APA: 21st Century Cures Act promises to reform system

In December 2016, the Senate passed the 21st Century Cures Act, a law that, according to the American Psychological Association, promises to reform the mental health system nationally. The law emphasizes research, education, changes to the criminal justice system, coordination between state and federal government on mental health matters and a focus on children.

Three years in the making, the 21st Century Cures Act is a “strongly bipartisan law,” said Laurel Stine, JD, MA, director of Congressional Affairs with the APA Practice Organization.

“The law is very comprehensive in scope and represents the intersection of mental health conditions in adults and youth. These programs will benefit children and adults with mental health and substance abuse comorbidities as well as those with physical health comorbidities,” she added.

The law has many important provisions, which comprise “a range of reauthorizations,” according to Stine.

Some of those provisions include $1.56 billion for the BRAIN Initiative; $12.7 million for a Minority Fellowship Program; $15 million to reauthorize the Graduate Psychology Education Program; and $10 million for an academic grant program to improve “diagnosis and treatment of mental health and substance use disorders.”

She said, “Each program has unique authority and scope.”

Other key measures include the reauthorization of the National Child Traumatic Stress Network and the Justice and Mental Health Collaboration Program that provides training for law enforcement professionals and alternatives to incarceration.

Stine reported that the same day billing exclusion for Medicaid billing has also been eliminated. “This has been a problem for years,” she said. “It has implications for the integration of primary and mental health care.”

The Treatment Advocacy Center applauded the law for its attention to data collection provisions. The law will require the reporting of financial data on the federal, state and local costs related to incarcerating inmates with serious mental illness as well as information on their criminal history.

Additionally, the 21st Century Cures Act calls for mental health data as it relates to law enforcement homicides and census data on forensic hospital beds in the country.

While the provisions of the 21st Century Cures Act hold promise for individuals, families and providers in the mental health community, Stine cautioned that implementing the initiatives may prove to be problematic. “There is no funding attached to the law. It remains to be seen how much money it will get,” she said.

Stine pointed out that the new government leadership’s direction will have an impact on the law. “Right now, the new government is consumed with the ACA. If Congress replaces the ACA and decides to give the states more authorization than the federal government, it could provide less federal funding and cost shift funding to the states, which are cash-strapped already,” she said.

“We don’t want to create further laws that place the burden on states who are struggling financially to provide for this population. We have to wait to see what plans are proposed.”

Furthermore, the decisions coming from the new Secretary of Health and Human Services will have an impact on mental health programs across the country, Stine noted. “We are especially looking at Tom Price. He’ll have oversight on APA programs and we are interested in how that will affect consumers,” she said.

Stine elaborated that HHS is the lead federal agency responsible for administering and overseeing health programs and grants (i.e., Medicaid, Medicare, SAMHSA programs, FDA, NIH, CDC, etc). She said the agency also promulgates regulations and issues guidance.

In spite of the uncertainly ahead, Stine is optimistic about the 21st Century Cures Act and the good that can come from the law. “At this point, I doubt the new Congress would tinker with a law that took three years in the making,” she said.