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SAMHSA Access to Recovery (ATR) Grants

Frequently Asked Questions (FAQ)


Bakground/Overview:  

What is Access to Recovery (ATR)?

ATR is a 3 year competitive discretionary grant program funded by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.  ATR is a presidential initiative which provides vouchers to clients for purchase of substance abuse clinical treatment and recovery support services.  The goals of the program are to expand capacity, support client choice, and increase the array of faith-based and community based providers for clinical treatment and recovery support services. 

How many grantees does the ATR program currently have?

14 State grantees and 1 Tribal organization are currently being funded.  These are: California, Connecticut, Florida, Idaho, Illinois, Louisiana, Missouri, New Jersey, New Mexico, Tennessee, Texas, Washington, Wisconsin, Wyoming and the California Rural Indian Health Board (CRIHB).      

How does the voucher system work?

ATR participants either get assessed at a central intake unit, a participating provider, or in a participating governmental agency.  If it is determined that the individual needs some form of ATR clinical treatment and/or recovery support services and accepts the services, the client is presented with a choice of at least two providers from whom services will be received.  Once the selection is made and choice has been ensured, a paper or electronic voucher is issued for the approved services.  The client then goes to the service provider and redeems his/her voucher for services. 

Financial Aspects:

How much funding does each grantee receive?

Each grantee receives no more than $7.6 million per year under the program. 

What percentage of funds can grantees use to pay for the administrative costs of managing the program? 

Grantees use no more than 15 percent of funds under this program to recover the costs of administration.  If the administration costs exceed 15 percent, the grantee is required to submit a formal request to SAMHSA’s grants management office for approval. 

Can ATR funds be used to supplant existing funds? 

ATR was designed to supplement existing programs.  Supplantation is not permissible under the program.  An example of supplanting a pre-existing program is as follows:  If a State or Tribal entity were already receiving funds from Medicaid to provide methadone treatment, and proposed to use ATR funds for this purpose while reallocating those Medicaid funds for another purposed, this would be interpreted as supplantation. 

Can ATR funds be used to pay the State portion of the match for Medicaid reimbursement for clinical treatment and/or recovery support services?

This is not permissible under the ATR program.  However, ATR funds could be used, for example, to pay for recovery support services that are not covered by Medicaid. 

On the 15 percent that is available for administrative costs, can the grantee  organization charge indirect costs on those expenses?

Yes. The 15 percent for administrative costs can include indirect costs expenses.

Choice: 

How are grantees assuring client choice under this program?

Grantees assure client choice for their clients through maintaining a diverse network of secular and faith-based providers that offer both clinical treatment and recovery support services.  Grantees keep their provider lists updated as well.  If it is determined that a client is in need and eligible for ATR services, he/she is presented with a choice of at least two providers.  The client makes the final determination as to which provider he/she will visit. 

Does a grantee have to provide clients with a choice of assessment locations?

According to the RFA, the grantee does not have to provide a choice of assessment locations.  Assessments must be provided pursuant to a voucher, and under ATR guidelines, choice does not have to be ensured until the client is at the point of entry into a clinical treatment or recovery support service. 

Providers:

Is there a standard set of eligibility criteria for providers to participate in ATR?

No.  Each ATR grantee determined the eligibility criteria for providers to participate, including providers previously unable to compete for Federal funds. 

Are the clinical treatment and recovery support service providers funded through ATR licensed or certified? 

Based on the eligibility criterion developed by the individual grantee, the organization may or may not be required to be licensed and/or certified.  In many cases, the licensure and certification requirements reflect local, state standards.     

The reporting criteria ask us to identify grass-roots, faith-based, and secular organizations.  In Tribal organizations, those lines are not that defined.  For example, many tribes sponsor faith-based activities within what might otherwise be considered a secular environment.  

Each ATR provider agency including those within Tribal organizations must self identify as either faith-based or secular. The RFA does not define faith-based providers. Applicants have the discretion to establish their own criteria.

Services:

What kinds of services are provided through ATR? 

