Tab A - Final Rule

Wednesday

March 31, 1993

I

P art XI

45 CFR Part 96

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Substance Abuse Prevention and
Treatment Block Grants, Intetlm Final
Rule

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Federal Register I Vol 58 No 60 I Wednesday March 31 1993 I Rules and RegulatIons

Grant and the application must be m
for Block Grants for fiscal year 1993
accordance WIth the law These mtenm
applicants must submIt an application
,
final regulations establIsh standards
contammg information which conforms
speafymg the cucwnstances m which
to all of the elements of the regulations
45 CFR Part 96
the SecretaryWIll consider an ~
Begmnmg in fiscal yeer 1994
application
for
a
~t
to
be
m
-~
applicants
are reqwred to use the
Substance Abuse PreventIon end
accordance WIth the law Based.on..the standard application form prescribed by
Treatment Block Grants
cntena established in law and
--~ HHS WIth the approval of the Office of
AGENCYSubstance Abw;e and Mental
lmplemented by this regulauon;ihere 1S Management and Budget (Oll,{B) under
Health Servl~S Adm1DIstratlon PHS
only one Indian robe that IScurrently'
the Paperwork. ReductIon Act of 1980
HHS
-'eligible for funds under thiS p~
Upon subD11$Slon
to OMB for review ra
All of the statutory reqwrements for ~ copy of this application may be
ACTlONIntenm F1D8.1
Rule
the SubstanceAbuse Prevention and
obtained from the Center for Substance
SUMMARY
Sections 1921 to 1954 of the
Treatment Block. Grant are ~pplIcable to Abuse Treatment DIVISion of State
PublIc Health Servlce "(PHS)Act
fiscal year 1993 Block Grants except
Programs Rockwall n Bldg -5600
authonze the Secretary to proVIde Block sectIon 1926 of the PHS Act.-lt IS theFIShersLane RockVllle MD 20851 The
Grants to States for the purposes of
Department 8 VIew that good cause'- ~
contract 'person IS Susan L. Becker The
prevention and treatment of substance
eXIststo show that notice and comment Secretary has had prelImInary
abuse which Includes alcohol ~d other are ImpractIcable
* or contrary to discussions and WIll have further
drugs Among other thmgs the Act
the publIc interest. 5 US 0. 553(b)(B)'" discussions WIth General Accountmg
reqUIres that fJ;1e
fundmg Qgreements
smce pursuant to section 1932(d)of the Office (GAO~ and the States about the
WIth the States provide for a number of
PHS Act Block Grantiunds for -reportIng
reqUIrements under section
proVIsions relating to mtravenous
substanceabuse may not be provided to
1942(a)of the PHS Ad. which ISpart of
substance abuse tuberculosIs and
States for fiscal year 1993 on or after
Ole application However the public is
human immunodeficiency VlIUS (lllv)
January 1 1993 If $e rule)s not ISSUed encour!lged to formally comment on all
testing and setVlces -grouphomes for
These Block Grants are the major source of the mformatlon collectIon
recovenng substance abusers and peer
of Federal funds to Statesto be used to
requirements contained In the standard
reVIew
requ~ments
ThIs speClfymg
Intenm final
establish and
supplement
VSfiOUS
formThese
under comments
the Paperwork
Reduction
rule
establishes
standards
the substance
abuse
prevention
and ~ -t,
Act
WIll be
carefully
OEPARTf..ENT OF HEALTH AND
HUMAN SERVICES

CIrCUmstancesill which the Secretary
WIll consider an application for a ~t
under section 1921 of the PHS Act to be
m accordance WIth the law
DATESEffective Date March 31 1993
Comment Date The Secretary IS
-to
requesting wrItten romments which
must be received on or before (Insert
date 60 days after pubh~tlon)

treatment programs and an mternlptlon
considered by OMB and the Secretary
or a delay m such fundIng could"have
and as a result of these comments any
a profound impact on the States ablhty
changes to the rule will be made by
to proVIde substance abuse preventIon
January 1 1994 or shortly then){lfter
and treatment a result which IScontrary
The State in Its applIcation as
the War on Drugs and the public
required by 6ed.1on 1932(a) of the PHS
mterest.
~ct. IS to subm1t the necessary
For slffillar reasons thiS regulation 1$-assurances as well as the State plan and
effective Immediately Dolaflng1he --the
report required by sectIons

ADDRESSES~
Wntten conunen\Snn this
Intenm final t:ule may 'be sent to Susan

effectIve date for a ~nod ofthutydays
IS contrary to the public mterest.
Requinng States that have submitted QD

1932(b)(1) and 1942(a) of the PHS Act.
respectIvely- SectIon "1932(b)(1) of the
PHS Act proVIdes that the States are to

L. Becker Director DIVIsJonof State
acceptable application to Waltan
..submit
a State plan doscnbmg how 1he
Programs ~nter tor 'SubstanceAbuse
addltlonal1h1rty days for payment
State plans to implement the
Treatment (CSA T) Rockwall n
-would
only COJ11pound
the problem of
requirements of the Act. such as those
"Buildmg.oth FlOOr 5600 Fishers Lane delay and burden the States further in
relatIng to the proVIsion of tuberculosIs
RockV11le"'MD20851
~
their proVIsion of substance abuse
and HIV servIceSand servIceSto
FORFURTHER
INFORMAT1ON
CONTACT
Susan L. Becker tele"phoneNo (301)
443-3820
-,..
-as
SUPPLEMENTARY
INFORMAT1ON
Sections
1921 to 1954 of the PHS Act 42 U S c.
300x-21-300x-35
proVIde for
allotments each year to States for the
purposes of planning carrymg out and
evaluatIng actIVIties to prevent and treat
substance abuse which ISdefined et
section 96 121 to mclude the abuse and!
or IlhClt use of alcohol and other drugs
The BlockCrant funds may be
I
expended to proVIde for a WIde range of
actiVIties to prevent and treat -substance
abuseand may be expended to deal
WIth the abuse of alcohol the use or
abuse of Illicit drugs the abuse of hClt
drugs and the use or abuse of tobacco
products
In order for the Secretary to award
Block Grants the States and eligible
Indian trIbeS must apply for the Block

