OMB No. 0930-0168 

Expiration Data: 6/30/2026

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to 

respond to, a collection of information unless it displays a currently valid OMB control 

number. The OMB control number for this project is 0930-0168. Public reporting burden for 

this collection of information is estimated to average 188 hours per respondent, per year, 

including the time for reviewing instructions, searching existing data sources, gathering, and 

maintaining the data needed, and completing and reviewing the collection of information. Send 

comments regarding this burden estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 

Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857. 

FFY 2024-2025 Combined Block Grant Application

Community Mental Health Services Block Grant (MHBG)

Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) 

Plan and Report

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration
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Table of Contents

I. INTRODUCTION .................................................................................................................... 1

A. Background ............................................................................................................................. 2

B. Impact on State Authorities and Systems................................................................................ 3

C. SAMHSA’s Priorities and Guiding Principles......................................................................... 4

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES...................................... 16

III. MENTAL AND SUBSTANCE USE DISORDER ASSESSMENT AND PLAN.............. 18

A. Framework for Planning........................................................................................................ 19

B. Planning Steps ....................................................................................................................... 26

C. Environmental Factors and Plan........................................................................................... 50

1. Access to Care, Integration, and Care Coordination – Required .......................................... 50

2. Health Disparities - Required................................................................................................ 52

3. Innovation in Purchasing Decisions - Requested .................................................................. 54

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness 

(ESMI)-10 percent set aside - Required for MHBG ....................................................... 57

5. Person Centered Planning (PCP) –Required for MHBG ...................................................... 59

7. Tribes – Requested................................................................................................................ 62

8. Primary Prevention-Required, SUPTRS BG only ................................................................ 63

9. Statutory Criterion for MHBG (Required for MHBG)......................................................... 72

10. Substance Use Disorder Treatment - Required for SUPTRS BG ........................................ 76

11. Quality Improvement Plan- Requested ................................................................................ 83

12. Trauma -Requested ............................................................................................................. 84

13. Criminal and Juvenile Justice - Requested.......................................................................... 85

14. Medications in the Treatment of Substance Use Disorders, Including Medication for Opioid 
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Use Disorder (MOUD) – Requested (SUPTRS BG only)............................................. 88

15. Crisis Services – Required for MHBG, Requested for SUPTRS BG .................................. 89

16. Recovery – Required........................................................................................................... 93

17. Community Living and the Implementation of Olmstead- Requested................................ 95

18. Children and Adolescents M/SUD Services –Required for MHBG, Requested for SUPTRS 

BG ................................................................................................................................... 96

19. Suicide Prevention – Required for MHBG ........................................................................ 100

20. Support of State Partners - Required for MHBG............................................................... 101

21. State Planning/Advisory Council and Input on the Mental Health/Substance use disorder 

Block Grant Application- Required for MHBG............................................................ 103

22. Public Comment on the State Plan- required .................................................................... 106

Acronyms.................................................................................................................................. 108

Resources .................................................................................................................................. 111

Appendix A ............................................................................................................................... 118

Side-by-side comparison of select required elements for the MHBG and SUPTRS BG ........ 118

1. Required Forms

a. Face Page—Community Mental Health Services Block Grant

b. Face Page—Substance Use Prevention, Treatment, and Recovery Services Block 

Grant

c. Funding Agreements/Certifications—Community Mental Health Services 

Block Grant

d. Funding Agreements/Certifications—Substance Use Prevention, 

Treatment, and Recovery Services Block Grant

e. Assurance
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FFY 2024-2025 Block Grant Application

I. INTRODUCTION

This is an application for SAMHSA’s Community Mental Health Services Block Grant (MHBG) 

and Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) 

(formally known as the Substance Abuse Prevention and Treatment Block Grant (SABG)), as 

authorized by sections 1911-1920 of Title XIX, Part B, Subpart I of the Public Health Service 

Act (42 U.S.C..§§ 300x-300x-9) and sections 1921-1935 of Title XIX, Part B, Subpart II of the 

Public Health Service Act (42 U.S.C.§ 300x-21-35), respectively, and sections 1941-1956 of 

Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C.§§ 300x-51-66). This 

block grant application includes four major parts: introduction; submission of application and 

plan time frames; mental and substance use disorder (M/SUD) assessment and plan; and report 

requirements. States that do not choose to apply for the MHBG or SUPTRS BG will have their 

funds redirected to other states as provided in statute. (42 U.S.C. §300x–54).1

The United States faces unprecedented mental health and substance use crises among people of 

all ages and backgrounds. Two out of five adults report symptoms of anxiety or depression, and 

under-resourced communities are disproportionately impacted. Even before the pandemic, rates 

of depression and anxiety were increasing. The grief, trauma, and physical and social isolation 

related to COVID-19 have exacerbated these issues for many. In addition, drug overdose deaths 

have reached a historic high, devastating individuals, families, and communities. More than 

107,600 Americans died due to a drug overdose in 2021. For these reasons, this Administration 

has prioritized mental health and the overdose epidemic as two of the four pillars of the 

President’s Unity Agenda2

. SAMHSA is actively working to advance this Agenda, which 

includes strengthening system capacity, connecting more Americans to care, and creating a 

continuum of support that aims to transform our health and social services infrastructure to 

address behavioral health holistically and equitably. The MHBG and SUPTRS BG are key 

levers towards realizing this Agenda. 

SAMHSA’s mission is to lead public health and service delivery efforts that promote mental 

health, prevent substance misuse, and provide treatments and supports to foster recovery while 

ensuring equitable access and better outcomes. SAMHSA’s vision is that people with, affected 

by, or at risk for mental health and substance use conditions receive care, thrive, and achieve 

wellbeing. SAMHSA has articulated its mission and vision in its Interim Strategic Plan3

. In 

order to achieve its mission, SAMHSA has identified five key priority areas and four core 

principles to better meet the behavioral health care needs of individuals, communities, and 

service providers. 

The five priority areas are:

• Preventing Overdose

• Enhancing Access to Suicide Prevention and Crisis Care 

• Promoting Resilience and Emotional Health for Children, Youth and Families 

1 http://www.samhsa.gov/grants/block-grants/laws-regulations 2 https://www.whitehouse.gov/omb/briefing-room/2022/03/28/fact-sheet-president-bidens-budget-advances-abipartisan-unity-agenda/ 3 https://www.samhsa.gov/about-us/interim-strategic-plan
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• Integrating Behavioral and Physical Health Care 

• Strengthening the Behavioral Health Workforce 

SAMHSA’s work is guided by four core principles that are infused throughout the Agency’s 

activities. The four core principles are:

• Equity

• Trauma-Informed Approaches 

• Recovery

• Commitment to Data and Evidence

As you develop your application, SAMHSA encourages you to discuss how each Block Grant’s 

funding can be utilized to advance these priorities and principles, as further described below 

under Section C SAMHSA’s Priorities and Principles. 

This application includes sections on planned expenditures for FY 2022-23 Consolidated 

Appropriations Act (COVID-19 Relief) Supplemental Funding and the FY 2022-23 American 

Rescue Plan (ARP) Supplemental Funding of MHBG and SUPTRS BG grantees and Bipartisan 

Safer Communities Act (BSCA) for MHBG. Additionally, the BSCA (P.L. 117-159) which 

passed on June 25, 2022 provides supplemental MHBG funds to state mental health authorities 

(SMHAs) to examine what is needed to address mass shootings and other threats to 

communities. As the United States works to address the massive disruption and loss of life 

caused by these crises, as well as other natural and man-made disasters, SAMHSA recommends 

that states utilize the BSCA funding to strengthen and enhance disaster preparedness and crisis 

response efforts for those with Serious Mental Illness (SMI) and or Serious Emotional

Disturbance (SED). This is a unique opportunity for states to develop sustainable and improved 

public mental health systems that meet the needs of vulnerable people, including those with more 

complex presentations. 

A. Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) oversees two 

major block grants: the Community Mental Health Services Block Grant (MHBG) and the 

Substance Use Prevention, Treatment, and Recovery Support Services Block Grant (SUPTRS 

BG). These block grants give states 4

 maximum flexibility to address the mental and substance 

use disorder (M/SUD) needs of their populations. The MHBG and SUPTRS BG differ in a 

number of their practices (e.g., targeted populations) and statutory authorities (e.g., method of 

calculating maintenance of effort (MOE), stakeholder input requirements for planning, set-asides 

for specific populations or programs, etc.5). As a result, information on the services and clients 

supported by block grant funds has varied by block grant and by state. Please see Appendix A 

for a side-by-side comparison of required elements for the MHBG and SUPTRS BG. 

4 The term “state” means each of the several states, the District of Columbia and each of the territories of the United States. The 

term “territories of the United States” means each of the Commonwealth of Puerto Rico, Virgin Islands, American Samoa, 

Commonwealth of the Northern Marianas Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands and 

the Republic of Palau.

5 In addition to statutory authority, SUPTRS BG is detailed by comprehensive regulation: http://www.samhsa.gov/grants/blockgrants/laws-regulations
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The FFY 2024-2025 Block Grant Application furthers SAMHSA’s efforts to have states use and 

report the opportunities offered under various federal initiatives. The FFY 2024-2025 Block 

Grant Application allows states to submit one application for both MHBG and SUPTRS BG

funds and requires a biennial plan for the MHBG while allowing a biennial plan for the 

SUPTRS BG. This Application also reflects a strong emphasis on coordinated and integrated 

care, along with the need to improve services for persons with mental and substance use 

disorders. In addition, questions about identified needs will allow SAMHSA to better design 

technical assistance to support state efforts.

Supplemental appropriations were provided through the American Rescue Plan Act (ARP), 2021 

[P.L. 117-2] in the sum of $3 billion ($1.5 billion each) to the block grants. SAMHSA through 

its guidance asks6 states to use these resources towards improving and enhancing their array of 

mental health and substance use services. States are required to address the treatment and 

recovery support service needs of people in rural areas and underserved populations7 through 

this round of supplemental funding and are encouraged to account for mental health and 

substance use disorder issues exacerbated by the pandemic and heightened by social inequities in 

the healthcare system. The timeline for funding planning and expenditure of these supplemental 

appropriations is from September 1, 2021, to September 30, 2025, which will necessitate 

changes to several years of block grant planning and reporting requirements. 

SAMHSA’s MHBG and SUPTRS BG provide states with the flexibility to design and implement 

activities and services to address the complex needs of individuals, families, and communities 

affected by substance use disorders and for adults with SMI and children with SED. The purpose 

of the block grant programs is to support services addressing these needs.

In order to assure that the block grant program continues to support the needed and necessary 

services for the target population, SAMHSA has indicated that the block grants may be used: 

1. To fund priority treatment and recovery support services for individuals who are 

uninsured or underinsured. 

2. For SUPTRS BG funds, to fund primary prevention: universal, selective, and indicated 

prevention activities.

3. To collect performance and outcome data for mental health and substance use, determine 

the effectiveness of promotion/SUD primary prevention, and treatment and recovery 

supports. 

B. Impact on State Authorities and Systems

SAMHSA seeks to ensure that SMHAs and Single State Agencies (SSAs) are prepared to address 

the priorities discussed throughout this document. By addressing these factors, SMHAs and 

SSAs will enhance their ability to increase access to evidence-based services. 

The block grant authorizing legislation and implementing regulations prohibit the provision of 

financial assistance to any entity other than a public or nonprofit entity, and require that the 

6 https://www.samhsa.gov/sites/default/files/american-rescue-plan-act-guidance.pdf 7

 “Underserved populations” is further defined in Executive Order 13985: https://www.whitehouse.gov/briefingroom/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underservedcommunities-through-the-federal-government/
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funding be used only for authorized activities.

8

 SAMHSA guidance on the use of block grant 

funding for co-pays, deductibles (including high deductible health plans), and premiums can be 

found at http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-forcost-sharing-assistance-for-private-health-insurance.pdf. States that choose to do this will need 

to develop specific policies and procedures for ensuring compliance with this guidance. 

C. SAMHSA’s Priorities and Guiding Principles

In order to achieve its mission, SAMHSA has identified five key priority areas and four core 

principles to better meet the behavioral health care needs of individuals, communities, and 

service providers. 

The five priority areas are:

• 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 

• Strengthening the Behavioral Health Workforce 

SAMHSA’s work is guided by four guiding principles that are infused throughout the Agency’s 

activities. The four principles are:

• Equity 

• Trauma-Informed Approaches 

• Recovery

• Commitment to Data and Evidence

Preventing Overdose

The isolation, anxiety, and reduced access to resources experienced by so many during the 

COVID-19 pandemic have exacerbated the overdose epidemic and contributed to a sharp rise in 

related deaths. In response, HHS released a new Overdose Prevention Strategy in October 2021 

which outlines four pillars: Primary Prevention, Harm Reduction, Evidence-Based Treatment, 

and Recovery Support. The Strategy is built on the principles of maximizing health equity by 

using the best available data and evidence to inform policy and actions, integrating substance use 

disorder (SUD) treatment services into other types of health care and social services, and 

reducing stigma. It recognizes the full continuum of integrated care and services needed to help 

prevent substance use, reduce harm, expand quality treatment, and sustain recovery from SUD, 

all while emphasizing HHS’ commitment to helping historically under-resourced populations. 

SAMHSA’s contributions to these efforts begin upstream with primary prevention programs 

which are supported through both technical assistance and funding, such as the SUPTRS BG and 

the Partnerships for Success grant programs. Recognizing that some individuals may have a SUD 

or need more intensive services, SAMHSA supports a range of more targeted mitigation 

8 http://www.samhsa.gov/grants/block-grants/laws-regulations
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services, including evidence-based harm reduction approaches such as distribution of naloxone 

and fentanyl test strips to those at high risk for overdose. 

SAMHSA’s treatment and recovery support programs include a range of evidence-based services 

such as the State Opioid Response, Harm Reduction and Building Communities of Recovery 

grants. These types of services specifically aim to link people with SUDs and those who have 

experienced an overdose to low threshold medication, non-pharmacologic treatment options, and 

peer support services to reduce repeat overdoses. Together, these efforts help address mental 

health and substance use conditions by meeting people wherever they are on the behavioral 

health continuum, through targeted services and supports that are evidence-based, culturally 

responsive, and driven by public health data. 

States are encouraged to use their Block Grant funds to strengthen overdose prevention efforts 

and further develop their primary prevention programs by leveraging the SUPTRS BG 20 

percent set-aside for primary prevention. 

Enhancing Access to Suicide Prevention and Crisis Care

Enhancing access to suicide prevention and crisis care is a key priority for SAMHSA, and by 

improving the nation’s efforts in this area, individuals experiencing suicidal ideation and other 

behavioral health crises can thrive and achieve well-being. 

Suicide is a preventable cause of premature mortality and a leading cause of death for adults and 

youth, there have been significant increases in suicidal behaviors among young people during the 

COVID-19 pandemic. 9

 In 2020, death by suicide was the second leading cause of death for 

youth ages 10-14 and the third leading cause of death among individuals between the ages of 15-

24 in the United States.10 The 2021 National Survey on Drug Use and Health (NSDUH) data 

estimate that the number of adults with serious thoughts of suicide was 12.3 million, those with 

plans for suicide was 3.5 million, and those who attempted suicide was about 1.7 million. 

Comprehensively addressing suicide involves preventive public health interventions as well as 

clinical workforce improvements so that all providers can consistently identify and provide basic 

management or evidence-based treatment of those at risk for suicidal ideation and suicidal 

behaviors. Individuals at risk include those who have indicated plans to complete suicide and 

those considering attempting suicide as well as individuals who have attempted suicide. 

As SAMHSA’s 2020 National Guidelines for Behavioral Health Crisis Care indicate,

comprehensive crisis care systems include several core services, such as crisis contact centers, 

mobile crisis teams, and crisis receiving and stabilizing facilities. More robust, culturally 

relevant, and responsive systems will be essential to meeting crisis care needs effectively and 

equitably across the nation. SAMHSA envisions a day when everyone across our country has 

someone to call, someone to respond, and a safe place to receive help. To help achieve this goal, 

on July 16, 2022, the National Suicide Prevention Lifeline transitioned to the 988 Suicide and 

9 Yard E RL, Ballesteros MF, Sheppard M, et al. Emergency Department Visits for Suspected Suicide Attempts 

Among Persons Aged 12-25 Years Before and During the COVID-19 Pandemic - United States, January 2019-May 

2021. Morb Mortal Wkly Rep. 2021;70(24):888-894. 10 National Institute of Mental Health. Suicide. National Institute of Mental Health. Available at: 

https://www.nimh.nih.gov/health/ statistics/suicide#part_2585. Accessed August 15, 2022.
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Crisis Lifeline. Services provided through this number include direct contact with a trained 

counselor and referral to services. For situations in which risk is imminent or the crisis is 

ongoing, a responder such as a mobile crisis response unit can go where the caller is and/or 

identify a place the caller can go for help. SAMHSA also continues to invest in key suicide 

prevention efforts such as the Garrett Lee Smith youth suicide prevention and Zero Suicide 

programs, the Suicide Prevention Resource Center and other needed technical assistance to the 

field.

States are encouraged to use their Block Grant funds to strengthen suicide prevention efforts for 

those with SMI and SED and further develop the crisis care system in the state. In particular, 

States are encouraged to leverage the MHBG’s crisis set-aside to provide evidence-based crisis 

care programs addressing the needs of individuals with serious mental illnesses and children with 

serious mental and emotional disturbances. States may use some or all of the set aside for a set of 

core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term 

residential crisis stabilization beds, and regional or State-wide crisis call centers coordinating in 

real time. 

Promoting Resilience and Emotional Health for Children, Youth and Families

Most people with mental health and substance use conditions first manifest signs in childhood, 

adolescence, and young adulthood. In fact, half of all mental illnesses emerge by the time a child 

turns 14, and nearly 75% by the time a person is 24 years old11. There is also a significant 

correlation between adverse childhood experiences (ACEs), which are potentially traumatic 

events that occur in childhood, as well as aspects of the child’s environment that can undermine 

their sense of safety, stability, and bonding, and negative physical and behavioral health 

outcomes in adulthood. 

Even before the COVID-19 pandemic, the nation’s youth were experiencing significant mental 

health and substance use challenges. Nearly 1 in 5 young people had a diagnosable mental health 

condition, and 1 in 10 had a serious emotional disturbance that negatively impacted their ability 

to function at home, in school, or in the community12 13. Unfortunately, many young people do 

not receive the treatment supports they need. Over half of children/youth with mental health 

needs did not receive services, and over 96% of young adults with a SUD did not receive 

appropriate treatment14 15. The pandemic has made this situation even worse with depression 

11 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset 

distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. Jun 

2005;62(6):593-602. 12 Bitsko RH, Claussen AH, Lichstein J, et al. Mental Health Surveillance Among Children - United States, 2013-

2019. MMWR Suppl. Feb 25 2022;71(2):1-42. 13 Williams NJ, Scott L, Aarons GA. Prevalence of Serious Emotional Disturbance Among U.S. Children: A MetaAnalysis. Psychiatr Serv. Jan 1 2018;69(1):32-40 14 Center for Behavioral Health Statistics and Quality. https://www.samhsa.gov/data/report/2020-nsduh-detailedtables. Available at: https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables. Accessed August 15, 2022. 15 American Academy of Child and Adolescent Psychiatry Committee on Health Care Access and Economics Task 

Force on Mental Health. Improving mental health services in primary care: reducing administrative and financial 

barriers to access and collaboration. Pediatrics. Apr 2009;123(4):1248-1251.
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and anxiety doubling in youth compared to pre-pandemic levels16, and more than 215,000 U.S. 

children have experienced the death of a primary or secondary caregiver due to COVID-19, with 

children of black, indigenous, and people of color disproportionately impacted17 18 19. The 

Centers for Disease Control and Prevention also released data indicating that 1 in 3 high school 

students experienced poor mental health during the pandemic and nearly half of students felt 

persistently sad or hopeless20 21. 

SAMHSA’s vision is that all children, youth, young adults, and their families thrive in their 

homes and communities. SAMHSA encourages states to achieve this through a tiered public 

health approach that expands access to effective interventions and matches each child with the 

right service at the right time through a comprehensive and integrated system of care. States can 

use implementation science, and evidence- and measurement-based approaches to promote 

wellness and prevention, focus on early identification, and implement quality services and 

supports to improve the health and well-being of children, youth, young adults, and families.

States are encouraged to use their Block Grant funds to strengthen their systems of care 

approaches and leverage the MHBG funding dedicated to the system of integrated services for 

children with SED and the SUPTRS BG primary prevention set-aside in service of this priority.

Integrating Behavioral and Physical Health Care

According to the 2021 NSDUH, 43.7 million people ages 12 and older in the United States 

needed substance use treatment in the past year; however, only 6.3% reported receiving any. 

Close to 58 million adults ages 18 or older reported having any mental illness in the past year; 

while 27.6% of them perceived having an unmet treatment need. People with serious mental 

illness and SUDs have shorter life expectancies compared to their peers without these conditions. 

Mortality from mental illness and SUD often stems from the conditions themselves but is 

regularly compounded by co-occurring physical health conditions. 

A key to achieving SAMHSA’s vision is advancing the bi-directional integration of behavioral 

health with all other health care services and systems. SAMHSA’s integration efforts provide 

16 Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety 

Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. Nov 1 

2021;175(11):1142-1150. 17 National Institute on Drug Abuse. COVID-19 & Substance Use. Available at: https://nida.nih.gov/researchtopics/comorbidity/covid19-substance-use. Accessed September 15, 2022. 18 Substance Abuse and Mental Health Services Administration. Peer Support. Substance Abuse and Mental Health 

Services Administration. Available at: 

https://www.samhsa.gov/sites/default/fles/programs_campaigns/brss_tacs/peer-support-2017.pdf. Accessed August 

15, 2022.

19 Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of 

the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. May 

1998;14(4):245-258. 20 Centers for Disease Control and Prevention. Adolescent Behaviors and Experiences Survey (ABES). Centers for 

Disease Control and Prevention. Available at: https://www.cdc.gov/healthyyouth/data/abes.htm. Accessed August 

15, 2022

21 Jones SE, Ethier KA, Hertz M, et al. Mental Health, Suicidality, and Connectedness Among High School Students 

During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 

2021. MMWR Suppl. Apr 1 2022;71(3):16-21.
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support in areas integral to its mission, including grant programs, technical assistance, training 

resources, and policy activities. These efforts also include the education and training of primary 

care providers to better promote prevention, screening, and early behavioral health interventions 

as well as investing in models that connect individuals with behavioral health issues to needed 

physical health screening and associated care. SAMHSA is working hard to eliminate the 

barriers that providers encounter when trying to deliver holistic health care and supports. These 

barriers are especially profound when serving communities disproportionally affected with comorbid infectious disease conditions.

States are encouraged to use their Block Grant funds in support of integrated systems of care, 

with special attention to the physical health care needs of individuals with M/SUD. 

Strengthening the Behavioral Health Workforce

The nation’s workforce of mental health and SUD providers is critical to providing Americans 

with access to essential health care services. Prior to the pandemic, there was already a projected 

shortage of behavioral health care providers, with acute shortages predicted for psychiatrists and 

addiction counselors through 2030. The supply of these providers is likely to be further reduced 

due to the negative impact of COVID-19 and burnout. At the same time, a higher demand for 

services is predicted due to increased prevalence of depressive and anxiety disorders and 

substance use related to COVID-19. Recognizing that a strong behavioral health workforce is 

critical to providing services to best meet people’s needs where they are, the 21st Century Cures 

Act directed SAMHSA to work with states and other stakeholders to develop and support 

recruitment and retention efforts specific to addressing mental health and substance use 

disorders.

This is particularly important considering lack of diversity in the workforce is a systemic issue 

that contributes to poor health outcomes for racial, ethnic, sexual and gender minorities. The use 

of telehealth among behavioral health providers is also a promising strategy that can help 

increase access to mental health and SUD treatment by addressing workforce shortages which 

are often more pervasive in certain geographic areas. 

States are encouraged to use their Block Grant funds towards strengthening the behavioral health 

workforce by focusing on training and technical assistance, expanding the use of 

paraprofessionals (i.e., peers), and focusing on increased diversity and cultural competency. 

Equity

Behavioral health equity is the right to access high-quality and affordable health care services 

and supports for all populations, including Black, Latino, Indigenous and Native American 

persons, Asian Americans and Pacific Islanders and other persons of color; members of religious 

minorities; veterans and military service members; older adults; lesbian, gay, bisexual, 

transgender, queer/questioning and intersex (LGBTQI+) persons; persons with disabilities; 

persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or 

inequality.

As population demographics continue to evolve, behavioral health care systems will need to 

expand their ability to fluidly meet the growing needs of a diverse population. By improving 

access to care, promoting quality programs and practice, and reducing persistent disparities in 
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mental health and substance use services for under-resourced populations and communities, 

SAMHSA will ensure that everyone has a fair and just opportunity to be as healthy as possible. 

In conjunction with promoting access to high-quality services, behavioral health disparities can 

be further mitigated by addressing social determinants of health, such as social exclusion, 

unemployment, ACEs, and food and housing insecurity, and increasing the usage of culturally 

and linguistically appropriate services.

In service of Executive Order 13985 (Advancing Racial Equity and Support for Underserved 

Communities Through the Federal Government), SAMHSA encourages States to better track 

access, service use, and outcomes for these communities to develop prioritized outreach, 

engagement, enrollment, and intervention strategies to reduce such disparities.

Recovery

SAMHSA’s working definition of recovery is described as a process of change through which 

individuals improve their health and wellness, live self-directed lives, and strive to reach their 

full potential. This definition is operationalized through the four major dimensions of recovery: 

1) health: overcoming or managing one’s disease(s) or symptoms, and making informed, healthy 

choices that support physical and emotional wellbeing; 2) home: having a stable and safe place 

to live; 3) purpose: conducting meaningful daily activities, such as a job, school volunteerism, 

family caretaking, or creative endeavors, and the independence, income, and resources to 

participate in society; and 4) community: having relationships and social networks that provide 

support, friendship, love, and hope. 

The concept of recovery signals a dramatic shift in the expectation for individuals who 

experience mental and/or substance use conditions to one in which we expect them to thrive. 

SAMHSA envisions not only individuals achieving recovery, but also supports developing and 

sustaining recovery-oriented systems of care and creating recovery facilitating environments. 

Today, when people with mental health and/or SUD seek help, they are met with the knowledge 

and belief that anyone can recover and/or manage their conditions successfully. 

SAMHSA encourages states to leverage block grant resources to promote individual, program, 

and system-level approaches that foster health and resilience; increase housing services to 

support recovery; reduce barriers to employment, education, and other life goals; and secure 

necessary social supports in their chosen community. 

Trauma-Informed Approaches

Trauma is a widespread and costly public health problem that occurs as a result of violence, 

abuse, neglect, loss, disaster, war, pandemic, and other emotionally harmful events. For those 

with mental health and substance use conditions, trauma is an almost universal experience.

Research has documented the relationships among exposure to traumatic situations, impaired 

neurodevelopmental and immune systems responses and subsequent health risk behaviors 

resulting in chronic physical and/or behavioral health disorders. Many people who experience 

trauma may overcome it, with some becoming stronger and more resilient; but for others, trauma 

can be overwhelming and disruptive. It is also important to recognize that whole communities 

can share trauma and can be profoundly shaped by traumatic experiences and history. 
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Trauma-informed approaches recognize and intentionally respond to the lasting adverse effects 

of experiencing traumatic events. A trauma-informed approach is defined through six key 

principles: 1) safety: participants and staff feel physically and psychologically safe; 2) peer 

support: peer support and mutual self-help as vehicles for establishing safety and hope, building 

trust, enhancing collaboration, and utilizing their lived experience; 3) trustworthiness and 

transparency: decisions are conducted with the goal of building and maintaining trust; 4) 

collaboration and mutuality: importance is placed on partnering and leveling power differences; 

5) cultural, historical, and gender issues: culture and gender-responsive services are offered 

while moving beyond stereotypes/biases; and 6) empowerment, voice and choice: organizations 

foster a belief in the primacy of the people who are served to heal and promote recovery from 

trauma. It is critical that linkages to recovery and resilience for those individuals and families 

impacted by trauma are promoted.

Commitment to Data and Evidence

Leveraging data and evidence strengthens SAMHSA’s activities. As the country continues to 

recover and heal from the collective traumas of COVID-19 and other impactful events such as 

natural disasters and the overdose epidemic, it is vital that data and evaluation inform policies 

and determine the impact of programs on mental health and substance use conditions. SAMHSA 

is steadfast in its efforts to advance the health of the nation while also promoting equity for 

under-resourced and historically marginalized communities.

Timely, high-quality, ongoing, and specific data help public health officials, policymakers, 

community practitioners, and the public to understand mental health and substance use trends 

and how they are evolving; inform the development and implementation of targeted evidencebased interventions; focus resources where they are needed most; and evaluate the success of 

response efforts. SAMHSA is streamlining and modernizing data collection efforts, while also 

coordinating evaluation across the agency to ensure funding and policies are data driven. A key 

objective is to decrease the burden on stakeholders while expanding and improving data 

collection, analysis, evaluation, and dissemination.

The backbone of a strong behavioral health system is an infrastructure with the ability to collect 

and analyze epidemiological data on M/SUD and its associated consequences. States must use 

this data to identify areas of greatest need, and to identify, implement, and evaluate evidencebased programs, practices, and policies that have the ability to improve health and well-being in

all communities. SAMHSA encourages states to leverage block grant resources in support of 

enhancing data collection, analysis, evaluation, and dissemination.

Evolving Priorities 

SAMHSA also recognizes a number of evolving priorities where states may want to focus their 

efforts.

Alcohol Use Disorder 

According to the 2020 NSDUH Annual National Report22, 50.0% of people aged 12 or older (or 

22 https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report
Page | 11 

138.5 million people) used alcohol in the past month (i.e., current alcohol users), 18.7 percent 

used a tobacco product, and 13.5 percent used an illicit drug. 40.3 million people aged 12 or 

older had an SUD in the past year, including 28.3 million who had alcohol use disorder, 18.4 

million who had an illicit drug use disorder, and 6.5 million people who had both alcohol use 

disorder and an illicit drug use disorder. Among people aged 12 or older in 2020, 22.2 percent 

(or 61.6 million people) were binge alcohol users in the past month. Among the 138.5 million 

current alcohol users aged 12 or older in 2020, 44.4 percent were past month binge drinkers. 

Among past month binge drinkers, 17.7 million people (28.8 percent of current binge drinkers 

and 12.8 percent of current alcohol users) were past month heavy drinkers. Among people aged 

12 to 20 in 2020, 16.1 percent were past month alcohol users. Estimates of binge alcohol use and 

heavy alcohol use in the past month among underage people were 9.2 percent and 1.8 percent, 

respectively.

The Drug Abuse Warning Network (DAWN): Findings from Drug-Related Emergency 

Department (ED) Visits, 2021,23 found that the top five drugs involved in drug-related ED visits 

in 2021 were alcohol (41.70% of all drug-related ED visits), opioids (14.79%), 

methamphetamine (11.29%), marijuana (11.19%), and cocaine (4.77%). Alcohol was the most 

common additional drug involved in methamphetamine-, marijuana-, and cocaine-related 

polysubstance ED visits. And the CDC’s Alcohol-Related Disease Impact (ARDI) 

application, found that excessive alcohol use was responsible for more than 140,000 deaths in the 

United States each year during 2015–2019, or more than 380 deaths per day. Each year, deaths 

from excessive drinking: 

• Shortened the lives of those who died by an average of 26 years, for a total of nearly 3.6 

million years of potential life lost.

