On December 27, 2022, President Biden signed into law the Consolidated Appropriations Act, 2023, a $1.7 trillion year-end omnibus spending bill passed by Congress on December 23, 2022. It provides billions of dollars to address mental health and addiction and includes several policy changes that will make critical changes to the way our nation addresses addiction.
The Consolidated Appropriations Act, 2023 incorporates the Restoring Hope for Mental Health and Well-Being Act, the mental health and addiction legislative package previously passed by the House of Representatives.
The bill authorizes grants for behavioral health resources for Native Americans and includes reauthorizations through 2027 for major funding sources for mental health and addiction prevention, treatment, and recovery services, including the:
- Community Mental Health Services Block Grant;
- Substance Use Prevention, Treatment, and Recovery Services Block Grant (formerly the Substance Abuse Prevention and Treatment Block Grant; this bill changes the name and language throughout to eliminate stigmatizing language); and
- State Opioid Response Grant.
The law includes provisions to address opioid prescribing, including:
- improving insurance coverage for non-opioid pain medications (the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act);
- reauthorization of the Emergency Department Alternatives to Opioids program to increase access to non-opioid treatments for pain management;
- training for pharmacists on verifying patient identity before dispensing opioid prescriptions;
- grants to support prescription drug monitoring programs; and
- steps to provide for safer disposal of opioids.
It also includes provisions to promote public awareness/education, including requiring:
- a public education campaign to raise awareness of synthetic opioids (e.g., fentanyl) and emerging drug issues;
- information for health care providers on synthetic opioids; and
- a training guide and webinar for first responders and others at high risk for exposure to synthetic opioids.
The law also reauthorizes and expands the STOP Underage Drinking program.
The law includes provisions to support youth mental health, which can also help prevent substance use. It:
- requires technical assistance and best practices for school-based mental health and substance use disorder services;
- reauthorizes youth mental health intervention and treatment programs;
- provides support for youth suicide prevention and mental health and substance use disorder services for students in higher education; and
- mandates research on the effects of smartphone and social media use on youth.
The law includes several provisions to support crisis continuums of care, including:
- establishing a Behavioral Health Crisis Coordinating Office;
- requiring best practices for a crisis response continuum of care and guidance to states on implementation and financing; and
- creating a five percent set-aside for crisis care services in the Community Mental Health Services Block Grant.
It also provides support for 988 and the Veterans Crisis Line, as well as mobile crisis response services, including:
- grants to establish/enhance mobile crisis response teams; and
- establishing new codes in Medicare for crisis services.
The law reauthorizes grants supporting naloxone prescribing training and naloxone access and education.
However, as with previous years, the law prohibits funds from being used to purchase sterile needles/syringes for illegal injection drug use, and it prohibits funds from being used to purchase, procure, or distribute pipes to smoke or inhale illegal substances.
The law includes several changes to stringent federal rules regarding medications for opioid use disorder.
To increase access to buprenorphine, the law:
- eliminates the buprenorphine wavier requirement (Mainstreaming Addiction Treatment (MAT) Act); and
- increases the amount of time a physician may hold long-acting injectable buprenorphine.
To increase access to methadone, the law:
- eliminates the separate registration requirement for opioid treatment program (OTP) mobile medication units;
- eliminates the requirement that patients have opioid use disorder for at least one year before being admitted to an OTP; and
- requires a study on the flexibilities granted to states and OTPs during the COVID public health emergency (telehealth, methadone take-home doses).
The law also aims to expand access to contingency management services by:
- requiring a study on establishing a safe harbor for evidence-based contingency management incentives and recommendations for improving access while ensuring strong safeguards against fraud and abuse.
The law also includes the Into the Light for Maternal Mental Health and Substance Use Disorders Act to support mental health and addiction care for pregnant and postpartum individuals, including through screening and treatment and a maternal mental health hotline.
The law aims to support continued availability and access to mental health and addiction services during and in response to public health emergencies, requiring a strategy and recommendations for doing so, as well as a report on Substance Abuse and Mental Health Services (SAMHSA) programs to support mental health and addiction services during COVID.
It also includes provisions to support care integration, including grants, technical assistance, and education to promote integration between physical and behavioral health.
The law strengthens parity enforcement by:
- eliminating the opt-out for nonfederal governmental health plans (the Closing Health Coverage Gaps for Public Servants Act); and
- authorizing grants to states to enforce and ensure compliance (Parity Implementation Assistance Act).
The law requires a study on Medicare Advantage plans that includes some parity analyses and requires some Medicaid plans to publicly publish and regularly update a searchable directory of network providers.
The law also expands coverage for mental health services in Medicare by allowing marriage and family therapist, mental health counselor, and intensive outpatient services.
The law provides support for recovery housing (Excellence in Recovery Housing Act), by:
- developing guidelines for states;
- supporting federal coordination; and
- providing grants to promote the availability of evidence-based recovery housing.
The law also supports peer support services, including through grants for virtual and other peer support services and expanding veteran peer support.
