1-877-SAMHSA-7 (1-877-726-4727)
5600 Fishers Lane • Rockville, MD 20857
www.samhsa.gov •
∙
May 18, 2021
Dear Single State Authority Director and State Mental Health Commissioner:
Public Law 117-2, the American Rescue Plan Act of 2021 (ARPA), signed by President Biden
on March 11, 2021, directed the Substance Abuse and Mental Health Services Administration
(SAMHSA) to provide additional funds to support states through Block Grants to address the
effects of the COVID -19 pandemic for Americans with mental illness and substance use
disorders. The COVID-19 pandemic has exposed and exacerbated severe and pervasive health and
social inequities in America, including the critical importance of supporting people with mental
illness and substance use disorders. As the pandemic swept through the states, societal stress and
distress over this newly emerging disaster created the need for nimble and evolving policy and
planning in addressing mental and substance use disorder services. SAMHSA, through this
guidance, is asking states to improve and enhance the mental health and substance use service
array that serves the community.
ARPA allocated $1.5 billion each for Mental Health Block Grant (MHBG) and Substance Abuse
Prevention and Treatment Block (SABG) grants to the states. States have until September 30,
2025, to expend these funds. Federal block grant monies are provided to support state priorities
and SAMHSA asks that states consider the following in developing an ARPA Funding Plan.
A. MHBG Guidance
States must spend the MHBG funds based on 42 U.S.C. Chapter 6A, Subchapter XVII, Part B,
Subpart I: Block Grants for Community Mental Health Services for adults with serious mental
illness (SMI) and children with serious emotional disturbance (SED). () Consistent with HHS
Disaster Relief Flexibilities, SAMHSA may waive requirements with respect to allowable
activities, timelines, or reporting requirements for the MHBG, as deemed necessary to facilitate a
grantee’s response to coronavirus.
The MHBG allocation requires states to set aside ten percent (10%) of their total allocation for
first-episode psychosis or early SMI programs.
SAMHSA encourages states to consider a focus on support of a behavioral health crisis
continuum. An effective statewide crisis system affords equal access to crisis supports that meet
needs anytime, anyplace, and for anyone. This includes those living in remote areas and
underserved communities as well as youth, older adults, persons of diverse backgrounds, and
other marginalized populations; the crisis service continuum will need to be able to equally and
adeptly serve everyone. SAMHSA recommends states consider use of the ARPA MHBG funds
to develop, enhance, or improve the following:
Behavioral Health is Essential to Health
• Prevention Works • Treatment is Effective • People Recover
• Develop partnerships with the emerging Suicide Lifeline (9-8-8) systems, Law
Enforcement, EMS, health care providers, housing authorities, Housing and Urban
Development (HUD) Continuum of Care, hospital systems, peer-based recovery
organizations, and substance use specific treatment providers, all of whom have a critical
role in the crisis continuum.
• Utilize five percent of funds for crisis services, as described in the FY 2021
appropriations language.
• A comprehensive 24/7 crisis continuum for children including screening and assessment;
mobile crisis response and stabilization; residential crisis services; psychiatric
consultation; referrals and warm hand-offs to home- and community-based services; and
ongoing care coordination.
• Provide increased outpatient access, including same-day or next-day appointments, for
those in crisis.
• Improve information technology infrastructure, including the availability of broadband
and cellular technology for providers, especially in rural and frontier areas; use of GPS,
to expedite response times, and to remotely meet with the individual in crisis.
• The adoption and use of health information technology, such as electronic health records,
to improve access to and coordination of behavioral health services and care delivery.
• Consider digital platforms, such as Network of Care, which facilitate access to behavioral
health services for persons with SMI-SED.
• Advance telehealth opportunities to expand crisis services for hard to reach locations,
especially rural and frontier areas. Expand technology options for callers, including the
use of texting, telephone, and telehealth. Note: States cannot use the funds to purchase
any items for consumers/clients.