• Usually involved adults aged 35 or older and males. 

• Were mostly due to health effects from drinking too much over time, such as various 

types of cancer, liver disease, and heart disease.

• Led to premature deaths. Deaths from drinking too much in a short time (from causes 

such as motor vehicle crashes, poisonings involving substances in addition to alcohol, 

and suicides) accounted for more than half of the years of potential life lost.

Altogether, these findings reiterate the urgent and longstanding need to connect individuals at 

risk for or diagnosed with alcohol use disorder and provide training, mentoring, and ongoing 

support for clinical sites and practitioners seeking to implement comprehensive screening and 

pharmacological interventions for AUD. 

Harm Reduction 

Harm reduction24 is an important part of SAMHSA’s comprehensive public health approach to 

addressing substance use disorders, where individuals who use substances set their own goals. 

Harm reduction is critical to keeping people who use drugs alive and as healthy as possible, and 

is a key pillar in HHS’ overdose prevention strategy. 

23 https://store.samhsa.gov/sites/default/files/pep22-07-03-002.pdf 24 Guidance on harm reduction services/supplies that are allowable costs which may be covered with SAMHSA 

funds can be found here: https://www.samhsa.gov/find-help/harm-reduction. 
Page | 12

Harm reduction is an approach that emphasizes engaging directly with people who use drugs to 

prevent overdose and infectious disease transmission, improve the physical, mental, and social 

wellbeing of those served, and offer low-threshold options for accessing substance use disorder 

treatment and other health care services. Harm reduction approaches incorporate a spectrum of 

strategies that meet people “where they are” on their own terms, and may serve as a pathway to 

additional prevention, treatment, and recovery services. Harm reduction works by addressing 

broader health and social issues through improved policies, programs, and practices.

Harm reduction services save lives by being available and accessible in a manner that 

emphasizes the need for humility and compassion toward people who use drugs. Harm reduction 

plays a significant role in preventing drug-related deaths and offering access to healthcare, social 

services, treatment, and recovery. These services decrease overdose fatalities, acute lifethreatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV.

A comprehensive public health and risk reduction strategy, harm reduction is part of the 

continuum of care. Harm reduction approaches have proven to prevent death, injury, disease, 

overdose, and substance misuse. Harm reduction is effective in addressing the public health 

epidemic involving substance use as well as infectious disease and other harms associated with 

drug use. Specifically, harm reduction services can:

Connect individuals to overdose education, counseling, and referral to treatment for infectious 

diseases and substance use disorders.

• Distribute opioid overdose reversal medications (e.g., naloxone) to individuals at risk of 

overdose, or to those who might respond to an overdose.

• Lessen harms associated with drug use and related behaviors that increase the risk of 

infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.

• Reduce infectious disease transmission among people who use drugs, including those 

who inject drugs by equipping them with accurate information and access to resources.

• Reduce overdose deaths, promote linkages to care, facilitate co-location of services as 

part of a comprehensive, integrated approach.

• Reduce stigma associated with substance use and co-occurring disorders

• Promote a philosophy of hope and healing by engaging those with lived experience of 

recovery in the management of harm reduction services, and connecting those who have 

expressed interest to treatment, peer support workers and other recovery support services.

Health Information Technology

The use of technologies may support better access to services. Certainly, health information 

technology (HIT) played a crucial role through COVID-19 towards ensuring individuals retained 

or had access to behavioral health services. Technology is playing a growing role in how 

individuals learn about, receive, and experience their behavioral health care services. Interactive

communication technologies (ICT) are being used more frequently to deliver various health care

and recovery support services by providers and to report health information and outcomes by

individuals. Where necessary and appropriate to meet programmatic expectations, SAMHSA 

grantees that provide clinical or other indicated services to individuals are encouraged to 

demonstrate ongoing clinical use of an EHR system. A certified EHR is a system that has been 

tested and certified by an approved Office of the National Coordinator (ONC) certifying body.
Page | 13 

States can leverage block grant dollars towards adoption of HIT and systems for providers that 

serve that targeted population and that meet the standards and certifications required for 

interoperable health information technology as issued by the Office of the National Coordinator 

for Health Information Technology (ONC).25 In addition to meeting common standards and 

certification, these systems should support the privacy and security of patient information across 

all HIT technologies. Such systems should be used to collect information on provider 

characteristics, client enrollment, demographics, and treatment services delivered. Current laws 

will require these systems to comply with national standards such as national provider numbers, 

International Classification of Diseases, Systematized Nomenclature of Medicine-Clinical Terms

(SNOMED-CT), normalized names for clinical drugs (RxNorm), Logical Observation Identifiers 

Names and Codes (LOINC), and Current Procedural Terminology (CPT)/Healthcare Procedure 

Coding System (HCPCS) codes. The information technology systems will also have to be 

interoperable with providers across the continuum of care, as well as health information 

exchanges (HIE), health information organizations (HIOs), and payers (e.g., Medicaid, Medicare, 

and private insurance plans, etc.). SAMHSA believes it is important for public health purchasers

to continue to collaborate and discuss system interoperability, electronic health records, federal

information technology requirements, and other related matters. Additional information can be 

found at SAMHSA26 and ONC27. 

States should continue to design and develop collaborative plans for health information systems. 

Health care payers will seek to promote electronic health records (EHR) and interoperable health 

information technology (HIT) systems that allow for the effective exchange and use of health 

data.

Criminal Justice

SAMHSA strongly encourages state behavioral health authorities to continue to work closely 

with their state courts to ensure the best coordination of services and outcomes, in light of 

pervasive health disparities and inequities, and to develop closer interdisciplinary programming 

for justice system involved individuals. This includes establishing effective partnerships 

between state behavioral health systems, providers, and state courts. Unfortunately, for many 

individuals and their families experiencing SMI, SED, and/or SUD, the state and local justice 

system is at times the entry point for obtaining treatment and services. Courts and criminal 

justice systems are a referral source for behavioral health treatment, and jails and detention 

centers are often major providers of behavioral health services requiring coordination with 

broader community behavioral health systems. Creating effective partnerships between state and 

local behavioral health and justice system leaders and agencies to develop and support systems to 

divert individuals with mental and substance use disorders from the criminal justice system, 

including jail diversion teams, police crisis intervention teams, police drop off assessment 

centers, certified community behavioral health clinics, the 988 effort, and court-based programs, 

are essential elements of all state plans. 

25 Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health 

IT efforts and is a resource to the entire health system to support the adoption of health information technology and the 

promotion of nationwide, standards-based health information exchange to improve health care. ONC is organizationally located 

within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).

26 https://www.samhsa.gov/section-223/certification-resource-guides/health-information-technology 27 https://www.healthit.gov/
Page | 14

Climate Change

Increasingly, climate related environmental changes are impacting, directly and indirectly, 

individuals, providers, caregivers, and communities experiencing behavioral health conditions. 

For instance, climate change may increase the likelihood of extreme weather events, such as 

heatwaves, that adversely impact persons with psychiatric conditions. Hurricanes may exacerbate 

suffering for those with behavioral health conditions. As well, growing numbers of youth and 

others are experiencing heightened anxiety related to current and potential impacts of climate 

change. Emergencies and disasters such as hurricanes also can disrupt access to and participation 

in substance use disorder treatment. SAMHSA is actively collaborating with a wide range of 

governmental and non-governmental partners to foster preparedness including the 

Administration for Strategic Preparedness and Response (ASPR), the Federal Emergency 

Management Agency (FEMA), and the HHS Office of Climate Change and Health Equity 

(OCCHE) to ensure inclusion of behavioral health needs in federal, state, local, tribal, and 

territorial emergency and disaster planning. 

SAMHSA similarly encourages SMHAs and SSAs to foster collaboration among governmental 

and non-governmental partners to strengthen community resilience, preparedness, response, and 

recovery in situations of emergencies and disasters. SAMHSA notes that underserved 

populations may be among those more vulnerable to emergencies and disasters and urges that 

Block Grant recipients consider especially the needs of such populations. SAMHSA also notes 

that underserved populations and persons with behavioral health conditions face increased risks 

from climate change, the COVID-19 public health emergency and other ongoing and potential 

future challenges. Taking all of this into account, in situations where State Mental Health 

Authorities (SMHAs) and Single State Agencies (SSAs) have identified environmental factors 

where climate related events are part of community and/or individual mental health and 

substance use conditions, the State Mental Health Authorities (SMHAs) and Single State 

Agencies (SSAs) may incorporate climate-informed approaches in clinical and non-clinical 

mental health and substance use treatment and prevention.

Parity

Many health plans must comply with requirements regarding parity in coverage of M/SUD 

benefits in relation to medical/surgical benefits under the Mental Health Parity and Addiction 

Equity Act (MHPAEA) of 200828. Generally, MHPAEA requires that the financial 

requirements (such as deductibles, copayments, or coinsurance) and treatment limitations 

imposed on mental health and substance use disorder benefits cannot be more restrictive than the 

predominant financial requirements and treatment limitations that apply to most physical health 

benefits.

States play an important role in the implementation and enforcement of parity protections, 

particularly in the oversight of Medicaid plans and private health plans that are subject to parity 

protections. States also have a role in working with providers and individuals and families that 

access mental health and substance use disorder services to ensure that people are aware of parity 

protections and know where to go if they feel that they may have experienced a violation of 

federal or state parity laws and regulations. State agencies (including SMHAs and SSAs, 

28 https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity
Page | 15

Medicaid, and departments of insurance) can work in partnership to ensure that their citizens are 

able to access the behavioral health benefits and services that they are entitled to under parity 

requirements.

SAMHSA published “The Essential Aspects of Parity: A Training Tool for Policymakers,” 

which provides state regulators and behavioral health staff an overview of mental health and 

substance use disorder parity and how to implement and comply with the federal parity law 

regarding employee-sponsored health plans and group and individual health insurance.

Sustainability

When developing strategies for purchasing services, SMHAs and SSAs should identify other 

state and federal sources available to purchase services. States should assist providers in the 

development of better strategies that allow providers to leverage existing funding, promote 

sustainability, and be less dependent on SMHA and SSA funding. Funding available from the 

Centers for Medicare & Medicaid Services (CMS), such as CHIP, Medicaid, and Medicare, may 

play an important role in the states’ financial strategy. There are also national demonstration 

projects and programs (e.g., Health Homes, Accountable Care Organizations, Certified

Community Behavioral Health Centers, the Value in Opioid Use Disorder Treatment Program, 

Integrated Care for Kids (InCK) Model, and Financial Alignment Initiative for MedicareMedicaid Enrollees) that support efforts to provide M/SUD services. States may also find the 

Medicare-Medicaid-Coordination Office a helpful resource in serving people who are dually 

enrolled in both Medicare and Medicaid, also known as dually eligible individuals. CMS

recently released guidance on mobile crisis services and behavioral health services for children 

and youth amongst other guidance available on mental health and substance use treatment 

services, integrated services, and collaborative care, available here: 

https://www.medicaid.gov/federal-policy-guidance/index.html.

In December 2016, the 21st Century Cures Act was signed into law. Through this Act (Public 

Law 114-255), the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) 

was established to make recommendations for actions that federal departments can take to better 

coordinate the administration of mental health services for adults with a serious mental illness or 

children with a serious emotional disturbance. This committee has been chaired by the Assistant 

Secretary of Mental Health And Substance Use and works to coordinate programs and policy 

across the whole of government.

Beyond SAMHSA and CMS, there have been broad investments in access to M/SUD services

across the federal government. For example, HHS/Health Resources and Services 

Administration (HRSA) has significantly expanded access to health and M/SUD services 

through its Health Center Program. HRSA has also made available funding and other 

opportunities to increase and enhance the quality of the M/SUD workforce (e.g., National Health 

Service Corps, training grants, etc.). Both TRICARE and the Department of Veterans’ Affairs 

(VA) have enhanced their M/SUD services, as well.

Some states have contracted with managed care organizations (MCO) or Administrative Services 

Organizations (ASO) to oversee and provide M/SUD services. State legislatures, state-based

Marketplace entities, and state insurance commissioners have developed policies and regulations 

related to Electronic Handbooks. SMHAs and SSAs should be involved in these efforts to 
Page | 16 

ensure that M/SUD services are appropriately included in plans, and M/SUD providers are 

included in networks. 

SMHAs and SSAs (as well as public health authorities responsible for prevention) should 

conduct a thorough survey to identify these potential resources, develop a strategy for matching 

resources to appropriate providers, engage, and collaborate with these partners at the federal, 

state and community levels. Persons eligible for such services should be assisted in accessing 

these services as appropriate.

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES

Statutory Deadlines

Statutory deadlines and block grant award periods remain unchanged. Applications for MHBG 

only are due no later than September 1, 2023. Applications for SUPTRS BG only are due no 

later than October 2, 2023. Combined Applications for MHBG and SUPTRS BG are due no 

later than September 1, 2023. SAMHSA encourages states to turn in their Application as early 

as possible to allow for a full discussion and review by SAMHSA. MHBG and SUPTRS BG

Reports are due by December 1, 2023. For the SUPTRS BG, the Annual Synar Report is due by 

December 31, 2023. 

Application Due Date Report Deadline

MHBG September 1, 2023 December 1, 2023

SUPTRS BG October 2, 2023 December 1, 2023

Annual Synar Report N/A December 31, 2023

Combined MHBG & SUPTRS BG September 1, 2023 December 1, 2023

States should submit their respective MHBG and SUPTRS BG Application(s) for FFYs 2024 

and 2025 based on the guidance provided in this document. The FFY 2024-2025 MHBG and 

SUPTRS BG Application(s) include(s) a two-year Mental and Substance Use Disorder Systems 

Assessment and Plan (Plan), as well as projected expenditure tables, certifications and 

assurances. Please see “Mental and Substance Use Disorder Assessment and Plan” for more 

details.

States are encouraged to submit a combined MHBG and SUPTRS BG application. If a state is 

submitting separate MHBG and SUPTRS BG plans, it should clarify which system is being 

described in this section (e.g., mental health, substance use/misuse prevention, SUD treatment, or 

recovery). 

Application Requirements

For the Secretary of HHS, acting through the Assistant Secretary for Mental Health and 

Substance Use, to make an award under the programs involved, states must submit an 

application(s) sufficient to meet the requirements described in SAMHSA’s block grant 

authorizing legislation and implementing regulations sufficient for SAMHSA to monitor the 

states’ compliance efforts regarding the obligation and expenditure of MHBG and SUPTRS BG
Page | 17 

funds. The funds awarded will be available for obligation and expenditure29 to plan, carry out, 

and evaluate activities and services for children with SED and adults with SMI; substance use 

primary prevention; youth and adults with a SUD; adolescents and adults with co-occurring 

disorders; and the promotion of recovery among persons with SED, SMI, or SUD.

A grant may be awarded only if a state’s application(s) include(s) a State Plan in the proper 

format containing information including, but not limited to, detailed provisions for complying 

with each funding agreement for a grant under section 1911 of Title XIX, Part B, Subpart I of the 

PHS Act (42 U.S.C. § 300x-1) or section 1921 of Title XIX, Part B, Subpart II of the PHS Act 

(42 U.S.C. § 300x-21) that is applicable to a state. The State Plan must include a description of 

the manner in which the state intends to obligate the grant funds, and it must include a report30 in 

the proper format containing information that the Secretary determines to be necessary for 

securing a record and description of the purposes for which both the MHBG and SUPTRS BG

were expended. States have the option of updating their plans during the two-year planning 

cycle.

MHBG statute requires states to provide services to those with SMI and SED as described in the 

state’s plan only through appropriate, qualified community programs (which may include 

community mental health centers, certified community behavioral health clinics, child mental 

health programs, psychosocial rehabilitation programs, mental health peer-support programs, and 

mental health consumer-directed programs) which meet the criteria as described in 42 USC 

§300x-2 (c). 

The MHBG portion of the statute requires the states expend the grant funds only for the purpose 

of providing community mental health services for adults with SMI and children with SED. In 

addition, states may use the funds to evaluate programs and services carried out under the plan; 

and for planning, administration, and educational activities related to providing services under 

the plan. 

Restrictions of use payments for MHBG funds include, inpatient services, cash payments to 

intended recipients of health services, purchase or improve land, purchase, construct, or 

permanently improve (other than minor remodeling) any building or other facility, or purchase of 

major medical equipment, and to use the MHBG to satisfy any requirement of expenditure of 

non-federal funds as a condition for the receipt of federal funds, and to provide financial 

assistance to any entity other than a public or nonprofit private entity. 

The SUPTRS BG portion of the statute requires that the States will expend the grant only for the 

purpose of carrying out the plan developed in accordance with the statute, and for planning, 

carrying out, and evaluating activities to prevent and treat substance use disorders and for related 

activities authorized in the statute (42 U.S.C. §300x–21 (b). 

The SUPTRS BG contains certain spending restrictions, including not expending funds for 

inpatient hospital services except as provided for in the regulations; prohibits cash payments to 

clients; disallows the purchase, construction, or improvement of land or buildings; and other 

29 Title XIX, Part B of the PHS Act, http://www.samhsa.gov/grants/block-grants/laws-regulations 30 Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a)), 

http://www.samhsa.gov/grants/block-grants/laws-regulations
Page | 18 

categories, including a limitation of up to 5% of SUPTRS BG for SSA expenditures related to 

the administration of the grant.

The application requests information on state efforts on certain policy, program, and technology 

advancements in physical and M/SUD prevention, treatment, and recovery. MHBG statute 

requires a description of the state’s comprehensive system of care for individuals with SMI and 

SED (42 U.S.C. §300x–1 (b) (1) (A)31) and MHBG funds must be used for those activities that 

are allowable based on statute. The SUPTRS BG portion of the statute provides for the 

application for the grant, and approval of a State plan that includes a comprehensive description 

of the State’s system of care, the establishment of goals and objectives for the period of the plan, 

and a description of how the State will comply with each funding agreement for the grant, 

including a description of the manner in which the State intends to expend grant funds (42 

U.S.C. §300x–32 (b) (1) (A)-(C)). This information will help SAMHSA understand the whole of 

the applicant state’s efforts and identify how SAMHSA can assist the applicant state in meeting 

its goals. In addition, this information will identify states that are models and assist other states 

with areas of common concern. 

Required Sections and Tables 

The FFY 2024-2025 Application requires states to submit a M/SUD assessment and plan; 

expenditure, performance, and utilization reports; executive summary; and funding agreements, 

assurances, and certifications. States are strongly encouraged to respond to each section so that

SAMHSA understands the totality of states’ efforts and how the block grant funding fits into the 

states’ overall goals and constraints. 

Section III.B, Planning Steps, requires states to undertake a needs assessment as part of their plan 

submission. This section identifies four key steps: (1) assess the strengths and needs of the 

service system; (2) identify unmet service needs and critical gaps; (3) prioritize state planning 

activities to include the required target populations and other priority populations; and (4) 

develop goals, objectives, strategies, and performance indicators. 

Section III.B, Plan Table 1 (Priority Area and Annual Performance Indicators), Plan Table 2 

(State Agency Planned Expenditure) and Plan Table 6 (Non-Direct Services/System 

Development Activities Planned Expenditures) are required for both MHBG and SUPTRS BG. 

For the SUPTRS BG, Plan Table 3 (SUPTRS BG Persons in need/receipt of treatment), Table 5a 

(SUPTRS BG Primary Prevention Planned Expenditures) and Table 5b (SUPTRS BG Planned 

Primary Prevention Prioritized Priorities) are required. 

III. MENTAL AND SUBSTANCE USE DISORDER ASSESSMENT AND PLAN

The Plan provides a framework for SMHAs and SSAs to assess the strengths and needs of their

systems and to plan for system improvement. The unique statutory and regulatory requirements 

of the specific block grants are described in the State Plan section. The Plan will cover a twoyear period aligning with states’ budget cycle for SFY 2024-2025. States will have the option to 

update their Plans when they submit their FFY 2025 Application. 

31 State plan for comprehensive community mental health services for certain individuals, Subchapter XVII—Block Grants

U.S.C. § 42 U.S. Code § 300x–1 (Oct. 17, 2020). https://www.law.cornell.edu/uscode/text/42/300x-1 
Page | 19 

The FFY 2024-2025 Plan seeks to collect information from states regarding their activities in 

response to federal laws, initiatives, changes in technology, and advances in research, 

implementation of innovative practices, and knowledge. The FFY 2024-2025 Plan has sections 

that are required and other sections that list SAMHSA priorities. The SAMHSA priority sections 

are necessary for a full understanding of the design of the state system of care and provides a 

benefit to both the states and SAMHSA. There will be no penalty assessed to states that provide 

only the information that is required.

SAMHSA values the importance of a thoughtful planning process that includes the use of 

available data to identify the strengths, needs, and service gaps for specific populations. By 

identifying needs and gaps, states can prioritize and establish tailored goals, objectives, 

strategies, and performance indicators. In addition, the planning process should provide 

information on how the state will specifically spend available block grant funds consistent with 

the statutory and regulatory requirements, environment, and priorities described in this document 

and the priorities identified in the state’s plan. 

Meaningful input of stakeholders in the development of the plan is critical. Evidence of the 

process and input of the Planning Council required by section 1914(b) of the PHS Act (42 U.S.C. 

§ 300x-4(b)) for the MHBG must be included in the application that addresses MHBG funds. 

States are also encouraged to expand this Planning Council to include prevention and substance 

use disorder stakeholders and use this mechanism to assist in the development of the state block 

grant plan for the SUPTRS BG application. States must describe the stakeholder input process 

for the development of both the SUPTRS BG and the MHBG plan, as mandated by section 1941 

of the PHS Act (42 U.S.C.§ 300x-5132), which requires that the state block grant plans be made 

available to the public in such a manner as to facilitate public comment during the development 

of the plan (including any revisions) and after the submission of the plan to the Secretary through 

SAMHSA. This description should also show involvement of persons who are service recipients 

and in recovery, families of individuals with M/SUD, providers of services and supports, 

representatives from underserved communities (as defined under EO 13985), and other key 

stakeholders. Evidence of meaningful consultation with federally recognized tribes (where tribal 

governments or lands are located within the boundaries of the state) are strongly encouraged for 

both MHBG and SUPTRS BG. 

A. Framework for Planning

States should identify and analyze the strengths, needs, and priorities of their M/SUD system. 

The strengths, needs, and priorities should take into account specific populations that are the 

current focus of the block grants and the changing health care environment. 

MHBG Framework

The MHBG program is designed to provide comprehensive community mental health servicesto

adults with SMI or children with SED. For purposes of block grant planning and reporting, 

SAMHSA has clarified the definitions of SED and SMI. States may have additional elements 

32 Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a condition of the funding agreement 

for the grant, states will provide an opportunity for the public to comment on the state block grant plan. States should make the 

plan public in such a manner as to facilitate comment from any person (including federal, tribal, or other public agencies) both 

during the development of the plan (including any revisions) and after the submission of the plan to SAMHSA.
Page | 20 

that are included in their specific definitions, but the following provides a common baseline 

definition. Children with SED refers to persons from birth to age 18 and adults with SMI refers 

to persons age 18 and over; who (1) currently meet or at any time during the past year has met 

criteria for a mental disorder – including within developmental and cultural contexts – as 

specified within a recognized diagnostic classification system (e.g., most recent editions of DSM, 

ICD, etc.), and (2) display functional impairment, as determined by a standardized measure, that

impedes progress towards recovery and substantially interferes with or limits the person’s role or 

functioning in family, school, employment, relationships, or community activities. 

Section 1912(b) of the Public Health Act (42 USC § 300x-1) establishes five criteria that must be 

addressed in MHBG plans. The criteria are defined below: 

• Criterion 1: Comprehensive Community-Based Mental Health Service Systems: Provides 

for the establishment and implementation of an organized community-based system of 

care for individuals with mental illness, including those with co-occurring M/SUD. 

States must have available services and resources within a comprehensive system of care, 

inclusive of the crisis services, provided with federal, state, and other public and private 

resources, in order to enable such individuals to function outside of inpatient or 

residential institutions to the maximum extent of their capabilities.

• Criterion 2: Mental Health System Data Epidemiology: Contains a state-level estimate of 

the incidence and prevalence of SMI among adults and SED among children; and 

includes quantitative targets to be achieved in the implementation of the system of care 

described under Criterion 1. 

• Criterion 3: Children’s Services: Provides for a system of integrated services for children 

to receive care for their multiple needs. Services that should be integrated into a 

comprehensive system of care include social services; child welfare services; educational 

services, including services provided under the Individuals with Disabilities Education 

Act; juvenile justice services; substance use disorder services; and health and mental 

health services. 

• Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults:

Provides outreach to and services for individuals who experience homelessness; 

community-based services to individuals in rural areas; and community-based services 

for older adults.

• Criterion 5: Management Systems: States describe their financial resources, staffing, and 

training for mental health services providers necessary for the plan; provides for training 

of providers of emergency health services regarding SMI and SED; and how the state 

intends to expend this grant for the fiscal years involved.

The MHBG Plan must include the following elements: 

Element 1: States must submit a plan on how they will utilize the 10 percent set-aside funding in 

the MHBG to support appropriate evidence-based programs for individuals with Early Serious 

Mental Illness (ESMI) including psychosis. If a state chooses to submit a plan to utilize the setaside for evidence-based services other than the services/principles components of Coordinated 

Specialty Care (CSC) approach developed via the Recovery After an Initial Schizophrenia 

Episode (RAISE) initiative, SAMHSA will review the plan with the state to assure that the 

approach proposed meets the understanding of an evidence-based approach. In consultation with 

the National Institute of Mental Health (NIMH), as needed, proposals will be accepted or 
Page | 21 

requests for modifications to the plan will be discussed and negotiated with the state. This 

initiative also includes a plan for program evaluation and data collection related to demonstrating

program effectiveness. Additional technical assistance and guidance on the expectations for 

evaluation, data collection and reporting will follow.

Element 2: The MHBG statute requires states to set-aside not less than 5 percent of their total 

MHBG allocation amount for each fiscal year to support evidence-based crisis care programs 

addressing the needs of individuals with serious mental illnesses and children with serious 

mental and emotional disturbances. The set-aside must be used to fund some or all of a set of 

core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term 

residential crisis stabilization beds, and regional or State-wide crisis call centers coordinating in 

real time.

Element 3: States are required to provide services for children with SED and their families or 

other caregivers. Each year the State shall expend not less than the amount expended in FY 

1994. If there is a shortfall in funding available for children’s mental health services, the state 

may request a waiver. A waiver may be granted if the Secretary determines that the state is 

providing an adequate level of comprehensive community mental health services for children 

with SED, as indicated by comparing the number of children in need of such services with the 

services actually available within the State.

Element 4: States are required to submit sufficient information for the Secretary to make a 

determination of compliance with the statutory maintenance of effort (MOE) requirements. 

MOE information is necessary to document that the state has maintained expenditures for 

community mental health services at a level that is not less than the average level of such 

expenditures maintained by the state for the 2-year period preceding the fiscal year for which the 

State is applying for the grant. The state shall only include community mental health services 

expenditures for individuals that meet the federal or state definition of SMI adults and SED 

children. states that received approval to exclude funds from the maintenance of effort 

calculation should include the appropriate MOE approval documents. 

SUPTRS BG Framework

The SUPTRS BG program provides substance use primary prevention, SUD treatment and 

recovery support services (and certain related activities) to at-risk individuals or persons in need

of SUD treatment. See 42 U.S.C. §§ 300x-300x-66. 

Section 1921 of the PHS Act (42 U.S.C.§ 300x-21) authorizes the States to obligate and expend 

SUPTRS BG funds to plan, carry out and evaluate activities and services designed to prevent and 

treat substance use disorders. Section 1932(b) of the PHS Act (42 U.S.C. § 300x-32(b))

established the criterion that must be addressed in the State Plan.

• Criterion 1: Statewide Plan for Substance Use Primary Prevention, Treatment and 

Recovery Services for Individuals, Families and Communities (42 U.S.C. § 300x-21 and 

45 CFR § 96.122). 

• Criterion 2: Primary Prevention (42 U.S.C. § 300x-22(a) and 45 CFR § 96.125). The 

authorizing legislation and implementing regulation established a 20 percent set-aside for 

substance use primary prevention programs, defined as programs for individuals who do 
Page | 22 

not require treatment for substance use disorders. States must utilize this set-aside to 

implement at least one of the six strategies and to carry out Section 1926 –Tobacco 

activities. States may utilize funds for non-direct services also.

• Criterion 3: Pregnant Women and Women with Dependent Children (42 U.S.C. § 300x22(b); 42 U.S.C. § 300x-27; 45 CFR § 96.124(c)(e); and 45 CFR § 96.131). The 

authorizing legislation and implementing regulation established a 5 percent set-aside that 

was applicable to the FFY 1993 and FFY 1992 SUPTRS BG Notices of Award. For 

FFY 1994 and subsequent fiscal years, States have been required to comply with a 

performance requirement that the States are required to obligate and expend funds for 

SUD treatment services designed for such women in an amount equal to the amount 

expended in FFY 1994.

• Criterion 4: Persons Who Inject Drugs (42 U.S.C. § 300x-23 and 45 CFR § 96.126). 

The authorizing legislation and implementing regulation established two performance 

requirements related to persons who inject drugs: (1) Any programs that receive 

SUPTRS BG funds to serve persons who inject drugs must comply with the 

requirement to admit an individual requesting admission to treatment within 14 days 

and not later than 120 days; and (2) outreach to encourage persons who inject drugs to 

seek SUD treatment Additionally, subject to the annual appropriation process, States

may authorize such programs to obligate and expend SUPTRS BG funds for elements

of a syringe services program (SSP) pursuant to guidance developed by the HHS’ 

Office of HIV/AIDS and Infectious Disease Policy (OHIDP). 

• Criterion 5: Tuberculosis Services (42 U.S.C. § 300x-24(a) and 45 CFR § 96.127). In 

accordance with §96.127, the state is required to make identified tuberculosis (TB) 

services available to each individual receiving SUD treatment services from the state’s 

SUPTRS BG approved SUD treatment providers. The state is required to assure that the 

SUPTRS BG sub-recipients’ activities being provided with these SUPTRS BG funds 

are limited to those §96.121 SUPTRS BG defined Tuberculosis Services and that the 

grantee’s expenditure of SUPTRS BG funds for such services has been the “payment of 

last resort” in accordance with §96.137 Payment Schedule. Services include counseling, 

testing, and referral to appropriate medical evaluation and treatment. 

• Criterion 6: Early Intervention Services Regarding the Human Immunodeficiency Virus

(42 U.S.C. § 300x-24(b) and 45 CFR § 96.128). The authorizing legislation and 

implementing regulation require designated States to set-aside five percent of the 

SUPTRS BG to establish 1 or more projects to provide EIS/HIV at the site(s) at which 

individuals are receiving SUD treatment services. 

• Criterion 7: Group Homes for Persons in Recovery from Substance Use Disorders (42 

U.S.C. § 300x-25 and 45 CFR § 96.129). The authorizing legislation and implementing 

regulation provide states with the flexibility to establish and maintain a revolving loan 

fund for the purpose of making loans, not to exceed $4,000, to a group of not more than 

six individuals to establish a recovery residence.

