1

FY 2014-2015

Block Grant Application

Community Mental Health Services Plan and Report

Substance Abuse Prevention and Treatment Plan and Report

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration
2

Table of Contents

1. Introduction........................................................................................................ 4

a. Background............................................................................................ 4

b. Current Environmental Factors.............................................................. 6

i... The Affordable Care Act ........................................................... 6

ii. Health Insurance Marketplace .................................................. 8

iii. Enrollment and Provider Business Practices/Billing...................9

iv. Primary and Behavioral Health Care Integration Activities.......10

v. Health Disparities.......................................................................14

vi. Use of Evidence in Purchasing Decisions ................................. 15

vii. Evidence-based Prevention and Treatment Approaches............17

viii. Program Integrity....................................................................... 17

ix. Tribes ......................................................................................... 18

x. Prevention .................................................................................. 18

xi. Quality........................................................................................ 23

xii. Trauma ....................................................................................... 24

xiii. Justice......................................................................................... 25

xiv. Parity Education......................................................................... 26

xv. Recovery .................................................................................... 26

xvi. Community Living and the Implementation of Olmstead..........27

xvii. Children and Adolescents Behavioral Health Services ............. 27

xviii. SAMHSA’s Strategic Initiatives................................................ 28

c. Impact on State Authorities and Systems .............................................. 29

d. Block Grant Programs’ Goals................................................................ 40

2. Submission of Application and Timeframes...................................................... 42

3. Behavioral Health Assessment and Plan............................................................ 44

a. Framework for Planning–Mental Health and 

Substance Abuse Prevention and Treatment.......................................... 45

b. Planning Steps........................................................................................ 47

c. Coverage of M/SUD Services................................................................ 69

d. Health Insurance Marketplace .............................................................. 69

e. Program Integrity................................................................................... 71

f. Use of Evidence in Purchasing Decisions ............................................. 72

g. Quality.................................................................................................... 73

h. Trauma ................................................................................................... 74

i. Justice..................................................................................................... 74

j. Parity Education..................................................................................... 76

k. Primary and Behavioral Health Care Integration Activities.................. 76

l. Health Disparities................................................................................... 77

m. Recovery ................................................................................................ 78

n. Prevention .............................................................................................. 80

o. Children and Adolescents Behavioral Health Services ......................... 82

p. Consultation with Tribes........................................................................ 83
3

q. Data and Information Technology......................................................... 84

r. Quality Improvement Plan..................................................................... 84

s. Suicide Prevention ................................................................................. 85

t. Use of Technology................................................................................. 85

u. Technical Assistance Needs................................................................... 86

v. Support of State Partners ....................................................................... 86

w. State Behavioral Health Advisory Council............................................ 87

x. Enrollment and Provider Business Practices/Billing..............................91

y. Comment on the State BG Plan ............................................................. 92

4. Community Mental Health Services Block Grant Reporting Section...... ......... 101

a. Introduction............................................................................................ 104

b. Implementation Report .......................................................................... 106

c. Expenditure Report ................................................................................ 107

d. Population and Services Report............................................................. 115

e. Performance Data and Outcomes........................................................... 134

5. Substance Abuse Prevention and Treatment Block Grant Reporting Section... 157

a._ Introduction............................................................................................ 160

b. Implementation Report .......................................................................... 162

c._ Expenditure Report ................................................................................ 163

d. Population and Services Report............................................................. 184

e._ Performance Data and Outcomes........................................................... 190

6. Required Forms

a. Face Page—Community Mental Health Services Block Grant

b. Face Page—Substance Abuse Prevention and Treatment Block Grant

c. Funding Agreements/Certifications—Community Mental Health Services 

Block Grant

d. Funding Agreements/Certifications—Substance Abuse Prevention and 

Treatment Block Grant

e. Assurances
4

1. INTRODUCTION

This Block Grant Application guidance document is laid out in three major sections: 

introduction, implication for states, and planning. Each of these sections includes 

subsections on the following policy topics: health reform, coverage of mental and 

substance use disorder (M/SUD) services, Health Insurance Marketplace, use of evidence 

in purchasing decisions, program integrity, tribes, quality, trauma, justice, parity 

education, primary and behavioral health1 care integration activities, health disparities, 

recovery, prevention, and children and adolescents behavioral health services. 

A. Background 

In 1981, President Reagan sought and received from Congress a new way of providing 

assistance to states for an assortment of services including substance abuse and mental 

health. Termed “Block Grants”, these grants were originally designed to give states

2

maximum flexibility in the use of the funds to address the multiple needs of their 

populations. This flexibility was given in exchange for reductions in the overall amount 

of funding available to any particular state. Over time, a few requirements were added by 

Congress directing the states’ use of these funds in a variety of ways. Currently, 

flexibility is given to allow states to address their unique issues; however, health care 

systems, laws, knowledge, and conditions have changed. The Substance Abuse and 

Mental Health Services Administration (SAMHSA) now observes a more complex 

interplay between the Block Grants and other funding streams, such as Medicaid, and 

increasing knowledge in the behavioral health field about evidence-based practices, selfdirection, and peer services that require more consistency and direction to ensure that the 

nation’s behavioral health system is providing the best and most cost effective care 

possible. This care is based on the best possible evidence, and tracking the quality and 

outcome of services enables informative reporting. This leads to improvements, which 

can be made as science and circumstances change. 

Since their inception, some assumptions about the nature and use of Block Grants have 

evolved. Over time, Block Grants have become equated with the common practice of 

allowing states to use funds in a generally unrestricted, flexible manner without strong 

accountability measures. Within behavioral health, newer, innovative, and evidencebased services have gone unfunded or without widespread adoption. The nation’s health 

care system is focusing more and more on quality and accountability, and because 

behavioral health care is essential to the nation’s health, the system must do so as well. 

 1 The term “behavioral health” in this document refers to a state of mental/emotional being and/or choices and actions 

that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious 

psychological distress, suicide, and mental and substance use disorders. This includes a range of problems from 

unhealthy stress to diagnosable and treatable diseases like serious mental illnesses and substance use disorders, which 

are often chronic in nature but that people can and do recover from. The term is also used to describe the service 

systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders, 

substance use, and related problems, treatments and services for mental and substance use disorders, and recovery 

support. 

2 References to states in this document include the 50 states and 9 Territories. The SABG also includes the Red Lake 

Band of the Chippewa. Each State designates a Single State Authority responsible for the MHBG and for the SABG.
5

The “science to service” lag and a lack of adequate and consistent person-level data have 

resulted in questions from stakeholders and policy makers, including Congress and the 

Office of Management and Budget (OMB), as to the effectiveness and accountability 

achieved through the two Block Grants administered by SAMHSA.

The Substance Abuse Prevention and Treatment Block Grant (SABG) and the 

Community Mental Health Services Block Grant (MHBG) differ in a number of their 

practices (e.g., data collection at individual or aggregate levels) 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.). 

Historically, the Centers within SAMHSA that administer these Block Grants have had 

different approaches to application requirements and reporting. To compound this 

variation, states have different structures for accepting, planning, and accounting for the 

Block Grants and the prevention set aside within the SABG. As a result, how these 

dollars are spent and what is known about the services and clients that receive these funds 

varies by Block Grant and by state.

In FY 2011, SAMHSA redesigned the FY 2012/2013 MHBG and SABG applications to 

better align with the current federal/state environments and related policy initiatives,

including the Patient Protection and Affordable Care Act (ACA), the Mental Health 

Parity and Addiction Equity Act (MHPAEA), and the Tribal Law and Order Act 

(TLOA). The new design offered states the opportunity to complete a combined 

application for mental health and substance abuse services, submit a bi-annual versus an 

annual plan,3,4 and provide information regarding their efforts to respond to various 

federal and state initiatives. Almost one-half of the states took advantage of this 

streamlined application and submitted combined plans for mental health and substance 

abuse services. Over 95 percent of the states provided specific information requested by 

SAMHSA regarding strategies to respond to a variety of areas including primary care and 

behavioral health integration, recovery support services, prevention of substance use, and 

promotion of emotional health. States continued to provide information regarding the 

spending of their Block Grant funds to support services identified in SAMHSA’s Good 

and Modern Service System brief.

The FY 2014/2015 Block Grant application builds upon the FY 2012/2013 application 

and furthers SAMHSA’s efforts to have states use and report the opportunities offered 

under various federal initiatives. In addition, the FY 2014/2015 Block Grant continues to 

allow states to submit a combined application for mental health and substance abuse 

services as well as a bi-annual versus an annual plan. 

 3 State Plan for Comprehensive Community Mental Health Services for Certain Individuals (Sec. 1912 of Title XIX, 

Part B, Subpart I of the Public Health Service (PHS) Act (42 USC § 300x-2)) 4 State Plan (Sec. 1932(b) of Title XIX, Part B, Subpart II of the Public Health Service (PHS) Act (42 USC § 300x32(b))
6

B. Current Environmental Factors

The Affordable Care Act 

Through the Affordable Care Act, up to 62 million people will benefit from Federal 

parity protections under the ACA. This includes 32 million who will gain coverage for 

behavioral health conditions, including 27 million who are currently uninsured, and 30.4 

million who have some behavioral health benefits and will benefit from federal parity 

protections[1]. According to the National Survey of Drug Use and Health (NSDUH),

approximately 11 million (29 percent) currently uninsured persons below 400 percent of 

FPL have a mental illness or substance use disorder. The Qualified Health Plans (QHPs) 

to be offered by the new Health Insurance Marketplace are required to have sufficient 

mental health and substance abuse providers to assure timely access to mental health and 

substance use disorder services. However, many providers supported by MHBG and 

SABG funds are not sufficiently prepared to be part of the network of providers under 

contract with QHPs, Medicaid and Medicare plans, and commercial insurance plans. It is 

critical for specialty behavioral health providers to be part of integrated care models, 

utilize interoperable electronic health records (EHRs), and bill for and collect insurance 

resources for which persons they serve are eligible in order to maximize limited MHBG 

and SABG funds for those services and those persons not covered by public and 

commercial insurance plans.

The Affordable Care Act also increases access for some important preventive services 

(including screening for various behavioral health conditions) at no additional cost to the

consumer. Finally, the Affordable Care Act stops health insurance issuers from 

retroactively canceling insurance coverage solely because an individual or their employer 

made a mistake on an insurance application.

Since 2010, the Centers for Medicare & Medicaid Services (CMS) have also

implemented significant changes in the Medicare and Medicaid programs. These 

changes will continue to have a significant impact on how State Mental Health 

Authorities (SMHAs) and State Substance Abuse Authorities (SSAs) use their limited 

resources. These changes seek to improve the coordination of care for individuals with 

behavioral health needs and others in primary care settings or transitioning from inpatient 

hospital, nursing facilities, and other settings. Specifically, some states have submitted 

comprehensive 1115 waivers or other innovative demonstration projects for integrated 

care programs that may impact individuals with behavioral health needs, both under 65 

with longer term disabilities and those over 65 with behavioral health needs.

Additionally, associated standards for stakeholder engagement have been issued that 

offer an opportunity for the development of robust stakeholder engagement processes

without any conflicts of interest.

 [1] http://www.samhsa.gov/enrollment/MAEnrollmentReport_01232012.pdf
7

In 2013, the Department of Health and Human Services (HHS) issued final rules on 

Essential Health Benefits and their application to qualified health plans (QHP) offered 

within Health Insurance Marketplace and to Medicaid benchmark coverage, now known 

as “Alternative Benefit Plans.” This guidance states that QHPs and Alternative Benefit 

Plans must provide coverage for mental health and substance use disorder services, 

including behavioral health treatment, and that the provision of this coverage must 

comply with the requirements of the Mental Health Parity and Addiction Equity Act 

(MHPAEA). . 

The Health Insurance Marketplace is designed to make buying health coverage easier and 

more affordable. Starting in 2014, the Marketplace will allow individuals, families and 

small businesses to compare health plans, get answers to questions, and enroll in a health 

plan that meets their needs. It will also allow individuals to find out if they are eligible 

for a new kind of advance tax credit to use immediately to lower the cost of monthly 

health plan premiums or for health programs like Medicaid or the Children’s Health 

Insurance Program (CHIP).

After the full implementation of the Affordable Care Act, SAMHSA strongly 

recommends that Block Grant funds be directed toward four purposes: (1) to fund 

priority treatment and support services for individuals without insurance or for whom 

coverage is terminated for short periods of time; (2) to fund those priority treatment and 

support services not covered by Medicaid, Medicare, or private insurance for low income 

individuals and that demonstrate success in improving outcomes and/or supporting

recovery; (3) to fund primary prevention: universal, selective, and indicated prevention 

activities and services for persons not identified as needing treatment; and (4) to collect 

performance and outcome data to determine the ongoing effectiveness of behavioral 

health promotion, treatment, and recovery support services and to plan the 

implementation of new services on a nationwide basis. State authorities should make 

every effort to ensure that the right recipient is receiving the right payment for the right 

reason at the right time. 

States should determine if established systems and procedures are sufficient to ensure that 

Block Grant funds are expended in accordance with program requirements and directed 

to support, not supplant, health reform activities. States may have to make changes to 

information systems and conduct more compliance reviews to assure better program 

integrity, which may include working closely with Medicaid and Health Insurance 

Marketplace to review information and determine whether individuals and providers in 

their systems are enrolled or implementing strategies to assist their providers to build the 

necessary infrastructures to operate in commercial and public (Medicaid and Medicare). 

States are encouraged to consider developing metrics or targets for their systems to 

measure increases in the number of individuals that become enrolled or providers that 

join commercial or publicly funded managed care networks.
8

Health Insurance Marketplace

The Health Insurance Marketplace is a crucial feature of the Affordable Care Act. 

Starting with coverage availability in January of 2014, the Marketplace will provide

qualified individual consumers, their families, and small businesses the opportunity to 

shop among a variety of affordable health insurance options (the QHPs) in a transparent 

marketplace. QHPs must be certified by meeting certain minimum requirements before 

they will be made available through a Marketplace. The federal government will also 

provide advance payments of premium tax credits and cost sharing reductions to eligible 

individuals in order to make QHPs within the Marketplace more affordable. Eligible 

individuals, with very few exceptions, will be anyone without access to affordable 

minimum essential coverage whose income is under 400 percent of the federal poverty 

level (FPL).

5

The establishment of the Marketplace is also paired with significant reforms to the 

Medicaid and CHIP programs. The Marketplace are required to establish an agreement 

with State Medicaid Agencies (SMAs) to streamline the eligibility determination and 

enrollment process for consumers applying for coverage in insurance affordability 

programs, which include Exchange premium tax credits, cost sharing reductions, and the 

Medicaid program. Additional resources are also available for states to develop a 

significantly more streamlined, data-driven eligibility determination process for Medicaid 

and the Marketplace. The new systems, which states have been actively engaged in 

developing since 2010, will reduce the burden on applicants and state agencies, and help 

to maintain strong program integrity. In addition, the Affordable Care Act requires the

Marketplace to develop outreach and enrollment assistance grant programs to provide 

additional help to applicants in the application and eligibility determination process, 

facilitate enrollment in the selected QHP, and provide information in a culturally and 

linguistically appropriate manner. In-person assistance programs, including Navigators,

6

will play a crucial role in facilitating the enrollment process. Entities eligible to receive 

Navigator grants include: community- and consumer-focused nonprofit groups; trade, 

industry, and professional associations; commercial fishing industry, ranching, and 

farming organizations; chambers of commerce; unions; resource partners of the Small 

Business Administration; licensed agents and brokers; and other public or private entities 

or individuals that meet the requirements. Other entities may include, but are not limited 

to, Indian tribes, tribal organizations, urban Indian organizations, and state or local 

human service agencies. The Congressional Budget Office (CBO) estimates that the 

Affordable Care Act will increase the number of non-elderly Americans who have health 

insurance by more than 25 million, resulting in 90 percent of people having health 

insurance coverage.

7

 5 Minimum Essential Coverage is defined in Section 5000A(f) of the Internal Revenue Code as added by section 1501 

of the Affordable Care Act

6 Section 1311(e)(3)(i) of the Act

7 Congressional Budget Office. CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010. (March 

20, 2011). Retrieved July 2, 2012 from <http://www.cbo.gov/ftpdocs/121xx/doc12119/03-30-

HealthCareLegislation.pdf>
9

At this time, states have identified what format of Marketplace they will use for at least 

the first year. SMHAs and SSAs should now be focused on four main questions related 

to Marketplace: (1)What are the state-specific Medicaid, CHIP, and Marketplace

eligibility determination and enrollment regulations, policies, and systems?; (2) Which 

QHPs are likely going to be operating in the state and what steps do behavioral health 

providers need to take in order to participate in the networks?; (3) What steps are the state 

(or federal) Marketplace organizations taking in establishing a Navigator program and 

what are the standards for participating organizations?; and (4) How is the state (or 

federal) Marketplace determining if the QHP has a sufficient number of providers that 

specialize in mental health and substance abuse?

QHPs must maintain a network of providers that is sufficient in the number and types of 

providers, including providers that specialize in mental health and substance abuse, to 

assure that all services will be accessible without unreasonable delay. Mental health and 

substance abuse providers were specifically highlighted in the final rule, “Patient 

Protection and Affordable Care Act; Establishment of the Marketplace and Qualified 

Health Plans; Marketplace Standards for Employers,”8 to encourage QHP issuers to 

provide sufficient access to a broad range of mental health and substance abuse services, 

particularly in low-income and underserved communities.

Enrollment and Provider Business Practices, including Billing Systems (3 Percent)

Beginning in FY 2014, the Affordable Care Act will provide behavioral health services to 

millions more Americans. To support providers in an effective transition in the first year 

of the ACA, states will be asked to set aside at least three percent each of their MHBG 

and SABG allocations to increase mental and substance use service providers’ capacity to 

bill public and private insurance and to support enrollment into health insurance for 

eligible individuals served in the mental and substance use disorder service system. Both 

mental health and substance abuse providers identify the field’s major needs are: 

education and technical support to improve business management; integration with 

primary care and support for effective deployment of electronic health records; and 

support for billing and scheduling systems that are aligned with public and private 

insurance and the primary care environment. Practitioner’s raised particular concern with 

the lack of providers’ experience (especially peer, recovery, and opioid treatment 

organizations) in negotiating contracts and billing third party payers, ensuring 

compliance, revenue management, and accountability reporting. Any state that receives 

one percent or more of the total amount distributed through the SABG (for carrying out 

section 1921 of the PHS Act) shall expend the amounts through competitive sub awards. 

Any state that receives two percent or more of the total amount distributed through the 

MHBG (for carrying out section 1911 of the PHS Act) shall expend the amounts through 

competitive sub awards.

Three percent of MHBG and SABG allocations should support the following activities: 

 8 77 Fed. Reg. 18,310, at 18470 (Mar. 27, 2012) (to be codified at 45 C.F.R. § 156.230(a)).
10

• Support outreach and enrollment for individuals in need of behavioral health 

services who may be eligible for Medicare, Medicaid, private insurance offered 

through the State and Federally Facilitated Marketplace;

• Redesign of business plans to be responsive to the changing market under the 

Affordable Care Act and MHPAEA, (e.g., development of a strategic plans for the

changing marketplace, identification of new markets, revision of data 

management systems, integration of recovery support and treatment service 

payment systems, negotiating agreements/partnerships with primary care 

organizations, [e.g., Federally Qualified Health Centers (FQHCs)] and other 

provider networks to develop business operations systems that ensure appropriate 

care management across the continuum of services, (e.g. preventive clinical 

services, treatment, referral and recovery support services);

• Development, redesign and/or implementation of improved provider billing 

practices, including practice management and accounts receivable systems that 

address billings, collections, risk management and compliance;

• Build provider capacity for third-party contract negotiations; e.g., negotiating 

contracts for participation in a qualified health plan, or Medicaid managed care 

plan; 

• Coordination of benefits among multiple funding sources, including insurance and 

MHBG/SABG funding; and Adoption of health information technology that 

meets meaningful use standards.

• Adoption of health information technology that meets meaningful use standards.

Use of MHBG and SABG dollars for these purposes will help states assist their specialty 

provider infrastructure to be prepared for the shifting funding environment and maximize 

limited block grant dollars for those individuals, services and activities not otherwise 

funded through other sources.

Primary and Behavioral Health Care Integration Activities

People with serious mental illness (SMI) have elevated rates of hypertension, diabetes, 

obesity, and cardiovascular disease, leading to morbidity and mortality disparities. These 

health conditions are exacerbated by unhealthy lifestyle practices such as lack of physical 

activity, poor nutrition, smoking, substance abuse and side effects of necessary

medication. As a result, those with SMI die on average at 53 years of age. Many of these

conditions are preventable through routine primary care screening, monitoring, treatment,

and care management/coordination strategies. The Massachusetts Department of Mental 

Health (DMH) found that for adults ages 25 to 44, cardiovascular mortality was 6.6 times 

higher among DMH clients than the general population.

