[Updated] Gun Reform Bill Calls for $2.16B in New Mental Health Funding, Nationwide CCBHC Expansion

Editor’s note, June 24, 2022: On Friday, the U.S. House of Representatives voted 234-193, with 14 Republicans joining all House Democrats, to approve the Bipartisan Safer Communities Act. Biden is expected to sign the bill into law.

The new U.S. gun reform framework proposes to allocate $2.16 billion to mental health initiatives and expand certified community behavioral health clinics (CCBHCs) nationwide. 

The bill, named the Bipartisan Safer Communities Act (BSCA), comes out of a handshake agreement among a cadre of key Republican and Democratic senators — led by Sens. John Cornyn (R-Texas) and Chris Murphy (D-Conn.) — in response to a rash of mass killings, most notably the 21-fatality shooting at Robb Elementary School in Uvalde, Texas. The bulk of the bill provides funding for youth mental health and school-based behavioral health services.

“We certainly welcome attempts to strengthen the mental health system, which is, as we’ve seen throughout the pandemic, has been, inadequate and needs strengthening,” David Lloyd, senior policy advisor at The Kennedy Forum, told Behavioral Health Business.

The bipartisan group behind the framework and the bill included 21 senators, including the 10 Republicans needed to secure the supermajority that beats procedural maneuvering. Democrats hold a tenuous tie in the Senate.

On Thursday afternoon, the Senate voted 65 to 34 to end the debate on the BSCA and move it forward in the lawmaking process. Senate Majority Leader Chuck Schumer said on the floor of the Senate Wednesday that he hopes to pass the bill by the end of the week. (This is a developing news situation and this story may be updated.)

Democratic Speaker of the House Nancy Pelosi reiterated Tuesday her intent to “swiftly” bring the BSCA to the floor for a vote once the House receives it.

“While more is needed, this package must quickly become law to help protect our children,” Pelosi said in a statement.

CCBHCs and what else?

Among the many mental health initiatives — many of which are specific to children — addressed in the BSCA, it allows all states to participate in the existing Medicaid demonstration model for certified community behavioral health clinics (CCBHCs).

(You can find detailed summaries of the BSCA here and here.)

Originally created in 2014, CCBHCs are clinics operated by nonprofits or government health authorities that provide, directly or through partnerships, nine types of services. To name a few, these include outpatient mental health services, 24/7 crisis response, addiction treatment, peer counseling and care coordination with other care providers.

They also see patients regardless of their ability to pay and operate under a Medicaid prospective payment system. Presently, there are over 430 CCBHCs operating in 42 states, according to the industry group the National Council for Mental Wellbeing.

“If passed, this bill will forever change how people access mental health and substance use treatment in their communities,” National Council CEO and President Chuck Ingoglia said in a statement. “Expanding [CCBHCs] nationwide is transformational and will dramatically expand access to comprehensive and lifesaving services while helping support and grow the behavioral health workforce.”

The organization points to a 2021 report from the Government Accountability Office, a nonpartisan congressional research body, that found CCBHCs reduced hospitalizations by 90%. It also cites its own survey data that finds 50% of CCBHCs provide same-day access for routine needs while 93% provide care within 10 days. About 89% of CCBHCs also provide access to medication-assisted treatment for addiction.

Over the next five federal fiscal years, the BSCA provides $1.42 billion for youth mental health, including $500 million in appropriations to train more school-based mental health professionals and another $500 million to increase the number of mental health services in schools.

It also appropriates $60 million to increase mental health training to primary care providers that treat children and $80 million to help pediatric providers connect with mental health specialists.

Here are other short highlights from the bill:

• Mandates that the Centers for Medicare and Medicaid Services issue guidance to states on how telehealth can increase access to care including mental health
• Reauthorization of the Pediatric Mental Health Care Access grant program for five years; expands pediatric teleconsults into emergency departments and schools
• Appropriation of $250 million over four years for SAMHSA’s Community Mental Health Block Grant program
• $150 million in one-time funding to support implementation of the 988 Suicide and Crisis Lifeline

“There is widespread recognition on both sides of the aisle on the importance of mental health right now and we need to keep that momentum going,” Lloyd said. Referring to the BSCA, he added. “If we’re ultimately able to get legislation enacted — which I think is what a lot of people hope — that will lend momentum to the broader efforts to strengthen the mental health and addiction system that are ongoing in both the House and Senate.”

What’s next?

While the BSCA moves several billions of dollars to mental health and makes other key legislative changes, there are still several other pending regulatory items that are top of mind for behavioral health operators and advocates not addressed by the bill. A key example is reimbursement parity.

One bill addressing parity includes the Restoring Hope for Mental Health and Well-Being Act of 2022 in the House of Representatives. Specifically, the bill would require compliance with federal mental health parity requirements, including by self-funded, non-federal insurance plans.

Behavioral Health Business reported Tuesday that the bill was slated to clear the House as it got a favorable assessment by several committees. It did so on Wednesday on a 402 to 20 vote. All nay votes were from Republicans.

Reimbursement discrimination between mental health and physical health reimbursement has been a long-running gripe in behavioral health. Earlier in the year, the U.S. Labor Department, Health and Human Services Department and Department of the Treasury issued a report that detailed frequent failings by insurers to abide by laws that require insurers to treat behavioral health in the same way that it treats physical health.

More broadly, the Restoring Hope for Mental Health and Well-Being Act reauthorizes several programs and makes new appropriations for youth mental health telehealth, addiction treatment, homeless efforts and other state grant programs. It also would eliminate a provision that requires most patients to be addicted to opioids for a year in order to be admitted to an opioid treatment program.

Also, in late May, members of the Senate Finance Committee released its first piece of draft legislation on mental health reform. It focuses on telehealth and Medicare. The committee has had several extensive hearings on mental health reform and released its first report on the topic in March.

Reyna Taylor, vice president of public policy and advocacy for the National Council for Mental Wellbeing, told Behavioral Health Business that the movement on a bipartisan gun bill portends well for other mental health initiatives, a sentiment Lloyd also echoed.

“It speaks to the mental health and substance use crises in our country right now that we’re probably going to have [multiple] packages around mental health,” Taylor said. “The collaboration that you see between the bipartisan supporters of the gun safety and mental health package seems to also be in collaboration with Senate Finance. … This isn’t taking something away from Senate Finance; this is addressing immediate needs in our community.”