• Criterion 8: Referrals to Treatment (42 U.S.C. § 300x-28(a) and 45 CFR § 96.132(a)

and Coordination of Ancillary Services (42 U.S.C. § 300x-28(c) and 45 CFR § 

96.132(c). The authorizing legislation and implementing regulation require States to 

promote the use of standardized screening and assessment instruments and placement 

criteria to improve patient retention and treatment outcomes.

• Criterion 9: Independent Peer Review (42 U.S.C. § 300x-58(a) (1) (A) and 45 CFR § 
Page | 23 

96.136). The authorizing legislation and implementing regulation require states to assess 

the quality, appropriateness, and efficacy of M/SUD treatment services.

• Criterion 10: Professional Development (42 U.S.C. § 300x-28(b) and 45 CFR § 

96.132(b). The authorizing legislation and implementing regulation requires any 

programs that receive SUPTRS BG funds to ensure that prevention, treatment and 

recovery personnel operating in the state’s substance use disorder system have an 

opportunity to receive training on an ongoing basis concerning recent trends in substance 

use in the state, improved methods and evidence-based practices for providing 

substance use primary prevention and treatment services, performance-based 

accountability, data collection and reporting requirements, and any other matters that 

would serve to further improves the delivery of substance use primary prevention, 

treatment, and recovery support services within the state.

The SUPTRS BG Plan must include a variety of other elements, as well:

Element 1: The authorizing legislation and implementing regulations for the SUPTRS BG

includes a specific SUPTRS BG State MOE Expenditure Requirement. A state must maintain its 

state expenditures for certain SUD prevention, treatment, and recovery support activities at a 

level that is no less than the state’s average expenditures for the previous two state fiscal years. 

State required MOE contribution for SFY 2021 was $3.3 billion and actual state expenditures 

exceeded $3.4 billion. States that do not meet the MOE requirement due to extenuating 

circumstances are given options to resolve their MOE deficiencies through a request for a waiver 

from the Assistant Secretary for Mental Health and Substance Use under the applicable statute 

and regulations. 

Element 2: Beginning in FY 1995 and subsequent fiscal years, states are required to “expend for 

such services for such women not less than an amount equal to the amount expended in by the 

state for fiscal year 1994.” Therefore, for FY 1995 and subsequent fiscal years, the Women’s 

Services MOE became a performance requirement that provides states with the flexibility to 

expend a combination of SUPTRS BG and state funds to support treatment services for pregnant 

women and women with dependent children. The SFY 21 SUPTRS BG MOE 1994 Baseline 

Requirement for Women’s Services reported required contributions for states and territories as 

totaling $197,203,799, and actual or estimated expenditures totals as $281,194,421. As a result 

of a shortfall in the Women’s Services MOE Expenditure Requirement, a state may submit and 

receive approval for a related waiver from the Assistant Secretary under the applicable statute 

and regulations. 

Element 3: As specified in 45 CFR § 96.125(b), states shall use a variety of evidence-based

programs, policies and practices in their prevention efforts that include funding at least one of the

six prevention strategies: Information dissemination; Education; Alternatives that decrease 

alcohol, tobacco, and other drug use; Problem identification and referral; Community based 

programming; and, Environmental strategies that establish or change written and unwritten 

community standards, codes, and attitudes, thereby influencing incidence and prevalence of the

misuse of alcohol, tobacco, and other drugs used in the general population. SUPTRS BG

primary prevention set-aside funds can only be used to fund strategies that prevent substance 

misuse.
Page | 24 

Prevention efforts should be consistent with the IOM Report on Preventing Mental Emotional 

and Behavioral Disorders, the Surgeon General’s Call to Action to Prevent and Reduce Underage 

Drinking33 and Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs 

and Health, SAMHSA’s Evidence Based Practices Resource Center and/or other materials 

documenting their effectiveness. For the education prevention strategy, evidence based 

repositories may be used to find appropriate programs that align with statutory requirements of 

the SUPTRS BG and the parameters of the specific populations that are being served (e.g. 

Blueprints for Healthy Youth Development).

These prevention efforts can include: tobacco use prevention and tobacco-free facilities that are 

supported by research and encompass a range of activities including policy initiatives and 

programs; engaging schools, workplaces, and communities to establish programs and policies to

improve knowledge about alcohol and other drug problems, denote effective ways to address the

problems, and enhance resiliency; implement evidence-based and cost-effective models to 

prevent substance use disorders in young people in a variety of community settings, e.g., 

families, schools, workplaces, and faith-based institutions, consistent with the current science;

policy and environmental programming to change the community’s norms around, and parental 

acceptance of, underage alcohol use; and offer the latest science and research on prevention, 

treatment and recovery; and addressing underserve communities that experience a cluster of risk 

factors that make them especially vulnerable to substance use and related problems.

Populations Served

At a minimum, the plan should address the following populations as appropriate for each block 

grant. (*Populations marked with an asterisk are required to be included in the state’s needs 

assessment for the MHBG or SUPTRS BG. To the extent that the other listed populations fall 

within any of the statutorily covered populations, states must include them in the plan.)

1. (MHBG) Comprehensive community-based mental health services for adults with SMI

and children with SED:

• Children with SED and their families*

• Adults with SMI* 

• Older Adults with SMI* 

• Individuals with SMI or SED in the rural and homeless populations, as applicable* 

• Individuals who have an Early Serious Mental Illness (ESMI) (10 percent MHBG set 

aside)

• Individuals in need of behavioral health crisis services (BHCS) (5 percent MHBG set 

aside)

2. (SUPTRS BG) Services for persons with or at risk of having substance use disorder: 

• Persons who inject drugs* 

• Adolescents with a substance use disorder or a substance use disorder with a cooccurring mental health problems.

• Children and youth who are at risk for substance misuse or addiction, which may 

include a co-occurring conduct disorder, anxiety, depression, or other mental, 

emotional, and behavioral disorders. 

33 https://www.ncbi.nlm.nih.gov/books/NBK44360/
Page | 25 

• Women who are pregnant and have a substance use disorder or a substance 

use disorder with a co-occurring mental disorder* 

• Parents with a substance use disorder who have dependent children* 

• Military personnel (active, guard, reserve, and veteran) and their families

• American Indians/Alaska Natives and other underserved populations, per EO 13985.

3. (SUPTRS BG) Services for persons with SUD who are at risk of contracting communicable 

diseases:

• Individuals with, or at risk for, tuberculosis* and other communicable diseases

• Persons at risk for HIV/AIDS who may be unaware of the infection status and 

persons living with HIV/AIDS who are in need of substance use disorder early 

intervention, treatment, recovery support, or prevention services*34

• The National HIV/AIDS Strategy (NHAS) for the United States and NHAS 

Implementation Plan 35

• Prevention of HIV among persons who inject drugs; substance use is associated 

with a greater likelihood of acquiring HIV infection. HIV screening and other 

comprehensive HIV prevention services should be coupled with SUD treatment 

programs 

4. (SUPTRS BG) Services for individuals in need of substance use primary prevention* 

5. (MHBG and SUPTRS BG) In addition to the prioritized/required populations and/or 

services referenced in statute, states are strongly encouraged to consider the following 

populations, and/or services:

• Individuals with mental and/or substance use disorders who experience

homelessness or involved in the criminal or juvenile justice systems

• Individuals with mental and/or substance use disorders who live in rural areas

• Underserved racial and ethnic minority and LGBTQI+ populations 

• Persons with disabilities 

• Members of religious minorities

• Community populations for environmental prevention activities, including policy 

changing activities, and behavior change activities to change community, school, 

family, and business norms through laws, policy and guidelines and enforcement. 

• Community settings for universal, selective, and indicated prevention interventions, 

including hard-to-reach communities and “late” adopters of prevention strategies 

34 For the purpose of determining the states and jurisdictions which are considered “designated states” as described in section 

1924(b)(2) of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 CFR § 

96.128(b) of the Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120-137),). SAMHSA 

relies on the HIV Surveillance Report AtlasPlus HIV data report produced by the CDC, National Center for HIV/AIDS, 

Hepatitis, STD, and TB Prevention (NCHHSTP). The HIV Surveillance Report, Volume 25, most current NCHHSTP AtlasPlus 

HIV data report will be used to determine the states and jurisdictions that will be required to set-aside 5 percent of their 

respective FY 2016 SUPTRS BG allotments to establish one or more projects to provide early intervention services for HIV at 

the sites at which individuals are receiving SUD treatment services. In FY 2012, SAMHSA developed and disseminated a policy 

change applicable to the EIS/HIV, which provided any state that was a “designated state” in any of the 3 years prior to the year 

for which a state is applying for SUPTRS BG funds with the flexibility to obligate and expend SUPTRS BG funds for EIS/HIV 

even though the state does not meet the AIDS case rate threshold for the fiscal year involved. Therefore, any state whose AIDS 

case rate is below 10 or more such cases per 100,000 and meets the criteria described in the 2012 policy guidance would be 

allowed to obligate and expend FY 2016 SUPTRS BG funds for EIS/HIV if they chose to do so, and may elect to do so by 

providing written notification to the CSAT SPO as a part of the SUPTRS BG Application. 35 https://www.hiv.gov/federal-response/national-hiv-aids-strategy/nhas-update
Page | 26

• Individuals new in their recovery who require additional recovery support services, 

as appropriate, to maintain their recovery.

In addition, states should consider linking their Olmstead planning work in the block grant

application, identifying trend data on individuals who are institutionalized or at risk of

institutionalization. There is a need generally for data that will help the state address housing and 

related issues in their planning efforts. To the extent that such data are available in a state’s 

Olmstead Plan, it should be used for block grant planning purposes.

B. Planning Steps

For each of the populations and common areas, states should follow the planning steps outlined 

below:

Step 1: Assess the strengths and organizational capacity of the service system to address the

specific populations.

Provide an overview of the state’s M/SUD prevention (description of the current prevention 

system’s attention to individuals in need of substance use primary prevention), early

identification, treatment, and recovery support systems, including the statutory criteria that must 

be addressed in the state’s Application. Describe how the public M/SUD system is currently

organized at the state and local levels, differentiating between child and adult systems. This

description should include a discussion of the roles of the SMHA, the SSA, and other state

agencies with respect to the delivery of M/SUD services. States should also include a description

of regional, county, tribal, and local entities that provide M/SUD services or contribute resources 

that assist in providing the services. In general, the overview should reflect the MHBG and 

SUPTRS BG criteria detailed in “Environmental Factors and Plan” section.

Further, in support of the Executive Order On Advancing Racial Equity and Support for 

Underserved Communities Through the Federal Government, SAMHSA is committed to 

advancing equity for all, including people of color and others who have been historically 

underserved, marginalized, and adversely affected by persistent poverty and inequality. 

Therefore, the description should also include how these systems address the needs of

underserved communities. Examples of system strengths might include long-standing 

interagency relationships, coordinated planning, training systems, and an active network of 

prevention coalitions. The lack of such strengths might be considered needs of the system, 

which should be discussed under Step 2. This narrative must include a discussion of the current 

service system’s attention to the MHBG and SUPTRS BG priority populations listed above 

under “Populations Served.”

Step 2: Identify the unmet service needs and critical gaps within the current system.

This step should identify the unmet service needs and critical gaps in the state’s current systems,

as well as the data sources used to identify the needs and gaps of the required populations 

relevant to each block grant within the state’s behavioral health system, including for other 

populations identified by the state as a priority. This step should also address how the state plans 

to meet the unmet service needs and gaps. The state’s priorities and goals must be supported by

data-driven processes. This could include data that is available through a number of different 

sources such as SAMHSA’s National Survey on Drug Use and Health (NSDUH), Treatment 
Page | 27 

Episode Data Set (TEDS), National Survey of Substance Use Disorder Treatment Services (NSSATS), the Behavioral Health Barometer, Behavioral Risk Factor Surveillance System 

(BRFSS) , Youth Risk Behavior Surveillance System (YRBSS), the Uniform Reporting System

(URS), and state data. Those states that have a State Epidemiological and Outcomes Workgroup

(SEOW) should describe its composition and contribution to the process for primary prevention 

and treatment planning. States with current Partnership for Success discretionary grants are 

required to have an active SEOW.

This narrative must include a discussion of the unmet service needs and critical gaps in the 

current system regarding the MHBG and SUPTRS BG priority populations, as well as a

discussion of the unmet service needs and critical gaps in the current system for underserved 

communities, as defined under EO 13985. States are encouraged to refer to the IOM reports, 

Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement

and The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for 

Better Understanding36 in developing this narrative.

Step 3: Prioritize state planning activities 

Prioritize state planning activities that will include MHBG and SUPTRS BG. The priorities must 

include the core federal Block Grant goals and aims of the MHBG and SUPTRS BG programs, 

as well as state programs with a focus on target priority populations (those required in legislation 

and regulation for each block grant) and other priority populations described in the document. 

States should list priorities in Plan Table 1 and indicate the priority type: substance use 

prevention (SAP), substance use disorder treatment (SAT), substance use disorder recovery 

(SAR), mental health services (MHS), early serious mental illness (ESMI), and behavioral 

health crisis services (BHCS). 

Step 4: Develop goals, objectives, performance indicators, and strategies

For each of the priorities, states should identify the relevant goals, measurable objectives, and at 

least one-performance indicator for each objective for the next two years. For each objective, the 

state should describe the specific strategy that will be used to achieve the objective. SMHAs and 

SSAs are well positioned to understand and use the evidence regarding various M/SUD services 

as critical input for making purchasing decisions and influencing coverage offered in their state

through commercial insurers and Medicaid. In addition, states may also be able to use this 

information to educate policymakers and to justify their budget requests or other strategic 

planning efforts. States may also want to consider undertaking a similar process within their

state to review local programs and practices that expand treatment technologies and show

promising outcomes.

These strategies may include developing and implementing various service-specific changes to 

address the needs of specific populations, substance use disorder and mental health treatment, 

substance use prevention activities, substance use disorder recovery activities, and system 

improvements that will address the objective. 

36 Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender people: Building a 

Foundation for Better Understanding. Washington, DC: The National Academies Press.
Page | 28

Strategies to consider and address include:

• Strategies that support successful integration and attention to SAMHSA’s five priorities 

(i.e., overdose prevention; 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) 

and four guiding principles (i.e., equity, trauma-informed approaches, recovery, and a 

commitment to data and evidence), as outlined above.

• Strategies that will integration and inclusion into the community. This includes housing

models that integrate individuals into the community instead of long-term care facilities 

or nursing homes and other settings that fail to promote independence and inclusion. 

This also can include strategies to promote competitive and evidenced-based supported 

employment in the community, rather than segregated programs.

• Strategies that result in developing recovery support services (e.g., peer support services, 

recovery housing, permanent housing and supportive employment or education for

persons with mental and substance use disorders). This includes how local authorities 

will be engaged to increase the availability of housing, employment, and educational 

opportunities, and how the state will develop services that will wrap around these

individuals to obtain and maintain safe and affordable housing, employment, and/or

education.

• Strategies that increase the use of person-centered planning, self-direction, and 

participant-directed care. This includes measures to help individuals or caregivers (when 

appropriate) identify and access services and supports that reinforce recovery or

resilience. These strategies should also include how individuals or caregivers have access 

to supports to facilitate participant direction, including the ability to manage a flexible 

budget to address recovery goals; identifying, selecting hiring and managing support workers 

and providers; and ability to purchase goods and services identified in the recovery or 

resilience planning process. Strategies should address workforce training in person centered 

planning and service systems, Shared Decision Making and patient/client reported outcomes.

• Strategies to address system improvement activities, as identified in the needs 

assessment, which should:

o Allow states to position their providers to increase access, retention, adoption, or

adaptation of EHRs or to develop strategies to increase workforce numbers. 

These system improvement activities should use federal and state resources 

currently available and those proposed for the planning period to enhance the

competency of the M/SUD workforce. System improvements that seek to expand 

the workforce should build upon existing efforts to increase M/SUD skill 

development in a wide range of professions as well as increase the role of people

in recovery from mental and substance use disorders in the planning and delivery

of services.

o Support providers to participate in networks that may be established through 

managed care or administrative service organizations (including accountable care 

organizations, ACOs). This may include assistance to develop the necessary 

infrastructure (e.g., electronic billing and EHRs) and reporting requirements to 

participate in these networks.

o Encourage the use of peer specialists or recovery coaches to provide needed 

recovery support services. Peers are trained, supervised, and regarded as staff and 
Page | 29

operate out of a community-based or recovery organization. A state’s strategy

should allow states to support peer and other recovery support services delivered.

States are encouraged to provide workforce training to non-peer staff supervisors 

and administrators on the purpose, roles, and activities of peer support 

specialists/recovery coaches consistent with the code of ethics and scope of 

practice for peer supports in their locality.

o Increase links between primary, specialty, emergency and rehabilitative care and 

M/SUD providers working with M/SUD provider organizations for expertise, 

collaboration, and referral arrangements, including the support of practitioner

efforts to screen patients for mental and substance use disorders. Activities 

should also focus on developing model contract templates for reciprocal health

and M/SUD integration and identifying state policies that present barriers to 

reimbursement. This would include efforts to implement dual eligible products, 

ACOs, and medical homes.

o Develop support systems to provide communities with necessary needs 

assessment information, planning, technical assistance, evaluation expertise, and 

other resources to foster the development of comprehensive community plans to 

improve mental, emotional, and M/SUD outcomes.

o Fund auxiliary aids and services to allow people with disabilities to benefit from 

the M/SUD services and language assistance services for people who experience

communication barriers to access.

o Develop benefit management strategies for high-cost services (e.g., youth out of

home services and adult residential services). SAMHSA believes that states 

should align their care management to guarantee that individuals get the right 

service at the right time in the right amount. These efforts should ensure that 

decisions made regarding these services are clinically sound.

Planning Tables

States should describe specific performance indicators that will be used to determine if the goals 

for that priority area were achieved. For each performance indicator, the state must describe the

data and data source that has been used to develop the baseline for FFY 2024 and how the state

proposes to measure the change in FFY 2025. States must use the template (Plan Table 1: 

Priority Areas by Goal, Strategy, and Performance Indicators) below. As a reminder, these 

population performance indicators should reflect the unmet need listed in Planning Step 2 and 

discussed above under Step 3 and Step 4.

Plan Table #1. Priority Area and Annual Performance Indicators

States should follow the guidelines presented above in Framework for Planning to complete Plan 

Table 1. States are to complete a separate table for each state priority area to be included in the

MHBG and SUPTRS BG. Please include the following information when entering into 

WebBGAS:

1. Priority area (based on an unmet service need or critical gap): After this information is

completed for the first priority area, another table will appear so additional priorities can

be added.

2. Priority type: From the drop-down menu, select SAP – substance use primary 
Page | 30 

prevention, SAT – substance use disorder treatment, SAR – substance use disorder 

recovery support, MHS – mental health service, ESMI – early serious mental illness, or 

BHCS – behavioral health crisis services. 

3. Priority/required populations: Indicate the population(s) required in statute for each 

block grant as well as those populations encouraged, as described in IIIA Framework for 

Planning. States must include at least one priority for each required population. For 

example, at least one priority and indicator must be denoted SAP and PP. From the dropdown menu select:

a. SMI: Adults with SMI, 

b. SED: Children with an SED, 

c. ESMI: Individuals with ESMI including psychosis, 

d. BHCS: Individuals in need of behavioral health crisis services, 

e. PWWDC: Pregnant women and women with dependent children who are 

receiving SUD treatment services, 

f. PP: persons in need of substance use primary prevention, 

g. PWID: Persons who inject drugs (formerly known as intravenous drug users, 

IVDU), 

h. EIS (Early Intervention Services)/HIV: Persons with or at risk of HIV/AIDS 

who are receiving SUD treatment services, 

i. TB: Persons with or at risk of tuberculosis who are receiving SUD treatment 

services, and/or 

j. Other- Specify (Refer to section IIIA of the Assessment and Plan). 

4. Goal of the priority area. Goal is a broad statement of general intention. Therefore, 

provide a general description of what the state hopes to accomplish.

5. Objective: Objective should be a concrete, precise, and measurable statement.

6. Strategies to attain the objective. Indicate program strategies or means to achieve the

stated objective. 

7. Annual Performance Indicators to measure success on a yearly basis. Each indicator

must reflect progress on a measure that is impacted by the block grant. After an indicator

is completed within the WebBGAS system for the first indicator, the table will then 

expand to enter additional indicators. For each performance indicator, specify the 

following components:

a) Baseline measurement from where the state assesses progress 

b) First-year target/outcome measurement (Progress to the end of SFY 2024) 

c) Second-year target/outcome measurement (Final to the end of SFY 2025) 

d) Data source 

e) Description of data; and 

f) Data issues/caveats that affect outcome measures.

Plan Table 1: Priority Area and Annual Performance Indicators

1. Priority Area:

2. Priority Type (SAP, SAT, SAR, MHS, ESMI, BHCS):

3. Population(s) (SMI, SED, ESMI, BHCS, PWWDC, PP, PWID, EIS/HIV, TB, OTHER): 

4. Goal of the priority area:

5. Objective:
Page | 31 

6. Strategies to attain the objective:

7. Annual Performance Indicators to measure achievement of the objective:

Indicator #1:

Plan Table 1: Priority Area and Annual Performance Indicators, continued

a) Baseline measurement (Initial data collected prior to and during SFY 2024): 

b) First-year target/outcome measurement (Progress to the end of SFY 2024):

c) Second-year target/outcome measurement (Final to the end of SFY 2025):

d) Data source: 

e) Description of data:

f) Data issues/caveats that affect outcome measures:

SAMHSA will work with states to monitor whether they are meeting the goals, objectives and 

performance indicators established in their plans, and to provide technical assistance as needed. 

SAMHSA staff will work with states during the year to discuss progress, identify barriers, and 

develop solutions to address these barriers.

If a state is unable to achieve its goals and objectives as stated in its application(s) approved by 

SAMHSA, the state will be asked to provide a description of corrective actions to be taken. If 

further steps are not taken, SAMHSA may ask the state for a revised plan, which SAMHSA will 

assist in developing, to achieve its goals and objectives. 
Page | 32 

Plan Table 2: State Agency Planned Expenditures

Table 2 addresses funds to be expended during the 24-month period of July 1, 2023 through June 30, 2025. Table 2 now includes 

columns to capture state expenditures for COVID-19 Relief Supplemental and ARP funds. Please use these columns to capture how 

much the state plans to expend over a 24-month period (7/1/23-6/30/25). Please document the use of COVID-19 Relief Supplemental 

and ARP funds in the footnotes. 

*Please note that MHBG and SUPTRS BG now have two separate Table 2 submissions.

MHBG – Include public mental health services provided by mental health providers or funded by the state mental health 

agency by source of funding

MHBG Table 2a

Planning Period: From: To:

State Identifier

State Agency Planned Expenditures

Activity A.

Mental 

Health 

Block 

Grant

B.

Medicaid 

(Federal, 

State, 

and 

Local)

C.

Other Federal Funds 

(e.g., ACF, TANF, 

CDC, CMS 

(Medicare), 

SAMHSA, etc.

D.

State 

Funds

E.

Local 

Funds 

(excluding 

local 

Medicaid)

F.

Other

G.

COVID-19 

Relief 

Funds 

(MHBG) a

H.

ARP 

Funds 

(MHBG) b

I.

Bipartisan 

Safer 

Communities 

Funds c

1. Mental Health Prevention d $ $ $ $ $ $ $ $ $

2. Evidence-Based Practices 

for Early Serious Mental 

Illness including First 

Episode Psychosis (10 

percent of total MHBG 

award) e

$ $ $ $ $ $ $ $ $

3. State Hospital $ $ $ $ $ $ $ $

4. Other Psychiatric Inpatient 

Care

$ $ $ $ $ $ $ $

5. Other 24-Hour Care 

(Residential Care)

$ $ $ $ $ $ $ $ $

6. Ambulatory/Community 

Non-24 Hour Care

$ $ $ $ $ $ $ $ $

7. Crisis Services (5 percent 

Set-Aside) f

$ $ $ $ $ $ $ $ $
Page | 33 

Table 2a (Cont.) 

Activity

A.

Mental 

Health 

Block 

Grant

B.

Medicaid 

(Federal, 

State, 

and 

Local)

C.

Other Federal Funds 

(e.g., ACF, TANF, 

CDC, CMS 

(Medicare), 

SAMHSA, etc.

D.

State 

Funds

E.

Local 

Funds 

(excluding 

local 

Medicaid)

F.

Other

G.

COVID-19 

Relief 

Funds 

(MHBG) a

H.

ARP 

Funds 

(MHBG) b

I.

Bipartisan 

Safer 

Communities

Funds c

8. Administration (Excluding 

Program and Provider 

Level) g

$ $ $ $ $ $ $ $ $

9. Total $ $ $ $ $ $ $ $ $

a

 The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is 

different from the expenditure period for the “standard” MHBG. Columns G should reflect the state planned expenditure period of 

July 1, 2023– June 30, 2025, for most states. Note: If your state has an approved no cost extension, you have until March 14, 2024 to 

expend the COVID-19 Relief supplemental funds. 

b The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 

30, 2025, which is different from the expenditure period for the “standard” MHBG. Columns H should reflect the state planned 

expenditure period of July 1, 2023– June 30, 2025, for most states. 

c The expenditure period for the 1st allocation of Bipartisan Safer Communities Act (BSCA) supplemental funding is from October 17, 

2022 thru October 16, 2024 and the expenditure for the 2nd allocation of BSCA funding will be from September 30, 2023 thru 

September 29, 2025 which is different from the expenditure period for the “standard” MHBG. Columns I should reflect the state 

planned expenditure period of July 1, 2023– June 30, 2025, for most states. d While the state may use state or other funding for prevention services, the MHBG funds must be directed toward adults with 

SMI or children with SED. e Column 2A should include Early Serious Mental Illness programs funded through MHBG set aside. 

f Row 7 should include Behavioral Health Crisis Services (BHCS) programs funded through different funding sources, including the 

MHBG set aside. States may expend more than 5 percent of their MHBG allocation.

f Per statute, administrative expenditures cannot exceed 5% of the fiscal year award.
Page | 34 

Plan Table 2b. State Agency Planned Expenditures

SUPTRS BG – ONLY include funds expended by the executive branch agency administering the SUPTRS BG

ACTIVITY

(See instructions for using 

Row 1.)

A. SUPTRS 

BG

B. 

Mental 

Health 

Block 

Grant

C. 

Medicaid

(Federal, 

State, and 

local)

D. Other 

Federal 

Funds 

(e.g., ACF 

(TANF), 

CDC, 

CMS 

(Medicare) 

SAMHSA, 

etc.)

E. State 

funds

F. Local 

funds

(excluding 

local

Medicaid)

G.

Other

H. 

COVID19 Relief 

Funds 

(MHBG) a 

I.COV

ID-19 

Relief 

Funds 

(SUPT

RS 

BG) a 

J. ARP 

Funds 

(SUPTR

S BG)

b 

1. Substance Use 

Prevention and 

Treatment

$ $ $ $ $ $ $ $

a. Pregnant Women and 

Women with 

Dependent Children*

b. Recovery Support 

Services

c. All Other 

2. Primary Prevention $ $ $ $ $ $ $ $

a. Substance Use 

Primary Prevention

b.Mental Health 

Primary Prevention

3. Evidence-Based 

Practices for Early 

Serious Mental Illness 

including First Episode 

Psychosis (10 percent 

of total award MHBG)f

4. Tuberculosis Services

5. Early Intervention 

Services for HIV

6. State Hospital
Page | 35 

a

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is 

different from the expenditure period for the “standard” MHBG/SUPTRS BG. If your state or territory has an approved No Cost 

Extension (NCE) for the FY 21 SUPTRS BG COVID-19 Supplemental Funding, you have until March 14, 2024 to expend the 

COVID-19 Relief Supplemental Funds. Per the instructions, the standard MHBG/SUPTRS BG expenditures captured in Columns A – 

G are for the state planned expenditure period of July 1, 2023 – June 30, 2025, for most states. Please enter SUPTRS BG COVID-19 

planned expenditures for the period of 7/1/23 through 6/30/25. 

b

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 

30, 2025, which is different from the expenditure period for the “standard” MHBG/SUPTRS BG. Per the instructions, the planning 

period for standard MHBG/SUPTRS BG expenditures is July 1, 2023 – June 30, 2025. Please enter SUPTRS BG ARP planned 

expenditures for the period of 7/1/23 through 6/30/25. c

Prevention other than primary prevention

d

The 20 percent set-aside funds in the SUPTRS BG must be used for activities designed to prevent substance misuse. e

While the state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or 

children with SED 

ACTIVITY

(See instructions for 

using Row 1.)

A. SUPTRS

BG

B. 

Mental 

Health 

Block 

Grant

C. Medicai

d

(Federal, 

State, and 

local)

D. Other

Federal

Funds (e.g.,

ACF

(TANF),

CDC, CMS

(Medicare)

SAMHSA,

etc.)

E. State

funds

F. Local

funds

(excluding 

local

Medicaid)

G. 

Other

H. 

COVID19 Relief 

Funds 

(MHBG) a

I.COV

ID-19

Relief

Funds

(SUPT

RS

BG) a

J. ARP

Funds

(SUPTR

S BG)

b

7. Other 24-Hour Care

8. Ambulatory/Communit

y Non-24 Hour Care

9. Administration

(excluding program /

provider level) MHBG

and SUPTRS BG must

be reported separately g

10. Crisis Services (5

percent set-aside)h 

12. Total $ $ $ $ $ $ $ $ $ $
Page | 36 

f

Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside. Per statute, Administrative 

expenditures cannot exceed 5% of the fiscal year award. 

g

Row 10 should include Crisis Services programs funded through different funding sources, including the MHBG set aside. States 

may expend more than 5 percent of their MHBG allocation.
Page | 37 

Plan Table 3: SUPTRS BG Persons in need/receipt of SUD treatment

To complete the Aggregate Number Estimated in Need column, please refer to the most recent edition of SAMHSA’s National Survey 

on Drug Use and Health (NSDUH) or other federal/state data that describes the populations of focus in rows 1-5. 

To complete the Aggregate Number in Treatment column, please refer to the most recent edition of the Treatment Episode Data Set 

(TEDS) data prepared and submitted to SAMHSA’s Behavioral Health Services Information System (BHSIS).

Plan Table 3 SUPTRS BG Persons in need/receipt of SUD treatment

State Identifier:

Aggregate number estimated in need Aggregate number in treatment

1. Pregnant Women

2. Women with Dependent Children

3. Individuals with a co-occurring M/SUD 

4. Persons who inject drugs

5. Persons experiencing homelessness

Please provide an explanation for any data cells for which the state does not have a data source.
Page | 38

Plan Table 4: SUPTRS BG Planned Expenditures

States must project how they will use SUPTRS BG funds to provide authorized services as required by the SUPTRS BG regulations, 

including the supplemental COVID-19 and ARP funds. Plan Table 4 must be completed for the FFY 2024 and FFY 2025 SUPTRS 

BG awards. The totals for each Fiscal Year should match the President’s Budget Allotment for the state.