prevention and treatment programs
pregnant women which are doscnbed m
Although the regulations are published
more detail below It also proVIdes that
an mtenm final rule and are effective the States are to descnbe how the Block.
Immediately the Secretary requests
Grant ISto be expended 45 CPR
comments on the regulations and IS
96 122(g) sets forth the information
parUC1llarlyInterested In comments on
States are to proVIde the Secretary under
alternative ways the law may be
the State plan
Implemented The Secretarywill
-SectIon 1942(a)..of the PHS A ct
consider all comments and after such
requires the States to submIt a report
consideration make any amendmentsto which doscnbos the purposes for which
the regulations by January i 1994 in a
the grant receiVed by the State for the
final rule
Y preceding fiscal yoars was expended a
...descnptlon
of the actIVitles of the Stat~
The Apphcatlon and Assurances
under the program and the reCIpients of
45 CPR96 122 and 96 123 are added
amounts proVIded In the grant. 45 Q'R
to descnbe what 1Sto be provided in the 96 122(f) sets forth the mformatlon that
application and the necessary
ISto be submitted to the Secretary in the
assurancesthat the States(which -report
mcludes the DiStnd. of Columbia and
In additIon the regulatIons
the1emtones) WIll proVIde to ensure
applicable to the report TeqUIreStates
the Secretarythat It will carry out the
to submit mformatlon on the use of
purposes of and expend the Block Grant Block Grant funds over a se\ eral year
m accordance \..lth the law In applYIng penod For example for fiscal year

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Federal Register I Vol 58 No 60 I Wednesday March 31 1993 I Rules and Regulations

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11063
-

1993 speCific lDformatIon ISto be
submitted for Federal fiscal years 1990
1991 and 1992 as well as for the most

which are provided as examples lD the
regulatIons or the State may submit
other procedures which the Secretary

AdmlDlstratIon ReorganizatIon Act Pubhc Law 102-321 July 10 1992 are
allowable actIVItIes under the Block

recent twelve month State expenditure
penod for which expenditure

determmes to reasonably Implement
reqUIrements of the Act and the

Grant but do not now count as pnmaryprevention

mfonnatIon 1Savailable.JnformatIon
from earheryears is necessary because
It often takes States two to three years
to acqUIre8ctual ~~dlture
and other
data The Secretary beheves it IS
essen~l that actu81 data (rather than
sImply estimates) be acqUIred for
monltonng-\he Block Grant funds to
ensure that the funds are expended for
authonmd purposes and m accordance
WIth the law
Also when mformatIon ISrequested
for fiscal years 1990 1991 and 1992
apphcants are to prOVIde Informallon
relatmg t6 Sllbstance abuse prevention

regulatIons
Certain Allocations and Pam
P
l
a.ry
~ven Ion
45 CFR 96 124 and 96 125 are added
to Implement the proVISIons of Sed.lon
1922 of the PHS Act which reqUIres
-§
States to expend the Blod. Grant on
VariOUSprograms SpeCifically the State
ISreqUIred to expend not less than 35
percent of the Blod;. Grant for
:prevention and treatment actIVIties
regarding alcohol and not less than 35
percent for treatment and preventIon
actIVIties relating to other drugs

SectIon 96 124 Impl~ments section
1922 of the PHS Act which proVIdes for
specific allocallons to increase the
avallablhty of treatment semoes
~
designed for pregnant Women and
women WIth dependent duldren Under
96 124 the State is reqUIred to expend
not less than 5 percent of the fiscal year
1993 grant to inaease (relative to fiscal
year 1992) sud1 ~mces coDS1sten(
WIth the base descnbed 8t § 96 124:(c)
ThIs reqnuement may be waived upon
the request of the State If the Secretary
detenmnes that the State is proVIding an
adequate level of serVIces for thIS

and treatment actiVIties under the
Alcohol Drug Abuse and Mental Health
SerVIces (ADMS) Block Grant formerly
authonzed by sections 1911 and 1926 of

In addition not less than 20 pe~nt
of the grant IS to be expended for
pnmary preventIon actiVIties-.- Section
96125 IS added which requires $tates to

populatIon
In detenmnmg whether an
adequate level does eXIst. -the SecretaIy
WIll reVIew the extent to which a State
IS proVIding serVIces to this population

the PHS Act Although those sections
have"been amended the Department
WIll reVIew those expenditures to
ensure that the Block Grant funds were
expended m accordance WIth the law lD
effect for those fiscal years
As has been the casetJDder the ADMS
Block Grant. the funding agreements
and assurances m the apphcatIon are to
be made-through certificatIon by the
chief executIve officer personally or by
an IndIVidual authon~ to make such
cerlIficatIon. on behalf o'f the chief
executIve officer If a delegatIon has
occurred a copy of the current
delegation of authonty must be
S\'lbIDltted With the applicatIon
The epphcatIon {m substantial -of
comphance WIth the statutory and
regulatory proVISIons) ISto be submitted
for fiscal year 1993 no later than nmety
days after publltatlon of these
regulations and for subsequentyears
no later than March 31 of the fiscal year
for which the State ISapplYIng for
funds. The Secretary beheves this WIll
allow States SllffiCient tIme to complete
the apphcatlons and as to the March 31
deadlme allow for a m~re orderly
process The term fiscal year refers to
the Federal fiscal year -nus WIll make
the InIS reVIew process more effiCIent
and may 13xpedttethe process of
reVIeWIngapphcatlons and B-wardmg
the grants
The Secretary WIll approve an
apphcatIon WIth -aState plan ...the
assurances and report whld1 satIsfy the
requirements of the Act 1I.ndthe
regulatIons The State IS required to
proVIde descnptIons of how the State IS
ImplementIng1he provISions of the Act
and the regulations Unless proVIded
otherwIse by the I'egtcllatlons the
Secretary WIll approve procedures

