Substance Abuse Prevention and Treatment Block Grant Overview

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Substance Abuse Prevention and Treatment Block
Grant Overview
WELCOME

• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Substance Abuse and Mental Health Services
  Administration
• Center for Substance Abuse Treatment
• www.samhsa.gov

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant
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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• Public Law 97-35 (PL 97-35) created the Alcohol,
  Drug Abuse and Mental Health Services (ADMS)
  Block Grant.
• PL 97-35 became effective on October 1, 1981.
• In addition to funding alcohol and drug services,
  the ADMS Block Grant included funds for mental
  health services.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• The ADAMHA Reorganization Act (Public Law
  102-321, 102d Congress) of 1992 created several
  significant changes in the Block Grant, including
  the following
• It created a distinct block grant for mental
  health services and a distinct block grant for
  substance abuse services.
• It changed the name of the portion of the Block
  Grant for alcohol and drug services to the
  Substance Abuse Prevention and Treatment (SAPT)
  Block Grant.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• The current Block Grant regulations were released
  in the Federal Register in March 1993.
• The official citation of the current regulations
  is Title 45 of the Code of Federal Regulations
  Part 96 (45 CFR Part 96), Substance Abuse
  Prevention and Treatment Block Grants Interim
  Final Rule.
• The regulations authorize the Secretary of the
  Department of Health and Human Services (DHHS) to
  provide Block Grants to States for the purpose
  of planning, carrying out, and evaluating
  activities to prevent and treat substance abuse.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• The SAPT Block Grant also incorporates provisions
  from each of the following
• The Tobacco Regulation for Substance Abuse
  Prevention and Treatment Block Grants, otherwise
  known as the Synar regulations, published in
  the Federal Register in January 1996.
• The Office of Management and Budget (OMB)
  Circular A-133.
• The Charitable Choice final rules published in
  the Federal Register on September 30, 2003.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• The Childrens Health Act of 2000 altered the
  following SAPT Block Grant requirements
• States are no longer required to spend a minimum
  of 35 percent of their Block Grant funds
  specifically on drug-related activities and a
  minimum of 35 percent on alcohol-related
  activities.
• States do not have to maintain a 100,000
  revolving loan fund to support homes for persons
  recovering from substance abusethis is now
  optional.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• States may allocate Block Grant funds to
  faith-based treatment programs that maintain
  their religious character and hire people of
  their same faith.
• The Secretary may exempt from maintenance of
  effort requirements any one-time infusion of
  funds that are used for a single purpose.
• The Childrens Health Act also required that by
  2002 the Secretary submit to Congress a plan that
  outlines how the Block Grant program will become
  a performance-based system.

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History and Intent of the Substance Abuse
Prevention and Treatment Block Grant

• Block Grant recipients must adhere to SAMHSAs
  National Outcome Measures (NOMs).

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96.122 Application Content and Procedures and
96.123 Assurances
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96.122 Application Content and Procedures and
96.123 Assurances

• Block Grant recipients include each of the 50
  States, each U.S. territory, the District of
  Columbia, and the Red Lake Band of Chippewa
  Indians of Minnesota.

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96.122 Application Content and Procedures and
96.123 Assurances

• The Block Grant application requires States to
  complete standard forms, tables, and narrative
  sections, including
• An annual report that describes the amounts of
  Block Grant expenditures and the activities
  funded by the grant
• A State Plan outlining the intended use of SAPT
  Block Grant funds, including how the State will
  comply with the Block Grant requirements
• Assurances that the State will comply with the
  Block Grant requirements as well as other
  applicable Federal requirements

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96.133 Submission to Secretary of Statewide
Assessment of Needs
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96.133 Submission to Secretary of Statewide
Assessment of Needs

• States are required to submit an assessment of
  statewide and locality-specific need for
  authorized Block Grant activities.
• The needs assessment must include the incidence
  and prevalence of drug abuse, alcohol abuse, and
  alcoholism.