9

 13 NASMHPD (2006), NASMHPD Medical Directors Council Technical Report: Morbidity and Mortality in People 

with Serious Mental Illness (Editors: Parks, J.; Svendsen, D.; Singer, P.; Foti, M.) Alexandria, VA14 Freeman, E., Yoe, 

J.T. The Poor Health Status of Consumers of Mental Healthcare: Behavioral Disorders and Chronic Disease, 

Presentation to NASMHPD Medical Directors Work Group, May 2006.15 Horwitz, S. M., Leaf, P. J., Leventhal, J. M., 

Forsyth, B., & Speechley, K. N. (1992). Identification and management of psychosocial and developmental problems in 

community-based primary care pediatric

Seventy percent of Maine’s 
11

population living with SMI has at least one of these chronic health conditions, 45 percent

have two, and almost 30 percent have three or more.10 Integration of behavioral health 

and primary care is just as important for children and youth: studies suggest that 

approximately a quarter of pediatric primary care visits are related to behavioral health 

issues.11,12 The needs of children and youth with SED are best addressed when 

coordinated within a System of Care approach that coordinates cross-sector services, 

including primary care, and a similar coordinated approach should be used to address the 

needs of youth with substance use problems.

Pursuant to the Affordable Care Act, HHS is undertaking several coordinated care 

initiatives. The purpose of these projects is to coordinate and integrate services through 

the co-location of primary and specialty care services in community-based behavioral 

health and primary care settings, all with the goal to improve the physical health status of 

individuals with various behavioral health conditions or at risk of these conditions. 

The passage of the Affordable Care Act has ensured many opportunities to improve 

health care quality through integration of primary and behavioral health care. SAMHSA 

has taken a leading role in the promotion and adoption of primary and behavioral health 

care integration nationwide through a number of different initiatives, including section 

520K of the Public Health Services Act (PHS Act), which authorizes the Primary and 

Behavioral Health Care Integration grants, and Section 2703 of the Affordable Care Act, 

which allows states to establish health homes through their Medicaid program, in 

addition to our ongoing work with the CMS Medicare Medicaid Coordination Office. 

This work includes several very important initiatives: 

• Primary and Behavioral Health Care Integration (PBHCI): This program 

supports community-based behavioral health agencies’ efforts to build the 

partnerships and infrastructures needed to initiate or expand the provision of 

primary healthcare services for people in treatment for SMI and co-occurring SMI 

and substance use disorders. The purpose of this program is to improve the 

physical health status of people with SMI and co-occurring SMI and substance 

use disorders by supporting community-based efforts to coordinate and integrate 

primary health care with mental health services in community-based behavioral 

health care settings. The anticipated outcomes are improved access to primary 

care services; improved prevention, early identification and intervention to reduce 

the incidence of serious physical illnesses, including chronic disease; increased 

availability of integrated, holistic care for physical and behavioral disorders; and

better overall health status of clients.

 14 Freeman, E., Yoe, J.T. The Poor Health Status of Consumers of Mental Healthcare: Behavioral Disorders and 

Chronic Disease, Presentation to NASMHPD Medical Directors Work Group, May 2006.15 Horwitz, S. M., Leaf, P. J., 

Leventhal, J. M., Forsyth, B., & Speechley, K. N. (1992). Identification and management of psychosocial and 

developmental problems in community-based primary care pediatric 15 Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Forsyth, B., & Speechley, K. N. (1992). Identification and management 

of psychosocial and developmental problems in community-based primary care pediatric

practices. Pediatrics, 89, 480–485.16 Cooper, S., et al. (2006). Running out of time: Physician management of 

behavioral health concerns in rural pediatric primary care. Pediatrics, 118, 132–138.
12

The types of services provided include: facilitated screening and referral for 

primary care prevention and treatment needs; assurances that primary care 

screening, assessment, treatment and referral be provided in a community-based 

behavioral health agency; the development and implementation of a registry or 

tracking system to follow primary health care needs and outcomes; prevention 

and wellness support services (utilizing no less than10% of grant funding); and

the establishment of referral and follow-up processes for specialized services 

beyond the primary care setting. Since 2009, SAMHSA has made grant awards to 

64 organizations at up to $500,000 per year for four years. In 2011, SAMHSA 

awarded a one-year health information technology supplement of $200,000 to 47 

grantees.

For more information please visit the website at 

http://www.integration.samhsa.gov.

• HRSA Health Center Grants: The Mental and Behavioral Health Education 

and Training Grants Program (MBHETG) is authorized through Title VII, Section 

756 of the PHS Act (U.S.C. 294e-1), as amended by Sec. 5306(a) of the 

Affordable Care Act, Public Law 111-148, to support eligible institutions of 

higher education with accredited health professions training programs in social 

work and psychology to recruit students and provide education and clinical 

experience in mental and behavioral health. Section 750 (a) of the PHS Act 

requires that academic institutions receiving assistance under Title VII, Part D of 

the PHS Act, Interdisciplinary Community-Based Linkages, must use the funds in 

collaboration with two or more disciplines. The program aims to increase the 

number of social workers and psychologists who pursue clinical work with high 

need and high demand populations. In this context, “high need and high demand”

refers to rural, vulnerable, and/or underserved populations, and veterans, military 

personnel and their families. The funding for this announcement is provided 

through the Affordable Care Act's Prevention and Public Health Fund (Section 

4002 (42 U.S.C. 300 u-11)). 

• Medicare-Medicaid Enrollees: CMS’ Federal Coordinated Health Care Office 

(Medicare-Medicaid Coordination Office) serves people who are enrolled in both 

Medicare and Medicaid (also known as dual eligibles). The Medicare Medicaid 

Coordination Office within CMS brings together officials of the Medicare and 

Medicaid programs to more effectively integrate benefits under those programs 

and improve the coordination between States and the federal government.

Some states have submitted requests for demonstrations for integrated care 

programs for dual eligible that may impact individuals with behavioral health 

needs, both under 65 with longer term disabilities and those over 65 with 

behavioral health needs. States are required to implement a robust stakeholder 

engagement process when developing their proposals.
13

• Accountable Care Organizations: HHS has implemented several initiatives 

involving Accountable Care Organizations (ACOs). ACOs help doctors, 

hospitals, and other health care providers better coordinate care for Medicare 

beneficiaries. The opportunity for ACOs to share in the savings with the 

Medicare program creates an incentive for health care providers to work together 

to treat an individual patient across care settings, including doctors’ offices, 

hospitals, and long-term care facilities. The final rule establishing the Medicare 

Shared Savings Program which includes the Pioneer ACOs, initiated over the past 

year, provides for monitoring to ensure that ACOs do not discriminate against 

certain populations (e.g., individuals with a substance use disorder) and require 

that all data sharing with ACOs complies with the protections under 42 CFR Part 

2 for information regarding substance abuse treatment, education, etc. 

• Health Homes; Patient-Centered Medical Home: Numerous provisions in the

Affordable Care Act contain funding or initiatives to improve the coordination of 

care for patients. One of these is through the promotion of Medicaid health 

homes authorized under Section 2703 of the Affordable Care Act, where States 

can qualify for increased Federal assistance to coordinate care for patients with 

chronic conditions. SAMHSA has consulted with more than fifteen states in their 

efforts to take advantage of the Medicaid Health Home provisions.

• Million Hearts Campaign: The CDC’s Million Hearts Campaign is an 

unprecedented national initiative that was launched by HHS in September 2011 to 

prevent 1 million heart attacks and strokes over five years. The Million Hearts 

initiative has and will continue to focus, coordinate, and enhance cardiovascular 

disease prevention activities across the public and private sectors while 

demonstrating to the American people that improving the health system can save 

lives. Million Hearts will scale-up proven clinical and community strategies to 

prevent heart disease and stroke across the nation. 

http://millionhearts.hhs.gov/index.html

• Wellness Initiative: The SAMHSA Wellness Initiative in an ongoing effort to 

educate the general public, providers, and individuals about the early mortality of 

individuals with mental and substance use disorders that co-occur with 

preventable medical conditions, such as cardiovascular disease, diabetes, and 

respiratory illnesses. The program seeks to reduce the rate of early mortality of 

through a state and community level approach.

Another concern of SAMHSA and its HHS partners is that individuals with mental or 

substance use disorders have much higher rates of smoking tobacco relative to the 

general population. In particular, individuals with schizophrenia have one of the highest 

rates of smoking (58-88 percent).13

 13 Kalman D, Morrisette SB, George TP. Co-morbidity of smoking with psychiatric and substance use disorders. Am J

Addict. 2005;14:106–23.

 In a population-based study of smoking prevalence 

in the U.S., Lasser and colleagues found that smoking prevalence among persons with 
14

and without a psychiatric disorder were 41 percent and 22.5 percent, respectively.14 The 

highest prevalence (67.9 percent) was found among persons with drug abuse.15

http://www.samhsa.gov/healthReform/healthHomes/index.aspx

 

SAMHSA has developed several national initiatives regarding primary care and 

behavioral health coordination to combat this additional risk factor and lower these 

disconcerting statistics. Information regarding these initiatives can be found at: 

Health Disparities

In accordance with the disparity-focused provisions of the Affordable Care Act, 

SAMHSA expects Block Grant dollars to support the reduction of disparities in access, 

services provided, and behavioral health outcomes among its diverse subpopulations. 

Grantees should collect and utilize data to: (1) identify subpopulations (i.e., racial, ethnic,

limited English speaking, tribal, sexual/gender minority groups, and people living with 

HIV/AIDS or other chronic diseases/impairments) 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. A strategy for 

addressing health disparities is use of the recently revised national Culturally and 

Linguistically Appropriate Services (CLAS) standards: 

http://www.ThinkCulturalHealth.hhs.gov.

The Affordable Care Act directed the Secretary of HHS to develop a plan to address 

health disparities and to develop standard guidelines for the collection of data to assess

these disparities. In April 2011, the Secretary released the Action Plan to Reduce Racial 

and Ethnic Health Disparities.

16 This plan outlines goals and actions that HHS agencies, 

including SAMHSA, will take to reduce health disparities among racial and ethnic 

minorities. Agencies are required to continuously assess the impact of their policies and 

programs on health disparities. 

The top Secretarial priority in the Action Plan is to “[a]ssess and heighten the impact of 

all HHS policies, programs, processes, and resource decisions to reduce health 

disparities. HHS leadership will assure that...program grantees, as applicable, will be 

required to submit health disparity impact statements as part of their grant applications. 

Such statements can inform future HHS investments and policy goals, and in some 

instances, could be used to score grant applications if underlying program authority 

permits.” In October 2011, in accordance with section 4302 of the Affordable Care Act, 

HHS issued final standards on the collection of race, ethnicity, primary language, and 

disability status.17

 14 Ibid.

 This guidance conforms to the existing OMB directive on 

racial/ethnic categories with the expansion of intra-group, granular data for the Latino 

and the Asian-American/Pacific Islander populations. In addition, SAMHSA and all 

other HHS agencies are in the process of updating their limited English proficiency plans 

and, in accordance with current and updated planning, will expect Block Grant dollars to 

support a reduction in disparities related to access, service use, and outcomes that are 

15 Ibid. 16 http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 17 http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208
15

associated with limited English proficiency. These three departmental initiatives, along 

with SAMHSA’s and HHS’s attention to disparities within and special service needs of 

tribal populations, LGBTQ populations, and women and girls, provide the foundation for 

addressing health disparities in the service delivery system. Additionally, 67% of 

American Indian and Alaska Natives live off-reservation.18 States provide behavioral 

health services to these individuals with state Block Grant dollars. While the Block 

Grant generally requires the use of evidence-based practices, consideration is given to the 

fact that many of these practices have not been normed on various diverse racial and 

ethnic populations. Therefore flexibility in the use of evidence-based practices, 

adaptation, and alternative practices may be allowed in special circumstances.

Use of Evidence in Purchasing Decisions

There is increased interest in having a better understanding of the evidence that supports 

the delivery of medical and specialty care including mental health and substance abuse 

services. Over the past several years, SAMHSA has received many requests from CMS, 

Health Resources and Services Administration (HRSA), state Medicaid agencies, state 

behavioral health authorities, legislators, and others regarding the evidence of various 

mental health and substance abuse prevention, 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. Increasingly, evidence finds that even some of the most popular and widely

disseminated programs are not evidence-based and can, in fact, be counterproductive 

(Goldman, et al., 2001). SAMHSA also acknowledges that evidence-based practices 

have not been tested in all population groups and that there is a possible impact of 

cultural factors in implementation of evidence-based services. In addition, the National 

Quality Forum and the Institute of Medicine (IOM) have recommended that evidence 

play a critical role in designing health and behavioral health benefits for individuals 

enrolled in commercial insurance, Medicaid, and Medicare.

To respond to these inquiries and recommendations, SAMHSA has undertaken several 

activities. Since 2001, SAMHSA has sponsored a National Registry of Evidenced-based 

Programs and Practices (NREPP). NREPP is a searchable online registry of more than 

220 interventions supporting mental health promotion and treatment and substance abuse 

prevention and treatment. The purpose of NREPP is to connect members of the public to 

intervention developers so that they can learn how to implement these approaches in their 

communities. The FY 2014 Budget includes a proposal to strengthen and update NREPP 

to include new interventions, up-to-date results for ongoing interventions, and research 

outcomes. Improving NREPP will increase the information on evidence-based practices 

available to agency staff and stakeholders to inform decisions that can lead to improved 

service activities and outcomes for individuals.

 18 Norris, T., Vines, P.L., and Hoeffel, E.M. The American Indian and Alaska Native Population: 2010. U.S. Census 

Bureau, January 2012.
16

In 2010, SAMHSA began a process to review the strength of the evidence of many 

services that were identified in SAMHSA’s Good and Modern Mental Health and 

Substance Abuse Services brief. SAMHSA reviewed and summarized the current 

evidence for a wide range of interventions for individuals with mental and substance use 

disorders, including youth and adults with chronic addiction disorders, adults with serious 

mental illness, and children and youth with serious emotional disturbances. It builds 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 (National 

Institute of Mental Health (NIMH), 1999),

19 The New Freedom Commission on Mental 

Health (Department of Health and Human Services, 2003),

20 the Institute of Medicine

(IOM) (National Academies Press, 2006),

21 and the National Quality Forum (National 

Quality Forum, 2007).

22 The review was a systematic assessment of the current research 

findings for the effectiveness of the services using a strict set of evidentiary standards. 

SAMHSA provided SMHAs and SSAs with information they could use to educate 

policymakers and purchasers about the evidence base for many mental health and 

substance abuse interventions. SAMHSA and other federal partners (CMS, 

Administration for Children and Families (ACF), and Office of Civil Rights (OCR)) have 

used this information to sponsor technical expert panels that provide specific 

recommendations to the behavioral health field regarding what the evidence indicates 

works and for whom, identify specific strategies for embedding these practices in 

provider organizations, and recommend additional service research. 

In addition to evidence-based practices, there are also promising practices. These are 

services that have not yet had the opportunity to be studied and become evidence-based 

practices, but anecdotal data and early studies indicate that they are effective.

SAMHSA’s Treatment Improvement Protocols (TIPs) are best practice guidelines for the 

treatment of substance abuse. The Center for Substance Abuse Treatment’s (CSAT)

Division of Services Improvement 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 substance abuse treatment facilities as 

alcohol and other drug disorders are increasingly recognized as a major problem.

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KITs) were 

developed to help move the latest information available on effective behavioral health 

practices into community-based service delivery. States, communities, administrators, 

practitioners, consumers of mental health care, and their family members can use the 

 19 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. 20 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 Abuse and 

Mental Health Services Administration.

21 Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive 

Disorders (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm 

Series. Washington, DC: National Acadamies Press.

22 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use 

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. 
17

KITs to design and implement behavioral health practices that work. The KITs, part of 

SAMHSA’s priority initiative on Behavioral Health Workforce–In Primary and Specialty 

Care Settings, cover 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. 

Evidence-Based Prevention and Treatment Approaches (5 Percent)

In FY 2014, states should take the scientific developments of the last 25 years into 

account and prioritize proven mental illness prevention, emotional health promotion, and 

treatment/recovery support approaches as they develop comprehensive and coordinated 

plans to address mental disorders. Evidence is growing about treatment approaches and 

system designs that can help to prevent and/or mitigate the disabilities caused by serious 

and persistent mental illness and severe emotional disturbances. This includes findings 

from the National Institute of Mental Health’s (NIMH) emerging work on early 

intervention with first break psychosis and the findings from SAMHSA’s mental health 

discretionary portfolio serving children and youth with the most serious mental disorders, 

In FY 2014, SAMHSA will work with states to utilize at least five percent of their 

MHBG funds to award competitive grants to implement the most effective evidencebased prevention and treatment approaches, focusing on promotion, prevention and early 

intervention. This new set-aside and focus will be used by states to demonstrate how 

both MHBG and other funding streams can be utilized in the changing funding and 

service delivery environment to have the most positive impact on the health and wellbeing of the persons and communities served through these set-aside awards. States that 

receive two percent or more of the total FY 2014 state allotment will be required to 

implement a competitive sub award process for their funds. Any state that receives two 

percent or more of the total amount distributed through the MHBG (for carrying out 

section 1911 of the PHS Act) shall expend the amounts through competitive sub awards.

Program Integrity

SAMHSA has placed 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 have a strong approach to assuring program integrity. Currently, the primary 

goals of SAMHSA program integrity efforts are to (1) promote the proper expenditure of 

Block Grant funds, (2) improve Block Grant program compliance nationally, and (3) 

demonstrate the effective use of Block Grant funds. The Affordable Care Act will have 

an impact on federal Block Grants and discretionary funds and therefore will also impact 

SAMHSA’s (and the states’) program integrity efforts. As indicated earlier in the 

document, SAMHSA is strongly recommending that states use the MHBG and SABG
18

resources to support, not supplant, individuals and services that will be covered through 

QHPs and Medicaid. This will require that SAMHSA change the lens through which it 

views its program integrity activities. Specifically, SAMHSA will provide additional 

guidance to the states to assist them in complying with SAMHSA’s Block Grant 

recommendation; develop new and better tools for reviewing the Block Grant application 

and reports, and train SAMHSA staff, including regional administrators in these new 

program integrity approaches and tools. In addition, SAMHSA will work with CMS and 

states to discuss possible strategies for sharing data and information to assist our program 

integrity efforts. 

Tribes

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. 

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 which results in effective collaboration 

and informed decision-making. 

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 federallyrecognized Indian tribal governments located within or governing tribal lands within their 

borders to solicit their input during the Block Grant planning process. Evidence these 

actions have been performed by the state should be reflected throughout the state’s plan. 

In further recognition of strengthening state/tribal relations, tribal governments shall not 

be required to waive sovereign immunity as a condition of receiving Block Grant funds 

or services.

Prevention

One of SAMHSA’s eight strategic initiatives articulated in Leading Change: A Plan for 

SAMHSA’s Roles and Actions 2011–2014 is the Prevention of Substance Abuse and 

Mental Illness: “creating communities where individuals, families, schools, faith-based 

organizations, and workplaces take action to promote emotional health and reduce the 

likelihood of mental illness, substance abuse including tobacco, and suicide. This 

initiative will include a focus on the nation’s high-risk youth, youth in tribal 

communities, and military families.” 
19

To support that initiative, SAMHSA promotes the use of its Strategic Prevention 

Framework (SPF), which uses a five-step process known to promote youth development, 

reduce risk-taking behaviors, build assets and resilience, and prevent problem behaviors. 

The SPF is built on a community-based risk and protective factors approach to prevention 

and a series of guiding principles that can be adapted and utilized at the federal, 

state/tribal, and community levels. The idea behind SPF is to use the findings from 

public health research along with evidence-based prevention programs to build capacity 

within states, territories, tribes, and the prevention field. For SABG purposes, the term 

“state” includes the fifty states, the District of Columbia, the Commonwealth of Puerto 

Rico, the U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the 

Northern Mariana Islands, Palau, Micronesia and the Marshall Islands, and the Red Lake

Band of Chippewa Indians. This framework will promote resilience and decrease risk 

factors in individuals, families, and communities.

Implementing evidence-based practices requires cooperation across a variety of 

community settings and service systems for all segments of the population, especially 

those who are at high risk for mental and substance use disorders. These settings include,

but are not limited to, health care, homes, childcare, child welfare, schools, juvenile and 

criminal justice systems, substance abuse treatment, and mental health services. In 

addition to program and practice improvements, a key part of a comprehensive 

prevention strategy is policy changes and environmental strategies, such as promoting the 

establishment or review of alcohol, tobacco, and drug use policies in schools; technical 

assistance to communities to maximize local enforcement procedures governing 

availability and distribution of alcohol, tobacco, and other drugs; modifying alcohol and 

tobacco advertising practices; product pricing strategies; social marketing; bullying 

policies and practices; laws regarding violence in or around schools; and child welfare 

laws and systems. Coordinated and targeted prevention programs in a range of settings 

together with research-supported environmental strategies can and will reduce the 

incidence of mental and substance use disorders.

In implementing the primary prevention comprehensive program, states should use a 

variety of programs, policies, practices, and strategies that target populations with 

different levels of risk. Prevention can be classified according to the traditional public 

health definitions of primary, secondary, and tertiary prevention, as well as the more 

recent classification advanced by the IOM. In the IOM model, the prevention category is 

divided into three classifications that are directed at whole populations and subsets of 

populations as follows: universal, selective, and indicated. The primary prevention of the 

onset of mental, emotional, behavioral, and substance use related problems may be best 

achieved by using a combination of universal and selective approaches. 