Plan Table 4 SUPTRS BG Planned Expenditures

State Identifier: 

Expenditure Category FFY 2024

SUPTRS BG

Award

COVID-19 

Award 1

ARP Award 2 FFY 2025

SUPTRS BG

Award

COVID-19 

Award 1

ARP Award 2

1. Substance Use Disorder 

Prevention3 and Treatment

$ $ $ $ $ $

2. Substance Use Primary 

Prevention

$ $ $ $ $ $

3. Early Intervention 

Services for HIV4

$ $ $ $ $ $

4. Tuberculosis Services $ $ $ $ $ $

5. Recovery Support 

Services5

6. Administration (SSA level 

only)

$ $ $ $ $ $

7. Total $ $ $ $ $ $

1

The 24-month expenditure period for the COVID-19 Relief Supplemental funding is March 15, 2021 - March 14, 2023. If your state 

or territory has an approved No Cost Extension (NCE) for the FY 21 SABG COVID-19 Supplemental Funding, you have until March 

14, 2024 to expend the COVID-19 Relief Supplemental Funds. Per the instructions, the planning period for the standard SUPTRS BG

expenditures for the FFY 2024 SUPTRS BG Award is October 1, 2023 - September 30, 2024. For purposes of this table, all COVID19 Relief Supplemental planned expenditures between 10/1/23 and 9/30/24 should be entered in this first COVID-19 column, and all 

COVID 19 Relief Supplemental planned expenditures between 10/1/24 and 9/30/25 should be entered in the second COVID-19 

column.

2

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 

30, 2025, which is different from the expenditure period for the FY 2024 "standard" SUPTRS BG, which is October 1, 2023 -

September 30, 2024. The SUPTRS BG ARP planned expenditures for the period of October 1, 2023 - September 30, 2024 should be 
Page | 39 

entered here in the first ARP column, and the SUPTRS BG ARP planned expenditures for the period of October 1, 2024, through 

September 30, 2025, should be entered in the second ARP column 

2

Prevention other than Primary Prevention

4

For the purpose of determining which states and jurisdictions are considered “designated states” as described in section 1924(b)(2) of 

Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 CFR § 96.128(b) of the 

Substance use disorder Prevention and Treatment Block Grant (SUPTRS BG); Interim Final Rule (45 CFR 96.120-137), SAMHSA 

relies on the AtlasPlus HIV data report produced by the Centers for Disease Control and Prevention (CDC,), National Center for 

HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP).. The most recent AtlasPlus HIV data report published on or before 

October 1 of the federal fiscal year for which a state is applying for a grant is used to determine the states and jurisdictions that will be 

required to set-aside 5 percent of their respective SUPTRS BG allotments to establish one or more projects to provide early 

intervention services regarding the human immunodeficiency virus (EIS/HIV) at the sites at which individuals are receiving SUD 

treatment services. In FY 2012, SAMHSA developed and disseminated a policy change applicable to the EIS/HIV which provided any 

state that was a “designated state” in any of the three years prior to the year for which a state is applying for SUPTRS BG funds with 

the flexibility to obligate and expend SUPTRS BG funds for EIS/HIV even though the state’s AIDS case rate does not meet the AIDS 

case rate threshold for the fiscal year involved for which a state is applying for SUPTRS BG funds. Therefore, any state with an AIDS 

case rate below 10 or more such cases per 100,000 that meets the criteria described in the 2012 policy guidance will be allowed to 

obligate and expend SUPTRS BG funds for EIS/HIV if they chose to do so and may elect to do so by providing written notification to 

the CSAT SPO as a part of the SUPTRS BG Application. 

5

 This expenditure category is mandated by Section 1243 of the Consolidated Appropriations Act, 2023.
Page | 40 

Table 5a: Primary Prevention Planned Expenditures

States must spend no less than 20 percent of their SUPTRS BG award on substance use primary 

prevention strategies. The state must spend the majority of the funds implementing a 

comprehensive primary prevention approach that includes at least one of the six substance use 

primary prevention strategies, as applicable. These strategies are directed at individuals not 

meeting the diagnostic criteria for a SUD or identified to not be in need of treatment. To report 

on their primary prevention planned expenditures, states must complete Table 5a. 

States need to make the most efficient use of funds for substance use primary prevention and be 

prepared to report on the outcomes of these efforts. This means that state-funded prevention 

providers will need to be able to collect data and report this information to the state. With 

limited resources, states should also look for opportunities to leverage different streams of

funding to create a coordinated data-driven substance use primary prevention system. 

Specifically, SAMHSA recommends that states align the 20 percent set-aside for primary 

prevention of the SUPTRS BG with other federal, state, and local funding that will aid the state

in developing and maintaining a comprehensive substance use primary prevention system, as 

well as collaborate with and assure that behavioral health is part of the state’s larger public 

health prevention activities.

Table 5a SUPTRS BG Primary Prevention Planned Expenditures by Strategy 

and IOM Category 

The state’s primary prevention program must include at least one of the six primary prevention 

strategies defined below. On Table 5a, states should list their FFY 2024 and FFY 2025 SUPTRS 

BG planned expenditures within the six primary prevention strategies, depending on capacity 

and other factors. Expenditures within the six strategies should be directly associated with the 

cost of completing the activity or task; for example, information dissemination should include 

the cost of developing pamphlets, the time of participating staff or the cost of public service 

announcements, etc. If a state plans to use strategies not covered by these six categories or the 

state is unable to calculate expenditures by strategy, please report them under “Other” in Table 

5a.

In most cases, the total SUPTRS BG amount should equal the amount reported on Plan Table 4, 

Row 2, Substance Use Primary Prevention. The one exception is if the state chooses to use a 

portion of the primary prevention set-aside to fund Non-Direct Services/System Development 

activities. The total on Table 6 prevention column combined with the total on Table 5a should 

equal to expenditure Table 4, Row 2 in most instances. 

Primary Prevention Planned Expenditures by IOM Category 

Information Dissemination– This strategy provides knowledge and increases awareness of the 

nature and extent of alcohol and other drug use, misuse, and addiction, as well as their effects on 

individuals, families, and communities. It also provides knowledge and increases awareness of 

available prevention and treatment programs and services. It is characterized by one-way 

communication from the source to the audience, with limited contact between the two.

Education - This strategy builds skills through structured learning processes. Critical life and 

social skills include decision making, peer resistance, coping with stress, problem solving, 
Page | 41 

interpersonal communication, and systematic and judgmental abilities. There is more interaction 

between facilitators and participants than in the information strategy.

Alternatives - This strategy provides participation in activities that exclude alcohol and other 

drugs. The purpose is to meet the needs filled by alcohol and other drugs with healthy activities 

and to discourage the use of alcohol and drugs through these activities. 

Problem Identification and Referral - This strategy aims at identification of those who have 

indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have 

indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through 

education. It should be noted, however, that this strategy does not include any activity designed 

to determine if a person is in need of treatment.

Community-based Process - This strategy provides ongoing networking activities and technical 

assistance to community groups or agencies. It encompasses neighborhood-based, grassroots 

empowerment models using action planning and collaborative systems planning.

Environmental - This strategy establishes, or changes written and unwritten community 

standards, codes, and attitudes; thereby, influencing alcohol and other drug use by the general 

population. 

Other - States that plan their primary prevention expenditures using the IOM model of universal, 

selective, and indicated should use Table 5a to list their FFY 2024 and FFY 2025 SUPTRS BG

planned expenditures in each of these categories. 

Institute of Medicine Classification: Universal, Selective, and Indicated

Prevention strategies may be classified using the IOM Model of Universal, Selective, and 

Indicated, which classifies preventive interventions by the population prioritized. Definitions for 

these categories appear below:

Universal: Activities prioritized to the public or a whole population group that have not been 

identified based on individual risk. 

Universal Direct. Row 1: Interventions directly serve an identifiable group of participants but 

who have not been identified on the basis of individual risk (e.g., school curriculum, after-school 

program, parenting class). This also could include interventions involving interpersonal and 

ongoing/repeated contact (e.g., coalitions). 

Universal Indirect. Row 2: Interventions support population-based programs and environmental 

strategies (e.g., establishing policies regarding alcohol, tobacco, and other drugs (ATOD), 

modifying ATOD advertising practices). This also could include interventions involving 

programs and policies implemented by coalitions.

Selective: Activities prioritized to individuals or a subgroup of the population whose risk of 

developing a disorder is significantly higher than average. 

Indicated: Activities prioritized to individuals in high-risk environments, identified as having 

minimal but detectable signs or symptoms foreshadowing disorder or having biological markers 
Page | 42 

indicating predisposition for disorder but not meeting diagnostic levels (Adapted from The 

Institute of Medicine). 

States that are able to report on both the strategy type and the population served (universal, 

selective, or indicated) should do so. If planned expenditure information is only available by 

strategy type, then the state should report planned expenditures in the row titled Unspecified (for 

example, Information Dissemination Unspecified).

Section 1926 - Tobacco: Costs Associated with the Synar Program. Per January 19, 1996, 45 

CFR Part 96 Tobacco Regulation for Substance Use Prevention and Treatment Block Grants; 

Final Rule (45 CFR § 96.130), states may not use the Block Grant to fund the enforcement of 

their statute, except that they may expend funds from their primary prevention set aside of their 

Block Grant allotment under 45 CFR § 96.124(b)(1) for carrying out the administrative aspects 

of the requirements such as the development of the sample design and the conducting of the 

inspections. 

Public Law 116-94, signed on December 20, 2019, supersedes this legislation and increased the 

minimum age for tobacco sales from 18 to 21. SAMHSA revised its guidance to clarify that the 

prevention set-aside may be used to fund revisions to States’ Synar program to comply with PL 

116-94. These funds should be reported in the appropriate columns. 

Plan Table 5a: SUPTRS BG Primary Prevention Planned Expenditures

State Identifier:

Report Period- From: To:

A B C

Strategy IOM Target

FFY 2024 FFY 2025

SUPTRS 

BG

COVID-19 1 ARP 2 SUPTR

S BG

COVID19 1 ARP 2

1. Information 

Dissemination

Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

2. Education Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

3. Alternatives Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

4. Problem Identification 

and Referral

Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

5. Community-Based 

Processes

Universal $ $
Page | 43 

Plan Table 5a (cont.)

A B C

Strategy IOM Target

FFY 2024 FFY2025

SUPTRS 

BG

COVID-19 1 ARP 2 SUPTR

S BG

COVID19 1ARP 2

Selective $ $

Indicated $ $

Unspecified $ $

Total

6. Environmental Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

7. Section 1926 (Synar)-

Tobacco

Universal $ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

8. Other Universal

Direct

$ $

Universal 

Indirect

$ $

Selective $ $

Indicated $ $

Unspecified $ $

Total

9. Total Prevention 

Expenditures

$ $

Total Award 3 $ $

Planned Primary 

Prevention

Percentage

% %

1

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 

2021 – March 14, 2023, which is different from the expenditure period for the “standard” SUPTRS 

BG. If your state or territory has an approved No Cost Extension (NCE) for the FY 21 SUPTRS BG

COVID-19 Supplemental Funding, you have until March 14, 2024 to expend the COVID-19 Relief 

Supplemental Funds. Per the instructions, the standard SUPTRS BG expenditures are for the planned 

expenditure period of October 1, 2023 – September 30, 2025, for most states.

2

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is 

September 1, 2021 – September 1, 2025, which is different from the expenditure period for the 

“standard” SUPTRS BG. Per the instructions, the standard SUPTRS BG expenditures are for the 

planned expenditure period of October 1, 2023 – September 30, 2025. 

3 Total SUPTRS BG Award is populated from Table 4 - SUPTRS BG Planned Expenditures

Plan Table 5b: SUPTRS BG Planned Primary Prevention Priorities (Required) 

States should identify the categories of substances the state BG plans to target with primary 

prevention set-aside dollars from the FFY 2024 and FFY 2025 SUPTRS BG awards. 

Planning Period Start Date: 10/12023 

Planning Period End Date: 9/30/2025 
Page | 44 

SUPTRS BG Award COVID-19 Award1 ARP Award2

Prioritized Substances

Alcohol ☐ ☐ ☐

Tobacco ☐ ☐ ☐

Marijuana ☐ ☐ ☐

Prescription Drugs ☐ ☐ ☐

Cocaine ☐ ☐ ☐

Heroin ☐ ☐ ☐

Inhalants ☐ ☐ ☐

Methamphetamine ☐ ☐ ☐

Fentanyl ☐ ☐ ☐

Priority Populations

Students in College ☐ ☐ ☐

Military Families ☐ ☐ ☐

LGBTQI+ ☐ ☐ ☐

American Indian/Alaska

Native

☐ ☐ ☐

African American ☐ ☐ ☐

Hispanic ☐ ☐ ☐

Persons Experiencing 

Homelessness

☐ ☐ ☐

Native Hawaiian/Pacific

Islander

☐ ☐ ☐

Asian ☐ ☐ ☐

Rural ☐ ☐ ☐

Other Underserved Racial

and Ethnic Minorities

☐ ☐ ☐

1

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – 

March 14, 2023, which is different from the expenditure period for the “standard” SUPTRS BG. If your 

Footnotes:
Page | 45 

state or territory has an approved No Cost Extension (NCE) for the FY 21 SUPTRS BG COVID-19 

Supplemental Funding, you have until March 14, 2024 to expend the COVID-19 Relief Supplemental 

Funds. Per the instructions, the standard SUPTRS BG expenditures are for the planned expenditure period 

of October 1, 2023 – September 30, 2025, for most states.

2

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is 

September 1, 2021 – September 1, 2025, which is different from the expenditure period for the 

“standard” SUPTRS BG. Per the instructions, the standard SUPTRS BG expenditures are for the planned 

expenditure period of October 1, 2023 – September 30, 2025. 

Plan Table 6 

Categories for Expenditures for System Development/Non-Direct-Service Activities

Please note there are separate tables for MHBG and SUPTRS BG. Only complete this table if 

the state plans to fund expenditures for non-direct services/system development with MHBG,

SUPTRS BG, COVID-19, BSCA, and/or ARP dollars. 

Expenditures for these activities may be direct expenditures (involving the time of state or substate personnel, or other state or sub-state resources) or be through funding mechanisms with 

independent organizations. Expenditures may come from the administrative funds and/or 

program funds (but may not include the SUPTRS BG HIV set-aside funds). These include state, 

regional, and local personnel salaries prorated for time spent and operating costs such as travel, 

printing, advertising, and conducting meetings related to the categories below. 

Non-direct services/system development activities exclude expenditures through funding 

mechanisms for providing treatment or mental health or substance use disorder “direct service” 

and primary prevention efforts themselves. Instead, these expenditures provide support to those 

activities.

Please utilize the following categories to describe the types of expenditures your state supports 

with BG funds, and if the preponderance of the activity fits within a category. Although the 

states may use a different classification system, please use these categories to describe the types 

of expenditures your state supports with BG funds, when the preponderance of the activity fits 

within a category. 

Information systems – This includes collecting and analyzing treatment data as well as 

prevention data under the SUPTRS BG in order to monitor performance and outcomes. Costs 

for EHRs and other health information technology also fall under this category. 

Infrastructure Support – This includes activities that provide the infrastructure to support 

services but for which there are no individual services delivered. Examples include the 

development and maintenance of a crisis-response capacity, including hotlines, mobile crisis 

teams, web-based check-in groups (for medication, treatment, and re-entry follow-up), drop-in 

centers, and respite services.

Partnerships, community outreach, and needs assessment – This includes state, regional, and 

local personnel salaries prorated for time and materials to support planning meetings, 

information collection, analysis, and travel. It also includes the support for partnerships across 

state and local agencies, and tribal governments. Community/network development activities, 
Page | 46 

such as marketing, communication, and public education, and including the planning and 

coordination of services, fall into this category, as do needs-assessment projects to identify the 

scope and magnitude of the problem, resources available, gaps in services, and strategies to close 

those gaps. 

Planning Council Activities – This includes those supports for the performance of a Mental 

Health Planning Council under the MHBG, a combined Behavioral Health Planning Council, or 

(OPTIONAL) Advisory Council for the SUPTRS BG. 

Quality assurance and improvement - This includes activities to improve the overall quality of 

services, including those activities to assure conformity to acceptable professional standards, 

adaptation and review of implementation of evidence-based practices, identification of areas of 

technical assistance related to quality outcomes, including feedback. Administrative agency 

contracts to monitor service-provider quality fall into this category, as do independent peerreview activities.

Research and evaluation - This includes performance measurement, evaluation, and research, 

such as services research and demonstration projects to test feasibility and effectiveness of a new 

approach as well as the dissemination of such information. 

Training and education - This includes skill development and continuing education for 

personnel employed in local programs as well as partnering agencies, as long as the training 

relates to either substance use disorder service delivery (prevention, treatment and recovery) for 

SUPTRS BG and services to adults with SMI or children with SED for MHBG. Typical costs 

include course fees, tuition, and expense reimbursements to employees, trainer(s) and support 

staff salaries, and certification expenditures.
Page | 47 

Table 6a: Please enter the total amount of the MHBG, COVID-19, ARP funds, and BSCA funds expended for each activity

Non-Direct-Services/System Development

MHBG Table 6a

State Identifier:

MHBG Planning Period From: To:

Activity A. 

FY24Block 

Grant

B. FY24 

COVID Funds1

C. FY24ARP 

Funds2 

D.FY24

BSCA Funds3

E. FY25 

Block Grant

F. FY25 

COVID 

Funds1 

G. FY25ARP 

funds2 

H. FY25 

BSCA Funds3

1. Information Systems $ $ $ $ $ $

2. Infrastructure Support $ $ $ $ $ $

3. Partnerships, community outreach, and 

needs assessment

$ $ $ $ $ $

4. Planning Council Activities (MHBG 

required, SUPTRS BG optional)

$ $ $ $ $ $

5. Quality assurance and improvement $ $ $ $ $ $

6. Research and Evaluation $ $ $ $ $ $

7. Training and Education $ $ $ $ $ $

8. Total $ $ $ $ $ $

1

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is 

different from the expenditure period for the “standard” MHBG. Per the instructions, the standard MHBG expenditures captured in 

Columns A – G are for the state planned expenditure period of July 1, 2023 – June 30, 2025, for most states. Note: If your state has an 

approved no cost extension, you have until March 14, 2024 to expend the COVID-19 Relief supplemental funds.

2

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 

30, 2025, which is different from the expenditure period for the “standard” MHBG. Per the instructions, the standard MHBG 

expenditures captured in Columns A – G are for the state planned expenditure period of July 1, 2023 – June 30, 2025, for most states.” 

3

The expenditure period for the 1st allocation of Bipartisan Safer Communities Act (BSCA) supplemental funding is October 17, 2022 

thru October 16, 2024 and for the 2nd allocation will be September 30, 2023 thru September 29, 2025 which is different from the 

expenditure period for the “standard” MHBG. Column D should reflect the spending for the state reporting period. The total may 

reflect the BSCA allotment portion used during the state reporting period. 
Page | 48 

Table 6b: Please enter the total amount of the SUPTRS BG, COVID-19, or ARP funds to be expended for each activity. 

SUPTRS BG Table 6b

Non-Direct-Services/System Development

FFY 2024 FFY 2025

Activity A. 

SUPTRS 

BG

Treatment 

B. 

SUPTRS 

BG

Prevention

C. SUPTRS 

BG

Integrated1

D. COVID19 2 E. ARP 3 A. SUPTRS 

BG

Treatment

B. SUPTRS 

BG

Prevention

C. SUPTRS 

BG

Integrated1 

D. COVID19 2 E. ARP 3

1. Information 

Systems

2. Infrastructure 

Support

3. Partnerships, 

community 

outreach, and 

needs 

assessment

4. Planning 

Council 

Activities 

(MHBG 

required, 

SUPTRS BG

optional)

5. Quality 

assurance 

and 

improvement

6. Research and 

Evaluation

7. Training and 

Education

8. Total $ $ $ $ $ $ $ $ $ $
Page | 49

1

Integrated refers to non-direct service/system development expenditures that support both treatment and prevention systems of care. 

2

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 - March 14, 2023, which is 

different from the expenditure period for the "standard" SUPTRS BG and MHBG. If your state or territory has an approved No Cost 

Extension (NCE) for the FY 21 SABG COVID-19 Supplemental Funding, you have until March 14, 2024 to expend the COVID-19 

Relief Supplemental Funds. Per the instructions, the standard SUPTRS BG expenditures are for the federal planned expenditure period 

of October 1, 2023 - September 30, 2025. Please list COVID-19 planned expenditures for each standard FFY period.

3

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 

30, 2025, which is different from the expenditure period for the "standard" SUPTRS BG. Per the instructions, the standard SUPTRS 

BG expenditures are for the federal planned expenditure period of October 1, 2023 - September 30, 2025. Please list ARP planned 

expenditures for each standard FFY period.
Page | 50 

C. Environmental Factors and Plan 

1. Access to Care, Integration, and Care Coordination – Required

Across the United States, significant percentages of adults with serious mental illness, children 

and youth with serious emotional disturbances, and people with substance use disorders do not 

access needed behavioral health care. States should focus on improving the range and quality of 

available services and on improving the rate at which individuals who need care access it. States 

have a number of opportunities to improve access, including improving capacity to identify and 

address behavioral needs in primary care, increasing outreach and screening in a variety of 

community settings, building behavioral health workforce and service system capacity, and 

efforts to improve public awareness around the importance of behavioral health. When 

considering access to care, states should examine whether people are connected to services, and 

whether they are receiving the range of needed treatment and supports. 

A venue for states to advance access to care is by ensuring that protections afforded by MHPAEA 

are being adhered to in private and public sector health plans, and that providers and people 

receiving services are aware of parity protections. SSAs and SMHAs can partner with their state 

departments of insurance and Medicaid agencies to support parity enforcement efforts and to 

boost awareness around parity protections within the behavioral health field. The following 

resources may be helpful: https://store.samhsa.gov/product/essential-aspects-of-parity-trainingtool-for-policymakers/pep21-05-00-001; https://store.samhsa.gov/product/Approaches-inImplementing-the-Mental-Health-Parity-and-Addiction-Equity-Act-Best-Practices-from-theStates/SMA16-4983. The integration of primary and behavioral health care remains a priority 

across the country to ensure that people receive care that addresses their mental health, substance 

use, and physical health problems. People with mental illness and/or substance use disorders are 

likely to die earlier than those who do not have these conditions.37 Ensuring access to physical 

and behavioral health care is important to address the physical health disparities they experience 

and to ensure that they receive needed behavioral health care. States should support integrated 

care delivery in specialty behavioral health care settings as well as primary care settings. States 

have a number of options to finance the integration of primary and behavioral health care, 

including programs supported through Medicaid managed care, Medicaid health homes, 

specialized plans for individuals who are dually eligible for Medicaid and Medicare, and 

prioritized initiatives through the mental health and substance use block grants or general funds. 

States may also work to advance specific models shown to improve care in primary care settings, 

including Primary Care Medical Homes; the Coordinated Care Model; and Screening, Brief 

Intervention, and Referral to Treatment.

Navigating behavioral health, physical health, and other support systems is complicated and many 

individuals and families require care coordination to ensure that they receive necessary supports 

in and efficient and effective manner. States should develop systems that vary the intensity of care 

coordination support based on the severity seriousness and complexity of individual need. States 

also need to consider different models of care coordination for different groups, such as HighFidelity Wraparound and Systems of Care when working with children, youth, and families; 

37 Druss, B. G., Zhao, L., Von Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011). Understanding excess mortality in persons with mental 

illness: 17-year follow up of a nationally representative US survey. Medical care, 599-604.Avaiable at: https://journals.lww.com/lwwmedicalcare/Fulltext/2011/06000/Understanding_Excess_Mortality_in_Persons_With.11.aspx
Page | 51 

providing Assertive Community Treatment to people with serious mental illness who are at a high 

risk of institutional placement; and connecting people in recovery from substance use disorders 

with a range of recovery supports. States should also provide the care coordination necessary to 

connect people with mental and substance use disorders to needed supports in areas like 

education, employment, and housing. 

1. Describe your state’s efforts to improve access to care for mental disorders, substance use 

disorders, and co-occurring disorders, including detail on efforts to increase access to services 

for: 

a) Adults with serious mental illness

b) Pregnant women with substance use disorders

c) Women with substance use disorders who have dependent children 

d) Persons who inject drugs 

e) Persons with substance use disorders who have, or are at risk for, HIV or TB

f) Persons with substance use disorders in the justice system

g) Persons using substances who are at risk for overdose or suicide

h) Other adults with substance use disorders 

i) Children and youth with serious emotional disturbances or substance use disorders 

j) Individuals with co-occurring mental and substance use disorders 

2. Describe your efforts, alone or in partnership with your state’s department of insurance and/or 

Medicaid system, to advance parity enforcement and increase awareness of parity protections 

among the public and across the behavioral and general health care fields. 

3. Describe how the state supports integrated behavioral health and primary health care, including 

services forindividuals with mental disorders, substance use disorders, and co-occurring 

mental and substance use disorders. Include detail about: 

a) Access to behavioral health care facilitated through primary care providers 

b) Efforts to improve behavioral health care provided by primary care providers 

c) Efforts to integrate primary care into behavioral health settings

4. Describe how the state provides care coordination, including detail about how care 

coordination is funded and how care coordination models provided by the state vary based on 

the seriousness and complexity of individual behavioral health needs. Describe care 

coordination available to: 
Page | 52 

a) Adults with serious mental illness

b) Adults with substance use disorders 

c) Children and youth with serious emotional disturbances or substance use disorders 

5. Describe how the state supports the provision of integrated services and supports for 

individuals with co-occurring mental and substance use disorders, including screening and 

assessment for co-occurring disorders and integrated treatment that addresses substance use 

disorders as well as mental disorders. Please describe how this system differs for youth and 

adults. 

6. Please indicate areas of technical assistance needed related to this section.

2. Health Disparities - Required 

In accordance with Advancing Racial Equity and Support for Underserved Communities 

Through the Federal Government (Executive Order 13985), Advancing Equality for Lesbian, 

Gay, Bisexual, Transgender, Queer, and Intersex Individuals (Executive Order 14075), the HHS 

Action Plan to Reduce Racial and Ethnic Health Disparities38, Healthy People, 202039, National 

Stakeholder Strategy for Achieving Health Equity40, and other HHS and federal policy 

recommendations, SAMHSA expects block grant dollars to support equity in access, services 

provided, and M/SUD outcomes among individuals of all cultures, sexual orientations, gender 

identities, races, and ethnicities. Accordingly, grantees should collect and use data to: (1) 

identify subpopulations (e.g., racial, ethnic, limited English speaking, tribal, sexual/gender 

minority groups, etc.) vulnerable to health disparities and (2) implement strategies to decrease

the disparities in access, service use, and outcomes both within those subpopulations and in 

comparison to the general population. One strategy for addressing health disparities is use of the

Behavioral Health Implementation Guide for the National Standards for Culturally and 

Linguistically Appropriate Services in Health and Health Care (CLAS).41

Collecting appropriate data are a critical part of efforts to reduce health disparities and 

promote equity. In October 2011, HHS issued final standards on the collection of race, 

38 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 39 http://www.healthypeople.gov/2020/default.aspx 40https://www.minorityhealth.hhs.gov/npa/files/Plans/NSS/NSS_07_Section3.pdf

41 http://www.ThinkCulturalHealth.hhs.gov
Page | 53 

ethnicity, primary language, and disability status.42 This guidance conforms to the existing

Office of Management and Budget (OMB) directive on racial/ethnic categories with the

expansion of intra-group, detailed data for the Latino and the Asian-American/Pacific Islander 

populations.43 In addition, SAMHSA and all other HHS agencies have updated their limited 

English proficiency plans and, accordingly, will expect block grant dollars to support a

reduction in disparities related to access, service use, and outcomes that are associated with 

limited English proficiency. These three departmental initiatives, along with SAMHSA’s and 

HHS’s attention to special service needs and disparities within tribal populations, LGBTQI+

populations, and women and girls, provide the foundation for addressing health disparities in 

the service delivery system. States provide M/SUD services to these individuals with state

block grant dollars. While the block grant generally requires the use of evidence-based and 

promising practices, it is important to note that many of these practices have not been normed 

on various diverse racial and ethnic populations. States should strive to implement evidencebased and promising practices in a manner that meets the needs of the populations they serve. 

In the block grant application, states define the populations they intend to serve. Within these

populations of focus are subpopulations that may have disparate access to, use of, or outcomes 

from provided services. These disparities may be the result of differences in insurance coverage, 

language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation. For 

instance, lack of Spanish primary care services may contribute to a heightened risk for metabolic 

disorders among Latino adults with SMI; and American Indian/Alaska Native youth may have an 

increased incidence of underage binge drinking due to coping patterns related to historical trauma

within the American Indian/Alaska Native community. In addition, LGBTQI+ individuals are at 

higher risk for suicidality due to discrimination, mistreatment, and stigmatization in society. 

While these factors might not be pervasive among the general population served by the block 

grant, they may be predominant among subpopulations or groups vulnerable to disparities.

To address and ultimately reduce disparities, it is important for states to have a detailed 

understanding of who is and is not being served within the community, including in what 

languages, in order to implement appropriate outreach and engagement strategies for diverse

populations. The types of services provided, retention in services, and outcomes are critical 

measures of quality and outcomes of care for diverse groups. For states to address the potentially 

disparate impact of their block grant funded efforts, they will address access, use, and outcomes 

for subpopulations. 

Please respond to the following items: 

1) Does the state track access or enrollment in services, types of services received and outcomes 

of these services by: race, ethnicity, gender, sexual orientation, and age? 

a) race ☐Yes ☐ No

b) ethnicity ☐Yes ☐ No

c) gender ☐ Yes ☐ No

42 https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-languageand-disability-status 43 : https://www.whitehouse.gov/wp-content/uploads/2017/11/Revisions-to-the-Standards-for-the-Classification-ofFederal-Data-on-Race-and-Ethnicity-October30-1997.pdf
Page | 54 

d) sexual orientation ☐ Yes ☐ No

e) gender identity ☐ Yes ☐ No

f) age ☐ Yes ☐ No

2) Does the state have a data-driven plan to address and reduce disparities in access, service use, 

and outcomes for the above subpopulation? ☐ Yes ☐ No

3) Does the state have a plan to identify, address, and monitor linguistic disparities/language 

barriers? ☐ Yes ☐ No

4) Does the state have a workforce-training plan to build the capacity of M/SUD providers to 

identify disparities in access, services received, and outcomes and provide support for 

improved culturally and linguistically competent outreach, engagement, prevention, treatment,

and recovery services for diverse populations? ☐ Yes ☐ No

5) If yes, does this plan include the Culturally and Linguistically Appropriate Services (CLAS) 

Standards? ☐ Yes ☐ No

6) Does the state have a budget item allocated to identifying and remediating disparities in 

M/SUD care? ☐ Yes ☐ No

7) Does the state have any activities related to this section that you would like to highlight?

8) Please indicate areas of technical assistance needed related to this section.

3. Innovation in Purchasing Decisions - Requested

While there are different ways to define value-based purchasing, its purpose is to identify 

services, payment arrangements, incentives, and players that can be included in directed strategies 

using purchasing practices that are aimed at improving the value of health care services. In short, 

health care value is a function of both cost and quality: 

Health Care Value = Quality ÷ Cost, (V = Q ÷ C)

SAMHSA anticipates that the movement toward value-based purchasing will continue as delivery 

system reforms continue to shape states systems. The identification and replication of such valuebased strategies and structures will be important to the development of M/SUD systems and 

services. The National Center of Excellence for Integrated Health Solutions44offers technical 

assistance and resources on value-based purchasing models including capitation, shared-savings, 

bundled payments, pay for performance, and incentivizing outcomes.

