Congress works to reauthorize behavioral and mental health programs in SUPPORT Act

Counseling

Key Takeaways

In 2018, Congress passed the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (P.L. 115-271). This comprehensive legislative package was the largest Congressional investment in overdose prevention at the time and was aimed to strengthen the country's response to the ongoing substance use crisis. 

On September 30, many policy provisions in the original package expired, requiring congressional reauthorization to continue these critical programs among a worsening overdose crisis. Below is a summary of SUPPORT Act reauthorization bills currently under consideration by Congress. 

Bill

Chamber

Committee

Description

Status

Support for Patients and Communities Reauthorization Act 
(H.R. 4531)

House

Committee on Energy and Commerce

Reauthorizes 2018 public health and substance use disorder programs and includes new Medicaid policies. Includes Medicaid policy reforms to IMD and mandates suspension versus termination of Medicaid for incarcerated individuals. 

Passed out of the House on December 12 

SUPPORT for Patients and Communities Reauthorization Act 
(S. 3393)

Senate

Committee on Health, Education, Labor and Pensions (Sponsor: Sen. Sanders - Chair)

Reauthorizes 2018 public health and substance use disorder programs; requires CMS to provide guidance to states on treating individuals with serious mental illness or children with serious emotional disturbance (does not include any specific Medicaid policy provisions).

Passed out of committee on December 12

SUPPORT for Patients and Communities Reauthorization Act of 2023
(S. 2433)

Senate

Committee on Health, Education, Labor and Pensions (Sponsor: Sen. Cassidy – Ranking Member)

Reauthorizes 2018 public health and substance use disorder programs; requires CMS to provide guidance to states on treating individuals with serious mental illness or children with serious emotional disturbance; makes policy changes to telemedicine and controlled substance delivery (does not include any specific Medicaid policy provisions).

Introduced in the Senate on July 20

Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 
(S. 3430)

Senate

Committee on Finance

Includes new reforms to Medicaid to include making the IMD state option permanent and the partial repeal of MIEP for pre-trial detainees.

Committee held mark-up on November 8

Importance for Counties

Counties are the backbone of our nation’s mental and behavioral health service system, administering treatment, recovery and support services through nearly 750 behavioral health authorities and over $80 billion in community health investments. The reauthorization of the SUPPORT Act will offer continued support to counties in their ongoing efforts to respond effectively to the ongoing behavioral health crisis. Of importance to counties:

  • The reauthorization contains several key funding streams to help support community-based substance use disorder related treatment and recovery, to include resources to bolster the behavioral health workforce.  
  • The Better Mental Health Care, Lower- Cost Drugs and Extenders Act of 2023 (S. 3430) includes a scaled down version of the Due Process Continuity of Care Act (S. 971), which seeks to amend Medicaid Inmate Exclusion Policies (MIEP) to allow for Medicaid coverage of certain pre-trial populations. 

Next Steps & Advocacy 

  • On November 17, Congress passed the Further Continuing Appropriations and Other Extensions Act, 2024 (P.L. 118-22). While this continuing resolution has kept many of the 2018 SUPPORT Act programs afloat past their original expiration, Congress is now working to reauthorize expired programs in a package to be passed alongside a beginning of year omnibus in January. 
  • The NACo Mental Health Commission recently wrote a letter to the Chair and Ranking Members on the Senate Committee on Finance and the Senate Committee on Health, Education, Labor and Pensions expressing their policy priorities to be included in any mental health legislative packages, such as the SUPPORT Act Reauthorization.

NACo will be doing a full analysis of the legislation and key provisions for counties early next year.

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