The Fiscal Year 2023 Omnibus Appropriations Bill that includes all 12 annual appropriations spending bills as well as a plethora of other important policy priorities was signed into law on December 29, 2022. Below is an initial summary of select provisions important to NAADAC and our members from the more than 4000 pages of the bill. A complete copy of the Consolidated Appropriations Act, 2023 can be accessed here (full text) as well as a copy of the Labor, Health and Human Services and Education and Related Agencies explanatory statement (here).
Of note, we are especially pleased to highlight the significant funding increase in several of NAADAC’s priority programs as well as the reauthorization of the newly renamed Substance Use Prevention and Treatment (SUPT) Block Grant.
Minority Fellowship Program:
- $19,516,000 is provided ($3,347,000 increase)
SUPT Block Grant:
- $2,008,079,000 is provided ($100 million increase)
- Substance Abuse Prevention and Treatment Block Grant (SABG).- The agreement does not include a new set-aside within the SABG for recovery services, but urges SAMHSA to strongly encourage States to use a portion of their SABG funding for recovery support services. [pg. 101]
- Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program. The agreement includes $40,000,000 for this program. [pg. 14]
- This represents a $16 million increase
Peer Support - The agreement includes no less than $14,000,000 for community-based experiential training for students preparing to become peer support specialists and other types of behavioral health-related paraprofessionals, as described in House Report 117-403. [pg. 14]
Opioids, Stimulants, and Pain Management - The agreement includes no less than $355,295,000 in NIDA for the HEAL Initiative. The agreement encourages NIDA to continue its efforts through the HEAL initiative in fiscal year 2023, with a focus on grant opportunities to support research and education to improve outcomes for people with both chronic pain and addiction in diverse settings across the United States, particularly those located in areas with high incidence of people living with chronic pain. The agreement also includes an additional $10,000,000 to support related research on pain and pain management, as described in the fiscal year 2023 budget request. [pgs. 73-74]
Reducing Opioid Disparities - The agreement supports efforts to address the disproportionate effects of the opioid overdose epidemic on Black/African Americans. NIDA, in coordination with NIMHD, is encouraged to support collaborations between qualified educational institutions and treatment partners with demonstrated excellence in addiction science and community-based research to lead several large multi-year research efforts. Funding calls should highlight the need for research to reduce barriers to care at the levels of State funding bodies, treatment agencies, individual clinicians, and among patients and community members. Specific areas of focus may include research that examines and mitigates stigma toward medications for opioid use disorder, evaluates reimbursement structures to incentivize improved patient outcomes, implements and evaluates effective environmental supports like crisis and respite housing and transportation assistance, and integrates treatment and recovery support services into nonmedical, community-based settings (e.g., interventions delivered by peer and community health workers). [pg. 74]
Building Communities of Recovery - The agreement provides an increase for enhanced long-term recovery support principally governed by people in recovery from substance use disorders. The agreement encourages SAMHSA to continue supporting recovery support programs principally governed by people in recovery from substance use disorders, including peer support networks. [pg. 104]
Treatment Assistance for localities - The agreement again recognizes the use of peer recovery specialists and mutual aid recovery programs that support Medication-Assisted Treatment. The agreement directs SAMHSA to support evidence-based, self-empowering, mutual aid recovery support programs that expressly support Medication-Assisted Treatment in its grant programs. [pg. 105]
Division FF of the bill contains reauthorization of expiring SAMHSA and HRSA programs that support mental health and SUD providers and services (see Division beginning on pg. 2991) as well as a number of expanded and new programs aimed at bolstering mental health and SUD proposed in various mental health bills this Congress. While the following is not comprehensive, selected provisions are highlighted below:
- Chapter 1 of this division includes establishment of a Behavioral Health Crisis Coordinating Office within SAMHSA (section 1101), requires SAMHSA to identify and publish of best practices for a crisis response continuum of care related to mental health and substance use disorders for use by health care providers, crisis services administrators, and crisis services providers in responding to individuals (including children and adolescents) experiencing mental health crises, substance-related crises, and crises arising from co-occurring disorders (section 1102), and includes suicide prevention lifeline improvements (section 1103).
- Chapter 2 contains the Summer Barrow Prevention, Treatment, and Recovery Act, which includes priority substance use disorder treatment needs of regional and national significance (section 1212), evidence-based prescription opioid and heroin treatment and interventions demonstration (section 1213), priority substance use disorder prevention needs of regional and national significance (section 1214), Sober Truth on Preventing (STOP) Underage Drinking Reauthorization (section 1215), grants for reducing overdose deaths (section 1219), and emergency department alternatives to opioids (section 1221), amongst other resources.
- Chapter 3 (sections 1421-1424) reauthorizes the Garrett Lee Smith Memorial program and includes SUD resources for students.
- Chapter 4 (sections 1241-1247) reauthorizes the Substance Abuse Prevention and Treatment Block Grant and renames it as the Substance Use Prevention and Treatment (SUPT) Block Grant. The reauthorization level is $1,908,079,000 for each of the next five years. This measure removes stigmatizing language throughout the statute. SAMHSA is also required, in consultation with States and other local entities providing prevention, treatment, or recovery support services related to substance use, to conduct a study on strategies to assess community needs with respect to such services in order to facilitate State use of block grant funding.
- Chapter 6 contains a section that authorizes $13 million per year for each of the next five years to develop, expand, and enhance access to mental health peer-delivered services. Use of funds include carrying out workforce development, recruitment, and retention activities to train, recruit, and retain peer-support providers.
- Sec. 1312 reauthorizes the Minority Fellowship Program at $25 million per year for each of the next five years.
The Agreement includes a 2-year extension (through December 2024) of Medicare telehealth flexibilities that were currently set to expire 151 days post-PHE. (Section 4113)
The legislation includes measures designed to improve mental health parity, including eliminating the opt-out for nonfederal governmental health plans (see Section 1321) and providing grants to enforce and ensure parity compliance (see Section 1331).
The agreement contains a number of maternal mental health resources, including establishment of a national maternal mental health hot line to provide emotional support, information, brief intervention, and mental health and substance use disorder resources to pregnant and postpartum women at risk of, or affected by, maternal mental health and substance use disorders, and to their families or household members.
The agreement contains both the Medication Access and Training Expansion (MATE) Act and the Mainstreaming Addiction Treatment (MAT) Act (sections 1262 and 1263).
The Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, which temporarily establishes separate payments for certain non-opioid treatments and that NAADAC actively supported, is also included in the legislation (section 4135).