• Implement an electronic bed registry that coordinates with existing HHS provider
directory efforts and treatment locator system that will help people access information on
crisis bed facilities, including their locations, available services, and contact information.
• Support for crisis and school-based services that promote access to care for children with
SED.
• Develop medication-assisted treatment (MAT) protocols to assist children and adults who
are in crisis, which may leverage telehealth when possible.
• Expand Assisted Outpatient Treatment (AOT) services.
• Develop outpatient intensive Crisis Stabilization Teams to avert and address crisis.
• Technical Assistance for the development of enhanced treatment and recovery support
services including planning for Certified Community Behavioral Health Clinics
(CCBHC).
SAMHSA requests that the following information is included when submitting the proposals:
1. Identify the needs and gaps of your state’s mental health services continuum including
prevention, intervention, access to crisis services, treatment, and recovery support
services.
Substance Abuse and Mental Health Services Administration
1-877-SAMHSA-7 (1-877-726-4727)
•
1-800-487-4889 (TDD)
•
www.samhsa.gov
2. Identify the needs and gaps of your state’s mental health services related to developing a
comprehensive crisis continuum. Focus on access to your states services through crisis
call centers with local knowledge of available services, availability of mobile crisis
response teams and crisis receiving and stabilization services.
3. Describe your state’s spending plan proposal, including a budget that addresses the needs
and gaps related to crisis and services continuum.
4. Describe how the state will advance the development of crisis and other needed
prevention, intervention, treatment and recovery support services so that your state’s
system is responsive to the needs of your residents with SMI and SED. Refer to the
Guidebook on crisis services.
5. Explain how your state plans to collaborate with other departments or agencies to address
crisis, treatment, and recovery support services.
6. Describe how the state plans to spend the ten percent set aside for first-episode
psychosis/early SMI and, if applicable, the five percent set aside for crisis services.
7. Describe other state priorities or activities that the state plans to fund during the
performance period using ARPA funds, with consideration given to disproportionately
high rates of MH/SUD in certain communities and disparities in COVID-19 BH-related
outcomes by race, ethnicity, and other factors.
8. Describe how the state will use, or consider, health IT standards if using funds for health
IT infrastructure or advancement. This includes a description of standards and, as
applicable, conformance to Office of the National Coordinator certification criteria in
health IT products used or that will be used to support behavioral health clinical priorities
and interoperable data exchange. States must use standards identified by the Office of
the National Coordinator for Health IT in 45 C.F.R. 170 where applicable and also should
consider standards identified in the Interoperability Standards Advisory
(https://www.healthit.gov/isa/), including but not limited to those standards described in
the, the “Allows for the Exchange of State Prescription Drug Monitoring Program
(PDMP) Data” section and the “Social Determinants of Health” section.
Using the WebBGAS Revision Request for the FFY 2021 Block Grant Application, upload the
document (Microsoft Word or pdf) using the tab into the State Information Section, Chief
Executive Officer’s Funding Agreement – Certifications and Assurances/Letter Designating
Signatory Authority [MH]. Please title this document “ARPA Funding Plan 2021 (MH).”
B. SABG Guidance
States are required to plan for, expend, and report on the FY 21 SABG ARPA Supplemental
Funding based on 42 U.S.C. Chapter 6A, Subchapter XVII, Part B, Subpart II: Block Grants for
Prevention and Treatment of Substance Abuse, and 45 CFR, Part 96, Subpart L.
Consistent with HHS Disaster Relief Flexibilities, SAMHSA may waive requirements with
respect to allowable activities, timelines, or reporting requirements for the SABG as deemed
necessary to facilitate a grantee’s response to coronavirus.
Accordingly, all regular provisions of the statute and regulations pertaining to the SABG are
fully applicable to the planning and expenditure of the SABG ARPA Supplemental Funding.
