Final bill contains provisions that would impact counties

Yesterday, following last week’s 392-26 vote in the House, the Senate passed H.R. 34, known as the “21st Century Cures Act,” which includes provisions related to criminal justice, mental health and addiction—key NACo priorities. With a 94-5 vote, the Senate sends the bill to the president’s desk this weekend for his signature, and he has already indicated his support. As you may recall, several of the county-supported provisions in the massive package were formerly separate pieces of legislation that had failed to advance on their own in the 114th Congress. With time running out in the “lame duck” session, Congress attached these provisions to an underlying bill aimed to accelerate new prescription drugs to market and stimulate research at the National Institutes of Health.

Some of the provisions will help counties by:

• Reducing the number of people with mental illness in jails: By reauthorizing the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), the bill will support local efforts to decrease mental illness in jails through a broad range of activities, including jail diversion programs, mental health courts, in-jail treatments and transitional services and crisis intervention training. Through the Stepping Up Initiative, counties are already working to reduce the estimated 2 million individuals with serious mental illnesses who are admitted to 3,100 local jails each year. This has been a long-standing NACo priority.
   
• Providing community-based behavioral health services: By reauthorizing the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants, the bill will continue to allow counties, through 750 behavioral health authorities and community providers, to deliver direct behavioral health services to those with mental health conditions and substance abuse disorders. While provisions to reform the mental health system are weaker than in previous stand-alone bills, the legislation still contains some county priorities for behavioral health reform, including strengthening the behavioral health workforce and enhancing the implementation of mental health parity. Mental health reform is a top priority for NACo.
   
• Combating the opioid epidemic: By authorizing $1 billion over two years for state grants to supplement opioid abuse prevention and treatment activities, lawmakers have taken a significant step in efforts to end the opioid epidemic. While this is a positive first step, until Congress appropriates funds for these bills, local opioid programs will not receive additional federal support. The appropriation of significant funding for local opioid programs was one of the recommendations made to federal leaders in a report recently released by NACo's Task Force on the Opioid Epidemic, jointly launched this year with the National League of Cities.

While the above provisions promise to address long-standing NACo priorities, we have serious concerns with how Congress plans to pay for the $6.3 billion legislation.

Over half of the bill ($3.5 billion) would be offset by future cuts to the U.S. Department of Health and Human Services Prevention and Public Health Fund (PPHF), which helps more than 1,900 county public health departments protect residents' health and safety and prevent the leading causes of death in our communities. Federal investments like the PPHF are responsible for approximately one-fourth of local health departments' revenue, and since 2008, budget cuts have led to the loss of over 50,000 jobs at local health departments. NACo has long fought to protect the PPHF, and will continue to do so.

We must continue to work with Congress to ensure that provisions within this bill are fully appropriated. Fortunately, the current draft of the stopgap funding package that Congress is expected to pass this week includes some initial funding to implement this legislation. Thank you for your continued advocacy on behalf of our nation's counties, and we will continue to keep you updated on the latest legislative developments.

If you have any questions, please contact Brian Bowden at bbowden@naco.org or 202.942.4275