President Joe Biden signed the $1.7 trillion Consolidated Appropriations Act of 2023, which will have a significant impact on the behavioral health industry, on December 29, 2022.
Strengthening of Federal Parity Laws
The Mental Health Parity and Addiction Equity Act (federal parity law) stipulates that the insurance coverage for mental health conditions, including substance use disorder, provided by group health plans cannot be more restrictive than coverage for other medical conditions. In 2010, the Affordable Care Act expanded federal parity laws to individual health plans.
Non-federal government entities, like states, municipalities, school districts, and other public systems, were exempted. Under the Consolidated Appropriations Act of 2023, the ability to completely opt out has been removed.
Grant Funding for Enforcement
While the Department of Labor oversees some parity provisions, the primary responsibility to enforce parity provisions for fully insured individual and employer health plans fall to the states. To aid states in enforcement of federal parity laws, $50 million in grants will be made available over the next five years under the bill.
Deregulation of Buprenorphine
Buprenorphine is a partial opioid agonist medication used to treat opioid-use disorder. The benefits of this medication include a reduction in opioid misuse and a decrease in overdoses. Despite its benefits, only 22% of patients with opioid-use disorder received medicated treatment. Federal policies used to require physicians to obtain a waiver from the Drug Enforcement Agency (DEA) to prescribe the medicated treatment to patients. By removing this hurdle, physicians can expand access to this lifesaving intervention.
Summary of Funding
This bipartisan legislation impacts nearly every corner of behavioral health.
Childhood Mental Health
The act offers increased access to mental health resources for children through various programs:
- Project AWARE, $20 million increase
- National Child Traumatic Stress Initiative, $12 million increase
- Infant and early childhood mental Health through Substance Abuse and Mental Health Services Administration (SAMHSA), $5 million increase
- Pediatric Mental Health Access through the Health Resources and Services Administration (HRSA), $2 million increase
Maternal Mental Health
The support of maternal mental health includes an increase of $119.5 million in HRSA funding including:
- $87 million increase in funding for the Maternal and Child Health Block Grant and a $26 million increase in funding for the State Maternal Health Innovations Grants
- $3.5 million increase in funding for the Screening and Treatment for Maternal Depression
- $3 million increase in funding for the Maternal Mental Health Hotline
Crisis Response
The grants include an $400 million increase in funding for behavioral health crisis services like the 988 Suicide and Crisis Lifeline and SAMHSA mental health crisis response grants.
Opioid Resources
Funding for opioid overdose prevention and surveillance includes:
- $45 million in additional funding through the National Institutes of Health (NIH) for research related to opioid, stimulants, and pain management
- $15 million increase in funding for the Centers for Disease Control and Prevention’s (CDC) opioid overdose prevention and surveillance programs
- $19 million in additional funding to SAMHSA for substance abuse prevention services
Substance Use Resources
There’s a $203 million increase in funding for substance use services, including prevention, treatment, and recovery through SAMHSA with $100 million specifically carved out for the Substance Use Prevention and Treatment Block Grants (SABG) and $50 million for State Opioid Response Grants.
Behavioral Health Support
The $707 million in additional funding to SAMHSA includes a $150 million increase to Mental Health Block Grants (MHBG) for broad support across the behavioral health industry.
Community Clinics
$70 million of additional funding goes to Certified Community Behavioral Health Clinics (CCBHC) designed to improve round-the-clock crisis services and access to mental health and substance use services regardless of ability to pay, place of residence, or age.
Workforce Development
Funds for increasing investment in behavioral health workforce training include an increase of $51 million for HRSA’s Title VII Health Professions Education and Training Program. Of that, $16 million is designated to the Substance Use Treatment and Recovery Loan Repayment Program. $14 million goes to other behavioral health workforce education and training programs.
An additional $22 million will be provided through the HHS Title VIII Public Health and Social Services Emergency Fund to improve mental and behavioral health workforce, infrastructure, and treatment services.
This unprecedented support will put at least $10 billion into behavioral health in the 2023 fiscal year. With this increased funding, behavioral health providers and CCBHCs will be able to expand behavioral health services and increase community reach.
Impact to Medicare and Medicaid
For Medicare and Medicaid beneficiaries, this bill will make behavioral healthcare more accessible by:
- Adding coverage to Medicare recipients for intensive outpatient mental health programs
- Covering treatment provided under marriage and family therapists and mental health counselors to Medicare patients
- Expanding Medicare and Medicaid access to telehealth services for an additional two years through December 31, 2024
- Increasing Medicare reimbursements rates for mental health services provided through mobile units
- Aiding states that design and implement crisis response services through increased Medicaid funding
- Improving Medicaid enrollment clarity
During the COVID-19 pandemic public health emergency (PHE), eligibility determinations were paused and states that made enrolling easier were offered additional funding. It’s unclear when the PHE will be declared over, so the bill set April 1, 2023, for returning Medicaid enrollment to normal. The bill provides funding and assistance for the transition.
The intent is to add clarity and help manage the transition back to Medicaid determinations. The bill also combats phantom networks by requiring searchable, up-to-date directories that include behavioral health providers.
Additionally, the bill softened the anticipated reductions to Medicare reimbursement. Physicians sought to remove the cuts altogether, and Congress met physicians in middle. There will be 2.5% cuts in 2023 and 1.25% cuts for 2024.
We’re Here to Help
To learn more about how the Consolidated Appropriations Act of 2023 could impact your organization, contact your Moss Adams professional.
You can find additional resources at our Health Care practice.