D.C. Special Update on FY 2015 Appropriations

July 24, 2014

The Senate Appropriations Committee today released its draft bill and report that would provide FY 2015 funding for the Department of Health and Human Services (HHS) – including NASADAD priority programs within the Substance Abuse and Mental Health Services Administration (SAMHSA). At this point, we are not aware of a specific date of potential action by the Committee regarding the draft. However, the documents released by the Committee are still extremely important in that they provide the road map of the full Senate Appropriations Committee led by Barbara Mikulski (D-MD), Chair. The Ranking Member is Richard Shelby (R-AL). The full report may be accessed at http://www.appropriations.senate.gov/news/fy15-lhhs-subcommittee-reported-bill-and-draft-report.

We offer a NASADAD summary below.

SAMHSA: Overall, the SAMHSA would receive $3,577,545,000 in FY 2015.

Substance Abuse Prevention and Treatment (SAPT) Block Grant – $1,815,443,000 or cut of $4.4 million compared to FY 2014. The Administration proposed level funding for FY 2015.

No redirection of funds or “tap” in the documents: NASADAD members may recall that the Administration proposed in previous budgets to allocate a certain percentage of SAPT Block Grant funds to other programs within HHS. This practice effectively cut the funding available to States through the SAPT Block Grant. Last year, Congress included language in the final FY 2014 funding bill exempting the SAPT Block Grant from having its funds redirected to other programs. For FY 2015, the SAMHSA budget observes this direction from the Appropriations Committee, noting, “The 2015 President’s Budget continues this exemption in 2015.” NASADAD applauded the Administration for this decision. In the draft released today, the Appropriations Committee specifically continues this exemption to ensure no “tap” is added through other mechanisms.

The Committee should be applauded for this action. The exact bill language is below:

The Committee recommendation continues bill language included last year that instructs the Administrator of SAMHSA and the Secretary to exempt the Mental Health Block Grant and the Substance Abuse Prevention and Treatment Block Grant from being used as a source for the PHS evaluation set-aside in fiscal year 2015, as was done prior to fiscal year 2012.

Center for Substance Abuse Prevention (CSAP) – $175,217,000 or level funding compared to FY 2014. The Administration proposed $185.5 million for an increase of $10 million over the FY 2014 level of $175.5 million. The Committee draft plan includes the following proposals for programs within CSAP:

Strategic Prevention Framework/Partnerships for Success Grants: $109.4 million or level funding compared to FY 2014. The Administration proposed $119.7 million for an increase of $10 million over FY 2014. This proposed $10 million would be allocated to the Strategic Framework Prescription Drug Abuse and Overdose Prevention (SPF Rx) Initiative. Of this proposed $10 million, the Administration would direct certain funds to support States to (1) use the State’s strategic plan to target prescription drug abuse and misuse within the State; (2) use data from Prescription Drug Monitoring Programs (PDMP) for prevention planning and (3) implement evidence-based practices and/or environmental strategies aimed at reducing prescription drug abuse and misuse.

The Appropriations Committee draft language is included below:

The Committee recommendation provides $109,484,000 for the Strategic Prevention Framework State Incentive Grant [SPFSIG] and Partnerships for Success programs. The Committee intends that these two programs continue to focus exclusively on: addressing State- and community-level indicators of alcohol, tobacco, and drug use; targeting and implementing appropriate universal pre-vention strategies; building infrastructure and capacity; and pre-venting substance use and abuse. Due to budgetary constraints, the Committee recommendation does not include funding for the new Strategic Prevention Framework Rx program requested by the administration.

The Committee does not approve of SAMHSA’s proposal to use $1,500,000 from the SPFSIG to expand the focus of community coalitions to include mental health promotion and mental illness prevention. SAMHSA is directed not to use any SPFSIG funds for this initiative.

The Committee directs that all of the money appropriated explicitly for substance abuse prevention purposes both in CSAP’s PRNS lines as well as the funding from the 20 percent prevention set-aside in the SAPT Block Grant be used only for bona fide substance abuse prevention programs and strategies and not for any other purposes.

