February 23, 2022

Credit: Roll Call, Sandhya Raman

Lawmakers hope to produce legislation to address growing mental health and substance use needs this year as deadlines approach, but the issue is competing for attention with other national priorities in a compressed election-year schedule.

Congress has until March 11 to extend a restriction on fentanyl-related substances, a large group of synthetic opioids that are responsible for most drug-related deaths.

And a dozen Substance Abuse and Mental Health Services Administration programs also must be reauthorized by the end of the fiscal year in September. The programs include the community mental health services block grant, mental and behavioral health education and training grants, and evidence-based programs within the National Mental Health and Substance Use Policy Laboratory.

The implementation in mid-July of a new three-digit suicide hotline number also is expected to bring awareness of mental health needs and policies.

The pandemic exacerbated the nation’s already disturbing mental health concerns. About 31.5 percent of adults reported symptoms of anxiety or depression in the two-week period ending Feb. 7, according to National Center for Health Statistics and Census Bureau data.

Lawmakers have not yet written a comprehensive bill in either chamber, but committees have held hearings recently. Any eventual package would need to be bipartisan and paid for with offsets to gain approval, but advocates are eying many policies that, packaged together, may add up.

Lobbyists speaking with CQ Roll Call suggested that a package in the $5 billion range could be difficult to offset. Others are more aspirational and say that if Congress were to actually meet the scope of the needs, a figure more in the $100 billion range over 10 years, similar to the approach taken with HIV/AIDS, would still fall short of addressing the impact of the pandemic.

“Our understanding of what makes it into the final package is it has to be a bipartisan policy,” said Sarah Corcoran, vice president of government relations at Guide Consulting Services. “It needs to be not controversial, and it needs to, obviously, fit within the parameters of what they can offset in a bipartisan way. So that automatically does kind of narrow you a bit because some of these larger, more transformative items just realistically are not going to fit within the [Congressional Budget Office] score that they can offset.”

It’s unclear yet when either chamber would see a floor vote, but leadership aides confirmed that mental health and addiction policies remain a priority.

“There’s no single problem with mental health in this country and so, therefore, there’s no single solution. Congress has made a lot of investments. We need to look at a multifaceted way to support Americans’ health and well-being,” House Energy and Commerce Oversight and Investigations Subcommittee Chairwoman Diana DeGette, D-Colo., said during a Feb. 17 hearing.

Areas of interest

Experts at multiple congressional hearings recently said the biggest issue in the mental health and substance use space is similar to other aspects of health care: developing a broader and more diverse workforce to serve a growing population. But workforce issues require long-term strategies to recruit and train individuals and are not limited to just behavioral health.

Sens. Debbie Stabenow, D-Mich., and Steve Daines, R-Mont., are spearheading a Finance Committee subgroup to put together legislation on strengthening the workforce.

The broader mental health and addiction issues that lawmakers are eyeing for legislation include telehealth, youth mental health, crisis care and suicide prevention, drug supply issues and treatment. Lawmakers also plan oversight of existing funds.

Rep. David Trone, D-Md., told CQ Roll Call that he has spoken to the White House and the president directly about the desire to do something on mental health and addiction.

“[There] was a significant appetite to do something on a bipartisan basis that sends a message to the country that we really do want to work together and we actually can work together on some things … mental health, addiction, the stigma around them, the death toll [and] the damage it does to our economy,” he said.

Lawmakers previously have taken limited action on youth mental health efforts, making it a priority for lawmakers this year.

Data from the Centers for Disease Control and Prevention’s Feb. 18 Morbidity and Mortality Weekly Report showed that weekly emergency room visits for girls 12-17 years old increased for five mental health conditions in January 2022 compared with 2019.

Two House-passed bipartisan youth mental health bills are awaiting Senate consideration. One would authorize grants to fund school-based mental health. The second would require agencies that get state educational grants to implement suicide awareness and prevention policies for grades six through 12.

The upcoming implementation of the national hotline number, 988, has also sparked renewed interest in suicide prevention bills, such as legislation by Sens. John Cornyn, R-Texas, and Michael Bennet, D-Colo., that would increase authorizations to the National Suicide Prevention Lifeline program to $50 million per year through fiscal 2026.

“I think that this is the best train leaving the station for transformative mental health policies before the end of the year. So we’ll have to see how things are at the state level in July, and that will help inform how much help is needed from Congress,” said Corcoran, pointing to an omnibus bill before the end of the year as a likely vehicle.

Telehealth

Multiple telehealth flexibilities have been temporarily loosened during the pandemic, and there is clear bipartisan interest in continuing telehealth coverage especially for mental health and substance use disorder treatment.

Interest groups want Congress to extend temporary flexibilities for three years, to allow for more investment and long-term planning in telehealth technology.

“What we’re hoping is to get that in an omnibus package,” said Megan S. Herber, director at the law and lobbying firm Faegre Drinker. “I think that, honestly, the biggest concern is the CBO score.”

Within telehealth, there are three policies that advocates say are crucial.

The fiscal 2021 omnibus spending law included language that expanded telehealth coverage through Medicare but required an individual to be seen in person by a provider in the prior six-month period.

A bill from Rep. Doris Matsui, D-Calif., and Sen. Bill Cassidy, R-La., seeks to repeal that in-person requirement to expand access for individuals who may not be able to visit the provider.

A 2008 online drug sales law regulates digital prescriptions and carves out exceptions for telehealth for controlled substances. The federal government eased restrictions during the public health emergency to allow opioid use disorder drugs like buprenorphine to be prescribed through telehealth. 

Two bills would include language to ease these restrictions. One by Sens. Catherine Cortez Masto, D-Nev., and Todd Young, R-Ind., would extend both the Medicare coverage and prescribing flexibilities for two years. It has the support of the American Counseling Association. The other, from Sens. Sheldon Whitehouse, D-R.I., and Rob Portman, R-Ohio, would make these Medicare telehealth waivers permanent to allow patients to receive these prescriptions without an in-person visit and to bill for audio-only telehealth.

The third priority is to renew a policy that would exempt some telehealth services from high-deductible health plan rules. The second COVID-19 relief law allowed individuals on these plans to use telehealth, including telemental health, before reaching their deductible. The provision expired in December.

A bill from Reps. Brad Schneider, D-Ill., and Brad Wenstrup, R-Ohio, would extend this policy until December 2023. Daines and Cortez Masto have a bill that would extend this policy permanently.

“We need to eliminate barriers to access so those facing a mental health challenge receive high-quality care no matter who they are, no matter where they live,” said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing. “Our goal is to make mental well-being, including recovery from substance use challenges, a reality for everyone. Our hope is that the important work Congress will engage in makes it easier for people to reach that goal.”