Article Published: 4/20/2023
The president’s 2023–2024 proposed budget aims to grow the behavioral health workforce; increase access to services, improve crisis care, and advance mental health research. President Biden’s overall goals include strengthening system capacity; connecting more Americans to care; and creating a continuum of support through investment in equitable, evidence-based mental health services.
Apply the Mental Health Parity and Addiction Equity Act to Medicare
Unlike most private and employer-based insurance and Medicaid plans, Medicare is not subject to the 2008 Mental Health Parity and Addiction Equity Act. The proposed budget would ensure parity requirements of this act apply to the mental health and substance use disorder benefits offered by Medicare Advantage plans, ensuring enrollees do not face greater limitations on reimbursement or access to care.
Eliminate the 190-day Lifetime Limit on Psychiatric Hospital Services
Under current law, once an individual receives Medicare benefits for 190 days of care in a psychiatric hospital during their lifetime, no further benefits of that type are available to that individual. The proposed budget would eliminate the lifetime limit on psychiatric hospital services and increase the overall availability of inpatient psychiatric hospital services.
Revise Criteria for Psychiatric Hospital Terminations From Medicare
Current law requires the Centers for Medicare & Medicaid Services (CMS) to terminate psychiatric hospital participation in Medicare after 6 months of noncompliance with conditions of participation, even if the deficiency does not jeopardize patient health and well-being. The budget proposal gives CMS flexibility to allow a psychiatric hospital to continue receiving Medicare payments when deficiencies are not considered to immediately jeopardize the health and safety of its patients.
Modernize Medicare Mental Health Benefits
While the Consolidated Appropriations Act of 2023 added coverage for mental health counselors, there remain significant gaps in Medicare mental health benefits. The budget proposal would allow Medicare to identify and designate additional professionals who could enroll in Medicare such as clinical social workers, peer support workers, and certified addiction counselors.
Require Medicare to Cover Three Behavioral Health Visits Without Cost-Sharing
Medicare Part B includes coverage of behavioral health visits to a doctor, therapist, or other clinician for services generally received outside of a hospital, but the annual Part B deductible and coinsurance apply, with limited exceptions. The budget proposal would require Medicare to cover up to three behavioral health visits per year without cost-sharing when furnished by participating providers, beginning in 2025.
The budget provides $10.8 billion for SAMHSA, an increase of $3.3 billion. The proposed increase will expand access to lifesaving behavioral health care and grow investments in crisis response, harm reduction, the behavioral health workforce, services to people experiencing homelessness, and recovery services.
Investing in Mental Health and Crisis Response
The budget provides $4.9 billion for SAMHSA’s mental health activities, an increase of $2.2 billion. The proposed investments will address suicide prevention, increase crisis response, and provide direct services to people experiencing homelessness.
988 and Behavioral Health Crisis Services
The budget builds on the historic investments in suicide prevention made in FY 2023 and ensures the 988 and Behavioral Health Crisis Services program is accessible and tailored to all people seeking help. In FY 2024, SAMHSA would dedicate $836 million to the 988 and Behavioral Health Services program. This would provide funds for a fully developed crisis response system that answers at any time or place, for specialized services for LGBTQI+ youth, and services for Spanish speakers. It invests significantly in local crisis centers and would develop a national media campaign.
Mental Health Infrastructure
The budget would continue to invest in the nation’s mental health infrastructure, beginning with $1.7 billion for the Community Mental Health Block Grant, an increase of $645 million. This block grant provides flexible funding and supports stable and effective services for our nation’s most vulnerable populations.
The budget includes $553 million for the Certified Community Behavioral Health Clinics grant program, an increase of $168 million.
In support of the president’s call for transforming the delivery of mental health care, the budget includes a $2 billion mandatory Mental Health System Transformation Fund to expand access to mental health services through workforce development and service expansion, including the development of nontraditional health delivery sites, the integration of quality mental health and substance use care into primary care settings, and dissemination of evidence-based practices.
Address Overdose Epidemic and Support Recovery
The budget would provide $5.7 billion for substance use prevention and treatment activities, an increase of $1.3 billion, funding states and territories to increase access to treatment for substance use disorder, advance public-health interventions like naloxone, and expand recovery support services.
The budget proposes to provide $50 million for a harm reduction program to continue the initiative first created in the American Rescue Plan. The budget also proposes to increase access to naloxone by providing $78 million to the First Responder Training program, an increase of $22 million, and providing $28 million for grants to prevent overdose, an increase of $12 million.
