House E&C Leadership Introduces Bipartisan Mental Health, SUD Package
- The package would reauthorize several SAMHSA and HRSA programs, among others.
- Policies would provide support for the 9-8-8 hotline, SUD crisis-related services, expanding access to care, and children’s mental health.
- The Health Subcommittee plans to markup and vote on the bill next week.
Today, House Committee on Energy and Commerce Chair Frank Pallone (D-NJ) and Ranking Member Cathy McMorris Rodgers (R-WA) introduced the Restoring Hope for Mental Health and Well-Being Act of 2022 (text; section-by-section). The package is an amalgamation of previously introduced, bipartisan legislation — as well as other bipartisan policies — geared towards improving mental and behavioral health treatment, as well as providing substance use disorder (SUD) care, in the U.S. Many of the provisions included in the package would reauthorize Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) programs. This high-level summary, based on materials publicly released by the Energy and Commerce Committee earlier today, will be followed by a deeper analysis by Thorn Run Partners as this language — and possible changes to the bill — is further considered by Congress.
Background. Growing mental health concerns exacerbated by the COVID-19 pandemic have spurred bipartisan interest in addressing behavioral and mental health concerns, as well as high rates of SUD. In addition to mounting concerns, several existing programs would expire at the end of FY 2022 without reauthorization. The House Energy and Commerce Committee has held several hearings to deliberate mental health bills in 2022 with the promise of introducing a bipartisan package. Additionally, the White House recently signaled its support for policy action surrounding mental health by announcing (TRP summary) a mental health strategy.
This legislative package addresses the impending implementation of the 9-8-8 hotline and other crisis-related supports, as well as efforts to aide in SUD treatment, prevention, and recovery. Another key aspect of the package focuses on expanding access to mental health care by improving workforce initiatives, among other avenues. Notably, the bill also includes provisions to address mental health concerns in children.
What’s Next? The Energy and Commerce Subcommittee on Health plans to markup and vote on the legislation next week.
Crisis Care & 9-8-8 Hotline — The first sections of the package would establish a Behavioral Health Crisis Coordinating Office across relevant divisions of SAMHSA, the Centers for Medicare and Medicaid Services (CMS), and HRSA to better coordinate work relating to behavioral health crisis care and would authorize $5 million for each fiscal year (FY) from 2023 through FY 2027 to carry out this work. It also requires HHS — within one year of this bill’s enactment — to publish “best practices” for a mental health crisis continuum of care response. The guidance would be geared towards health care providers, service administrators, and service providers.
Maternal Health & SUD — The Restoring Hope for Mental Health and Well-Being Act of 2022 includes the Into the Light for Maternal Mental Health Act (H.R. 7073), which would reauthorize Screening and Treatment for Maternal Mental Health and Substance Use Disorders grants that allow states to improve screening, assessment, and treatment for mental health and SUD in pregnant and post-partum women. To carry out this initiative, the bill would provide $24 million per year from FY 2023 through FY 2028. Additionally, the legislation would authorize $10 million from FY 2023 through FY 2028 to establish an information and intervention hotline for pregnant and postpartum women at risk of, or currently experiencing, maternal mental health or SUD.
REACHING Improved Mental Health Outcomes for Patients Act of 2022 — The proposal introduced today includes the Reauthorizing Evidence-based and Crisis Help Initiatives Needed to Generate (REACHING) Improved Mental Health Outcomes for Patients Act of 2022 (H.R. 7237), which would replace Community Crisis Response Systems Grants with a Mental Health Crisis Response Partnership Pilot Program and authorize $10 million each year from FY 2023 through FY 2027. It would also authorize seven SAMHSA grants related to maternal health from FY 2023 through FY 2027:
- National Mental Health and Substance Abuse Policy Laboratory, authorized at $10 million each FY;
- Interdepartmental Serious Mental Illness Coordinating Committee;
- Mental Health Needs Priority Regions of National Significance (PRNS), authorized at $599.036 million each FY;
- Mental Health Awareness Training (MHAT) Grants, authorized at $24.963 million each FY;
- Adult Suicide Prevention, authorized at $30 million each FY;
- Assertive Community Treatment Grants, authorized at $15 million each FY; and
- Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness, authorized at $22 million each FY.
Anna Westin Legacy Act of 2022 — The Anna Westin Legacy Act of 2021 (H.R. 7249), included in this larger legislative package, would authorize a National Center of Excellence for Eating Disorders within SAMHSA.. The bill would authorize $1 million each year from FY 2023 through FY 2027 to the Center for the purposes of awarding subgrants for developing and providing training and assistance to health care providers surrounding the identification and treatment of individuals with eating disorders.