There is increased interest in having a better understanding of the evidence that supports the

44 https://www.thenationalcouncil.org/program/center-of-excellence/ 
Page | 55

delivery of medical and specialty care including M/SUD services. Over the past several years, 

SAMHSA has collaborated with CMS, HRSA, SMAs, state M/SUD authorities, legislators, and 

others regarding the evidence for the efficacy and value of various mental and substance use

prevention, SUD treatment, and recovery support services. States and other purchasers are

requesting information on evidence-based practices or other procedures that result in better health 

outcomes for individuals and the general population. While the emphasis on evidence-based 

practices will continue, there is a need to develop and create new interventions and technologies 

and in turn, to establish the evidence. SAMHSA supports states’ use of the block grants for this 

purpose. The NQF and the IOM/NASEM recommend that evidence play a critical role in 

designing health benefits for individuals enrolled in commercial insurance, Medicaid, and

Medicare.

To respond to these inquiries and recommendations, SAMHSA has undertaken several activities. 

SAMHSA’s Evidence Based Practices Resource Center (EBPRC) assesses the research 

evaluating an intervention's impact on outcomes and provides information on available resources 

to facilitate the effective dissemination and implementation of the program. SAMHSA’s EBPRC 

provides the information & tools needed to incorporate evidence-based practices into 

communities or clinical settings.

SAMHSA reviewed and analyzed the current evidence for a wide range of interventions used with 

individuals with mental illness and substance use disorders, including youth and adults with 

substance use disorders, adults with SMI, and children and youth with SED. The 

recommendations build on the evidence and consensus standards that have been developed in 

many national reports over the last decade or more. These include reports by the Surgeon 

General,

45 The New Freedom Commission on Mental Health,46 the IOM,￼ NQF, and the 

Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).

47 

One activity of the EBPRC48 was a systematic assessment of the current research findings for the 

effectiveness of the services using a strict set of evidentiary standards. This series of assessments 

was published in “Psychiatry Online.”49 SAMHSA and other HHS federal partners, including the 

Administration for Children and Families, Office for Civil Rights, and CMS, have used this 

information to sponsor technical expert panels that provide specific recommendations to the

M/SUD field regarding what the evidence indicates works and for whom, to identify specific 

strategies for embedding these practices in provider organizations, and to recommend additional 

service research.

In addition to evidence-based practices, there are also many innovative and promising

practices in various stages of development. Anecdotal evidence and program data indicate 

effectiveness for these services. As these practices continue to be evaluated, evidence is 

45 United States Public Health Service Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. 

Rockville, MD: Department of Health and Human Services, U.S. Public Health Service 46 The President’s New Freedom Commission on Mental Health (July 2003). Achieving the Promise: Transforming Mental 

Health Care in America. Rockville, MD: Department of Health and Human Services, Substance use disorder and Mental 

Health Services Administration. 47 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use 

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. 48 https://www.samhsa.gov/ebp-resource-center/about 49http://psychiatryonline.org/
Page | 56 

collected to determine their efficacy and develop a more detailed understanding of for who and 

in what circumstances they are most effective.

SAMHSA’s Treatment Improvement Protocol Series (TIPS)

50 are best practice guidelines for 

SUD treatment. SAMHSA draws on the experience and knowledge of clinical, research, and 

administrative experts to produce the TIPS, which are distributed to a growing number of facilities 

and individuals across the country. The audience for the TIPS is expanding beyond public and 

private SUD treatment facilities as alcohol and other drug disorders are increasingly recognized as 

a major health problem.

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)

51 was

developed to help move the latest information available on effective M/SUD practices into 

community-based service delivery. States, communities, administrators, practitioners, consumers 

of mental health care, and their family members can use KIT to design and implement M/SUD

practices that work. Each KIT covers getting started, building the program, training frontline staff, 

and evaluating the program. The KITs contain information sheets, introductory videos, practice 

demonstration videos, and training manuals. Each KIT outlines the essential components of the

evidence-based practice and provides suggestions collected from those who have successfully 

implemented them.

SAMHSA is interested in whether and how states are using evidence in their purchasing 

decisions, for educating policymakers, or supporting providers to offer high quality services. In 

addition, SAMHSA is interested with what additional information is needed by SMHAs and SSAs 

to support their and other purchasers’ decisions regarding value-based purchase of M/SUD 

services. Please respond to the following items:

1. Is information used regarding evidence-based or promising practices in your purchasing or 

policy decisions? ☐ Yes ☐ No

2. Which value-based purchasing strategies do you use in your state? (check all that apply):

a) ☐ Leadership support, including investment of human and financial resources. 

b) ☐ Use of available and credible data to identify better quality and monitored the impact of 

quality improvement interventions.

c) ☐ Use of financial and non-financial incentives for providers or consumers.

d) ☐ Provider involvement in planning value-based purchasing.

e) ☐ Use of accurate and reliable measures of quality in payment arrangements.

f) ☐ Quality measures focus on consumer outcomes rather than care processes.

g) ☐ Involvement in CMS or commercial insurance value-based purchasing programs 

(health homes, ACO, all payer/global payments, pay for performance (P4P)). 

h) ☐ The state has an evaluation plan to assess the impact of its purchasing decisions.

50 http://store.samhsa.gov 51 https://store.samhsa.gov/?f%5B0%5D=series%3A5558 
Page | 57 

3. Does the state have any activities related to this section that you would like to highlight? 

4. Please indicate areas of technical assistance needed related to this section.

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness 

(ESMI)-10 percent set aside - Required for MHBG

Much of the mental health treatment and recovery service efforts are focused on the later stages of 

illness, intervening only when things have reached the level of a crisis. While this kind of 

treatment is critical, it is also costly in terms of increased financial burdens for public mental 

health systems, lost economic productivity, and the toll taken on individuals and families. There 

are growing concerns among individuals and family members that the mental health system needs 

to do more when people first experience these conditions to prevent long-term adverse 

consequences. Early intervention* is critical to treating mental illness before it can cause tragic 

results like serious impairment, unemployment, homelessness, poverty, and suicide. The duration 

of untreated mental illness, defined as the time interval between the onset of a mental disorder and 

when an individual gets into treatment, has been a predictor of outcomes across different mental 

illnesses. Evidence indicates that a prolonged duration of untreated mental illness may be viewed 

as a negative prognostic factor for those who are diagnosed with mental illness. Earlier treatment 

and interventions not only reduce acute symptoms but may also improve long-term prognosis. 

SAMHSA’s working definition of an Early Serious Mental Illness is “An early serious mental 

illness or ESMI is a condition that affects an individual regardless of their age and that is a 

diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic 

criteria specified within DSM-5 (APA, 2013). For a significant portion of the time since the onset 

of the disturbance, the individual has not achieved or is at risk for not achieving the expected 

level of interpersonal, academic or occupational functioning. This definition is not intended to 

include conditions that are attributable to the physiologic effects of a substance use disorder, are 

attributable to an intellectual/developmental disorder or are attributable to another medical 

condition. The term ESMI is intended for the initial period of onset.” 

States may implement models that have demonstrated efficacy, including the range of services 

and principles identified by National Institute of Mental Health (NIMH) via its Recovery After an 

Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the 

amount of investment, and by leveraging funds through inclusion of services reimbursed by 

Medicaid or private insurance, states should move their system to address the needs of individuals 

with a first episode of psychosis (FEP). RAISE was a set of NIMH sponsored studies beginning 

in 2008, focusing on the early identification and provision of evidence-based treatments to 

persons experiencing FEP. The NIMH RAISE studies, as well as similar early intervention 
Page | 58 

programs tested worldwide, consist of multiple evidence-based treatment components used in 

tandem as part of a Coordinated Specialty Care (CSC) model, and have been shown to improve 

symptoms, reduce relapse, and lead to better outcomes. 

States shall expend not less than 10 percent of the MHBG amount the State receives for carrying 

out this section for each fiscal year to support evidence-based programs that address the needs of 

individuals early serious mental illness, including psychotic disorders, regardless of the age of the 

individual at onset. In lieu of expending 10 percent of the amount the State receives under this 

section for a fiscal year as required a state may elect to expend not less than 20 percent of such 

amount by the end of such succeeding fiscal year. 

* MHBG funds cannot be used for primary prevention activities. States cannot use MHBG funds 

for prodromal symptoms (specific group of symptoms that may precede the onset and diagnosis 

of a mental illness) and/or those who are not diagnosed with an SMI. 

1. Please name the model(s) that the state implemented including the number of programs for 

each model for those with ESMI using MHBG funds. 

Model(s)/EBP(s) for SMI/FEP Number of programs

2. Please provide the total budget/planned expenditure for ESMI/FEP for FY 24 and FY 25 (only 

include MHBG funds).

FY2024 FY 2025

3. Please describe the status of billing Medicaid or other insurances for ESMI/FEP services? 

How are components of the model currently being billed? Please explain. 

4. Please provide a description of the programs that the state funds to implement evidence-based 

practices for those with ESMI/FEP.

5. Does the state monitor fidelity of the chosen EBP(s)? ☐ Yes ☐ No

6. Does the state provide trainings to increase capacity of providers to deliver interventions 

related to ESMI/FEP? ☐ Yes ☐ No
Page | 59 

7. Explain how programs increase access to essential services and improve client outcomes for 

those with an ESMI/FEP? 

8. Please describe the planned activities in FY2024 and FY2025 for your state’s ESMI/FEP

programs. 

9. Please list the diagnostic categories identified for your state’s ESMI/FEP programs. 

10. What is the estimated incidence of individuals with a first episode psychosis in the state?

11. What is the state’s plan to outreach and engage those with a first episode psychosis who need 

support from the public mental health system?

12. Please indicate area of technical assistance needed related to this section. 

5. Person Centered Planning (PCP) –Required for MHBG 

States must engage adults with a serious mental illness or children with a serious emotional 

disturbance and their caregivers where appropriate in making health care decisions, including 

activities that enhance communication among individuals, families, caregivers, and treatment 

providers. Person-centered planning is a process through which individuals develop their plan of 

service. The PCP may include a representative who the person has freely chosen, and/or who is 

authorized to make personal or health decisions for the person. The PCP team may include 

family members, legal guardians, friends, caregivers, and others that the person or his/her 

representative wishes to include. The PCP should involve the person receiving services and 

supports to the maximum extent possible, even if the person has a legal representative. The PCP 
Page | 60 

approach identifies the person’s strengths, goals, preferences, needs and desired outcome. The 

role of state and agency workers (for example, options counselors, support brokers, social 

workers, peer support workers, and others) in the PCP process is to enable and assist people to 

identify and access a unique mix of paid and unpaid services to meet their needs and provide 

support during planning. The person’s goals and preferences in areas such as recreation, 

transportation, friendships, therapies, home, employment, education, family relationships, and 

treatments are part of a written plan that is consistent with the person’s needs and desires.

In addition to adopting PCP at the service level, for PCP to be fully implemented it is important 

for states to develop systems which incorporate the concepts throughout all levels of the mental 

health network. Resources for assessing and developing PCP systems can be found at the National 

Center on Advancing Person-Centered Practices and Systems https://ncapps.acl.gov/home.html

with a systems assessment at https://ncapps.acl.gov/docs/NCAPPS_SelfAssessment_201030.pdf. 

1. Does your state have policies related to person centered planning? ☐ Yes ☐ No

2. If no, describe any action steps planned by the state in developing PCP initiatives in the

future.

3. Describe how the state engages consumers and their caregivers in making health care

decisions and enhances communication.

4. Describe the person-centered planning process in your state.

5. What methods does the SMHA use to encourage people who use the public mental health

system to develop Psychiatric Advance Directives (for example, through resources such as

SAMHSA’s A Practical Guide to Psychiatric Advance Directives)?

6. Please indicate areas of technical assistance needed related to this section.
Page | 61 

SAMHSA has a strong emphasis on ensuring that block grant funds are expended in a manner 

consistent with the statutory and regulatory framework. This requires that SAMHSA and the 

states have a strong approach to assuring program integrity. Currently, the primary goals of 

SAMHSA program integrity efforts are to promote the proper expenditure of block grant funds, 

improve block grant program compliance nationally, and demonstrate the effective use of block 

grant funds. 

While some states have indicated an interest in using block grant funds for individual co-pays 

deductibles and other types of co-insurance for M/SUD services, SAMHSA reminds states of 

restrictions on the use of block grant funds outlined in 42 U.S.C. §§ 300x–5 and 300x-31, 

including cash payments to intended recipients of health services and providing financial 

assistance to any entity other than a public or nonprofit private entity. Under 42 U.S.C. § 300x–

55(g), SAMHSA periodically conducts site visits to MHBG and SUPTRS BG grantees to 

evaluate program and fiscal management. States will need to develop specific policies and 

procedures for assuring compliance with the funding requirements. Since MHBG funds can only 

be used for authorized services made available to adults with SMI and children with SED and 

SUPTRS BG funds can only be used for individuals with or at risk for SUD. SAMHSA guidance 

on the use of block grant funding for co-pays, deductibles, and premiums can be found at: 

http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-cost-sharingassistance-for-private-health-insurance.pdf. States are encouraged to review the guidance and 

request any needed technical assistance to assure the appropriate use of such funds.

The MHBG and SUPTRS BG resources are to be used to support, not supplant, services that will 

be covered through the private and public insurance. In addition, SAMHSA will work with CMS 

and states to identify strategies for sharing data, protocols, and information to assist our program 

integrity efforts. Data collection, analysis, and reporting will help to ensure that MHBG and 

SUPTRS BG funds are allocated to support evidence-based, culturally competent programs,

substance use primary prevention, treatment and recovery programs, and activities for adults with 

SMI and children with SED. 

States traditionally have employed a variety of strategies to procure and pay for M/SUD services 

funded by the MHBG and SUPTRS BG. State systems for procurement, contract management, 

financial reporting, and audit vary significantly. These strategies may include: (1) appropriately 

directing complaints and appeals requests to ensure that QHPs and Medicaid programs are 

including essential health benefits (EHBs) as per the state benchmark plan; (2) ensuring that 

individuals are aware of the covered M/SUD benefits; (3) ensuring that consumers of M/SUD 

services have full confidence in the confidentiality of their medical information; and (4)

monitoring the use of M/SUD benefits in light of utilization review, medical necessity, etc. 

Consequently, states may have to become more proactive in ensuring that state-funded providers 

are enrolled in the Medicaid program and have the ability to determine if clients are enrolled or

eligible to enroll in Medicaid. Additionally, compliance review and audit protocols may need to 

be revised to provide for increased tests of client eligibility and enrollment.

Please respond to the following: 

1) Does the state have a specific policy and/or procedure for assuring that the federal program

requirements are conveyed to intermediaries and providers? ☐ Yes ☐ No

6. Program Integrity - Required
Page | 62 

2) Does the state provide technical assistance to providers in adopting practices that promote 

compliance with program requirements, including quality and safety standards? ☐ Yes ☐ No

3) Does the state have any activities related to this section that you would like to highlight?

4) Please indicate areas of technical assistance needed related to this section. 

7. Tribes – Requested

The federal government has a unique obligation to help improve the health of American Indians 

and Alaska Natives through the various health and human services programs administered by 

HHS. Treaties, federal legislation, regulations, executive orders, and Presidential memoranda 

support and define the relationship of the federal government with federally recognized tribes, 

which is derived from the political and legal relationship that Indian tribes have with the federal 

government and is not based upon race. SAMHSA is required by the 2009 Memorandum on 

Tribal Consultation52 to submit plans on how it will engage in regular and meaningful 

consultation and collaboration with tribal officials in the development of federal policies that have 

tribal implications. 

Improving the health and well-being of tribal nations is contingent upon understanding their

specific needs. Tribal consultation is an essential tool in achieving that understanding. 

Consultation is an enhanced form of communication, which emphasizes trust, respect, and shared 

responsibility. It is an open and free exchange of information and opinion among parties, which 

leads to mutual understanding and comprehension. Consultation is integral to a deliberative

process that results in effective collaboration and informed decision-making with the ultimate goal 

of reaching consensus on issues. 

In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a 

government-to-government interaction and should be distinguished from input provided by 

individual tribal members or services provided for tribal members whether on or off tribal lands. 

Therefore, the interaction should be attended by elected officials of the tribe or their designees and 

by the highest possible state officials. As states administer health and human services programs 

that are supported with federal funding, it is imperative that they consult with tribes to ensure the 

programs meet the needs of the tribes in the state. In addition to general stakeholder consultation, 

states should establish, implement, and document a process for consultation with the federally 

recognized tribal governments located within or governing tribal lands within their borders to 

solicit their input during the block grant planning process. Evidence that these actions have been 

performed by the state should be reflected throughout the state’s plan. Additionally, it is 

important to note that approximately 70 percent of American Indians and Alaska Natives do not 

live on tribal lands. The SMHAs, SSAs, and tribes should collaborate to ensure access and 

52

https://www.energy.gov/sites/prod/files/Presidential%20Memorandum%20Tribal%20Consultation%20%282009%29

.pdf
Page | 63 

culturally competent care for all American Indians and Alaska Natives in the states.

States shall not require any tribe to waive its sovereign immunity in order to receive funds or for 

services to be provided for tribal members on tribal lands. If a state does not have any federally 

recognized tribal governments or tribal lands within its borders, the state should make a 

declarative statement to that effect. 

Please respond to the following items:

1. How many consultation sessions have the state conducted with federally recognized tribes?

2. What specific concerns were raised during the consultation session(s) noted above? 

3. Does the state have any activities related to this section that you would like to highlight?

4. Please indicate areas of technical assistance needed related to this section.

8. Primary Prevention-Required, SUPTRS BG only

SUPTRS BG statute requires states to spend not less than 20 percent of their SUPTRS BG

allotment on primary prevention strategies directed at individuals who do not meet diagnostic 

criteria for a substance use disorder and are identified not to be in need of treatment. While 

primary prevention set-aside funds must be used to fund strategies that have a positive impact on 

the prevention of substance use, it is important to note that many evidence-based substance use 

primary prevention strategies also have a positive impact on other health and social outcomes 

such as education, juvenile justice involvement, violence prevention, and mental health.

The SUPTRS BG statute requires states to develop a comprehensive primary prevention program 

that includes activities and services provided in a variety of settings. The program must target 

both the general population and sub-groups that are at high risk for substance misuse. The 

program must include, but is not limited to, the following strategies:

1. Information dissemination providing awareness and knowledge of the nature, extent, and 

effects of alcohol, tobacco, and drug use, misuse and addiction on individuals families and 

communities.

2. Education aimed at affecting critical life and social skills, such as decision making, refusal 
Page | 64 

skills, critical analysis, and systematic judgment abilities;

3. Alternative programs that provide for the participation of target populations in activities 

that exclude alcohol, tobacco, and other drug use; 

4. Problem identification and Referral, that aims at identification of those who have indulged 

in illegal/age inappropriate use of tobacco or alcohol, and those individuals who have 

indulged in first use of illicit drugs, in order to assess if the behavior can be reversed by 

education to prevent further use; 

5. Community-based processes that include organizing, planning, and enhancing effectiveness 

of program, policy, and practice implementation, interagency collaboration, coalition 

building, and networking; and 

6. Environmental strategies that establish or change written and unwritten community 

standards, codes, and attitudes, thereby influencing incidence and prevalence of the abuse of 

alcohol, tobacco, and other drugs used in the general population. 

In implementing the comprehensive primary prevention program, states should use a variety of 

strategies that target populations with different levels of risk, including the IOM classified 

universal, selective, and indicated strategies.

Please respond to the following questions: 

Assessment

1. Does your state have an active State Epidemiological and Outcomes Workgroup (SEOW)? 

a) ☐ Yes ☐ No

2. Does your state collect the following types of data as part of its primary prevention needs 

assessment process? (check all that apply):

a) ☐ Data on consequences of substance-using behaviors 

b) ☐ Substance-using behaviors 

c) ☐ Intervening variables (including risk and protective factors) 

d) ☐ Other (please list) 

3. Does your state collect needs assessment data that include analysis of primary prevention 

needs for the following population groups? (check all that apply):

a) ☐ Children (under age 12) 

b) ☐ Youth (ages 12-17) 

c) ☐ Young adults/college age (ages 18-26) 

d) ☐ Adults (ages 27-54) 

e) ☐ Older adults (age 55 and above) 

f) ☐ Cultural/ethnic minorities

g) ☐ Sexual/gender minorities 

h) ☐ Rural communities
Page | 65 

i) ☐ Other (please list) 

4. Does your state use data from the following sources in its primary prevention needs 

assessment? (check all that apply):

a) ☐ Archival indicators (Please list) 

b) ☐ National Survey on Drug Use and Health (NSDUH) 

c) ☐ Behavioral Risk Factor Surveillance System (BRFSS)

d) ☐ Youth Risk Behavior Surveillance System (YRBS) 

e) ☐ Monitoring the Future 

f) ☐ Communities that Care

g) ☐ State-developed survey instrument) 

h) ☐ Other (please list) 

5. Does your state use needs assessment data to make decisions about the allocation of SUPTRS 

BG primary prevention funds? 

a) ☐ Yes ☐ No

i) If yes, (please explain in the box below) 

ii) If no, please explain how SUPTRS BG funds are allocated:

6. Does your state integrate National CLAS Standards53 into the assessment step?

a) ☐ Yes ☐ No

53 https://thinkculturalhealth.hhs.gov/clas
Page | 66 

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

7. Does your state integrate sustainability into the assessment step?

a) ☐Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Capacity Building

1. Does your state have a statewide licensing or certification program for the substance use 

primary preventionworkforce?

a) ☐ Yes (if yes, please describe) 

b) ☐ No

2. Does your state have a formal mechanism to provide training and technical assistance to the

substance use primary prevention workforce?

a) ☐ Yes (if yes, please describe mechanism used) 

b) ☐ No

3. Does your state have a formal mechanism to assess community readiness to implement 

prevention strategies?

a) ☐ Yes (if yes, please describe mechanism used) 

b) ☐ No
Page | 67 

4. Does your state integrate the National CLAS Standards into the capacity building step?

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

5. Does your state integrate sustainability into the capacity building step?

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Planning

1. Does your state have a strategic plan that addresses substance use primary prevention that was 

developed within the last five years? 

a) ☐ Yes (If yes, please attach the plan in WebBGAS)

b) ☐ No

2. Does your state use the strategic plan to make decisions about use of the primary prevention 

set-aside of the SUPTRS BG? 

a) ☐ Yes ☐ No

☐ Not applicable (no prevention strategic plan) 

3. Does your state’s prevention strategic plan include the following components? (check all that 

apply): 

a) ☐ Based on needs assessment datasets the priorities that guide the allocation of SUPTRS 

BG primary prevention funds

b) ☐ Timelines

c) ☐ Roles and responsibilities

d) ☐ Process indicators

e) ☐ Outcome indicators

f) ☐ Cultural competence component (i.e., National CLAS Standards) 

g) ☐ Sustainability component 

h) ☐ Other (please list) 
Page | 68 

i) ☐ Not applicable/no prevention strategic plan 

4. Does your state have an Advisory Council that provides input into decisions about the use of 

SUPTRS BG primary prevention funds? 

a) ☐ Yes ☐ No

5. Does your state have an active Evidence-Based Workgroup that makes decisions about 

appropriate strategies to be implemented with SUPTRS BG primary prevention funds? 

a) ☐ Yes ☐ No

b) If yes, please describe the criteria the Evidence-Based Workgroup uses to determine 

which programs, policies, and strategies are evidence based? 

6. Does your state integrate the National CLAS Standards into the planning step? 

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

7. Does your state integrate sustainability into the planning step? 

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Implementation

1. States distribute SUPTRS BG primary prevention funds in a variety of different ways. Please 

check all that apply to your state: 

a) ☐ SSA staff directly implements primary prevention programs and strategies.

b) ☐ The SSA has statewide contracts (e.g., statewide needs assessment contract, statewide 

workforce training contract, statewide media campaign contract).
Page | 69 

c) ☐ The SSA funds regional entities that are autonomous in that they issue and manage 

their own sub-contracts.

d) ☐ The SSA funds regional entities that provide training and technical assistance.

e) ☐ The SSA funds regional entities to provide prevention services. 

f) ☐ The SSA funds county, city, or tribal governments to provide prevention services. 

g) ☐ The SSA funds community coalitions to provide prevention services. 

h) ☐ The SSA funds individual programs that are not part of a larger community effort. 

i) ☐ The SSA directly funds other state agency prevention programs. 

j) ☐ Other (please describe)

2. Please list the specific primary prevention programs, practices, and strategies that are funded 

with SUPTRS BG primary prevention dollars in at least one of the six prevention strategies. 

Please see the introduction above for definitions of the six strategies:

a) Information Dissemination: 

b) Education: 

c) Alternatives:

d) Problem Identification and Referral:

e) Community-Based Processes:

f) Environmental: 

3. Does your state have a process in place to ensure that SUPTRS BG dollars are used only to 

fund primary prevention services not funded through other means? 

a) ☐ Yes (if so, please describe) 

b) ☐ No

4. Does your state integrate National CLAS Standards into the implementation step? 

a) ☐Yes ☐ No
Page | 70 

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

5. Does your state integrate sustainability into the implementation step?

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Evaluation 

1. Does your state have an evaluation plan for substance use primary prevention that was 

developed within the last five years? 

a) ☐ Yes (If yes, please attach the plan in WebBGAS)

b) ☐ No 

2. Does your state’s prevention evaluation plan include the following components? (check all 

that apply) 

a) ☐ Establishes methods for monitoring progress towards outcomes, such as prioritized

benchmarks 

b) ☐ Includes evaluation information from sub-recipients

c) ☐ Includes SAMHSA National Outcome Measurement (NOMs) requirements

d) ☐ Establishes a process for providing timely evaluation information to stakeholders 

e) ☐ Formalizes processes for incorporating evaluation findings into resource allocation and 

decision-making 

f) ☐ Other (please describe)

g) ☐ Not applicable/no prevention evaluation plan 

3. Please check those process measures listed below that your state collects on its SUPTRS BG

funded prevention services: 

a) ☐ Numbers served
Page | 71 

b) ☐ Implementation fidelity

c) ☐ Participant satisfaction

d) ☐ Number of evidence-based programs/practices/policies implemented

e) ☐ Attendance

f) ☐ Demographic information

g) ☐ Other (please describe)

4. Please check those outcome measures listed below that your state collects on its SUPTRS BG

funded prevention services: 

a) ☐ 30-day use of alcohol, tobacco, prescription drugs, etc.

b) ☐ Heavy use 

☐ Binge use 

☐ Perception of harm 

c) ☐ Disapproval of use 

d) ☐ Consequences of substance use (e.g., alcohol-related motor vehicle crashes, drugrelated mortality)

e) ☐ Other (please describe)

5. Does your state integrate the National CLAS Standards into the evaluation step?

a) ☐ Yes ☐ No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

6. Does your state integrate sustainability into the evaluation step?

a) ☐ Yes ☐ No
Page | 72 

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

9. Statutory Criterion for MHBG (Required for MHBG)

Criterion 1: Comprehensive Community-Based Mental Health Service Systems

Provides for the establishment and implementation of an organized community-based system of 

care for individuals with mental illness, including those with co-occurring mental and substance 

use disorders. Describes available services and resources within a comprehensive system of care, 

provided with federal, state, and other public and private resources, in order to enable such 

individual to function outside of inpatient or residential institutions to the maximum extent of 

their capabilities.

1. Describe available services and resources in order to enable individuals with mental illness, 

including those with co-occurring mental and substance use disorders to function outside of 

inpatient or residential institutions to the maximum extent of their capabilities.

2. Does your state coordinate the following services under comprehensive community-based 

mental health service systems? 

a) Physical health ☐ Yes ☐ No

b) Mental Health ☐ Yes ☐ No

c) Rehabilitation services ☐ Yes ☐ No

d) Employment services ☐ Yes ☐ No

e) Housing services ☐ Yes ☐ No

f) Educational services ☐ Yes ☐ No

g) Substance misuse prevention and SUD treatment services ☐ Yes ☐ No

h) Medical and dental services ☐ Yes ☐ No

i) Support services ☐ Yes ☐ No

j) Services provided by local school systems under the Individuals with Disabilities 

Education Act (IDEA) ☐ Yes ☐ No

k) Services for persons with co-occurring M/SUDs ☐ Yes ☐ No
Page | 73 

Please describe or clarify the services coordinated, as needed (for example, best practices, service 

needs, concerns, etc.) 

3. Describe your state’s case management services 

4. Describe activities intended to reduce hospitalizations and hospital stays.

5. Please indicate areas of technical assistance needed related to this section. 

Criterion 2: Mental Health System Data Epidemiology 

Contains an estimate of the incidence and prevalence in the state of SMI among adults and SED 

among children; and have quantitative targets to be achieved in the implementation of the system 

of care described under Criterion 1. 

1. In order to complete column B of the table, please use the most recent SAMHSA prevalence 

estimate or other federal/state data that describes the populations of focus. Column C requires 

that the state indicate the expected incidence rate of individuals with SMI/SED who may 

require services in the state’s M/SUD system 

MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED

Target Population (A) Statewide prevalence (B) Statewide incidence (C)

1. Adults with SMI

2. Children with SED

2. Describe the process by which your state calculates prevalence and incidence rates and 

provide an explanation as to how this information is used for planning purposes. If your state 

does not calculate these rates, but obtains them from another source, please describe. If your 

state does not use prevalence and incidence rates for planning purposes, indicate how system 

planning occurs in their absence.
Page | 74 

3. Please indicate areas of technical assistance needed related to this section. 

Criterion 3: Children’s Services

Provides for a system of integrated services for children to receive care for their multiple needs. 

Does your state integrate the following services into a comprehensive system of 54

a) Social Services ☐ Yes ☐ No

b) Educational services, including services provided under IDEA ☐ Yes ☐ No

c) Juvenile justice services ☐ Yes ☐ No

d) Substance misuse prevention and SUD treatment services ☐ Yes ☐ No

e) Health and mental health services ☐ Yes ☐ No

f) Establishes defined geographic area for the provision of the services of such systems 

☐ Yes ☐ No

Please indicate areas of technical assistance needed related to this section. 

Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults

Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults.

a. .Describe your state’s targeted services to rural population. See SAMHSA’s Rural Behavioral 

Health page for program resources (https://www.samhsa.gov/rural-behavioral-health). 

b. Describe your state’s targeted services to people experiencing homelessness. See SAMHSA’s 

Homeless Programs and Resources for program resources55 

54 A system of care is: A spectrum of effective, community-based services and supports for children and youth with 

or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds 

meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help 

them to function better at home, in school, in the community, and throughout life.

https://gucchd.georgetown.edu/products/Toolkit_SOC_Resource1.pdf

55 https://www.samhsa.gov/homelessness-programs-resources
Page | 75 

c. Describe your state’s targeted services to the older adult population. See SAMHSA’s

Resources for Older Adults webpage for resources56 

d. Please indicate any other areas of technical assistance needed related to this section. 

Criterion 5: Management Systems

States describe their financial resources, staffing, and training for mental health services providers 

necessary for the plan; provides for training of providers of emergency health services regarding 

SMI and SED; and how the state intends to expend this grant for the fiscal years involved.

a. Describe your state’s management systems.