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• Incidence and prevalence data must be obtained
  using generally accepted research methods.
• Incidence refers to the number of new cases
  that emerge with a given period of time.
• Prevalence refers to the total number of cases
  at a given moment in time.
• Social indicator studies and household surveys
  are examples of generally accepted research
  methods.

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• State and sub-State data have to be collected and
  reported by
• Age
• Sex
• Race/ethnicity

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• Data must include five substance abuse problems
• Marijuana (including hashish)
• Cocaine (including crack)
• Hallucinogens (including PCP)
• Heroin
• Alcohol

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• States should also use common diagnostic criteria
  (e.g., DSM criteria) to measure dependence.
• States must provide detailed descriptions of
• Current prevention and treatment activities
• Intended use of prevention and treatment funds
• Treatment capacity
• Primary prevention activities must be broken down
  by strategies used and other characteristics
  outlined in the Block Grant regulations.

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• Primary prevention strategies should be
  appropriate for each target group and include,
  but not be limited to, approaches such as
• Information dissemination
• Education
• Alternatives
• Problem identification and referral
• Community-based processes
• Environmental strategies

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• States must identify the entities that provide
  prevention and treatment services, and they must
  describe those services.
• States must submit information on treatment
  utilization that describes the type of care and
  utilization by primary diagnoses of
• Alcohol abuse
• Drug abuse
• A combination of alcohol and drug abuse

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96.133 Submission to Secretary of Statewide
Assessment of Needs

• States must describe efforts to improve substance
  abuse treatment and prevention activities,
  including
• Strategies used to improve existing programs
• New programs created
• Actions taken to remove barriers

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96.134 Maintenance of EffortRegarding State
Expenditures
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96.134 Maintenance of Effort Regarding State
Expenditures

• The Principal State Agency for substance abuse
  prevention and treatment must maintain aggregate
  State expenditures for authorized activities at a
  level that is not less than the average level of
  such expenditures for the preceding 2 State
  fiscal-year periods.

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' 96.124 Certain Allocations
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' 96.124 Certain Allocations
Special Services for Pregnant Women and Women
with Dependent Children

• States were required to establish a base of
  expenditures for special treatment services for
  pregnant women and women with dependent children.
• Women with dependent children include women who
  are attempting to regain custody of those
  children.

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' 96.124 Certain AllocationsSpecial Services for
Pregnant Women and Women with Dependent Children

• States must ensure that programs that receive
  funds set aside for pregnant women and women with
  dependent children provide or arrange for
• Primary medical care, including prenatal care
• Primary pediatric care for the womens children,
  including immunizations
• Gender-specific substance abuse treatment
• Other therapeutic interventions for women
  addressing issues such as relationships, sexual
  and physical abuse, and parenting

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' 96.124 Certain AllocationsSpecial Services for
Pregnant Women and Women with Dependent Children

• Therapeutic interventions for children in custody
  of women in treatment to address, among other
  things, developmental needs, sexual abuse,
  physical abuse, and neglect
• Child care while the women are receiving services
• Sufficient case management and transportation to
  ensure that the women and their children have
  access to the above services
• States must also require programs that receive
  this set-aside to treat the family as a unit and
  therefore admit both women and their children
  into treatment, when appropriate.

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' 96.124 Certain AllocationsSpecial Services for
Pregnant Women and Women with Dependent Children

• The Secretary also strongly encourages States to
  require programs that receive these set-aside
  funds to provide or arrange for the following
  additional services
• Case management to assist in establishing
  eligibility for public assistance programs
  provided by Federal, State, or local governments
• Employment and training programs
• Education and special education programs
• Drug-free housing for women and their children

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' 96.124 Certain AllocationsSpecial Services for
Pregnant Women and Women with Dependent Children

• Therapeutic day care, Head Start, and other early
  childhood programs for children
• Block Grant-funded programs must use the Block
  Grant as the payment of last resort and only
  for those who have no other financial means for
  obtaining services for pregnant women and women
  with dependent children.