Community Mental Health Services Block Grant Reauthorization Act — The Community Mental Health Services Block Grant Reauthorization Act (H.R. 7241) is also included in the Energy and Commerce Committee’s current legislative package released today. The bill would reauthorize Community Mental Health Services Block Grants at approximately $857.6 million each year from FY 2023 through FY 2027 to support community efforts focused on adults with “serious mental illness” and children with “serious emotional disturbances.” The legislation would also facilitate performance and outcome data collection, and the bill stipulates that five percent of funds must be used for crisis care services and another five percent can be used for early intervention efforts.
Native Behavioral Health Access Improvement Act of 2021 — The Energy and Commerce package includes the Native Behavioral Health Access Improvement Act of 2021 (H.R. 4251), which would reauthorize the Alcohol and Drug Prevention or Treatment Services for Indians and Native Alaskans Grant Program at $40 million each year from FY 2023 through FY 2027. The Program aims to provide culturally appropriate and competent care for mental health and SUD concerns facing Native American and Alaskan Native populations.
Summer Barrow Prevention, Treatment, and Recovery Act — This mental health and SUD package includes provisions from the Summer Borrow Prevention, Treatment, and Recovery Act (H.R. 7234), which would amend the Public Health Service Act to reauthorize 11 SAMHSA programs with respect to mental health conditions and SUD, and for other purposes. For each fiscal year from FY 2023 through FY 2027, it would authorize a total of $932.7 million for these programs and an additional $500,000 for a review and report from the National Academy of Sciences to study behavioral health issues. Specifically, these programs include:
- Formula Grants for the Benefit of Homeless Individuals, authorized at $41.304 million each FY;
- Substance Use Disorder Treatment Programs of Regional and National Significance (PRNS), authorized at $521.517 million each FY;
- Prescription Opioid and Heroin Treatment and Interventions Demonstration Grants, authorized at $25 million each FY;
- Substance Use Disorder Prevention PRNS, authorized at $218.219 million each FY;
- Programs to Reduce Underage Drinking, including an annual report, a national media campaign, Community-based Coalition Enhancement Grants to Prevent Underage Drinking, Pediatric Provider Screening and Brief Intervention Grants, and data collection and research, authorized for a collective $23 million FY;
- National Academy of Sciences review and report to Congress authorized at $500,000 for FY 2023;
- Jail Diversion Program and Grants, authorized at $14 million FY;
- Projects for Assistance in Transition from Homelessness Program, authorized at $64.635 million FY;
- Grants for Reducing Overdose Deaths authorized at $5 million FY;
- State Pharmacy Opioid Overdose Medication Access and Education Grants, authorized at $5 million FY;
- State and Local Integrated Comprehensive Opioid Use Disorder Response, authorized at $5 million FY; and
- Emergency Department Alternatives to Opioids Demonstration Grants, authorized at $10 million FY.
Excellence in Recovery Housing Act — This package also includes the Excellence in Recovery Housing Act (H.R. 2376), which would require SAMHSA to promote the availability of high-quality recovery housing for individuals with SUD through various activities. Specifically, this bill would require SAMHSA to (1) develop and publish on its website best practices and guidelines for recovery housing; (2) award grants to states, tribal nations, territories, and localities to implement such standards and guidelines; (3) convene an interagency working group to coordinate federal activities related to recovery housing; and (4) arrange for research on the supply, quality, and effectiveness of recovery housing. Additionally, the bill would reauthorize $5 million for the period of FY 2023 through 2027 for the program.
Substance Use Prevention, Treatment, and Recovery Services Block Grant — This proposal includes a bill entitled, the Substance Use Prevention, Treatment, and Recovery Services Block Grant Act of 2022 (H.R. 7235), which would make certain improvements with respect to block grants for substance use prevention, treatment, and recovery services, and for other purposes, authorized at $1.908 billion annually for FY 2023 through FY 2027. Subsequently, it would update the basis by which states are designated as required to provide HIV related services based on HIV case rate rather than AIDS case rate effective FY 2025.
Timely Treatment for Opioid Use Disorder — Additionally, this package, as proposed, includes the Timely Treatment for Opioid Use Disorder Act of 2022 (H.R. 7238), which would direct HHS to revise opioid treatment program (OTP) admission criteria to eliminate the requirement that patients must be addicted for at least one year prior to being admitted for treatment. This proposal would also require the Assistant Secretary for Mental Health and Substance to conduct a study and report within 180 days on the impact of treatment flexibilities allowed during the COVID-19 pandemic on the effectiveness and safety of the OTP. It would also instruct HHS to establish new criteria to allow certain patients to receive take home medications in either a 14 day or one-month supply.
