Substance Abuse Agency Wants to End ‘Contractor-Driven’ Approach to Care

A contractor group is objecting to the Substance Abuse and Mental Health Services Administration’s plan to cut back on “technical assistance” contracts, citing the value those contractors can bring to communities, especially in the face of the ongoing opioid crisis.

The Professional Services Council, which represents some 400 firms, on April 5 requested a meeting with Dr. Elinore McCance-Katz, the Health and Human Services assistant secretary for mental health and substance use, to defend the role of TA contractors in defining needed drug treatment services.

McCance-Katz, in a March 22 blogpost, had announced an end to a “contractor-driven” approach in order to better economize the agency’s resources, she said. “I do not believe the government or its contractors are best equipped to determine the needs of a grantee,” wrote the agency’s former medical director and now its first leader to hold an assistant secretary title. “I believe that grantees know their programs and their needs best. It is not the role of staff in Rockville, Md., to determine what every community needs.”

Before issuing a series of stop-work orders on current contracts and notices of intent to cancel future ones, McCance-Katz called the use of external contractors “an antiquated system.”

Ensuring that all SAMHSA programs are “evaluated in a robust and high-quality manner,” does not necessitate spending millions of dollars to fund external contracts, she wrote. “SAMHSA will be bringing much of its evaluation work in-house. Grantees will no longer be asked to collect reams of data that this government agency doesn’t even use. We will, instead, be collecting key outcome measures, which federal staff will utilize to analyze programs’ successes and areas for improvement.”

The council countered that “Even with different policy objectives than years past, and particularly in light of the growing opioid epidemic, we believe that contractors are now—and can continue to be—part of SAMHSA’s solutions and successes,” wrote Alan Chvotkin, the PSC’s executive vice president and counsel, citing three decades of contractor experience helping SAMHSA grantees. “Compared with other tools, contracts use taxpayer money effectively and provide strong health outcomes,” the letter said.

“A contract offers SAMHSA greater accountability and control over implementation as the contract is binding, the statement of work is negotiated and stipulates specific actions/deliverables, key personnel require government review and approval, government penalties can be exercised, and there are standard contracting provisions to protect the government’s interests,” the PSC wrote. “Contracts often offer stronger incentives for innovation and excellence, and there is a more rigorous government selection process for the highest skills and best past performance.”