The budget includes $2.7 billion for the Substance Use Prevention, Treatment, and Recovery Services Block Grant—an increase of $700 million.
The budget also includes $2 billion for the State Opioid Response grant program, a $425 million increase, to provide direct services to prevent, treat, and promote recovery from issues related to opioid misuse.
Building Capacity to Improve Nation’s Behavioral Health
The budget would continue to support access to high-quality public health data regarding mental health and substance use.
Expanding and Diversifying the Behavioral Health Workforce
The budget includes $37 million for SAMHSA’s Minority Fellowship Program, an increase of $17 million. Since the Fellowship began in 1973, the program has increased the number of culturally competent behavioral health professionals who teach, administer, conduct services research, and provide direct mental illness or substance use disorder treatment services for underserved populations. The proposed investment in this program will almost double the number of fellows and increase the number of trained providers to 6,500.
Behavioral Health Workforce Development
HRSA’s behavioral health workforce development programs train new behavioral health providers—including clinicians, peer support specialists, and others—and increase the number of providers practicing in areas of high demand throughout the country. The FY 2024 budget includes $387 million, an increase of $190 million, to train about 18,000 behavioral health providers to help respond to the mental health and substance use crisis currently affecting our country.
Supporting the Mental Health and Wellness of the Health Professions Workforce
The FY 2024 budget invests $25 million in support of the Dr. Lorna Breen Act for a new program to support the development of a culture of wellness in health care facilities, including hospitals, rural health clinics, community health centers, and medical professional associations.
Rural Opioids Response
Within the total for Rural Health, the budget invests $165 million for the Rural Communities Opioid Response Program, an increase of $20 million. This increase will support the development and continuation of community-based grant programs and technical assistance that provide needed behavioral health, including opioid use disorder and substance use disorder services to rural residents.
Rural Behavioral Health Initiative
The budget for rural health includes $10 million for a new Rural Health Clinic Behavioral Health Initiative to expand access to mental health services in rural communities.
Youth Mental Health Promotion and Treatment
The budget request includes $90 million, an increase of $52 million, for CDC’s What Works in Schools program. The program strengthens the integrated delivery of mental health promotion and treatment interventions to students and families across a range of care settings with a focus on Black and Hispanic youth, female students, and LGBTQI+ youth who experience disproportionately adverse mental health outcomes.
The FY 2024 budget requests $80 million, an increase of $50 million, for the Suicide Prevention Program to expand the CDC’s work, and other nongovernmental organizations and university research programs to reduce suicide, to all 50 states, the District of Columbia, and 18 tribal and territorial communities.
Combatting Overdose and Addiction
The budget includes over $1.8 billion within NIH for opioids, stimulant and pain research. Of this total, $1.2 billion would support ongoing research across the Institutes and Centers, while $636 million is allocated to the Helping to End Addiction Long-term (HEAL) Initiative. Founded in 2018, the HEAL initiative strives to address opioid addiction by developing new treatments and strategies to address both pain and opioid use disorder and advance healthy equity.
Innovating Mental Health Research and Treatment
The FY 2024 budget includes an increase of $200 million for the National Institute of Mental Health to support better diagnostics, improved treatments, and enhanced precision of care for mental health.
Agency for Health Care Research and Quality (AHRQ) Programs
The FY 2024 budget requests $5 million in new funding, which would allow AHRQ to conduct new research to better understand how to scale and spread existing local integrated care network models. Local integrated care networks provide behavioral health support systems for primary care practices.
The proposal provides $125 million in mandatory funding over 5 years for grants to states to enforce mental health and substance use disorder parity requirements. Any funds not expended by states at the end of 5 fiscal years would remain available to the HHS secretary to make additional mental health parity grants.
The budget plan from the White House would significantly expand mental health workforce development programs for counselors through new initiatives offered by SAMHSA, HRSA, and CDC, and significantly increase funding for crisis and mobile services at the local level. These initiatives and others highlighted in this report, if enacted, would offer new opportunities for counselors to participate in several delivery systems and programs in the public and private sectors.
The FY 2024 budget process is still in its early phases, and there will likely be several changes to the budget between now and the end of the calendar year. NBCC will be closely monitoring the budget development process and reporting on progress in investments in the mental health system.
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