The ATR program offers a range of clinical treatment and recovery support services.  Clinical treatment includes such services as screening/assessment, brief intervention, treatment planning, individual counseling, group counseling, and pharmacological interventions.  Recovery support services include such services as case management, medical services, after care, educational services, and peer-to-peer services.  For a more expanded list of services offered under the program please refer to Appendix A of the RFA.    

Can screening be covered using vouchers?

Screening can be covered using vouchers.  However, we do not recommend this because any voucher services need to meet SAMHSA’s GPRA data collection requirement, including the6-month follow up.  Using ATR vouchers for screening may give the grantee a pool of clients who screen negative but still need to be surveyed with the GPRA instruments. These clients may be tougher to locate and follow up.   

What kind of housing services can be covered using ATR funds?

The Appendix A of the RFA titled “Comprehensive Array of Clinical Treatment and Recovery Support Services” lists some examples of Clinical Treatment and Recovery Support Services. Housing Assistance and Services is defined to include transitional housing, recovery living centers or homes, supported independent living, sober housing, short-term and emergency or temporary housing, and housing assistance or management. These services provide a safe, clean, and sober environment for adults with substance use disorders. Lengths of stay may vary depending on the form of housing. This assistance also includes helping families in locating and securing affordable and safe housing, as needed. Assistance may include accessing a housing referral service, relocation, tenant/landlord counseling, repair mediation, and other identified housing needs.

ATR grant funds may not be used to:

  • Provide residential or outpatient treatment services when the facility has not yet been acquired, sited, approved, and met all requirements for human habitation and services provision. (Expansion or enhancement of existing residential services is permissible.)
  • Pay for housing other than residential mental health and/or substance abuse treatment.

Are there any RSS tools available to grantees?  

Currently, we do not have any validated RSS tools to share with the applicants.
Applicants are expected to identify, modify, or develop a recovery support service assessment tool that can be used in their programs. CSAT is in the process of developing a standard RSS tool which will be shared with applicants in the future.  In the meantime, applicants are responsible for developing a tool or submitting a plan on how to develop a tool. Applicants can refer to the following resources in their proposals: the ASI tool which has some questions related to RSS, tools used by Medicare and Medicaid to assess the needs for RSS, resources used by the Child Care Block Grant for RSS on child care, and questions related to HUD-funded housing programs for housing services. Additionally, SMAHSA will provide technical assistance to grantees to develop certain tools suitable for your target population and target areas.

Are vouchers issued in ATR 1 carried over to ATR 2?

No.  Grantees should treat the two awards as separate funding pools.  Funds from unredeemed/expired vouchers issued in ATR 1 may be expended during a no cost-extension period for that project.  All no cost extensions must first be approved by SAMHSA.

Will RFA review teams include IT specialists to look at the IT structures for each grant?  Will they be knowledgeable enough to make judgments?

Yes. Each review team will have the skills to evaluate the proposals based on the RFA evaluation criteria.

Is the target number of clients duplicated or unduplicated?  

The target number of clients serviced is an unduplicated number, except for any clients who may have been either discharged or not received any ATR services for 60 days and are reassessed to receive more ATR services.

If a person had 3 months of service within that year, and then came back at month number 9 and was readmitted, is he considered one client or two?

The person would be counted as two clients.  The person is treated as a new client if sixty or more days have elapsed. 

Data:

What data are grantees submitting to the Federal government as part of the grant? 

      Grantees submit data on the follow GPRA outcomes domains:

  • Abstinence from drug and alcohol use
  • Employment/education
  • Crime and criminal justice
  • Family and living conditions
  • Social connectedness
  • Access/capacity
  • Retention

How often does SAMHSA collect the GPRA data?

Every three months grantees are officially required to upload their GPRA data into the Services Accountability Improvement System (SAIS), which permits the federal agency to view the data. 

How are ATR grantees transferring the GPRA data to CSAT?

Grantees go to the website, www.samhsa-gpra.samhsa.gov, where they can enter and submit their GPRA data. 

Does CSAT/SAMHSA have a standard client satisfaction survey?  

No. SAMHSA does not have a standard client satisfaction survey. Grantees have the flexibility to develop their own survey or modify whatever instruments suit its purposes. If the State knows of appropriate, validated scales, those instruments can certainly be used. We can suggest some reliable satisfaction instruments used for other programs, but we expect that each State is likely to want to modify these basic instruments to fit their circumstances.

