By: Jennifer Taylor
In our last behavioral health blog post back in November, we filled you in on a few key mental health bills under consideration by Congress, namely H.R. 2646, the Helping Families in Mental Health Crisis Act (Rep. Tim Murphy, R-PA) and S. 1945, the Mental Health Reform Act of 2015 (Sen. Chris Murphy, D-CT and Sen. Bill Cassidy, R-LA). While both bills continue to serve as the foundation for conversations about mental health reform in Washington, Congress has more recently concentrated its efforts on grappling with opioid abuse.
In the last 15 years, deaths from prescription painkillers have quadrupled in America, evidence of a “prescription painkiller overdose epidemic” according to the Centers for Disease Control and Prevention (CDC). Members of Congress are hearing horror stories of opioid overdoses from constituents across the country, and many feel compelled to take action. Since January there have been several hearings in both the House and Senate that explored the topic of opioid addiction, and it seems likely that any final behavioral health reform package that receives a vote in Congress will include proposals related to opioid abuse.
President Obama’s FY17 budget included $1.1 billion to combat the opioid abuse epidemic, and while Congress may not heed much of his budget request, they are exploring similar approaches in the more than 50 opioid-related bills that have been introduced in Congress this session. These bills propose to address the problem from a wide variety of perspectives, including addiction prevention, provider prescribing practices, drug treatment programs, and criminal justice reform.
The Senate acted first, and is expected to pass S. 524, the Comprehensive Addiction and Recovery Act (CARA) (Sen. Sheldon Whitehouse, D-RI and Sen. Rob Portman, R-OH) with strong bipartisan support this week. This bill would redirect about $78 million in existing funding and authorizations for substance abuse prevention and treatment programs to address the opioid epidemic through a combination of prevention, treatment, and recovery efforts. While the bill is widely supported, many Senators expressed concern that it relies on limited existing funding streams and pressed for additional new funding to fight the epidemic. Ultimately the Senate rejected an amendment from Senator Jeanne Shaheen (D-NH) to add $600 million in emergency FY16 supplemental appropriations for the Department of Health and Human Services and the Department of Justice to address heroin and opioid drug abuse. It remains to be seen whether new funding might be included in future bills under consideration later this year.
The Senate’s work on this issue is far from over, with two new draft bills being released just this week and set to be considered in the Senate HELP Committee at a hearing on March 16. On March 7, the first of the two bills was released – a bipartisan discussion draft based on the earlier mental health reform bill released by Senators Murphy and Cassidy. This new version of the bill, the Mental Health Reform Act of 2016, includes provisions designed to improve coordination between federal agencies and evaluations of mental health programs, updates federal block grant funding, promotes evidence-based treatment practices, and targets increased access to mental health care for veterans, women, children, and homeless individuals.
The second new bill set to be released this week will contain additional provisions related to opioid abuse, the details of which have not been shared yet. No matter what that draft bill contains, with so many different ideas being discussed it is likely that Senators will want to offer amendments to try to advance their own legislation. Some Senators are focusing their efforts on bills such as S. 1913, the Stopping Medication Abuse and Protecting Seniors Act (Sen. Pat Toomey, R-PA and Sen. Sherrod Brown, D-OH), which would allow Part D drug plans to implement patient review and restriction (PRR) programs, also known as “lock-in” programs, to lock certain Medicare recipients into one prescriber and one pharmacy to help manage potential addiction. Other widely discussed bills seek to improve the distribution of naloxone, an effective overdose reversal medication, or to change federal restrictions around prescribing for opioid replacement medications used as part of Medication-Assisted Therapy (MAT) for addiction. We’ll keep an eye on all of these bills as the legislative process continues to unfold.
While the Senate is currently driving much of the conversation, House conversations about behavioral health reform are also starting to pivot to opioid abuse. After expressing frustration with the process around mental health reform legislation in the House, Energy and Commerce Democrats led by Representatives Gene Green (D-TX) and Doris Matsui (D-CA), released H.R. 4435, the Comprehensive Behavioral Health Reform and Recovery Act, an alternative to Rep. Tim Murphy’s mental health bill (H.R. 2646), that includes several similar provisions but also makes key changes relative to the structure and function of the Substance Abuse and Mental Health Services Administration (SAMSHA), patient privacy language, and assisted outpatient treatment programs. The Democratic bill carries over several key provisions for health centers, including same-day billing for Medicaid mental and physical health visits and an extension of FTCA medical liability coverage to Health Center volunteer providers, while adding an emphasis on early intervention as well as several provisions to address opioid abuse, including provider prescribing practices.
NACHC is continuing to engage with Members of Congress and their staff on mental and behavioral health reform proposals, including those specific to opioid abuse, as well as to work with health center behavioral health experts to better inform Congressional action in the coming months. We’ll keep you updated on the next steps in Congress, but in the meantime we’d love to hear about innovative work around behavioral health and opioid abuse at your health center – please share your thoughts with NACHC Federal Affairs staff at federalaffairs@nachc.org.