Congress Reaches Deal on Opioid Funding, Mental Health
On Wednesday, the House of Representatives overwhelmingly passed the 21st Century Cures Act – a medical research and innovation bill that includes important funding for addictions. The bill authorizes $1 billion over the next two years to address the opioid crisis, and would create and reauthorize a number of federal mental health grant programs. The Senate is set to consider the bill early next week.
The House-approved bill awards $500 million in grants to states for both FY2017 and FY2018 to supplement their current efforts addressing opioid abuse. The funding for FY2018 is not yet secured and would be subject to next year’s appropriations process.
The state efforts this funding could supplement may include:
- Improving state prescription drug monitoring programs;
- Implementing prevention activities, and evaluating such activities to identify effective strategies to prevent opioid abuse;
- Training health care practitioners on best practices for prescribing opioids, pain management, recognition of potential cases of substance misuse and abuse, and overdose prevention;
- Supporting access to federally certified opioid treatment programs and others that treat substance use disorders; and
- Funding other public health activities the state determines appropriate for addressing opioid abuse.
Within each state, the government agency responsible for substance use services will be the primary recipient of these funds. It is not yet clear how the money would be divided among states; however, states with a higher incidence or prevalence of opioid abuse may be given priority over others. Grantees would report on grant activities as a part of the Substance Abuse Prevention and Treatment (SAPT) Block Grant Report.
Of important note, the opioid funding in the bill is not tied to provisions within the Comprehensive Addiction and Recovery Act. The National Council remains diligent in its advocacy efforts to secure full and proper funding of CARA and its many programs and provisions.
MENTAL HEALTH AND SUBSTANCE USE
The bill’s mental health provisions, drawn from Rep. Tim Murphy’s (R-PA) Helping Families in Mental Health Crisis Act, mainly reauthorizes a number of existing federal grant programs focused on suicide prevention, workforce education and training, jail diversion, mental health awareness training, and more. Importantly, the bill also contains provisions on:
- Same Day Billing for Mental Health and Primary Care: The legislation clarifies that nothing in the Medicaid statute should be interpreted as prohibiting separate payment for the provision of mental health and primary care services provided to an individual on the same day.
- Parity Enforcement: The legislation strengthens the implementation of the mental health and addiction parity law by requiring HHS to issue new compliance guidance to health plans and to create an action plan for improved federal and state coordination related to parity enforcement.
- Providing EPSDT Services to Children in IMDs: The legislation specifies that, effective January 1, 2019, children receiving Medicaid-covered inpatient psychiatric hospital services are also eligible for the full range of early and periodic screening, diagnostic, and treatment services.
This package does not include the more controversial provisions originally included in the Helping Families in Health Crisis Act such as the removal of the Institutes of Mental Disease (IMD) exclusion, changes to health record confidentiality in HIPAA and 42 CFR Part 2, and reduced funding for Protection and Advocacy organizations.
While Congress continues to give attention to mental health and addiction, the provisions of the Cures package do not expand the overall capacity of the nation’s behavioral health care system, which is needed to meet growing demand. The pending legislation only authorizes modest increases in funding and that funding hinges on further action from Congress to appropriate money in the future.
Meaningful system reform will come from increased payment rates from Medicaid and other insurance payers to service providers, not more grant-based programs. Without greater investment, behavioral health care providers cannot be expected to expand services and recruit and retain a quality workforce. To help address this problem, the National Council has long advocated for the expansion of the Certified Community Behavioral Health Center (CCBHC) demonstration, which will begin providing participating providers an enhanced payment rate starting in 2017. The Expand Excellence in Mental Health Act would expand the demonstration program to include all 24 planning grant states. The National Council is disappointed that this legislation was not also included as a part of 21st Century Cures.
Despite its limitations, Cures is an important legislative opportunity to gain more funding for opioid addiction services as well as create and reauthorize key mental health treatment programs. Cures passed the House chamber on Wednesday and the Senate is expected to vote on the measure early next week. Your voice is needed to turn this bipartisan legislation into law. Take action today and urge your Senators to support addictions funding and mental health legislation!