The RFA requires that programs assess client satisfaction with the voucher system of care. Most existing scales are designed to measure the client’s satisfaction with the specific services they have received, rather than to measure the voucher system as a whole. Our suggestion is to select an instrument asking about satisfaction with individual providers, use this tool as a base, and simply add a few questions pertaining to satisfaction with the overall system. Examples would be: “Do you feel this voucher system allowed you to access services you might not have gotten otherwise?”

The State would collect the data from this instrument at each agency in the voucher system, which will show client satisfaction at the level of the individual provider. Then the State can aggregate the results across all the agencies within the voucher network, which would give a measure at the systems level.

In terms of instruments, CSAT suggested the following:

  • The Client Satisfaction Questionnaire (CSQ), by Atkinson, which is reliable and validated and comes in four versions, depending on the number of questions: CSQ-18, CSQ-12, CSQ-10, and CSQ-8. Both CSAT and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have used these instruments in a number of programs and studies.
  • The Mental Health Statistics Improvement Program (MHSIP) survey, which was modified for use with substance abuse clients by a number of States in CSAT’s Treatment Outcomes Performance Pilot Studies Enhancement (TOPPS II) study.
What is the requirement about the post-exit 6-month data collection on p.10 of RFA?

The RFA only requires that grantees propose a plan for collecting 6-month post-exit data from a paid service on a sample basis by the third year of the grant.

Is a face-to-face interview required for the 6-month follow up?

Yes.

What are the timeframes for collecting GPRA data? 

For intake and discharge:  The GPRA data collection form should be completed at the time of intake and discharge. 

For the six month post-intake follow up: This GPRA data should be collected anytime between 30 days prior to the six month date and 60 days after the six month date.  For example, if six months is on October 15, it is allowable for the GPRA to be collected anytime between September 15 and December 15.

**All GPRA data should be entered into the Services Accountability Improvement System (SAIS) within 7 days of completing the GPRA interview, whether it is intake, discharge, or the six month follow-up.  

Which GPRA files are grantees required to upload?

(1) the client outcomes measures (see Appendix I of RFA)
(2) vouchers information (see Appendix J of RFA)
(3) voucher transaction information (see Appendix K)

Will CSAT continue to require the GPRA data files in xml format?

Yes.

How often must grantees upload their GPRA data?

All GPRA data should be entered into the Services Accountability Improvement System (SAIS) within 7 days of completing the GPRA interview form, whether it is intake, discharge, or the six-month post-intake follow up. 

How can grantee/providers submit GPRA data? Whether through website of SAMHSA or upload automatically?  

Grantees will have a choice to upload or enter directly. Grantees can only choose only one option.

Do you have a plan for how to track the methamphetamine services we allocate in our proposals?  Where will that be identified?

This will be tracked via the GPRA tool.

At what point are GPRA client identifier numbers issued?

The program has flexibility to determine when to issue a client identifier number in order to meet SAMHSA’s GPRA reporting requirements.    

If a client is in service for 9 months, gets discharged and is readmitted 3 months later, is the same GPRA client identifier number used?

Yes.  The client always retains the same client identifier regardless of how many times he/she is discharged or readmitted. 

What is the minimum period of time after discharge before another assessment is required for re-admittance into the program?

The minimum period of time after discharge before another assessment is required for re-admittance into the program is 60 days

Are the clients served under ATR being reported under the TEDS system, and are they to be rolled into NOMS accounting as well?

The inclusion of ATR data into the TEDS system and NOMS accounting is State-specific since these decisions are made at the State level. Some States only report to TEDS what’s seen in the Block Grant. Other states report all clients.

Monitoring and Evaluation:

What are the requirements placed on applicants to monitor the operation and effectiveness of this program?

Grantees monitor a variety of activities, including but not limited to voucher utilization, fraud, waste, and abuse, performance outcomes, and fiscal burn rates

See Also: Does CSAT/SAMHSA have a standard client satisfaction survey?  



Last Update: 9/13/2007