Substance Abuse and Mental Health Services Administration
1-877-SAMHSA-7 (1-877-726-4727)
•
1-800-487-4889 (TDD)
•
www.samhsa.gov
This includes, but is not limited to, the definitions, assurances, requirements, and restrictions of
the SABG standard funding.
The SABG allocation requires states to expend not less than twenty percent (20%) of their total
allocation for substance use disorder (SUD) primary prevention services for individuals who do
not require treatment for substance abuse, in accordance with 42 USC 300x-22 and 45 CFR
96.124 and 96.125. The SABG allocation also requires “designated states” to expend five percent
(5%) of their total allocation for EIS/HIV Services, in accordance with 42 USC 300x-24(b) and
45 CFR 96.128.
The SUD prevention, intervention, treatment, and recovery support services continuum includes
various evidence-based services and supports for individuals, families, and communities. Integral
to the SABG are its efforts to support health equity through its priority focus on the provision of
SUD prevention, treatment, and recovery support services to identified underserved populations.
These underserved and marginalized populations include, but are not limited to, pregnant women
and women with dependent children; persons who inject drugs; persons using opioids and/or
stimulant drugs associated with drug overdoses; persons at risk for HIV, TB, and Hepatitis;
persons experiencing homelessness; persons involved in the justice system; persons involved in
the child welfare system; Black, Indigenous, and People of Color (BIPOC); LGBTQ individuals;
rural populations; and other underserved groups.
SAMHSA recommends states develop, enhance or improve the following through the SABG
ARPA funds:
• Develop and expand the use of FDA-approved medications and digital therapeutics as a
part of addiction treatment that can provide interactive, evidence-based behavioral
therapies for the treatment of opioid use disorders, alcohol use disorders, and tobacco use
disorders, along with the implementation of other evidence-based treatments and
practices.
• Provide increased access, including same-day or next-day appointments, and low barrier
approaches, for those in need of SUD treatment services.
• Direct critical resources in expanding broad-based state and local community strategies
and approaches in addressing the drug overdose epidemic, involving SUD prevention,
intervention, treatment, and recovery support services.
• Improve information technology infrastructure, including the availability of broadband
and cellular technology for providers, especially in rural and frontier areas, and use of
GPS to expedite response times and to remotely meet with the individual in need of
services.
• The adoption and use of health information technology to improve access to and
coordination of SUD prevention, intervention, treatment, and recovery support services
and care delivery, consistent with the provisions of HIPAA and 42 CFR, Part 2.
• Advance telehealth opportunities to expand services for hard-to-reach locations,
especially rural and frontier areas. Expand technology options for callers, including the
use of texting, telephone, and telehealth. Note: States may not use the funds to purchase
any items for consumers/clients.
Substance Abuse and Mental Health Services Administration
1-877-SAMHSA-7 (1-877-726-4727)
•
1-800-487-4889 (TDD)
•
www.samhsa.gov
• Enhance the primary prevention infrastructure within your state and communities using
the Strategic Prevention Framework planning model and implementing evidence-based
practices, the six CSAP prevention strategies with an emphasis on environmental
approaches.
• Consider incorporating strategies around adverse childhood experiences to improve
substance misuse outcomes among all populations, but especially young adults 18-25 and
those over 26 years of age; preventing and reducing marijuana use by youth below the
state’s legal age of use; and mitigating the impact of increased alcohol access by youth as
identified during the COVID-19 pandemic. It is important to identify and address
disparities and describe how you are incorporating equitable approaches.
• Support expansion of peer-based recovery support services (e.g. recovery community
organizations, recovery community centers, recovery high schools, collegiate recovery
programs, recovery residences, alternative peer group programs) to ensure a recovery
orientation which expands support networks and recovery services. These programs are
helping people sustain their recovery, engaging families and significant others, bridging
the gap between treatment and long-term recovery, and supporting people reentering the
community from incarceration.
