Congress is poised to take an important first step this week in improving the nation's struggling system of care for millions of Americans suffering from mental illness and drug addiction.
The House is scheduled to vote Wednesday on a sweeping package of mental healthcare and addiction treatment reforms as part of broader legislation, called the 21st Century Cures Act, to speed regulatory approval of new prescription drugs and medical devices. The Senate is expected to vote soon after on the legislation, which was crafted by House and Senate leaders from both parties.
The bill would authorize $1 billion over the next two years to address the nation's opioid abuse crisis, and would authorize or re-authorize smaller amounts of funding for a wide range of federal grants for mental health and substance abuse services. But Congress would still have to decide next year whether to appropriate that money.
Mental health advocates expressed cautious optimism that President-elect Donald Trump's administration and congressional Republican leaders will support that funding—even though House Speaker Paul Ryan and other GOP leaders have promised to cut taxes, boost military outlays and reduce discretionary federal spending.
“A lot of advocacy will have to occur around getting some of these initiatives funded,” said Ron Honberg, senior policy adviser at the National Alliance on Mental Illness, a coalition of advocacy groups. “I feel pretty confident a number of them will be funded, but probably not all of them.”
He and other advocates are worried, however, that GOP plans to repeal the Affordable Care Act's Medicaid expansion, turn Medicaid into a state block-grant program, and reduce federal contributions could undercut the benefits of the new legislation. “With Medicaid expansion, a lot of single, adult males who have serious mental illness have become eligible for coverage,” said Frankie Berger, director of advocacy for the Treatment Advocacy Center. If the expansion is repealed, she added, states will have to figure out how to pay for their care.
The pending bill's mental health provisions, drawn mainly from the Helping Families in Mental Health Crisis Act, which passed the House 422-2 in July, would create a new HHS assistant secretary in charge of mental health and substance abuse disorders; authorize grants for community treatment teams and assisted outpatient treatment for noncooperative patients; and create a path to allow Medicaid managed-care plans to pay for short-term inpatient stays.
In addition, the bill requires HHS to clarify when providers may share patient information. It would also step up enforcement of rules for insurers to cover mental healthcare on parity with physical health; boost support for training more mental health professionals; help providers more easily track available inpatient beds; support a wide range of programs to combat suicide and improve screening, early diagnosis and early intervention for mental illness in children; and push to reduce incarceration of nonviolent, mentally ill offenders.
Hospitals and physicians will welcome a provision clarifying that Medicaid is allowed to pay providers for the delivery of mental health and primary-care services to a patient on the same day, ending a source of frustration for primary-care providers.
Providers and families of behavioral health patients also may welcome provisions that require HHS and the Office for Civil Rights to clarify when providers can use patient information protected by the Health Information Portability and Accountability Act for treatment purposes and share such information with patients' family members and caregivers.
On opioid treatment, the new bill resolves, for now, a partisan battle over funding for the Comprehensive Addiction and Recovery Act, for which President Barack Obama and congressional Democrats demanded more money. The CARA bill strengthens prevention, treatment, and recovery initiatives by giving providers and law enforcement officials more tools to help drug addicts and expanding access to a drug to help reverse overdoses.