An earlier IOM23

 23 Institute of Medicine (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. 

P.J. Mrazek & R.J. Haggerty, Editors. Committee on Prevention of Mental Disorders, Division of Biobehavioral 

Sciences and Mental Disorders. Washington, DC: National Academies Press.

report proposed a framework for classifying preventive interventions 

by the population targeted. Under this classification, universal interventions target the 
20

entire population, selective interventions target specific sub-populations whose risk of a 

disorder is significantly higher than average, and indicated interventions target 

individuals or communities who are exhibiting indicators that are at higher risk of 

developing a substance abuse disorder or an environment which supports risk behavior. 

“Universal strategies, whether implemented through the mass media, legislation, 

community-wide interventions, change in cultural norms, or other types of efforts, can 

reach broad segments of the population. Selective procedures can target classes of 

individuals who have a high probability of developing a problem outcome with 

interventions of greater scope and intensity than would be necessary, practical, or 

affordable in a universal approach.”24

The MHBG statute currently directs funding only to those children and adults with the 

most severe disorders without recognizing the growing science about preventing mental 

disorders or preventing the disability caused by early onset of such disorders through 

earlier intervention. The scientific understanding of mental health promotion and mental 

illness prevention was not well-known or developed when the MHBG was first 

authorized in the 1980s. Since that time, the knowledge base of effective mental health 

promotion and mental illness prevention and mitigation approaches has rapidly expanded 

via research findings, the identification of best practices in community coordination, and 

proven planning processes such as the Strategic Prevention Framework. SAMHSA 

efforts such as Project LAUNCH, Safe Schools/Healthy Students, Implementing 

Evidence-Based Prevention Practices in Schools, along with suicide prevention activities 

have demonstrated that such approaches can achieve successful outcomes. The landmark 

2009 Institute of Medicine report, Preventing, Mental, Emotional, and Behavioral 

Disorders Among Young People, and the Clinical Manual of Prevention in Mental Health

(Michael Compton, MD, ed.) clearly defined and delineated the efficacy of such models. 

These models can ultimately assist states and the nation as a whole reduce the future 

prevalence along with the human and financial costs of mental and substance use 

disorders.

MHBG and SABG funds have the flexibility to support this targeted approach. States 

may use some of their current MHBG to support services that are preventative in nature 

for adults with serious mental illness (SMI) and children with serious emotional disorders 

(SED) and their families. Such services (e.g., Screening, Brief Intervention, and Referral 

to Treatment (SBIRT)) can help promote early intervention and prevent future worsening 

of mental disorders. In the meantime, SAMHSA is working with states to increase their 

accountability systems for prevention and to develop necessary reporting capacities. For 

example, in the FY 2012/2013 uniform block grant application, SAMHSA requested 

states to provide the most recent copy of the state’s suicide prevention plan or describe 

when the state would create or update the state’s suicide prevention plan. States are then 

 24 National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral 

Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and 

Substance Abuse among Children, Youth and Young Adults: Research Advances and Promising Interventions. Mary 

Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, editors. Board on Children, Youth, and Families, division of 

Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
21

to report any updates on the plans’ progress since that time and to attach a new or 

updated suicide prevention plan to the FY 2014/2015 Uniform Block Grant Application.

Consistent with SAMHSA’s emphasis on prevention in states, territories, tribes, and 

communities, SAMHSA is encouraging states to provide a coordinated and combined 

plan addressing services and activities for the primary prevention of mental and substance 

use disorders (including the use of universal, selective, and indicated strategies) in the 

planning section of the current Block Grant application. In so doing, SAMHSA 

encourages coordination with partners responsible for early childhood and education as 

well as with community coalition partners working to address prevention of substance 

abuse and other adolescent prevention activities. SAMHSA also encourages coordination 

and collaboration with partners representing senior services to address prevention of 

depression, suicide and prescription drug abuse among older adults.

Some of the information provided in response to this Block Grant Application will apply 

to the prevention grants. Recent data on youth drug use from the Monitoring the Future 

Survey highlights both the success of prevention and the need for additional prevention 

efforts. Specifically, data from the 2011 survey show that both alcohol and tobacco use 

among youth are at historically low rates: these are prevention success stories. However, 

marijuana use has increased, youths’ perception that marijuana use is harmful has 

decreased, and prescription drug abuse continues to be a problem, highlighting the need 

for continued prevention efforts aimed at these substances, as well as continued vigilance 

on keeping tobacco and alcohol use rates low.

In times of declining federal, state, and local resources, states need to make the most 

efficient use of substance abuse prevention funds, which should be used to support 

evidence-based substance abuse programs and practices. Many evidence-based substance 

abuse prevention programs have a positive impact on the prevention of substance use and 

abuse as well as other health and social outcomes such as education, juvenile justice 

involvement, violence prevention, and mental health. States must be prepared to report 

the outcomes of their efforts on substance abuse-related attitudes and behaviors. This 

means that state-funded prevention providers will need 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 

abuse prevention system. Thus, states must describe how all substance abuse prevention 

dollars in the state are planned and coordinated for a comprehensive, evidence-based, and 

effective substance abuse prevention system. States should include the SABG 20 percent 

set-aside for substance abuse primary prevention, the Strategic Prevention Framework 

State Incentive Grant (SPF-SIG), the Partnerships for Success (PFS) grant and other 

federal, state, and local dollars.

Current Environmental Factors regarding Substance Abuse Primary Prevention and 

Mental Health Promotion and Mental Illness Primary Prevention

SAMHSA requires that States spend no less than 20 percent of their SABG allotment on 

substance abuse primary prevention programs, and many states elect to spend a higher 
22

percentage. The Interim Final Rule for substance abuse primary prevention, §96.125 (a), 

and for purposes of §96.124, states that “each State/Territory shall develop and 

implement a comprehensive substance abuse primary prevention program which includes 

a broad array of substance abuse primary prevention strategies directed at individuals not 

identified to be in need of treatment. The 20% set aside funds of the Substance Abuse 

Block Grant must be used only for substance abuse primary prevention activities by the 

State. The comprehensive substance abuse primary prevention program shall include 

activities and services provided in a variety of settings for both the general population as 

well as targeting subgroups who are at high risk for substance abuse.” 

At this critical point in time, Single State Authorities should be focused on following the 

SPF Logic Model to develop a comprehensive plan for substance abuse primary 

prevention programming that includes the following main areas: 

(1) Ensuring data on substance use consumption and consequences are collected 

and analyzed to identify the substances of abuse and populations that should 

be targeted with prevention set-aside funds; 

(2) Ensuring prevention activities and services purchased with SABG funds are 

both consistent with this needs assessment data and are not being funded 

through other public or private sources, including private commercial health 

insurance or Medicaid; 

(3) Developing capacity throughout the state to implement a comprehensive 

approach to substance abuse issues identified by their SEOW or other 

statewide epidemiological work group; 

(4) Collaborating with natural partners within the communities and state to focus 

on health and wellness to assist in the implementation of the newly revised 

Comprehensive Prevention Plan for their state; 

(5) Including the use of environmental strategies to assist with the goal of 

behavior change, e.g., parental/community attitudes on underage drinking; 

and,

(6) Collecting and analyzing outcome data to ensure the most cost-efficient use of 

substance abuse primary prevention funds. 

As specified in 45 C.F.R. 96.125(b), states shall use a variety of evidence-based 

programs, policies, and practices that include information dissemination, education, 

alternatives, problem identification and referral, community-based processes, and 

environmental strategies. It is important to note that classification of preventive 

interventions by strategy and by IOM category is not mutually exclusive, as strategy 

classification indicates the type of activity while IOM classification indicates the 

population served by the activity. It is SAMHSA’s expectation that prevention set-aside 

funding be used to fund substance abuse prevention interventions in all six strategies that 

target universal, indicated, and selective populations.

Quality
23

SAMHSA will implement a comprehensive and practical approach to improving the 

quality and outcomes of behavioral health services. To meet this challenge, SAMHSA 

will focus on improvement in access to and utilization of services, service quality, and 

outcomes of prevention, treatment, and recovery support services. This requires 

addressing a number of systems and measurement issues, including the development of 

consistent definitions and formulae for the calculation of measures. Additionally, 

SAMHSA will work closely with those in the field to advance the adoption of Electronic 

Health Record (EHR) systems, particularly among behavioral health providers, and the 

promotion of greater systems interoperability between behavioral health care, primary 

care, and general medicine.

In conjunction with HHS’s National Quality Strategy, SAMHSA has created the National 

Behavioral Health Quality Framework (NBHQF). The NBHQF complements the 

broader National Quality Strategy (NQS) being advanced by the federal government. 

Both the NQS and the NBHQF will pursue three broad aims to improve the quality of 

health and behavioral health care nationally and within states, communities, territories, 

and tribes:

• Better Care: Improve the overall quality, by making behavioral health care more 

person-, family-, and community-centered, reliable, accessible, and safe.

• Healthy People/Healthy Communities: Improve the behavioral health of the 

U.S. population by supporting proven interventions to address behavioral, social, 

cultural, and environmental determinants of positive behavioral health in addition 

to delivering higher-quality behavioral health care.

• Affordable Care: Increase the value of behavioral health care for individuals, 

families, employers, and governments.

To advance these aims, SAMHSA will initially focus on six priorities that generally 

parallel those within the NQS. They are:

• Promote the most effective prevention, treatment, and recovery practices for 

behavioral health disorders;

• Assure behavioral health care is person-, family-, and community-centered;

• Encourage effective coordination within the behavioral health care field and 

between behavioral health care providers and other health care, recovery, and 

social support services;

• Assist communities to utilize best practices to enable healthy living;

• Make behavioral health care safer by reducing harm caused in the delivery of 

care; and

• Foster affordable, high-quality behavioral health care for individuals, families, 

employers, and governments by developing and advancing new—and recoveryoriented—delivery models.

SAMHSA recently made a policy decision to provide a coordinated approach to 

collecting facility and client-level data from states to reduce redundancy among 
24

SAMHSA’s data collection efforts and data systems, thereby reducing the reporting 

burden on state agencies. In the FY13, under the direction of the Center for Behavioral 

Health Statistics and Quality (CBHSQ), SAMHSA will engage stakeholders in a 

comprehensive review of measures to support both discretionary and Block Grant data 

reporting. The state and national Behavioral Health Barometer, currently in 

development, will be published and can be used by states for problem identification and 

planning activities.

SAMHSA is committed to engaging in a meaningful, structured process in consultation 

with states, other stakeholders, and policymakers, including HHS and OMB, to build on 

current accountability measures for the Block Grants. Through the Block Grant 

Application and planning process and in conversation with states, providers, service 

recipients, individuals in recovery, families, and other stakeholders, SAMHSA will create 

a flexible, deliberate, and careful method of identifying meaningful and appropriate 

measures which may be modified as needs change and new science evolves. As the 

quality and outcome measures for the Block Grants develop through SAMHSA’s 

Strategic Initiative on Data, Outcomes, and Quality, SAMHSA’s approach to 

accountability will allow those measures to drive the application(s), review, approval, and 

monitoring processes.

Consistent with SAMHSA’s focus on implementing a coordinated approach to the 

collection and application of data to inform policy and programmatic decisions, the Block 

Grant planning and reporting will be focused initially on a small, defined set of nationally 

collected data elements derived from the four major recovery domains: health, home, 

community, and purpose. These will provide a set of benchmarks for states and 

communities to assess the impact of resource decisions on the health and wellness of 

those involved in programs supported by the Block Grants. States will be provided with 

data that shows state, regional, and national data on the four core national measures, as 

well as other significant data of interest to SAMHSA and the states. For this two-year 

period, states should identify up to three additional measures to focus on in developing 

their state plan, which may be drawn from the state’s behavioral health barometer or 

submitted in the application with information about the definition, source, periodicity, 

and calculation. These four to seven measures would serve as the basis for state planning 

for at least two years of the planning period.

Trauma

Trauma is a widespread, harmful, and costly public health problem. It occurs as a result 

of violence, abuse and maltreatment, neglect, loss, disaster, war, and other emotionally 

harmful experiences. Trauma has no boundaries with regard to age, gender, 

socioeconomic status, race, ethnicity, geography, or sexual orientation. Traumatic 

exposures may have only transient effects or result in no apparent harm; however, 

traumatic exposures often result in psychological harm, increased rates of mental and 

substance use disorders, suicide, risk-taking behaviors, and chronic physical disorders. 

Exposure to trauma may increase the likelihood of substance abuse and lead to 

disruptions in daily functioning in educational and employment settings. Trauma is an 
25

almost universal shared experience of people receiving treatment for mental and 

substance use disorders, including those served through public systems.

Trauma is especially prevalent among populations who have been involved with the 

child welfare and criminal/juvenile justice systems, or who reside in communities with 

high rates of violence. Given the relatively high rates of exposure to traumatic events and 

the potential for long-term consequences when unrecognized and untreated, it is critical 

that public health systems screen for and intervene early with evidence-supported trauma 

interventions. Trauma-specific interventions have been developed for use across the lifespan; however, practitioners are often unaware of or may not use interventions based on 

the best evidence. With the increased recognition of the centrality of trauma in mental 

and substance use disorders, public systems embrace the need to create trauma-informed 

service delivery systems that support behavioral health consumers and survivors of 

trauma. A trauma-informed approach to care is based on consumer choice and decisionmaking, prohibition of coercive or forced treatment, and promotion of safety and 

strengths-based practice.

Justice

More than half of all prison and jail inmates meet criteria for having mental health problems, 

six in ten meet criteria for a substance use problem, and more than one third meet criteria for 

having both a substance abuse and mental health problem. The coverage expansions 

included in the Affordable Care Act will mean that individuals reentering communities from 

jails and prisons, who generally have not had health coverage in the past, will soon be 

eligible for coverage for some services for mental and substance use disorders. Addressing 

the behavioral health needs of these individuals can reduce recidivism, improve public safety, 

reduce criminal justice expenditures, and improve coordination of care for a population that 

disproportionately experiences costly chronic physical and behavioral health conditions. 

Addressing these needs can also reduce health care system utilization and improve broader 

health outcomes. Achieving these goals will require new efforts around enrollment, 

workforce and service development, and coordination across Medicaid, criminal and juvenile 

justice systems, SMHAs, and SSAs. Enrollment efforts will begin in 2013 and expanded 

eligibility for coverage will begin in January of 2014.
26

Parity Education

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) generally 

requires that group health plans and health insurance issuers to ensure that financial 

requirements and treatment limitations applicable to mental or substance use disorder 

(M/SUD) benefits are no more restrictive than the requirements or limitations applied to 

medical/surgical benefits. The legislation applies to both private and public sector 

employer plans that have more than 50 employees, including both self-insured and fullyinsured arrangements. MHPAEA also applies to health insurance issuers that sell 

coverage to employers with more than 50 employees. The Affordable Care Act extends 

these requirements to issuers selling individual market coverage. Small group and 

individual issuers participating in the Health Insurance Marketplace (as well as most 

small group and individual issuers outside the Marketplace) are required to offer EHBs, 

which are required by statute to include services for M/SUDs and behavioral health 

treatment. Guidance was released for states in January of 201325

Since its enactment, public awareness about MHPAEA has been limited. Some recent 

research suggests that the public does not fully understand mental health benefits, 

services covered, and to whom the law applies.

26 Increasing the public’s awareness 

about MHPAEA could increase access and use of behavioral health services, provide 

financial benefits (e.g., reduced deductibles and co-payments) to individuals and families, 

and lead to reduced confusion and discrimination associated with M/SUDs. SAMHSA 

will be developing and implementing a parity communications plan.

Recovery

The implementation of recovery-based approaches is imperative for providing 

comprehensive, quality behavioral health care. SAMHSA has identified recovery support 

services as one of its strategic initiatives. The urgency of health reform compels 

SAMHSA to promote the availability, quality, and financing of vital services and support

systems that facilitate recovery for individuals. In addition, 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 promote a high-quality and satisfying life in the community 

for all Americans. 

Recently, SAMHSA released the following working definition of recovery from mental 

and substance use disorders: “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: 

 25 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-001.pdf

26 Rosenbach, M., Lake, T., Williams, S., Buck, S. (2009). Implementation of Mental Health Parity: Lessons from 

California. Psychiatric Services. 60(12) 1589 – 1594. 
27

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 individual, family, community strengths, and responsibility;

Recovery is based on respect.

Please see SAMHSA’s Working Definition of Recovery from Mental Disorders and 

Substance Use Disorders, which can be found online at 

http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/.

Community Living and the Implementation of Olmstead

Title II of the ADA and the regulations promulgated for its enforcement require that 

states provide services in the most integrated arrangement appropriate and prohibit 

needless institutionalization and segregation in work, living, and other settings. In 

response to the tenth anniversary of the Supreme Court’s Olmstead decision, Secretary 

Sebelius directed the creation of the Coordinating Council on Community Living at the 

HHS. SAMHSA has been a key member of the Coordinating Council on Community 

Living and has funded a number of technical assistance opportunities to promote 

integrated services for people with behavioral health needs, including a policy academy 

to share effective practices with states.

Community living has been a priority across the federal government with recent changes 

to Section 811 and other housing programs operated by the Department of Housing and 

Urban Development (HUD). There is a focus on collaboration between HUD and HHS 

to fund supportive housing opportunities for persons with disabilities, which 

encompasses those with behavioral health needs. In addition, there has been increased 

enforcement by the Department of Justice (DOJ) and the OCR at HHS, including a 

number of actions involving state mental health systems: traditional institutions and 

other residences that have institutional characteristics. Very recently, there has been 

litigation regarding supported employment services and challenging sheltered workshops.

Children and Adolescents Behavioral Health Services

Each year, an estimated 20 percent of children in the U.S. have a diagnosable mental 

health condition and about one in ten suffers from a serious mental disorder that 

contributes to substantial impairment in functioning at home, at school, or in the 

community. Most mental disorders have their roots in childhood, with about 50 percent 

of affected adults manifesting disorders by age 14 and 75 percent by age 24. Eleven 

percent of high school students have a diagnosable substance use disorder involving 
28

nicotine, alcohol, or other drugs. Nine out of ten 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 before the age of 18, one in four develop an addiction 

compared to one in twenty-five who started using substances after age 21. Mental and 

substance use disorders in children and adolescents are complex, typically involving 

multiple problems, diagnoses, and co-occurring disorders. These children and youth are 

frequently involved in more than one specialized system, whether it is mental health, 

substance abuse, primary health, education, child care, child welfare, juvenile justice, or 

developmental disabilities. This multi-system involvement often results in fragmented 

and inadequate care, leaving families overwhelmed and children’s needs unmet. To 

address the need for additional coordination, SAMHSA is encouraging states to identify a 

liaison for children to assist schools in assuring identified children are connected with 

available mental health and/or substance abuse treatment and recovery support services.

For the past 25 years, the system of care approach has been the major framework for 

improving delivery systems, services, and outcomes for children and youth with mental, 

and/or substance use disorders and co-occurring disorders. This approach is comprised 

of a spectrum of effective, community-based services and supports that are organized into 

a coordinated network. The system of care helps to build meaningful partnerships with 

families and youth, and addresses cultural and linguistic needs, which improves the 

child’s functioning in home, school and community and promotes recovery and 

resilience. The system of care approach provides individualized services, builds on the 

strengths of the child/youth and family, is delivered in the least restrictive environment, 

incorporates evidence-based practices, and provides effective cross-system collaboration 

including integrated management of service delivery and costs.

This approach has guided system reform in many states, communities, tribes, and 

territories. Extensive research and evaluation have documented the effectiveness of this 

approach in improving clinical and functional outcomes for children, including increases 

in behavioral and emotional strengths, reductions in suicide attempts, improvements in 

school performance and attendance, fewer contacts with law enforcement, reductions in 

inpatient care, and more stable living situations. Outcomes have also been documented at 

the family-level, including reduced caregiver strain, more adequate array of resources, 

fewer missed days of work due to behavioral health needs and crises of the child, and 

improvement in overall family unit functioning. 

SAMHSA’s Strategic Initiatives 

In addition to health reform, SAMHSA has established eight Strategic Initiatives to 

improve the delivery and financing of prevention, treatment, and recovery support 

activities and services to advance and protect the nation’s health. These initiatives will 

allow SAMHSA’s to capitalize on emerging opportunities to focus on improving lives. 

As each initiative is developed and integrated throughout SAMHSA activities, 

information will be disseminated to states, stakeholder groups, national organizations, 

and policy makers. With this guidance, states should develop plans and applications with 
29

a focus on SAMHSA’s Strategic Initiatives. The areas and goals that comprise the 

strategic initiatives include:

1. Prevention of Substance Abuse and Mental Illness: Creating communities where 

individuals, families, schools, faith-based organizations, and workplaces take action 

to promote emotional health and reduce the likelihood of mental illness, substance 

abuse (including tobacco), and suicide. This initiative focuses especially on the 

nation’s high risk youth, youth in tribal communities, and mental illness and 

substance abuse among military families.

2. Trauma and Justice: Reducing the pervasive, harmful, and costly health impact of 

violence and trauma by integrating trauma-informed approaches throughout health, 

behavioral health, and related systems; as well as addressing the behavioral health 

needs of people involved or at risk of involvement in the criminal and juvenile justice 

systems. 

3. Military Families: Supporting America’s service men and women–Active Duty, 

National Guard, Reserve, and Veterans–together with their families and communities 

by leading efforts to ensure needed behavioral health services are accessible and 

outcomes are successful.