develop a comprehensive prevention
program which proVIdes a broad array
of prevention actIVIties and services
mcludJng such actiVIties and serviceS to
discourage the use of alcoholic
beveragesand tobacco products by
mmors These actiVIties and serVIces
must be proVIded m a variety of settings
for both the general population es well
as targeted subgroups who are at lugh
nsk for substance abuse Section 96 125
proVIdes examples of stra.tegIesthe
States may use m developwg a
comprehenSIve pnmary prevention
program Under eacb strategy examples
of a<:x:eptablep~s
are listed
The ':)ecret8rytieheves the examples
8<:x:eptablestrategies and ~ctlVltles Me
Important to alleVIate any confuSIon m
the preventIon field as to acceptable
pnmary preventIon actiVitIes under the
Block Grant This IS particularly
Important because of the major cllange
In how prevention for purposes of the
20 percent set aSide ISdefined lD the
Block Grant-that IS pnmary
p~ventlon only as compared to
prevention and early mterventlon
It -should be noted however that the
pnmary preventIon definition IS for
pwposes of the "Substance Abuse
Prevention and Treatmen Block Grant
.regulallons only ThIs definition does
not apply to other programs
admlDlstered by SAMHSA or the Center
for Substance Abuse Prevention such as
lhgh RIsk Youth prog!"amS whIch
lDclude intervention activities which go
beyond 8ctlvitles authonzed by these
I'egtcllatlons
--all
The Secretary assU1'CS
States that early
lDtervention actiVIties whlcll counted as
part of the 20 percent prevention set
aside pnor to passageof the Alcohol
Drug Abuse and Mental Health

and WIll consider whethel'the-fnlmmUIll
level of services stipulated m -§961.24(6) ::...:.
are beIng provided for pre8nant women
and women With dependent children
who are bemg-,;erved
At a mmunum the Secretary reqUIres
States to ensure that treatment programs
receiVIng funding from the Blod;. Grant
set aside for pregnant women and
women WIth dependent children for
such serviceS also proVIde or arrange for
the folloWIng (1) Pnmary ~ed1cal care
for women who are.recelVlng substan~
abuse serviceS mclud1ng prenatal care
and wh1le women are receIving such
treatment clllld care (2),pnmary
-pedlatnc care lor fuelr cliddren
mcludmg lIDIDumzatIQns (3) geild'.er':.~
speCIfic substance abuse trea~en~8JJ;.d
other therapeutic 1nfervenuons for 1 f
women that may address lSSU#tS
of t
relationships sexual and physical ~use
and parenting and child care while the
women are receiVIng these GerYJces(4)
therapeutic interventIons for clllidren m
custody of women m treatment which
may among other thrngs address their
developmental needs and theIr J5SUes
of sexual8nd phYSical abuse and
neglect. 8nd (5) suffiCient case
management 8nd transportation services
to ensure that women and their children
have access to the serVIceSproVIded by
(1) through (4)
Because of the unportant heal th lSSUes
relatIng to \he proVIsion of treatment
serviceS to pregn8nt women and women
WIth dependent children the Secretary
strongly enco~ges the StatescS{o
~~
programs that proVlde -serVIcesto
women to 8.lso proVIde a comprehensIve
range of serviceS to ~uch women 8nd
their children either directly or through
linkages wIth communlty~ed
~
orgamzatlons These serviceS mclu e

the

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Federal RegIster I Vol 58 No 60 I Wednesday March 31 1993 I Rules and Regulations

;sse management to assist in
~tabllshlng ellglblltty for public

I

I

effiCIent but cost effedlve means to
Implement this section.

on the central registry concept and aoy
altematlvesto
a central regiStry

asslstan~ programs proVIded by
In addition 8ectlon .1923of the PHS
Federal State or local governments
Act reqwres the State to ensure that
employment and training programs
each individual who requestsand Is In
education and Special education
need of treatment for intra\'enous drug
programs drug free housing for women
abusebe admitted to the p~
not
and their chIldren prenatal care and
later than 14 days afterm~1he
other health-are f.ervi~s therapeutic
request lor admiSS1onto such a program
day care for children Head Start. and
or 120 days a1terthe date of such
other early childhood programs.
7 -J'equest. if no such program has the
In addition to proVIdIng the DllDlIDum capaCIty to admit the indiVIdual on the
semces.--theState is to reqwre tIIat all
date -ofsuch request and if mtenm
programs which provide substan~
".L. servi~s are made ~v81lablelo.the
abusetreatnlent sem~s to pregnant -indiVIdual
not later th8l148 hours after
women and women WIth dependent -such
requesL
children using ~ds from the Blocl::
In C8rJYlngout thesq proVISIOnsthe
Grant amount set aside for such
SecretaryJ'eqWresthe State to estAblIsh
purposes must "treat'the f8D111y
as a UnIt
a waitIng 1xst @anagement-program
and therefore admit both women and ~
whIch proVIdes systematic reporting of
thelr dtIldren Into treatnlent when
treatment demand The State is to
appropnate Such an admiSSionmay not require any program receiVIng fundmg
be appropnate however If for example from the 8I"8!lt for the purposes of
the father of the child ISable to
treating injectIng drug abusersto
ade uatel care for the chIld In
establish a waiting list whIch 1I).c1udes
a
umque drug
patient
IdentIfier
for treatment
flach
a d~tI on ih e amoun t set asld e ~or su ch
injecting
abuser
seel-.mg
sem~s m~ be expended on
including those receiVIng intenm
indiVIdualS who have no other finanCIal servl~S whIle aw81tmg admiSSionto