Telehealth is a mode of service delivery that has been used in clinical settings for over 60 years 

and empirically studied for just over 20 years. Telehealth is not an intervention itself, but rather a 

mode of delivering services. This mode of service delivery increases access to screening, 

assessment, treatment, recovery supports, crisis support, and medication management across 

diverse behavioral health and primary care settings. Practitioners can offer telehealth through 

synchronous and asynchronous methods. A priority topic for SAMHSA is increasing access to 

treatment for SMI and SUD using telehealth modalities. Telehealth is the use of 

telecommunication technologies and electronic information to provide care and facilitate clientprovider interactions. Practitioners can use telehealth with a hybrid approach for increased 

flexibility. For instance, a client can receive both in-person and telehealth visits throughout their 

treatment process depending on their needs and preferences. Telehealth methods can be 

implemented during public health emergencies (e.g., pandemics, infectious disease outbreaks, 

wildfires, flooding, tornadoes, hurricanes) to extend networks of providers (e.g., tapping into outof-state providers to increase capacity). They can also expand capacity to provide direct client 

care when in-person, face-to-face interactions are not possible due to geographic barriers or a lack 

of providers or treatments in a given area. However, implementation of telehealth methods should 

not be reserved for emergencies or to serve as a bridge between providers and rural or 

underserved areas. Telehealth can be integrated into an organization’s standard practices, 

providing low-barrier pathways for clients and providers to connect to and assess treatment needs, 

create treatment plans, initiate treatment, and provide long-term continuity of care. States are 

encouraged to access, the SAMHSA Evidence Based Resource Guide, Telehealth for the 

Treatment of Serious Mental Illness and Substance Use Disorders. 

56 https://www.samhsa.gov/resources-serving-older-adults
Page | 76 

b. Describe your state’s current telehealth capabilities, how your state uses telehealth modalities 

to treat individuals with SMI/SED, and any plans/initiatives to expand its use. 

c. Please indicate areas of technical assistance needed related to this section.

10. Substance Use Disorder Treatment - Required for SUPTRS BG

Criterion 1: Prevention and Treatment Services - Improving Access and Maintaining a 

Continuum of Services to Meet State Needs. 

Improving access to treatment services

1. Does your state provide: 

a) A full continuum of services:

i) Screening ☐ Yes ☐ No

ii) Education ☐Yes ☐ No

iii) Brief intervention ☐ Yes ☐ No

iv) Assessment ☐ Yes ☐ No

v) Withdrawal Management (inpatient/residential) ☐Yes ☐ No

vi) Outpatient ☐ Yes ☐ No

vii) Intensive outpatient ☐Yes ☐ No

viii) Inpatient/residential ☐ Yes ☐ No

ix) Aftercare/Continuing Care ☐ Yes ☐No

x) Recovery support ☐ Yes ☐ No

b) Services for special populations:

Prioritized services for veterans? ☐ Yes ☐No

Adolescents? ☐ Yes ☐ No

Older adults? ☐ Yes ☐ No

Criterion 2: Improving Access and Addressing Primary Prevention – see Section 8

Criterion 3: Pregnant Women and Women with Dependent Children (PWWDC)

1. Does your state meet the performance requirement to establish and or maintain new programs 

or expand programs to ensure treatment availability? ☐ Yes ☐ No

2. Does your state make prenatal care available to PWWDC receiving services, either directly or 

through an arrangement with public or private nonprofit entities? ☐ Yes ☐ No
Page | 77 

3. Have an agreement to ensure pregnant women are given preference in admission to treatment 

facilities or make available interim services within 48 hours, including prenatal care?

☐ Yes ☐ No

4. Does your state have an arrangement for ensuring the provision of required supportive 

services? ☐ Yes ☐ No

5. Has your state identified a need for any of the following? 

a) Open assessment and intake scheduling? ☐Yes ☐ No

b) Establishment of an electronic system to identify available treatment slots? ☐ Yes ☐ No

c) Expanded community network for supportive services and healthcare? ☐ Yes ☐ No

d) Inclusion of recovery support services? ☐ Yes ☐ No

e) Health navigators to assist clients with community linkages? ☐ Yes ☐ No

f) Expanded capability for family services, relationship restoration, and custody issues?

☐ Yes ☐ No

g) Providing employment assistance? ☐ Yes ☐ No

h) Providing transportation to and from services? ☐ Yes ☐ No

i) Educational assistance? ☐ Yes ☐ No

6. States are required to monitor program compliance related to activities and services for 

PWWDC. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems.

Criteria 4, 5 and 6: Persons Who Inject Drugs (PWID), Tuberculosis (TB), Human 

Immunodeficiency Virus (HIV), Hypodermic Needle Prohibition, and Syringe Services 

Program 

Persons Who Inject Drugs (PWID) 

1. Does your state fulfill the: 

a) 90 percent capacity reporting requirement? ☐ Yes ☐ No

b) 14-120 day performance requirement with provision of interim services? ☐ Yes ☐ No

c) Outreach activities? ☐ Yes ☐ No

d) Syringe services programs? ☐ Yes ☐ No

e) Monitoring requirements as outlined in the authorizing statute and implementing 

regulation? ☐ Yes ☐ No

2. Has your state identified a need for any of the following:

a) Electronic system with alert when 90 percent capacity is reached? ☐ Yes ☐ No

b) Automatic reminder system associated with 14–120-day performance requirement? 

☐ Yes ☐ No

c) Use of peer recovery supports to maintain contact and support? ☐ Yes ☐ No
Page | 78 

d) Service expansion to specific populations (e.g., military families, veterans, adolescents, 

LGBTQI+, older adults)? ☐ Yes ☐ No

3. States are required to monitor program compliance related to activities and services for 

PWID. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems.

Tuberculosis (TB) 

1. Does your state currently maintain an agreement, either directly or through arrangements with 

other public and nonprofit private entities to make available tuberculosis services to 

individuals receiving SUD treatment and to monitor the service delivery? 

a) ☐ Yes ☐ No 

2. Has your state identified a need for any of the following: 

a) Business agreement/MOU with primary healthcare providers? ☐ Yes ☐ No

b) Cooperative agreement/MOU with public health entity for testing and treatment? 

☐ Yes ☐ No

c) Established co-located SUD professionals within FQHCs? ☐ Yes ☐ No

3. States are required to monitor program compliance related to tuberculosis services made 

available to individuals receiving SUD treatment. Please provide a detailed description of the 

specific strategies used by the state to identify compliance issues and corrective actions 

required to address identified problems. 

Early Intervention Services for HIV (For “Designated States” Only) 

1. Does your state currently have an agreement to provide treatment for persons with substance 

use disorders with an emphasis on making available within existing programs early 

intervention services for HIV in areas that have the greatest need for such services and 

monitoring such service delivery? ☐ Yes ☐ No

2. Has your state identified a need for any of the following: 

a) Establishment of EIS-HIV service hubs in rural areas? ☐ Yes ☐ No

b) Establishment or expansion of tele-health and social media support services? 

☐ Yes ☐ No

c) Business agreement/MOU with established community agencies/organizations serving 

persons with HIV/AIDS? ☐ Yes ☐ No
Page | 79 

Syringe Service Programs 

1. Does your state have in place an agreement to ensure that SUPTRS BG funds are NOT 

expended to provide individuals with hypodermic needles or syringes for the purpose of 

injecting illicit substances (42 U.S.C.§ 300x-31(a)(1)(F)? ☐ Yes ☐ No

2) Do any of the programs serving PWID have an existing relationship with a Syringe Services 

Program? ☐ Yes ☐ No

3) Do any of your programs use SUPTRS BG funds to support elements of a Syringe Services 

Program?

a) ☐ Yes ☐ No

b) If yes, please provide a brief description of the elements and the arrangement

Criteria 8, 9 and 10: Service System Needs, Service Coordination, Charitable Choice, 

Referrals, Patient Records, and Independent Peer Review

Service System Needs

1. Does your state have in place an agreement to ensure that the state has conducted a statewide

assessment of need, which defines prevention, and treatment authorized services available, 

identified gaps in service, and outlines the state’s approach for improvement? ☐ Yes ☐ No

2. Has your state identified a need for any of the following: 

a) Workforce development efforts to expand service access? ☐ Yes ☐ No

b) Establishment of a statewide council to address gaps and formulate a strategic plan to 

coordinate services? ☐ Yes ☐ No

c) Establish a peer recovery support network to assist in filling the gaps? ☐ Yes ☐ No

d) Incorporate input from special populations (military families, service members, veterans, 

tribal entities, older adults, sexual and gender minorities)? ☐ Yes ☐ No

e) Formulate formal business agreements with other involved entities to coordinate services 

to fill gaps in the system, such as primary healthcare, public health, VA, and community 

organizations? ☐ Yes ☐ No

f) Explore expansion of services for:

i) MOUD

(1) ☐ Yes ☐ No

ii) Tele-health

(1) ☐ Yes ☐ No

iii) Social media outreach

(1) ☐ Yes ☐ No
Page | 80

Service Coordination

1. Does your state have a current system of coordination and collaboration related to the 

provision of person-centered and person-directed care? ☐ Yes ☐ No

2. Has your state identified a need for any of the following:

a) Identify MOUs/Business Agreements related to coordinate care for persons receiving 

SUD treatment and/or recovery services. ☐ Yes ☐ No

b) Establish a program to provide trauma-informed care. ☐ Yes ☐ No

c) Identify current and perspective partners to be included in building a system of care, such 

as FQHCs, primary healthcare, recovery community organizations, juvenile justice 

system, adult criminal justice system, and education. ☐ Yes ☐ No

Charitable Choice

1. Does your state have in place an agreement to ensure the system can comply with the services 

provided by nongovernment organizations (42 U.S.C.§ 300x-65, 42 CF Part 54 (§54.8(b) and 

§54.8(c)(4)) and 68 FR 56430-56449)? ☐ Yes ☐ No

2. Does your state provide any of the following:

a) Notice to Program Beneficiaries? ☐ Yes ☐ No

b) An organized referral system to identify alternative providers? ☐ Yes ☐ No

c) A system to maintain a list of referrals made by religious organizations? ☐ Yes ☐ No

Referrals

1. Does your state have an agreement to improve the process for referring individuals to the 

treatment modality that is most appropriate for their needs? ☐ Yes ☐ No

2. Has your state identified a need for any of the following:

a) Review and update of screening and assessment instruments? ☐ Yes ☐ No

b) Review of current levels of care to determine changes or additions? ☐ Yes ☐ No

c) Identify workforce needs to expand service capabilities? ☐ Yes ☐ No

d) Conduct cultural awareness training to ensure staff sensitivity to client cultural orientation, 

environment, and background? ☐ Yes ☐ No

Patient Records

1. Does your state have an agreement to ensure the protection of client records? ☐Yes ☐ No

2. Has your state identified a need for any of the following:

a) Training staff and community partners on confidentiality requirements? ☐ Yes ☐ No

b) Training on responding to requests asking for acknowledgement of the presence of 

clients? ☐ Yes ☐ No

c) Updating written procedures which regulate and control access to records? ☐ Yes ☐ No

d) Review and update of the procedure by which clients are notified of the confidentiality of 

their records include the exceptions for disclosure? ☐ Yes ☐ No
Page | 81 

Independent Peer Review

1. Does your state have an agreement to assess and improve, through independent peer review, 

the quality and appropriateness of treatment services delivered by providers? 

a. ☐ Yes ☐ No

2. Section 1943(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C.§ 

300x-52(a)) and 45 § CFR 96.136 require states to conduct independent peer review of not 

fewer than 5 percent of the block grant sub-recipients providing services under the program 

involved. 

a) Please provide an estimate of the number of block grant sub-recipients identified to 

undergo such a review during the fiscal year(s) involved 

3. Has your state identified a need for any of the following?

a) Development of a quality improvement plan? ☐ Yes ☐ No 

b) Establishment of policies and procedures related to independent peer review? 

☐ Yes ☐ No

c) Development of long-term planning for service revision and expansion to meet the needs 

of specific populations? ☐ Yes ☐ No 

4. Does your state require a block grant sub-recipient to apply for and receive accreditation from 

an independent accreditation organization, such as the Commission on the Accreditation of 

Rehabilitation Facilities (CARF), The Joint Commission, or similar organization as an 

eligibility criterion for block grant funds? 

a) ☐ Yes ☐ No

b) If Yes, please identify the accreditation organization(s)

i) ☐ Commission on the Accreditation of Rehabilitation Facilities

ii) ☐ The Joint Commission

iii) ☐ Other (please specify) _______________________ 

Criterion 7 and 11: Group Homes for Persons In Recovery and Professional Development 

Group Homes

1. Does your state have an agreement to provide for and encourage the development of group 

homes for persons in recovery through a revolving loan program? ☐ Yes ☐ No

2. Has your state identified a need for any of the following:

a) Implementing or expanding the revolving loan fund to support recovery home 

development as part of the expansion of recovery support service? ☐ Yes ☐ No

b) Implementing MOUs to facilitate communication between block grant service providers 

and group homes to assist in placing clients in need of housing? ☐ Yes ☐ No
Page | 82 

Professional Development

1. Does your state have an agreement to ensure that prevention, treatment and recovery 

personnel operating in the state’s substance use disorder prevention, treatment and recovery 

systems have an opportunity to receive training on an ongoing basis, concerning:

a) Recent trends in substance use disorders in the state? ☐ Yes ☐ No

b) Improved methods and evidence-based practices for providing substance use disorder 

prevention and treatment services? ☐ Yes ☐ No

c) Performance-based accountability? ☐ Yes ☐ No

d) Data collection and reporting requirements? ☐ Yes ☐ No

If the answer is No to any of the above, please explain the reason.

2. Has your state identified a need for any of the following:

a) A comprehensive review of the current training schedule and identification of additional

training needs? ☐ Yes ☐ No

b) Addition of training sessions designed to increase employee understanding of recovery

support services? ☐ Yes ☐ No

c) Collaborative training sessions for employees and community agencies’ staff to 

coordinate and increase integrated services? ☐ Yes ☐ No

d) State office staff training across departments and divisions to increase staff knowledge of 

programs and initiatives, which contribute to increased collaboration and decreased 

duplication of effort? ☐ Yes ☐ No

Has your state utilized the Regional Prevention, Treatment and/or Mental Health Training and 

Technical Assistance Centers57 (TTCs) ? 

e) Prevention TTC? ☐ Yes ☐ No

f) Mental Health TTC? ☐ Yes ☐ No

g) Addiction TTC? ☐ Yes ☐ No

h) State Opioid Response? ☐ Yes ☐ No

Waivers 

Upon the request of a state, the Secretary may waive the requirements of all or part of the sections 

300x-22(b), 300x-23, 300x-24 and 300x-28 (42 U.S.C. §300x-32(e))).

1. Is your state considering requesting a waiver of any requirements related to: 

a) Allocations Regarding Women (300x-22(b)) ☐ Yes ☐ No

57 https://www.samhsa.gov/technology-transfer-centers-ttc-program
Page | 83 

2. Is your state considering requesting a waiver of any requirements related to:

a) Intravenous substance use (300x-23) ☐ Yes ☐ No

3. Is Your State Considering Requesting a Waiver of any Requirements Related to Requirements 

Regarding Tuberculosis Services and Human Immunodeficiency Virus (300x-24) 

a) Tuberculosis ☐ Yes ☐ No

b) Early Intervention Services Regarding HIV ☐ Yes ☐ No

4. Is Your State Considering Requesting a Waiver of any Requirements Related to Additional 

Agreements (300x-28) 

a) Improvement of Process for Appropriate Referrals for Treatment ☐ Yes ☐ No 

b) Professional Development ☐ Yes ☐ No

c) Coordination of Various Activities and Services ☐ Yes ☐ No

Please provide a link to the state administrative regulations that govern the Mental Health 

and Substance Use Disorder Programs.

11. Quality Improvement Plan- Requested

In previous block grant applications, SAMHSA asked states to base their administrative

operations and service delivery on principles of Continuous Quality Improvement/Total Quality 

Management (CQI/TQM). These CQI processes should identify and track critical outcomes and 

performance measures, based on valid and reliable data, consistent with the NBHQF, which will 

describe the health and functioning of the mental health and addiction systems. The CQI 

processes should continuously measure the effectiveness of services and supports and ensure that 

they continue to reflect this evidence of effectiveness. The state’s CQI process should also track 

programmatic improvements using stakeholder input, including the general population and 

individuals in treatment and recovery and their families. In addition, the CQI plan should include

a description of the process for responding to emergencies, critical incidents, complaints, and 

grievances. 

1. Has your state modified its CQI plan from FFY 2022-FFY 2023? 

a) ☐ Yes ☐ No

Please indicate areas of technical assistance needed related to this section. 
Page | 84

12. Trauma -Requested

Trauma58 is a common experience for adults and children in communities, and it is especially 

common in the lives of people with mental and substance use disorders. For this reason, the need 

to address trauma is increasingly seen as an important part of effective behavioral health care and 

an integral part of the healing and recovery process. It occurs because of violence, abuse, neglect, 

loss, disaster, war, and other emotionally harmful and/or life-threatening experiences. Trauma 

has no boundaries regarding age, gender, socioeconomic status, race, ethnicity, geography, 

ability, or sexual orientation. Additionally, it has become evident that addressing trauma requires 

a multi-pronged, multi-agency public health approach inclusive of public education and 

awareness, prevention and early identification, and effective trauma-specific assessment and 

treatment. To maximize the impact of these efforts, they need to be provided in an organizational 

or community context that is trauma informed.

Individuals with experiences of trauma are found in multiple service sectors, not just in M/SUD 

services. People in the juvenile and criminal justice system and children and families in the child 

welfare system have high rates of mental illness, substance use disorders and personal histories of 

trauma. Similarly, many individuals in primary, specialty, emergency, and rehabilitative health 

care also have significant trauma histories, which impacts their health and responsiveness to 

health interventions. Also, schools are now recognizing that the impact of traumatic exposure

among their students makes it difficult for students to learn and meet academic goals. As 

communities experience trauma, for some, these are rare events and for others, these are daily 

events. Children and families living in resource scarce communities remain especially vulnerable 

to experiences of trauma and thus face obstacles in accessing and receiving M/SUD care. States 

should work with these communities to identify interventions that best meet the needs of their 

residents. In addition, the public institutions and service systems that are intended to provide 

services and supports for individuals are often re-traumatizing, making it necessary to rethink 

how practices are conducted. These public institutions and service settings are increasingly 

adopting a trauma-informed approach distinct from trauma-specific assessments and treatments. 

Trauma-informed refers to creating an organizational culture or climate that realizes the 

widespread impact of trauma, recognizes the signs and symptoms of trauma, responds by 

integrating knowledge about trauma into policies and procedures, and seeks to actively resist retraumatizing clients and staff. This approach is guided by key principles that promote safety, 

trustworthiness and transparency, peer support, empowerment, collaboration, and sensitivity to 

cultural and gender issues with a focus on equity and inclusion. A trauma-informed approach 

may incorporate trauma-specific screening, assessment, treatment, and recovery practices or refer 

individuals to appropriate services.

It is suggested that states refer to SAMHSA’s guidance for implementing the trauma-informed 

approach discussed in the Concept of Trauma59 paper.

58 Definition of Trauma: Individual trauma results from an event, series of events, or set of circumstances that is experienced by 

an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s 

functioning and mental, physical, social, emotional, or spiritual well-being. 59 Ibid
Page | 85 

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Does the state have a plan or policy for M/SUD providers that guides how they will address 

individuals with trauma-related issues? ☐ Yes ☐ No

2. Does the state provide information on trauma-specific assessment tools and interventions for 

M/SUD providers? ☐ Yes ☐ No 

3. Does the state provide training on trauma-specific treatment and interventions for M/SUD 

providers? ☐ Yes ☐ No

4. Does the state have a plan to build the capacity of M/SUD providers and organizations to 

implement a trauma-informed approach to care? ☐ Yes ☐ No 

5. Does the state encourage employment of peers with lived experience of trauma in developing 

trauma-informed organizations? ☐ Yes ☐ No

6. Does the state use an evidence-based intervention to treat trauma? ☐ Yes ☐ No

5) Does the state have any activities related to this section that it would like to highlight.

6)Please indicate areas of technical assistance needed related to this section. 

13. Criminal and Juvenile Justice - Requested

More than a third of people in prisons and nearly half of people in jail have a history of mental 

health problems.60 Almost two thirds of people in prison and jail meet criteria for a substance use 

disorder .61 As many as 70 percent of youth in the juvenile justice system have a diagnosable 

mental health problem.62 States have numerous ways that they can work to improve care for these 

individuals and the other people with mental and substance use disorders involved in the criminal 

justice system. This is particularly important given the overrepresentation of populations that face 

mental health and substance use disorder disparities in the criminal justice system 

Addressing the mental health and substance use disorder treatment and service needs of people 

involved in the criminal justice system requires a variety of approaches. These include:

60 Bronson, J., & Berzofsky, M. (2017). Indicators of mental health problems reported by prisoners and jail 

inmates, 2011–12. Bureau of Justice Statistics, 1-16. 61 Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among 

state prisoners and jail inmates, 2007–2009. Washington, DC: United States Department of Justice, Office 

of Juvenile Justice and Delinquency Prevention. 62 Vincent, G. M., Thomas Grisso, Anna Terry, and Steven M. Banks. 2008. “Sex and Race Differences in 

Mental Health Symptoms in Juvenile Justice: The MAYSI-2 National Meta-Analysis.” Journal of the 

American Academy of Child and Adolescent Psychiatry 47(3):282–90.
Page | 86 

• Better coordination across mental health, substance use, criminal justice and other 

systems (including coordination across entities at the state and local levels);

• Data sharing and use of data to identify individuals in need of services, improve service 

delivery and coordination, and/or address disparities across racial and ethnic groups;

• Improvement of community capacity to provide MH and SUD services to people 

involved in the criminal justice system; 

• Supporting the ability of law enforcement to respond to people experiencing mental 

illness or SUD (e.g. Crisis Intervention Teams, co-responder models, and coordinated 

police/emergency drop-off)

• Partnering with other state agencies and localities to improve screening and assessment 

for MH and SUD and standards of care for these illnesses for people in jails and prisons;

• Supporting coordination across community-based care and care in jails and prisons, 

particularly upon reentry into the community; 

• Building crisis systems that engage people experiencing a MH or SUD related crisis in 

MH or SUD care instead of involvement with law enforcement and criminal justice 

(including coordination of 911 and 988 systems);

• Creating pathways for diversion from criminal justice to MH and SUD services 

throughout the criminal justice system (before arrest, at booking, jails, the courts, at 

reentry, and through community corrections);

• Coordination with juvenile court systems and development of programs to improve 

outcomes for children and youth involved in the juvenile justice system;

• Developing interventions during vulnerable periods, such as reentry to the community 

from jail or prison, to ensure that MH, SUD, and other needs are met;

• Addressing other barriers to recovery for people with M/SUD involved in the criminal 

justice system, such as health insurance enrollment, SSI/SSDI enrollment, homelessness 

and housing insecurity, and employment challenges; 

• Partnering with the judicial system to engage in cross-system planning and development 

at the state and local levels;

• Providing education and support for judges and judicial staff related to navigating the 

mental health and substance use service system; and

• Supporting court-based programs, including specialty courts and diversion programs that 

serve people with M/ SUD.

• Addressing the increasing number of individuals who are detained in jails or state 

hospitals/facilities awaiting competence to stand trial assessments and restoration.

These types of approaches can improve outcomes and experiences for people with M/SUD 

involved in the criminal justice system and support more efficient use of criminal justice resources. 

The MHBG and SUPTRS BG may be especially valuable in supporting a stronger array of 

community-based services in these and other areas. SSAs and SMHAs can also play a key role in 

partnering with state and local agencies to improve coordination of systems and services. This 

includes state and local law enforcement, correctional systems, and courts. SAMHSA strongly 

encourages state behavioral health authorities to work closely with these partners, including their

state courts, to ensure the best coordination of services and outcomes, especially in light of health

disparities and inequities, and to develop closer interdisciplinary programming for justice system

involved individuals. Promoting and supporting these efforts with a health equity lens is a 

SAMHSA priority.
Page | 87

Please respond to the following items:

1. Does the state (SMHA and SSA) engage in any activities of the following activities:

☐ Coordination across mental health, substance use disorder, criminal justice and other systems

☐ Data sharing and use of data to identify individuals in need of services, improve service 

delivery and coordination, and/or address disparities across racial and ethnic groups

☐ Improvement of community capacity to provide MH and SUD services to people involved in 

the criminal justice system, including those related to medications for opioid use disorder

☐ Supporting the ability of law enforcement to respond to people experiencing mental illness or 

SUD (e.g., Crisis Intervention Teams, co-responder models, and coordinated 

police/emergency drop-off )

☐ Partnering with other state agencies and localities to improve screening and assessment for 

MH and SUD and standards of care for these illnesses for people in jails and prisons;

☐ Supporting coordination across community-based care and care in jails and prisons, 

particularly upon reentry into the community

☐ Building crisis systems that engage people experiencing a MH or SUD related crisis in MH or 

SUD care instead of involvement with law enforcement and criminal justice (including 

coordination of 911 and 988 systems)

☐ Creating pathways for diversion from criminal justice to MH and SUD services throughout the 

criminal justice system (before arrest, booking, jails, the courts, at reentry, and through 

community corrections)

☐ Coordination with juvenile court systems and development of programs to improve outcomes 

for children and youth involved in the juvenile justice system

☐ Developing interventions during vulnerable periods, such as reentry to the community from 

jail or prison, to ensure that MH, SUD, and other needs are met

☐ Addressing other barriers to recovery for people with M/SUD involved in the criminal justice 

system, such as health insurance enrollment, SSI/SSDI enrollment, homelessness and housing 

insecurity, and employment challenges

☐ Partnering with the judicial system to engage in cross-system planning and development at the 

state and local levels

☐ Providing education and support for judges and judicial staff related to navigating the mental 

health and substance use service system

☐ Supporting court-based programs, including specialty courts and diversion programs that 

serve people with M/SUD

☐ Addressing Competence to Stand Trial; assessments and restoration activities.

2. Does the state have any specific activities related to reducing disparities in service receipt and 

outcomes across racial and ethnic groups for individuals with M/SUD who are involved in the 

criminal justice system? If so, please describe. ☐ Yes ☐ No
Page | 88

3. Does the state have an inter-agency coordinating committee or advisory board that addresses 

criminal and juvenile justice issues and that includes the SMHA, SSA, and other 

governmental and non-governmental entities to address M/SUD and other essential domains 

such as employment, education, and finances? ☐ Yes ☐ No

4. Does the state have any activities related to this section that you would like to highlight?

5.Please indicate areas of technical assistance needed related to this section. 

14. Medications in the Treatment of Substance Use Disorders, Including Medication for Opioid 

Use Disorder (MOUD) – Requested (SUPTRS BG only)

In line with the goals of the Overdose Prevention Strategy and SAMHSA’s priority on Preventing 

Overdose, SAMHSA strongly request that information related to medications in the treatment of 

substance use disorders be included in the application.

There is a voluminous literature on the efficacy of the combination of medications for addiction 

treatment and other interventions and therapies to treat substance use disorders, particularly 

opioid, alcohol, and tobacco use disorders. This is particularly the case for medications used in 

the treatment of opioid use disorder, also increasingly known as Medications for Opioid Use 

Disorder (MOUD). The combination of medications such as MOUD; counseling; other 

behavioral therapies including contingency management; and social support services, provided in 

individualized, tailored ways, has helped countless number of individuals achieve and sustain 

remission and recovery from their substance use disorders. However, many treatment programs 

in the U.S. offer only abstinence-based, or non-medication inclusive, treatment for these 

conditions. The evidence base for medications as standards of care for SUDs is described in 

SAMHSA TIP 49 Incorporating Alcohol Pharmacotherapies Into Medical Practice and TIP 63 

Medications for Opioid Use Disorders.

SAMHSA strongly encourages that the states require treatment facilities providing clinical care to 

those with substance use disorders demonstrate that they both have the capacity and staff 

expertise to offer MOUD and medications for alcohol use disorder or have collaborative 

relationships with other providers that can provide all FDA-approved medications for opioid and 

alcohol use disorder and other clinically needed services.

Individuals with substance use disorders who have a disorder for which there is an FDA-approved 

medication treatment should have access to those treatments based upon each individual patient’s 

needs. States should use Block Grant funds for the spectrum of evidence-based interventions for 

opioids and stimulants including medications for opioids use disorders and contingency 

management.

In addition, SAMHSA also encourages states to require equitable access to and implementation of 

medications for opioid use disorder (MOUD), alcohol use disorder (MAUD) and tobacco use 

disorders within their systems of care.
Page | 89 

SAMHSA is asking for input from states to inform SAMHSA’s activities.

Please respond to the following: 

1. Has the state implemented a plan to educate and raise awareness within SUD treatment 

programs regarding the use of medications for substance use disorders? ☐ Yes ☐ No

2. Has the state implemented a plan to educate and raise awareness of the use of medications for 

substance disorder, including MOUD, within special target audiences, particularly pregnant 

women? ☐ Yes ☐ No

3. Does the state purchase any of the following medication with block grant funds?

a) ☐ Methadone 

b) ☐ Buprenorphine; Buprenorphine/naloxone 

c) ☐ Disulfiram

d) ☐ Acamprosate

e) ☐ Naltrexone (oral, IM)

f) ☐ Naloxone 

4. Does the state have an implemented education or quality assurance program to assure that 

evidence-based treatment with the use of FDA-approved medications for treatment of 

substance use disorders is combined with other therapies and services based on individualized 

assessments and needs ? ☐ Yes ☐ No

5. Does the state have any activities related to this section that you would like to highlight?

15. Crisis Services – Required for MHBG, Requested for SUPTRS BG

Substance Abuse and Mental Health Services Administration (SAMHSA) is directed by Congress 

to set aside 5 percent of the Mental Health Block Grant (MHBG) allocation for each state to 

support evidence-based crisis systems. The statutory language outlines the following for the 5 

percent set-aside:

.......to support evidenced-based programs that address the crisis care needs of individuals 

with serious mental illnesses and children with serious emotional disturbances, which may 

include individuals (including children and adolescents) experiencing mental health crises 

demonstrating serious mental illness or serious emotional disturbance, as applicable. 

CORE ELEMENTS: At the discretion of the single State agency responsible for the 

administration of the program, the funds may be used to expend some or all of the core 

crisis care service components, as applicable and appropriate, including the following: 

o Crisis call centers

o 24/7 mobile crisis services
Page | 90

o Crisis stabilization programs offering acute care or subacute care in a hospital or 

appropriately licensed facility, as determined by such State, with referrals to 

inpatient or outpatient care.

STATE FLEXIBILITY: In lieu of expending 5 percent of the amount the State receives 

pursuant to this section for a fiscal year to support evidence-based programs as required 

a State may elect to expend not less than 10 percent of such amount to support such 

programs by the end of two consecutive fiscal years. 

A crisis response system will have the capacity to prevent, recognize, respond, de-escalate, and 

follow-up from 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-intervention and response systems. Given 

the multi-system involvement of many individuals with M/SUD issues, the crisis system approach 

provides the infrastructure to improve care coordination, stabilization service to support reducing 

distress, promoting skill development and outcomes, manage costs, and better invest resources.

SAMHSA developed Crisis Services: Meeting Needs, Saving Lives, which includes “National 

Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit” as well as an Advisory: 

Peer Support Services in Crisis Care and other related National Association of State Mental 

Health Programs Directors (NASMHPD) papers on crisis services. SAMHSA also developed 

“National Guidelines for Child and Youth Behavioral Health Crisis Care” which offers best 

practices, implementation strategies, and practical guidance for the design and development of 

services that meet the needs of children, youth, and their families experiencing a behavioral health 

crisis. Please note that this set aside funding is dedicated for the core set of crisis services as 

directed by Congress. Nothing precludes states from utilizing more than 5 percent of its MHBG 

funds for crisis services for individuals with serious mental illness or children with serious 

emotional disturbances. If states have other investments for crisis services, they are encouraged 

to coordinate those programs with programs supported by this new 5 percent set aside. This 

coordination will help ensure services for individuals are swiftly identified and are engaged in the 

core crisis care elements.