Sober Truth on Preventing Underage Drinking (STOP Act) – $7 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Fetal Alcohol Spectrum Disorder – $1 million or level funding compared to FY 2014. The FASD portfolio absorbed a significant cut of $8.8 million last year when the program went from $9.8 million in FY 2013 to $1 million in FY 2014. SAMHSA noted that the $1 million would be supporting the FASD Center of Excellence in FY 2015.

Center for the Application of Prevention Technologies (CAPTs) – $7.5 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Building Behavioral Health Coalitions Program – The Senate Committee Report does not allow $1.5 million from CSAP “…to support active community coalitions and/or organizations to expand their focus and activities to include mental health promotion, mental illness prevention and substance abuse prevention.” Under this proposal, CSAP funds would be provided “…to coalitions with a mental health focus to expand their activities to include substance abuse prevention.”

The committee language is below:

Center for Substance Abuse Treatment (CSAT) – $324,573,000 or a cut of approximately $37 million compared to FY 2014. The Committee’s draft plan compares to the Administration’s proposed cut of $64 million or $297,400,000. The Committee’s draft report includes the following proposals for programs within CSAT:

Opioid Treatment Programs/Regulatory Activities – $8.7 million or level funding compared to FY 2014 and the Administration’s proposal.

Screening and Brief Intervention and Referral to Treatment (SBIRT) – $46,889,000 or level funding FY 2014. The Administration proposed $30 million in FY 2015.

The Committee included specific language on SBIRT which is included below:

The Committee provides funding for SBIRT through budget authority rather than through transfers from section 241 of the PHS Act as requested by the administration. The Committee continues to direct SAMHSA to ensure that funds provided for SBIRT are used for existing evidence-based models of providing early intervention and treatment services to those at risk of developing substance abuse disorders.

Targeted Capacity Expansion (TCE) Program – $23.2 million or an increase of $10 million compared to FY 2014. The Administration proposed $15.2 million or an increase of $2 million compared to FY 2014.

Specific funding for States for Opioid Treatment – including Medication Assisted Treatment (MAT):The Committee draft provides $12 million for discretionary grants (as part of the Targeted Capacity Expansion (TCE) portfolio) to States to expand treatment services for those with opioid dependence. The grants would include, as an allowable use, the support of medication- assisted treatment (MAT) and other clinically appropriate services. This recommendation aligns with testimony submitted by NASADAD to Congress regarding FY 2015 appropriations priorities. NASADAD applauds the Senate Appropriations Committee for recognizing the pressing nature of the opioid problem.

The language appearing in the Committee draft is below:

The Committee recognizes that the United States has seen a 500 percent increase in admissions to treatment for prescription drug abuse since 2000. Further, according to a recent study, 37 States saw an increase in admissions to treatment for heroin dependence during the past 2 years. Of the amount provided for Targeted Capacity Expansion, the Committee recommendation includes $12,000,000 for discretionary grants to States for the purpose of expanding treatment services to those with heroin or opioid dependence. The Committee directs CSAT to ensure that these grants include as an allowable use the support of medication assisted treatment [MAT] and other clinically appropriate services. These grants should be made available to States with the highest rates of primary treatment admissions for heroin and opiates per capita, and should target those States that have demonstrated a dramatic increase in admissions for the treatment of opiates and heroin in recent years.

Pregnant and Postpartum Women (PPW) Program – $15.9 million or level funding compared to FY 2014 and the Administration’s request.

Strengthening Treatment Access and Retention – $1 million or a cut of $668,000 compared to the FY 2014 level of $1.6 million. The Committee’s draft is the same as the Administration’s proposal for FY 2015.

Access to Recovery (ATR) – Eliminated for a cut of $50 million compared to FY 2014. It is important to note that ATR sustained a cut of $43 million in FY 2014. This draft is the same as the Administration’s proposal for FY 2015.

Primary Care and Addiction Services Integration (PCASI) – The Committee did not provide funding for this proposal. The Administration proposed $20 million for this new program in FY 2015.

Children and Families Program – $29.6 million or level funding compared to FY 2014 and the Administration’s request for FY 2015.