Intenm serVIces for the-putposes of
6ect1on96 126 may entail any number of
servl~S includ1ng intenm methadone
m81ntenan~ as authorized by 8ect1on
1976 of the PHS Act and the apphcable
regulations. The Secretary however
requires that at a minimum Interim -~
sem~s Include counse~
and
education abqut mv and tuberculosis
about the nsk.s of needle-shanng. .about
the nsks of tran.c:m1s-510n
to sexualpartners and infants and aQout sleps ~
that can"be tgken to ensure that mv transmission does not outth1s~on
tne
Secretary allows grant funds 10be used
for th1Sp~ose onlY.if a phYSiCian
makes a determmatIonthat. (1)The
primary diagnosIs '1fthe mdtVldualls
substance abuse and the physiCian
cetUfies thiS fact (2) the lndlVldual cannot be safely treated m a
community based nonhosPltal
residential treatment program 13)the
service can reasonably be expected 10
Improve an indiVidual S condition or
level of fundlonmg and (4) the
hOSpltal-basedsubstance abuse prognml
follows national standards of substance
abuse professional practIce In addition
grant money may be expended {or such
SCrvlCCS
only to the ~xtent that It IS
medically necessary i e only for those
days that the patient cannot be safely
treated m a residential COmmUl\ity
based program
"
Section 1931 of the PHS Act also
proVides that grant money may not be
u~d to pt1lCbaseor lmprove land
purci}ase construct or permanently
Improve (other than mmor remodelmg)
any bwlding1>r.other faahty or --'
pu:rcl1asemajor medical. eqwpment. The
PHS Ad. proVides however that the
Secretary may grant a waiver to a ~
roquestmg State of the restrIctIon on
expending a grant for the constructIon
of a new faal.ty or rehabll.tatIon of an
eXlstmg faCll.ty but not for land
~
acqUiSitIon
The Secretary may approve a Waiver
only If (1) the fitate demonstrates to the
Secretary that adequate treatment
cannot be provided through the use of
eXlstmg faalItIes and that alternative
faCll.tIes m eXlstmg swtable bwldmgs
are not (ivwable (2) the $t8.t~has -..
care.fully des)gQec)-aprogram tha~W1Uu
mulimlze the costs of 64dttIonal beds and (3) the State agrees With ~pect to
the costs to be m~d
bythe-Statem
.carrying out the pwpose of the waiver,
to make available non Federal"
-contnbutIons m tasn toward such wsts
in an amount equal to not less than $1
for each $1 of Federal funds proVided
under sectIon 1931 In grwltIng a
waiver the Secretary Will ~llow the use
of Ii speafied amount of funds to

construct

or

number
and

of

rehabilItate

beds

a sp6C1fied

outpatient

costs

number

estImates

of

SectIon
that
is

96 135
needed

expendItures
law

for

of

as

to

or

make

to

any

to

Extension

1988

of

relatmg

to

the

needles

to

m~ng

The

State

to

pay

the

the

costs
State

grant

for

correctIonal

by

sectIon

which

the

for

Independent

the

qualIty

m

program
5

in
are

IndIVIdual

at

peer

semres

on

treatment
abuse

than

on

reVIew

process

the

and

15

treatment

drug

abusers
~

""-

..}-

i'

requl~the

alcohol.and
Because

treatment
drug

~

reVIewers
expertise

to
In

be
the

abuse
servlres treatmenL,,
If1ay

multl,pl~
peer

must

Intentnf

system

peer

representative

the

The

regulations

by

and

substance

alcohol

WIth

treatment

that

treatment

rather

State

treatment

r

the

proVIdIng

qualIty

peer

independent

the

the

the

mdIV1~uals

utlltzed

proVIded

such

improve

10

mdlVIdu6l

assess

mdependent

Independent

proVIded

to

ensure

focus

continuously

The

proVIde

entities

practitioners

the

year

to

under

under

of

and

S8rVIceS

-

-and

the

of

system

WIthIn

fiscal

semces

State

IS to

programs

Act.

which

the

review

reVIew

reVIew

the

PHS

revIewed

appropnateness

to

the

and

the

Stale
presalbed

provided

of

15 to

serVIce

the

mdIvIduals

purpose

reVIew

of

for
is

peI1:ent

program

The

amount

IS added

to

servIceS

The

an

provldmg
or

Review

involved

least

penal

treatment

State

45 CFR96 46(c) 1S81nendedto
establish cnteria prescnbed by tho
Secretary as is reqUired by section
1933(d)(3) of the PHSAct. Itestabhshos
-cntena that Indian tnbes or tnb61
organIzatIons which are eligIble for a
direct grant must follow Essentially
these entitles must ablds by all the
statutory provisions and accompanying
regulatIons ex~pt for the folloWIng
proVIsions of the PHS Ad.. £ectlon 1923
which relates to proVIsions on
Intravenous substan~ abuse section
1925 whichproVldes for group homes
for recovenng substance abqsers section 1.926 regardmg State laws on the
sale
of tobacedures
(13) StateWIde assessmentof neeQsas which the SeCl'etary deterJnmes tQ
proVided In § 96133
-reasonably Implement the reqUIrements
The aggregate$tate dollar
of the Act
projected expenditures by the-pnnc1pal §9G123 Aaauran~a
agen~ of a State for authonzed
(a)The applIcatIon must include,
'
~ctlvffies for the fiscal year for which"
assurances thatthe Block Grant ISto be expended as
'{I) the State w1II expend the Blad;.
well as the 8~gate obhgat1onsor_\..
Grant m accordan~ W1th 1~e pe~ntage
expenditures when a!aIlable for
to be allocated to treatme(1t. erevenuon
authonzed actlVltIes for the two years
and other actiVlues as pre:;cnbed by lawpnor to such fiscal year as requ1nJ'dby
and "also for the purposes prescnbed by
§ 96 134
-law
r
(15) Unless wa1ved a descnptIon of
(2) The activItIes relatIng-to
""the ~mces and actl.VltIest't>~
Y
Intravenous drug use pursuant to
proVided by the Stata Wlth }Jlod: Grant
§ 96 12.6~ll be Gamed out
funds consIstent ~lli § 96 124 for
(3) The TB semces and referral will
allocatIons to be spent on serv1ceSto
be Gamed out pursuant to § 96127 as
pregnant women and women Wlth
well as the early lDterventton ~ervlces

