Requirements Under the Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant

RECIPIENTS

• All OASAS Funded Treatment Service Providers
• Local Governmental Units (LGUs)
   

PURPOSE

The purpose of this Bulletin is to provide information on Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant requirements (45 CFR Part 96 Subpart L).

 

BACKGROUND

Annually, the State of New York receives funding from the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA) under the SAPT Block Grant. The Office of Alcoholism and Substance Abuse Services (OASAS) uses these Federal dollars in support of local prevention, treatment and recovery programming efforts, in accordance with the applicable rules and regulations that govern the use of such funds.

 

REQUIREMENTS AND PROVIDER RESPONSIBILITIES

All OASAS-funded prevention and treatment providers, regardless of whether or not they receive Federal SAPT Block Grant funds, are subject to the provisions of 45 CFR Part 96 Subpart L:

 

Admission Requirements

• Priority Admission Policies for Pregnant Women and People Who Use Substances Intravenously. Providers of treatment services must establish policies to offer admission preference to individuals who are pregnant and/or who inject drugs intravenously. In this regard, providers must apply the following priority admission policy:

 

APPLICANT GROUP	PRIORITY FOR ADMISSION
Pregnant Women Who Inject Substances	First
Pregnant Women With Substance Use Disorders	Second
Individuals Who Inject Substances	Third
All Others	Fourth

 

Admission policies must reflect the following:

• Pregnant Women. Treatment providers must ensure timely access to treatment services for pregnant women. If a treatment provider is contacted by an applicant regarding admission (via telephone or in person), program staff must inquire if the prospective client is pregnant, and, if so, the provider must prioritize an evaluation of the individual as urgently as possible and determine the appropriate level of care for the individual. The provider shall prioritize the admission of the pregnant woman and act with urgency to admit her, unless she requires a service not offered by that provider. In that case, the program staff should determine whether an appropriate treatment referral can be found using the Find Addiction Treatment website at https://findaddictiontreatment.ny.gov or contact their local provider network and/or their LGU to determine the availability of treatment in order to refer the applicant to a provider that could best meet her needs.

• Individuals Who Inject Substances. Treatment providers must ensure timely access to treatment services for individuals who inject substances intravenously, establishing admission policies that are similar to those described above for pregnant women. In general, given the great risks associated with intravenous substance use, including but not limited to overdose death, treatment providers should make every attempt to immediately admit individuals who inject drugs into treatment, or rapidly refer them to a provider who can provide immediate access to appropriate treatment. However, Federal law also requires that providers establish and maintain an Applicant Waiting List using the PAS-51N, the provisions of which are described below. While the information below describes minimal Federal requirements, the expectation for treatment providers in New York State are that people who inject drugs receive immediate access to treatment and support services.

 

If a placement cannot be made, program staff should contact their appropriate OASAS Regional Office. OASAS Regional Office staff will ensure that the most appropriate referral is made on a timely basis. Through the use of on-line reporting mechanisms, monthly utilization reports, direct contacts with local providers, and other mechanisms, OASAS will identify treatment providers that have the available capacity to admit those who are pregnant or who inject substances intravenously.

 

Waiting List Requirements

 

If individuals in need of treatment cannot be admitted into a program within 14 days due to insufficient capacity in both a particular treatment program and the surrounding community, the provider must establish a waiting list of applicants seeking treatment, including those receiving interim services, while awaiting admission to such treatment. Using the PAS-51N, a waiting list shall only include applicants who meet the following criteria:

• The applicant is eligible and could be admitted to the treatment program or clinic if space were available and/or the staff caseload permitted additional clients.
• The applicant is either currently not in treatment in any substance use disorder program or is currently in treatment in another program and is awaiting transfer to a different level of care that is available at this program.

When an opening becomes available, the program must make at least one attempt to contact the next applicant on the waiting list based on the Priority Admission Policy noted in this Bulletin.

 

Each provider must establish a policy defining what an applicant must do to remain active on a waiting list and the criteria for removing an applicant from the list. Please see “Outreach” on page four.

