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Overview of the 

FFY18-19 SAMHSA Block Grant Application: 

Behavioral Health Assessment and Plans

Annual Reports
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Purpose

This presentation will review the changes in the FFY 2018-19 

Block Grant Application, Behavioral Health Assessment and Plan 

and Annual Report from the FFY16-17 guidance and additional 

changes resulting from the 21st Century Cures Act (P.L. 114-255).

• General structural changes

• MHBG specific changes

• SABG specific changes
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General Changes

• Movement away from multiple narrative descriptions of 

states activities to a more quantitative response to specific 

questions reflecting statutory/regulatory requirements, or 

reflecting use of block grant funding.

• Required and requested sections have been clearly identified.

• In FFY 2016-17, SAMHSA gave policy guidance on system 

issues which were not authorized services under the block 

grants – this proved confusing, and so has been eliminated.

• Where applicable, statutory criteria have been included as 

references.
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General Changes cont’d.

• Quality and Data Collection has been moved from Planning Steps to a 

separate section in the Behavioral Health Assessment and Plan. 

• State Parity Efforts are now included within the Health Care System, Parity 

and Integration.

• Participant Directed Care has been separated into Person Centered 

Planning and Self-Direction.

• Public Comment on the State Plan is now separated from the Planning 

Council section.

• Elimination of the “Block Grant Expenditure by Service Tables” (Table 3)

• Resource Development Table (Table 6)changed to “Expenditures for 

System Development/Non-Direct Service Activities”

• Two (2) new sections on statutory criterion for MHBG and SABG
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Block Grant Purposes

This section was changed from goals to purposes.

Block grant funds should be used to:

• To fund services for those without insurance either short or 

long-term

• To fund priority services not covered by another payor and 

that are successful in improving outcomes and/or supporting 

recovery

• To collect data to determine effectiveness of services and to 

plan for implementation of new services
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Introduction: Background and Impact on 

State Authorities and Systems

• The MHBG Application is now required to be biennial. 

Combined MHBG and SABG applications are encouraged.

• The Public Health 3.0: A Call to Action to Create a 21st Century 

Public Health Infrastructure is a new reference that 

encourages adherence to Public Health Accreditation Board 

(PHAB) criteria.
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Framework for Planning

• The State should identify strengths, needs, and priorities that account for 

the block grant target populations, changing health care environment, and 

SAMHSA’s Strategic Initiatives.

• SAMHSA has clarified the definition of SMI and SED, but states can add 

additional elements.

• The SABG and MHBG statutory criteria must be addressed in the planning 

steps.

• The MHBG must describe how the 10% set aside for evidence-based 

programs for those with Early Serious Mental Illness (ESMI) will be 

expended. 

• The MHBG application should be linked to the Olmstead planning work.
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CHECKLIST FOR 

ADMINISTRATIVE FORMS

State Information – One form for both MH and SA

‒ Include use of third party administrator, if applicable

CEO Funding Agreements- Certifications and Assurances for MH 

and for SA are separate forms.

Governor’s Letter(s) Designating Signatory Authority, if 

applicable (SABG: if the state is co-designating for purposes of 

calculating MOE, include that co-designation here)

Disclosure of Lobbying Activities
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Planning Steps: MHBG and SABG

• Identify unmet service needs and critical gaps in the system 

though needs assessment and/or data review.

• The 21st Century Cures Act made changes to the required 

content in Steps 1 and 2.

• There is an enhanced focus on cross-cutting and systems 

integration.

• ESMI is added as a required population for MHBG
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Planning Step 1: SABG

• Provision of or arrangement for Tuberculosis (TB) services including testing 

to determine presence of TB and needed treatment. Includes referral to 

another source if a person is not admitted.

• In “designated States,” at least one project for early HIV intervention services 

for those in treatment—only in geographic areas with greatest need—

includes pre-test counseling, testing, and post-testing counseling

• Group home revolving loan fund not to exceed $100,000 with individual 

loans; no more than $4,000 to non-profit entities who agree to certain rules

• State law prohibiting sale of tobacco products to persons under age 18 with 

related monitoring activities

• Establish policies that prohibit using SABG to purchase hypodermic needles 

or bleach
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Planning Step 2: SABG

Cures ACT – Needs Assessment:

Assessment of need for both local and state including the:

• Incidence and prevalence of drug abuse, alcohol abuse, and 

alcoholism

• Current prevention and treatment activities; and

• Need for technical assistance to conduct the assessment.
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Planning Step 2: Required SUD Elements

Guidance (Cont’d):

• Use the state’s data system as well as SAMHSA’s data sets:

National Survey on Drug Use and Health (NSDUH)

National Facilities Surveys on Drug Abuse and Mental 

Health Services 

Treatment Episode Data Set (TEDS)

State and National Behavioral Health Barometers

State Epidemiological and Outcomes Workgroup 

Healthy People Initiative

Other data sets: HUD, CDC, etc.
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Planning Step 1: Required SUD Elements

Statutory Criteria (Cont’d)

• Establish policies that prohibit using SABG to purchase hypodermic needles 

or bleach

• Establish an Independent Peer Review process for at least 5% of funded 

entities per year to assess the quality, appropriateness, and efficacy of 

treatment services

• A state can also fulfill the requirement by demonstrating that it requires 

block grant sub-recipients to be independently accredited

• Establish a system to prevent unauthorized disclosure of treatment records

• Policies that protect the nature of providers who are religious organizations 

and that protect the rights of recipients to not participate in religious 

activities and to seek alternative treatment
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Planning Step 1: Required SUD Elements

Statutory Criteria (Cont’d)

• Require and advertise preference in admission for pregnant 

women and require a referral when a program is full including 

interim services within 48 hours if no program is available.