(4) A detaued descnptlon of the State
procedures to mon1tor programs that

dependent cluldren
alcohol and other
drug treatment and preventIon

reach 90% capaCIty pursuant to
§ 96 126(a)
(5) A detailed deSCrIptIonof the State
procedures to implement the 14/120 day
reqUIrement proVIded by § 96 126(b) as
well as the mtenm SCI"\'lces
to be
proVided and a dOSO1ptIonof the
strategies to be used m momtormg
progr81ncomplIance m accordance Wlth

Includmg pnmary preventIon and any
(4) The revolVIng funds to estabhsh
other requirement
group homes for recovering subst4qce
-(16) A descrIptIon Qfthe State
sbusers ISin place conslst'~nt WIth the
procedures to tmplement § 96 132(e)
proVls1ons of § 96 129 and the loans WIll
regarding mappropnate disclosure of
be made and used as proVllded for by
patIent records
--law
(17) A .deSCrIptIonof the amounts to
(5) [Reserved)
be spent for pnmary preventIon In -,6)
Pregnant women-are proVided
accordance With § 96 125
~ -preference lD adIDlSS1onto treatment -

§ 96 126(f)
(6) A full descnptIon

(18) A deSCrIptIon of the ~oUDts
be spent on -actIVItIes relatIng to "\.

of the outreach

efforts States Wllll"eqwre entItIes wl11ch
~Ive
funds to proVIde pursuant to
§ 96 126(e)
(7) A detaIled descnptIon of the State
p~dures "ImplementIng TB serVIceS
pursuant to:§'96 lU-'8Qd a deSCrIptIon
of the strategies to be used m
oIJ1omtonngprogram complIance In
8ccordanQJWlth § 96 127(b)

to

substance ab.xsesuch as plannmg
coordInatIon needs 4SSessment.-quahty
assurance Uamlngafcounselors
program developm~nt. research and
development -QUdthe -devel!:?pment
of -'"
mformatIon systems
-.::
(19) A deSCrIptIonaf the State plans
regardmg purchasmg substance abuse
services

fOTmv proVided
designated State

for m § ~6 128 If a

centers as proVided by-§ 9~) 131 and are
proVIded lDtenm semces as neceSSalY

and as ~
bllaw
(7) The State Will improve the Process..
lD the State for referrals ofrodlVldu8.ls to the treatment modalIty ~thatis UloSt ~
:appropnate for the "IndiVIduals 'Will
~
ensure that conunlllng ed11catIon.is
provided to employees of any funded
entItyprov1dlDg preventIclD actIVitIes or
treatment serVIces and W111cooromate

I
17073

I

prevention actIVities and treatment
serVI~s WIth the proVision of other
appropnate serVIceSas provided by
§ 96 132
(6) The State will sub[I1ltan
assessmentof need as reqwred by
sectIon Q6 133
(9)The State WIll for such yesr
maIntain aggregateState expenditures
by the prinCipal agency of a State for
authonzed actIVities at a level that IS.not
less tDan the averagelevel-of such
-expendittttes maIntaIned by the State
for the 2 year penod precedmg the fiscal
yesr for which the State is applytng for
the grant as proVided by § 96 134
(10) The Block Grant WIll not be used

§96124 Certainauocatfonc.
(a) States are required to expend the
Block: Grant on vanous adlVltles in
~rtam proportions Speafically as to
treatment and pnlventlon the State
shall e~nd the.grant as follows
(1) not less thaO35 percent for
prevention and tre«(ment actiVities
reg~
alcohoL and
(2) not less than 35 percent for
prevention and treatment actiVities -by
re8-8cfd1cng
other drugs
(b) The States are also to expend the
Blad: Grant on pnmary prevention
p~ms
as follows
(1] J;onslstent WIth § 96 125 the State
shalf expend not less than 20 percent for

(2) For fiscal year 1"9~14the State
shall consistent WIth Pliragra h ( )
this section. expend nolless ~an ~;~( of
percent of the grant to iJlcrease ( 1
to fiscal year 1993) the uVa1l4bihr:r~~ve
such serVI~S to Pregnallt wome
d
women WIth dependent childre n an
(3) For grants beyond fiscal n. ~
the States shall e
nd 110Ie year 1994
anIount equal to ~ am
t liSthan-en
the State for fiscal y~~9~rnded
(d) U
th
Secre PO~a e request ~If a State the
requ=ent
~;~
1 h1~
~ the
section if the Secre
P
s
the State is
dintary determines that
of serVIces fo~fu.s g 81J~:~te
level

to supplant
other-drug

programs
for indiViduals
who do not
reqUIre treatment
for substance abuse

detem11D1
-of serVIces or

State funding of alcohol
prevention
and treatment

In

,

--'

servl~S Th1s detenntnatlon may be
supported by a combma'tlon of criminal
lustl~ data the National Drug and
Treatment Umts Survey statewideneeds assessmentdata ,vaitmg list dat;.=.
welfare department data including
medicaid expenditures. ,Drother State
statistical data that are s:,.stematlca1ly
collected The Secretary Will -also ,,~
consider the extent to which the State
offers the minimum services required
under § 96 124(e) The Sacretary shall
approve or deny a reque:;t for a waiver

