including but not limited to                      maintain a voucher management system
                                                  dialogue that states may engage in to                   psychosis at any age. SAMHSA worked                   to support vouchering and the reporting
                                                  determine the various approaches used                   collaboratively with the National                     of data to enhance accountability by
                                                  to develop their responses to each of the               Institutes of Health, National Institute              measuring outcomes. Meeting these
                                                  focus areas.                                            on Mental Health (NIMH) to review                     voucher program challenges by creating
                                                     The proposed revisions are described                 evidence showing efficacy of specific                 and coordinating a wide array of service
                                                  below:                                                  practices in ameliorating SMI and                     providers, leading them though the
                                                     • Health Care System and                             promoting improved functioning. NIMH                  innovations and inherent system change
                                                  Integration—This section is a                           has released information on                           processes results in the building of an
                                                  consolidation of the FY 2014–2015                       Components of Coordinated Specialty                   integrated system that provides holistic
                                                  sections on the Affordable Care Act,                    Care (CSC) for First Episode Psychosis.               care to individuals recovering from
                                                  health insurance marketplace,                           Results from the NIMH funded Recovery                 mental and substance use disorders.
                                                  enrollment and primary and behavioral                   After an Initial Schizophrenia Episode                   • Medication Assisted Treatment
                                                  health care integration. It is vital that               (RAISE) initiative, a research project of             (MAT)—There is a voluminous
                                                  SMHAs and SSAs programming and                          the NIMH, suggest that mental health                  literature on the efficacy of Food and
                                                  planning reflect the strong connection                  providers across multiple disciplines                 Drug Administration (FDA)-approved
                                                  between behavioral and physical health.                 can learn the principles of CSC for First             medications for the treatment of
                                                  Fragmented or discontinuous care may                    Episode of Psychosis (FEP), and apply                 substance use disorders. However, many
                                                  result in inadequate diagnosis and                      these skills to engage and treat persons              treatment programs in the U.S. still offer
                                                  treatment of both physical and                          in the early stages of psychotic illness.             only abstinence-based treatment for
                                                  behavioral conditions, including co-                       States can implement models across a               these conditions. The evidence base for
                                                  occurring disorders. Health care                        continuum, which have demonstrated                    medication assisted treatment of these
                                                  professionals, consumers of mental,                     efficacy, including the range of services             disorders is described in several of
                                                  substance use disorders, co-occurring                   and principles identified by NIMH.                    SAMHSA’s Treatment Improvement
                                                  mental, and substance use disorders                     Utilizing these principles, regardless of             Protocol Series (TIPS) publications
                                                  treatment recognize the need for                        the amount of investment, and with                    numbered 40, 43, 45, and 49. SAMHSA
                                                  improved coordination of care and                       leveraging funds through inclusion of                 strongly encourages the states to require
                                                  integration of primary and behavioral                   services reimbursed by Medicaid or                    that treatment facilities providing
                                                  health care. Health information                         private insurance, every state will be                clinical care to those with substance use
                                                  technology, including electronic health                 able to begin to move their system                    disorders be required to either have the
                                                  records (EHRs) and telehealth are                       toward earlier intervention, or enhance               capacity and staff expertise to utilize
                                                  examples of important strategies to                     the services already being implemented.               MAT or have collaborative relationships
                                                  promote integrated care. Use of EHRs—                      • Participant Directed Care—As                     with other providers such that these
                                                  in full compliance with applicable legal                states implement policies that support                MATs can be accessed as clinically
                                                  requirements—may allow providers to                     self-determination and improve person-                indicated for patient need. Individuals
                                                  share information, coordinate care and                  centered service delivery, one option                 with substance use disorders who have
                                                  improve billing practices.                              that states can consider is the role that             a disorder for which there is an FDA-
                                                     Implementation by SMHAs, SSAs and                    vouchers may play in their overall                    approved medication treatment should
                                                  their partners of the Affordable Care Act               financing strategy. Many states have                  have access to those treatments.
                                                  is an important part of efforts to ensure               implemented voucher and self-directed                    • Crisis Services—In the on-going
                                                  access to care and better integrate care.               care programs to help individuals gain                development of efforts to build an
                                                  In a recent report, the Congressional                   expanded access to care and to enable                 evidence-based robust system of care for
                                                  Budget Office estimates that by 2018, 25                individuals to play a more significant                adults diagnosed with an SMI, children
                                                  million persons will have enrolled in                   role in the development of their                      with a serious emotional disturbance
                                                  the Affordable Care Act Marketplace                     prevention, treatment and recovery                    (SED) and persons with addictive
                                                  and 12 million in Medicaid and the                      services. The major goal of a voucher                 disorders and their families via a
                                                  State Children’s Health Insurance                       program is to ensure individuals have a               coordinated continuum of treatments,
                                                  Program (SCHIP). The Department of                      genuine, free, and independent choice                 services and supports, growing attention
                                                  Health and Human Services Assistant                     among a network of eligible providers.                is being paid across the country to how
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                                                  Secretary for Planning and Evaluation                   The implementation of a voucher                       states and local communities identify
                                                  (ASPE) estimates that 32 million                        program expands mental and substance                  and effectively respond to behavioral
                                                  Americans will acquire coverage for                     use disorder treatment capacity and                   health crises. SAMHSA has taken a
                                                  mental and substance use disorder                       promotes choice among clinical                        leadership role in deepening the
                                                  treatment as a result of the Affordable                 treatment and recovery support                        understanding of what it means to be in
                                                  Care Act, including both previously                     providers, providing individuals with                 crisis and how to effectively respond to
                                                  uninsured persons and those enrolled in                 the ability to secure the best treatment              crisis as experienced by people with
                                                  plans that lacked adequate coverage. In                 options available to meet their specific              behavioral health conditions.


