Title 42—Public Health--Volume 1
PART 51d—MENTAL HEALTH AND SUBSTANCE ABUSE EMERGENCY RESPONSE PROCEDURES
§ 51d.1   To what does this subpart apply?
The regulations in this subpart apply to grants that enable public entities to respond to needs in local communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the Public Health Service Act (42 U.S.C. 290aa(m)).
§ 51d.2   Definitions.
As used in this part:
Federally recognized Indian Tribal government means the governing body of any Indian tribe, band, nation, or other organized group or community, including any Native village as defined in, or established pursuant to, the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq. ), which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians;
Immediate award means a short term award of up to $50,000, or such greater amount as determined by the Secretary on a case-by-case basis, to address the immediate needs resulting from a mental health or substance abuse emergency. Such funding may be provided for a period of up to 90 days.
Intermediate award means an award intended to meet the more ongoing needs resulting from a mental health or substance abuse emergency than is possible under an Immediate award. Intermediate awards may fund up to one year of services, although in some exceptional circumstances, and to the extent that funding is available, such funding may be continued for an additional period of up to one year.
Public entity means any State, any political subdivision of a State, any Federally recognized Indian tribal government or tribal organization.
Secretary means the Secretary of Health and Human Services (HHS) or any other officer or employee of that Department to whom the authority involved has been delegated.
State means one of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the Trust Territory of the Pacific Islands.
Tribal organization means the recognized governing body of any Indian tribe; any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities.
§ 51d.3   Who is eligible for an award under this subpart?
An applicant must be a public entity as defined by this subpart. Applicants are eligible for either or both Immediate and Intermediate awards.
§ 51d.4   What information is required in the application?
(a) Application for Immediate awards: The application is to contain the following information:
(1) A certification by the State's chief executive officer, or, for the purposes of a Federally recognized Indian tribal government, the principal elected official, or such officer's or official's designee, that a mental health or substance abuse emergency exists, as well as a written statement setting out the basis for the certification;
(2) A brief program plan describing needs;
(3) An estimate of the number of people to be served and the geographical area to be served;
(4) A description of the types of services to be provided;
(5) A budget justifying the amount of the request;
(6) Required certifications; and
(7) Such other pertinent information as the Secretary may require.
(b) Application for Intermediate awards: The application is to be submitted on an OMB-approved application form and contain the following:
(1) If the applicant has not applied previously for an Immediate award, a certification by the State's chief executive officer, or, for the purposes of a Federally recognized Indian tribal government, the principal elected official, or such officer's or official's designee, that a mental health or substance abuse emergency exists, as well as a written statement setting out the basis for the certification;
(2) An application submission date within three months of the date of the event that precipitated the mental health or substance abuse emergency, as certified in accordance with 51d.4(a)(1) or (b)(1), except that upon the request of a State, the Secretary may provide a waiver of this application submission deadline if the Secretary determines there is good cause to justify the waiver;
(3) A detailed and comprehensive assessment of need;
(4) Demographics specific to the estimated number of people to be served;
(5) A description of the services that were provided up to the date of the submission of the Intermediate award application;
(6) The geographical area to be served;
(7) A detailed implementation program plan and related time line, including a description of outreach to special population groups affected by the crisis;
(8) A budget justifying the amount of the request for personnel, equipment, supplies, travel, training, data collection and any technical assistance required; the budget shall include an identification of the resources the applicant is able to commit to the project, if any, including any in-kind contributions;
(9) Any information that has changed since an Immediate application was submitted, if one was submitted; and
(10) such other pertinent information as the Secretary may require.
(c) Signature on Award Applications. The application must be signed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the statute, all applicable regulations, and any additional conditions of the grant.
§ 51d.5   How is an emergency determined to exist?
(a) In making a decision as to whether a mental health or substance abuse emergency exists for purposes of section 501(m) of the PHS Act, the Secretary, using discretion, will consider all relevant factors, but at a minimum the following must exist:
(1) Existing State, Tribal and local systems for mental health and/or substance abuse services are overwhelmed or unable to meet the existing mental health or substance abuse needs of the local community at issue; and
(2) This inability to meet the mental health and/or substance abuse service needs of a local community is the direct consequence of a clear precipitating event. This precipitating event must:
(i) Have a sudden, rapid onset and a definite conclusion, such as:
(A) A natural disaster (including, but not limited to, a hurricane, tornado, storm, flood, earthquake, fire, drought, or other natural catastrophe); or
(B) A technological disaster (including, but not limited to, a chemical spill, a major industrial accident, or a transportation accident); or
(C) A criminal act with significant casualties (including, but not limited to, a domestic act of terrorism, a hostage situation, or an incident of mass violence including school shootings and riots); and
(ii) Result in significant:
(A) Death,
(B) Injury,
(C) Exposure to life-threatening circumstances,
(D) Hardship,
(E) Suffering,
(F) Loss of property, or
(G) Loss of community infrastructure (e.g., loss of treatment facilities, staff, public transportation and/or utilities, or isolation from services); and
(3) No other local, State, Tribal or Federal funding is available to adequately address the specific level of need resulting from the precipitating event and resulting emergency mental health and/or substance abuse service needs of the impacted community.
(b) In making a determination that a mental health or substance abuse emergency exists, the Secretary will consider the certification and written statements provided in accordance with § 51d.4(a)(1) or (b)(1), and other information independently available to the Secretary.
(c) Once the Secretary determines that a mental health or substance abuse emergency exists, the Secretary may exercise discretion to make awards to enable public entities to respond to the emergency, within the limits of funds available.
§ 51d.6   How will applications be evaluated and awarded?