manner as to faCilItate comment from
any person (mcludm8: any Federal or
other public ag.ency)dUrIng the
development of the State Plan and after
the submission of the State Plan
(including any re~Slons) to the
Secretasyas provided by § 1941 of the
PHS Act
(14) The 'Stale WIll for the fiscal year
for which the grant ISproVided provide
for mdependent peer reView to assess
the quality appropnate,ess and
efficacy of treatment services proVided
In the State to indiViduals under the
program Involved as reqwred by
§ 96 136
(151 The Stale has In effect a system

products by mdtVlduals to whom it is
unlawful to sell or dlstnbute such
beverages or products
(c) Subject to paragraph (d) of tlus
section a State ISreqUIred to expend the
Block Grant on women sem~s as
follows
(1) The State for fiscal ye-ar1!l93 shull
expend not less than five percent of the
grant to increase (relative to fiscal year
1992)the avallabllttyoftreatment
serviceSdesigned for pregnant women
and women WIth dependent children
(either by establlshmg new programs or
expandIng the capaclty-of eXISting
programs) The base for fiscal year 1993
shall be an amount equal to the fiscal

not later than 120 days after the.date on
which the request is.made Any waiver
provided by the Secretary shall be
applicable only to the fiscal year
Involved
(e) WIth respect to par~graph (c) of
this section the amount se\:aside for
such semoos shall be expended on
mdlVlduals who have D(JI'OtherfinanClal
means of obtaining such$6m~s as
proVided m § 96131 AU programs
proVldmg such sem~s 'WIll treat the
family as a UnIt and thel1~forewill admIt
both women and their clllldren mto
treatment servIces If appropnate The
State shall ensure that all a DlInlmum
treatment programs receIVIng funding

year 1992 alcohol

for such

t

to protect
patient

I

don.

aded eqU4th te level
s
mg
ProVI
SeCl"etaryWIll
reVJew
-th,~extente..-to

(11)proVide for actiVities to redu~ the
nsk of such abuse b the indiViduals
(2) The Slate shalf In carrymg out
paregraph (b)(I) of this sectJon(I) give pnonty to programs for
populations that are at nsk of
developmg a pattern of such abuse and
(II) ensure that programs recetvmg
pnonty under paragraph (b)(2)(t) of thiS
section develop communIty based
strategies for prevention of such abuse
Includmg strategies to discourage the
use of alcoholic beveragesand tobacco

rt

§§

I

h th popu
W
bee er an

( ) ms
progra
11 For purposes of maintenan~ of
e 0 pursuan to
g6 121 96 126
and 96 '134 the State WIll calculate the
base using Generally Accepted
Accounting PnnClples and the
compositIon of the base WIll be applied
conSIstently from year to year
(12)The State WIll for the fiscal yesr
for which «;hegrant ISproVided comply
WIth the restnctlons on the expenditure
of Blad: Grant funds as provided by
§ 96135
(131 The State WIll make the State
~ filan public WIthin tbe State m such
a

I

and

from

records

Inappropnale
maintained

(f)

(f)

dIsclosure
by the State

m connedlon WIth an entity which is
receIVIng amounts from the grant
(16) The State WIll comply WIth
chapter 1S of title 31 United States
Code pertamihg to audits and
(17) The -StateWIll abide by all
apphcable Federal laws and regulatIons
mcludlng those relating to lobbytng (45
CFRPart 93) drug free worKpla~ (4')
Q'R 1G GOO)diSCrImination (PHS Act
Sec. 1941) false statements or failure to
disclose certain events (PHS Act Sec.
1946) and as lo the State of Hawau
servl~S for Native Hawaiians (pHS Act
Scc 1953)

which

programs(I) educate
and counsel the

d

In

d

IVI

al

U

Block: Grant

ch

son

su

b

a

d

use

an

and drug serVIces

expenditures

and State

expenditures for 1>regnantwomen and
women WIth dependent children as
descnbed m paragraph (e)of this
section and to tms baseshall be added
at least 5 percent of the 1993Block
Grant allotment. The base shall be
calculated USIngGenerally Accepted
Accounting PnnClples and the
composItion of the base snall be applied
consistently from year to year States
shall report the methods used to
calculate their base for fiscal year 1992
expenditures on t.reatmentfor pregnant
women and women WIth dependent
children

which

such

indtVJduals

a~

..."

servIces

for the proVIsion

iYing

&"'-"

e.1s0 pnlVlde

or arrange

of the (')llowmg

serVIces td pregnant wonlen and women
WIth dependent dnldren. includlllg
women who are attempbng to regain
custody of their children
.."-(1) pnmary medical ~re for women
mcludmg referral for prenatal care.and
while the women m:e recelVl.Dgsuch
-serVIces child care
-.."
(2).pnmary pedlatnc care including
lmmuntzstlon for their (:lul~n -I
(3) ~ender speCIfic substance abuse
treatment and other the~lpe'U't1c -I
mterventlons for women which may
address issues of relatlOfLShips ~xua .\
and physical abuse and parentll~ end

17074

Federal

RegiSter I Vol

ld care while the women
'eIvmg these services

58 No 60 I Wednesday

are

dIstInguished
Dlssemmauon

March 31 1993 I Rules and Regulau'GDS

from the Infomlauon
strategy by the fact that

4) therapeuticinterwnuons for
interactIonbetweentheeducator!
ctnldren in custodyof womenm
facIlitator and the partiCIpantsISthe
treatmentwhich may amongother
basisof Its actIVIties ActlVluesunder
thIngs addresstheir developmental
thiSstrategyaim to effectcntIcall1fe
needs their issuesof sexualand
and SOCIal
skills' includIng deCISIon
physIcal abuseand Di!glect;and -.making
refusalskills cntlcal analySIs
(5) suffi~t
transp<'rtabon

=~gh

case management and
(0 ensure that *omen

(e g of media messages) and systematIc
JUdgment ah1l1ues Examples of ~

and thelr-c1uldrenhaveaa:ess.to -actlVl1les
conductedand methodsw;ed
Sr;:r~d
by-paragraphs{e}(1) for this strategymclude(butue-not
(f)~dures::
~~
--~~
hInlted to) thefollowmgof p8!BgrBphs(c)~ (e)01=::
(I) Classroomand/or ~mangl'OUll
WIll be dawloped In mnsu1tat1
th
seSSIons
(all ages)
the StateMedical ~or
far S:"~
(u)ParentIngand fam1lymanagement
Abuse SerVIces...

classes
(lU) Peer leader/helperprogratns.