 

Under no circumstances should a person be on the waiting list for longer than 120 days. However, if an individual on the waiting list cannot be located, or if the individual refuses treatment, the applicant may be taken off the waiting list. In cases where such individuals later seek treatment, providers are not obligated to provide treatment within the original 120-day time frame but are required to provide such service within 120 days of the person's replacement on the waiting list.

 

All providers of treatment services must maintain separate records of their waiting lists and have them readily available for review.

• Waiting List Report. To measure the need for additional treatment capacity and to manage access to treatment, OASAS has established a Waiting List Report in the Client Data System. Using non-personal unique identifiers, the system identifies and counts the number of applicants who present and are determined to be appropriate for substance use disorder treatment but are unable to be placed as there is no capacity. It enables OASAS to monitor whether an applicant is on more than one waiting list; the length of time the applicant is on the waiting list; whether the applicant is pregnant; and whether the applicant has an intravenous substance use disorder. The Waiting List Report also tracks the date of placement; date of removal; and the reason for removal.

All OASAS-certified treatment programs are required to report waiting list information online using the Waiting List Applicant Data Report (PAS-51N).

• Interim Services for Pregnant Women and People Who Use Substances Intravenously. When a person who has an intravenous substance use disorder and/or is pregnant seeks treatment and there are no appropriate treatment services available, interim services must be made available within 48 hours to the individual. Interim services must be provided until an individual is admitted to a treatment program. The purposes of the services are to reduce the adverse health risks of such abuse, promote the health of the individual and reduce the risk of transmission of disease. At a minimum, interim services must include counseling and education about:

• • Human Immunodeficiency Virus (HIV) and Tuberculosis (TB);
  • the risks of needle-sharing;
  • the risks of transmission to sexual partners and infants; and
  • steps that can be taken to ensure that HIV and TB transmission does not occur, as well as referral for HIV or TB treatment services if necessary.

 

For pregnant women, interim services must also include counseling on the effects of alcohol and drug use on the fetus, as well as referral for prenatal care.

 

OASAS sees the role of the Health Coordinator intrinsic in compliance with these services as noted in OASAS regulations. Each treatment program must have a qualified individual designated as the Health Coordinator and be entered into the Provider Directory System (PDS) to assure the provision of education, risk reduction, counseling and referral services to all patients regarding HIV/AIDS (including pre- and post-exposure prophylaxis), tuberculosis, viral hepatitis, sexually transmitted diseases, and other communicable diseases.

 

• Capacity Management System. OASAS has established a capacity management system. Major components of this system require treatment programs to:

• • provide systematic reporting of treatment demand;
  • provide a unique identifier for each individual awaiting admission to treatment;
  • have procedures to ensure the individuals on a waiting list receive interim services;
  • maintain contact with applicants;
  • initiate the timely referral of individuals on a waiting list to a treatment program within a reasonable geographic area; and
  • remove of individuals from the waiting list who cannot be located for admission or who refuse treatment.

 

Additional Treatment Responsibilities

• Outreach. Providers of treatment services for individuals who inject substances and/or are pregnant and parenting women must conduct outreach activities to encourage individuals to participate in such treatment. Providers must use outreach models that are scientifically sound, or if no such models are available which are applicable to the local situation, to use an approach which reasonably can be expected to be an effective outreach method. The model shall require that outreach efforts include the following:
  • selecting, training and supervising outreach workers;
  • contacting, communicating and following-up with high-risk individuals who inject substances, their associates, and neighborhood residents, within the constraints of Federal and State confidentiality requirements, including 42 C.F.R. Part 2;
  • promoting awareness among individuals who inject drugs intravenously about the relationship between injecting substances and communicable diseases such as HIV;
  • recommending steps that can be taken to ensure that HIV transmission does not occur; and
  • encouraging entry into treatment.
• Tuberculosis Services. Tuberculosis Services means counseling the individual with respect to tuberculosis; testing to determine whether the individual has been infected with mycobacteria tuberculosis to determine the appropriate form of treatment for the individual; and providing for or referring the individuals infected by mycobacteria tuberculosis for appropriate medical evaluation and treatment.

