[UPDATED] Biden Makes Behavioral Moves As Stakeholders Push for Policies to Improve Equity, Innovation

When President Joe Biden was first elected, behavioral health stakeholders predicted he would usher in a number of positive changes for the industry. Now that Biden has officially stepped into office, his administration has already made moves to alter multiple behavioral health policies — for the better or worse of providers.

Recently, the Biden administration rolled back a new medication-assisted treatment (MAT) policy designed to automatically allow most doctors to prescribe buprenorphine.

The policy, which was introduced by the Trump administration Jan. 14, eliminated X-waiver requirements for DEA-licensed physicians. Such requirements — which mandate hours of training before doctors can prescribe buprenorphine — often prevent physicians from dispensing MAT medications.

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The Trump-era policy change was praised by stakeholders for increasing access to MAT. However, the Biden administration believes the rule change comes with “significant legal and clinical concerns,” according to a draft announcement obtained by the Washington Post. Additionally, legal experts quoted in the story say the Department of Health and Human Services (HHS), which issued the policy change, doesn’t have the authority to give doctors permission to bypass the MAT training requirements, which are mandated by Congress.

On Wednesday, the Biden administration put out the following statement: “On January 14, 2021, HHS announced forthcoming Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. Unfortunately, the announcement was made prematurely. Therefore, the Guidelines previously announced cannot be issued at this time. However, HHS and ONDCP are committed to working with interagency partners to examine ways to increase access to buprenorphine, reduce overdose rates and save lives.”

While behavioral advocates have expressed disappointment about the policy reversal, they’ve praised other behavioral initiatives from the new president.

For example, on Thursday, President Biden signed an executive order to reopen enrollment for the Affordable Care Act (ACA), as well as another measure designed to strengthen Medicaid. Both actions will give more Americans the opportunity to gain behavioral health coverage and care.

Plus, on Jan. 14, then President-elect Biden unveiled his $1.9 trillion coronavirus plan, which calls on Congress to appropriate $4 billion to Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) to expand access to behavioral health services. 

Additionally, the relief package, called the American Rescue Plan, includes proposals like the expansion of health care subsidies, which would help people access mental health care. Industry groups like the National Alliance on Mental Illness (NAMI) endorsed the changes as positive.

“More people — including our nation’s youth and first responders — are reporting their mental health is worse than it was a year ago,” NAMI CEO Daniel Gillison Jr. said in a press release. “NAMI applauds the president’s call for substantial resources to expand access to mental health and substance use services.”

It’s likely more pro-behavioral changes will come in the near future. Pre-election, Biden expressed his plans to address veterans mental health, insurance parity and the opioid epidemic during an interview with the nonprofit Mental Health for US. Plus, he said he wants to expand the Certified Community Behavioral Health Clinic Demonstration and improve integrated care.

What behavioral stakeholders want

Meanwhile, behavioral stakeholders have plans and priorities of their own that they’d like to see the new administration tackle. For example, take Margarita Alegría, a psychiatry professor at Harvard Medical School and chief of the disparities research unit at Massachusetts General Hospital.

Alegría and various coauthors recently penned a Health Affairs commentary proposing a number of behavioral health care policy changes they’d like to see from President Biden over the next four years.

In the piece, Alegría and her coauthors called on the new administration to emphasize behavioral health equity and innovation by meeting people with services where they are, decriminalizing behavioral health conditions and better addressing the social needs that, when left unaddressed, can often lead to behavioral health problems.

Additionally, the authors called for more federal support to bolster the behavioral health workforce and improve outcome measurement, as well as for more generous behavioral funding in general. Doing so will not only be better for patients but for the nation in general, they argue.

“It is often misleading to regard the ‘cost’ of an illness to be the direct cost of treating the patient with the condition,” the authors wrote. “Untreated behavioral health conditions are often more costly, in terms of both health care and the impact on broader social systems.”

Meanwhile, behavioral health organizations at large seem to have similar opinions — and similar hopes for the Biden administration. In December, a leadership coalition of 14 behavioral health CEOs released a plan to transform behavioral health care through new policies, programs and standards.

Important elements outlined by the group include better identifying and preventing behavioral health conditions; improving crisis response and suicide prevention; addressing racism and other inequities in the delivery of behavioral health services; improving integrated care; ensuring behavioral health parity; developing evidence-based standards; and increasing the behavioral health workforce.

In the plan, the group — which includes CEOs from the National Council for Behavioral Health, the American Psychiatric Association and other large industry advocacy organizations — offered up “shovel-ready” solutions the administration could easily put into action, with the goal being to “harness public-private partnerships and inspire systemic change,” according to a press release announcing the news.

“Mental health needs to be a priority of everyone, particularly now in the context of COVID-19 and everything that has gone on this year,” Gillison, who is one of the CEOs in the group, said in the press release. “It requires immediate action by the new administration, as well as state and local governments in all 50 states, and an acknowledged, consistent commitment to fix what’s broken in our system of care.”

While President Biden has taken some of the requested actions — such as moving to increase behavioral health funding — only time will tell how the rest of his behavioral health policies shake out.

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