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                                                                               Federal Register / Vol. 80, No. 58 / Thursday, March 26, 2015 / Notices                                           16015

                                                     • A crisis response system will have                 legal requirements that are consistent                efforts designed to develop a set of
                                                  the capacity to recognize and respond to                with SAMHSA’s mission to reduce the                   common core performance, quality, and
                                                  crises across a continuum, from crisis                  impact of substance abuse and mental                  cost measures to demonstrate the impact
                                                  planning, to early stages of support and                illness on America’s communities.                     of SAMHSA’s discretionary and block
                                                  respite, to crisis stabilization and                    Being an active member of a community                 grant programs and guide SAMHSA’s
                                                  intervention, to post-crisis follow-up                  is an important part of recovery for                  evaluation activities.
                                                  and support for the individual and their                persons with behavioral health                           The foundation of this effort is
                                                  family. SAMHSA expects that states                      conditions. Title II of the ADA and the               National Quality Behavioral Health
                                                  will build on the emerging and growing                  regulations promulgated for its                       Framework, which derives from the
                                                  body of evidence for effective                          enforcement require that states provide               National Quality Strategy and seeks to
                                                  community-based crisis response                         services in the most integrated                       improve the delivery of health care
                                                  systems. Given the multi-system                         arrangement appropriate and prohibit                  services, individual patient health
                                                  involvement of many individuals with                    needless institutionalization and                     outcomes, and the overall health of the
                                                  behavioral health issues, the crisis                    segregation in work, living, and other                population. The overarching goals are to
                                                  response system approach provides the                   settings. In response to the tenth                    ensure that services are evidence-based
                                                  infrastructure to improve care                          anniversary of the Supreme Court’s                    and effective; that they are person/
                                                  coordination and outcomes, manage                       Olmstead decision, then HHS Secretary                 family-centered; that care is coordinated
                                                  costs and better invest resources.                      Sebelius directed the creation of the                 across systems; that services promote
                                                     • Pregnant Women and Women With                      Coordinating Council on Community                     healthy living; and that they are safe,
                                                  Dependent Children—Substance-                           Living at the HHS. SAMHSA has been                    accessible and affordable.
                                                  abusing pregnant women have been a                      a key member of the Coordinating                         For the FY 2016–2017 MHBG and
                                                  leading priority population throughout                  Council on Community Living and has                   SABG reports, achieving these goals will
                                                  the history of the SABG (Section 1922(b)                funded a number of technical assistance               result in a more coordinated behavioral
                                                  of Title XIX, Part B, Subpart II, of the                opportunities to promote integrated                   health data collection program that
                                                  PHS Act (42 U.S.C. 300x–22(b)). The                     services for people with behavioral                   complements other existing systems
                                                  authorizing legislation required states to              health needs, including a policy                      (e.g., Medicaid administrative and
                                                  expend not less than 5 percent of the FY                academy to share effective practices                  billing data systems; and state mental
                                                  1993 and FY 1994 SABG to increase the                   with states.                                          health and substance abuse data
                                                  availability of treatment services                         Community living has been a priority               systems), ensures consistency in the use
                                                  designed for pregnant women and                         across the federal government with                    of measures that are harmonized across
                                                  women with dependent children. The                      recent changes to Section 811 and other               various agencies and reporting systems,
                                                  purpose of these programs is to expand                  housing programs operated by the                      and provides a more complete
                                                  the availability of comprehensive,                      Department of Housing and Urban                       understanding of the delivery of mental
                                                  residential substance use disorder                      Development (HUD). HUD and HHS                        health and substance abuse services.