 

Providers must follow OASAS and NYS Department of Health procedures regarding how the program will:

• Directly or through arrangements with other public or nonprofit private entities, routinely make available tuberculosis services to each individual receiving substance use disorder treatment;
• Refer the individual to another provider of tuberculosis services (in the case of an individual in need of such treatment who is denied admission to the program on the basis of the lack of the capacity of the program to admit the individual); and
• Implement infection control procedures, which are designed to prevent the transmission of tuberculosis, including the following: screening of patients; identifying those individuals who are at high risk of becoming infected; meeting all State reporting requirements while adhering to Federal and State confidentiality requirements, including 42 CFR part 2; conducting case management activities to ensure that individuals receive such services; and reporting all individuals identified with active tuberculosis shall be reported to the appropriate State official as required by law.

• Human Immunodeficiency Virus. With respect to individuals undergoing treatment for substance use disorder, the State shall make available to the individual’s early intervention services for HIV disease at the sites at which the individuals are undergoing such treatment.
   

Early Intervention Services for HIV disease means:

• appropriate pretest counseling for HIV and AIDS;
• testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease;
• appropriate post-test counseling; and
• providing appropriate therapeutic measures.

Providers must establish linkages with a comprehensive community resource network of related health and social services organizations to ensure a wide-based knowledge of the availability of these services.

 

Providers must follow procedures developed by OASAS in cooperation with NYS Department of Health. NYS healthcare providers are mandated to offer HIV testing at least once a year to all patients.

 

Services must be undertaken voluntarily by, and with the informed consent of, the individual and undergoing such services must not be required as a condition of receiving treatment services for substance use disorder or any other services.

• Treatment Services for Pregnant Women and Women with Dependent Children Including Women Who Are Attempting to Regain Custody of Children. All programs providing such services will treat the family as a unit and therefore will admit both women and their children into treatment services, if appropriate.

Programs must provide or arrange for the provision of the following services to pregnant women and women with dependent children, including women who are attempting to regain custody of their children:

• primary medical care for women, including referral for prenatal care and, while the women are receiving such services, child care;
• primary pediatric care, including immunization, for their children;
• gender specific substance use disorder treatment and other therapeutic interventions for women, which may address issues of relationships, sexual and physical abuse and parenting, and child care while the women are receiving these services;
• therapeutic interventions for children in custody of women in treatment which may, among other things, address their developmental needs, their issues of sexual and physical abuse, and neglect; and
• sufficient case management and transportation to ensure that women and their children have access to the services described above.

The provider will publicize the availability of services for pregnant women and women with dependent children and the fact that pregnant women receive priority admission. This may be done by means of street outreach programs, ongoing public service announcements (radio/television), regular advertisements in local/regional print media, posters placed in targeted areas, and frequent notification of availability of such treatment distributed to the network of community-based organizations.

 

RESTRICTIONS ON EXPENDITURES OF SAPT BLOCK GRANT

 

SAPT Block Grant funds cannot be spent on the following activities:

1. To provide inpatient hospital services;
2. To make cash payments to intended recipients of health services;
3. To purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
4. To satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds;
5. To provide financial assistance to any entity other than a public or nonprofit private entity; or
6. To provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs.

 

Providers shall make every reasonable effort, including the establishment of systems for eligibility determination, billing, and collection, to collect reimbursement for the costs of providing such services to persons who are entitled to insurance benefits under the Social Security Act, including programs under Title XVIII and Title XIX, any State compensation program, any other public assistance program for medical expenses, any grant program, any private health insurance, or any other benefit program; and secure from patients or clients payments for services in accordance with their ability to pay.

 

CHARITABLE CHOICE

 

SAMHSA’s two Charitable Choice provisions [Sections 581-584 and Section 1955 of the Public Health Service (PHS) Act, 42 USC 290k, et seq., and 42 USC 300x-65 et seq., respectively] allow religious organizations to provide SAMHSA-funded substance use disorder services without impairing their religious character and without diminishing the religious freedom of those who receive their services. These provisions contain important protections both for religious organizations that receive SAMHSA funding and for the individuals who receive their services and apply to religious organizations and to State and local governments that provide substance use disorder prevention and treatment services under SAMHSA grants.

