Squeezed in between last week’s presidential politics, the House and Senate were trying to work out final deals on mental health and drug legislation.
House-Senate Conferees agreed to a bill or conference report on the “CARA” legislation although the Democrats were holding out for increased appropriations that would fund the new provisions. The House adopted the conference report on Friday afternoon before leaving for the weekend.
CARA or the Comprehensive Addiction and Recovery Act is an authorization meaning that it is up to Congress to appropriate funds to actually carry out many of the proposed funding. Democrats have been calling for new funding of approximately $920 million which would go toward expanded treatment, prevention and enforcement provisions of the bill but failure to get the funds is unlikely to stop final action in the Senate. Much of the urgency has been driven by the expansion of opioid use across much of the country.
Among other items, the agreement amends CAPTA to create specificity in regard to infant “safe care plans.” State plan requirements are amended under CAPTA to require states to address the health needs and any substance use disorder resulting from a caregiver’s substance use. The amendments also direct greater monitoring of states by HHS, new data reporting through the current data collection systems and greater dissemination of best practices by HHS. That section of the bill also directs a new Government Accountability Office (GAO) report on the prevalence of Neonatal Abstinence Syndrome.
The legislation amends a number of parts of federal law that impact on drug use. It amends the Public Health Services Act and the Omnibus Crime Control and Safe Streets Act of 1968 and creates a number of prevention initiatives. It includes a directive to HHS to convene a pain management best practices inter-agency task force. The task force would be required to establish best practices for pain management and for prescribing pain medication. In addition, the task force would develop a strategy for disseminating those best practices. It also establishes a number of other drug monitoring efforts. The most recent heroin wave or epidemic is linked to the overuse of prescription pain pills such as oxycodone.
The legislation allows grants to state and local substance abuse agencies, Indian tribes or tribal organizations, or nonprofit organizations in geographic areas that have a high rate of—or have had rapid increases in—heroin or other opioids to expand treatment. Other initiatives target schools and institutions of higher education.
In addition to the CARA Act, on Wednesday, July 6, the House passed by a vote of 422 to two the Helping Families in Mental Health Crisis Act, (HR 2646). This enacts a number of reforms to the national mental health funding structure. It is an authorization and does not guarantee more funding. The legislation will create a new higher status Assistant Secretary for Mental Health and Substance Use Disorders and would replace the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). It also provides for pediatric mental health subspecialists to become eligible for National Health Service Corps programs and allows child psychiatry to be designated as a health professional shortage area.
The legislation does have it distractors which include those who have concerns about protecting health information of an individual with a serious mental illness and the potential disclosure of such information.to caregivers under certain circumstances.
Despite the vote, an agreement must be reached with senators.