As the current session of Congress heads toward its close, several major points of behavioral health legislation remain unresolved. For stakeholders in the mental health and substance use treatment sectors, issues surrounding parity, workforce expansion, telehealth, and medication-assisted treatment (MAT) continue to be high-priority topics as we approach 2023. While uncertainty persists, there are glimmers of progress. The Bipartisan Safer Communities Act, passed earlier this year, signals the potential for meaningful action on behavioral health initiatives within both Congress and the Biden administration. For providers, payers, and advocates, it’s a reminder that even in a complex legislative environment, behavioral health legislation 2023 can be leveraged to expand access to care and address urgent behavioral health needs.
Bipartisan Safer Communities Act: Mental Health At The Forefront
The Bipartisan Safer Communities Act emerged in response to the tragic mass shooting in Uvalde, Texas, and, while widely framed as gun reform legislation, the act’s behavioral health components are among its most impactful. Passed into law in June 2023, the bill provides billions of dollars for youth mental health services, including school-based mental health programs and funding for school-based mental health professionals.
The legislation also expanded the Certified Community Behavioral Health Clinic (CCBHC) program, supporting community-based access to comprehensive behavioral health services. For organizations like Centerstone, which advocates for accessible behavioral health services nationwide, the bill represents a positive step toward addressing gaps in care.
It was framed as gun reform legislation, but the gun reform provisions were very, very narrow, said Laura Conaboy, senior vice president of national policy for Centerstone.
The act’s passage demonstrates that bipartisan collaboration on behavioral health is possible, and it sets a precedent for future behavioral health legislation 2023 addressing mental health services, workforce development, and access to treatment.
Parity In Behavioral Health Legislation
Mental health parity continues to be a major focus for payers, providers, and advocacy groups. Despite legislative efforts to ensure equal coverage for mental health and substance use disorder services, uncertainty around compliance remains a challenge.
Payers have been waiting for more than two years for federal guidance on demonstrating parity compliance. Jim Laughman, president of PerformCare, emphasized that, while health plans are actively working to comply with parity laws, the lack of clear federal guidance creates uncertainty.
We believe, very clearly, that we’re demonstrating and that we’re doing parity, Laughman said. But minus that guidance and understanding from what the federal government is looking for … that makes it difficult.
In late September, the House passed the Mental Health Matters Act (H.R. 7780), largely along party lines. The bill strengthens enforcement by enabling the U.S. Department of Labor (DOL) to penalize payers that fail to comply with federal parity laws. However, payers remain concerned about insufficient guidance on tracking non-quantitative treatment limitations (NQTLs), a requirement of the 2021 parity legislation.
Doug Nemecek, chief medical officer of behavioral health for Evernorth, noted, There hasn’t been enough guidance yet on all of the documentation and all the information that is necessary from a health plan to demonstrate and get certified as compliant with mental health parity rules.
For many plans, the focus has shifted to collaborating with regulators to help shape administrative measures for parity compliance.
To date, as far as we know, there hasn’t been a plan that has been certified by the DOL as compliant and not have any issues, Nemecek said. We don’t have anything to look back to yet to say, Alright, here’s the target and now we can move forward.
These challenges remain central to ongoing discussions around behavioral health legislation 2023, as payers and policymakers work together to ensure mental health parity is fully realized.
Telehealth: The Future Of Accessible Care
Telehealth has proven critical in expanding access to behavioral health services, especially as the COVID-19 pandemic disrupted traditional in-person care. Many stakeholders are advocating for permanent legislative recognition of telehealth flexibilities previously allowed under public health emergencies.
Telehealth is an essential tool for reaching people who may have been resistant to or unable to attend in-person care, Laughman said. Even as social distancing measures have ended, behavioral health providers continue to utilize telehealth regularly.
Telehealth has played a particularly important role in medication-assisted treatment (MAT) for opioid use disorder. Virtual behavioral health startups experienced significant investment growth during the pandemic, taking advantage of temporary regulatory flexibilities. However, the lack of clarity on whether these flexibilities will remain poses a risk to both providers and patients.
Nemecek highlighted the ongoing crisis: Not nearly enough people are accessing MAT for opioid use disorder even as the number of people dying from opioid overdose has reached historic highs. Over 108,000 people have died of overdoses — mostly synthetic opioids — in the 12 months ending with April 2022, according to CDC data.
The Restoring Hope for Mental Health and Well-Being Act (H.R. 7666) seeks to address some of these issues by establishing telehealth oversight measures for government-backed health plans while also making important changes to MAT accessibility. This legislation is a key component of behavioral health legislation 2023, particularly as policymakers look to expand care options nationwide.
Eliminating The X Waiver
The X waiver has long restricted providers’ ability to prescribe buprenorphine and other MAT for opioid use disorder, requiring special training and limiting patient panel sizes. Many advocates are pushing for its removal to expand access to treatment.
Pamela Greenberg, CEO of the Association for Behavioral Health and Wellness, emphasized the disparity: You don’t require doctors prescribing opioids to have any extra education at all — nothing. But yet, the doctors that want to treat opioid addiction have to get additional training? Talk about disparity and non-parity.
Congressional support appears strong for eliminating the X waiver, particularly as lawmakers focus on addressing the ongoing opioid crisis. Removing this barrier is considered a major step in behavioral health legislation 2023, increasing provider capacity and improving patient access to MAT.
Workforce And Behavioral Health Records
A critical barrier to care remains the shortage of trained behavioral health professionals. The Biden administration is currently formulating rules to make it easier to share substance use disorder health records, as mandated by the CARES Act of 2021. Amending regulations under 42 CFR Part 2 would allow providers to access and share patient records more efficiently, particularly important as telehealth continues to expand.
Several master’s-level mental health practitioners, such as licensed professional counselors and marriage and family therapists, are currently ineligible for Medicare reimbursement. Addressing this gap could dramatically improve access to care.
In September, the Senate Finance Committee released a discussion draft exploring measures to optimize and expand the behavioral health workforce. These measures included allowing LMFTs and licensed professional counselors to provide care to Medicare beneficiaries — a move that could significantly expand the available workforce.
Five bills have been introduced that address workforce development:
- Training Psychiatrists for the Future Act
- More Behavioral Health Providers Act
- Expand Qualified Psychologist Services Act
- Protect Our Physicians Act
Together, these initiatives are shaping the future of behavioral health legislation 2023, aiming to increase provider availability, reduce care gaps, and improve system-wide access.
Looking Ahead: Opportunities And Challenges
As Congress concludes this session, the behavioral health landscape remains a mix of progress and uncertainty. While key bills such as the Bipartisan Safer Communities Act have advanced access to youth mental health services and CCBHCs, significant work remains on parity enforcement, telehealth regulation, MAT access, and workforce expansion.
The next year will likely see continued collaboration between federal agencies, lawmakers, and industry stakeholders to address these pressing issues. Ensuring clarity on regulatory compliance, expanding access to care, and strengthening the behavioral health workforce will be central to improving outcomes for millions of Americans.
The legislative developments of 2023 represent both a challenge and an opportunity: a chance to build a more accessible, equitable, and responsive behavioral health system for the future, making behavioral health legislation 2023 a critical focus for all stakeholders.