                                                  treatment, and recovery support services                collaborate to support housing                        Both goals can only be achieved through
                                                  for pregnant and postpartum women                       opportunities for persons with                        continuous collaboration with and
                                                  and their minor children, including                     disabilities, including persons with                  feedback from SAMHSA’s state
                                                  services for non-residential family                     mental/substance use disorders. The                   partners.
                                                  members. This population continues to                   Department of Justice (DOJ) and HHS                      SAMHSA anticipates this movement
                                                  be of utmost concern, since by helping                  Office of Civil Rights (OCR) cooperate                is consistent with the current state
                                                  such women along their recovery                         on enforcement and compliance                         authority’s movement toward system
                                                  journey, additional benefits may result:                measures. DOJ and HHS OCR have                        integration and will minimize
                                                  Fetal alcohol spectrum disorder may be                  expressed concern about some aspects                  challenges associated with changing
                                                  prevented; a normal birth-weight may                    of state mental health systems including              operational logistics of data collection
                                                  be achieved; and intergenerational                      use of traditional institutions and other             and reporting. SAMHSA understands
                                                  transmission of addiction may be                        settings that have institutional                      some modifications to data collection
                                                  interrupted. Women with dependent                       characteristics to serve persons whose                systems may be necessary, but will work
                                                  children are also identified as a priority              needs could be better met in community                with the states to minimize the impact
                                                  for specialized treatment (as opposed to                settings. More recently, there has been               of these changes.
                                                  treatment as usual) in the implementing                 litigation regarding certain employment
                                                  regulations governing the SABG. In                      services such as sheltered workshops.                 Other Changes
                                                  1995 and subsequent fiscal years states                 States should ensure Block Grant funds                   The overall format has been
                                                  are required to expend no less than an                  are allocated to support treatment and                streamlined to integrate the
                                                  amount equal to that spent by the state                 recovery services in community settings               environmental factors throughout the
                                                  in prior fiscal years for treatment                     whenever feasible and remain                          behavioral health assessment and plan
                                                  services designed for pregnant women                    committed, as SAMHSA is, to ensuring                  narrative. This has reduced the length of
                                                  and women with dependent children.                      services are implemented in accordance                the application by 10 pages.
                                                     • Community Living and the                           with Olmstead and Title II of the ADA.                   While the statutory deadlines and
                                                  Implementation of Olmstead—The                             • Quality and Data Collection—The                  block grant award periods remain
                                                  community living and Olmsted section                    FY 2014–2015 Quality, Data and                        unchanged, SAMHSA encourages states
                                                  was included in the environmental                       Information Technology sections have                  to turn in their application as early as
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                                                  factors/background section of the FY                    been consolidated into one section in                 possible to allow for a full discussion
                                                  2014–2015 application and has been                      the FY 2016–2017 application and is                   and review by SAMHSA. Applications
                                                  added to the planning section of the FY                 part of the planning section. SAMHSA                  for the MHBG-only is due no later than
                                                  2016–2017 application. The integration                  is moving forward on the task of                      September 1, 2015.
                                                  mandate in Title II of the Americans                    advancing a system for the collection of                 The application for SABG-only is due
                                                  with Disabilities Act (ADA) and the                     client level substance abuse and mental               no later than October 1, 2015. A single
                                                  Supreme Court’s decision in Olmstead                    health treatment data. As such,                       application for MHBG and SABG is due
                                                  v. L.C., 527 U.S. 581 (1999), provide                   SAMHSA is undertaking a series of                     no later than September 1, 2015.


