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.

Update: Congress passed the end-of year funding package on December 23, beating the clock. Read down to find out what’s in the bill for mental health.

It’s late December, and Washington is in the midst of an almost yearly dance: Can Congress pass a spending bill before the government shutdown deadline? At this point, the deadline is Friday, December 23, before the next Congress – the 118th – begins in January. With the East Coast about to get walloped by winter weather, members may be less likely to run out the clock. Odds at the moment seem to favor quicker-than-usual passage – and a historic victory for mental health advocates.

On Tuesday, top appropriators released final language for the bill. As expected, it would increase funding for mental health programs, approve some new policy measures and reauthorize vital existing mental health services.

The Senate and House will have to scramble to pass the bill to get it to President Biden’s desk by midnight on Friday. Here’s a look at what’s currently in the 4,155-page bill related to mental health.   

New Mental Health Policies

The Senate Finance Committee has spent much of the past year working on mental health reform and released five drafts on different areas of mental health and substance use policy. The House Ways and Means Committee engaged in its own process and moved several mental health bills in the fall. Provisions from both are included in the end-of-year omnibus package, including measures to:

  • Allow licensed mental health counselors and marriage and family therapists to provide services to Medicare beneficiaries.
  • Enable mobile crisis response services to be covered by Medicare for the first time through the physician fee schedule.
  • Requires the Centers for Medicare and Medicaid Services to issue guidance for states on coverage of crisis care services for Medicaid and CHIP.
  • Extend pandemic rules allowing coverage of health and mental health services via telehealth, including audio only, for all of 2023.

Mental Health and Substance Use Reauthorizations

Several mental health and substance use programs funded through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) were up for renewal this year. The House Energy & Commerce Committee passed a bill earlier this summer to reauthorize them, and, after negotiations with the Senate Health, Education, Labor and Pensions (HELP) Committee, those provisions made it into the omnibus bill. The bill would also:

  • Authorize the Behavioral Health Crisis Coordinating Office at SAMHSA.
  • Require HHS to issue best practice guidelines for crisis services at all levels of care.
  • Authorize $60 million in grants to support collaborative-care practices that integrate behavioral and primary health care.
  • Authorize $10 million in grants to states to support mental health and substance use parity enforcement. 

FY 2023 Funding for Mental Health Programs

SAMHSA would receive total funding of $7.5 billion, an increase of $790 million above fiscal year 2022 levels. That includes $2.8 billion for mental health, an increase of $707 million. Key provisions include:

  • $1.01 billion for the Mental Health Block Grant, $150 million more than in FY 2022. Of this amount 5% will again be reserved for crisis care.
  • $385 million in grants for community mental health centers to enter the Certified Community Behavioral Health Clinics program, $70 million more than in FY 2022.
  • $140 million for Project AWARE, mental health awareness trainings for school-aged youth, an increase of $20 million above FY 2022.
  • $94 million for the National Child Traumatic Stress Initiative, which funds interventions to reduce the impact of trauma on children, an increase of $12 million above FY 2022.
  • $502 million for 988 and Behavioral Health Crisis Services, an increase of $390 million above FY 2022.
  • $20 million, an increase of $10 million, to help communities create mobile behavioral health crisis response teams.

Also included with SAMHSA, Substance use services would be funded at $4.2 billion, which is an increase of $203 million above FY 2022. This includes:

  • $2 billion for the Substance Abuse Prevention and Treatment Block Grant (SABG), an increase of $100 million over FY 2022.
  • $1.58 billion for State Opioid Response Grants, an increase of $50 million over FY 2022.
  • $237 million for substance abuse prevention services, an increase of $19 million above FY 2022.

There have been rumors for months on what an end-of-year package might look like. While it has taken longer than expected to come to this point, lawmakers have delivered a robust end-of-year spending package with significant funding increases and new policy initiatives in mental health.  The bill still must pass both chambers and be signed into law by Friday evening to stave off a temporary shutdown.  If members of Congress can cross the finish line on this end-of-year package, they will wrap up a 117th Congress that delivered unprecedented levels of policymaking and funding for mental health. 

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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