Collaborate in an Orderly and Cohesive Manner Act — In order to address access issues related to mental health care coverage, this package would incorporate the Collaborate in an Orderly and Cohesive Manner Act (H.R.5218) to reauthorize $60 million annually for FY 2022 through FY 2026 for HHS to award grants for implementing and evaluating specified models of care that integrate the delivery of behavioral health and primary care services. Specifically, HHS would be required to award grants to primary care providers for the initial costs of implementing such models. In awarding the grants, HHS would have to prioritize recipients that provide care to medically underserved populations and in areas where the prevalence of behavioral health conditions exceeds the national average. To further incentivize recipients to use appropriate billing codes and quality measures for behavioral health services, HHS would be instructed to provide additional incentive payments to such recipients that use those codes and measures.
Health Care Workforce — Under the bill, several provisions of the Helping Enable Access to Lifesaving Services Act (H.R. 5583) would be included to bolster the health care workforce. Specifically, the Liability Protections for Health Professional Volunteers program — which extends liability protections for the performance of certain medical related functions to certain Volunteer Health Professionals (VHPs) — would be reauthorized from October 1, 2022, through October 1, 2027. Additionally, the Minority Fellowship Program — which seeks to boost the knowledge of mental and SUD practitioners on issues of prevention, treatment, and recovery, as well as for other purposes — would be modified to include crisis care management professionals as mental and SUD treatment professionals eligible for such fellowships. The legislation would also reauthorize Mental and Behavioral Health Education and Training Grants at $50 million for each of FYs 2023 through 2027, and would additionally reauthorize the Training Demonstration Program — which seeks to provide further training for health professionals in underserved, community-based settings that integrate primary care with mental and SUD prevention and treatment services — at $10 million annually for FYs 2023 through 2027.
Eliminating the Opt-Out for Non-Federal Governmental Health Plans — The legislation stipulates that self-funded, non-federal governmental plans would be mandated to adhere to mental health parity requirements beginning 180 days after the bill’s enactment. Under the bill, certain exceptions would be provided to allow for an extended compliance period contingent upon the terms of the plan agreement — specifically with regard to certain collectively bargained plans.
Children’s Mental Health Care Access — The proposal, which is derived from the Supporting Children’s Mental Health Care Access Act of 2022 (H.R. 7076), would reauthorize two programs aimed at improving mental health care access for children, including:
- HRSA’s Pediatric Mental Health Care Access Grant Program, which would be authorized at $14 million for each of FYs 2023 through 2025 and $30 million for each of FYs 2026 through 2027. This grant program seeks to integrate behavioral health services into pediatric primary care via the bolstering of related telehealth access programs at the state level; and
- SAMHSA’s Infant and Early Childhood Mental Health Grant Program, which would be authorized for a total of $50 million for the entirety of FYs 2023 through 2027. This grant program aims to enhance mental health services for children from birth to the age of 12 in order to improve overall health outcomes.
Continuing Systems of Care for Children Act — Today’s package includes the Continuing Systems of Care for Children Act (H.R. 7248), which would reauthorize certain mental health programs for children, including the:
- Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Grants at $125 million for each of FYs 2023 through 2027. The bill would additionally alter the definition of the term “eligible” within the program to cover parents and/or kinship caregivers; and
- Enhancement and Expansion of Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families (Youth and Family TREE) Grants at $29.605 million for each of FYs 2023 through 2027.
Garrett Lee Smith Memorial Reauthorization — Additionally, the legislative package incorporates the Garrett Lee Smith Memorial Reauthorization Act (H.R. 7255), which aims to reauthorize several grant programs related to suicide prevention. Specifically, the package includes updates to the:
- Suicide Prevention Resource Center, reauthorized at $9 million for each of FYs 2023 through 2027;
- State and Tribal Youth Suicide Prevention and Early Intervention Grants Program, reauthorized at $40 million for each of FYs 2023 through 2027, and additionally stipulates that such funds can be used by parents, legal guardians, and family members of youths to purchase supplies to properly store and secure commonly used means within the household that youth could use to complete suicide;
- Mental Health Youth Suicide Prevention Campus Grants, reauthorized at $7 million for each of FYs 2023 through 2027; and
- Mental and Behavioral Health Public Outreach and Education on College Campuses program, to be renamed the “Mental and Behavioral Health Public Outreach and Education at Institutions of Higher Education program.” The program would be reauthorized at $1 million for FY 2023 through 2027 and would additionally be mandated to include, in the program’s working group, representatives from minority-serving institutions and community colleges.