When individuals experience a crisis related to mental health, substance use, and/or homelessness

(due to mental illness or a co-occurring disorder), a no-wrong door comprehensive crisis system 

should be put in place. Based on the National Guidelines, there are three major components to a 

comprehensive crisis system, and each must be in place in order for the system to be optimally 

effective. These three-core structural or programmatic elements are: Regional Crisis Call Center, 

Mobile Crisis Response Team, and Crisis Receiving and Stabilization Facilities.

Regional Crisis Call Center. In times of mental health or substance use crisis, 911 is typically 

called, which results in police or emergency medical services (EMS) dispatch. A regional crisis 

call center provides an alternative. Regional crisis call centers should be made available 

statewide, provide real-time access to a live mental health professional on a 24/7 basis, meet 

National Suicide Prevention Lifeline operational guidelines, and serve as “Air Traffic Control” to 

assess and determine the appropriate response to a crisis. In doing so, these centers should 

integrate and collaborate with existing 911 and 211 centers, as well as other applicable call 

centers, to ensure access to the appropriate level of crisis response. 211 centers serve as an entry 
Page | 91

point to crisis services in many states and provide information and referral to callers on where to 

obtain assistance from local and national social services, government agencies, and non-profit 

organizations.

The public has become accustomed to calling 911 for any emergency because it is an easy number 

to remember, and they receive a quick response. Many of the crisis systems in the United States 

continue to use 911 because either they are still building their crisis systems or because they have 

no mechanism to fund a call center separate from 911. However, they recognize that the sure way 

to minimize the involvement of law enforcement in a behavioral health crisis response is to divert 

calls from 911. There are basically three diversion models in operation at this time: (1) the 911-

based system with dispatchers who forward calls to either the police department’s co-responder 

team (police officer with a behavioral health professional) or to their Crisis Intervention Team 

(CIT) with police officers who have received Mental Health First Aid and Crisis Intervention 

Training, including de-escalation methods and behavioral health symptoms; (2) the 911-based 

system with well-trained 911 dispatchers who triage calls to state or local crisis call centers for 

individuals who are not a threat to themselves or others; the call centers then refer to local mobile 

response teams (MRTs), also called mobile crisis teams (MCTs); and (3) State or local Crisis Call 

Centers with well-trained counselors who receive calls directly (without utilizing 911 at all) on 

their own toll-free numbers.

Mobile Crisis Response Team. Once a behavioral health crisis has been identified and a crisis 

line has been called, a mobile response may be required if the crisis cannot be de-escalated by 

phone. In the current system, police are often dispatched to the location of the individual in crisis. 

But in an effective crisis system, two-person teams, including a clinician, should be dispatched to 

the location of the individual in crisis, accompanied by Emergency Medical Services (EMS) or 

police only as warranted. Ideally, peer support professionals would be integrated into this 

response. Assessment should take place on site, and the individual should be transported to the 

appropriate level of care, if needed, as deemed by the clinician and response team.

Crisis Receiving and Stabilization Facilities. In typical response system, EMS or police would 

transport the individual in crisis either to an ED or to a jail. Crisis Receiving and Stabilization 

Facilities provide a cost-effective alternative. These facilities should be available to accept 

individuals by walk-in or drop-off 24/7 and should have a no-reject policy. Particularly when 

police or EMS are dropping off an individual, the hand-off should be “warm” (welcoming) and 

efficient, and these facilities provide assessment and address mental health and substance use 

crisis issues. A warm hand-off establishes an initial face-to-face contact between the client and 

the crisis facility worker. The multi-disciplinary team, including peers, at the facility can work 

with the individual to coordinate next steps in care, to help prevent future mental health crises and 

repeat contacts with the system.

Currently, the 988 Suicide and Crisis Lifeline (Lifeline) connects with local call centers 

throughout the United States. Call center staff is comprised of professionals and volunteers who 

are trained to utilize best practices in handling distress calls. Local call centers automatically 

perform a safety check for every call; if an imminent risk exists and cannot be deescalated, they 

forward the call to either 911 or to a local mobile crisis team for a response. If there is no 

imminent risk, the call center will work with the individual (or the person calling on their behalf) 

for as long as needed or, if necessary, dispatch a local MRT.
Page | 92

988 – 3-Digit behavioral health crisis number. The National Suicide Hotline Designation Act 

(P.L. 116-172) provides an opportunity to support the infrastructure, service and long-term 

funding for community and state 988 response, a national 3-digit behavioral health crisis number 

that was approved by the Federal Communications Commission in July 2020. In July 2022, the 

National Suicide Prevention Lifeline transitioned to 988 but the , 1-800-273-TALK is still 

operational. The 988 transition has supported and expanded to the Lifeline network and will 

continue utilizing the live-saving behavioral health crisis services that the Lifeline and Veterans 

Crisis Line centers currently provide.

Building Crisis Services Systems. Most communities across the United States have limited crisis 

services, but a few have an organized system of services that coordinate and collaborate to divert 

from jails, minimize the use of EDs, reduce hospital visits, and reduce the involvement of law 

enforcement. Those that have such systems did not create them overnight, but it involved 

dedicated individuals, collaboration, considerable planning, and creative methods of blending 

sources of funding.

1. Briefly narrate your state’s crisis system. For all regions/areas of your state, include a 

description of access to crisis call centers, availability of mobile crisis and behavioral 

health first responder services, utilization of crisis receiving and stabilization centers.

2. In accordance with the guidelines below, identify the stages where the existing/proposed 

system will fit in.

a) The Exploration stage: is the stage when states identify their communities’ needs, assess 

organizational capacity, identify how crisis services meet community needs, and 

understand program requirements and adaptation.

b) The Installation stage: occurs once the state comes up with a plan and the state begins 

making the changes necessary to implement the crisis services based on the SAMHSA 

guidance. This includes coordination, training and community outreach and education 

activities.

c) Initial Implementation stage: occurs when the state has the three-core crisis services 

implemented and agencies begin to put into practice the SAMHSA guidelines.

d) Full Implementation stage: occurs once staffing is complete, services are provided, 

and funding streams are in place.

e) Program Sustainability stage: occurs when full implementation has been achieved, 

and quality assurance mechanisms are in place to assess the effectiveness and quality 

of the crisis services.

Other program implementation data that characterizes crisis services system development.

1. Someone to talk to: Crisis call Capacity 

a. Number of locally based crisis call Centers in state

i. In the 988 Suicide and Crisis Lifeline network

ii. Not in the suicide lifeline network

b. Number of Crisis Call Centers with follow up Protocols in place 

c. Percent of 911 calls that are coded out as BH related
Page | 93 

2. Someone to respond: Number of communities that have mobile behavioral health crisis 

mobile capacity (in comparison to the total number of communities) 

a. Independent of first responder structures (police, paramedic, fire)

b. Integrated with first responder structures (police, paramedic, fire)

c. Number that employs peers

3. Safe place to go or to be: 

a. Number of Emergency Departments

b. Number of Emergency Departments that operate a specialized behavioral health 

component. 

c. Number of Crisis Receiving and Stabilization Centers (short term, 23-hour units that 

can diagnose and stabilize individuals in crisis) 

a. Check one box for each row indicating state's stage of implementation 

Exploration

Planning 

Installation Early 

implementation 

Less than 25% of 

counties 

Partial 

Implementation

About 50% of 

counties

Majority 

Implementation 

At least 75% of 

counties 

Program 

Sustainment 

Someone to 

talk to

Someone to 

respond

Safe place to 

go or to be

b. Briefly explain your stages of implementation selections here. 

3. Based on SAMHSA’s National Guidelines for Behavioral Health Crisis Care, explain how 

the state will develop the crisis system. 

4. Briefly describe the proposed/planned activities utilizing the 5% set aside.

5. Please indicate areas of technical assistance needed related to this section. 

16. Recovery – Required

Recovery supports and services are essential for providing and maintaining comprehensive, 

quality M/SUD care. The expansion in access to; and coverage for, health care drives SAMHSA 

to promote the availability, quality, and financing of vital services and support systems that 

facilitate recovery for individuals. Recovery encompasses the spectrum of individual needs 

related to those with mental disorders and/or substance use disorders. 
Page | 94 

Recovery is supported through the key components of: health (access to quality health and 

M/SUD treatment); home (housing with needed supports), purpose (education, employment, and 

other pursuits); and community (peer, family, and other social supports). The principles of a 

recovery- guided approach to person-centered care is inclusive of shared decision-making, 

culturally welcoming and sensitive to social determinants of health. The continuum of care for 

these conditions involves interventions to address acute episodes or recurrence of symptoms 

associated with an individual’s mental or substance use disorder, and services to reduce risk 

related to them. Because mental and substance use disorders can become chronic relapsing 

conditions, long term systems and services are necessary to facilitate the initiation, stabilization,

and management of recovery and personal success over the lifespan.

SAMHSA has developed the following working definition of recovery from mental and/or 

substance use disorders: 

Recovery is a process of change through which individuals improve their health and wellness,live 

a self-directed life, and strive to reach their full potential.

In addition, SAMHSA identified 10 guiding principles of recovery: 

• Recovery emerges from hope; 

• Recovery is person-driven; 

• Recovery occurs via many pathways; 

• Recovery is holistic;

• Recovery is supported by peers and allies;

• Recovery is supported through relationship and social networks; 

• Recovery is culturally-based and influenced; 

• Recovery is supported by addressing trauma;

• Recovery involves individuals, families, community strengths, and responsibility;

• Recovery is based on respect.

Please see SAMHSA’s Working Definition of Recovery from Mental Disorders and Substance

Use Disorders. 

States are strongly encouraged to consider ways to incorporate recovery support services, 

including peer-delivered services, into their continuum of care. Technical assistance and training 

on a variety of such services are available through the SAMHSA supported National Technical 

Assistance and Training Centers. SAMHSA strongly encourages states to take proactive steps to

implement and expand recovery support services and collaborate with existing RCOs and RCCs. 

Because recovery is based on the involvement of consumers/peers/people in recovery, their 

family members and caregivers, SMHAs and SSAs can engage these individuals, families, and 

caregivers in developing recovery-oriented systems and services. States should also support 

existing organizations and direct resources for enhancing consumer, family, and youth networks 

such as RCOs and RCCs and peer-run organizations; and advocacy organizations to ensure a 

recovery orientation and expand support networks and recovery services. States are strongly 

encouraged to engage individuals and families in developing, implementing, and monitoring the 

state M/SUD treatment system. 
Page | 95 

1. Does the state support recovery through any of the following:

a) Training/education on recovery principles and recovery-oriented 

practice and systems, including the role of peers in care? ☐ Yes ☐ No

b) Required peer accreditation or certification? ☐ Yes ☐ No

c) Use block grant funding of recovery support services? ☐ Yes ☐ No

d) Involvement of people with lived experience /peers/family members

in planning, implementation, or evaluation of the impact of the 

state’s M/SUD system? ☐ Yes ☐ No

2. Does the state measure the impact of your consumer and recovery 

community outreach activity? ☐ Yes ☐ No

3. Provide a description of recovery and recovery support services for

adults with SMI and children with SED in your state. 

4. Provide a description of recovery and recovery support services 

for individuals with substance use disorders in your state. i.e., 

RCOs, RCCs, peer-run organizations. 

5. Does the state have any activities that it would like to highlight? 

6. Please indicate areas of technical assistance needed related to this section. 

17. Community Living and the Implementation of Olmstead- Requested

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 M/SUD on America’s 

communities. Being an active member of a community is an important part of recovery for 

persons with M/SUD conditions. Title II of the ADA and the regulations promulgated for its 

enforcement require that states provide services in the most integrated setting appropriate to the 

individual and prohibit needless institutionalization and segregation in work, living, and other 

settings. In response to the 10th anniversary of the Supreme Court’s Olmstead decision, the 

Coordinating Council on Community Living was created at HHS. SAMHSA has been a key 

member of the council and has funded a number of technical assistance opportunities to promote 

integrated services for people with M/SUD needs, including a policy academy to share effective

practices with states.
Page | 96 

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 behavioral illnesses. The Department of Justice (DOJ) 

and the HHS Office for Civil Rights (OCR) cooperate on enforcement and compliance measures. 

DOJ and 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 evidenced-based supported employment services such as

sheltered workshops. States should ensure block grant funds are allocated to support prevention, 

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.

It is requested that the state submit their Olmstead Plan as a part of this application, or address the 

following when describing community living and implementation of Olmstead:

1. Does the state’s Olmstead plan include: 

Housing services provided ☐ Yes ☐ No

Home and community-based services ☐ Yes ☐ No

Peer support services ☐ Yes ☐ No

Employment services. ☐ Yes ☐ No

2. Does the state have a plan to transition individuals from hospital to community settings? 

☐ Yes ☐ No

3. What efforts are occurring in the state or being planned to address the ADA community 

integration mandate required by the Olmstead Decision of 1999? 

4. .Please indicate areas of technical assistance needed related to this section.

18. Children and Adolescents M/SUD Services –Required for MHBG, Requested for SUPTRS 

BG

MHBG funds are intended to support programs and activities for children and adolescents with 

SED, and SUPTRS BG funds are available for prevention, treatment, and recovery services for 

youth and young adults with substance use disorders. Each year, an estimated 20 percent of 

children in the U.S. have a diagnosable mental health condition and one in 10 suffers from a 

serious emotional disturbance that contributes to substantial impairment in their functioning at 
Page | 97

home, at school, or in the community.63 Most mental disorders have their roots in childhood, with 

about 50 percent of affected adults manifesting such disorders by age 14, and 75 percent by age 

24.64 For youth between the ages of 10 and 14 and young adults between the ages of 25 and 34, 

suicide is the second leading cause of death and for youth and young adults between 15 and 24, 

the third leading cause of death.65 

It is also important to note that 11 percent of high school students have a diagnosable substance 

use disorder involving nicotine, alcohol, or illicit drugs, and nine out of 10 adults who meet 

clinical criteria for a substance use disorder started smoking, drinking, or using illicit drugs before 

the age of 18. Of people who started using substances before the age of 18, one in four will 

develop an addiction compared to one in 25 who started using substances after age 21.66

Mental and substance use disorders in children and adolescents are complex, typically involving 

multiple challenges. These children and youth are frequently involved in more than one

specialized system, including mental health, substance use, primary health, education, childcare,

child welfare, or juvenile justice. This multi-system involvement often results in fragmented and 

inadequate care, leaving families overwhelmed and children’s needs unmet. For youth and young 

adults who are transitioning into adult responsibilities, negotiating between the child- and adultserving systems becomes even harder. To address the need for additional coordination, SAMHSA

is encouraging states to designate a point person for children to assist schools in assuring

identified children relate to available mental health and/or substance use screening, treatment and 

recovery support services.

Since 1993, SAMHSA has funded the Children’s Mental Health Initiative (CMHI) to build the

system of care approach in states and communities around the country. This has been an 

ongoing program with 173 grants awarded to states and communities, and every state has 

received at least one CMHI grant. Since then, SAMHSA has awarded planning and 

implementation grants to states for adolescent and transition age youth SUD treatment and 

infrastructure development. This work has included a focus on financing, workforce

development, and implementing evidence-based treatments. 

For the past 25 years, the system of care approach has been the major framework for improving

delivery systems, services, and outcomes for children, youth, and young adults with mental and/or

SUD and co-occurring M/SUD and their families. This approach is comprised of a spectrum of

effective, community-based services and supports that are organized into a coordinated network. 

This approach helps build meaningful partnerships across systems and addresses cultural and 

linguistic needs while improving the child, youth and young adult functioning in home, school,

and community. The system of care approach provides individualized services, is family driven; 

youth guided and culturally competent; and builds on the strengths of the child, youth or young 

63 Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011. 

MMWR 62(2).

64 Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 

593–602. 65 Centers for Disease Control and Prevention. (2010). National Center for Injury Prevention and Control. Web-based Injury 

Statistics Query and Reporting System (WISQARS) [online]. (2010). Available from www.cdc.gov/injury/wisqars/index.html. 66 The National Center on Addiction and Substance use disorder at Columbia University. (June, 2011). Adolescent Substance use 

disorder: America’s #1 Public Health Problem.
Page | 98 

adult and their family to promote recovery and resilience. Services are delivered in the least 

restrictive environment possible, use evidence-based practices, and create effective cross-system 

collaboration including integrated management of service delivery and costs.67

According to data from the 2017 Report to Congress68on systems of care, services: 

reach many children and youth typically underserved by the mental health system. 

1 improve emotional and behavioral outcomes for children and youth. 

2 enhance family outcomes, such as decreased caregiver stress. 

3 decrease suicidal ideation and gestures.

4 expand the availability of effective supports and services; and

5 save money by reducing costs in high cost services such as residential settings, 

inpatient hospitals, and juvenile justice settings. 

SAMHSA expects that states will build on the well-documented, effective system of care 

approach. Given the multi- system involvement of these children and youth, the system of care 

approach provides the infrastructure to improve care coordination and outcomes, manage costs, 

and better invest resources. The array of services and supports in the system of care approach 

includes: 

• non-residential services (e.g., wraparound service planning, intensive case management, 

outpatient therapy, intensive home-based services, SUD intensive outpatient services, 

continuing care, and mobile crisis response); 

• supportive services, (e.g., peer youth support, family peer support, respite services, 

mental health consultation, and supported education and employment); and

• residential services (e.g., therapeutic foster care, crisis stabilization services, and inpatient 

medical withdrawal management). 

Please respond to the following:

1. Does the state utilize a system of care approach to support: 

a) The recovery of children and youth with SED? ☐ Yes ☐ No

b) The resilience of children and youth with SED? ☐ Yes ☐ No

c) The recovery of children and youth with SUD? ☐ Yes ☐ No

d) The resilience of children and youth with SUD? ☐ Yes ☐ No

2. Does the state have an established collaboration plan to work with other child- and youthserving agencies in the state to address M/SUD needs 

a) Child welfare? ☐ Yes ☐ No

67 Department of Mental Health Services. (2011) The Comprehensive Community Mental Health Services for Children and Their 

Families Program: Evaluation Findings. Annual Report to Congress. Available from 

https://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-Families-ProgramEvaluation-Findings-Executive-Summary/PEP12-CMHI0608SUM 68 https://store.samhsa.gov/sites/default/files/d7/priv/cmhi-2017rtc.pdf
Page | 99 

b) Health care? ☐ Yes ☐ No

c) Juvenile justice? ☐ Yes ☐ No

d) Education? ☐ Yes ☐ No

3. Does the state monitor its progress and effectiveness, around: 

a) Service utilization? ☐ Yes ☐ No

b) Costs? ☐ Yes ☐ No

c) Outcomes for children and youth services? ☐ Yes ☐ No

4. Does the state provide training in evidence-based: 

a) Substance misuse prevention, SUD treatment and recovery services for

children/adolescents, and their families? ☐ Yes ☐ No

b) Mental health treatment and recovery services for children/adolescents and their families? 

☐ Yes ☐ No

5. Does the state have plans for transitioning children and youth receiving services: 

a) to the adult M/SUD system? ☐ Yes ☐ No

b) for youth in foster care? ☐ Yes ☐ No

c) Is the child serving system connected with the FEP and Clinical High Risk for Psychosis 

(CHRP) systems? ☐ Yes ☐ No

d) Does the state have an established FEP program? A CHRP program? ☐ Yes ☐ No

e) Is the state providing trauma informed care? ☐ Yes ☐ No

6. Describe how the state provides integrated services through the system of care (social 

services, educational services, child welfare services, juvenile justice services, law 

enforcement services, substance use disorders, etc.)

7. Does the state have any activities related to this section that you would like to highlight?

8. Please indicate areas of technical assistance needed related to this section. 
Page | 100 

19. Suicide Prevention – Required for MHBG

Suicide is a major public health concern, it is a leading cause of death nationally, with over 

47,000 people dying by suicide in 2021 in the United States. The causes of suicide are complex 

and determined by multiple combinations of factors, such as mental illness, substance use, painful 

losses, exposure to violence, and social isolation. Mental illness and substance use are possible 

factors in 90 percent of the deaths from suicide, and alcohol use is a factor in approximately onethird of all suicides. Therefore, SAMHSA urges M/SUD agencies to lead in ways that are 

suitable to this growing area of concern. SAMHSA is committed to supporting states and 

territories in providing services to individuals with SMI/SED who are at risk for suicide using 

MHBG funds to address these risk factors and prevent suicide. SAMHSA encourages the M/SUD

agencies play a leadership role on suicide prevention efforts, including shaping, implementing, 

monitoring, care, and recovery support services among individuals with SMI/SED.

Please respond to the following: 

1. Have you updated your state’s suicide prevention plan in the last 2 years? ☐ Yes ☐ No

2. Describe activities intended to reduce incidents of suicide in your state.

3. Have you incorporated any strategies supportive of the Zero Suicide Initiative? 

☐ Yes ☐ No

4. Do you have any initiatives focused on improving care transitions for suicidal patients 

being discharged from inpatient units or emergency departments? ☐ Yes ☐ No

If yes, please describe how barriers are eliminated. 

5. Have you begun any prioritized or statewide initiatives since the FFY 2022 - 2023 plan 

was submitted? ☐ Yes ☐ No

If so, please describe the population of focus? 

6. Have you conducted any work using the suicide protocol language with your crisis 

services set-aside? ☐ Yes ☐ No

If so, please describe the work?
Page | 101 

7. Please indicate areas of technical assistance needed related to this section. 

20. Support of State Partners - Required for MHBG

The success of a state’s MHBG and SUPTRS BG programs will rely heavily on the strategic 

partnership that SMHAs and SSAs have or will develop with other health, social services, and 

education providers, as well as other state, local, and tribal governmental entities. Examples of 

partnerships may include: 

• The State Medicaid Authority agreeing to consult with the SMHA or the SSA in the 

development and/or oversight of health homes for individuals with chronic health 

conditions or consultation on the benefits available to any Medicaid populations. 

• The state justice system authorities working with the state, local, and tribal judicial 

systems to develop policies and programs that address the needs of individuals with 

M/SUD who come in contact with the criminal and juvenile justice systems, promote 

strategies for appropriate diversion and alternatives to incarceration, provide screening and 

treatment, and implement transition services for those individuals reentering the 

community, including efforts focused on enrollment; 

• The state education agency examining current regulations, policies, programs, and key 

data-points in local and tribal school districts to ensure that children are safe, supported in 

their social/emotional development, exposed to initiatives that target risk and protective 

factors for mental and substance use disorders, and, for those youth with or at-risk of 

emotional behavioral and SUDs, to ensure that they have the services and supports needed 

to succeed in school and improve their graduation rates and reduce out-of-district 

placements; 

• The state child welfare/human services department, in response to state child and family 

services reviews, working with local and tribal child welfare agencies to address the 

trauma and mental and substance use disorders in children, youth, and family members 

that often put children and youth at-risk for maltreatment and subsequent out-of-home 

placement and involvement with the foster care system, including specific service issues, 

such as the appropriate use of psychotropic medication for children and youth involved in 

child welfare; 

• The state public housing agencies which can be critical for the implementation of 

Olmstead.

• The state public health authority that provides epidemiology data and/or provides or leads 

prevention services and activities; and 

• The state’s office of homeland security/emergency management agency and other partners 

actively collaborate with the SMHA/SSA in planning for emergencies that may result in 

M/SUD needs and/or impact persons with M/SUD conditions and their families and 

caregivers, providers of M/SUD services, and the state’s ability to provide M/SUD

services to meet all phases of an emergency (mitigation, preparedness, response and 
Page | 102

recovery) and including appropriate engagement of volunteers with expertise and interest 

in M/SUD.

• The state’s agency on aging which provides chronic disease self-management and social 

services critical for supporting recovery of older adults with M/SUD. 

• The state’s intellectual and developmental disabilities agency to ensure critical 

coordination for individuals with ID/DD and co-occurring M/SUD conditions. 

• Strong partnerships between SMHAs and SSAs and their counterparts in physical health, 

public health, and Medicaid, Medicare, state and area agencies on aging and educational 

authorities are essential for successful coordinated care initiatives. While the State 

Medicaid Authority (SMA) is often the lead on a variety of care coordination initiatives, 

SMHAs and SSAs are essential partners in designing, implementing, monitoring, and

evaluating these efforts. SMHAs and SSAs are in the best position to offer state partners 

information regarding the most effective care coordination models, connect current

providers that have effective models, and assist with training or retraining staff to provide

care coordination across prevention, treatment, and recovery activities.

• SMHAs and SSAs can also assist the state partner agencies in messaging the importance

of the various coordinated care initiatives and the system changes that may be needed for

success with their integration efforts. The collaborations will be critical among M/SUD 

entities and comprehensive primary care provider organizations, such as maternal and 

child health clinics, community health centers, Ryan White HIV/AIDS CARE Act 

providers, and rural health organizations. SMHAs and SSAs can assist SMAs with 

identifying principles, safeguards, and enhancements that will ensure that this integration 

supports key recovery principles and activities such as person-centered planning and selfdirection. Specialty, emergency and rehabilitative care services, and systems addressing 

chronic health conditions such as diabetes or heart disease, long-term or post-acute care, 

and hospital emergency department care will see numerous M/SUD issues among the 

persons served. SMHAs and SSAs should be collaborating to educate, consult, and serve 

patients, practitioners, and families seen in these systems. The full integration of 

community prevention activities is equally important. Other public health issues are 

impacted by M/SUD issues and vice versa. States should assure that the M/SUD system is 

actively engaged in these public health efforts.

• SAMHSA seeks to enhance the abilities of SMHAs and SSAs to be full partners in 

implementing and enforcing MHPAEA and delivery of health system improvement in 

their states. In many respects, successful implementation is dependent on leadership and 

collaboration among multiple stakeholders. The relationships among the SMHAs, SSAs, 

and the state Medicaid directors, state housing authorities, insurance commissioners, 

prevention agencies, child-serving agencies, education authorities, justice authorities, 

public health authorities, and HIT authorities are integral to the effective and efficient 

delivery of services. These collaborations will be particularly important in the areas of 

Medicaid, data and information management and technology, professional licensing and 

credentialing, consumer protection, and workforce development.

Please respond to the following items:

1. Has your state added any new partners or partnerships since the last planning period?

☐ Yes ☐ No
Page | 103 

2. Has your state identified the need to develop new partnerships that you did not have in place? 

☐ Yes ☐ No

If yes, with whom?

3. Describe the manner in which your state and local entities will coordinate services to 

maximize the efficiency, effectiveness, quality and cost-effectiveness of services and 

programs to produce the best possible outcomes with other agencies to enable consumers to 

function outside of inpatient or residential institutions, including services to be provided by 

local school systems under the Individuals with Disabilities Education Act. 

4. Please indicate areas of technical assistance needed related to this section.

21. State Planning/Advisory Council and Input on the Mental Health/Substance use disorder

Block Grant Application- Required for MHBG

Each state is required to establish and maintain a state Mental Health Planning/Advisory Council 

to carry out the statutory functions as described in 42 U.S. C. 300x-3 for adults with SMI and 

children with SED. To meet the needs of states that are integrating services supported by MHBG 

and SUPTRS BG, SAMHSA is recommending that states expand their Mental Health Advisory

Council to include substance misuse prevention, SUD treatment, and recovery representation, 

referred to here as an Advisory/Planning Council (PC). SAMHSA encourages states to expand 

their required Council’s comprehensive approach by designing and implementing regularly 

scheduled collaborations with an existing substance misuse prevention, SUD treatment, and 

recovery advisory council to ensure that the council reviews issues and services for persons with, 

or at risk, for substance misuse and SUDs. To assist with implementing a PC, SAMHSA has 

created Best Practices for State Behavioral Health Planning Councils: The Road to Planning 

Council Integration.

69 

Planning Councils are required by statute to review state plans and implementation reports; and 

submit any recommended modifications to the state. Planning councils monitor, review, and 

evaluate, not less than once each year, the allocation and adequacy of mental health services 

within the state. They also serve as an advocate for individuals with M/SUD problems. 

SAMHSA requests that any recommendations for modifications to the application or comments to 

69 https://www.samhsa.gov/sites/default/files/manual-planning-council-best-practices-2014.pdf
Page | 104 

the implementation report that were received from the Planning Council be submitted to 

SAMHSA, regardless of whether the state has accepted the recommendations. The 

documentation, preferably a letter signed by the Chair of the Planning Council, should state that 

the Planning Council reviewed the application and implementation report and should be 

transmitted as attachments by the state.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. How was the Council involved in the development and review of the state plan and report? 

Attach supporting documentation (e.g., meeting minutes, letters of support, etc.)

2. What mechanism does the state use to plan and implement community mental health 

treatment, substance misuse prevention, SUD treatment, and recovery support services?

3. Has the Council successfully integrated substance misuse prevention and SUD treatment 

and recovery or co-occurring disorder issues, concerns, and activities into its work? 

☐ Yes ☐ No

4. Is the membership representative of the service area population (e.g., ethnic, cultural,

linguistic, rural, suburban, urban, older adults, families of young children? 

☐ Yes ☐ No 

5. Please describe the duties and responsibilities of the Council, including how it gathers 

meaningful input from people in recovery, families, and other important stakeholders, and 

how it has advocated for individuals with SMI or SED. 

6. Please indicate areas of technical assistance needed related to this section.
Page | 105 

Additionally, please complete the Advisory Council Members and Behavioral Health Advisory 

Council Composition by Member Type forms.70

 Advisory Council Members

Name Type of 

Membership*

Agency or Organization

Represented*

Address 

Phone & 

Fax

Email Address

(If Available) 

**State Mental 

Health Agency

**State Education 

Agency 

**State Vocational 

Rehabilitation Agency 

**State Criminal Justice

Agency 

**State Housing 

Agency 

**State Social Services 

Agency 

**State Medicaid 

Agency 

***State

Marketplace 

Agency 

***State Child Welfare

Agency 

***State Health Agency

***State Agency on 

Aging 

*Council members should be listed only once by type of membership and Agency/organization

represented. 

** Required by Statute. 

***Requested not required 

70 There are strict state Council membership guidelines. States must demonstrate: (1) the involvement of people in recovery and their family 

members; (2) the ratio of parents of children with SED to other Council members is sufficient to provide adequate representation of that 

constituency in deliberations on the Council; and (3) no less than 50 percent of the members of the Council are individuals who are not state 

employees or providers of mental health services. 
Page | 106 

Advisory Council Composition by Member Type

Type of Membership Number Percentage of Total Membership

Individuals in Recovery (to include adults with SMI who are receiving, or 

have received, mental health services)

Family Members of Individuals in Recovery (to include family members of 

adults with SMI)

Parents of children with SED

Vacancies (individual & family members)

Others (Advocates who are not State employees or providers)

Total Individuals in Recovery (to include adults with SMI who are receiving, 

or have received, mental health services), Family Members and Others

State Employees

Providers

Vacancies

TOTAL State Employees & Providers

Individuals/Family Members from Diverse Racial and Ethnic Populations

Individuals/Family Members from LGBTQI+ Populations

Persons in recovery from or providing treatment for

or advocating for SUD services

Representatives from Federally Recognized Tribes

Youth/adolescent representative (or member from an

organization serving young people).

