21st Century Cures Act Includes Several Noteworthy Mental Health and Substance Use Provisions

By Laura Nelson

The 21st Century Cures Act (Act), enacted in December 2016, has received widespread coverage for funding biomedical research and streamlining the drug approval process. The Act also includes the Helping Families in Mental Health Crisis Reform Act of 2016. 

Key provisions related to mental health and substance use disorders include:

  • Mental Health Parity Guidance and Enforcement. The Secretaries of Health and Human Services, Labor and the Treasury, in consultation with the Inspectors General of such agencies, are directed to issue a compliance program guidance document, not later than 12 months following enactment of the Act, which must include illustrative, de-identified examples of compliance and non-compliance with existing mental health parity requirements. The Secretary of Health and Human Services must also produce an action plan for improved federal and state coordination related to enforcement of mental health parity and addiction equity requirements.
  • Medicaid Clarification and Expansion. The federal Medicaid statute is clarified to permit same-day billing of mental health and primary care services furnished at the same facility and, effective January 1, 2019, expand coverage of children receiving Medicaid-covered inpatient psychiatric hospital services.
  • Increasing Providers in Underserved Areas. Grants are authorized to encourage professionals, including medical residents and fellows, nurse practitioners, physician's assistants, health service psychologists and social workers, to provide mental health and substance use disorder services in underserved communities and a Minority Fellowship Program is created to increase the number of mental health and substance use disorders professionals providing services to ethnic minorities. Both will be administered by the Health Resources and Services Administration (HRSA).
  • Pediatric Mental Health Care. HRSA grants are authorized for behavioral health integration in pediatric primary care, including pediatric mental health statewide or regional telehealth networks. Additionally, the Act requires that at least 10 percent of states' annual block grants of funding for mental health be used for early intervention programs.
  • Eating Disorders Awareness, Training and Parity. The Secretary of Health and Human Services and the Secretary of Education are directed to provide training for health professionals and school personnel to identify eating disorders and intervene early. The Act also clarifies that residential treatment for eating disorders is included within the scope of mental health parity.
  • Community Resources. A number of grants and pilot programs are authorized or reauthorized to address mental health and substance use disorders in the community, including crisis intervention team programs and de-escalation training for law enforcement and other first responders, a pilot federal mental health court program and expansion of treatment and transitional services for individuals with serious mental illness or substance use disorders.
  • Grants to Address Opioid Abuse. The Act authorizes $1 billion in federal grants to states for use in carrying out opioid abuse prevention and treatment programs, including (1) improving state prescription drug monitoring programs; (2) implementing and evaluating prevention activities to identify effective strategies to prevent opioid abuse; (3) training health care practitioners in best practices for prescribing opioids, pain management, recognizing potential cases of substance abuse, referral of patients to treatment programs, and overdose prevention; (4) supporting access to health care services, including opioid treatment programs; and (5) other public health-related activities as the state deems appropriate.
  • HIPAA Clarifications. In an effort to clarify permitted uses and disclosures of health information by health care professionals to facilitate communication with caregivers of adults with serious mental illness, the Act directs the Secretary of Health and Human Services to ensure that health care providers, professionals, patients and their families, and others involved in mental health or substance use disorder treatment have adequate, accessible, and easily comprehensible resources relating to appropriate uses and disclosures of protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To this end, the Secretary is required to develop and disseminate model training programs and materials within one year of enactment of the Act. Further, the Secretary is directed to convene a group of stakeholders to determine the effect of federal regulations relating to confidentiality of alcohol and drug abuse patient records on patient care, health outcomes, and patient privacy, not more than one year after such regulations are updated (a final rule updating the 42 C.F.R. Part 2 confidentiality regulations was published on January 18, 2017 and will take effect February 17, 2017).
  • Federal Leadership. New high-level federal positions are established, including an Assistant Secretary for Mental Health and Substance Use and a Chief Medical Officer for the Substance Abuse and Mental Health Services Administration. The authorities of the existing SAMHSA Administrator are transferred to the Assistant Secretary. The Act also establishes interdisciplinary working groups focused on improving the coordination and delivery of mental health services.

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