December 22, 2020

Last night, Congress approved a $2.4 trillion year end spending and stimulus package including Fiscal Year 2021 appropriations, COVID-19 stimulus package, Medicaid program extensions, and a number of other provisions. Below is a topline summary of the mental health and substance use provisions.

Click here for a detailed report on the entire package.

COVID Relief Provisions

The bipartisan COVID-relief proposal includes an appropriation of $4.25 billion for mental health and substance use programs above and beyond regular FY21 spending, including:

• $1.65 billion for the Substance Abuse Prevention and Treatment Block Grant
• $1.65 billion for the Community Mental Health Services Block Grant with no less than 50 percent of funds being directed to behavioral health providers
• $600 million for Certified Community Behavioral Health Clinic Expansion Grants to be allocated by SAMHSA
• $50 million for suicide prevention programs
• $50 million for Project AWARE
• $240 million in emergency grants to states
• $125 million of the above-mentioned allocations should be funding to tribes

The package also included in the following provisions

• Certified Community Behavioral Health Clinics. The bill extends a series of CMS-funded programs, including the CCBHC Medicaid demonstration, through to September 30, 2023. This extension applies to existing PPS-receiving CCBHC states. The package also extends the enhanced FMAP payment through September 30, 2023 for these states. Visit the CCBHC Success Center page for details on the demonstration states.

•  Telehealth. The bill permanently expands access to telehealth services in Medicare to allow beneficiaries to receive mental health services via telehealth, including from the beneficiary’s home. To be eligible to receive these services via telehealth, the beneficiary must have been seen in person at least once by the physician or non-physician practitioner during the six months period prior to the first telehealth service, with additional face-to-face requirements determined by the Secretary. The final text also calls for a study of the effectiveness of telehealth during the COVID-19 pandemic. The current Drug Enforcement Agency flexibilities to prescribe controlled substances via telemedicine are still allowed per the Public Health Emergency declaration.

• Parity. The package includes provisions of the Strengthening Behavioral Health Parity Act of 2020 (H.R. 7539) which authorizes and requires the Departments of Labor, Treasury and Health and Human Services to conduct random audits and comparative analyses of at least 20 insurance plans per year to ensure proper and full enforcement of existing parity laws. Additionally, the act appropriates $2.5 million in grants to each state to establish all-payer claims databases. This is an important step that will help move states toward parity with greater access and transparency into claims data.

• Small Businesses. $325 billion for Small Business Administration is allocated for a second round of Paycheck Protection Program (PPP) loans. This includes eligibility for 501(c)(6) nonprofit organizations with as many as 300 employees.

• Provider Relief Fund. The final package provides an additional $9 billion in support for health care providers including $3 billion in grants for hospital and health care providers to be reimbursed for health care related expenses or lost revenue directly attributable to the public health emergency resulting from coronavirus, along with direction to allocate not less than 85 percent of unobligated funds in the Provider Relief Fund through an application-based portal to reimburse health care providers for financial losses incurred in 2020.

• Additional Relief. The act provides for a one-time, one-year increase in the Medicare physician fee schedule of 3.75 percent, in order to support physicians and other professionals in adjusting to changes in the Medicare physician fee schedule during 2021, and to provide relief during the COVID-19 public health emergency.

• Coronavirus Relief Fund Extension. Extends the date by which state and local governments much make expenditures with CARES Act Coronavirus Relief Fund awards from December 30, 2020 to December 31, 2021.

• Telehealth Grants and Broadband Access: The final package appropriates funding for three programs for funding telehealth and greater broadband connectivity. The first appropriates an additional $250 to the Federal Communications Commission for the COVID-19 Telehealth reimbursement program authorized by the CARES Act in March, 2020; the second, establishes the Emergency Broadband Benefit Program at the FCC, under which eligible households may receive a discount of up to $50, or up to $75 on Tribal lands, off the cost of internet service and a subsidy for low-cost devices such as computers and tablets; the third, establishes grant programs at the National Telecommunications and Information Administration to bolster broadband connectivity on tribal lands and in state and local governments across the country.

FY2021 SAMHSA Appropriations

The $1.4 trillion omnibus appropriations package also includes annual funding for health-related agencies and priorities for fiscal year 2021. These allocations are in addition to the COVID relief provisions described above. Detailed below are spending allotments for regular order appropriations for the Substance Abuse and Mental Health Services Administration.