Religious organizations need to take steps to ensure that their inherently religious activities, such as religious worship, instruction, or proselytization, are separate - in time or location - from the government-funded services that they offer.

Right to services from an alternative provider
 

(a) General requirements. If an otherwise eligible program beneficiary or prospective program beneficiary objects to the religious character of a program participant, within a reasonable period of time after the date of such objection, such program beneficiary shall have rights to notice, referral, and alternative services, as outlined in paragraphs (b) through (d) of this section.

(b) Notice. Program participants that refer an individual to alternative service providers, and the State government that administers the applicable programs, shall ensure that notice of the individual's right to services from an alternative provider is provided to all program beneficiaries or prospective beneficiaries. The notice must clearly articulate the program beneficiary's right to a referral and to services that reasonably meet the requirements of timeliness, capacity, accessibility, and equivalency as discussed in this section.

 

(c) Referral to an alternative provider. If a program beneficiary or prospective program beneficiary objects to the religious character of a program participant that is a religious organization, that participating religious organization shall, within a reasonable time after the date of such objection, refer such individual to an alternative provider. The State shall have a system in place to ensure that referrals are made to an alternative provider. That system shall ensure that the following occurs:

 

(1) The religious organization that is a program participant shall, within a reasonable time after the date of such
objection, refer the beneficiary to an alternative provider;
 

(2) In making such referral, the program participant shall consider any list that the State or local government makes available to entities in the geographic area that provide program services, which may include utilizing any treatment locator system developed by SAMHSA;

(3) All referrals shall be made in a manner consistent with all applicable confidentiality laws, including, but not limited to, 42 CFR Part 2 (“Confidentiality of Alcohol and Drug Abuse Patient Records”);

(4) Upon referring a program beneficiary to an alternative provider, the program participant shall notify the State or responsible unit of government of such referral; and

(5) The program participant shall ensure that the program beneficiary makes contact with the alternative provider to which he or she is referred.
 

(d) Provision and funding of alternative services. If an otherwise eligible applicant or recipient objects to the religious character of a SAMHSA-funded service provider, the recipient is entitled to receive services from an alternative provider. In such cases, the State or local agency must provide the individual with alternative services within a reasonable period of time, as defined by the State agency. That alternative provider must be reasonably accessible and have the capacity to provide comparable services to the individual. Such services shall have a value that is not less than the value of the services that the individual would have received from the program participant to which the individual had such objection, as defined by the State agency. The alternative provider need not be a secular organization. It must simply be a provider to which the recipient has no religious objection. States may define and apply the terms “reasonably accessible,” “a reasonable period of time,” “comparable,” “capacity,” and “value that is not less than. ” The appropriate State or local governments that administer SAMHSA-funded programs shall ensure that notice of their right to alternative services is provided to applicants or recipients. The notice must clearly articulate the recipient's right to a referral and to services that reasonably meet the timeliness, capacity, accessibility, and equivalency requirements discussed above.

 

Additional Requirements

-- Continuing Education. Continuing education in such services or activities (or both, as the case may be) shall be made available to employees of the facility who provide the services or activities.
 

-- Coordination of Services. Providers must coordinate prevention and treatment activities with the provision of other appropriate services (including health, social, correctional and criminal justice, educational, vocational rehabilitation, and employment services).
 

-- Inappropriate Disclosures. Providers must have in effect a system to protect from inappropriate disclosure of patient records. Records must be maintained in compliance with all applicable State and Federal laws and regulations, including 42 CFR Part 2. This system shall include provisions for employee education on the confidentiality requirements and the fact that disciplinary action may occur upon inappropriate disclosures.

OASAS MONITORING

 

OASAS will periodically monitor provider compliance with all of the requirements and procedures described in this Bulletin during scheduled and unscheduled site visits.

 

SOURCE(S) OF FURTHER INFORMATION

If you require further clarification of the issues detailed in this Bulletin, please contact the appropriate Regional Office.