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' 96.124 Certain Allocations
Calculating the Required Expenditure Level for
Services for Pregnant Women and Women with
Dependent Children

• By Federal fiscal year 1994 (October 1,
  1993September 30, 1994), States were required to
  establish base expenditure levels for services
  for pregnant women and women with dependent
  children.

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96.131 Treatment Services for Pregnant Women
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96.131 Treatment Services for Pregnant Women

• States must require all Block Grant-funded
  programs to give pregnant women preference in
  admissions to treatment.
• Programs that serve an injecting drug abuse
  population must give preference to treatment in
  the following order
• Pregnant injecting drug users first
• Other pregnant substance abusers second
• Other injecting drug users third
• All others

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96.131 Treatment Services for Pregnant Women

• States must also publicize the availability of
  services for pregnant women, including the fact
  that such women receive admissions preference.
• States must require Block Grant-funded programs
  to refer pregnant women to the State when such
  women cannot be admitted due to insufficient
  capacity.

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96.131 Treatment Services for Pregnant Women

• For women referred to States because of lack of
  capacity, States must
• Refer the women to programs with the capacity to
  admit them or
• Ensure that interim services, including prenatal
  care, are made available to the women within 48
  hours after the women seek treatment

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96.131 Treatment Services for Pregnant Women

• Therefore, States must maintain
• A continually updated system for identifying
  treatment capacity for pregnant women who cannot
  be admitted
• A mechanism for matching such women to treatment
  programs with sufficient capacity
• States must also have effective strategies for
  monitoring programs compliance with this
  section.

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96.126 Capacity of Treatment for Intravenous
Substance Abusers
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96.126 Capacity of Treatment for Intravenous
Substance Abusers
Capacity Management System

• States must establish capacity management systems
  that enable and require programs that provide
  treatment for intravenous drug abuse to
• Readily report to the State when the programs
  reach 90 percent of their capacities
• Make such reports within 7 days

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96.126 Capacity of Treatment for Intravenous
Substance AbusersCapacity Management System

• The capacity management system should also ensure
  that the State
• Is capable of maintaining a continually updated
  record of reports of programs reaching 90 percent
  of their capacities
• Makes excess capacity information available to
  Block Grant-funded programs that treat
  intravenous substance abuse

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96.126 Capacity of Treatment for Intravenous
Substance AbusersCapacity Management System

• States must have a waiting list management system
  that systematically reports treatment demand and
  requires Block Grant-funded programs that treat
  intravenous drug abuse to
• Establish waiting lists with a unique client
  identifier for each waiting list client
• Consult the States capacity management system to
  ensure that waiting list clients are transferred
  to programs within a reasonable geographic area
  at the earliest possible time
• Allow waiting list clients to be removed from the
  lists only when they cannot be located or the
  clients refuse treatment

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96.126 Capacity of Treatment for Intravenous
Substance AbusersCapacity Management System

• Block Grant-funded programs that treat
  individuals for intravenous substance abuse must
  admit each individual who requests and is in need
  of treatment for intravenous drug abuse not later
  than 14 days.
• When programs cannot admit individuals for
  intravenous substance abuse within 14 days, the
  program must
• Admit these individuals within 120 days
• Have a mechanism for maintaining contact with
  individuals awaiting admission
• Make interim services available within 48 hours

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96.126 Capacity of Treatment for Intravenous
Substance AbusersCapacity Management System

• Interim services must include counseling and
  education about
• HIV and TB
• The risks of needle sharing
• The risks of transmission to sexual partners and
  infants
• Steps that can be taken to ensure that HIV
  transmission does not occur

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96.126 Capacity of Treatment for Intravenous
Substance AbusersCapacity Management System

• Interim services must also include referrals for
  HIV and TB services, if necessary.
• For pregnant women, interim services should also
  include referrals for prenatal care and
  counseling on the effects of alcohol and drug use
  on the fetus.
• Interim services may also include federally
  authorized methadone maintenance.

