On Tuesday, congressional leaders released a bill that will fund the federal government through the current federal fiscal year 2023 and back several behavioral health efforts.
The bill includes over $10 billion for behavioral health initiatives. These include $4.9 billion in funding to address opioid abuse and $5.27 billion for mental health treatment, prevention and research initiatives.
The topline funding numbers are increased compared to the previous budget year. Mental health funding is up about 18% while funding to address opioid abuse is up about 6%, according to summaries provided by Democrats and Republicans from the Senate Appropriations Committee. Overall, these two segments saw a 12% funding increase.
“The dramatic increase in spending we see, at least for the Substance Abuse and Mental Health Services Administration, shows us that the framework that Congress is trying to put together for next year is very strongly supportive of trying to help abate the mental health and substance use crisis that’s facing our nation,” Reyna Taylor, senior vice president of public policy for the National Council for Mental Wellbeing (NCMW), told Behavioral Health Business.
The $1.66 trillion funding bill is up for a vote in the Senate on Tuesday, according to Reuters. Congress had already passed a stop-gap bill that funded the federal government through Friday.
Extensions of Medicare telehealth flexibilities
The omnibus bill extends the flexibility of Medicare beneficiaries to receive behavioral health and other services via telehealth or audio-only modalities for two years after the public health emergency (PHE) ends.
It also includes a comparable delay in the requirement that Medicare beneficiaries have an in-person appointment every year or within a year of starting telehealth services.
Medicare formally has no power over how other health plans manage telehealth. However, industry experts have previously told BHB that Medicare sets the pace for private health plans on this like telehealth.
No Ryan Haight Act changes
The bill itself does not address COVID-era prescribing regulations that allowed providers to dole out controlled substances via telehealth. It does, however, again direct the Drug Enforcement Administration to create a special registration process for addiction treatment through medication-assisted treatment (MAT) and telehealth.
In 2018, Congress passed the SUPPORT for Patients and Communities Act which, in part, required the Drug Enforcement Administration to create a special registration process for prescribing controlled substances via telehealth. It has so far failed to do so, creating uncertainty for virtual MAT as a practice and for the startups that specialized in it.
“The hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff,’” Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, said in a statement. “Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.”
MAT changes open access
The bill includes provisions that eliminate the X-waiver, an extra certification that prescribers have to get from the DEA to be able to prescribe buprenorphine. Buprenorphine is a controlled substance used to treat opioid use disorder (OUD) and is considered part of the gold-standard treatment for OUD, pairing the medication with therapy and similar services.
The number of providers receiving an X waiver has increased significantly over the last several years. But many point to the COVID-driven rise in overdose deaths in the U.S. — largely driven by the opioid fentanyl — as an impetus to increasing MAT access for OUD.
Effectively, the bill would eliminate the X waiver but require an 8-hour training in identifying and treating addiction when a prescriber applies for or renews their DEA registration to prescribe controlled substances.
Advocates of the move say deregulating buprenorphine will increase access to care. Opponents worry about the safety ramifications of prescribers that do not specialize in addiction treatment being able to prescribe the drug, which is in the same controlled substance class as ketamine and medications that also contain codeine.
“That’s consistent with some work we were doing with other groups to ensure that individuals have baseline training on this, not just coming into it cold,” Shawn Coughlin, president and CEO of the National Association for Behavioral Healthcare, told BHB.
Behavioral health workforce funding is up
Behavioral health workforce development efforts total at least $197 million for fiscal 2023. These include the Behavioral Health Workforce Education and Training program and Mental and Behavioral Health graduate education programs. Funding for these behavioral health-specific programs is up 22% compared to fiscal 2022.
While not specifically dedicated to behavioral health, funding for the National Health Service Corps is up 33% to $125.6 million. The National Health Service Corps offers loan forgiveness and scholarships in exchange for professionals working in specific medical fields in areas with provider shortages. It is overseen by the Health Resources and Services Administration.
For fiscal 2022, 41%, or about 10,000, of the roughly 24,600 professionals in the National Health Service Corps worked in the mental health field, according to HRSA data.
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