The law also expands the Substance Use Prevention, Treatment, and Recovery Services Block Grant (formerly the Substance Abuse Prevention and Treatment Block Grant) to include recovery support services.
Behavioral Health Workforce
The law helps expand the behavioral health treatment workforce, including by:
- requiring health care practitioners, as a condition of receiving or renewing their license to prescribe controlled substances, to receive a one-time, eight-hour training on substance use disorder (Medication Access and Training Expansion (MATE) Act);
- reauthorizing education and training programs;
- expanding fellowship, scholarship, and loan repayment programs; and
- adding psychiatry residency slots.
The law extends the temporary scheduling of fentanyl-related substances to Schedule I until the end of 2024.
As with previous years, the law includes provisions on marijuana that prohibit D.C. from creating a legal recreational marijuana market and prevent the Justice Department from interfering with states that have medical marijuana laws.
The funding for government agencies for FY 2023 includes billions of dollars to address mental health and addiction.
It includes $7.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) ($970 million increase over FY 2022), including:
- $2.8 billion for mental health ($707 million increase), including over $1 billion for the Mental Health Block Grant, as well as increased funding for:
- behavioral health crisis services (e.g., 988, mobile crisis response teams);
- Certified Community Behavioral Health Clinics (CCBHCs); and
- youth mental health programs (e.g., Project AWARE, infant and early childhood mental health, the National Child Traumatic Stress Initiative).
- $4.2 billion for substance use treatment ($203 million increase), including:
- nearly $1.6 billion for State Opioid Response Grants;
- $2 billion for the Substance Abuse Prevention and Treatment Block Grants; and
- $2 million to evaluate treatment programs.
- $236.9 million for substance use prevention ($19 million increase).
- $301.9 million for health surveillance and program support, including $31.4 million for national surveys on drug use and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities.
Centers for Disease Control and Prevention (CDC) funding includes $505 million for opioid overdose surveillance and prevention. The appropriations include targeted increases at the Food and Drug Administration (FDA) to address the opioid crisis, as well as increased funding at the National Institutes of Health (NIH) for research related to opioids, methamphetamines, and pain and increased funding for the National Institutes on Drug Abuse (NIDA), Alcohol Abuse and Alcoholism (NIAAA), and Mental Health (NIMH). Health Resources and Services Administration (HRSA) funding includes increased funding for maternal health, youth mental health services, behavioral health workforce programs (e.g., Substance Use Treatment and Recovery Loan Repayment Program, Behavioral Health Workforce Education and Training Programs), and rural behavioral health services (e.g., Rural Communities Opioid Response Program).
The law includes $471 million for the Office of National Drug Control Policy ($22 million increase), including:
- $302 million for the High-Intensity Drug Trafficking Area (HIDTA) program ($5.4 million increase);
- $109 million for the Drug-Free Communities program ($3 million increase); and
- $3 million for drug court training and technical assistance.
It also includes $111 million for Department of Education programs to increase mental health services in schools, as well as increased funding for social emotional learning programs, including:
- grants to address student social, emotional, and cognitive needs ($87 million);
- support for professional development and pathways into teaching that include a strong foundation in social emotional learning and “whole child” strategies ($90 million); and
- funding for Full Service Community Schools ($150 million).
The law includes $13.9 billion for veteran mental health, $183.3 million for veteran substance use disorder programs, $663 million for opioid misuse prevention, and $86 million for Whole Health Initiatives.
It includes funding for criminal justice, law enforcement, and reentry programs, including:
- drug, mental health, and veterans treatment courts;
- Residential Substance Abuse Treatment for State Prisoners grants;
- prescription drug monitoring;
- the Comprehensive Opioid, Stimulant, and Substance Use Disorder Program;
- the Community Oriented Policing Services (COPS) anti-methamphetamine and anti-heroin task forces;
- crisis intervention teams to embed behavioral health services with law enforcement;
- First Step Act implementation (e.g., medication for addiction treatment, recidivism reduction programs, reentry assistance); and
- a juvenile justice initiative related to youth affected by substance use.
Funding for drug interdiction and supply reduction includes funding for:
- the Drug Enforcement Administration (DEA);
- Drug Interdiction and Counter-Drug Activities at the Department of Defense;
- International Narcotics Control and Law Enforcement at the State Department; and
- screening personnel and technology at Customs and Border Protection.
The appropriations also increased funding to programs that can help improve social determinants of health and ultimately help prevent substance use, such as:
- nutrition programs (e.g., SNAP, WIC, Children Nutrition Programs);
- housing programs (e.g., rural housing, Homeless Assistance Grants, Native community housing, rental assistance);
- child care and family services (e.g., Child Care and Development Block Grant, Head Start, Family Violence Prevention and Services Act, kinship navigator programs, Child Abuse Prevention and Treatment Act (CAPTA) grants); and
- education programs (e.g., Student Support and Academic Enrichment State Grants, Nita M. Lowey 21st Century Community Learning Centers, Education for Homeless Children and Youth, Statewide Family Engagement Centers).