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Outreach
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Outreach

• States must ensure that entities that receive
  Block Grant funds to treat intravenous substance
  abuse conduct outreach activities to encourage
  individuals in need of such services to undergo
  treatment.
• States must use outreach models that are
  scientifically sound.

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Outreach

• The regulations identify three examples of
  scientifically sound models
• The Standard Intervention model
• The Health Education model
• The Indigenous Leader model
• If no models are applicable to the local
  situation, the State can use an approach which
  reasonably can be expected to be effective.

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Outreach

• States must ensure that outreach efforts
• Consist of contacting, communicating with, and
  following up with high-risk substance abusers,
  their associates, and neighborhood residents
• Adhere to Federal and State confidentiality
  requirements
• Promote awareness about the relationship between
  injecting drug abuse and communicable diseases
• Recommend steps that can be taken to prevent HIV
  transmission
• Address the selection, training, and supervision
  of outreach workers
• Encourage entry into treatment

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96.127 Requirements Regarding Tuberculosis
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96.127 Requirements Regarding Tuberculosis
Tuberculosis Services

• States must require programs receiving funds to
  treat substance abuse to routinely make TB
  services available to each individual receiving
  treatment for substance abuse.
• Required TB services include
• Counseling individuals with respect to TB
• TB testing
• Appropriate medical evaluation and treatment for
  individuals with TB

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96.127 Requirements Regarding Tuberculosis
Tuberculosis Services

• Programs can provide the required TB services
  either directly or through arrangements with
  other public or nonprofit private entities.
• The Principal State Agency must also establish
  linkages with other health providers to ensure
  that TB services are routinely made available.
• The Principal State Agency in consultation with
  the primary State infectious disease authority
  must have written procedures and protocols to
  prevent the transmission of TB.

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96.127 Requirements Regarding Tuberculosis
Tuberculosis Services

• States must also require Block Grant-funded
  treatment programs to implement infection control
  procedures that are consistent with those
  established by the Principal State Agency.
• The infection control procedures must address how
  programs
• Screen patients and identify individuals who are
  at high risk of becoming infected
• Meet all State reporting requirements while
  adhering to Federal and State confidentiality
  requirements, including 42 CFR part 2
• Provide case management activities to ensure that
  individuals receive TB services

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96.127 Requirements Regarding Tuberculosis
Tuberculosis Services

• When clients cannot be admitted to a program due
  to lack of capacity, the program must refer such
  clients to other providers of TB services.
• States must develop effective strategies for
  monitoring compliance with these requirements,
  particularly to ensure that required services are
  being provided.
• States must also
• Use SAPT Block Grant funds as the Apayor of last
  resort_at_ for TB services
• Make reasonable efforts to determine eligibility
  and bill and collect payment for services

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96.127 Requirements Regarding Tuberculosis
TB Maintenance of Effort

• States were required to establish a base
  expenditure level for State-appropriated funds
  expended on TB services for individuals receiving
  substance abuse treatment.
• The base expenditure calculation is the average
  of the 2 State fiscal years preceding SFY93.

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96.127 Requirements Regarding Tuberculosis TB
Maintenance of Effort

• Once the base is established, the State must
  maintain this level of expenditures for each year
  thereafter.

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96.128 Requirements Regarding Human
Immunodeficiency Virus
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96.128 Requirements Regarding Human
Immunodeficiency Virus
HIV Services

• States with 10 or more HIV cases per 100,000
  people are considered HIV Designated States.
• Designated States must provide one or more HIV
  early intervention projects at the sites at which
  individuals are undergoing treatment for
  substance abuse.
• Your State is not currently an HIV Designated
  State.