:;""

tralnlng of1:.ey people m the ~stem
staff/oTficfaIs ~
-"

-

(u) Systematic lannID
(lU)Mu1tI-8ge~ COO~8t10n endcollaboration
.(IV)A~1Ug semces andJimdj{;g ehd
(v) Commumtyte4IIl~uild:~
(6).Ennronmental Th1sl~trateiY

-establ1~8$
unwntten

or changes wntten and
commumty staniIards. cod8$

§ 96125 Primacy
prevention.
(IV)Educationprogramsfor youth
(a)For purposesof§ 96.124each
groups and
Statetrerntory shall developand
(v)Chlldren of substanceabusers
Implementa comprehenSIve
prevention
groups
programwhich Includesa broad arrayof
(3) Alternatives This strategy
preventionstrategiesdlIected at
proVJdesfor the partICIpationof target
IndJVldualsnot JdenhJiedlobe In.need populations In tlctIVluesthat exclude

-endattitude$.-thereby1nfiu,e~'
lOClden~ and provalen~ oftha~use
of alcoh04tobaccoand other drugs used
In the generalpopulation. ~rh1sstrategy
ISdtVJdedmto two subcategonesto
pemlit dIstlDctlonbetweenactlVltl8$
whIch ~nter on legal and l'6gu1atory

of treatment The compreLenslve
program. shall be proVIded eltlleJ'
directly or through one or Dl(lrepubl1c
or nonprofit pnvate.entities. 'The
comprehenSIve pnmary prevention
'1rogram shall Include actiVities and

lDltIatlves and those which relate to the
sem~ and actIon-onented initlauves..
Examples of actIVIties concJ:uctedand
method& used for thIS strautgy shall
mclude (but not be bmIted to} the
folloWIng

alcohol tobacco and other drug use- The
assumption IS that constructive and
healthy actIVItIes offset the attJactlon to
or oth6rwlse meet the needs ~Iy
filled by alcohol tobacco and other
drugs and would therefore mmimize or

mcesprouded in.a varietyof settings obviate resortto the latter Ex8Dlplesof

(4)ProblemIdentJficatJonand

the commmntyto moreeffectively
proVIde

preventIon

serviceS

for

Health

fau'S/hee.lth

promotIon

and

advertISIng practIceS anroVldes awarenessand

(u) technical aSSlStance
to <:ommttntues
to maJamlzelocal enforo!ment

er

folloWIng"

reVIew-of alcohol. tobacx:rJ'and drug
usepol1C1esm schools.

un

program th« State shall use-avariety of
strategies ~ appropriate for Bach target
group including but not hmrted to the

limited to) the folloWIng
(1)Drug free dancesand partIes.

(1)promotingthe establ1shrllent
and

dlh

.sk for substanceabuse.
(bJIn iInplementmgtheprevention

actIVIties conducted and methods used
for this strategy Include (but are not

a

t' both the-general population as well
targetmg.&ub-groupswho are at high

I

networkIng Examplesof actiVIties
conductedand methodsu~;edfor this
strategymclude (but are n~JthmIted to)
the followmg
(1)Commumtyand 'Volunt.3ertramIng
e g neIghborhoodactloll .traImng

~

I

~-

of serviceS Implementation
lOter agency
collaboration
coal1uon
bulldmg
and

receive

I

reportsand which makese:CCt!Ss...
--'--f
~

capaCity

mformatlon

available

to sucll

~

Federal RegISter I Vol 56 No 60 I Wednesday March ~1 1993 I Rules and RegulatIons

I

of treatment

for

1S adm1tted

later
after

adInlsslon
(2) 120

if no

such

serVices

incluenditureof
grant. .-

proVide
th
~f;

the

folloWing
k c

data
be

lf avallable

e "Y""~'C ns lactors 109addressed
byactIVlty the age raC)3/ethnlaty ana
b
genth
der of the population belOg targeted
y e prevention actiVity- and the
community SIzeand type where the
activity is camed out As to all
treatment and preventIon actIVitIes
IncludIng pnmary preventIon the State
11proVide the ldentitIes of the
ItIes that p~Vlde the semces and
~bethe semces proVided The
e shall submit lDfonnatIon on
treatment ul1llutIon to descnbe the
type of care and the utilization
accordihg to pnmary diagnoSIs of
alcobol or drug abuse or a dual
diagnosIs of drug and alcohol abuse
(3) The State may desm"be the need
for technIcal asslstahce to carry out
Block Grant actIVitIes 1Ddudmg
actIvltles relating to the collection of
1Oadence and prevalenC)3data
ldentlfied m paragraph (a)(1)of thiS
sectIon
(4) The State shall estAblIShgoals and
objectIves for unprovmg substance
abuse treatment and prevention
actIvltles and shall report actIVities
taken m support of these goals and
objectIves 10 lts application
(5) The State sha1lsubmll a detailed
desao1ptIonon.!he extent to which the
availability of preventIon and treatment
actIVitIes IS msuffic.ent to meet the need
for the actIVitIes the mtenm servl~ to
be made ava11ableunder sectIons 96 126
and 96131 and the manner m which
such semces are to be so avatlable..
Spectal attention should 00 proVIded to
~ followmg groups
) Pregnanladdlcts
'..
1)Women who.are addIcted and who
3 dependent chIldren
11)injecting drug.addlcts and
(tv) Substance abusersInfected Wlth
HIV or who have tuberculosis

