As the country marks two years of living with COVID-19, it’s abundantly clear the diseasecaused shutdowns, closures, and social limitations have led to a significant increase in the prevalence of mental health and substance use disorders (MH/SUD). Although pandemic life continues to take its toll on communities throughout the nation, federal policymakers are responding by pivoting away from reactionary stopgap measures in favor of forward-thinking systemic changes.

Recently three federal departments (Labor, Health and Human Services (HHS) and Treasury) issued their 2022 Report to Congress, building the case for regulatory action on one of the Biden Administration’s top behavioral health priorities: to ensure that the financial requirements and treatment limitations imposed by insurers on MH/SUD benefits are no more restrictive than those that apply to medical and surgical benefits. The report indicates the Administration is concerned that insurers are not delivering the parity in care as required by the 2008 Mental Health Parity and Addiction Equity Act – even as demand for MH/SUD treatment services spiked during the pandemic. 

In addition to rulemaking that clarifies the MH/SUD parity requirements under existing law, HHS plans to issue regulations this year that would help providers treating opioid-use disorders by increasing access to extended take-home doses of methadone and permitting medication-assisted treatment through telehealth appointments.

After infusing the behavioral health care system with billions of dollars in emergency funding through the passage of the American Rescue Plan Act last year, Congress is now looking to take proactive steps to strengthen federal programs that facilitate state approaches to meeting unmet behavioral health needs. And since 2022 is an election year, federal policymakers are prioritizing non-controversial, bipartisan proposals that could be enacted during what promises to be another politically polarized year.

Specifically, there are several initiatives to watch as the year progresses:

• The leaders of the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee recently announced their intention to put together a legislative package this summer that would address MH/SUD issues. Both Senate Committees, as well as the House Energy and Commerce Committee and the Ways and Means Committee, have held hearings over the last several weeks. This recent flurry of Congressional activity from both sides of the Capitol represents a concerted bipartisan effort to develop meaningful solutions. It builds on a Senate Finance Committee initiative begun last fall in which the panel solicited public policy changes from health care stakeholders that would increase access to mental health services, make treatments more effective, and reduce the financial burdens associated with the delivery of care. This bipartisan effort continues into 2022 as a top priority for Chairman Ron Wyden (DOR) and Ranking Member Mike Crapo (RID). Finding budget offsets to pay for largescale programmatic changes, as well as navigating election year politics, will be the primary challenges for lawmakers seeking to improve the delivery of behavioral health care services

• Another bipartisan initiative launched last year, by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT), focuses on expanding and enhancing existing federal MH/SUD programs set to expire this year. Stemming from the 2016 21st Century Cures Act, improvements to these programs could be included in FDA user fee reauthorization legislation expected to be considered later this summer.

• The House Bipartisan Addiction and Mental Health Task Force continues working through its robust agenda of more than 70 pieces of MH/SUD legislation. The task force notched several legislative victories in 2021 and its leaders are hopeful the bipartisan nature of the caucus will move more bills across the goal line.

• Congress continues ongoing efforts to combat the opioid epidemic, and other SUDs, by exploring how to improve the programs started with the passage of the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act, both of which became law in 2016. Many of the SUDs programs and associated funding must be reauthorized this year, so updated versions of these laws are being considered in the Congressional health committees.

• Behavioral health stakeholders are calling on Congress to pass an omnibus appropriations bill that will fund federal MH/SUD programs and MH/SUD pandemic response initiatives for the remainder of the fiscal year, which ends Sept. 30. The federal government is currently funded by a continuing resolution that will expire Feb. 18. Stakeholders are urging Congress to act quickly to ensure the passage of appropriations that will support mental health block grants to states, a new ‘988’ national suicide hotline, 24/7 call centers staffed by mental health professionals, mobile response teams, and crisis stabilization services that connect people to follow-up care. The stakeholder community views these investments as critical to meeting pandemic-driven behavioral health needs.