Treatment Systems for Homeless – $41 million or level funding compared to FY 2014 and the Administration’s request for FY ’15.

Minority AIDS Initiative – $65.5 or level funding compared to FY 2014. The Administration proposed $58.9 million or a cut of $6.8 million compared to the FY 2014 level.

Criminal Justice Activities – $74.8 million or level funding compared to FY 2014. The Administration proposed $64.4 million or a cut of $10.4 million compared to the FY 2014 level of $74.8 million.

The draft Committee Report includes the following language regarding Drug Treatment Courts:

Drug Treatment Courts: The Committee continues to direct SAMHSA to ensure that all funding appropriated for Drug Treatment Courts is allocated to serve people diagnosed with a substance use disorder as their primary condition. The Committee expects CSAT to ensure that non-State substance abuse agency applicants for any drug treatment court grant in its portfolio continue to demonstrate extensive evidence of working directly and extensively with the corresponding State substance abuse agency in the planning, implementation, and evaluation of the grant.

Addiction Technology Transfer Centers (ATTCs) – $11 million or an increase of $2 million compared to FY 2014. The Administration proposed $8 million in FY 2015 or a cut of $1 million compared to FY 2014.

The Committee included Report Language for the ATTC program that is included below:

Addiction Technology Transfer Centers [ATTCs]: The Committee rejects the administration’s proposed reduction to the ATTCs, which are a network of regional and national centers that develop and strengthen the addiction treatment workforce. The Committee notes that the demand for substance use disorder treatment services is anticipated to increase as a result of the Affordable Care Act and the Mental Health Parity and Addictions Equity Act. The Committee recommendation includes $11,024,000 for the ATTCs. The Committee expects that the increased funding should be used by the National and Regional ATTCs to enhance the skills of the current addiction workforce and to recruit and mentor new professionals into the addiction workforce. The Committee expects a report on the use of these additional funds in the SAMHSA fiscal year 2016 CJ. The Committee continues to direct SAMHSA to ensure that ATTCs maintain a primary focus on addiction treatment and recovery services.

Selected Mental Health Services Programs

Community Mental Health Services (CMHS) Block Grant – $482,571,000 or a decrease of approximately $1 million compared to FY 2014. The Administration proposed $483.7 million or level funding compared to FY 2014. The CMHS Block Grant, per a directive by Congress in the FY 2014 appropriations bill, includes a new set-aside for evidence-based programs that address the needs of individuals with early serious mental illness. The set-aside amount equals $24.1 million.

The Committee Report Language is included below:

The Committee recommends $482,571,000 for the MHBG. The recommendation includes $21,039,000 in transfers available under section 241 of the PHS Act. The MHBG distributes funds to 59 eligible States and territories through a formula based on specified economic and demographic factors. Grant applications must include an annual plan for providing comprehensive community mental health services to adults with a serious mental illness and children with a serious emotional disturbance. The Committee recommendation continues the bill language it added last year requiring that at least 5 percent of the funds for the Mental Health Block Grant program be set-aside for evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders. The Committee commends SAMHSA for its collaboration with NIMH on the implementation of this set-aside. The Committee notes that it usually takes 17 years to translate research findings into practice, and hopes that this joint effort between NIMH and SAMHSA may be a model for how to reduce this timeframe. The Committee recommends that SAMHSA continue its collaboration with NIMH to ensure that funds from this set-aside are used only for programs showing strong evidence of effectiveness.

Center for Mental Health Services (CMHS) – $378 million for CMHS or level funding compared to FY 2014. The Administration proposed $354.7 million or a decrease of approximately $23 million compared to the FY 2014 level of $378 million.

Project AWARE (Advancing Wellness and Resilience in Education) State Grants – Approximately $40 million or level funding compared to FY 2014. This program, according to SAMHSA, builds on the Safe Schools/Healthy Students State Planning and Community Pilot Program. The grants, if funded by Congress, would “…go to 20 State Educational Authorities (SEAs) and in collaboration with Education and Justice, will promote comprehensive, coordinated and integrated State efforts to make schools safer and increase access to mental health services.” SAMHSA notes that SEAs would be required to partner with State mental health directors and State law enforcement authorities.

