The Senate Finance Committee’s release of a draft bill focused on addressing youth and adolescent mental and behavioral health challenges marks the latest positive indicator of bipartisan interest in enacting legislation to respond to this growing national concern.
The discussion draft, released on June 15th, contains about 10 specific provisions, most of which would cost little to no federal funding. Its issuance comes as legislators are also working toward a deal on gun control legislation that would likely include provisions focused on expanding supports for mental health care, including care delivered via telehealth. It also comes as Finance Committee members are continuing to work on other pieces of a larger bill, and as other committees — notably the Senate Health, Education, Labor and Pensions (HELP) and House Energy & Commerce Committees — are also working on mental and behavioral health legislation.
Many of the provisions in the draft bill require issuances of guidance on specific topics or require enhanced reporting. Provisions would:
- Issue guidance to state Medicaid programs and school districts to enhance delivery of school-based care to children on Medicaid and CHIP, including targeted guidance to small schools in rural areas.
- Provide states with the option of providing care to youth on Medicaid or CHIP who are incarcerated and awaiting disposition of charges.
- Provide for a review by the Department of Health and Human Services (HHS) — within two years of enactment and every five years thereafter — of any gaps in care under the Early Periodic Screening, Detection and Treatment (EPSDT) benefit and to provide technical assistance to address any deficiencies along with guidance on best practices. It also requires a similar report, within three years of enactment, by the Government Accountability Office (GAO).
- Issue guidance and best practices to enhance delivery of care to children and families covered by the Indiana Health Service (IHS) along with a corresponding GAO study.
- Change current law to permit Medicaid to pay separately for mental health and primary care services if delivered on the same day.
- Issue guidance to states to improve access to mental health and substance use disorder (SUD) services to children and young adults covered by Medicaid and CHIP, including strategies to deliver services in home or community-based settings as well as best practices to serve beneficiaries from underserved communities.
The bill also includes a provision to create a federal pathway to screen providers asked to care for children from other states because the children’s care needs could not be met by providers in their home state. This is an amended version of the bipartisan Accelerating Kids’ Access to Care Act, sponsored by Sens. Chuck Grassley (R-IA) and Michael Bennet (D-CO) and Reps. Katherine Clark (D-MA) and Jaime Herrera Beutler (R-WA) and cosponsored by about 120 lawmakers.
However, the bill does not contain more sweeping proposals, such as the Strengthen Kids’ Mental Health Now Act, that would provide for parity in payment for pediatric mental and behavioral health under Medicaid and CHIP with similar services paid under Medicare and establish new funding streams to build the pediatric mental and behavioral health workforce and help fund construction of facilities to provide such care.
Other discussion drafts focused on additional aspects of mental and behavioral health are anticipated in the near-term with the expectation that the pieces would be rolled upon into a larger comprehensive bill. In addition to improving access to behavioral health services for young people, the Finance Committee earlier this year created bipartisan working groups focused on the mental and behavioral health care workforce, increasing integration and coordination of care, advancing the use of telehealth to deliver care and ensuring parity between mental and physical healthcare benefits.
A major looming question is what the precise path forward will be, particularly since other committees are engaging on the issue as well as linkages between this topic and potential gun control legislation. The limited legislative calendar could also be a factor in addition to a large and growing list of issues demanding member attention.