Survey of Evidence-Based Practices for Mental Health and Substance Use Disorders in State Medicaid Plans: Coverage Structures, Access and Challenges

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MMHSA Survey MMHSA Survey	Form and Instruction	New	Available
Abt-Supp Statement-Medicaid Survey-FINAL 6-14-2011.docx	Supporting Statement B	Uploaded 2011-06-14	Available
Abt-Supp Statement-Medicaid Survey-FINAL 6-14-2011.docx	Supporting Statement A	Uploaded 2011-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197385	MMHSA Survey	Form and Instruction	New

ICR Details

OMB Control No: 0930-0326	ICR Reference No: 201104-0930-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Survey of Evidence-Based Practices for Mental Health and Substance Use Disorders in State Medicaid Plans: Coverage Structures, Access and Challenges
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/17/2011
	Date Received in OIRA: 04/21/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	09/30/2012
Responses	51	0	0
Time Burden (Hours)	51	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA will disseminate a comprehensive survey instrument for state Medicaid directors that will provide information on state Medicaid coverage and implementation of mental health and substance abuse evidence-based practices (EBPs) from a number of valuable vantage points. The survey will provide data on which states are currently covering EBPs within their Medicaid programs and which EBPs they are covering, state mechanisms for advancing EBPs in their Medicaid mental health and substance abuse programs, how states fund EBPs using Medicaid, how/whether states use SAMHSA toolkits and other materials to ensure fidelity to the practices, and access issues. The Survey of Evidence-Based Practices for Mental Health and Substance Use Disorders in State Medicaid Plans: Coverage Structures, Access and Challenges includes questions on the overall management and delivery of mental health and substance abuse services within Medicaid and on the implementation of eight specific EBPs within the state Medicaid program.

---

Authorizing Statute(s): US Code: 42 USC 501 Name of Law: SAMHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 5391	01/31/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 19106	04/06/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
MMHSA Survey	MMHSA Survey	MMHSA Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	51	0	0	51	0	0
Annual Time Burden (Hours)	51	0	0	51	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: this is a new data collection.

---

Annual Cost to Federal Government: $112,995

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/21/2011

---