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Dec 29 -- The Substance Abuse and Mental Health Services Administration (SAMHSA) of HHS invites comments by February 27, 2023 regarding the proposed information collection for Community Mental Health Services Block Grant and Substance Abuse Prevention and Treatment Block Grant FY 2024-2025 Plan and Report.

Currently, the Community Mental Health Services Block Grant (MHBG) and Substance Abuse Prevention and Treatment Block Grant (SABG) 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.

SAMHSA has conveyed that block grant funds must 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. SAMHSA's five priorities (Preventing Overdose; Enhancing Access to Suicide Prevention and Crisis Care; Promoting Resilience and Emotional Health for Children, Youth and Families; Integrating Behavioral and Physical Health Care; and Strengthening the Behavioral Health Workforce) are highlighted and states are encouraged to incorporate them into their systems improvement efforts.

States will need help to meet future challenges associated with the implementation and management of an integrated physical health, mental health, and addiction service system. SAMHSA has established 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 continues to fully exercise SAMHSA's existing authority regarding states', territories' and the Red Lake Band of the Chippewa Indians' (subsequently referred to as “states”) use of block grant funds as they fully integrate behavioral health services into the broader health care continuum.

Consistent with previous applications, the FY 2024-2025 application has required sections and other sections where additional information is requested. The FY 2024-2025 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 equity. Therefore, as part of this block grant planning process, states should identify promising or effective strategies as well as technical assistance needed to implement the strategies identified in their plans for FYs 2024 and 2025. A narrative was added to discuss the Bipartisan Safter Communities Act funding for MHBG.

Pursuant to the supplemental funding appropriations for the MHBG and the SABG found in the Consolidated Appropriations Act, 2021 [Pub. L. 116-260] and the American Rescue Plan Act, 2021 [Pub. L. 117-2], SAMHSA has made changes to the Block Grant Plan and Report requirements for FFY 2024 and 2025. These changes are necessary to ensure that funds are spent in an appropriate and timely manner. Adjustments were made to pre-existing tables in the plan and report.

On the SABG narrative portion of the Block Grant Plan document major changes include the removal of words and terms with negative connotations and addition of those that are more appropriate. Examples include changing the word “abuse” to “use” and “Medication Assisted Treatment” to “Medication for Opioid Use Disorder” throughout the document. Language is included regarding the promotion of recovery for those who are in recovery, or who are receiving recovery support services, but who may not have participated in treatment in any fashion. The section regarding the Consolidated Appropriations Act (COVID-19) has been removed as it is no longer applicable after FY 2023. Additionally, there is a new narrative section outlining the concept of health equity and how Single State Authorities can work within their states to promote equitable promotion and use of resources. A new section on Harm Reduction efforts was added to illustrate that this work will be instrumental in SUD Prevention and Treatment moving forward. The SABG MOE requirements, Women's MOE requirements, Tuberculosis screening requirements, and restrictions on funding sections have been revamped for a better understanding of program requirements.

For the planning tables, changes were made to tables 10, 14, and a slight change to table 15. Updated information regarding the requesting of waivers under table 10, section 11 was added to reflect relevant sections of the PHS Act. Considerable updates to the narrative in question 14 regarding Medication for Opioid Use disorder reflect not only the new change in terminology but advances in the field. Lastly, table 15 “Crisis Services” has been listed as requested for future SABG applications.

On the MHBG report there are changes with the addition of one new table to the performance indicators and accomplishments section (Table 19b on the MHBG). With the addition of this new table, the original MHBG table 19b has been relabeled 19c. All MHBG tables that collect gender and race information have been updated to include transgender, Two-Spirt for the AI/AN population, and Some Other Race. In addition, MHBG tables have been updated to make age groups consistent across all applicable tables (Table 8a/b, 9, 11, 13a/b, 14, 15a, 18, 19, 19a, 19b, 19c, 20, 23a/b, 24 on the MHBG). A column was added to the MHBG tables for the Bipartisan Safter Communities Act funding. The additional tables should not require excessive effort as all data will already be collected by the states for the additional funding efforts.

Similarly, modifications to SABG reports were made to allow for the accurate capture of information for the FY 2024/FY 2025 reporting period and SABG priorities. A new table, 10b, was added to assess the number of persons served by SABG funds who receive recovery support services. The table also captures client characteristics, specifically age and gender. Although SABG reporting will allow for applicable grantees to continue to report data on COVID-19 expenditures and persons served using those funds, reporting requirements were streamlined with the elimination of table 2b. Reports were modified to more capture information on grantees' harm reduction activities. Namely, table 3a was modified to capture SABG expenditures on Narcan and Fentanyl Test Strips. Modifications to table 12 were also made to request the number of persons at risk for HIV/AIDS that were referred for PrEP services. Lastly, minor modifications were made to prior tables to clarify information previously requested or to address a missing category. For example, tables 11a and 11b, were modified to add an “other self-gender identities' to ensure that individuals who are non-gender conforming would be captured in the estimate of the number of persons served.

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 are due no later than September 1, 2023. The application for SABG-only is due no later than October 1, 2023. A single application for MHBG and SABG combined is due no later than September 1, 2023.
 
MHBG: https://www.samhsa.gov/grants/block-grants/mhbg
SAABG: https://www.samhsa.gov/grants/block-grants/sabg
Draft FY2024-2025 Block Grant Documents: https://www.samhsa.gov/grants/block-grants
FRN: https://www.federalregister.gov/d/2022-28403

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