October 18, 2024

(Following info is from the National Council)

As we approach the November 5 election, National Council aims to continue sharing timely information about what we might see in terms of legislative and regulatory policy, along with what to expect from the appropriations process as we wrap up 2024 and move into 2025.   

There are several possible factors that could influence both the lame duck session and policy priorities for the 119th Congress. We plan to share updates on what to expect on a monthly basis from now until the 119th Congress convenes in January 2025.  
 
Here are some key considerations and areas of focus as we approach the election:  

Timing of Election Results and Key Congressional Actions: Congress is currently set to return on November 12th. Given how close the presidential race and several key congressional races are likely to be, it is possible that we will not know the results of the presidential election or who controls each chamber of Congress until several days after November 5th. With this potential uncertainty, the time needed for organizational efforts leading into the next Congress, and the need to address a disaster relief supplemental, there may be limited time for Congress to pass a substantial policy or funding package during the lame duck session.  

Election Scenarios:   

Trump Wins Election:

• If Trump wins the election and Republicans control one chamber of Congress, it is possible that we may see Congressional Republicans block action on an omnibus and force through a limited continuing resolution keeping funding at current levels into early next year.  Under this scenario, Congress would likely punt major funding items into next year so that decisions can be made once Republicans have control of the Presidency, allowing for greater influence over the final decisions. However, should Republicans sweep the elections, we may see discussion of moving through the fiscal year 2025 funding bills to clear the deck, allowing for focus on a reconciliation package which would advance major tax policies and may contain changes to Medicaid and the Affordable Care Act Marketplace programs.  Under both scenarios, similar to what we saw with the minibus passed in March of this year, action on substantive healthcare policy items would be limited, with the majority of non-essential priorities punted into 2025.    

Harris Wins Election:   

• Should Vice President Harris win the Presidency, it is likely that Congress will do their best to reach agreement on the fiscal year 2025 funding bills.  While some House Republicans could try and assert their perspective on the bills, they do not have the numbers to stop the process.  Further, given the number of retiring Republicans and those who are intent on legislating and achieving legacy wins, an appropriations package is likely to come together.  However, even under this scenario, a sizable bill containing significant funding is unlikely.

Disaster Relief Package: While Congress is not set to reconvene until November 12th, given the widespread impact of Hurricanes Helene and Milton, it is possible that they could return earlier to authorize additional disaster relief funding. Regardless of when Congress returns, they will be forced to move a large disaster relief package that may include funding for related behavioral health services, with funds for first responder mental health programs and other similar efforts potentially included. Given the extent of the storm damage in Florida, Georgia, North Carolina and Tennessee, a lame duck disaster supplemental appropriations bill could be of unprecedented size – with unpredictable effects on unrelated congressional healthcare spending priorities.  

Lame Duck Mental Health and Substance Use Policy Considerations:  

• CCBHCs: National Council is actively engaged in discussions on Capitol Hill to ensure that key provisions of the Ensuring Excellence in Mental Health Act are included in a potential lame duck omnibus package. This includes:
  • Defining CCBHCs, their full scope of services as outlined in the SAMHSA criteria, and the prospective payment system (PPS) payment methodology; and
  • Creating ongoing technical assistance infrastructure to enhance and improve existing CCBHCs and state-based implementation of the CCBHC model.
• Telehealth: Several critical telehealth flexibilities are set to expire at the end of 2024. Among  them is a Drug Enforcement Administration (DEA) waiver allowing certain controlled substances such as buprenorphine, to be prescribed via telehealth. However, the waiver will expire on Dec. 31, 2024, and there has been a strong and well-organized push by a large group of advocates, including National Council, to extend the waiver. A final rule creating another extension is currently with the White House Office of Management and Budget (OMB), and we expect the rule to mirror the flexibilities for prescribing of controlled substances that are currently in place. While we do not know exactly when the rule will be released, we will continue to keep you apprised of further developments as they unfold.
• SUPPORT Act Reauthorization: Several provisions of the original SUPPORT Act were made permanent as part of the Consolidated Appropriations Act, 2024, passed earlier this year. However, reauthorization of the remainder of the SUPPORT Act, which includes a range of substance use treatment programs, has bipartisan backing, but has been stalled since last year’s deadline for renewal passed. If a large health package comes together during the lame duck session, the SUPPORT Act may be included. 

Regardless of how the presidential and congressional elections unfold, it is very unlikely that funding for CCBHCs and other core behavioral health programs will lapse or experience any significant shortfalls. 

In addition to monthly updates containing a revised version of this document, National Council will continue to share relevant updates on developing legislative and regulatory news and priorities to our members, as well as through our weekly Capitol Connector newsletter, which any member can sign up to receive.  

Depending on how funding packages are coming together, National Council may identify opportunities for advocacy from members in some (potentially all) states. This could take the form of sign on letter campaigns, earned media opportunities (op-eds, letters to the editor, etc.) and messages to Congress via our virtual advocacy platform. We will stay in regular touch about these opportunities as they present themselves.   

If you have any questions about any of the information presented here, please do not hesitate to reach out to me or Peter Delia at peterd@thenationalcouncil.org.