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.

We are less than one week away from the midterm elections and the start of the lame duck session. At the end of a Congressional session that has focused more on mental health issues – and passed more funding for behavioral health – than any Congress in history, could further substantive legislation still emerge?

The answer, as always these days, is maybe. When members of Congress head back to Washington, DC after the elections, they face a full slate of items to wrap up before the 118^th Congress begins in January. While it’s historically easier to get legislation over the finish line after elections have been decided, the number of outstanding items creates complexity.

Over the past year, multiple committees have been engaged in developing mental health policy. Some of that work ended up taking shape in the gun safety bill known as Bipartisan Safer Communities Act that President Biden signed into law in June. But there are still many policy and funding initiatives that have emerged from their work that could be included in an end-of-year package if one comes together. Here’s where things stand in the committees:

Mental Health Reauthorization in the House and Senate

The House Energy & Commerce Committee and Senate Health, Education, Labor & Pensions (HELP) Committee are each engaged in a reauthorization process for multiple mental health programs across two agencies within the Department of Health and Human Services – SAMHSA (the Substance Abuse and Mental Health Services Administration) and HRSA (the Health Resources and Services Administration). Both committees will have to find final agreement on the details and funding levels of existing programs and the creation of new ones in order to complete the reauthorization process.  

This summer, the House passed HR 7666, the Energy & Commerce reauthorization package, on a bipartisan vote of 402 to 20. It included some increases in funding levels for existing programs and added:

-$116.6 million per year to support the new 988 crisis line, the Behavioral Health Crisis Coordinating Office and mobile crisis services through the 2027 fiscal year.

-$60 million per year to fund a new collaborative care program designed to better integrate behavioral health and primary care through FY 27.  

The Senate HELP Committee is engaging in a similar process and may release its draft reauthorization bill in November. If not, we expect negotiations between Democratic and Republican leaders on the committee to continue until larger negotiations occur between the House and Senate.

Other House Committee Activities

In late September, the House Ways and Means Committee considered and passed several Medicare mental health bills, including one that allows licensed mental health counselors and marriage and family therapists to provide services to Medicare beneficiaries.   

At the end of September, the full House passed the Mental Health Matters Act (HR 7780) that includes funding for various school-based mental health programs, as well as provisions that strengthen implementation of laws requiring health insurers to provide parity in their coverage of mental health and substance use care. 

Senate Finance Committee

Since last fall, the Senate Finance Committee has been working on mental health legislation in a bipartisan way, starting with a stakeholder Request for Information. After holding multiple hearings earlier this year, the committee announced five focus areas. So far, the committee has released drafts of legislation concerning workforce issues, telehealth issues, and youth issues. A fourth draft, focused on behavioral health integration, collaborative care and crisis services is expected in November. The final draft will be focused on health insurance parity. 

With this many individual committees engaging in mental health policy development, how could these bills come together? It will require a vehicle to which individual bills can be attached.  Enter FY 2023 Appropriations.

FY 2023 Appropriations

The new 2023 Fiscal Year started on October 1, and as it does most years, Congress passed a Continuing Resolution (CR) to keep the government open and funded.  This time, it goes through December 16. Th resolution keeps most funding levels at the FY 2022 level with a few exceptions.  In the mental health space, the CR includes an additional $62 million for implementation of the 988 Suicide & Crisis Lifeline.

The House Appropriations Committee advanced its FY 2023 Labor, Health and Human Services, & Education bill to the House floor this summer. The Senate Appropriations Committee released its subcommittee drafts in July. 

Usually, if the majority party flips in either chamber of Congress after a midterm election, an end-of-year omnibus bill combining the 12 appropriations subcommittee bills is not likely. Whatever happens next week, this year may be different. The two senators who lead the Appropriations Committee, Chairman Patrick Leahy (D-VT) and Ranking Member Richard Shelby (R-AL) are retiring at the end of this Congress and might be putting together an end of year omnibus as a legacy item. 

Once the midterms are decided, making end-of-year predictions may get easier – but certainly not foolproof.  We still have the better part of two months left until the 117^th Congress concludes, and the new Congress is sworn in. Whatever happens, this amount of sustained – and bipartisan – focus on mental health and substance use policy is unprecedented, and hopefully a good sign for what’s to come.   

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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