4. Recovery Support: Partnering with people in recovery from mental and substance use 

disorders to guide the behavioral health system and promote individual-, program-, and 

system-level approaches that foster health and resilience; increase permanent housing, 

employment, education, and other necessary supports; and reduce barriers to social 

inclusion.

5. Health Reform: Broadening health coverage to increase access to appropriate high 

quality care, and to reduce disparities that currently exist between the availability of 

services for substance abuse, mental disorders, and other medical conditions.

6. Health Information Technology: Ensuring the behavioral health system, including 

states, community providers, and peer and prevention specialists, fully participates 

with the general health care delivery system in the adoption of Health Information 

Technology (HIT) and interoperable EHRs.

7. Data, Outcomes, and Quality: Realizing an integrated data strategy that informs 

policy and measures program impact leading to improved quality of services and 

outcomes for individuals, families, and communities.

8. Public Awareness and Support: Increasing understanding of mental and substance use 

disorders to achieve the full potential of prevention, help people recognize mental and 

substance use disorders and seek assistance with the same urgency as any other health 

condition, and make recovery the expectation.

C. Impact on State Authorities and Systems
30

SAMHSA seeks to ensure that SMHAs and SSAs are prepared and ready to address the 

priorities described above. These environmental factors are key drivers that will enhance 

the ability of SMHAs and SSAs to take advantage of many changes that will decrease the 

prevalence of mental and substance use disorders and/or improve the health of 

individuals with mental illness and addictions, improve how they experience care, and 

reduce costs. With all of the recent changes that will take effect on January 1, 2014, state

authorities must be mindful of what services they buy, how they adapt to operate in a new 

health care environment, and how to best help their providers to offer effective care. The 

changes to the Block Grant application(s) incorporate several key assumptions:

• States should be more strategic in their efforts to purchase services. 

The availability of new evidenced-based approaches and funding will require 

states to rethink what services they purchase as well as how those services are 

purchased. Although access to Medicaid and private insurance will increase over 

the next few years, gaps in coverage will remain for specific populations and 

services. SMHAs and SSAs need to begin to identify those gaps by first mapping 

out which populations will be covered by various coverage options available 

under health reform. Secondly, within the different insurance packages, states 

have to consider the extent to which specific M/SUD services will remain 

uncovered. In order to identify gaps in the continuum of services, SMHAs and 

SSAs will need to determine what specific M/SUD services they should cover in 

addition to or above what is being covered by insurers and other payers. States 

should use SAMHSA’s description of a Good and Modern Mental Health and 

Addiction Service System27 when they consider service issues. States will need 

to become more diligent in their efforts to identify individuals in their systems 

that may currently qualify, but are not enrolled in the CHIP, Medicaid, and 

Medicare programs. Accordingly, states may want to look at outreach 

opportunities in order enroll those qualified for these programs, as well as QHPs 

offered through Health Insurance Marketplace or other commercial insurance 

plans. 

When developing strategies for purchasing services, SMHAs and SSAs must 

identify other state and federal sources that can be used to purchase services. 

States should also consider promoting and supporting the revenue diversification 

efforts of funded providers in order to develop a provider pool that is more adept 

at navigating the new environment. Providers need to develop better financial 

strategies that will allow them to be less dependent on SMHA and SSA funding. 

Funding available from CMS, such as Medicaid, CHIP, Medicare, and national 

demonstration projects (e.g., Money Follows the Person, Rebalancing Initiatives, 

Health Homes, IMD Demonstration), will play a more important role to states 

given the recent reductions in state, local, and federal funding for behavioral 

health services. In addition, funding from HRSA must be considered as states 

develop these strategies. HRSA has significantly expanded access to health and 

 27 Substance Abuse and Mental Health Services Administration. (2010), Description of a Modern Addictions and 

Mental Health Delivery System, Office of Policy, Planning, and Innovation, Rockville, MD

http://www.samhsa.gov/healthreform/docs/AddictionMHSystemBrief.pdf
31

behavioral health services offered through its Federally Qualified Health Center 

(FQHC) Program. HRSA has also made available funding and other 

opportunities to increase and enhance the quality of the behavioral health 

workforce (e.g., loan forgiveness program, National Health Service Corps, 

training grants, etc.). This means that SMHAs and SSAs (as well as public health 

authorities responsible for prevention) will need to engage and collaborate with 

different partners at the state, federal, and community levels. Both TRICARE and 

the Department of Veterans’ Affairs (VA) provide behavioral health services as 

well. 

The new environment may create new ways to purchase services: reimbursement 

for episodes of care and pay-for-outcomes are just two strategies that payers may 

use in the future, though these strategies have not been widely deployed by public 

behavioral health payers. SAMHSA suggests that SMHAs and SSAs consider 

using their Block Grant funds and develop reimbursement strategies that are 

consistent with the intent of health reform and pay for better services, not just 

more services. 

• States should think more broadly than the populations they have historically 

served through Federal Block Grants and other funding. 

The focus of SAMHSA’s Block Grant programs has not changed significantly 

over the past 20 years. While many of these populations originally targeted for 

the Block Grants are still a priority, certain populations have evolving needs that 

must be addressed. These populations include military families, youth who need 

substance use disorder services, individuals who experience trauma, increased 

numbers of individuals released from correctional facilities, and lesbian, gay, 

bisexual and transgendered and questioning (LGBTQ) individuals. 

The context of service delivery has also significantly changed. Services should be 

delivered in a manner that promotes recovery and resiliency. Individuals that 

have personal experiences with mental or substance abuse disorders are playing 

an increasingly important role in the delivery of recovery-oriented systems of 

care. Services should also take into account ethnic- and culture-specific services 

for racial and ethnic minorities. For example, services should address the unique 

needs of tribal populations and the unique role of tribal governments in planning 

and delivering services. Advances in technology have changed significantly since 

1991, SAMHSA’s inception. Technology is playing a growing role in how 

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

Interactive Communication Technologies (ICTs) are being more frequently used 

to deliver various health care and recovery support services by providers and to 

report health information and outcomes by individuals. A more detailed 

discussion regarding ICTs is provided later in this document in Section 3m. 

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

Health care payers seek to promote EHR and interoperable information technology 

systems that allow for the effective exchange and utilization of health data. 
32

Purchasers of behavioral health services should acquire information technology 

systems that are Office of the National Coordinator for Health Information 

Technology (ONC) Meaningful Use certified EHR applications which collect 

information on provider characteristics, client enrollment, demographics, and 

treatment. Current laws will require these systems to comply with national standards 

(national provider numbers, International Classification of Diseases (ICD-10), 

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 other payers (e.g., Medicaid, Medicare, and private 

insurance plans). SAMHSA believes it is important for public behavioral health 

purchasers in a state (or region) to begin or continue to collaborate and discuss 

system interoperability, electronic health records, federal information technology 

requirements, and other related matters.

• States may form strategic partnerships in order for individuals to have access to a 

good and modern services system. 

SAMHSA seeks to enhance SMHAs’ and SSAs’ abilities to be full partners in 

developing and implementing MHPAEA and health reform strategies in their 

states. In many respects, successful implementation will be dependent on 

leadership and collaboration among multiple stakeholders. The relationships

among the SMHAs, SSAs, and the State Medicaid Director, Insurance 

Commissioner, prevention agencies, child serving agency, education authority, 

justice authorities, public health authorities, and health information technology 

authorities are of integral during this time of transition. These collaborations will 

be particularly important in the areas of Medicaid expansion, data and information 

management and technology, professional licensing and credentialing, consumer 

protection, and workforce development. 

To increase the likelihood of cooperative success, there must be a long-range 

view, open communication, knowledge-sharing, and a consideration of all 

stakeholder concerns and priorities. SMHAs and SSAs should develop strategic 

partnerships with TRICARE, primary care, public health, criminal and juvenile 

justice, education, child welfare, VA, National Guard Bureaus, insurers, and 

employers. State authorities should also consider the practice of tribal 

consultation as an effective means to learn of resources and services not 

previously considered as they undertake their Block Grant planning process(es). 

• State authorities should focus more on recovery from mental health and substance 

use problems. 

People can and do recover from behavioral health problems, and services and 

supports must foster individual and family capacity for self-directed recovery. 

Recovery benefits both the individual with a behavioral health condition, as well 

as the community leading to a healthier and more productive population. 

SAMHSA is committed to assisting states, providers, people with mental and 
33

substance use disorders, families, and others in promoting recovery.

• State authorities should monitor the coverage of behavioral health services 

offered by qualified health plans and Medicaid to ensure that individuals with 

behavioral health conditions have adequate coverage and access to services. 

Some states are currently putting out requests for proposals (RFPs) for managed 

care organizations (MCOs). State legislatures, state Marketplace entities, and 

state insurance commissioners are developing policies and regulations related to 

the EHBs. SMHAs and SSAs should be involved in these efforts to ensure that 

mental health and substance abuse services are appropriately included in plans, 

and that mental health and substance abuse providers are included in networks. 

Given the high proportion of mental health and substance use consumers that will 

be insured through Health Insurance Marketplace and expanded Medicaid 

eligibility, significant consideration should be given to the inclusion of necessary 

services and providers.

• States should make primary substance abuse prevention a priority. 

In order to respond to the primary prevention set-aside requirement of the SABG, 

states should keep in mind that the backbone of a Good and Modern Prevention 

System is an infrastructure with the ability to collect and analyze epidemiological 

data on substance use and its associated consequences. The system must also be 

able to use this data to identify areas of greatest need, and to identify, implement, 

and evaluate evidence-based programs, practices, and policies that have the ability 

to reduce substance use and improve health and well-being in all communities.

• State authorities should be strategic in leveraging scarce resources to fund 

prevention services. 

In times of declining federal, state, and local resources, states need to make the 

most efficient use of substance abuse prevention funds 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 abuse 

prevention system. Specifically, SAMHSA recommends that states align the 20

percent set-aside for primary prevention of the SABG with other federal, state, 

and local funding which will aid the state in developing and maintaining a 

comprehensive substance abuse prevention system. 

• State authorities should monitor the Marketplace to ensure that individuals with 

behavioral health conditions are aware of their eligibility, able to get enrolled, 

and able to stay enrolled. 

Now that the Marketplace is going into effect, state legislatures, state Marketplace

entities, and state insurance commissioners are developing policies and 

regulations related to the coordination between the Marketplace, Medicaid, and 

CHIP. This includes the role that community-based organizations will play in 
34

providing outreach and enrollment assistance. SMHAs and SSAs should be 

involved in these efforts to ensure that the organizations performing the outreach 

and enrollment assistance are prepared to help individuals with mental and 

substance use disorders. Historically, the individuals who have the most 

difficulty navigating public health insurance eligibility determination and 

enrollment process have disproportionately high rates of behavioral health 

conditions. In order to avoid a similarly disproportionate representation among 

the uninsured after 2014, SMHAs and SSAs need be proactive in ensuring that 

their state’s efforts do not overlook individuals with behavioral health conditions. 

• State authorities should make every effort to ensure that the right recipient is 

receiving the right payment for the right reason at the right time. 

After the full implementation of the Affordable Care Act, SAMHSA strongly 

recommends that Block Grant funds be directed toward four purposes: (1) to fund 

priority treatment and support services for individuals without insurance or for 

whom coverage is terminated for short periods of time; (2) to fund those priority 

treatment and support services not covered by Medicaid, Medicare, or private 

insurance for low income individuals and that demonstrate success in improving 

outcomes and/or supporting recovery; (3) to fund primary prevention: universal, 

selective, and indicated prevention activities and services for persons not 

identified as needing treatment; and (4) to collect performance and outcome data 

to determine the ongoing effectiveness of behavioral health promotion, treatment, 

and recovery support services and to plan the implementation of new services on 

a nationwide basis. 

States should determine if established systems and procedures are sufficient to 

ensure that Block Grant funds are expended in accordance with program 

requirements and directed to support, not supplant, health care reform activities. 

States may have to make changes to information systems and conduct more 

compliance reviews to assure better program integrity, which may include 

working closely with Medicaid and the Health Insurance Marketplace to review 

information and determine whether individuals and providers in their systems are 

enrolled or implementing strategies to assist their providers to build the necessary 

infrastructures to operate in commercial and public (Medicaid and Medicare). 

States are encouraged to consider developing metrics or targets for their systems 

to measure increases in the number of individuals that become enrolled or 

providers that join commercial or publicly funded managed care networks.

• State authorities should use evidence to support their funding and purchasing 

decisions. 

Information gathered from the FY 2011 Block Grant Addendum and the FY 

2012/2013 Block Grant Application indicates that almost all states are using 

Block Grant funds to purchase services in all categories identified in SAMHSA’s 

Description of a Modern Addictions and Mental Health Service System. In 

addition, state Medicaid programs purchase a subset of these services, some of 

which will be included in EHBs offered through commercial insurers participating 
35

in the Health Insurance Marketplace and the Medicaid benchmark plans. SMHAs 

and SSAs will be well-positioned to understand and use the evidence regarding 

various behavioral health services as a 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 (including legislators) and to support 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 show promising outcomes. North Carolina’s Practice Improvement 

Collaborative, is an excellent example of a state’s effort to provide guidance in 

determining the future evidence based services and supports that will be provided 

through their public system. 

• State authorities should ensure that they comport with changes in quality 

reporting. 

The NBHQF will provide a platform for the data SAMHSA requests from states 

through the Block Grant and receives from both its discretionary and formula 

grantees. SAMHSA has been working with states to identify and implement 

within the NBHQF a core set of quality and outcome measures. Once finalized, 

these measures will be used for SAMHSA’s performance monitoring and quality 

improvement activities. This effort has sought both to guide and align the 

measurement requirements of other major service purchasers, such as Medicaid 

and Medicare, and thus facilitate efficiencies in state reporting of behavioral 

health quality measures to federal entities. It is anticipated that once 

implemented, states will have a series of questions–both general to all states and 

unique to their particular state–regarding the specifics and realities of how these 

measures are being collected and reported, as well as how this effort is being 

coordinated with required reporting activities from Medicaid, Medicare, and other 

public payers.

• State authorities should pay particular attention to trauma. 

Individuals who have been exposed to traumatic events are at increased risk for 

mental and substance use disorders. Many symptoms of trauma are similar to and 

may contribute to other behavioral health problems including depression, anxiety, 

disruptive behavioral disorders, personality disorders, and substance use 

disorders. Exposure to past trauma may also complicate treatment for mental and 

substance abuse disorders. 

The current behavioral health workforce needs training on the role of trauma in 

people’s lives, the centrality of trauma to behavioral health disorders, traumaspecific interventions, and strategies to build trauma-informed systems that better 

identify and address trauma. Practitioners and policymakers also need to have a 

better understanding of how their policies, practices, and behaviors can promote 

healing and recovery or be secondarily traumatizing to people. There is a 

growing evidence base for the treatment of trauma and generic therapies have not 

been shown to be effective in addressing trauma. There are a number of 
36

evidence-based approaches that states should focus on adopting. States can better 

address this issue by screening for trauma, providing trauma-focused treatments, 

and offering trauma-informed care.

• State authorities should collaborate closely with their counterparts in the criminal 

and juvenile justice systems. 

Because individuals involved in the criminal and juvenile justice systems 

experience comparatively high rates of mental and substance use disorders, an 

opportunity exists to coordinate new health coverage with other efforts to 

facilitate improved functioning and health. The impending coverage expansion 

will have a large impact on funding sources for mental health and substance abuse 

services for individuals involved in the criminal and juvenile justice systems. A 

majority of these individuals are male adults below 133 percent of the FPL, 

placing them squarely within the Medicaid expansion population. Given that 

many of these individuals would not have had coverage for services before or 

would have relied on public systems and/or charity care, this change provides 

opportunities for increased levels of coverage as well as the opportunity to shift 

current coverage for individuals receiving services through the MHBG and SABG 

to new funding sources. 

Block Grant resources will be important in this new environment. Significant 

workforce needs are related to behavioral health in the criminal justice system. 

Police and other first responders need training and consultation to respond 

appropriately and safely to people with mental and substance use disorders in 

crisis. Judges and other court officials need education and support to develop 

successful specialty court and other diversion programs for people with mental 

and substance use disorders. The behavioral health workforce also needs to 

develop a better understanding of issues that may come up when serving 

individuals who are involved in the justice system. States should place an 

emphasis on screening and services provided prior to adjudication and/or 

sentencing to divert persons with mental and/or substance use disorders from

correctional settings. Secondarily, states should work with courts, correctional 

systems, and law enforcement personnel to help with enrollment and coverage 

during periods of lapsed coverage, and coordination with reentry programs to 

provide services to help prevent relapse and re-incarceration.

The Administration on Children, Youth, and Families (ACYF) and the broader 

child welfare system are placing an increased focus on the social and emotional 

well-being of children and youth in foster care. Congress passed the Child and 

Family Services Improvement and Innovation Act in 2011. This Act gives states 

the option of applying for waivers to focus state funding received through Titles 

IV-E and IV-B of the Social Security Act on improving wellness and outcomes 

for children and youth in the foster care system. In addition to focusing on 

behavioral health supports for children in foster care, this flexibility will allow 

states to place an increased emphasis on risk factors such as child trauma and 

parental substance abuse. Given that 63 percent of youth in the foster care system 
37

have met the criteria for at least one behavioral health diagnosis at some point in 

their lives and the recent developments in state and federal policy, states should 

consider coordinating MHBG and SABG funding with work in the child welfare 

system.

• States authorities should monitor compliance with the federal parity law to ensure 

that individuals with behavioral health conditions are receiving the mandated 

coverage and access. 

Plans and issuers subject to MHPAEA that offer mental health and substance 

abuse coverage as part of the overall health benefits packages must comply with 

the requirements regarding coverage of mental and substance use disorder 

benefits in relation to medical/surgical benefits. However, the law does not 

require insurance plans to provide mental or substance use disorder benefits. 

Whether it is federal- or state-level parity, continued efforts for education are key 

to increase awareness of the benefits of mental health and addiction services and 

open the door to appropriate services, especially for potential first time users. 

Some states have taken steps to enforce parity (e.g., California, Vermont, and 

Maryland) and are building on lessons learned to improve their implementation 

processes. States can work with their constituents and advocacy groups to 

develop resources and toolkits to address barriers to limited awareness. This 

active involvement to increase awareness helps to assure that consumers receive 

quality behavioral health care services within their state and are aware of what 

protections, if any, that exist in their state should their claim be denied

inappropriately by insurance companies.

• State authorities should be key players in primary and behavioral health care 

integration activities. 

Strong partnerships between SMHAs and SSAs and their counterparts in health, 

public health, and Medicaid are essential for successful coordinated care 

initiatives. While the State Medicaid Agency 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. For instance, CMS and 

SAMHSA strongly suggest that State Medicaid Agencies include SMHAs and 

SSAs in designing their approaches for health homes under Section 2703 of the 

Affordable Care Act. SMHAs and SSAs are in the best position to offer their 

Medicaid partners information regarding the most effective care coordination 

models, connect current providers (such as the SAMHSA PBCHI grantees) that 

have effective models, and assist with training or retraining staff to provide care 

coordination across primary care and behavioral health care. 

The SMHAs and SSAs can also assist the Medicaid agency in messaging the 

importance of the various coordinated care initiative and the system changes that 

may be needed for success with their integration efforts. States are beginning to 

develop client-level and systemic strategies (e.g., moving to ACOs and carve-in 

managed care arrangements) that are aimed at enhancing integration between 

primary care and specialty care. The collaborations will be critical among
38

behavioral health 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 State Medicaid Agencies with identifying key principles, 

safeguards, and enhancements that will ensure that this integration supports key 

recovery principles and activities such as person-centered planning and selfdirection. 

In addition, states play a key role in developing strategies for reducing smoking 

among individuals with a behavioral health condition. States should consider 

several strategies for reducing smoking, including moving towards tobacco-free 

behavioral health facilities and grounds and screening, referring, and/or treating 

tobacco use.

• Population changes in many states have created a demographic imperative to 

focus on improving behavioral health care for diverse racial, ethnic, and LGBTQ

populations with the goal of reducing disparities for these subpopulations. 

States are increasingly recognizing the value in addressing health disparities, 

realizing that failure to take action results in continued excess costs and spending 

and lost lives. States have developed plans to address these disparities through 

incentives in health insurance plans, training initiatives and requirements for 

language access, targeted quality improvement and cost containment plans, cost 

and impact estimates for the most vulnerable populations, and tracking 

mechanisms to evaluate progress in improving health equity. Few of these plans, 

however, have focused specifically on behavioral health. SSAs and SMHAs need 

to better track access, service use, and outcomes for these subpopulations in order 

to develop targeted outreach, engagement, enrollment, and intervention strategies 

to reduce behavioral health disparities.

• State authorities are encouraged to implement, track, and monitor recoveryoriented, quality behavioral health care services within their states as authorized 

under the SABG and MHBG. 

Behavioral health care recovery-support services include the following four major 

dimensions that support a life in recovery (the dimensions of recovery):

1. Health: overcoming or managing one’s disease(s) or symptoms—for 

example, abstaining from use of alcohol, illicit drugs, and non-prescribed 

medications if one has an addiction problem—and for everyone in 

recovery, making informed, healthy choices that support physical and 

emotional wellbeing.

