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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.

(Updates story to note Senate passage and pending House action in first and second paragraphs.)

It’s been years since any major gun control or mental health reforms have come out of Congress. But on Thursday, after multiple tragedies and two weeks of negotiations between four Senators – two Democrats and two Republicans – a gun-violence prevention package, the Bipartisan Safer Communities Act, was passed by the Senate on a 65-33 vote. The bill will be taken up by the House of Representative on Friday.

The package, negotiated by Democrats Chris Murphy of Connecticut and Kyrsten Sinema of Arizona, and Republicans John Cornyn of Texas and Thom Tillis of North Carolina, provides almost $15 billion in new funding for mental health and school safety, school-based mental health programs, children and family mental health services and crisis intervention programs. If passed, it will now factor into the work of several committees considering significant mental health policy changes and funding increases.

Here’s a rundown on what’s in the bill, which has been endorsed by Senate Minority Leader Mitch McConnell and should attract the 60 votes needed to overcome a Republican filibuster.

School-Based Mental Health Policies and Funding

• Provides $1 billion spread to increase funding for Safe and Healthy Students Programs to fund services such as mental health resources, drug and violence prevention, mentoring, crisis intervention, suicide prevention and human trafficking training for school personnel.

• $500 million for to a program that recruits and reduces turnover for mental health professionals to work in schools.

• $500 million to a pipeline program that supports innovative partnerships between institutions of higher education and school districts to prepare school-based mental health service providers to work in high-need schools.

• $50 million to improve and expand academic enrichment and youth development.

The bill also requires CMS to issue guidance to states about how they can receive Medicaid funding for health services provided in school settings, as well as tools and resources to implement, enhance, and expand school-based health programs under Medicaid. It also requires the establishment of a technical assistance center at CMS and provides $50 million for planning grants to help states take advantage of the flexibilities and best practices outlined in the guidance.

Increases in Supplemental Mental Health Funding

• $150 million in Fiscal Year 2022 to the National Suicide Prevention Lifeline to assist in implementing 988 as the new three-digit crisis number.

• $250 million over four years for the Mental Health Block Grant for states and territories.

• $80 million over four years to help pediatricians get rapid telehealth consults from mental health specialists.

• $60 million for mental health training for primary care clinicians who treat youth through HRSA’s Primary Care Training and Enhancement Program.

• $240 million for Project AWARE, which aims to boost awareness of mental health issues among school-aged youth and provides training for school personnel and other adults who interact with school-aged youth to detect and respond to mental health issues.

• $120 million for the Mental Health Awareness Training program, including $28 million for grants to support trauma care in school settings.

 • $40 million to SAMHSA’s National Child Traumatic Stress Network grant to improve treatment and services for children, adolescents, and families who have experienced traumatic events.

Mental Health Programs and Guidance Across States

• Expands the Certified Community Behavioral Health Clinic (CCBHC) Medicaid program nationwide, allowing up to 10 new states to participate every two years. This would be the largest single investment in expanding access to outpatient mental health care since President John F. Kennedy signed the Community Mental Health Act into law in October 1963. Exact cost is unclear but is likely in the billions of dollars.

• Calls for the Centers for Medicare and Medicaid Services (CMS) to provide guidance to states on how they can increase access to telehealth services, including mental health, under Medicaid and the Children’s Health Insurance Program (CHIP).

• Reauthorizes the Pediatric Mental Health Care Access program administered by the Health Resources and Services Administration (HRSA), which supports state or regional networks of pediatric mental health care teams through teleconsultation, training, technical assistance, and care coordination to pediatric primary care providers of children with mental health conditions.

• Requires regular CMS review of states’ implementation of the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which guarantees comprehensive health coverage for children enrolled in Medicaid. This will support better access to mental health care for children, including preventive, early intervention, and treatment services. 

Guns, School Safety and Justice Provisions

• $750 million for state crisis intervention programs including mental health courts, drug courts, veterans courts and extreme risk protection order programs.

• $300 million for the STOP School Violence school safety programs, which include school resource officers.

• $250 million for community violence intervention programs, through the Department of Justice.

Several provisions clarify access to juvenile records and purchasing of firearms, create new penalties for firearms traffickers and enhance criminal tools to investigate and prosecute “straw purchasers” and gun traffickers. Finally, the bill adjusts current loopholes by applying to unmarried partners restrictions on the purchase of guns by people convicted of domestic violence.

How Might this Affect Congressional Work Already Underway?

Several provisions in the bill were also in the previously released telehealth and youth mental health drafts that have been part of the Senate Finance Committee’s work on mental health. Some advocates are concerned that if this bill is signed into law, it may derail the prospects of a more comprehensive mental health bill emerging from the Senate Finance Committee. Others speculate that the Committee’s work has advanced too far to be derailed.

The Senate Health, Education, Labor and Pensions Committee and the House Energy & Commerce Committee have already begun work on the SAMHSA and HRSA program reauthorizations that are scheduled for this year, so it’s unclear if these will be affected.

What’s Next?

The Senate may try to get the bill voted on tomorrow morning before going on a two-week recess on Friday, June 24. If they succeed, it could go to the House for a weekend vote with a goal of sending it to President Biden to sign into law before the July 4th holiday. This means moving expeditiously over the next few days, but right now, it appears this ambitious timeline might actually become reality.

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.

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