y
precedmg

the

fiscal

year

~
L._L
,-or Wu.u.;u

th

e

State is applYing for the grant. The
Blod Grant shall not be used to
suppl~t State fundmg of alcohol and
other drug prevention and treatment
p~ms
(1»)Upon the request of a State the
Secretary may waive all or part of the
requirement establiShed m paragraph (a)
of this sedJon 1f the Secretary
detemunes that extraordmary economic
condItions mthe State Justlfy the
waiver: The State mvolved must submit
lDformatIon suffiClem for the Secretary
to make the determInatIon rncludlOg
the nature of the extraordlnary
econonuc CIrcumstances documented
evidence and appropriate data to
support the claun and documentation
on the year for whIch the State seeks the
waiver The Secretary Wlil approve or
deny a request for a Walver not later
than 12() days after-the date on which
the request is made .Any Walver
proVIded by the Secretary shall be
appliqble only to the fiscal year
lOvolvM Extraordmary economic
conditions mean a finanCIal CnSlSm
which the total tax revenue dechnes at
least one and one-half pen:enl. and
either unemployment Increases by at
least one ~ntctge
pawl. or
employment declines by at least one
and one-Mlf percent.
(c) in mabUg a Block..Gi-antto a State
for a fiscal year the Secretary shall
make a detenmnatlon of whether for
the preV1OUS
fiscal yea} or years the
State ~t8.lDed
m~tenal compliance
Wlth any agrooment made under I
paragraph {a} of thiS seqwn If the
Secretary detexmmes that a State has
fa,led to mamtam such compl1ance the
Secret~ shall reduce the amount of the
allotment for: the Stale for the fiscal yoor
for wh~ch the grant is beUlg made by an
amount equal to tile amount

( a ) Th e St ate s h a 11 not e'cpen d the
Block
Grant
on the folloWIng
acllVltles

(1)To proVide mpatIent hospital
servlC)3SexC)3ptas providEd in
paragraph (c) of thIS section
(2)To make-cash paymelIts to
Intended reaplents of hea1!thsemws
(3) To purchase or Impn)V6 IffDd
purcltase construct or pelmanently
Improve (other than InlnOI remodellOg)
any buIldIng or other faCility or
purcltase majOr medtcal e<;[Uipment
(4)To satIsfy any~mntment
for the
expenditure of non Federal funds as a
condition for the receipt oj; Federal
funds
(5) To proVide finanCIal asSlstanceto
any entity other than a pulillc or
nonprofit pnvate entity or
.(6)To proVide mdlvlduEls Wlth
hypodermic noodles or syrlDg~ 60 that
sucl1rndlVlduals may use nllegal drugs
unless the Surgeon General of the Public
Health Service determmes that a
demonstratlon needle excf:lange program
would be effective m redu.:mg drug
abuse and the nsk that the public WIll
become mfected With the E'tlologtCagent
for AIDS
(b) The State shall l1mlt ,axpendttures
on the folloWlDg
(1) The Stat6lDvolved "ill not
expend more than 5 percelll of the grant
to pay the costs of admmlstenng the
grant and
(2)The State will nol. 10 exper.dmg
the grant for the purpose of proVidIng
treatment serViceSm peMl or
correctional InStitUtIOns of the State
expend more than an amolmt prescnbed
by sectIon 1931(a)(3} or (bIt PHS Act
(c) Exception Iegarotng IJlp8l16nt
hospital SerVlces.
(1) With respect to compllanre WIth
the agreement made under paragraph (a)
of thiS section a State (actLDg through
the Director of the pnnap;il agency)
msy expend a grant for rnpsuent

Federal

I
I

I

RegIster I Vol

58 No 60 I Wednesday

March 31 1993 I Rules and Regul.1Uons

17079

hospital based substance abuse
programs subject to the lImitatIons of
paragraph (c)(2) of thiS section only
when 1,thas been-detennlned by a
physICIan that
(I) The pnmary diagnosIs of the
mdlVlduai is substance abuse and the
physiCIan certIfies this fact
(u) The mdzVldual cannot be safely
treated m 8 i:ommumty based
nonhospitaL resldentlal ~atment
p~m

proJected number of residentIal and/or
(XIII) Any other mfon~atIon the
ou~atlent clients to be served
Secretary may determine to be
(111)
The speCIfic amount of Block
appropnate
Grant funds to be used for thIS project
(IV) The numberofoutpatlent
§9613G IndGpendentpe-Kr.vlew
treatment slots planned or the number
(a)The State shall for the fiscal year
of residentIal beds planned If
for which the grant is proVided provide
applicable
for mdependent peer rn'rlew to assess
(v) The estImate of the total cost of the the quality appropnateJJess and
constructIon or rehabllttatlon (and a
efficacy of treatment serVi(j;s proVided
descnptlon of how these estimates were in the State to indzvldwLls under the
detennined) based on an Independent
program lD,Volved and ~Insure that at -

(lU) The SerVIce can reasonably be
expected to improve an mdtVldual s

estImate of S8:1dcost. uswg.standardlzod
measures as determmed by ~

condltlon or level of functIonmg
(IV) The hospltal-based substance
abuse program follows natIonal
standard$ of substance abuse -appltcable
professional practIce and
(2) In the case of an mdtvldual for
whom a grant IS expended to provlde
mpatlent hospital serVIcesdescnbed
above the allowable expenditure shall
confonn to the following
(I) The dally rate of payment provided
to the hospital for provldmg the serVIces
to the mdlVldual WIll not exceed the
comparable dally rate proVIded for
communIty based nFile Typeapplication/pdfAuthorjnewsome [ S611823 ]File Modified0000-00-00File Created2003-12-09