Beltway Update is an occasional column keeping you up to date on timely Congressional and administrative action on mental and behavioral health bills and policy in Washington, DC.
(Updated March 16 to include President Biden signing the legislation).
Almost halfway into the current fiscal year, President Joe Biden finally signed an appropriations bill that will fully fund the government for the rest of the year – and that contains substantial increases in mental health funding. Until now, the government has been funded through four short-term continuing resolutions (CRs) while negotiations dragged on between leaders of the House and Senate appropriations committees.
The newly passed Consolidated Appropriations Act for Fiscal Year 2022 contains regular appropriations, additional funding outside the standard appropriations process and some policy items. The omnibus also marks the return of community project funding, commonly referred to as “earmarks,” that have been disallowed for a decade. Now, members of Congress can once again request funds for specific projects within their districts, including mental health and substance use services.
Congress also used the omnibus bill to extend the use of telehealth services beyond the end of the Public Health Emergency declaration passed in response to Covid. These provisions delay by 151 days rules that require Medicare beneficiaries to have an initial in-person visit before they can use tele-mental health services and also impose other geographic restrictions for the use of telehealth.
The 2741-page bill was released overnight March 9 and voted on in the House later that day. The Senate passed the bill the next night, along with another short-term extension that runs out at midnight on March 15. President Biden is expected to sign the bill into law before then.
While dollar amounts have decreased from levels proposed last year, there are still substantial investments in mental health and substance use services contained in the bill. Here are a few highlights:
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA is funded at $6.5 billion, an increase of $530 million above the level passed in FY 2021, and includes the following mental health items:
- A $100 million increase to the Mental Health Block Grant, bringing the total to $857 million
- Continues the 5% set-aside in the mental health block grant that provides money to states to implement and improve mental health crisis systems
- Children’s mental health programs, such as:
- $120 million for Project AWARE, mental health awareness trainings for school-aged youth, an increase of $13 million above FY 2021
- $81.8 million for the National Child Traumatic Stress Initiative which develops and implements interventions to reduce the impact of trauma on children, an increase of $10 million
- $10 million for Infant and Early Childhood Mental Health, an increase of $2 million
- Suicide prevention programs, such as:
- $101.6 million for the Suicide Lifeline – an increase of $77.6 million – to support the implementation of the Lifeline’s new 988 number
- $5 million to create a new Behavioral Health Crisis and 988 Coordinating Office to implement 988 within the Substance Abuse and Mental Health Services Administration
- $38.8 million for Garrett Lee Smith Youth Suicide Prevention grants, an increase of $2.3 million
- A new Mental Health Crisis Response Partnership Pilot Program, which will provide $10 million to help communities create mobile behavioral health crisis response teams
- Certified Community Behavioral Health Clinics get $315 million, an increase of $65 million
The SAMHSA portfolio also includes funding for several substance use disorder services, including:
- $1.908 billion, $50 million above FY 2021, for the Substance Abuse Prevention and Treatment Block Grant (SABG)
- $1.525 billion for State Opioid Response Grants, an increase of $25 million
- $101 million, an increase of $10 million, for Medication Assisted Treatment for Prescription Drug and Opioid Addiction grants
- $127.4 million for the Strategic Prevention Framework providing resources to community prevention planners, $8 million above FY 2021
- $12 million for the Sober Truth on Preventing Underage Drinking (STOP Act), an increase of $2 million over FY 2021
There are a few additional mental health appropriations outside of SAMHSA, including:
- $24 million, an increase of $8 million, for the Substance Use Disorder Treatment and Recovery Loan Repayment Program within the Health Resources and Services Administration (HRSA)
- $20 million increase for the National Institute of Mental Health (NIMH) to expand research on the impact of the COVID-19 pandemic on mental health
- Additional funding to the Centers for Disease Control and Prevention (CDC) to expand its suicide prevention program and increase its surveillance on suicidal behavior.
As we await the president’s signature, Capitol Hill appropriations staff can take a short breath. Later this month President Biden’s budget for FY 2023 is expected to be released, and the process begins again.
Sarah Corcoran is vice president of government relations at Guide Consulting Services (GCS), a government relations consulting practice based in Washington, DC. GCS represents mental health providers, technology companies, patient advocacy organizations and state mental health agencies before Congress and the administration. A complete list of GCS clients can be found here.