What’s in the FY 2022 Appropriations Act?

Congress passed and President Biden signed a $1.5 trillion spending package to fund the federal government for the remainder of fiscal year 2022, through September. It includes 12 appropriations bills for the various federal departments and agencies.

The package contains billions of dollars for addressing the mental health and addiction crises, including:

• $6.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) (a $530 million increase over FY 2021), including:
  • $2 billion for mental health, including increases in funding for the Mental Health Services Block Grant and a 5% set-aside for evidence-based crisis systems, youth mental health programs and resources (e.g., Project AWARE, National Child Traumatic Stress Initiative, Infant and Early Childhood Mental Health, first episode psychosis prevention/intervention), Certified Community Behavioral Health Clinics (CCBHCs), suicide prevention (e.g., grants, 988 implementation), and behavioral health crisis response services.
  • $3.9 billion for substance use treatment, including funding for the Substance Abuse Prevention and Treatment Block Grant, State Opioid Response grant program, Building Communities of Recovery program, services for pregnant and postpartum women, and evaluation of substance use treatment programs.
  • $218.2 million for substance use prevention, including funding for the Strategic Prevention Framework and Sober Truth on Preventing Underage Drinking.
  • $31.4 million to carry out national surveys on drug use and mental health, collect and analyze program data, and conduct public awareness and technical assistance activities
• $449 million for the Office of National Drug Control Policy (ONDCP), including:
  • $296.6 million for the High Intensity Drug Trafficking Area (HIDTA) program (increase of $7 million)
  • $106 million for the Drug-Free Communities program (increase of $4 million)
  • $3 million for drug court training and technical assistance
  • $1.3 million for the Model Acts Program to advise states on model drug policies
• $50 million in increased funding for National Institutes of Health research related to opioid addiction, opioid alternatives, stimulant misuse and addiction, pain management, and addiction treatment, as well as $1.6 billion for the National Institute on Drug Abuse, $2.1 billion for the National Institute of Mental Health, and $573.7 million for the National Institute on Alcohol Abuse and Alcoholism.
• $491 million for opioid prevention and surveillance at the Centers for Disease Control and Prevention (a $15 million increase).
• Increased Health Resources and Services Administration (HRSA) funding to expand the behavioral health workforce, including through the Substance Use Disorder Treatment Loan Repayment Program, National Health Service Corps, and fellowship programs.
• Veterans Affairs funding, including $13.2 billion for mental health care, $621 million for opioid misuse prevention, and $84 million for Whole Health Initiatives.
• Funds for the Indian Health Service Substance Abuse and Suicide Prevention Program; opioid prevention, treatment, and recovery services; Zero Suicide Initiative; and Telebehavioral Health Center of Excellence.
• Funding for Department of Education programs to increase the availability of mental health services in schools, including through increased funding for the Social Emotional Learning (SEL) Initiative, which includes grants to address student social, emotional, and cognitive needs ($82 million); teacher professional development and pathways into teaching that provide a strong foundation in implementing SEL and whole-child strategies ($85 million); Mental Health Services Professional Demonstration Grants and School-Based Mental Health Services Grants ($111 million); and Full-Service Community Schools ($75 million).
• Funding for criminal justice, law enforcement, and reentry programs, including for First Step Act programs, Second Chance Act programs including a grant program for crisis stabilization and community reentry, a drug data research center, drug courts, mental health courts, veterans treatment courts, the Residential Substance Abuse Treatment for State Prisoners grants, a program to monitor prescription drugs, a juvenile justice delinquency prevention initiative relating to youth affected by substance use, and the comprehensive opioid, stimulant, and substance abuse program.
• Funding for drug interdiction and supply reduction, including $2.4 billion for the Drug Enforcement Administration; funding for interdiction, counter-drug, and anti-trafficking activities through the Department of Defense, State Department, and Department of Justice; and grants to state and tribal law enforcement agencies to investigate illegal drug activity.

In addition to funding, the bill also includes several policy provisions. It includes provisions:

• Giving the Food and Drug Administration (FDA) authority over synthetic nicotine, currently a loophole in its authority. As the FDA has cracked down on e-cigarette makers to curb youth use, some companies, including Puff Bar, one of the brands most popular with youth, have begun switching to synthetic nicotine products to avoid FDA regulation. Makers of synthetic nicotine products will now have to be authorized by the FDA like other tobacco products. This will help FDA continue to remove addictive products from the market that are appealing to and popular among youth.
• Extending the scheduling of fentanyl analogues as Schedule I drugs through the end of the year.
• Extending the Medicare telehealth flexibilities provided during COVID-19 for five months after the public health emergency ends. It extends rules allowing Medicare beneficiaries to access virtual care from their homes, delaying in-person requirements for virtual mental health care, expanding telehealth access for mental health services provided by Federally Qualified Health Centers and Rural Health Clinics, allowing audio-only telehealth services, and providing access for high-deductible plans before patients hit their deductibles. It does not include flexibility to prescribe controlled substances over telehealth.
• On marijuana. The bill includes the rider included in previous years preventing D.C. from establishing a regulated cannabis market, despite a referendum in 2014 legalizing recreational marijuana. It also continues to protect medical markets legal at the state level, but does not extend those protections to adult-use markets.

For more information, see the full text of the law here, summaries from the House Appropriations Committee here, and summaries from the Senate Appropriations Committee here.