• Promote health and recovery-support services for individuals with mental 

and/or substance use disorders.

• Promote health, wellness, and resiliency.

• Promote recovery-oriented service systems.
39

• Engage individuals in recovery and their families in self-directed care, 

shared decision-making and person-centered planning.

• Promote self-care alternatives to traditional care.

2. Home: a stable and safe place to live.

• Ensure that supported independent housing, and recovery housing are 

available for individuals with mental and/or substance use disorders.

• Improve access to mainstream benefits, housing assistance programs, and 

supportive services for people with mental and/or substance use disorders.

• Build leadership, promote collaborations, and support the use of evidencebased practices related to permanent supportive housing and recovery 

housing.

• Increase knowledge of the behavioral health field about housing and 

homelessness among people with mental and/or substance use disorders.

3. Purpose: meaningful daily activities, such as a job, school, volunteerism, 

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

and resources to participate in society.

• Increase gainful employment and educational opportunities for individuals 

with or in recovery from mental and/or substance use disorders.

• Increase the proportion of individuals with mental and/or substance use 

disorders who are gainfully employed and/or participating in self-directed 

educational endeavors.

• Develop employer strategies to address national employment and 

education disparities among people with identified behavioral health 

problems.

• Implement evidence-based practices related to employment and education 

for individuals with mental and/or substance use disorders.

4. Community: relationships and social networks that provide support, 

friendship, love, and hope.

• Promote peer support and the social inclusion of individuals with or in 

recovery from mental and/or substance use disorders in the community.

• Increase the number and quality of consumer/peer recovery support 

specialists and consumer-operated/peer run recovery support service 

provider organizations.

• Promote the social inclusion of people with mental and/or substance use 

disorders.

These elements—health, home, purpose, and community—are central to recovery 

from mental and substance use disorders. Recovery support services include 

efforts such as self-directed care, shared decision making, peer-operated services, 
40

peer specialists and recovery coaches, wellness activities, supported housing, 

recovery housing, self-care, supported employment, supported education, warm 

lines, person-centered planning, peer and family support, social inclusion 

activities, and rights protection.

States should evaluate their services to ensure that they are provided in the most 

integrated setting appropriate and maximize the ability to interact with persons 

without disabilities. State mental health authorities should carefully review all 

settings where people with mental illness reside and should work with their 

housing development partners to develop additional capacity for supported 

housing in integrating settings. In addition, states should look closely at how 

persons with mental illness are spending their time during the day to ensure that 

individuals with behavioral health needs have opportunities for supported 

employment, leading to competitive employment in the community.

• State authorities should ensure that their states have a system of care approach to 

children’s and adolescents’ behavioral health services. 

The success of the systems of care approach has shown that interagency 

coordination centered on serving the unique needs of the child/youth and family is 

critical. Facilitating and sustaining this approach at the local level requires a 

parallel effort at the state level, and as states adopt a system of care approach, 

they should address developing or amending state policies that can support local 

efforts, identifying financing mechanisms, and enabling a family and youth input 

to policy at the state level. In addition to identifying the resources needed for 

services, states will need to develop a realistic planning process for enabling 

systems of care in their states that includes the necessary staff time and 

administrative resources. 

States should also consider their existing administrative and programmatic 

infrastructures as they work to support local systems of care. Existing councils,

such as children’s cabinets, can be used to avoid duplication of effort when 

working towards better interagency coordination. Children and youth served 

through systems of care are likely to be involved in multiple systems and are 

probably already the focus of state-level programs and partnerships (e.g., in 

education, juvenile justice, or child welfare), so these efforts may also be part of 

the foundation for a statewide systems of care approach. States must look at the 

impact of adopting this approach across different agencies, addressing issues like 

the best place(s) to house care coordination or case management resources, how 

to handle information sharing, and which components of a local system of 

care/the agencies are best situated to provide the necessary funding.

D. Block Grant Programs’ Goals 

SAMHSA’s SABG and MHBG are designed to provide states with the flexibility to 

design and implement activities and services to address the complex needs of individuals, 

families, and communities impacted by mental disorders, substance use disorders, and 
41

associated problems. The goals of the Block Grant programs are consistent with 

SAMHSA’s vision for a high-quality, self-directed, and satisfying life. The components 

of a healthy life are the dimensions of recovery: 

a. A physically and emotionally healthy lifestyle (health); 

b. A stable, safe and supportive place to live (a home); 

c. Meaningful daily activities such as a job, school, volunteerism, family 

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

to participate in society (a purpose); and, 

d. Relationships and social networks that provide support, friendship, love, and 

hope (a community). 

Additional aims of the Block Grant programs reflect SAMHSA's role as a public health 

agency:

1. The focus is about everyone, not just those with an illness or disease, but the 

whole population.

2. The focus is on prevention and wellness activities.

3. The activities are data driven: a public health agency uses surveillance data as 

well as an analysis of other public health drivers/levers to inform targets of 

opportunity.

4. There is an emphasis on access to services and availability.

5. There is an emphasis on policy impact and support: an analysis of the laws, 

rules, and infrastructure which informs and supports the work.

These goals are significant drivers in the revised Block Grant application(s). SAMHSA’s 

and other federal agencies’ focus on accountability, person-directed care, family-driven 

care for children and youth, underserved populations, tribal sovereignty, and 

comprehensive planning across health and specialty care services are reflected in these 

goals. States should use these aims as drivers in developing their application(s).
42

2. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES 

As referenced in the Introduction, changes to the SABG and MH BG applications are, in 

part, being driven by MHPAEA and related laws, which require a number of 

standardizations amongst applications. SAMHSA wants to ensure that SMHAs and 

SSAs are well positioned during FYs 2014 and 2015. While the statutory deadlines and 

Block Grant award periods remain unchanged, SAMHSA has made changes to the 

timeframe in which states are asked to submit application(s) and report their progress 

towards implementing planned activities. These changes were made to better coincide 

with the majority of states’ fiscal year calendars, which are from July 1st through June 

30th of the following year. In addition, both the MHBG and the SABG applications will 

be due on the same date, whereas previously, they were due in different months. The 

dates for providing reports and assurances and the reporting periods for both Block 

Grants were also different and SAMHSA has aligned the annual report due dates and 

annual expenditure reporting periods to be consistent across both Block Grants.

The FY 2014/2015 MHBG and SABG application(s) includes a two year Block Grant 

Behavioral Health Systems Assessment and Plan (Plan) as well as projected expenditure 

tables, certifications and assurances. The Plan will cover a two year period (7/1/13-

6/30/15) to align with most states’ fiscal year budget cycle.

28 States will have the option 

of amending their Plans when they submit their 2015 application. The following table 

identifies Application and Plan due dates.

Application(s) for Application Plan Planning Reports 

FY Due Due Period Due 

 

2014 10/1/13 (SABG) Yes 7/1/13 – 6/30/15 12/1/13

 9/1/13 (MHBG)

2015 4/1/14 No * 12/1/14

 

2016 4/1/15 Yes 7/1/15 – 6/30/17 12/1/15

 

2017 4/1/16 No * 12/1/16

 

*States may revise previously submitted plans

 28 Reporting timeframes for Synar will remain on the current schedule. Annual Synar Reports (ASR) are due on 

December 31. The data reported in the ASR due on December 31, 2012, will be from inspections completed in FFY 

2012 (October 1, 2011, through September 30, 2012).
43

States should submit their Block Grant application(s) for 2014 and 2015 based on the 

guidance provided in this document. The Plan provides a consistent framework for 

SMHAs and SSAs to assess the strengths and needs of their systems and to plan for 

system improvement, which is consistent with the strategic planning framework currently 

used by SAMHSA for various grants. The unique statutory requirements of the specific 

Block Grants and the three areas requiring or requesting a combined plan are covered in 

the State Plan section. 

The FY 2014/2015 Plan seeks to collect information from states regarding their activities 

in response to new federal legislation, initiatives, changes in technology, and advances in 

research and knowledge. The FY 2014/2015 Block Grant Application and Plan have

sections that are required and other sections where additional information is requested but 

not required. Section 3b requires states to undertake a needs assessment as part of their 

plan submission. This section identifies the populations that states must include in their 

assessment but are encouraged to plan for other populations (e.g. youth with a substance 

use disorders). Section 3b, Plan Tables 2 and 5a are required. 

Sections 3.c-v requests information on state efforts on certain policy, program, and 

technology advancements in health and behavioral health care. While this information is 

not required, it will help SAMHSA understand the whole of the applicant state’s efforts 

and identify how it can assist the applicant state meet its goals in a changing 

environment. In addition, this information will identify states that are models and assist 

other states with areas of common concern. Section 3x is required for both the SABG 

and MHBG. Section 3w is required for those states submitting a combined Block Grant 

application or states submitting just their MHBG application. 

Some states may choose not to include other populations in their needs assessment or 

provide the requested information in other sections of the plan. While not submitting this 

information will not impact SAMHSA’s approval of the Plan or award, states are strongly 

encouraged to submit as much as they can so the nation, as a whole, will have a complete 

picture of needs of individuals with behavioral health conditions, as well as the 

innovative approaches states are undertaking in these areas as well as the barriers they 

encounter designing and implementing important policies and programs.

In order for the Secretary of HHS, acting through the Administrator of SAMHSA, to 

make an award under the programs involved, states must submit an application(s). 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 and their 

consequences; substance abuse prevention; youth and adults with a substance use 

disorder; adolescents and adults with co-occurring disorders; and the promotion of

recovery among persons with SED, SMI, or substance use disorder. 

 29 Title XIX, Part B of the PHS Act 
44

A grant may be awarded only if an application(s) submitted by a state include(s) a State 

BG Plan30, 31 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 BG Plan should include a description of the manner in which the state

intends to obligate the grant funds, and it must include a report32 in the proper format

containing information that the Secretary determines to be necessary for securing a record 

and description of the purposes for which the grant will be expended. States shall have 

the option of updating their plans during the two year planning cycle. 

States are encouraged to submit a combined mental health and substance abuse 

prevention and treatment application. If a state is submitting separate applications, it 

should clarify which system is being described in this section (e.g., mental health or 

substance abuse prevention and treatment). 

3. BEHAVIORAL HEALTH ASSESSMENT AND PLAN 

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, 

strategies, and measurable targets. 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 abuse stakeholders and utilize this mechanism to assist in the 

development of the State BG Plan for the SABG application. States must also describe 

the stakeholder input process for the development of both the SABG plan and the MHBG

plan, as mandated by section 1941 of the PHS Act (42 U.S.C. 300x-51), which requires 

that the State BG Plans be made available to the public in such a manner as to facilitate 

comment from any person 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/or in recovery, 

families of individuals with substance use and mental disorders, providers of services and 

supports, representatives from racial and ethnic minorities, LGBTQ populations, persons 

with co-existing disabilities, and other key stakeholders. Evidence of meaningful 

consultation with federally recognized tribes where tribal governments or lands are 

 30 Section 1912 of Title XIX, Part B, Subpart I of the PHS Act (42 U.S.C. § 300x-2) 31 Section 1932(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-32(b)) 32 Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a))
45

located within the boundaries of the state must be provided in the application(s) for both

MHBGs and SABGs.

A. Framework for Planning—Mental Health and Substance Abuse Prevention and 

Treatment 

States should identify and analyze the strengths, needs, and priorities of the state’s 

behavioral health system. The strengths, needs, and priorities should take into account 

specific populations that are the current focus of the Block Grants, the changing health 

care environment, and SAMHSA’s Strategic Initiatives. At a minimum, the plan should 

address the following populations as appropriate for each Block Grant:

• Comprehensive community-based services for adults with SMI and children 

with SED:

o Children with SED and their families*

o Adults with SMI*

o Older Adults with SMI*

• Services for persons with or at risk of having substance use and/or mental 

disorders:

o Persons who are intravenous drug users (IDU)*

o Adolescents with substance abuse and/or mental health problems

o Children and youth who are at risk for mental, emotional, and behavioral 

disorders, including, but not limited to addiction, conduct disorder and 

depression 

o Women who are pregnant and have a substance use and/or mental 

disorder*

o Parents with substance use and/or mental disorders who have dependent 

children*

o Military personnel (active, guard, reserve, and veteran) and their families

o American Indians/Alaska Natives 

• Services for persons with or at risk of contracting communicable diseases:

o Individuals with tuberculosis* and other communicable diseases 

o Persons living with or at risk for HIV/AIDS and who are in need of mental 

health or substance abuse early intervention, treatment, or prevention 

services*

o The National HIV/AIDS Strategy (NHAS) for the United States (p. 15) 

and NHAS Implementation Plan (p. 11)(.pdf documents attached)

 1.2.4 Prevent HIV among substance users: substance use is 

associated with a greater likelihood of acquiring HIV infection. 

HIV screening and other comprehensive HIV prevention services 

should be coupled with substance treatment programs (P. 15)
46

• Services for individuals in need of primary substance abuse prevention *

• In addition to the targeted/required populations and/or services required in 

statute, states are encouraged to consider the following populations, and/or 

services:

o Individuals with mental and/or substance use disorders who are homeless 

or involved in the criminal or juvenile justice systems

o Individuals with mental and/or substance use disorders who live in rural 

areas

o Underserved racial and ethnic minority and LGBTQ populations

o Persons with disabilities

o 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.

o Community settings for universal, selective and indicated prevention 

interventions, including hard-to-reach communities and “late” adopters of 

prevention strategies

Populations that are marked with an asterisk are required to be included in the state’s 

needs assessment for the MHBG or SABG. To the extent that the other listed populations 

fall within any of the statutorily covered populations, states must include them in the 

plan.

States should undertake a broader approach to their assessment and planning process and 

include other individuals who are in need of behavioral health services. In particular, 

states should begin planning now for individuals with incomes below 400% FPL who are 

currently uninsured but will be covered by Medicaid or private insurance in FY 2014. 

This planning will present new opportunities for public behavioral health systems to 

expand access and capacity. In addition, states should identify who will not be covered 

after FY 2014 and how federal funds will be used to support these individuals who may 

need treatment and supports.

33

MHPAEA, other legislation that enhances access to Medicaid, and SAMHSA’s Strategic 

Initiatives place an emphasis on identifying the health, behavioral health, and long-term 

care needs of individuals with mental and substance use disorders. These laws and 

initiatives also present significant opportunities for states to include in their benefit 

design recovery support services for adults, youth, and families who have behavioral 

health needs. In addition, policy drivers place a heavy emphasis on wellness and the 

prevention of mental, emotional, and behavioral disorders. These major themes are 

relevant for SSAs and SMHAs. 

 33 SAMHSA will provide each state with information regarding the projected number and demographics of potentially 

uninsured individuals.
47

The planning steps established for the MHBG and SABG follow the process described in 

the SPF. The SPF encompasses the following five steps: (1) assess needs; (2) build 

capacity to address needs; (3) plan to implement evidence-based strategies that address 

the risk and protective factors associated with the identified needs; (4) implement 

appropriate strategies across the spheres of influence (individual, family, school, 

community, environment) that reduce substance abuse, mental disorders, and their

associated consequences; and (5) evaluate progress towards goals. SAMHSA is 

encouraging states to undertake each of the following planning steps in a timely manner. 

In addition, states should consider linking their Olmstead planning work in the Block 

Grant Application, identifying individuals who are needlessly 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 is 

available in a state’s Olmstead Plan, it should be used for Block Grant Application 

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 needs of the service system to address the specific 

populations. 

Provide an overview of the state’s behavioral health prevention, early identification, 

treatment, and recovery support systems. Describe how the public behavioral health 

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 SSA, 

the SMHA, and other state agencies with respect to the delivery of behavioral health 

services. States should also include a description of regional, county, tribal, and local 

entities that provide behavioral health services or contribute resources that assist in 

providing the services. The description should also include how these systems address 

the needs of diverse racial, ethnic, and sexual gender minorities. 

Step 2: Identify the unmet service needs and critical gaps within the current system. 

This step should identify the data sources used to identify the needs and gaps of the 

populations relevant to each Block Grant within the state’s behavioral health care system, 

especially for those required populations described in this document and other 

populations identified by the state as a priority. 

The state’s priorities and goals must be supported by a data-driven process. This could 

include data and information that are available through the state’s unique data system 

(including community-level data), as well as SAMHSA’s data set including, but not 

limited to, the National Survey on Drug Use and Health (NSDUH), the Treatment 

Episode Data Set (TEDS), the National Facilities Surveys on Drug Abuse and Mental 

Health Services, and the Uniform Reporting System (URS). Those states that have an

SEOW should describe its composition and contribution to the process for primary 
48

prevention and treatment planning. States should also continue to use the historically 

reported prevalence formulas for adults with SMI and children with SED, as well as the 

prevalence estimates, epidemiological analyses, and profiles to establish substance abuse 

prevention, mental health treatment, and substance abuse treatment goals at the statelevel. In addition, states should obtain and include in their data sources information from 

other state agencies that provide or purchase behavioral health services. This will allow 

states to have a more comprehensive approach to identifying the number of individuals 

that are receiving behavioral health services and the services they are receiving. 

SAMHSA’s Behavioral Health Barometer is intended to provide a snapshot of the state 

of behavioral health in America. This annual report will present a set of substance use 

and mental health indicators measured through two of SAMHSA’s populations- and 

treatment facility-based survey data collection efforts, the NSDUH and the National 

Survey of Substance Abuse Treatment Services (N-SSATS). Collected and reported 

annually, these indicators uniquely position SAMHSA to offer both an overview 

reflecting the behavioral health of the nation at a given point in time, as well as, a 

mechanism for tracking change and trends over time. It is hoped that the Behavioral 

Health Barometer will assist the agency in furthering its mission of reducing the impact 

of substance abuse and mental illness on America’s communities.

SAMHSA will provide each state with its state-specific outcome data for several 

indicators from the Behavioral Health Barometer. States can use this to compare their 

data to national data and to focus their efforts and resources on the areas where they need 

to improve. In addition to in-state data, SAMHSA has identified several other data sets 

that are available to states through various federal agencies: CMS, the Agency for 

Healthcare Research and Quality (AHRQ), and others. The data sets that states could use 

for developing their needs assessment and plans are included in the attachment. 

Through the Healthy People Initiative, HHS has identified a broad set of indicators and 

goals to track and improve the nation’s health. By using the indicators included in 

Healthy People34, states can focus their efforts on priority issues, support consistency in 

measurement, and use indicators that are being tracked at a national-level enabling better 

comparability. States should consider this resource in their planning.

Step 3: Prioritize state planning activities

Using the information in step two, states should identify specific priorities that will be 

included in the MHBG and SABG. The priorities must include the core federal goals and 

aims of the Block Grant programs: target populations (those that are required in 

legislation and regulation for each Block Grant) and other priority populations described 

in this document. States should list the priorities for the plan in Plan Table 1and indicate 

the priority type (i.e., substance abuse prevention (SAP), substance abuse treatment 

(SAT), mental health prevention (MHP), or mental health services (MHS).

 34 http://www.healthypeople.gov/2020/default.aspx
49

Step 4: Develop objectives, strategies, and performance indicators. 

For each of the priorities identified in step three, states should identify the relevant goals, 

strategies, and performance indicators over the next two years. For each priority area, 

states should identify at least one measurable goal/objective.

For each goal, the state should describe the specific strategy that will be used to reach the 

goal. These strategies may include developing and implementing various service-specific 

changes to address the needs of specific populations, substance abuse prevention 

activities, improving emotional health and prevention of mental illness, and system 

improvements that will address the goal. 

Strategies that use service-specific changes to achieve a goal should be consistent with 

SAMHSA’s continuum of services identified in the Good and Modern System brief.

35 If 

the state is recommending services that are not specifically referenced in this brief, please 

describe the population(s) that will receive these services, the rationale for this 

recommendation, and the evidence regarding the effectiveness of this service. In 

addition, the description of the strategy should provide the context for how the servicespecific change will be implemented. Strategies that should be considered and addressed 

include: 

• Strategies that are targeted for children and youth with SED or substance use 

disorders should utilize a system of care approach that has been well-established 

for children with SED and co-occurring substance use disorders. This approach 

should be utilized state-wide, coordinating care with other state agencies (e.g., 

schools, child welfare, juvenile justice, primary care, etc.) to deliver evidencebased treatments and supports through a family-driven, youth-guided, culturally 

competent, individualized treatment plan. For adolescents with substance use 

disorders and SED, this approach should be used in conjunction with evidencebased interventions for substance abuse or dependence. 

• Strategies targeted for adults with M/SUDs that will design and implement 

recovery-oriented services. 

• Strategies that will promote integration and inclusion into the community. This 

includes housing models that integrate individuals into the community instead of 

nursing homes and other settings that fail to promote independence and inclusion. 

This also can include strategies to promote competitive and supported 

employment in the community, rather than segregated programs. 