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96.135 Restrictions on Expenditureof the Grant
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96.135 Restrictions on Expenditure of the Grant

• States cannot expend the Block Grant to
• Provide inpatient hospital services except under
  those conditions outlined in the regulations
• Make cash payments to intended recipients of
  health services
• Purchase or improve land
• Purchase, construct, or permanently improve
  buildings or other facilities
• Purchase major medical equipment
• Satisfy any requirement for the expenditure of
  non-Federal funds as a condition for the receipt
  of Federal funds

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96.135 Restrictions on Expenditure of the Grant

• Provide financial assistance to any entity other
  than a public or nonprofit private entity
• Provide individuals with hypodermic needles or
  syringes
• Expend more than the amount of Block Grant funds
  expended in FFY91 for treatment services provided
  in penal or correctional institutions of the
  State
• States cannot expend more than 5 percent of SAPT
  Block Grant funds to administer the grant.

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96.132 Additional Agreements
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96.132 Additional Agreements

• In their funding agreements with Block
  Grant-funded prevention and treatment programs,
  States must ensure that such programs make
  continuing education available to employees who
  provide those services.
• Principal State Agency must coordinate with other
  appropriate services such as health, social,
  correctional and criminal justice, educational,
  vocational, and employment service systems.

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96.132 Additional Agreements

• States can use methods such as the following to
  demonstrate service coordination
• Memoranda of agreement
• Inclusion of service coordination requirements in
  grants and contracts
• Principal State Agency and subrecipients of Block
  Grant funds must have a system to protect patient
  records from inappropriate disclosure.

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96.132 Additional Agreements

• The systems that States and programs use to
  protect clients records must
• Comply with all applicable State and Federal laws
  and regulations, including 42 CFR part 2
• Include provisions for employee education on the
  confidentiality requirements and the fact that
  disciplinary action may occur upon inappropriate
  disclosures

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96.136 Independent Peer Review
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96.136 Independent Peer Review

• States must have independent peer review systems
  that assess the quality, appropriateness, and
  efficacy of Block Grant-funded treatment
  services.
• The regulations define Quality as the provision
  of treatment services that meet accepted
  standards and practices that will improve
  patient/client health and safety in the context
  of recovery.

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96.136 Independent Peer Review

• The regulations define Appropriateness as the
  provision of treatment services consistent with
  each individuals identified clinical needs and
  level of functioning.
• To determine quality and appropriateness of
  treatment, reviews must include an examination of
  a representative sample of client/patient
  records.

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96.136 Independent Peer Review

• In reviewing client/patient records, reviewers
  will examine
• Admission criteria/intake processes
• Assessments
• Treatment planning
• Documentation of implementation of treatment
  strategies
• Discharge and continuing care planning
• Indications of treatment outcomes

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96.136 Independent Peer Review

• Independent peer reviewers must consist of
  individuals who are
• Experts in the substance abuse field
• Representative of the various disciplines used by
  the program being reviewed
• Knowledgeable about the modality being reviewed
  and its underlying theoretical approach to
  addictions treatment
• Sensitive to the cultural and environmental
  issues that may influence the quality of services
  being provided

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96.136 Independent Peer Review

• Not providers/practitioners of the program under
  review
• Not individuals who have administrative oversight
  of or authority to make funding decisions about
  the program under review
• The peer review system must review a minimum of 5
  percent of the States Block Grant-funded
  treatment programs each year.
• States must ensure that independent peer review
  is not conducted as a part of the program
  licensing/certification process.

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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside
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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside

• Before the Childrens Health Services Act of
  2000 was passed, States were required to
  maintain a 100,000 revolving fund to support
  homes for persons recovering from substance
  abuse.
• The Childrens Health Services Act makes this
  provision optional.