(a) In assessing applications for funding, the Secretary will utilize the following criteria.
(1) Documentation of Need. Applicant has demonstrated mental health and/or substance abuse needs directly resulting from the precipitating event. The precipitating event is clearly identified along with information regarding its impact. Applicant has identified any high risk groups or populations with special concerns that may impact the delivery of services (e.g., children, adolescents, older adults, ethnic and cultural groups, lower income populations). This documentation of need shall include the extent of physical, psychological and social problems observed, and a description of how the estimate of the number of people to be served was made. Applicant has clearly documented that no other local, State, Tribal or Federal funding sources are available to address the need.
(2) Plan of Services. Applicant has a clear plan of services to address documented needs within a defined geographic area and in a specified time period. The plan of services is appropriate to the type of grant requested (e.g., Immediate or Intermediate) and specifically addresses the needs of any high risk groups or populations with special concerns identified in the assessment of need. The plan of services clearly identifies the following:
(a) The types of services to be provided (e.g., outreach, crisis counseling, public education on stress management and crisis mental health, public education on substance abuse prevention, information and referral services, short term substance abuse or mental health prevention and/or treatment services);
(b) Strategies for targeting those identified as needing services, including high risk groups or populations with special concerns identified in the needs assessment;
(c) Appropriate training to be provided to staff to assure that services are appropriate to the crisis situation and the plans for community recovery;
(d) Quality control methods in place to assure appropriate services to the target population;
(e) Staff support mechanisms that are available;
(f) Plans for coordination of services with key local, State, Tribal and Federal partners involved in addressing the precipitating event (e.g., emergency management agencies, law enforcement, education agencies, public health agencies, and other agencies active in crisis response); and
(g) An estimate of the length of time for which said services requiring Federal funding will be needed, and the manner in which long-term cases will be referred for continued assistance after Federal funds have ended.
(3) Organizational Capability. Applicant is a public entity with demonstrated organizational capacity to deliver services as described in the plan of services. The applicant should also have a demonstrated history of service delivery to the target population within the defined service area for the program. The budget submitted shall provide sufficient justification and demonstrate that it is consistent with the documentation of need and plan of services. This shall include a description of the facilities to be utilized, including plans for securing office space if necessary to the project.
(b) In determining the appropriateness and necessity of funding, the Secretary may consult with other Federal agencies responsible for responding to crisis incidents, including the Readiness, Response and Recovery Directorate within the Federal Emergency Management Agency (FEMA), the Safe and Drug Free Schools Program within the U.S. Department of Education, the Office for Victims of Crime (OVC) within the U.S. Department of Justice, the National Transportation Safety Board (NTSB) within the U.S. Department of Transportation, the Emergency Response Program within the Environmental Protection Agency (EPA), the Bureau of Indian Affairs (BIA) within the U.S. Department of the Interior, the Animal and Plant Health Inspection Service within the U.S. Department of Agriculture, the Indian Health Service (IHS) within the U.S. Department of Health and Human Services, and other Federal agencies with jurisdiction over specific types of crisis response.
§ 51d.7   What are the limitations on how award funds may be used?
Unallowable Expenses: The following expenses will not be reimbursed under section 501(m) of the PHS Act:
(1) Major construction costs;
(2) Childcare services, unless provided by the institution or entity providing mental health or substance abuse treatment and integral to the treatment program;
(3) Services outside of the geographic area specified in the application, except to the extent that the precipitating event requires physical relocation of either affected parties or facilities;
(4) Any mental health or substance abuse services not directly related to the mental health or substance abuse emergency;
(5) Any expenses that supplant ongoing local, State, Tribal or Federal expenditures; and
(6) Any other costs unallowable by Federal law or regulation.
§ 51d.8   Which other HHS regulations apply to these awards?
Several other HHS regulations apply to grants under this part. These include, but are not limited to:
§ 51d.9   What other conditions apply to these awards?
Award funding made under this authority is to be supplemental in nature. Consistent with the criteria in § 51d.5 and the certification in § 51d.4(a)(1), such funds will only be made available if no other local, State, Tribal or Federal source is available to adequately address the emergency mental health and/or substance abuse service needs of the impacted community.
§ 51d.10   What are the reporting requirements?
(a) For immediate awards:
(1) A mid-program report only if an Intermediate award application is being prepared and submitted. This report shall be included as part of the Intermediate award application,
(2) Quarterly financial status reports of expenditures to date, due 30 days following the end of the reporting period, as permitted by 45 CFR 75.341,
(3) A final program report, a financial status report, and a final voucher 90 days after the last day of Immediate award services, in accordance with CFR 75.342.
(b) For intermediate awards:
(1) Quarterly progress reports, due 30 days following the end of the reporting period, as permitted by CFR 75.342,
(2) Quarterly financial status reports of expenditures to date, due 30 days following the end of the reporting period, as permitted by 45 CFR 75.341,
(3) A final program report, to be submitted within 90 days after the end of the program services period, in accordance with CFR 75.342,
(4) A financial status report, to be submitted within 90 days after the end of the program services period, in accordance with CFR 75.342,
(5) Such additional reports as the Secretary may require.
(c) The following shall be specifically addressed in final program reports:
(1) Description of services provided,
(2) Number of individuals assisted,
(3) Amount of funding expended and for what purposes,
(4) Personnel costs,
(5) Training costs,
(6) Technical consultation costs,
(7) Equipment costs,
(8) Travel and transportation costs, and
(9) A narrative describing lessons learned and exemplary practices, and a description of the transition plan, for how services will be funded or provided when Federal funds have been exhausted.