• Strategies on how technology, especially ICTs will be used to engage individuals 

and their families into treatment and recovery supports. Almost 40 percent of 

uninsured individuals are under the age of 30 and use technology (internet or 

texting) as a substantial, if not primary, mode of communication.36

• Strategies that result in developing recovery support services, e.g., permanent 

housing and supportive employment or education for persons with mental and 

 35 Substance Abuse and Mental Health Services Administration. (2010), Description of a Modern Addictions and 

Mental Health Delivery System, Office of Policy, Planning, and Innovation, Rockville, MD

http://www.samhsa.gov/healthreform/docs/AddictionMHSystemBrief.pdf

37 Center of Budget and Policy Priorities
50

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 will increase the availability of SBIRT. In 2013, SAMHSA 

brought SBIRT to scale under the SABG. States now have the opportunity to use 

Block Grant funds for SBIRT services. However, states should be aware that 

primary prevention set-aside funds cannot be used to fund SBIRT and should be 

encouraging the State Medicaid Agency and Health Insurance Marketplace to 

include SBIRT as a covered prevention or service delivery benefit. 

• Strategies that will enable the state to document the diversity of its service 

population and providers and to specify the development of an array of culturalspecific interventions and providers to improve access, engagement, quality, and 

outcomes of services for diverse ethnic and racial minorities and LGBTQ 

populations. States will be encouraged to refer to the 2009 IOM report, Race, 

Ethnicity, and Language Data: Standardization for Health Care Quality 

Improvement37

• Strategies that will build the state and provider capacity to provide evidencebased trauma-specific interventions in the context of a trauma-informed delivery 

system. Recognizing trauma as a central factor in the development of mental and 

substance use disorders, states should build provider competence in using

effective trauma treatments. States should ensure that these treatments are 

provided in systems that understand the impact of trauma on their service 

population and work to eliminate organizational practices and policies that may 

cause new or exacerbate existing trauma. 

in developing this strategy. 

• Strategies that increase the use of person-centered planning, self-direction, and 

participant-directed care. This includes measures to help an individual or their 

caregiver (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 identify, choose, and hire their providers.

• Strategies that are developed to prevent substance abuse and mental disorders and 

promote emotional health and prevention of mental illness should be consistent 

with the latest research. The 2009 IOM report, Preventing Mental, Emotional, 

and Behavioral Disorders Among Young People: Progress and Possibilities.

38

 37 Institute of Medicine. (2009).Race, Ethnicity, and Language Data: Standardization for Healthcare quality 

Improvement. Subcommittee on Standardization Collection of Race/Ethnicity Data for Healthcare Quality 

Improvement, Board on Healthcare Services. Cheryl Ulmer, Bernadette McFadden, and David R. Nerenz, Editors, 

Washington, DC: The National Academies Press

This report articulates the current scientific understanding of the prevention of 

mental and substance use disorders. It also describes a set of interventions that 

have proven effective in preventing substance abuse and mental illness, 

38 National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral 

Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and 

Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary 

Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of 

Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press
51

promoting positive emotional health by addressing risk factors, and promoting 

protective factors related to these problems. States should identify strategies for 

the SABG that reflect the priorities identified from the needs assessment process, 

including: 

• As specified in 45 C.F.R. §96.125(b), states shall use a variety of evidence-based 

programs, policies and practices in their prevention efforts that include:

o Information dissemination;

o Education;

o Alternatives that decrease alcohol, tobacco, and other drug use; 

o Problem identification and referral;

o Community based programming; and,

o 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. 

• Prevention strategies should also 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 Drinking39

o Strategies that target tobacco use prevention, tobacco cessation, and 

tobacco-free facilities that are supported by research and encompass a 

range of activities including policy initiatives and programs.

, the NREPP, and/or

other materials documenting their effectiveness. These strategies include:

o Strategies that engage 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.

o Strategies that address underage drinking based in science and encompass 

a range of connected activities including policy and regulation, 

enforcement, and normative/behavior change initiatives and programs.

o Strategies that implement evidence-based and cost-effective models to 

prevent substance abuse in young people in a variety of community 

settings, e.g., families, schools, workplaces, and faith-based institutions, 

consistent with the current science.

o Strategies that follow the Surgeon General’s National Strategy to Prevent 

Underage Drinking, developed in coordination with the Interagency 

Coordinating Committee on the Prevention of Underage Drinking

(ICCPUD), that focus on policy and environmental programming to 

change the community’s norms around, and parental acceptance of, 

underage alcohol use.

o Strategies that address harder-to-reach racial/ethnic minority and LGBTQ 

communities that experience a cluster of risk factors that make them 

especially vulnerable to substance use and related problems.

 39 http://www.surgeongeneral.gov/library/calls/underagedrinking/calltoaction.pdf
52

o Strategies that follow the Surgeon General’s National Strategy for Suicide 

Prevention, including promoting the awareness that suicide is a public 

health problem that is preventable and implementing community-based 

suicide prevention programs.

• States should identify strategies for the MHBG that reflect the priorities identified 

from the needs assessment process. Goals that are focused on emotional health 

and the prevention of mental illnesses should be consistent with the IOM report 

on Preventing Mental, Emotional, and Behavioral Disorders Among Young 

People and should include: 

o Strategies that work with schools, workplaces, and communities to deliver 

programs to improve mental health literacy and enhance resilience.

o Strategies that target prevention and early intervention programs for 

children and their families through partnerships between mental health, 

maternal and child health services, schools, and other related 

organizations, and to include evidence-based and cost-effective models of 

intervention for early psychosis in young people.

o Strategies that implement suicide prevention activities to identify youth at 

risk of suicide and improve the effectiveness of services and support 

available to them, including educating frontline workers in emergency, 

health, and other social services settings about mental health and suicide 

prevention.

o Strategies that implement evidenced-based interventions and traumaspecific treatments for highly vulnerable children and young people who 

have experienced physical, sexual, or emotional abuse, bullying, and/or 

other trauma, with a separate focus on youth from racial/ethnic minority 

and LGBTQ communities.

• System improvement activities may be included as strategies to address issues 

identified in the needs assessment. System improvement activities 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 as more individuals will be covered in FY 2014. 

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 behavioral health workforce. System 

improvements that seek to expand the workforce should build upon 

existing efforts to 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 

ACOs). This may include assistance to develop the necessary 

infrastructure (e.g., electronic billing and EHRs) and reporting 

requirements to effectively participate in these networks. 

o Encourage the use of peer specialists or recovery coaches to provide 

needed recovery support services, which are already delivered by 
53

volunteers and paid staff. Peers are trained, supervised, and regarded as 

staff and 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 under either model. The infrastructure, 

including paid staff, to coordinate and encourage the use of volunteerdelivered or run services should also be supported. 

o Increase links between primary care and behavioral health providers

working with behavioral health provider organizations for expertise, 

collaboration, and referral arrangements, including the support of primary 

care provider efforts to screen patients for mental and substance use 

disorders. Activities should also focus on developing model contract 

templates for reciprocal primary care and behavioral health integration and 

identifying state policies that present barriers to reimbursement. This 

would include efforts to implement health homes (§2703 of the Affordable 

Care Act), dual eligible products, ACOs, and primary care 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 behavioral health 

outcomes. 

o Fund auxiliary aids and services to allow people with disabilities to benefit 

from the mental health and substance use 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. SAMHSA will expect states to develop spending 

targets for certain services and manage within those targets.

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 FY 

2014 and how the state proposes to measure the change in FY 2015. States shall use the 

template (Plan Table 1: Priority Areas by Goal, Strategy, and Performance Indicators)

below.
54

Plan Table #1. Priority Area and Annual Performance Indicators

States should follow the guidelines presented above in Framework for Planning—Mental 

Health and Substance Abuse Prevention and Treatment (3A) and Planning Steps (3B) to 

complete Plan Table 1. States are to complete a separate table for each state priority area 

to be included in the MHBG and SABG. The following information is required:

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 edited.

2) Priority Type. From the drop-down menu, select:

SAP–substance abuse prevention,

SAT–substance abuse treatment,

MHP–mental health promotion, or

MHS–mental health service.

3) Targeted/required populations. Indicate the population(s) required in statute for each 

Block Grant as well as those populations encouraged, as described in 3A Framework 

for Planning—Mental Health and Substance Abuse Prevention and Treatment. From 

the drop-down menu select:

SMI–Adults with serious mental illness,

SED–Children with a serious emotional disturbance,

PWWDC–Pregnant women and women with dependent children,

IVDUs–Intravenous drug users,

HIV EIS–Persons with or at risk of HIV/AIDS who are in treatment for 

substance abuse,

TB–Persons with or at risk of TB who are in treatment for substance abuse,

and/or

Other: Specify (Refer to section 3a of the Assessment and Plan). 

4) Goal of the priority area. Provide a general description of what the state hopes to 

accomplish. 

5) Strategies to attain the goal. Indicate state program strategies or means to reach 

the stated goal.

6) Annual Performance Indicators to measure success on a yearly basis. For the 

SABG, each indicator must reflect progress on a measure that is impacted by the 

Block Grant. After this is completed, the information for the first indicator below, 

the table will expand to enter additional indicators. For each performance 

indicator, specify the following components:

(a) Baseline measurement, 

(b) First-year target/outcome measurement (Progress to end of SFY 2014),

(c) Second-year target/outcome measurement (Final to end of SFY 2015),

(d) Data source, 
55

(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, MHP, MHS):

3. Population(s) (SMI, SED, PWWDC, IVDUs, HIV EIS, TB, OTHER): 

4. Goal of the priority area:

5. Strategies to attain the goal:

6. Annual Performance Indicators to measure goal success:

Indicator #1:

a) Baseline measurement (Initial data collected prior to and during SFY 2014):

b) First-year target/outcome measurement (Progress to end of SFY 2014):

c) Second-year target/outcome measurement (Final to end of SFY 2015):

d) Data source: 

e) Description of data:

f) Data issues/caveats that affect outcome measures:

States are accountable for meeting the goals and performance targets established in their 

plans. SAMHSA staff will work closely with states during the year to discuss progress, 

identify barriers, and develop solutions to address these barriers. 

If a state fails to achieve its goals as stated in its application(s) approved by SAMHSA, 

the state will provide a description of corrective actions to be taken. If further steps are 

not taken, SAMHSA may ask the state for a revised plan, that SAMHSA will assist in 

developing, to achieve its goals. States that do not choose to apply for the MHBG or 

SABG will have their funds redirected to other states as provided in statute.

Plan Table 2: State Agency Planned Expenditures 

States should project how the SMHA and/or the SSA will use available funds to provide 

authorized services. Plan Table 2 must be completed for the planning period.
56

Plan Table 2: State Agency Planned Expenditures

Plan Table 2 State Agency Planned Expenditures 

(Include ONLY funds expended by the executive branch agency administering the SABG and/or the MHBG*

Planning Period- From: To:

State Identifier:

Source of Funds

ACTIVITY

(See instructions for using 

Row 1.)

A. 

SA BG

B.

MH BG 

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

1. Substance Abuse 

Prevention* and 

Treatment

a. Pregnant Women 

and Women with 

Dependent 

Children*

$ $ $ $ $ $

b. All Other $ $ $ $ $ $

2. Primary 

Prevention***

$ $ $ $ $ $ $

a. Substance Abuse 

Primary Prevention

b. Mental Health 

Primary prevention

Evidence Based 

Prevention and 

Treatment Grants (5% 

of total award MHBG)

3. Tuberculosis Services $ $ $ $ $ $

4. HIV Early 

Intervention Services

$ $ $ $ $ $

5. State Hospital $ $ $ $ $ $

6. Other 24 Hour Care $ $ $ $ $ $

7. Ambulatory/Community 

Non-24 Hour Care

$ $ $ $ $ $

8. Administration 

(excluding program / 

provider level

$ $ $ $ $ $ $

9. Subtotal (Rows 1, 2, 3, 4, 

and 8)

$ $ $ $ $ $ $
57

* Prevention other than primary prevention.

** States may only use MH Block Grant funds to provide primary prevention services to the priority 

populations of adults with serious mental illness and children with serious emotional disturbance.

***The 20% set aside funds in the SABG must be used for activities designed to prevent substance abuse.

10. Subtotal (Rows 5, 6, 7, 

and 8)

$ $ $ $ $ $ $

11. Total $ $ $ $ $ $ $
58

Plan Table 3: State Agency Planned Block Grant Expenditures by Service

States should project how SABG and MHBG funds will be used to provide services for the target populations or areas identified in 

their plans. Plan Table 3 must be completed for the planning period. If the state purchases services or activities that are not included 

in the listed categories, please report them in the last row of the table in the “Other” category. 

Plan Table 3 State Agency Planned Block Grant Expenditures by Service

State Identifier:

Planning Period – From: To: 

Service Unduplicated Individuals

Unit

Type

Unit

Quantity

MHBG

Expenditure

s

SABG

Expenditure

s

Healthcare Home/Physical Health $ $

General and Specialized Outpatient Medical Services $ $

Acute Primary Care $ $

General Health Screens, Tests and Immunizations $ $

Comprehensive Care Management $ $

Care Coordination and Health Promotion $ $

Comprehensive Transitional Care $ $

Individual and Family Support $ $

Referral to Community Services $ $

Prevention examples of approaches include: $ $

a. Prevention including Promotion

Screening, Brief Intervention and Referral to Treatment $ $

Brief Motivational Interviews $ $

Screening and Brief Intervention for Tobacco Cessation $ $

Parent Training $ $

Facilitated Referrals $ $

Relapse Prevention/Wellness Recovery Support $ $

Warm Line $ $

b. Substance Abuse Primary Prevention

Classroom and/or small group sessions (Education) $ $
59

Plan Table 3 State Agency Planned Block Grant Expenditures by Service

State Identifier:

Planning Period – From: To: 

Service Unduplicated Individuals

Unit

Type

Unit

Quantity

MHBG

Expenditure

s

SABG

Expenditure

s

Media campaigns (Information Dissemination) $ $

Systematic Planning/Coalition and Community Team Building(Community 

Based Process)

$ $

Parenting and family management (Education) $ $

Education programs for youth groups (Education) $ $

Community Service Activities (Alternatives) $ $

Student Assistance Programs (Problem Identification and Referral) $ $

Employee Assistance programs (Problem Identification and Referral) $ $

Community Team Building (Community Based Process) $ $

Promoting the establishment or review of alcohol, tobacco, and drug use policies 

(Environmental) 

$ $

Engagement Services $ $

Assessment $ $

Specialized Evaluations (Psychological and Neurological) $ $

Service Planning (including crisis planning) $ $

Consumer/Family Education $ $

Outreach $ $

Outpatient Services $ $

Individual Evidenced-based Therapies $ $

Group Therapy $ $

Family Therapy $ $

Multi-family Therapy $ $

Consultation to Caregivers $ $

Medication Services $ $

Medication Management $ $

Pharmacotherapy (including MAT) $ $

Laboratory Services $ $
60

Plan Table 3 State Agency Planned Block Grant Expenditures by Service

State Identifier:

Planning Period – From: To: 

Service Unduplicated Individuals

Unit

Type

Unit

Quantity

MHBG

Expenditure

s

SABG

Expenditure

s

Community Support (Rehabilitative) $ $

Parent/Caregiver Support $ $

Skill Building (social, daily living, cognitive) $ $

Case Management $ $

Behavior Management $ $

Supported Employment $ $

Permanent Supported Housing $ $

Recovery Housing $ $

Therapeutic Mentoring $ $

Traditional Healing Services $ $

Recovery Supports $ $

Peer Support $ $

Recovery Support Coaching $ $

Recovery Support Center Services $ $

Supports for Self-directed Care $ $

Other Supports (Habilitative) $ $

Personal Care $ $

Homemaker $ $

Respite $ $

Supported Education $ $

Transportation $ $

Assisted Living Services $ $

Recreational Services $ $

Trained Behavioral Health Interpreters $ $

Interactive Communication Technology Devices $ $

Intensive Support Services $ $

Substance Abuse Intensive Outpatient (IOP) $ $
61

Plan Table 3 State Agency Planned Block Grant Expenditures by Service

State Identifier:

Planning Period – From: To: 

Service Unduplicated Individuals

Unit

Type

Unit

Quantity

MHBG

Expenditure

s

SABG

Expenditure

s

Partial Hospital $ $

Assertive Community Treatment $ $

Intensive Home-based Services $ $

Multi-systemic Therapy $ $

Intensive Case Management $ $

Out of Home Residential Services $ $

Crisis Residential/Stabilization $ $

Clinically Managed 24-hour Care (SA) $ $

Clinically Managed Medium Intensity Care (SA) $ $

Adult Mental Health Residential $ $

Youth Substance Abuse Residential Services $ $

Children's Residential Mental Health Services $ $

Therapeutic Foster Care $ $

Acute Intensive Services $ $

Mobile Crisis $ $

Peer-based Crisis Services $ $

Urgent Care $ $

23-hour Observation Bed $ $

Medically Monitored Intensive Inpatient (SA) $ $

24/7 Crisis Hotline Services $ $

Other (please list) $ $

$ $

Total $ $
62

Plan Table 4: SABG Planned Expenditures.

States should project how they will use SABG funds to provide authorized services as required by the SABG regulations. Plan Table

4 must be completed for the FY 2014 and FY 2015 SABG awards.

Plan Table 4: SABG Planned Expenditures

Plan Table 4 SABG Planned Expenditures

State Identifier: 

Expenditure Category FY 2014 SA Block Grant Award FY 2015 SA Block Grant Award

1. Substance Abuse Prevention* and Treatment $ $

2. Primary Substance Abuse Prevention $ $

3. HIV Early Intervention Services** $ $

4. Tuberculosis Services $ $

5. Administration (SSA level only) $ $

6. Total $ $

* Prevention other than Primary Prevention

 ** HIV Designated States Only
63

Plan Table 5a: SABG Primary Prevention Planned Expenditures 

States should project how they will use SABG funds to conduct and/or fund primary

prevention and §192640-related activities. Primary prevention activities are those directed at 

individuals who do not require treatment for substance abuse. In implementing a 

comprehensive primary prevention program, the state shall use a variety of strategies 

including but not limited to the six strategies included on Plan Table 5a. If a state employs 

strategies not covered by these six strategies, they should be reported under ‘Other’ in a 

separate row for each strategy; or, alternatively, the state may choose to report those activities 

utilizing the IOM model of universal, selective, and indicated. Note that the row entitled 

‘Section 1926 Tobacco” on Plan Table 5a must be completed by states reporting expenditures 

by the six strategies and for those reporting by IOM category. Plan Table 5a must be 

completed for the FY 2014 and FY 2015 SABG awards. The total amounts should equal 

amount reported on Plan Table 4, Row 2, Primary Prevention. 

Plan Table 5a: SABG Primary Prevention Planned Expenditures

State Identifier:

Report Period- From: To:

A B C

Strategy IOM Target FY 2014 SA Block 

Grant Award

FY 2015 SA Block 

Grant Award

1. Information Dissemination Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

2. Education Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

3. Alternatives Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

4. Problem Identification and Referral Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

5. Community-Based Processes Universal $ $

 40 Section 1926 of the PHS Act as added by the Alcohol, Drug Abuse, and Mental Health Administration 

Reorganization Act (P.L. 102-321, section 202).
64

Selected $ $

Indicated $ $

6. Environmental Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

7. Section 1926-Tobacco Universal $ $

Selected $ $

Indicated $ $

8. Other Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

9. Total Prevention Expenditures $ $

Total SABG Award $ $

Planned Primary Prevention

Percentage

% %
65

Plan Table 5b: SABG Primary Prevention Planned Expenditures 

States should project how they will use SABG funds to conduct and/or fund primary 

prevention and §1926-related activities. Plan Table 5b must be completed for the FY 2014 

and FY 2015 SABG awards. The total amounts for each award should equal amount 

reported on Plan Table 4, Row 2, Primary Prevention. 

Plan Table 5b: SABG Primary Prevention Planned Expenditures

Plan Table 5b: SABG Primary Prevention Planned 

Expenditures by IOM Category 

State Identifier:

Activity

FY 2014 SA

Block Grant 

Award

FY 2015 SA

Block Grant 

Award

Universal Direct $ $

Universal Indirect $ $

Selective $ $

Indicated $ $

Column Total $

Total SABG 

Award

$ $

Planned Primary 

Prevention

Percentage

% %
66

Plan Table 5c: SABG Planned Primary Prevention Targeted Priorities. 

States should identify the categories of substances the State BG Plans to target with 

primary prevention set-aside dollars from the FY 2014 and FY 2015 SABG awards. 

Plan Table 5c: SABG Planned Primary Prevention Targeted Priorities

Targeted Substances

Alcohol

Tobacco

Marijuana

Prescription Drugs

Cocaine

Heroin

Inhalants

Methamphetamine 

Synthetic Drugs (i.e. Bath salts, 

Spice, K2)

Instructions: In the table below identify the special population categories the State BG Plans to targets 

with primary prevention set-aside dollars.

Targeted Populations

Students in College

Military Families

LGBTQ

American Indians/Alaska Natives

African American

Hispanic

Homeless

Native Hawaiian/Other Pacific Islanders

Asian 

Rural 

Underserved Racial and Ethnic 

Minorities
67

Plan Table 6a: SABG Resource Development Activities Planned Expenditures 

States should project how they will use SABG funds to conduct and/or fund resource development activities. 

Plan Table 6a must be completed for the FY 2014 and FY 2015 SABG awards. 

