On April 5, the House Energy and Commerce Subcommittee on Health held a hearing titled, “Communities in Need: Legislation to Support Mental Health and Well-Being.” The subcommittee discussed 19 bills to promote access to mental health and substance use disorder services, particularly among children and youth, tribal populations, and individuals in the perinatal period.
Specifically, the subcommittee considered eight bipartisan bills to reauthorize 30 Substance Abuse and Mental Health Services Administration (SAMHSA) programs and two Health Resources and Services Administration (HRSA) programs that are slated to expire in September. This discussion was informed by testimony from SAMHSA Assistant Secretary Miriam Delphin-Rittmon, PhD, and HRSA Administrator Carole Johnson. Delphin-Rittmon and Johnson previously testified before the Senate Health, Education, Labor, and Pensions Committee about the need to reauthorize these existing programs [refer to Washington Highlights, March 25].
In his opening statement, committee Chair Frank Pallone, Jr. (D-N.J.) discussed the committee’s ongoing work to promote access to mental and behavioral health services, particularly among children and young people. He highlighted several pieces of legislation, including the Mental Health Justice and Parity Act of 2022 (H.R. 7254), which applies mental health parity laws to self-funded, non-federal governmental health plans, and the KIDS CARES Act (H.R. 7233), which requires state Medicaid programs to screen eligible juveniles for behavioral health conditions prior to their release from incarceration.
Echoing Pallone’s comments, subcommittee Chair Anna Eshoo (D-Calif.) highlighted the urgent need to address the nation’s youth mental health crisis, citing “insufficient insurance coverage, limited options due to poor provider reimbursement, and an aging system” as the primary barriers to accessing care. She raised the Strengthen Kids’ Mental Health Now Act (H.R. 7236), which she co-sponsored and that requires state Medicaid programs to reimburse for pediatric mental health services at Medicare rates through 2027 in order to enhance behavioral health provider network adequacy. Eshoo also noted other bills that seek to improve the mental health of youth, create high-quality housing for individuals with substance use disorders, and enhance virtual peer support services, stating, “this slate of bills shows that there is clearly bipartisan demand to address the mental health crisis in both the pediatric and adult populations.”
Subcommittee Ranking Member Brett Guthrie (R-Ky.) underscored the impact of substance use disorders, compounded by the increasing prevalence of fentanyl, in his home state. “In Kentucky, illicit fentanyl accounted for over 70% of these drug overdoses in 2020 alone, up from 58% in 2019,” he said. To address this challenge, Guthrie raised a bipartisan bill that he co-sponsored, the Substance Use Prevention, Treatment, and Recovery Services Block Grant Act of 2022 (H.R. 7235), which reauthorizes the SAMHSA’s Substance Abuse Prevention and Treatment Block Grant program. “Above all, it is incredibly important now more than ever, for Congress to be working on bipartisan solutions to address and close gaps in care for those seeking help,” he said.
The committee heard from Steven Adelsheim, MD, director of the Stanford Center for Youth Mental Health and Wellbeing and clinical professor of psychiatry and behavioral sciences at Stanford Medicine. Adelsheim noted that although many mental and behavioral health conditions manifest during the early stages of a person’s life, the nation’s mental health system is ill-equipped to detect and treat these issues. “If there has been any silver lining in this pandemic it is the current national recognition of the mental health needs of our children and young people and a renewed commitment to mental health support across the country,” he stated.
To address the mental health challenges reported by children and young people, Adelsheim outlined several key policy recommendations, including the provision of integrated behavioral health services through school-based health centers and community-based programs. In addition, he described the challenges created by comparatively low reimbursement rates under Medicaid, stating, “by raising Medicaid reimbursement rates to align with Medicare reimbursements we are making the choice to equally value the wellbeing of our youth early and increasing their opportunities for successful and productive lives.” The issue of comparatively low reimbursement rates and the broader implications for behavioral health network adequacy was raised during the Senate Finance Committee’s March 30 hearing on mental health parity [refer to Washington Highlights, April 1].
Adelsheim also underscored the urgent need to invest in the behavioral health workforce and establish a path for individuals from underserved and underrepresented communities to enter the profession. “[I]t is critical to ensure that behavioral health workforce opportunities as well as interventions reach communities of color, thereby connecting children with culturally competent, developmentally appropriate care,” he stated.