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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside

• Each loan
• Must be for homes of six or more people
• Can only be made to private nonprofit entities
• Cannot exceed 4,000
• Must be repaid within 2 years
• Has to be repaid in monthly installments

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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside

• Comes with the condition that alcohol or illegal
  drug use must be prohibited in the home, and
  residents who violate the conditions must be
  expelled
• Must require that residents pay the costs of
  housing, including fees for rent and utilities
• Must require the majority vote of residents to
  establish policies governing the house

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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside

• States must also
• Identify and define the purposes for which loan
  funds will be spent
• Set reasonable criteria for determining
  eligibility of prospective borrowers
• Establish procedures and a process for applying
  for a loan
• Provide clear written instructions to applicants
  concerning what is expected of them

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96.129 Revolving Funds for Establishment of
Homes in Which Recovering Substance Abusers May
Reside

• Keep a written record of the number and amounts
  of loans as well as the identities of borrowers
  and their repayment history
• Establish reasonable criteria for selecting a
  fund management group, if the State decides to
  delegate fund management to a separate
  organization
• The State and any entity managing the revolving
  fund must abide by all Federal, State, and local
  laws and regulations in managing the revolving
  fund.

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Other Applicable Requirements
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Other Applicable Requirements
Single State Audit

• The Office of Management and Budget (OMB)
  Circular A-133 prescribes the conditions under
  which non-Federal entities must have single State
  and program-specific audits.
• According to OMB Circular A-133, a non-Federal
  entity that has 500,000 or more in Federal
  expenditures during the entitys fiscal year must
  receive a single State audit.

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Other Applicable RequirementsSingle State Audit

• A non-Federal entity with 500,000 or more in
  Federal expenditures may elect to have a
  program-specific audit if
• The expenditures are under only one Federal
  program and
• The Federal program does not require an A-133
  audit

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Other Applicable RequirementsSingle State Audit

• A non-Federal entity that expends less than
  500,000 in Federal awards during the entitys
  fiscal year
• Is exempt from Federal audit requirements for
  that year
• Must retain records to support expenditures and
  must make those records available for review or
  audit by appropriate officials of the Federal
  agency, the pass-through entity, and the General
  Accounting Office

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Other Applicable Requirements
OMB A-133 Compliance Supplement

• The OMB A-133 Compliance Supplement identifies
  important compliance requirements that the
  Federal Government expects to be considered for
  each major program that is audited under the
  auspices of OMB A-133.

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Other Applicable Requirements OMB A-133
Compliance Supplement

• One section of the Supplement specifically
  addresses the audit requirements associated with
  the SAPT Block Grant program including
• Objectives and procedures for conducting an A-133
  audit of the Block Grant program
• Objectives and suggested audit procedures for
  determining compliance with SAPT Block Grant
  requirements

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Other Applicable Requirements
Subrecipient Monitoring

• OMB A-133 defines recipients of Federal Awards as
  Pass-through Entities and Subrecipients.
• A Pass-through Entity is a non-Federal entity
  that receives a Federal award and passes portions
  of it on to subrecipients to carry out a Federal
  program.
• A Subrecipient is a non-Federal entity that
  expends Federal awards received from a
  pass-through entity to carry out a Federal
  program.

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Other Applicable RequirementsSubrecipient
Monitoring

• For example, when an Principal State Agency
  subcontracts with programs to provide Block
  Grant-funded prevention, treatment, and
  rehabilitation services, the Principal State
  Agency is the pass-through entity and programs
  are subrecipients.

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Other Applicable RequirementsSubrecipient
Monitoring

• OMB A-133 requires pass-through entities to
• Inform each subrecipient of Federal awards,
  including the Catalogue of Federal Domestic
  Assistance title and number, the award name and
  number, and the award year
• Convey requirements from Federal laws and
  regulations, the provisions of contracts or grant
  agreements, and any supplemental requirements
  imposed by the pass-through entity

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Other Applicable RequirementsSubrecipient
Monitoring

• Monitor subrecipients to ensure that Federal
  awards are used for authorized purposes in
  compliance with laws, regulations, and the
  provisions of contracts or grant agreements and
  that performance goals are achieved
• Ensure that subrecipients meet applicable OMB
  A-133 audit requirements
• Issue management decisions on audit findings
  within 6 months after receiving subrecipients'
  audit reports
• Ensure that the subrecipients take appropriate
  and timely corrective action to resolve any audit
  findings

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Other Applicable RequirementsSubrecipient
Monitoring

• Determine if the subrecipient audits call for
  adjustments in the pass-through entity's own
  records
• Require each subrecipient to permit the
  pass-through entity and auditors to have access
  to the records and financial statements

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Other Applicable Requirements
Fiscal Controls

• States are exempt from the provisions of OMB cost
  principle circulars therefore, State cost
  principle requirements apply to the SAPT Block
  Grant instead.

