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Will block grant flexibility come at a price?

April 13, 2011
by Gary A. Enos, Contributing Editor
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Affected parties closely studying this week’s announced changes in approach for SAMHSA grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) uses terms such as “flexibility” and “streamlining” to characterize changes it announced this week for its block grant programs in addiction and mental health. Yet the changes also come with expectations that states will serve a broader range of populations and take a more recovery-oriented approach with these federal dollars, so it remains to be seen whether SAMHSA’s new direction will prove less bureaucratic or more burdensome.

For now, state authorities and providers that are affected by block grant procedures simply are trying to digest the voluminous amount of material published April 11 in the Federal Register announcement. Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), says SAMHSA previously had articulated goals of flexibility, reduced paperwork burden and a less prescriptive approach with regard to the block grants. Now NASADAD staff along with other addiction- and mental health-focused organizations are studying the procedural details that SAMHSA believes will fulfill those objectives.
SAMHSA administers the Substance Abuse Prevention and Treatment (SAPT) Block Grant and the Community Mental Health Services (CMHS) Block Grant for states’ efforts to meet behavioral health service needs.
While there has been loud opposition over the years to the occasional call to merge the block grant programs into a fully integrated funding pool, particularly from the addiction treatment community, one change announced this week could usher in more coordination. SAMHSA has established uniform planning, application and reporting dates for the two grants, beginning with the fiscal 2012 grant cycle, and it will allow states to submit a coordinated plan for both grants.
The SAMHSA text outlining the block grant changes makes it clear that the federal agency believes other changes in healthcare are forcing a new look at the block grants.
An agency description of grant application procedures states that “changes to the SAPT and CMHS Block Grant applications are, in part, being driven by [the Mental Health Parity and Addiction Equity Act] and other legislation. SAMHSA wants to ensure that [state mental health and substance abuse authorities] are well into strategic planning and implementation phases before 2014 approaches,” when more individuals are expected to have Medicaid or third-party insurance coverage as a result of health reform legislation.
Among the newly defined expectations that are likely to capture the attention of states and service providers, states will be asked to reach beyond the populations they have traditionally served with block grant funding; to identify more specifically for Washington the strengths and needs of the state behavioral health system; and to develop collaborative plans for health information systems.
And among the specific targets for block grant funding are primary prevention activities and the collection of performance and outcome data to evaluate current services and inform the implementation of new services.
These are among the broad strokes, but the little details ultimately will determine how states and their funded providers judge the latest changes regarding the block grants.

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