On Wednesday, the House Energy and Commerce Committee unanimously approved a revised version of the Helping Families in Mental Health Crisis Act (H.R. 2646). Introduced and championed by Rep. Tim Murphy (R-PA), the bill now heads to the House floor where it awaits consideration from the full chamber. According to reports, Speaker Paul Ryan (R-WI) aims to bring the bill up for a vote by the full House this summer. There is currently no companion mental health bill in the Senate, though similar measures have been introduced.

The passage of H.R. 2646 signals the latest action from the House of Representatives on meaningful addictions and mental health legislation. Last month, the chamber approved a series of bills related to addictions and curbing the nation’s opioid epidemic.

Key provisions of the amended Helping Families in Mental Health Crisis Act include:

• IMD Exclusion – The bill codifies a limit on Medicaid coverage for inpatient mental health care at institutions for mental diseases (IMDs) per the final Medicaid managed care rule.
• HIPAA – The bill no longer includes language that would loosen Health Information Portability Accountability Act (HIPPA) restrictions. It does, however, create a program to educate providers about what information can and cannot be shared.
• Parity – The approved legislation no longer requires the Centers for Medicare and Medicaid Services (CMS) to report on federal investigations into compliance with the law. It does requires the Government Accountability Office (GAO) to complete a study detailing federal oversight of group health plans – including Medicaid managed care plans – to ensure those plans are not using discriminatory coverage limitations for persons with mental health and substance use conditions.
• Grant Programs – The approved bill reauthorizes grant programs – including the Garrett Lee Smith program and a program dedicated to early intervention and prevention of youth suicide. No new funding streams were provided these initiatives.
• Assisted Outpatient Treatment (AOT) – The amended version no longer includes a provision that would provide states with existing AOT laws a 2 percent increase in block grant funding, as was included in previous drafts. The bill extends an assisted outpatient grant program for individuals with a serious mental illness (SMI) through 2020.
• Assistant Secretary for Mental Health – The new bill includes the creation of an Assistant Secretary for Mental Health within the Department of Health and Human Services (HHS). This position assumes the roles and responsibilities of the SAMHSA Administrator but will no longer require Senate confirmation.
• SAMHSA Strategic Plan – The amended bill requires the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a strategic plan in coordination with the National Institutes of Mental Health, the Assistant Secretary of Mental Health, and the HHS Secretary. The bill also calls for an independent evaluation of SAMHSA to determine whether the agency is meeting its indicated mission effectively.

The National Council is disappointed that provisions based on the Excellence in Mental Health Act and the Mental Health First Aid Act did not appear in committee-approved bill. The Certified Community Behavioral Health Clinic demo is one of the only provisions that expends additional federal resources for community-based programs. During the markup hearing, Representatives Leonard Lance (R-NJ) and Doris Matsui (D-CA) spoke at length about the importance of expanding the Certified Community Behavioral Health Clinic demonstration program. Mental Health First Aid, though a continued priority for appropriators, was also not included in the final bill. The National Council remains diligent in its efforts to have these provisions added during final deliberations.

During the markup hearing, Committee members offered and withdrew a number of National Council-supported amendments. Symbolic in nature, these amendments could resurface as the bill moves through its final stages on the way to passage. They include:

• Parity: Rep. Joe Kennedy (D-MA) introduced an amendment based on his parity enforcement legislation, the Behavioral Health Coverage Transparency Act (H.R. 4276). The bill would require insurance providers to disclose the analysis they utilize in making parity determinations as well as the rates and reasons for mental health claims denials versus medical/surgical denials.
• Mental Health in Schools: Rep. Ben Ray Lujan (D-NM) introduced an amendment based on the Mental Health in Schools Act (S. 1588/H.R. 1211). This bill – a legislative ask at National Council Hill Day – builds on successful, evidence-based programs within SAMHSA, incorporating promising practices to help communities take action and help youth and adolescents in need.

To be clear, approval out of committee is the latest in a long series of parliamentary steps for a bill to become law. If approved by the House of Representatives, an identical bill would still need to be passed by the Senate before it would head to the White House for consideration by the President. In the Senate, Senators Bill Cassidy (R-LA) and Chris Murphy (D-CT) have introduced the Mental Health Reform Act (S. 2680). There is no news to date as to when that bill will be considered by the full Senate chamber.

As always, the National Council will continue to update its members with these and other important developments on our blog, the Capitol Connector.

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