Plan Table 6a: SABG Resource Development Activities Planned Expenditures

Plan Table 6A SABG Resource Development Activities Planned Expenditures

State Identifier:

FY 2014 SA Block Grant Award FY 2015 SA Block Grant Award

Prevention Treatment Combined Total Prevention Treatment Combined Total

1. Planning, Coordination, 

and Needs Assessment

$ $ $ $ $ $ $ $

2. Quality Assurance $ $ $ $ $ $ $ $

3. Training (postemployment)

$ $ $ $ $ $ $ $

4. Education (preemployment)

$ $ $ $ $ $ $ $

5. Program Development $ $ $ $ $ $ $ $

6. Research and Evaluation $ $ $ $ $ $ $ $

7. Infor mation Systems $ $ $ $ $ $ $ $

9. Enrollment and Provider 

Business Practices (3 

percent of BG award)

8. Total $ $ $ $ $ $ $ $
68

Plan Table 6b: MHBG Non-Direct Service Activities Planned Expenditures

States should project how they will use MHBG funds to conduct and/or fund non-direct 

service activities. Plan Table 6b must be completed for the planning period. States should 

only report the planned expenditures of the MHBG by the SMHA or programs that they 

directly contract with. States should not report on planned expenditures by programs more 

than one-level down from the state in funding. For example, if a state provides MHBG 

funds to county mental health authorities that in turn contract with private, not-for-profit 

mental health providers, only the planned expenditures by the SMHA and the county 

mental health authorities should be reported in this table.

Plan Table 6b: MHBG Non-direct Service Activities Planned Expenditures

Plan Table 6B MHBG Non-Direct Service Activities Planned Expenditures

State Identifier:

Planning Period - From: To: 

Service MH Block Grant 

MHA Technical Assistance Activities

MHA Planning Council Activities

MHA Administration

MHA Data Collection/Reporting

Enrollment and Provider Business Practices (3 

percent of total award)

MHA Activities Other Than Those Above

Total Non-Direct Services

Comments on Data:
69

C. Coverage for M/SUD Services

Beginning in 2014, Block Grant dollars should be used to pay for (1) people who are 

uninsured and (2) services that are not covered by insurance and Medicaid. Presumably, 

there will be similar concerns at the state-level that state dollars are being used for people 

and/or services not otherwise covered. States (or the Federal Marketplace) are currently 

making plans to implement the benchmark plan chosen for QHPs and their expanded 

Medicaid programs (if they choose to do so). States should begin to develop strategies 

that will monitor the implementation of the Affordable Care Act in their states. States 

should begin to identify whether people have better access to mental and substance use 

disorder services. In particular, states will need to determine if QHPs and Medicaid are 

offering mental health and substance abuse services and whether services are offered 

consistent with the provisions of MHPAEA. 

Please answer the following questions:

1. Which services in Plan Table 3 of the application will be covered by Medicaid or 

by QHPs on January 1, 2014?

2. Do you have a plan for monitoring whether individuals and families have access 

to M/SUD services offered through QHPs and Medicaid? 

3. Who in your state is responsible for monitoring access to M/SUD services by the 

QHPs? Briefly describe their monitoring process.

4. Will the SMHA and/or SSA be involved in reviewing any complaints or possible 

violations or MHPAEA? 

5. What specific changes will the state make in consideration of the coverage 

offered in the state’s EHB package?

D. Health Insurance Marketplace

The Health Insurance Marketplace (Marketplace) will be responsible for performing a 

variety of critical functions to ensure access to desperately needed behavioral health 

services. Outreach and education regarding enrollment in QHPs or expanded Medicaid 

will be critical. SMHAs and SSAs should understand their state’s new eligibility 

determination and enrollment system, as well as how insurers (commercial, Medicaid,

and Medicare plans) will be making decisions regarding their provider networks. States 

should consider developing benchmarks regarding the expected number of individuals in 

their publicly-funded behavioral health system that should be insured by the end of FY 

2015. In addition, states should set similar benchmarks for the number of providers who 
70

will be participating in insurers’ networks that are currently not billing third party 

insurance.

QHPs must maintain a network of providers that is sufficient in the number and types of 

providers, including providers that specialize in mental health and substance abuse, to 

assure that all services will be accessible without unreasonable delay. Mental health and 

substance abuse providers were specifically highlighted in the rule to encourage QHP 

issuers to provide sufficient access to a broad range of mental health and substance abuse 

services, particularly in low-income and underserved communities. 

Please answer the following questions:

1. How will the state evaluate the impact that its outreach, eligibility determination, 

enrollment, and re-enrollment systems will have on eligible individuals with 

behavioral health conditions?

2. How will the state work with its partners to ensure that the Navigator program is 

responsive to the unique needs of individuals with behavioral health conditions 

and the challenges to getting and keeping the individuals enrolled?

3. How will the state ensure that providers are screening for eligibility, assisting 

with enrollment, and billing Medicaid, CHIP, QHPs, or other insurance prior to 

drawing down Block Grant dollars for individuals and/or services?

4. How will the state ensure that there is adequate community behavioral health 

provider participation in the networks of the QHPs, and how will the state assist 

its providers in enrolling in the networks?

5. Please provide an estimate of the number of individuals served under the MHBG

and SABG who are uninsured in CY 2013. Please provide the assumptions and 

methodology used to develop the estimate.

6. Please provide an estimate of the number of individuals served under the MHBG

and SABG who will remain uninsured in CY 2014 and CY 2015. Please provide 

the assumptions and methodology used to develop the estimate.

7. For the providers identified in Table 8 “Statewide Entity Inventory” of the FY 

2012 MHBG and SABG Reporting Section, please provide an estimate of the 

number of these providers that are currently enrolled in your state’s Medicaid 

program. Please provide the assumptions and methodology used to develop the 

estimate.

8. Please provide an estimate of the number of providers estimated in Question 7 

that will be enrolled in Medicaid or participating in a QHP. Provide this estimate 

for FY 2014 and a separate estimate for FY 2015, including the assumptions and 

methodology used to develop the estimate.

 .
71

E. Program Integrity

The Affordable Care Act directs the Secretary of HHS to define EHBs. Nongrandfathered plans in the individual and small group markets both inside and outside of 

the Marketplace, Medicaid benchmark and benchmark-equivalent plans, and basic health 

programs must cover these EHBs beginning in 2014. On December 16, 2011, HHS 

released a bulletin indicating the Secretary’s intent to propose that EHBs be defined by 

benchmarks selected by each state. The selected benchmark plan would serve as a 

reference plan, reflecting both the scope of services and any limits offered by a “typical 

employer plan” in that state as required by the Affordable Care Act.

SMHAs and SSAs should now be focused on two main areas related to EHBs: 

monitoring what is covered and aligning Block Grant and state funds to compensate for 

what is not covered. There are various activities that will ensure that mental and 

substance use disorder services are covered. These include: (1) appropriately directing 

complaints and appeals requests to ensure that QHPs and Medicaid programs are 

including EHBs as per the state benchmark; (2) ensuring that individuals are aware of the 

covered mental health and substance abuse benefits; (3) ensuring that consumers of 

substance abuse and mental health services have full confidence in the confidentiality of 

their medical information; and (4) monitoring utilization of behavioral health benefits in 

light of utilization review, medical necessity, etc.

States traditionally have employed a variety of strategies to procure and pay for 

behavioral health services funded by the SABG and MHBG. State systems for 

procurement, contract management, financial reporting, and audit vary significantly. 

SAMHSA expects states to implement policies and procedures that are designed to 

ensure that Block Grant funds are used in accordance with the four priority categories 

identified above. Consequently, states may have to reevaluate their current management 

and oversight strategies to accommodate the new priorities. They may also be required 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.

States should describe their efforts to ensure that Block Grant funds are expended 

efficiently and effectively in accordance with program goals. In particular, states should 

address how they will accomplish the following: 

1. Does the state have a program integrity plan regarding the SABG and MHBG?

2. Does the state have a specific staff person that is responsible for the state 

agency’s program integrity activities?

3. What program integrity activities does the state specifically have for monitoring 

the appropriate use of Block Grant funds? Please indicate if the state utilizes any 

of the following monitoring and oversight practices:

a. Budget review;
72

b. Claims/payment adjudication;

c. Expenditure report analysis;

d. Compliance reviews;

e. Encounter/utilization/performance analysis; and

f. Audits.

4. How does the state ensure that the payment methodologies used to disburse 

funds are reasonable and appropriate for the type and quantity of services 

delivered? 

5. How does the state assist providers in adopting practices that promote 

compliance with program requirements, including quality and safety standards?

6. How will the state ensure that Block Grant funds and state dollars are used to 

pay for individuals who are uninsured and services that are not covered by 

private insurance and/or Medicaid?

SAMHSA will review this information to assess the progress that states have made in 

addressing program integrity issues and determine if additional guidance and/or technical 

assistance is appropriate.

F. Use of Evidence in Purchasing Decisions

SAMHSA is interested in whether and how states are using evidence in their purchasing 

decisions, educating policymakers, or supporting providers to offer high quality services. 

In addition, SAMHSA is concerned with what additional information is needed by 

SMHAs and SSAs in their efforts to continue to shape their and other purchasers 

decisions regarding mental health and substance abuse services. SAMHSA is requesting 

that states respond to the following questions:

1) Does your state have specific staff that are responsible for tracking and disseminating 

information regarding evidence-based or promising practices?

2) Did you use information regarding evidence-based or promising practices in your 

purchasing or policy decisions?

a) What information did you use? 

b) What information was most useful?

3) How have you used information regarding evidence-based practices?

a) Educating State Medicaid agencies and other purchasers regarding this 

information?

b) Making decisions about what you buy with funds that are under your control?
73

 

G. Quality

Up to 25 data elements, including those listed in the table below, will be available 

through the Behavioral Health Barometer which SAMHSA will prepare annually to share 

with states for purposes of informing the planning process. The intention of the 

Barometer is to provide information to states to improve their planning process, not for 

evaluative purposes. Using this information, states will select specific priority areas and 

develop milestones and plans for addressing each of their priority areas. States will 

receive feedback on an annual basis in terms of national, regional, and state performance 

and will be expected to provide information on the additional measures they have 

identified outside of the core measures and state barometer. Reports on progress will 

serve to highlight the impact of the Block Grant-funded services and thus allow 

SAMHSA to collaborate with the states and other HHS Operating Divisions in providing 

technical assistance to improve behavioral health and related outcomes.

Prevention Substance Abuse 

Treatment

Mental Health Services

Health Youth and Adult 

Heavy Alcohol UsePast 30 Day 

Reduction/No Change 

in substance use past 

30 days 

Level of Functioning

Home Parental Disapproval 

Of Drug Use 

Stability in Housing Stability in Housing 

Community Environmental 

Risks/Exposure to 

prevention Messages 

and/or Friends 

Disapproval

Involvement in SelfHelpImprovement/Increase in 

quality/number of 

supportive relationships 

among SMI population

Purpose Pro-Social 

Connections–

Community 

Connections

Percent in TX 

employed, in school, 

etc. (TEDS)

Clients w/ SMI or SED 

who are employed, or in 

school

1) What additional measures will your state focus on in developing your State BG Plan

(up to three)?

2) Please provide information on any additional measures identified outside of the core 

measures and state barometer.

3) What are your states’ specific priority areas to address the issues identified by the 

data?
74

4) What are the milestones and plans for addressing each of your priority areas?

H. Trauma

In order to better meet the needs of those they serve, states should take an active 

approach to addressing trauma. Trauma screening matched with trauma-specific 

therapies, such as exposure therapy or trauma-focused cognitive behavioral approaches,

should be used to ensure that treatments meet the needs of those being served. States 

should also consider adopting a trauma-informed care approach consistent with 

SAMHSA’s trauma-informed care definition and principles. This means providing care 

based on an understanding of the vulnerabilities or triggers of trauma survivors that 

traditional service delivery approaches may exacerbate so that these services and 

programs can be more supportive and avoid being traumatized again. 

Please answer the following questions:

1. Does your state have any policies directing providers to screen clients for a 

personal history of trauma? 

2. Does the state have policies designed to connect individuals with trauma histories 

to trauma-focused therapy? 

3. Does your state have any policies that promote the provision of trauma-informed 

care?

4. What types of evidence-based trauma-specific interventions does your state offer 

across the life-span?

5. What types of trainings do you provide to increase capacity of providers to deliver 

trauma-specific interventions?

I. Justice

The SABG and MHBG may be especially valuable in supporting care coordination to 

promote pre-adjudication or pre-sentencing diversion, providing care during gaps in 

enrollment after incarceration, and supporting other efforts related to enrollment. 

Communities across the United States have instituted problem-solving courts, including 

those for defendants with mental and substance abuse disorders. These courts seek to 

prevent incarceration and facilitate community-based treatment for offenders, while at the 

same time protecting public safety. There are two types of problem-solving courts 
75

related to behavioral health: drug courts and mental health courts. In addition to these 

behavioral health problem-solving courts, some jurisdictions, operate courts specifically

for DWI/DUI, veterans, families, and reentry, as well as courts for gambling, domestic 

violence, truancy, and other subject-specific areas. 41,42 Rottman described the 

therapeutic value of problem-solving courts: “Specialized courts provide a forum in 

which the adversarial process can be relaxed and problem solving and treatment 

processes emphasized. Specialized courts can be structured to retain jurisdiction over 

defendants, promoting the continuity of supervision and accountability of defendants for 

their behavior in treatment programs.” Youths in the juvenile justice system often 

display a variety of high-risk characteristics that include inadequate family support, 

school failure, negative peer associations, and insufficient utilization of community-based 

services. Most adjudicated youth released from secure detention do not have community 

follow-up or supervision; and therefore, risk factors remain unaddressed.

43

A true diversion program takes youth who would ordinarily be processed within the 

juvenile justice system and places them instead into an alternative program. States 

should place an emphasis on screening, assessment, and services provided prior to 

adjudication and/or sentencing to divert persons with mental and/or substance use 

disorders from correctional settings. States should also examine specific barriers such as 

lack of identification needed for enrollment; loss of eligibility resulting from 

incarceration; and care coordination for individuals with chronic health conditions, 

housing instability, and employment challenges. Secure custody rates decline when 

community agencies are present to advocate for alternatives to detention

Please answer the following questions:

1. Does your state have plans to enroll individuals involved in the criminal and 

juvenile justice systems in Medicaid as a part of coverage expansions?

2. What screening and services are provided prior to adjudication and/or sentencing 

for individuals with mental and/or substance use disorders?

3. Are your SMHA and SSA coordinating with the criminal and juvenile justice 

systems with respect to diversion of individuals with mental and/or substance use 

disorders, behavioral health services provided in correctional facilities, and the 

reentry process for those individuals?

4. Do efforts around enrollment and care coordination address specific issues faced 

by individuals involved in the criminal and juvenile justice systems?

5. What cross-trainings do you provide for behavioral health providers and 

criminal/juvenile justice personnel to increase capacity for working with 

individuals with behavioral health issues involved in the justice system?

 41 The American Prospect: In the history of American mental hospitals and prisons, The Rehabilitation of the Asylum.

David Rottman,2000. 42 A report prepared by the Council of State Governments. Justice Center. Criminal Justice/Mental Health Consensus 

Project. New York, New York for the Bureau of Justice Assistance Office of Justice Programs U.S. Department of 

Justice, Renee L. Bender, 2001.

43 Journal of Research in Crime and Delinquency: Identifying High-Risk Youth: Prevalence and Patterns of Adolescent 

Drug Victims, Judges, and Juvenile Court Reform Through Restorative Justice. Dryfoos, Joy G. 1990, Rottman, David, 

and Pamela Casey, McNiel, Dale E., and Renée L. Binder. OJJDP Model Programs Guide.
76

J. Parity Education

SAMHSA encourages states to take proactive steps to improve consumer knowledge 

about parity. As one plan of action states can develop communication plans to provide 

and address key issues. SAMHSA is in a unique position to provide content expertise to 

assist states, and is asking for input from states to address this position. 

Please answer the following questions:

1. How will or can states use their dollars to develop communication plans to 

educate and raise awareness about parity?

2. How will or can states coordinate across public and private sector entities to 

increase awareness and understanding about benefits (e.g., service benefits, cost 

benefits, etc.?

3. What steps and processes can be taken to ensure a broad and strategic outreach is 

made to the appropriate and relevant audiences that are directly impacted by 

parity?

K. Primary and Behavioral Health Care Integration Activities

Numerous provisions in the Affordable Care Act and other statutes improve the 

coordination of care for patients through the creation of health homes, where teams of 

health care professionals will be rewarded to coordinate care for patients with chronic 

conditions. States that have approved Medicaid State Plan Amendments (SPAs) will 

receive 90 percent Federal Medical Assistance Percentage (FMAP) for health home 

services for eight quarters. At this critical juncture, some states are ending their two 

years of enhanced FMAP and returning to their regular state FMAP for health home 

services. In addition, many states may be a year into the implementation of their dual 

eligible demonstration projects. 

Please answer the following questions:

1. Describe your involvement in the various coordinated care initiatives that your 

state is pursuing? 

2. Are there other coordinated care initiatives being developed or implemented in 

addition to opportunities afforded under the Affordable Care Act?
77

3. Are you working with your state’s primary care organization or primary care 

association to enhance relationships between FQHCs, community health centers 

(CHC), other primary care practices and the publicly funded behavioral health 

providers?

4. Describe how your behavioral health facilities are moving towards addressing 

nicotine dependence on par with other substance use disorders.

5. Describe how your agency/system regularly screens, assesses, and addresses 

smoking amongst your clients. Include tools and supports (e.g. regular screening 

with a carbon monoxide (CO) monitor) that support your efforts to address 

smoking.

6. Describe how your behavioral health providers are screening and referring for:

a. heart disease,

b. hypertension,

c. high cholesterol, and/or

d. diabetes.

L. Health Disparities

In the Block Grant application, states are routinely asked to define the population they 

intend to serve (e.g., adults with SMI at risk for chronic health conditions, young adults 

engaged in underage drinking, populations living with or at risk for contracting 

HIV/AIDS). 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, Latino adults with 

SMI may be at heightened risk for metabolic disorder due to lack of appropriate inlanguage primary care services, 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, and African 

American women may be at greater risk for contracting HIV/AIDS due to lack of access 

to education on risky sexual behaviors in urban low-income communities. 

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 being served or 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 
78

diverse groups. In order for states to address the potentially disparate impact of their

Block Grant funded efforts, they will be asked to address access, use, and outcomes for 

subpopulations, which can be defined by the following factors: race, ethnicity, language,

gender (including transgender), tribal connection, and sexual orientation (i.e., lesbian, 

gay, bisexual).

In the space below please answer the following questions:

1. How will you track access or enrollment in services, types of services (including 

language services) received and outcomes by race, ethnicity, gender, LGBTQ, and

age?

2. How will you identify, address and track the language needs of disparityvulnerable subpopulations?

3. How will you develop plans to address and eventually reduce disparities in 

access, service use, and outcomes for the above disparity-vulnerable 

subpopulations?

4. How will you use Block Grant funds to measure, track and respond to these 

disparities?

M. Recovery

SAMHSA encourages states to take proactive steps to implement recovery support 

services. SAMHSA is in a unique position to provide content expertise to assist states, 

and is asking for input from states to address this position. To accomplish this goal and 

support the wide-scale adoption of recovery supports, SAMHSA has launched Bringing 

Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS). BRSS 

TACS assists states and others to promote adoption of recovery-oriented supports, 

services, and systems for people in recovery from substance use and/or mental disorders. 

Indicators/Measures

Please answer yes or no to the following questions:

1. Has the state has developed or adopted (or is the state in the process of developing 

and/or adopting) a definition of recovery and set of recovery values and/or 

principles that have been vetted with key stakeholders including people in 

recovery?

2. Has the state documented evidence of hiring people in recovery in leadership 

roles (e.g., in the state Office of Consumer Affairs) within the state behavioral 

health system?
79

3. Does the state’s plan include strategies that involve the use of person-centered 

planning and self-direction and participant-directed care?

4. Does the state’s plan indicate that a variety of recovery supports and services that 

meets the holistic needs of those seeking or in recovery are (or will be) available 

and accessible? Recovery supports and services include a mix of services outlined 

in The Good and Modern Continuum of Care Service Definitions, including peer 

support, recovery support coaching, recovery support center services, supports for 

self-directed care, peer navigators, and other recovery supports and services (e.g., 

warm lines, recovery housing, consumer/family education, supported 

employment, supported employments, peer-based crisis services, and respite 

care).

5. Does the state’s plan include peer-delivered services designed to meet the needs 

of specific populations, such as veterans and military families, people with a 

history of trauma, members of racial/ethnic groups, LGBT populations, and 

families/significant others?

6. Does the state provide or support training for the professional workforce on 

recovery principles and recovery-oriented practice and systems, including the role 

of peer providers in the continuum of services?

7. Does the state have an accreditation program, certification program, or standards 

for peer-run services?

8. Describe your state’s exemplary activities or initiatives related to recovery 

support services that go beyond what is required by the Block Grant application 

and that advance the state-of-the-art in recovery-oriented practice, services, and 

systems. Examples include: efforts to conduct empirical research on recovery 

supports/services, identification and dissemination of best practices in recovery 

supports/services, other innovative and exemplary activities that support the 

implementation of recovery-oriented approaches, and services within the state’s 

behavioral health system.