Total Membership (Should count all members of the council)

22. Public Comment on the State Plan- required

Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a 

condition of the funding agreement for the grant, states will provide an opportunity for the public 

to comment on the state block grant plan. States should make the plan public in such a manner as 

to facilitate comment from diverse audiences (including federal, tribal, or other public agencies, 

racial, ethnic, sexual and gender minority populations) both during the development of the plan 

(including any revisions) and after the submission of the plan to SAMHSA.

1. Did the state take any of the following steps to make the public aware of the plan and allow 

for public comment?

a) Public meetings or hearings? ☐ Yes ☐ No

b) Posting of the plan on the web for public comment? ☐ Yes ☐ No

If yes, provide URL: 
Page | 107 

If yes for the previous plan year, was the final version posted for the previous year? 

Please provide that URL:

c) Other (e.g., public service announcements, print media) ☐ Yes ☐ No

d) Please indicate areas of technical assistance needed related to this section.
Page | 108

Acronyms

ACF Administration for Children and Families

ACL Administration for Community Living 

ACO Accountable Care Organization

ACT Assertive Community Treatment

AHRQ Agency for Healthcare Research and Quality 

AI American Indian

AIDS Acquired Immune Deficiency Syndrome 

AN Alaskan Native

ARP American Rescue Plan

AOT Assisted Outpatient Treatment

BHSIS Behavioral Health Services Information System 

BHCS Behavioral Health Crisis Services

CAP Consumer Assistance Programs

CBHSQ Center for Behavioral Health Statistics and Quality 

CCBHC Certified Community Behavioral Health Center

CFR Code of Federal Regulations

CHC Community Health Center

CHIP Children’s Health Insurance Program

CLAS Culturally and Linguistically Appropriate Services 

CMHC Community Mental Health Center

CMS Centers for Medicare and Medicaid Services 

COVID Coronavirus Disease of 2019

CPT Current Procedural Terminology

CSC Coordinated Specialty Care

DSM-V Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

EBP Evidence-Based Practice

EHB Essential Health Benefit

EHR Electronic Health Record 

EIS Early Intervention Services (association with Human Immunodeficiency 

Virus (HIV))

ESMI Early Serious Mental Illness

FFY Federal Fiscal Year

FMAP Federal Medical Assistance Percentage 

FPL Federal Poverty Level

FQHC Federally-Qualified Health Center 

HCPCS Healthcare Common Procedure Coding System 

HHS Department of Health and Human Services

HIE Health Information Exchange 

HIT Health Information Technology 

HIV Human Immunodeficiency Virus (associated with Early Intervention 

Services)

HRSA Health Resources and Services Administration

ICD-10 The International Statistical Classification of Diseases and Related Health

Problems, 10th Revision

ICT Interactive Communication Technology
Page | 109 

IDU Intravenous Drug User 

IMD Institutions for Mental Diseases 

KIT Knowledge Information Transformation (associated with EBP 

implementation)

LGBTQI+ Lesbian, gay, bisexual, transgender, queer/questioning and intersex 

MAUD Medications for Alcohol Use Disorder 

MCO Managed Care Organization

MHBG Community Mental Health Services Block Grant 

MHPAEA Mental Health Parity and Addiction Equity Act 

MOE Maintenance of Effort

M/SUD Mental and/or Substance Use Disorder 

NAS National Academies of Science

NBHQF National Behavioral Health Quality Framework 

NHAS National HIV/AIDS Strategy 

NIAAA National Institute on Alcoholism and Alcohol Abuse 

NIDA National Institute on Drug Abuse 

NIMH National Institute on Mental Health

NOMS National Outcome Measures

NQF National Quality Forum

NQS National Quality Strategy 

OCR Office for Civil Rights 

OMB Office of Management and Budget

PBHCI Primary and Behavioral Health Care Integration 

PBR Patient Bill of Rights 

PHS Public Health Service

PPW Pregnant and Parenting Women

PPWC Pregnant and Postpartum Women and Children 

PWWDC Pregnant Women and Women with Dependent Children

PWID Persons Who Inject Drugs

QHP Qualified Health Plan 

RAISE Recovery After an Initial Schizophrenia Episode

RCO Recovery Community Organization 

RFP Request for Proposal 

SUPTRS BG Substance Use Prevention, Treatment, and Recovery Services

Block Grant 

SAMHSA Substance Abuse and Mental Health Services Administration

SBIRT Screening, Brief Intervention, and Referral to Treatment

SED Serious Emotional Disturbance 

SFY State fiscal year

SEOW State Epidemiological Outcome Workgroup 

SMHA State Mental Health Authority 

SMI Serious Mental Illness 

SPA State Plan Amendment 

SPF Strategic Prevention Framework 

SSA Single State Agency 

SUD Substance Use Disorder
Page | 110

TIP Treatment Improvement Protocol 

TLOA Tribal Law and Order Act 

U.S.C. United States Code

VA U.S. Department of Veterans Affairs
Page | 111 

Resources

TOPIC LINK DESCRIPTION

SAMHSA Block Grants http://samhsa.gov/grants/block-grants

Description of Block Grant, its purpose, deadlines, laws and 

regulations and resources

SAMHSA Topic Search http://www.samhsa.gov/topics

Search SAMHSA's website for resources, information and 

updates by topic or program

SAMHSA Store http://store.samhsa.gov/

Search SAMHSA’s store to download or order publications 

and resources

RESOURCES IN ALPHABETICAL ORDER BY TOPIC/TITLE

TOPIC LINK DESCRIPTION

21st Century Cures Act

https://www.congress.gov/114/bills/hr34/BILLS

-114hr34enr.pdf

Link to the 21st Century Cures Act, which includes the 

section on Helping Families in Mental Health Crisis Reform 

Act of 2016

Center for Integrated 

Health Solutions http://www.integration.samhsa.gov/

HRSA-SAMHSA Center for Integrated Health Solutions 

offers resources, trainings, hot topics, and webinars on 

primary and behavioral health care integration

Characteristics of State 

Mental Health Agency 

Data Systems

http://store.samhsa.gov/product/Characteristicsof-State-Mental-Health-Agency-DataSystems/SMA08-4361

Reviews current information technology (IT) systems and 

technology implementation efforts in state mental health 

agencies. Reports key findings on IT and structure, clientlevel and claims-level data, linking to other state data, and 

electronic health records. (Downloadable report)

Children Mental Health 

https://store.samhsa.gov/product/Comprehensiv

e-Community-Mental-Health-Services-forChildren-and-Their-Families-ProgramEvaluation-Findings-ExecutiveSummary/PEP12-CMHI0608SUM

Presents program evaluation findings of a federally funded 

initiative that supports systems of care for community-based 

mental health services for children, youth, and their families. 

Reports on FFY2010 data that track service characteristics, 

use, and outcomes. (Downloadable report)
Page | 112 

TOPIC LINK DESCRIPTION

Co-Occurring Resources 

and Models http://www.samhsa.gov/co-occurring/

SAMHSA's webpage dedicated to co-occurring models and 

practice. Includes: resources, webinars, public resource links 

and more.

Health Care Integration 

https://www.samhsa.gov/grants/grantannouncements/sm-15-005

Overview of SAMHSA Health Care Integration initiatives 

and links to resources and information about health care 

integration

Health Homes

http://www.integration.samhsa.gov/integratedcare-models/health-homesSAMHSA's description of Health Homes and resources 

around health homes

Healthy People Initiative

http://www.healthypeople.gov/2020/default.asp

x

Government website that reviews the goals of Healthy People 

2030 and provides resources to help meet the goals. 

Health Financing

https://www.samhsa.gov/homelessnessprograms-resources/hpr-resources/healthfinancing-impact-homelessness

SAMHSA guides, trainings and technical assistance resources 

around health reform implementation.

Integrated Treatment for 

Co-Occurring Disorders 

Evidence-Based Practices 

(EBP) KIT

https://store.samhsa.gov/product/IntegratedTreatment-for-Co-Occurring-DisordersEvidence-Based-Practices-EBP-KIT/SMA08-

4366

Provides practice principles about integrated treatment for cooccurring disorders, an approach that helps people recover by 

offering M/SUD services at the same time and in one setting. 

Offers suggestions from successful programs.

LGBTQI+ Populations

https://www.samhsa.gov/behavioral-healthequity/LGBTQI+

Resources on the LGBTQI+ population include national 

survey reports, agency and federal initiatives, and related 

behavioral health resources.

Medicaid Policy Guidance

http://www.medicaid.gov/Federal-Policyguidance/federal-policy-guidance.html

Searchable database of Medicaid Policy Guidance’s; 

including: peer support services, affordable care act, health 

homes, prescription drugs, etc.
Page | 113 

TOPIC LINK DESCRIPTION

Medications for Addiction 

Treatment

http://www.samhsa.gov/medication-assistedtreatment SAMHSA's resources, guides and TIPs 

Mental Health and 

Substance use disorder 

Block Grant Laws and 

Regulations

http://www.samhsa.gov/grants/blockgrants/laws-regulationsLinks to the laws and regulations that govern the Mental 

Health and Substance use disorder Block Grants

Mental Health Crisis

https://store.samhsa.gov/product/CoreElements-for-Responding-to-Mental-HealthCrises/SMA09-4427

Presents guidelines to improve services for people with 

serious mental illness or emotional disorders who are in 

mental health crises. Defines values, principles, and 

infrastructure to support appropriate responses to mental 

health crises in various situations.

National CLAS Standards http://www.ThinkCulturalHealth.hhs.gov

The National Standards for Culturally and Linguistically 

Appropriate Services in Health and Health Care (the National 

CLAS Standards) are intended to advance health equity, 

improve quality, and help eliminate health care disparities by 

providing a blueprint for individuals and health and health 

care organizations to implement culturally and linguistically 

appropriate services.

National HIV/AIDS 

Strategy (NHAS) for the 

United States 

https://www.hiv.gov/federal-response/nationalhiv-aids-strategy/nhas-updateJuly 2010 PDF of the National HIV/AIDS Strategy for the 

United States

National Partnership for 

Action to End Health 

Disparities https://www.minorityhealth.hhs.gov/npa/

Offers an overview and resources to help end health 

disparities
Page | 114 

TOPIC LINK DESCRIPTION

SAMHSA’s EvidenceBased Practices Resource 

Center https://www.samhsa.gov/resource-search/ebp

The Evidence-Based Practices Resource Center (EBPRC) 

provides communities, clinicians, policy-makers and others in 

the field with the information and tools they need to 

incorporate evidence-based practices into their communities 

or clinical settings. The EBPRC contains a collection of 

resources for a broad range of audiences, including 

Guidebooks, Advisories, Treatment Improvement Protocols, 

toolkits, resource guides, and clinical practice guidelines.

National Strategy for 

Suicide Prevention

http://store.samhsa.gov/product/NationalStrategy-for-Suicide-Prevention-2012-Goalsand-Objectives-for-Action/PEP12-

NSSPGOALS

https://www.hhs.gov/sites/default/files/sprccall-to-action.pdf

Outlines a national strategy to guide suicide prevention 

actions. Includes 13 goals and 60 objectives across four 

strategic directions: wellness and empowerment; prevention 

services; treatment and support services; and surveillance, 

research, and evaluation. (Downloadable report) 

The goal of the Call to Action is to broaden perceptions of 

suicide, who is affected, and of the many factors that can 

affect suicide risk. There are a variety of influences at the 

individual, relationship, community, and societal levels that 

can increase suicide risk or precipitate a crisis, including 

social isolation, relationship problems, the loss of a loved 

one, and legal or financial issues. 
Page | 115 

RESOURCES LINK DESCRIPTION

Olmstead

https://www.samhsa.gov/sites/default/files/olmsteadpolicy-academy.pdf

Links to the Olmstead decision document, as well 

as, a report that offers a basic primer on 

supportive housing, as well as a thorough review 

of states’ current Olmstead planning efforts in 

this area

The Essential 

Aspects of Parity: 

A Training Tool for 

Policymakers 

https://store.samhsa.gov/product/essential-aspects-ofparity-training-tool-for-policymakers/pep21-05-00-

001?referer=from_search_result

This document provides an overview of essential 

information necessary for understanding mental 

health and substance use disorder parity and how 

to implement and comply with federal parity 

laws. This guide applies to parity laws in 

employer-sponsored health plans and group and 

individual insurance. 

Approaches in 

Implementing the 

Mental Health 

Parity and 

Addiction Equity 

Act: Best Practices 

from the States

https://store.samhsa.gov/product/Approaches-inImplementing-the-Mental-Health-Parity-and-AddictionEquity-Act-Best-Practices-from-the-States/SMA16-

4983?referer=from_search_result

This report offers best practices for implementing 

the Mental Health Parity and Addiction Equity 

Act of 2008. It covers processes for implementing 

parity and collaborating with other organizations. 

The report also discusses tools for understanding 

and monitoring compliance. 

Prevention of 

Underage Drinking http://www.ncbi.nlm.nih.gov/books/NBK44360/

The Surgeon General's Call to Action To Prevent 

and Reduce Underage Drinking seeks to engage 

all levels of government as well as individuals 

and private sector institutions and organizations 

in a coordinated, multifaceted effort to prevent 

and reduce underage drinking and its adverse 

consequences.

Recovery https://www.samhsa.gov/brss-tacs

SAMHSA's resources, guides and technical 

assistance on recovery
Page | 116 

RESOURCES LINK DESCRIPTION

SAMHSA.gov 

Data Resources http://www.samhsa.gov/data/

Links to SAMHSA data sets including: NSDUH, 

DAWN, NSSATS/NMHSS, TEDS, Uniform 

Reporting System (URS), National and State 

Barometers, etc.

SAMHSA's 

Evidenced Based 

Practice 

Knowledge 

Information 

Transformation 

(KIT)

http://store.samhsa.gov/product/Assertive-CommunityTreatment-ACT-Evidence-Based-Practices-EBPKIT/SMA08-4345

SAMHSA’s Evidence-Based Practice Knowledge 

Informing Transformation (KIT) product on 

Assertive Community Treatment was developed 

to. 

Substance Use 

Disorder for 

Women

https://store.samhsa.gov/sites/default/files/d7/priv/sma13-

4789.pdf

Guidance on components of quality SUD 

treatment services for women, states can refer to 

the documents found at this link 

Suicide Prevention 

https://www.samhsa.gov/suicide-prevention Links to resources and guides around suicide 

prevention and other mental and substance misuse 

prevention topics. 

Synar Program http://samhsa.gov/synar 

Description and overview of the SYNAR 

program, which is a requirement of the SUPTRS 

BG. 

Telehealth Policy 

Resource

https://store.samhsa.gov/sites/default/files/pep21-06-02-

001.pdf

Telehealth Medicaid Policy site that provides 

telehealth laws and reimbursement by state, 

telehealth policy PDF and a review of pending 

legislations
Page | 117 

RESOURCES LINK DESCRIPTION

Trauma & 

Violence 

http://www.samhsa.gov/trauma-violence

https://www.nctsn.org/

Includes information around violence and trauma, 

including the definition and review of trauma 

informed care.

The National Child Traumatic Stress Network 

(NCTSN) is an unique network of frontline 

providers, family members, researchers, and 

national partners is committed to changing the 

course of children’s lives by improving their care 

and moving scientific gains quickly into practice 

across the U.S.

Criminal & 

Juvenile Justice http://www.samhsa.gov/criminal-juvenile-justice

Review of behavioral health services and 

resources in the criminal justice and juvenile 

justice systems.

Tribal Consultation

Memorandum on Tribal Consultation and Strengthening 

Nation-to-Nation Relationships

The White House memorandum regarding the 

requirements related to tribal consultation
Page | 118 

Appendix A

Side-by-side comparison of select required elements for the MHBG and SUPTRS BG

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Biennial Plan 42 USC -6A XVII §300x–1. (b), 

300x–6

Criteria for plan and Application 

for grant

In accordance with subsection (a), 

a State shall submit to the 

Secretary a plan every two years... 

The plan contains requirements for 

the submission of funding 

agreements, certification, 

assurances of compliance, and a 

description of needs, persons 

served, services, resources, 

priorities, goals and objectives.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-32. Application 

for grant; approval of State Plan 

(a) In general; (b) State plan

The plan contains requirements for 

the submission of funding 

agreements, certification, 

assurances of compliance, and a 

description of needs, persons 

served, services, resources, 

priorities, goals and objectives.

Joint 

Application

42 USC 6A, Subchapter XVII, 

Subpart III, 300x–68 

Joint applications

The Secretary, acting through the 

Assistant Secretary for Mental 

Health and Substance Use, shall 

permit a joint application to be 

submitted for grants under subpart 

I and subpart II upon the request 

of a State. Such application may 

be jointly reviewed and approved 

by the Secretary with respect to 

such subparts, consistent with the 

purposes and authorized activities 

of each such grant program. A 

State submitting such a joint 

application shall otherwise meet 

the requirements with respect to 

each such subpart.

42 USC 6A, Subchapter XVII, 

Subpart III, 300x–68

The Secretary, acting through the 

Assistant Secretary for Mental 

Health and Substance Use, shall 

permit a joint application to be 

submitted for grants under subpart 

I and subpart II upon the request 

of a State. Such application may 

be jointly reviewed and approved 

by the Secretary with respect to 

such subparts, consistent with the 

purposes and authorized activities 

of each such grant program. A 

State submitting such a joint 

application shall otherwise meet 

the requirements with respect to 

each such subpart.
Page | 119 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Plan- Tables 

1,2,6

42 USC 6A XVII Part B:§300x–

1.(b) (1)(B); §300x–1.(b) (2) (d) 

(1)

State plan for comprehensive 

community mental health services 

for certain individuals and 

management services

Table 1 provides information on 

priority areas and performance 

indicators. Table 2 requests state 

agency planned expenditures. 

Table 6 requests non-direct 

services/system development 

activities planned expenditures.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-32. Application 

for grant; approval of State Plan 

(b) State plan; (1) In general

Table 1 provides information on 

priority areas and performance 

indicators. Table 2 requests state 

agency planned expenditures. 

Table 6 requests non-direct

services/system development 

activities planned expenditures.

Plan- Tables 3, 

5a, 5b

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-32. Application 

for grant; approval of State Plan 

(b) State plan; (1) In general

Table 3 requests a summary of 

need, and a summary of persons 

served in SUD treatment. Tables 

5a and 5b request a description of 

planned primary prevention 

expenditures.

Set-aside for 

Children

42 USC XVII 6A Part B: §300x–2 

(a)

Allocation for systems of 

integrated services for children

The state must demonstrate the 

amount expended is greater or 

equal to dollars spent to provide 

services for children with SED in 

FY 1994.

N/A Rather than a specific set-aside for 

children, the SUPTRS BG requires 

a 20% Primary Prevention SetAside which focuses primarily on 

children and adolescents, but does 

not require that all activities be 

directed to this population.

Maintenance of 

Effort (MOE)

42 USC XVII 6A Part B: §300x–

4. (b)

Maintenance of effort regarding 

State expenditures for mental 

health

The state must demonstrate the 

state funds expended for the state 

community mental health system 

is at least the average of the two 

years prior.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-30. Maintenance 

of effort regarding State 

expenditures (a) In general; (b) 

Exclusion of certain funds

The methodology for the 

calculation for the SUPTRS BG

MOE expenditure requirement is 

based on an average of the state 

expenditures for the past two state 

fiscal years, but normally includes 

only those funds which flow 

directly through the SSA, so this 

MOE total may or may not include 

state Medicaid funds for SUD 

treatment. CSAT provides states 

with the option of co-designation 

of state Medicaid funds managed 

by another state agency when 

certain criteria are met.
Page | 120 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

MOE-Women N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-22. Certain 

allocations (b) Allocations 

regarding women (1) In general; 

(2) Waiver; (3) Childcare and 

prenatal care

The state is required to expend on 

SUD treatment services for 

pregnant women and women with 

dependent children an amount not 

less than the amount expended for 

such services in FY 1994.

Tuberculosis N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-24. Requirements 

regarding tuberculosis (a) 

Tuberculosis (1) In general; (2) 

Tuberculosis services 

The state is required to routinely 

make available tuberculosis 

services to each individual 

receiving substance use disorder 

treatment services.

Restrictions re 

inpatient 

Hospitalization

42 USC 6A XVII Part B: §300x–5 

Restrictions on use of payments

A funding agreement for a grant 

under section 300x of this title is 

that the State involved will not

expend the grant—

(1) to provide inpatient services.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-31. Restrictions 

on expenditure of grant (b) 

Exception regarding inpatient 

hospital services (1) Medical 

necessity as precondition; (2) Rate 

of payment

The restriction on the use of funds 

for SUD inpatient hospital 

services provides for an exception, 

only if it is determined that an 

individual cannot be effectively 

treated in a community-based, 

non-hospital residential program 

of treatment.

Prohibit Cash 

Payments

42 USC 6A XVII Part B: §300x–5

Restrictions on use of payments

A funding agreement for a grant 

under section 300x of this title is 

that the State involved will not 

expend the grant— to make cash 

payments to intended recipients of 

health services.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-31. Restrictions 

on expenditure of grant (a) In 

general (1) Certain restrictions (B)

A funding agreement for a grant 

under section 300x of this title is 

that the State involved will not 

expend the grant— to make cash 

payments to intended recipients of 

health services.

Planning 

Council

42 USC 6A XVII Part B: 300x–3 

State mental health planning 

council

A funding agreement for a grant 

under section 300x of this title is 

that the State involved will 

establish and maintain a State 

mental health planning council.

N/A Requested or recommended item 

in annual SUPTRS BG

Application/Behavioral Health 

Assessment and Plan, 

Environmental Factors and Plan, 

Advisory Council Members, and 

Advisory Council Composition by 

Member Type.
Page | 121 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Public Input to 

Plan

42 USC 6A XVII Part B: 300x–51

Opportunity for public comment 

on State plans

A funding agreement for a grant 

under section 300x or 300x–21 of 

this title is that the State involved 

will make the plan required in 

section 300x–1 of this title, and 

the plan required in section 300x–

32 of this title, respectively, public 

within the State in such manner as 

to facilitate comment from any 

person (including any Federal or 

other public agency) during the 

development of the plan 

(including any revisions) and after 

the submission of the plan to the 

Secretary.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart iii §300x-51. Opportunity 

for public comment on state plans

Required item in SUPTRS BG

Application/Behavioral Health 

Assessment and Plan, Form 22. 

Public Comment on the State Plan.

10% Set-aside 

for Early SMI

42 USC 6A XVII Part B:300x–

9(c)

Early serious mental illness

...a State shall expend not less than 

10 percent of the amount the State 

receives for carrying out this 

section for each fiscal year to 

support evidence-based programs 

that address the needs of 

individuals with early serious 

mental illness, including psychotic 

disorders, regardless of the age of 

the individual at onset.

N/A N/A

Primary 

Prevention

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-22. Certain 

allocations (a) Allocation 

regarding primary prevention 

programs

The state is required to expend not 

less than 20% of the SUPTRS BG

allocation for persons who do not 

require treatment for a substance 

use disorder.
Page | 122 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Annual Report 2 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart iii §300x-52. Requirement 

of reports and audits by States (a) 

Report

SUPTRS BG and MHBG: The 

state is required to submit to the 

Secretary a report with a 

description of the purposes for 

which the grant received by the 

State for the preceding fiscal year 

under the program involved were 

expended and a description of the 

activities of the State under the 

program.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart iii §300x-52. Requirement 

of reports and audits by States (a) 

Report

The state is required to submit to 

the Secretary a report with a 

description of the purposes for 

which the grant received by the 

State for the preceding fiscal year 

under the program involved were 

expended and a description of the 

activities of the State under the 

program.

Independent 

Peer Review

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart iii §300x-53. Additional 

requirements (a) In general

SUPTRS BG and MHBG: The 

state is required to annually 

provide for independent peer 

review to assess the quality, 

appropriateness, and efficacy of 

treatment services provided in the 

State to individuals under the 

program involved.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart iii §300x-53. Additional 

requirements (a) In general

The state is required to annually 

provide for independent peer 

review to assess the quality, 

appropriateness, and efficacy of 

treatment services provided in the 

State to individuals under the 

program involved.

Persons who 

inject drugs 

(syringe 

services, etc.)

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-23. Intravenous 

substance abuse (a) Capacity of 

treatment programs; (b) Outreach 

to persons who inject drugs

The state is required to ensure that 

each SUPTRS BG funding 

subrecipient maintain an active 

capacity management system, and 

to notify the state upon reaching 

90% of its capacity to admit 

individuals to the program. 

Syringe Services is also a required 

item in annual SUPTRS BG

Application/Behavioral Health 

Assessment and Plan, 

Environmental Factors, Form 23. 

Syringe Services (SSP), and 

Syringe Services (SSP) Program 

Information – Table A.
Page | 123 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

5% set-aside 

for Early 

Identification 

Services (EIS) 

for HIV

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-24. Requirements 

regarding human 

immunodeficiency virus (b) 

Human immunodeficiency virus

Designated states are required to 

expend 5% of each allocation on 

HIV services for individuals in 

SUD treatment who have HIV, or 

who are at risk for HIV.

Recovery 

ResidencesRevolving 

Loan Fund

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-25. Group homes 

for persons in recovery from 

substance use disorders (a) State 

revolving funds for establishment 

of homes

States may establish and maintain 

the ongoing operation of a 

revolving loan fund to support 

group homes for persons in 

recovery from substance use 

disorders.

Services for 

individuals 

with cooccurring 

disorders

42 USC 6A XVII, Part B: 300x–

66

Services for individuals with cooccurring disorders

States may use funds available for 

treatment under sections 300x and 

300x–21 of this title to treat 

persons with co-occurring 

substance use and mental 

disorders as long as funds 

available under such sections are 

used for the purposes for which 

they were authorized by law and 

can be tracked for accounting 

purposes.

42 USC 6A XVII, Part B: 300x–

66

States may use funds available for 

treatment under sections 300x and 

300x–21 of this title to treat 

persons with co-occurring 

substance and mental disorders as 

long as funds available under such 

sections are used for the purposes 

for which they were authorized by 

law and can be tracked for 

accounting purposes.

States are required under 42 USC 

CHAPTER 6A, SUBCHAPTER 

XVII, Part B, subpart ii §300x-32. 

to provide information in the plan 

on the need for substance use 

disorder prevention and treatment 

services in the State, to include 

individuals with a co-occurring 

mental health and substance use 

disorder. 
Page | 124 

Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Professional 

Development

N/A N/A 42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-28. Additional 

agreements (b) Professional 

development

The state is required to ensure that 

prevention, treatment, and 

recovery personnel operating in 

the States’s substance use disorder 

prevention, treatment and recovery 

systems have an opportunity to 

receive training, on an ongoing 

basis, on a number of designated 

topics that would serve to further 

improve the delivery of substance 

use disorder prevention and 

treatment services within the State. 

Crisis Services Consolidated Appropriations and 

Coronavirus Response and Relief 

Supplement Appropriations Act, 

2021 [P.L. 116-260]

Funding was established for states 

to develop centrally deployed 24/7 

mobile crisis units, short-term 

residential crisis stabilization beds, 

evidence-based protocols for 

delivering services to individuals 

with suicide risk, and regional or 

State-wide crisis call centers 

coordinating in real time.

Requested Requested or recommended item 

narrative in annual SUPTRS BG

Application/Behavioral Health 

Assessment and Plan, 

Environmental Factors and Plan, 

Form 15. Crisis Services.

Recovery 42 USC 6A: XVII Part B:300x–1. 

(b) (1)(A) (vii) (IV)

Comprehensive community-based 

health systems

The plan shall provide a 

description of recovery and 

recovery support services for 

adults with a serious mental illness 

and children with a serious 

emotional disturbance.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-32. Application 

for grant; approval of State plan 

(b) State plan

The state is required to provide a 

description of the system that is 

available to provide services by 

modality, including the provision 

of recovery support services.
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Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Children’s 

Services

Required

42 USC 6A XVII, Part B:300–1. 

(b) (1)(C)

Children's services

In the case of children with a 

serious emotional disturbance (as 

defined pursuant to subsection 

(c)), the plan shall provide for a 

system of integrated social 

services, educational services, 

child welfare services, juvenile 

justice services, law enforcement 

services, and substance use 

disorder services that, together 

with health and mental health 

services, will be provided in order 

for such children to receive care 

appropriate for their multiple 

needs (such system to include 

services provided under the 

Individuals with Disabilities 

Education Act).

N/A N/A

Services to 

rural and 

homeless 

populations

42 USC 6A XVII, Part B 300x–1, 

(b) (1) (D)

Targeted services to rural and 

homeless populations

The plan shall describe the State's 

outreach to and services for 

individuals who are homeless and 

how community-based services 

will be provided to individuals 

residing in rural areas.

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-32. Application 

for grant; approval of State Plan 

(a) In general; (b) State plan

States are required to provide 

information in the plan on the 

need for substance use disorder 

prevention and treatment services 

in the State, to include persons 

who are experiencing 

homelessness.

Suicide 

Prevention

42 USC 6A: XVII, Part B:300x–1. 

(b) (1)(A) (vii) (II)

Comprehensive community-based 

health systems

The plan shall provide a 

description of the activities 

intended to reduce incidents of 

suicide for people with SMI and 

SED using the block grant funds.

N/A N/A
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Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Support of 

State Partners

42 USC 6A XVII, Part B:300x–1. 

(b) (1)(A) (iii)

Comprehensive community-based 

health systems

The plan shall include a 

description of the manner in which 

the State and local entities will 

coordinate services to maximize 

the efficiency, effectiveness, 

quality, and cost-effectiveness of 

services and programs to produce 

the best possible outcomes 

(including health services, 

rehabilitation services, 

employment services, housing 

services, educational services, 

substance use disorder services, 

legal services, law enforcement 

services, social services, child 

welfare services, medical and 

dental care services, and other 

support services to be provided 

with Federal, State, and local 

public and private resources) with 

other agencies to enable 

individuals receiving services to 

function outside of inpatient or 

residential institutions, to the 

maximum extent of their 

capabilities, including services to 

be provided by local school 

systems under the Individuals with 

Disabilities Education Act [20 

U.S.C. 1400 et seq.].

42 USC CHAPTER 6A, 

SUBCHAPTER XVII, Part B, 

subpart ii §300x-28. Additional 

agreements (c) Coordination of 

various activities and services

The state is required to coordinate 

SUD prevention and treatment 

activities with the provision of 

other appropriate services 

(including health, social, 

correctional and criminal justice, 

educational, vocational 

rehabilitation, and employment 

services).
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Item MHBG MHBG Notes SUPTRS BG SUPTRS BG Notes

Reporting 

Requirements

42 USC 6A XVII, Part B: 300x–

35, (b) (3)

Core data set

A State that receives a new grant, 

contract, or cooperative agreement 

from amounts available to the 

Secretary under paragraph (1), for 

the purposes of improving the data 

collection, analysis and reporting 

capabilities of the State, shall be 

required, as a condition of receipt 

of funds, to collect, analyze, and 

report to the Secretary for each 

fiscal year subsequent to receiving 

such funds a core data set to be 

determined by the Secretary in 

conjunction with the States.

42 USC 6A XVII, Part B: 300x–

35, (b) (3) Core data set

A State that receives a new grant, 

contract, or cooperative agreement 

from amounts available to the 

Secretary under paragraph (1), for 

the purposes of improving the data 

collection, analysis and reporting 

capabilities of the State, shall be 

required, as a condition of receipt 

of funds, to collect, analyze, and 

report to the Secretary for each 

fiscal year subsequent to receiving 

such funds a core data set to be 

determined by the Secretary in 

conjunction with the States.