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Other Applicable Requirements
Salary Limitation

• States and subrecipients cannot use the Block
  Grant to pay salaries in excess of Level I of the
  Federal Senior Executive Service pay scale (e.g.,
  no more than 191,300 in 2008).

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SAMHSAs National Outcome Measures

• SAMHSAs National Outcome Measures (NOMs)
• All recipients of the following grants must now
  comply with and report on the NOMs
• SAPT Block Grant
• Community Mental Health Services Block Grant
• CSAT, CSAP, and CMHS discretionary grants

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SAMHSAs National Outcome Measures

• States must have systems in place to avoid
  duplicated client counts.
• At a minimum, such systems shall include the
  following
• Recording admission and discharge information for
  a clients episode of care as a single record
• Using a unique client identifier for each client

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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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SAMHSAs National Outcome Measures
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Charitable Choice (45 CFR Part 54a)

• According to Charitable Choice regulations,
  Federal, State, and local governments that
  receive funds under these programs cannot
  discriminate against an organization that is, or
  applies to be, a program participant on the basis
  of the organizations religious character or
  affiliation.
• Applicants for Block Grant funding must certify
  that they will comply with all the SAMHSA
  Charitable Choice requirements.

101
Charitable Choice (45 CFR Part 54a)

• Under Charitable Choice, Block Grant-funded
  faith-based organizations
• Retain the authority over their internal
  governance
• May retain religious terms in their
  organizations names
• May select board members on a religious basis
• May include religious references in the
  organizations mission statements and other
  governing documents
• May use space in their facilities to offer Block
  Grant-funded activities without removing
  religious art, icons, scriptures, or other symbols

102
Charitable Choice (45 CFR Part 54a)

• Block Grant-funded faith-based organizations
  cannot use these funds for inherently religious
  activities such as the following
• Worship
• Religious instruction
• Proselytization
• Organizations can engage in such religious
  activities only if
• The activities are offered separately, in time or
  location, from Block Grant-funded activities
• Participation in the activities is voluntary

103
Charitable Choice (45 CFR Part 54a)

• In delivering services, including outreach
  activities, SAMHSA-funded religious organizations
  cannot discriminate against current or
  prospective program participants based on
• Religion
• Religious belief
• Refusal to hold a religious belief
• Refusal to actively participate in a religious
  practice
• If an otherwise eligible client objects to the
  religious character of a Block Grant-funded
  program, the program shall refer the client to an
  alternative provider within a reasonable period
  of time of the objection.

104
Charitable Choice (45 CFR Part 54a)

• Similar to all other nongovernmental
  organizations that receive Block Grant funds,
  religious organizations must use generally
  accepted auditing and accounting principles to
  account for Block Grant funds.
• Religious organizations shall segregate Federal
  funds from non-Federal funds. Only the Federal
  funds shall be subject to audit by the government.

105
Charitable Choice (45 CFR Part 54a)

• State or local governments that contribute funds
  to supplement Block Grant-funded activities have
  the option of keeping the State/local funds
  separate from the Block Grant funds or
  commingling State/local funds with Block Grant
  funds.
• When a State or local government commingles
  State/local funds with Block Grant funds, the
  Charitable Choice requirements will apply to all
  the commingled funds.

106
Thank you for your participation!

• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Substance Abuse and Mental Health Services
  Administration
• Center for Substance Abuse Treatment
• www.samhsa.gov