Involvement of Individuals and Families

Recovery is based on the involvement of consumers/peers and their family 

members. States must work to support and help strengthen existing consumer, 

family, and youth networks; recovery organizations; and community peer support 

and advocacy organizations in expanding self-advocacy, self-help programs, 

support networks, and recovery support services. There are many activities that 

SMHAs and SSAs can undertake to engage these individuals and families. In the 

space below, states should describe their efforts to actively engage individuals and 

families in developing, implementing and monitoring the state mental health and 

substance abuse treatment system. In completing this response, state should 

consider the following questions:

1. How are individuals in recovery and family members utilized in the 

planning, delivery, and evaluation of behavioral health services?

2. Does the state sponsor meetings or other opportunities that specifically 

identify individuals’ and family members’ issues and needs regarding the 
80

behavioral health service system and develop a process for addressing 

these concerns?

3. How are individuals and family members presented with opportunities to 

proactively engage the behavioral health service delivery system;

participate in treatment and recovery planning, shared decision making;

and direct their ongoing care and support? 

4. How does the state support and help strengthen and expand recovery 

organizations, family peer advocacy, self-help programs, support 

networks, and recovery-oriented services?

Housing

1. What are your state’s plans to address housing needs of persons served so 

that they are not served in settings more restrictive than necessary?

2. What are your state’s plans to address housing needs of persons served so 

that they are more appropriately incorporated into a supportive 

community?

N. Prevention

1. As specified in 45 C.F.R. §96.125(b), states shall use a variety of evidencebased programs, policies, and practices to develop prevention, including primary 

prevention strategies (45 CFR §96.125). Strategies 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 Drinking, the 

NREPP or other materials documenting their effectiveness. 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 abuse 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 SABG statute directs states to implement strategies including : (1) 

information dissemination: providing awareness and knowledge of the nature, 

extent, and effects of alcohol, tobacco, and drug use, abuse, and addiction on 

individuals families and communities; (2) education aimed at affecting critical life 

and social skills, such as decision making, refusal 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,
81

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.

States should provide responses to the following questions:

1. How did the state use data on substance use consumption patterns, consequences 

of use, and risk and protective factors to identify the types of primary prevention 

services that are needed (e.g., education programs to address low perceived risk of 

harm from marijuana use, technical assistance to communities to maximize and 

increase enforcement of alcohol access laws to address easy access to alcohol

through retail sources)?

2. What specific primary prevention programs, practices, and strategies does the 

state intend to fund with SABG prevention set-aside dollars, and why were these 

services selected? What methods were used to ensure that SABG dollars are used 

to purchase primary substance abuse prevention services not funded through other 

means?

3. How does the state intend to build the capacity of its prevention system, including 

the capacity of its prevention workforce?

4. What outcome data does the state intend to collect on its funded prevention 

strategies and how will these data be used to evaluate the state’s prevention 

system?

5. How is the state’s budget supportive of implementing the Strategic Prevention 

Framework?

6. How much of the SABG prevention set-aside goes to the state, versus community 

organizations? (A community is a group of individuals who share common 

characteristics and/or interests.)

7. How much of the prevention set-aside goes to evidence-based practices and 

environmental strategies? List each program.

2. Evidence Based Prevention and Treatment Approaches for the MHBG (5 

percent)
82

States are being asked to utilize at least five percent of their MHBG funds to 

award competitive grants to implement the most effective evidence-based 

prevention and treatment approaches focusing on promotion, prevention and early 

intervention. States that receive two percent or more of the total FY 2014 state 

allotment will be required to implement a competitive sub award process. States 

should describe how they intend to implement the competitive grants and/or sub 

award process.

O. Children and Adolescents Behavioral Health 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 over 160 grants awarded to states and communities, and 

every state has received at least one CMHI grant. In 2011, SAMHSA awarded System of 

Care Expansion grants to 24 states to bring this approach to scale in states. In terms of 

adolescent substance abuse, in 2007, SAMHSA awarded State Substance Abuse 

Coordinator grants to 16 states to begin to build a state infrastructure for substance abuse 

treatment and recovery-oriented systems of care for youth with substance use disorders. 

This work has continued with a focus on financing and workforce development to 

support a recovery-oriented system of care that incorporates established evidence-based 

treatment for youth with substance use disorders.

SAMHSA expects that states will build on this well-documented, effective system of care 

approach to serving children and youth with behavioral health needs. Given the multisystem 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, like wraparound service planning, intensive care management, 

outpatient therapy, intensive home-based services, substance abuse intensive outpatient 

services, continuing care, and mobile crisis response; supportive services, like peer youth 

support, family peer support, respite services, mental health consultation, and supported 

education and employment; and residential services, like therapeutic foster care, crisis 

stabilization services, and inpatient medical detoxification.

Please answer the following questions:
83

1. How will the state establish and monitor a system of care approach to support the 

recovery and resilience of children and youth with mental and substance use 

disorders?

2. What guidelines have and/or will the state establish for individualized care 

planning for children/youth with mental, substance use and co-occurring 

disorders?

3. How has the state established collaboration with other child- and youth-serving 

agencies in the state to address behavioral health needs (e.g., child welfare, 

juvenile justice, education, etc.)?

4. How will the state provide training in evidence-based mental and substance abuse 

prevention, treatment and recovery services for children/adolescents and their 

families?

5. How will the state monitor and track service utilization, costs and outcomes for 

children and youth with mental, substance use and co-occurring disorders? 

6. Has the state identified a liaison for children to assist schools in assuring 

identified children are connected with available mental health and/or substance 

abuse treatment and recovery support services, and if so, what is that position

(with contact information) and has it been communicated to the Department of 

Education?

P. Consultation with Tribes

SAMHSA is required by the 2009 Memorandum on Tribal Consultation 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.

Consultation is an enhanced form of communication, which emphasizes trust, respect,

and shared responsibility. It is an open and free exchange of information and opinions

between 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. 

For the context of the Block Grants 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. SAMHSA is requesting that states provide a description of how they 

consulted with tribes in their state, which should indicate how concerns of the tribes were 

addressed in the State Block Grant plan(s). States shall not require any tribe to waive its 

sovereign immunity in order to receive funds or in order for services to be provided for 
84

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. For states that are currently working with tribes, a description of 

these activities must be provided in the area below. States seeking technical assistance 

for conducting tribal consultation may contact the SAMHSA project officer prior to or 

during the Block Grant planning cycle. 

Q. Data and Information Technology

In the FY 2012/2013 Block Grant application, SAMHSA asked each state to: 

• Describe its plan, process, and resources needed and timeline for developing the 

capacity to provide unique client-level data;

• List and briefly describe all unique information technology systems maintained 

and/or utilized by the state agency;

• Provide information regarding its current efforts to assist providers with 

developing and using EHRs; 

• Identify the barriers that the state would encounter when moving to an 

encounter/claims based approach to payment; and

• Identify the specific technical assistance needs the state may have regarding data 

and information technology.

Please provide an update of your progress since that time. 

R. Quality Improvement Plan

In the FY 2012/2013 Block Grant application, 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, which will describe the health of the mental health and addiction systems. 

The CQI processes should continuously measure the effectiveness of services and 

supports and ensure that services, to the extent possible, continue reflect this evidence of 

effectiveness. The state’s CQI process should also track programmatic improvements 

and garner and use stakeholder input, including individuals in 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. In an attachment, states must 

submit a CQI plan for FY 2014/2015.

S. Suicide Prevention
85

In the FY 2012/2013 Block Grant application, SAMHSA asked states to: 

• Provide the most recent copy of your state’s suicide prevention plan; or

• Describe when your state will create or update your plan.

States shall include a new plan as an attachment to the Block Grant Application(s) to 

provide a progress update since that time. Please follow the format outlined in the new 

SAMHSA document Guidance for State Suicide Prevention Leadership and Plans

available on the SAMHSA website at 

http://www.samhsa.gov/grants/blockGrant/docs/SAMHSA_State_Suicide_Prevention_Pl

ans_Guide_Final.pdf.

T. Use of Technology

In the FY 2012/2013 Block Grant application, SAMHSA asked states to describe: 

• What strategies the state has deployed to support recovery in ways that leverage 

ICT;

• What specific application of ICTs the State BG Plans to promote over the next 

two years;

• What incentives the state is planning to put in place to encourage their use; 

• What support system the State BG Plans to provide to encourage their use;

• Whether there are barriers to implementing these strategies and how the State BG 

Plans to address them;

• How the State BG Plans to work with organizations such as FQHCs, hospitals, 

community-based organizations, and other local service providers to identify 

ways ICTs can support the integration of mental health services and addiction 

treatment with primary care and emergency medicine;

• How the state will use ICTs for collecting data for program evaluation at both the 

client and provider levels; and

• What measures and data collection the state will promote to evaluate use and 

effectiveness of such ICTs.

States must provide an update of any progress since that time.

U. Technical Assistance Needs

States shall describe the data and technical assistance needs identified during the process 

of developing this plan that will facilitate the implementation of the proposed plan. The 

technical assistance needs identified may include the needs of the state, providers, other 
86

systems, persons receiving services, persons in recovery, or their families. Technical 

assistance includes, but is not limited to, assistance with assessing needs; capacity 

building at the state, community and provider level; planning; implementation of 

programs, policies, practices, services, and/or activities; evaluation of programs, policies, 

practices, services, and/or activities; cultural competence and sensitivity including how to 

consult with tribes; and sustainability, especially in the area of sustaining positive 

outcomes. The state should indicate what efforts have been or are being undertaken to 

address or find resources to address these needs, and what data or technical assistance 

needs will remain unaddressed without additional action steps or resources.

1. What areas of technical assistance is the state currently receiving? 

2. What are the sources of technical assistance? 

3. What technical assistance is most needed by state staff? 

4. What technical assistance is most needed by behavioral health providers? 

V. Support of State Partners

The success of a state’s MHBG and SABG 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. States 

should identify these partners in the space below and describe how the partners will 

support them in implementing the priorities identified in the planning process. In 

addition, the state should provide a letter of support indicating agreement with the 

description of their role and collaboration with the SSA and/or SMHA, including the state

education authority(ies), the State Medicaid Agency, entity(ies) responsible for health 

insurance and health information Marketplace (if applicable), adult and juvenile 

correctional authority(ies), public health authority (including the maternal and child 

health agency), and child welfare agency. SAMHSA will provide technical assistance 

and support for SMHAs and SSAs in their efforts to obtain this collaboration. These 

letters should provide specific activities that the partner will undertake to assist the 

SMHA or SSA with implanting its plan.

44 This could include, but is not limited to:

• The State Medicaid Agency 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 the expanded Medicaid 

population.

 44 SAMHSA will inform the federal agencies that are responsible for other health, social services, and education 

programs of this requirement. 
87

• The state justice system authorities that will work with the state, local, and tribal

judicial systems to develop policies and programs that address the needs of 

individuals with mental and substance use disorders 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 actors for mental and substance use disorders, and, for those 

youth with or at-risk of emotional behavioral and substance use disorders, 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. 

Specific service issues, such as the appropriate use of psychotropic medication,

can also be addressed for children and youth involved in child welfare.

• The state public health authority that provides epidemiology data and/or provides 

or leads prevention services and activities.

W. State Behavioral Health Advisory Council

Each state is required to establish and maintain a state Behavioral Health Advisory 

Council (Council) for services for individuals with a mental disorder. While many states 

have established a similar Council for individuals with a substance use disorders, that is 

not required. SAMHSA encourages states to expand their required Council’s 

comprehensive approach by designing and implementing regularly scheduled 

collaborations with an existing substance abuse prevention and treatment advisory 

council to ensure that the Council reviews issues and services for persons with, or at risk 

for, substance abuse and substance use disorders. In addition to the duties specified 

under the MHBG statute, a primary duty of this newly formed Council will be to advise, 

consult with, and make recommendations to SMHAs and SSAs regarding their activities. 

The Council must participate in the development of the MHBG state plan and is 

encouraged to participate in monitoring, reviewing, and evaluating the adequacy of 

services for individuals with substance abuse and mental disorders within the state. 

SAMHSA’s expectation is that the State will provide adequate guidance to the Council to 

perform their review consistent with the expertise of the members on the Council. States 
88

are strongly encouraged to include American Indians and/or Alaska Natives in the 

Council; however, their inclusion does not suffice as tribal consultation. In the space 

below describe how the state’s Council was actively involved in the plan. Provide 

supporting documentation regarding this involvement (e.g., meeting minutes, letters of 

support, etc.)

Additionally, please complete the following forms regarding the membership of your 

state’s Council. The first form is a list of the Council members for the state and second 

form is a description of each member of the Council. 

There are strict state Council membership guidelines. States must demonstrate (1) that 

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 

(2) that no less than 50 percent of the members of the Council are individuals who are not 

state employees or providers of mental health services. States must consider the 

following questions:

• What planning mechanism does the state use to plan and implement substance 

abuse services?

• How do these efforts coordinate with the SMHA and its advisory body for 

substance abuse prevention and treatment services?

• Was the Council actively involved in developing the State BG Plan? If so, 

please describe how it was involved.

• Has the Council successfully integrated substance abuse prevention and 

treatment or co-occurring disorder issues, concerns, and activities into the work 

of the Council?

• Is the membership representative of the service area population (e.g., ethnic, 

cultural, linguistic, rural, suburban, urban, older adults, families of young 

children)?

• Please describe the duties and responsibilities of the Council, including how it 

gathers meaningful input from people in recovery, families and other important 

stakeholders.

Behavioral Health Advisory Council Members
89

Name Type of 

Membership*

Agency or 

Organization 

Represented*

Address 

Phone & 

Fax

Email 

Address (If 

Available)

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. 
90

Behavioral Health Advisory Council Composition by Member Type

Type of Membership

Number 

Percentage 

of Total 

Membership

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 (Not State employees or providers)

Total Individuals in Recovery, Family Members and

Others

State Employees

Providers

Federally Recognized Tribe Representatives 

Vacancies

TOTAL State Employees & Providers

Individuals/Family Members from Diverse Racial, 

Ethnic and LGBTQ Populations

Providers from Diverse Racial, Ethnic and LGBTQ 

Populations

TOTAL Individuals and Providers from Diverse 

Racial, Ethnic, and LGBTQ Populations 

Persons in recovery from or providing treatment for 

or advocating for substance abuse services

*States are encouraged to select these representatives from state Family/Consumer 

organizations 
91

X. Enrollment and provider business practices, including Billing Systems

Each state is asked to set-aside three percent each of their SABG and MHBG allocations 

to support mental and substance use service providers in improving their capacity to bill 

public and private insurance and to support enrollment into health insurance for eligible 

individuals served in the public mental and substance use disorder service system. The 

state should indicate how it intends to utilize the three percent to impact enrollment and 

business practices taking into account the identified needs, including:

• Outreach and enrollment support for individuals in need of behavioral

health services.

• Business plan redesign responsive to the changing market under the 

Affordable Care Act and MHPAEA.

• Development, redesign and/or implementation of practice management and 

accounts receivable systems that address billing, collection, risk management 

and compliance.

• Third-party contract negotiation.

• Coordination of benefits among multiple funding sources.

• Adoption of health information technology that meets meaningful use 

standards.
92

Y. Comment on the State BG Plan

Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. 300x-51) requires that, as 

a condition of the funding agreement for the grant, states will provide an opportunity for 

the public to comment on the State BG 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 the Secretary of HHS. 
93

ACRONYMS

ACA: Patient Protection and Affordable Care Act

ACF: Administration for Children and Families

ACL: Administration for Community Living

ACO: Accountable Care Organization

AHRQ: Agency for Healthcare Research and Quality

AI: American Indian

AIDS: Acquired Immune Deficiency Syndrome

AN: Alaska Native

BHSIS: Behavioral Health Services Information System

CAP: Consumer Assistance Programs

CBHSQ: Center for Behavioral Health Statistics and Quality

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

CMHS: Center for Mental Health Services

CMS: Centers for Medicare & Medicaid Services

CO: Carbon Monoxide

CPT: Current Procedural Terminology

CSAP: Center for Substance Abuse Prevention

CSAT: Center for Substance Abuse Treatment

EBP: Evidence-Based Practice

EHB: Essential Health Benefit

EHR: Electronic Health Record

FFY: Federal Fiscal Year

FMAP: Federal Medical Assistance Percentage

FPL: Federal Poverty Level

FQHC: Federally-Qualified Health Center

FY: Fiscal Year
94

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

HRSA: Health Resources and Services Administration

ICD-10: The International Statistical Classification of Diseases and Related Health 

Problems, 10th Revision

ICT: Interactive Communication Technology

IDU: Intravenous Drug User

IMD: Institutions for Mental Diseases

IOM: Institute of Medicine

LGBT: Lesbian, Gay, Bisexual, and Transgendered

LGBTQ: Lesbian, Gay, Bisexual, Transgendered, and Questioning

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

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

NQS: National Quality Strategy

NREPP: National Registry of Evidence-based Programs and Practices

OCR: Office of Civil Rights

OMB: Office of Management and Budget

PBHCI: Primary and Behavioral Health Care Integration

PBR: Patient Bill of Rights
95

PHS: Public Health Service

PPACA: Patient Protection and Affordable Care Act

QHP: Qualified Health Plan

RFP: Request for Proposal

SABG: Substance Abuse Prevention and Treatment Block Grant

SAMHSA: Substance Abuse and Mental Health Services Administration

SBIRT: Screening, Brief Intervention, and Referral to Treatment

SED: Serious Emotional Disturbance

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 Authority

SUD: Substance Use Disorder

TIP: Treatment Improvement Protocol

TLOA: Tribal Law and Order Act

VA: Veterans Administration
96

ATTACHMENT

Substance Use and Mental Health Issues

Source Link Description of Data Source

Substance Abuse 

Mental Health Services 

Administration

http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k1

0MHResults.htm

National Household Data Survey on Health, 

Drug Use and Mental Health Findings. 2010.

SAMHSA Data Archive http://www.icpsr.umich.edu/icpsrweb/SAMHDA/ Can be sorted by issue, state, report including 

DAWN, N-SSATS, NSDUH, TEDS, Quick Tables 

and interactive maps. Can be queried by state.

Health Issues

Source Link Description of Data Source

Centers for Disease 

Control and Prevention 

(CDC)

http://www.cdc.gov/nchhstp/atlas/index.htm?s_cid=bb-odatlas_005Atlas is an interactive tool allowing access to 

the CDC’s active data bases inclusive of HIV, 

AIDS, TB, Hepatitis and sexual transmitted 

disease conditions sortable by state. Can be 

queried by state.

U.S. Library of 

Medicine/National 

Institute of Health

http://www.nlm.nih.gov/hsrinfo/disparities.html#495Data,%

20Tools,%20and%20Statistics

Variety of tools and publications covering a 

range of health disparities by demographic 

group/ethnicity/culture /age ranges in US.

U.S. Department of 

Health and Human 

Services/Health 

Resources and Services 

Administration

http://bphc.hrsa.gov/healthcenterdatastatistics/statedata/in

dex.html

Data by state summarizing patient counts, 

insurance status, health conditions, special 

population data including homeless, migrant 

populations, etc.

Youth and Adolescent Issues

Source Link Description of Data Source
97

Substance Abuse 

Mental Health Data 

(SAMHDA) 

Archive/InterUniversity Consortium 

for Political and Social 

Research (ICPSR)

http://www.monitoringthefuture.org/data/data.html Sample of high school students on a variety of 

issues contains 2011 data tables; alcohol/drug 

use, tobacco use, adolescent health issues, 

parental influences etc.

Annie E. Casey 

Foundation Kids Count

http://datacenter.kidscount.org/ Data organized by state and includes data sets 

including over 100 measures of child wellbeing

National Center for 

Educational Statistics

http://nces.ed.gov/surveys/sdds/ed/index.asp Data and mapping tools which allows for view 

maps of states and school districts, while 

overlaying statistics on population and 

housing, race and ethnicity, economics and 

social characteristics. Can be queried by 

state/regional or local area including 

information on American Indian/Alaska 

Natives.

Criminal Justice- Adolescent and Adult

Source Link Description of Data Source

U.S. Department of 

Justice/Bureau of 

Justice Statistics

http://www.bjs.gov/index.cfm?ty=dca Data encompassing state and federal 

parole/probation, jails, inmates, arrest related 

deaths, emergency room data on intentional 

violence injuries, Tribal law enforcement, jails 

in Indian country.

General Population Statistics
98

Source Link Description of Data Source

U.S. Bureau of the 

Census

http://www.census.gov/ Data that can be sorted by state and location 

and includes the following: population, 

housing economic, household, ethic/race, age 

groups, government and other demographic 

features. Can be queried by state.

U.S. Bureau of Labor 

Statistics

http://www.bls.gov/data/ Data that can be sorted by state, local and 

regional areas and includes information on 

civilian employment and unemployment, wage 

information, farm and seasonal workforce. 

Can be tailored to answer queries by state.

U.S. Department of 

Housing and Urban 

Development

http://www.hudhre.info/documents/2010HomelessAssessme

ntReport.pdf

2010 Statistical report on Homeless in US.

National Alliance to 

End Homelessness

http://www.endhomelessness.org/content/article/detail/375

9

2011 Media Map by state/location regarding 

the status of homelessness by location.

Veterans Issues

Source Link Description of Data Source

Department of 

Veteran's Affairs

http://www.va.gov/vetdata/veteran_population.asp Data includes current veteran population by 

state and county with particular details by 

race, ethnicity, retired, active, gender.