Mental Health First Aid – $15 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Healthy Transitions – $20 million or level funding compared to FY 2014. This program would “assist 16 to 25 year olds with mental illnesses and their families in accessing and navigating behavioral health treatment systems.” In particular, SAMHSA notes the program for States would focus on “new and creative approaches to provide support for transition-age youth with mental health and/or co-occurring substance abuse disorders and their families.”

Youth Violence Prevention – $23 million or level funding compared to FY 2014 and the Administration’s proposed FY 2015 budget.

National Traumatic Stress Network – $45.8 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Children and Family programs – $6.4 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Consumer and Family Networks – $4.9 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Mental Health Transformation and Health Reform – $3.7 million compared to $10.5 million in FY 2014 and the Administration’s proposed $10.5 million in FY 2015.

Project LAUNCH – $34.5 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Primary and Behavioral Health Care Integration – $49.8 million or level funding compared to FY 2014. The Administration proposed $26 million for this program in FY 2015.

The Committee’s language on this initiative is below:

The Committee provides funding for this program through budget authority rather than through transfers from the PPH Fund as requested by the administration. The Committee continues to direct SAMHSA to ensure that new Integration grants awarded for fiscal year 2015 are funded under the authorities in section 520K of the PHS Act.

National Strategy for Suicide Prevention – $2 million or level funding compared to FY 2014. The Administration proposed $4 million in FY 2015.

Suicide Lifeline – $7.1 million or level funding compared to FY 2014. The Administration proposed $5.5 million in FY 2015.

There are a number of additional CMHS programs not listed here. See the link provided at the end for the full report.

Additional Aspects of the Appropriations Committee Report – Specific Language

Viral Hepatitis Screening:

The Committee commends SAMHSA’s leadership to recommend screening injection drug users [IDUs] in opioid treatment programs for viral hepatitis. The Committee encourages SAMHSA to continue to expand opportunities for screening constituents who are at-risk for hepatitis. Injection drug use is a factor in many of the newly acquired viral hepatitis C cases and IDUs are more likely to experience adverse hepatitis related health outcomes compared to other infected populations.

The Committee continues to be deeply concerned about the increasing number of unintentional overdose deaths attributable to prescription and nonprescription opioids. The Committee commends SAMHSA for the letter sent in April to State agencies that administer the SAPT block to clarify that block grant funds may be used for the purchase of naloxone, as well as for assembling and disseminating overdose kits. The Committee encourages SAMHSA to continue to support initiatives that improve access to naloxone for public health and law enforcement professionals.

Data collection:

The Committee is aware that SAMHSA is taking steps to change the platforms used to collect data describing outcomes associated with substance abuse grants and mental health grants. The Committee maintains a distinct interest in not only the type of data col-lected but the mechanisms used to gather this important information. The Committee believes that any data collection effort must reflect the fact that mental illness and addiction are two separate and unique diseases requiring different data elements to accurately assess program performance. Therefore the Committee directs SAMHSA to submit a report to the Committee by October 31, 2014, describing any changes made to date and any plans for additional changes to data platforms; the reasons behind the structural changes; the process by which input is sought regarding any proposed changes to the type of data by multiple stakeholders and any other relevant information.

The Committee recommendation includes $1,000,000 requested by the administration for the Behavioral Health Minimum Data Set, which will develop consistent data collection methods to iden-tify and track the behavioral health workforce needs.

Language on transferring funds:

The Committee does not include bill language requested by the administration that would provide additional transfer authority to the Administrator beyond that which is already provided to the Secretary.

Next Steps: The release of the draft documents comes during a period of continued uncertainty about the fate of FY 15 appropriations measures. Budget observers note the potential for a “Continuing Resolution” or stop-gap funding bill that would fund government operations through some period after the November elections. No such “CR” has cleared Congress yet, however. Speaker Boehner today he expects that a “CR” will be considered by the House of Representatives after Congress returns from its August break. NASADAD will continue to monitor budget issues and report on developments as they occur.