SAMHSA requests that the following information is included when submitting the proposals:
1. Identify the needs and gaps of your state’s SUD services continuum, related to
developing a comprehensive prevention, intervention, treatment, and recovery support
services continuum.
2. Describe how your state’s spending plan proposal will address the state’s substance use
disorder services continuum, including a budget that addresses the needs and gaps related
to this continuum.
3. Describe your state’s progress in addressing the rising drug overdose rate in many parts
of the country, and what steps the state will be taking to improve access to SUD
treatment, by improving identification of persons in need, reducing barriers to admission
to treatment, and strengthening mechanisms to promote client engagement and retention
in SUD treatment and recovery support services.
4. Describe your state’s progress in implementing the increased and widespread use of FDA
approved medications for the treatment of opioid use disorder, alcohol use disorder, and
tobacco use disorder, in combination with other substance use disorder evidence-based
treatments and practices.
5. Explain how your state plans to collaborate with other departments or agencies to address
the SUD services continuum.
6. Describe how the state plans to use SABG ARPA funding to promote health equity
among identified underserved populations, and how it plans to address heath disparities
in the planning, delivery, and evaluation of SUD prevention, intervention, treatment, and
recovery support services.
7. Describe the state’s efforts and plans to promote an increased emphasis on the
development, delivery, and support of widespread SUD recovery support services,
systems, and mechanisms across the state.
Substance Abuse and Mental Health Services Administration
1-877-SAMHSA-7 (1-877-726-4727)
•
1-800-487-4889 (TDD)
•
www.samhsa.gov
/Tom Coderre/
8. Describe other state priorities or activities that the state plans to fund during the
performance period of September 1, 2021 through September 30, 2025 using ARPA
funds.
9. Describe your state plans for enhancing your state’s prevention infrastructure which may
include incorporating work around ACEs and improving substance misuse outcomes
among young adults and older adults. (Primary Prevention set-aside)
a. The impact of increased access to marijuana and the state’s strategies to prevent
misuse by the underage population.
b. Strategies to reduce the COVID-19 impact of increased alcohol accessibility and
misuse.
c. How the state is using equitable strategies to reduce disparities in the state’s
prevention planning and approaches. Using the WebBGAS Revision Request for
the FFY 2021 Block Grant Application, upload the document (Microsoft Word or
pdf) using the tab into the State Information Section, Chief Executive Officer’s
Funding Agreement – Certifications and Assurances/Letter Designating Signatory
Authority [SA]. Please title this document “ARPA Funding Plan 2021 (SA).”
10. Describe how the state will use, or considered, health IT standards if using funds for
health IT infrastructure or advancement. This includes a description of standards and, as
applicable, conformance to Office of the National Coordinator certification criteria in
health IT products used or that will be used to support SUD clinical priorities and
interoperable data exchange. States must use standards identified by the Office of the
National Coordinator for Health IT in 45 C.F.R. 170 where applicable and also should
consider standards identified in the Interoperability Standards Advisory
(https://www.healthit.gov/isa/), including but not limited to those standards described in
the “Allows for the Exchange of State Prescription Drug Monitoring Program (PDMP)
Data” section and the “Social Determinants of Health” section.
States must upload separate proposals based on MHBG and SABG guidance into the
WebBGAS system. Upon submission, SAMHSA will review the proposal to ensure it is
complete and responsive. Proposals must be submitted to WebBGAS by Friday, July 2,
2021,11:59 EST.
SAMHSA is ready and willing to assist you in addressing the needs of individuals with
mental illness and substance use disorders. Please feel free to contact your SAMHSA state
project officers and grants management specialists with any questions that you may have.
Sincerely,
Tom Coderre
Acting Assistant Secretary for
Mental Health and Substance Use
Substance Abuse and Mental Health Services Administration
1-877-SAMHSA-7 (1-877-726-4727)
•
1-800-487-4889 (TDD)
•
www.samhsa.gov
