Magazine article The Alcoholism Report

Congress Told HHS Provides 'Minimal' Oversight of States' Use of ADMS Block

Magazine article The Alcoholism Report

Congress Told HHS Provides 'Minimal' Oversight of States' Use of ADMS Block

Article excerpt

Despite billions of dollars invested, the federal government does not have the information necessary to assess the impact of spending on drug abuse treatment by the states, using alcohol, drug abuse and mental health services (ADMS) block grant funds, the General Accounting Office (GAO) concluded in a report to the House Select Committee on Narcotics Abuse and Control.

"The Congress receives limited information on the results of states' drug abuse treatment services funded by the ADMS block grant," testified Mark V. Nadel, GAO Associate Director for National and Public Health Issues, in releasing the report at an Oct. 17 hearing by the committee, chared by Rep. Charles Rangel (D-NY).

In explaining why he asked for the GAO study, Rangel said, "For those who are addicted or dependent on illegal drugs, we need effective drug abuse treatment. As federal spending for substance abuse treatment has increased substantially in recent years, so have concerns about accountability."

The GAO's Nadel said that state annual report and blocks grant applications "provide limited information on the nature of state drug abuse treatment activities or on the quality and appropriateness of serices." The GAO official said the lack of adequate information arises from what he termed HHS's "voluntary compliance policy" in regard to state reporting of their use of ADMS block grant money, administered by the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA).

"The Secretary (of HHS) has not exercised his authority to specify how states should comply with legislative block grant requirements nor how they should report on their block grant activities," Nadel said. "As a result, states provide HHS with limited and diverse information in their ADMS block grant annual reports and applications. State annual reports vary significantly in the information provided on drug treatment services, making comparisons or assessments of federally supported drug treatment services difficult."

Since 1981, when the ADMS block was created, states have been required to provide HHS with information on their block grant activities. However, GAO said the 1981 legislation was weakened by HHS's interpretation of the reporting requirements in the regulations fleshing out the law.

The regulations state that ADAMHA will "defer to a state's interpretation of its assurances and of the provisions of the block grant statutes unless the interpretation is clearly erroneous."

GAO said HHS oversight was also influenced by a Presidential Executive Order, issued in October, 1987, which advised federal agencies to be guided by the "fundamental principles of federalism," and grant states the maximum administrative discretion possible.

The Anti-Drug Abuse Act of 1988 contained a new requirement that states must agree to provide for "periodic independent peer review to assess the quality and appropriateness of treatment services provided by entities that receive funds from the state." However, according to GAO, the act did not define the terms, "peer review," "quality," or "appropriateness" or specify the processes to be used to implement this requirement. In addition, the 1988 act removed previous language that prohibited HHS from prescribing the manner in which states should comply with the act's requirements and establishing burdensome annual reporting requirements. …

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