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                                                  16016                                  Federal Register / Vol. 80, No. 58 / Thursday, March 26, 2015 / Notices

                                                  Estimates of Annualized Hour Burden                                      following tables showing burden                                               reporting. Year 2 includes the estimates
                                                    The estimated annualized burden for                                    separately for Year 1 and Year 2. Year                                        of burden for the application update and
                                                  a uniform application is 37,429 hours.                                   1 includes the estimates of burden for                                        annual reporting. The reporting burden
                                                  Burden estimates are broken out in the                                   the uniform application and annual                                            remains constant for both years.

                                                                                         TABLE 1—ESTIMATES OF APPLICATION AND REPORTING BURDEN FOR YEAR 1
                                                                                                                                                                                                                                     Burden/
                                                                                                                                                                                                      Responses/
                                                                     Application element                                                    Number respondents                                                                      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
                                                  SAPTBG Report ..............................................            60 1 .................................................................                          1                      186             11,160
                                                  Table 5 ............................................................    15 2 .................................................................                          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.

                                                                                         TABLE 2—ESTIMATES OF APPLICATION AND REPORTING BURDEN FOR YEAR 2
                                                                                                                                                                                                                                     Burden/
                                                                                                                                                                                                      Responses/
                                                                     Application element                                                    Number respondents                                                                      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
                                                  SAPTBG Report ..............................................            60   ...................................................................                        1                      186             11,160
                                                  Table 5 ............................................................    15   ...................................................................                        1                        4                 60

                                                        Reporting Subtotal ...................................            60 ...................................................................     ........................   ........................         24,259

                                                               Total ..................................................   119 .................................................................      ........................   ........................         25,219



                                                    The total annualized burden for the                                    commenters are encouraged to submit                                           DEPARTMENT OF HEALTH AND
                                                  application and reporting is 37,429                                      their comments to OMB via email to:                                           HUMAN SERVICES
                                                  hours (49,639 + 25,219 = 74,858/2 years                                  OIRA_Submission@omb.eop.gov.
                                                  = 37,429).                                                               Although commenters are encouraged to                                         Centers for Disease Control and
                                                    Link for the application: http://www.                                  send their comments via email,                                                Prevention
                                                  samhsa.gov/grants/block-grants.                                          commenters may also fax their
                                                                                                                                                                                                         [30Day–15–0963]
                                                    Written comments and                                                   comments to: 202–395–7285.
                                                  recommendations concerning the                                           Commenters may also mail them to:                                             Agency Forms Undergoing Paperwork
                                                  proposed information collection should                                   Office of Management and Budget,                                              Reduction Act Review
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                                                  be sent by April 27, 2015 to the                                         Office of Information and Regulatory
                                                  SAMHSA Desk Officer at the Office of                                     Affairs, New Executive Office Building,                                         The Centers for Disease Control and
                                                  Information and Regulatory Affairs,                                      Room 10102, Washington, DC 20503.                                             Prevention (CDC) has submitted the
                                                  Office of Management and Budget                                                                                                                        following information collection request
                                                  (OMB). To ensure timely receipt of                                       Summer King,                                                                  to the Office of Management and Budget
                                                  comments, and to avoid potential delays                                  Statistician.                                                                 (OMB) for review and approval in
                                                  in OMB’s receipt and processing of mail                                  [FR Doc. 2015–06915 Filed 3–25–15; 8:45 am]                                   accordance with the Paperwork
                                                  sent through the U.S. Postal Service,                                    BILLING CODE 4162–20–P                                                        Reduction Act of 1995. The notice for


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Document Created: 2015-12-18 11:46:51
Document Modified: 2015-12-18 11:46:51
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
FR Citation80 FR 16013 

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