• In the referral process, use standardized screening and assessment 

instruments and placement criteria so that retention and 

treatment outcomes improve.

• Provide continuing education for staff of agencies providing 

services.

• Coordinate prevention and treatment services with other services 

including health, social, correctional and criminal justice, 

educational, vocational rehabilitation, and employment services
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Planning Step 3 and Table 1: MH and SUD 

Prioritized State Planning Activities

• Using information contained in Planning Step 2, the state should identify 

specific priorities for the MHBG and the SABG based on areas that will be the 

main focus of attention during the next 2 years.

• Priorities should relate to core federal goals and aims for the BG programs 

related to:

Target Populations including those with ESMI

Other Priority Populations

• Priorities are broad areas of attention (e.g. moving to managed care, 

downsizing state hospitals, implementation of selected best practices, 

increasing/maintaining numbers served/programs, improve data collection, 

etc.)

• Priorities should be identified by type: substance misuse prevention (SAP), 

substance use disorder treatment (SAT), or as mental health services (MHS) 

in Table 1.
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Planning Step 4 and Table 1: MH and SUD

• For each priority identified in Step 3, the state should list at least 

one goal, objective, strategy, and performance indicator. 

• Goals are broad statements of desired outcome (what you hope 

to accomplish) and may have more than one objective, strategy, 

and performance indicator.

• Objectives are concrete, precise, and measurable statements.

• Strategies are means to achieve the goals – how/what you will 

do.

• Performance Indicators are a quantitative measure of success 

each year. Need to be able to establish a baseline, Year 1, and 

Year 2 measures. 
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Planning Step 4 and Table 1: MH and SUD

Here is an example: 

• Priority – Improve quality of services

• Goal –Implement trauma-informed care in contract/certified providers

• Objective 1 – Add requirement to Contracts and Certification Standards for 

assessment of trauma at intake

• Strategy 1– create policies/protocols to assure that trauma is assessed at 

intake

• Performance Indicators – Baseline – no policies/protocols exist. Year 1 –

Inform providers that the State is moving to requiring trauma-informed care. 

Create intake protocol that includes trauma assessment at intake. Year 2 –

Contracts and certification/licensure standards require all providers to use 

the trauma intake protocol.

Continued on the next page
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Planning Step 4 and Table 1: MH and SUD

• Objective 2 – Train 50% of direct service staff to use trauma-informed 

clinical interventions

• Strategy 1 – Select trainers and training curriculum and start training

• Performance Indicators - Baseline – no training is conducted. Year 1 –

training curriculum is selected and trainers identified. 25% of staff are 

trained. Year 2 – 50% of staff are trained.
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MHBG: Major Changes

• New section- EBPs for Early Interventions to Address ESMI -

10% set aside – Required

• Participant Directed Care changed to Person Centered 

Planning (Required) and Self- Direction

• New section – Statutory Criterion for MHBG – Required

• Recovery – now Required

• Children and Adolescents BH Services – now Required

• Suicide Prevention – now Required

• Support of State Partners – now Required
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FISCAL TABLE 2: MHBG

• Table 2, Row 3 was revised to reflect the set-aside for ESMI/ FEP. The 

amount listed should be 10% of your MHBG award. 

• Note that MHBG funds cannot be spent for prevention except as related to 

adults with SMI and children with SED.
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FISCAL TABLES MH and SUD

• Tables 5a and 5b for Primary Prevention Planned Expenditures are 

interactive. If the State chooses to complete 5b ( IOM Model of Universal, 

Selective, and Indicated), Section 1926 – Tobacco on Form 5a must also be 

completed. 

• Table 6 merged the former 6a and 6b and has two new rows: 

Infrastructure Support

Partnerships, community outreach, and needs assessment

• Footnotes are helpful to explain uses of block grant funds.
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Public Review and Comment

• The State should decide how to best obtain public review and 

comment.

• Possible methods include:

Information on department’s website

Distribution to local boards with a request for 

dissemination

Public hearings
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Block Grant Report

These are the sections of the Report in WebBGAS:

• State Information

• Annual Report

• Expenditure Reports

• Population and Services Reports

• Performance Indicators and Accomplishments
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Block Grant Report - MHBG

• Table 2 in the MHBG was separated into two tables.

• Table 2a is the same as before except that Row 3 reflects the 

10% set-aside for ESMI/FEP.

• Table 2b is new and addresses the ESMI/FEP set-aside. 

• Report only those programs that are providing all 

components of a Coordinated Specialty Care (CSC) model in 

Row 1. If only certain components of a CSC model are 

provided, report expenditures in Row 2.

• Table 3 Children’s Set-aside includes the FY1994 target for 

comparison to actual expenditures rather than 2008 

expenditures as required in 2016. 
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Block Grant Report – SABG

• Table 1 will be pre-populated by what was entered in the 

application.

• The state will indicate what was achieved or not achieved. If not 

achieved, an explanation is required.

• A report for Syringe Services Program was added (applicable to 

the FY 2019 Annual SABG Report). 
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Acronyms and Resources

• A list of acronyms and resources is provided at the end of the 

MHBG Guidance.