Last night the U.S. Senate passed H.R. 2471, Omnibus Appropriations for Fiscal Year 2022, a $1.5 trillion package to fund the federal government through the end of the fiscal year and provide aid to Ukraine. The president is expected to sign it today. The Labor-Health and Human Services-Education appropriations measure included in the omnibus bill provides critical funding for mental health programs. The American Psychiatric Association (APA) expresses its support for the progress made in funding many key programs, as well as provisions that would continue certain flexibilities facilitating access to telehealth for an additional five months after the current public health emergency expires.

Specifically, the extended flexibilities include waiving geographic site of service requirements, allowing for audio-only telehealth services to be provided to Medicare beneficiaries, and delaying the implementation of the requirement that Medicare patients have an in-person evaluation for mental health services within six months of the first telehealth visit with their clinician.

“Congress’s continued investment in mental health remains essential as we navigate our emergence from COVID,” said APA President Vivian Pender, M.D. “This summer, as we implement the national 9-8-8 hotline for mental health, these funds will be a critical piece of a larger puzzle.”

“Telehealth access to mental health services during the pandemic has been a lifeline that made it easier for patients to keep appointments and get the psychiatric care they need,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “That experience shows how important it is to continue telehealth access for patients not only this year, but permanently.”

Among the provisions and programs in the bill that APA supports are:

• A $2.25 billion increase over the FY 2021 enacted level for the National Institutes of Health (NIH) to $45 billion, including increases for National Institute of Minority Health and Health Disparities ($68 million), National Institute on Drug Abuse ($115 million), National Institute of Mental Health ($87 million), and National Institute on Alcohol Abuse and Alcoholism ($18 million).
• Funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) at $6.5 billion, a $530 million increase, including $2 billion directed to mental health programs, an increase of $288 million over FY 2021. This includes $102 million in additional resources for the implementation of the 9-8-8 hotline number, $42 million set aside to help communities improve related crisis care response and services, and a $10 million new pilot program to help communities create or enhance mobile crisis response teams consisting of mental health responders and avoiding unnecessary police response.
• $17 million to promote and train culturally competent care via the SAMHSA Minority Fellowship Program.
• $24 million for the Loan Repayment Program for Substance Use Disorder (SUD) Treatment Workforce to provide as much as $250,000 in loan repayments to psychiatrists and other SUD clinicians who agree to work full-time in a health professional shortage area or county with abnormally high overdose rates for up to six years.
• $25 million split between the Centers for Disease Control and Prevention and NIH to support research to identify the most effective ways to prevent firearm-related injuries and deaths, and to broaden firearm injury data collection.
• An increase of $5 million for the Employee Benefits Security Administration, which is responsible for enforcing compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) for the 2.2 million employer-sponsored health plans regulated under the Federal Employee Retirement Income Security Act. Importantly the package specifically directs additional resources be utilized to fully fund the hiring and training of additional health investigators to focus exclusively on MHPAEA compliance.
• Extending the availability of enhanced Medicaid funding for Puerto Rico and other U.S. territories through Dec. 13, 2022.
• The legislation would extend through Sept. 30 the Conrad 30 J-1 Visa Waiver Program which serves the dual purposes of easing the administrative burdens for certain international medical graduates (IMGs) while boosting the workforce of physicians available to treat mental illness and addiction in rural and other medically underserved areas.

APA commends Congress for providing this additional funding, but also notes that the final agreement on funding allocations resulted in far fewer resources for mental health services and programs than the House had initially proposed. Those initial proposals were more in keeping with the gravity of the mental health and substance use crisis our nation is experiencing. We look forward to working with the Appropriations Committees and others in Congress to devote more significant resources to the mental health and substance use needs in fiscal year 2023 and beyond.

American Psychiatric Association

The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,400 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information please visit www.psychiatry.org.