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By District Policy Group
Sarah Mills, Senior Government Relations Manager
Jeremy Scott, Senior Vice President

1st Century Cures: Mental Health

On December 13, 2017, the Senate Health, Education, Labor and Pensions Committee held a hearing to review the implementation of provisions included in the 21st Century Cures Act, signed into law one year ago this month, to improve treatment for mental health and substance abuse disorders. Dr. Elinore McCance-Katz, Assistant Secretary for Mental Health and Substance Use within the Substance Abuse and Mental Health Services Administration (SAMHSA), was present to testify before the committee. Ultimately, lawmakers expressed concerns that these provisions have been unfulfilled due to a lack of funding. Among the provisions included was the creation of a new position within the Department of Health and Human Services (HHS) to oversee mental health and substance abuse disorder treatments, ensure compliance with mental health parity rules and mandate funding for mental health block grants. While the law called for Congress to appropriate $1 billion to support state health care efforts, only about half of the funding has been distributed. Much of the 21st Century Cures funding has been delayed as Congress continues work on reaching a budget agreement and passing funding legislation for the new fiscal year.

Following the hearing, SAMHSA released the Interdepartmental Serious Mental Illness Coordinating Committee report to Congress on policy recommendations to improve mental health services. The executive summary is available here and the full report can be found here.

White House, Agencies and Congress Prioritizing Efforts to Address Opioid Epidemic

During the last half of 2017, federal officials across the Administration and Congress launched significant efforts to tackle substance abuse issues and the opioid epidemic. In 2018, we expect the momentum for these issues to continue with Congress likely to devote significant time to legislation that will address the opioid crisis and agencies continuing efforts to study evidence-based solutions and work with stakeholders on advancing programs that will curb prescription led substance abuse disorders.

On October 26, 2017, President Trump declared the opioid crisis a public health emergency. Though the announcement stopped short of declaring a national emergency as recommended by the President’s Commission on Combating Drug Addiction and the Opioid Crisis (Commission), the declaration was useful in taking crucial next steps to address the epidemic. As a result of the declaration, additional funds were made available by allowing the transfer and repurposing of funds across federal programs and expanding access to telemedicine services include remote prescribing. Lawmakers in Congress have also held hearings to discuss the necessity for providing supplemental funding, which could be included in end of year budget negotiations (see below for timing and end of year negotiations).

As noted in our previous updates, CPNP submitted comments in response to the Commission’s draft interim report. On November 1, 2017, the Commission released a draft final report with recommendations for the Administration and Congress on ways to address the devastating crisis. To name just a few of the agencies taking up action on this issue: The Food and Drug Administration (FDA) has established a steering committee to explore new requirements on manufacturers of prescription opioids to reverse overprescribing; the National Institutes of Health (NIH) is investigating non-addictive pain relief alternatives and new treatments for addiction and overdose; and an $81 million joint research partnership has been established across the Department of Defense (DOD), the Department of Veterans Affairs (VA), NIH and the broader Department of Health and Human Services to explore nondrug approaches to managing pain, particularly as it relates to the needs of service members and veterans.

Congress Faces Numerous Obstacles in Completing End of Year Work

After a number of failed attempts Republicans in Congress have, for the moment, put aside their efforts to pass legislation fully repealing and replacing the ACA. Instead, Republicans have zeroed in on priority #2 – passing legislation to overhaul the U.S. tax code before end of year. This is a crucial objective for the President as his first year in office comes to a close. Still, a small number of Republicans saw an opportunity through tax reform to chip away at the ACA and as a result, the final tax bill is expected to include a provision ending the ACA’s individual mandate. At the same time, Congress may move a bipartisan bill sponsored by Senators Alexander (R-TN) and Murray (D-WA), the top two ranking members on the Senate Health committee, to allow the continuation of cost-sharing subsidies in order to stabilize the ACA markets in the short-term. House and Senate each completed work on their versions of tax reform bills in the past weeks and have since been working to resolve their differences in a conference between the two chambers. The conference concluded negotiations today as this issue of CPNP Perspectives went to press with the House and Senate each due to vote on a final bill early the week of December 18th. If passed, the bill will be sent to the President’s desk for final signature before the end of the year.

The ACA and tax reform efforts combined have resulted in little time for Congress to complete work on other important legislation, meaning we are down to the wire again on passing legislation to fund federal programs in FY 2018. The short-term funding provided by Congress this fall under a continuing resolution (CR) expires December 22. While lawmakers are continuing work on an omnibus bill to provide fiscal year (FY) 2018 funding, it’s very likely another short-term CR that maintains funding at FY 2017 levels will be passed to carry work over into the New Year.

In addition, Congress is overdue in passing legislation to reauthorize funding for the Children’s Health Insurance Program. Funding for the program expired on September 30th and states have struggled to find ways to stretch their dollars until end of year. Versions of CHIP reauthorization legislation have been considered by both chambers of Congress. The House passed their version earlier this year and while a Senate version has been approved by a key committee, the full Senate has not yet voted. Ultimately, lawmakers agree the CHIP program will be reauthorized, but disagreements on how to pay for the program remain a hurdle. Continued funding for the program will likely be extended in the short-term CR.

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