This is the second article in a series on the 21st Century Cures Act (the “Cures Act”), which was signed into law on December 13, 2016. Over the next few weeks, we will publish a series of articles summarizing various components under the Cures Act. The articles in our series are located here.

Title VI of the of the Cures Act illustrates the multi-dimensional nature of the subjects that come within the purview of the Cures Act. Title VI of the Cures Act will provide support for families in mental health crisis by strengthening leadership and accountability in the Substance Abuse and Mental Health Services Administration (“SAMHSA”). SAMHSA is the agency within the U.S. Department of Health and Human Services (“HHS”) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities by increasing access to services relating to the prevention and treatment of substance abuse and mental illness.

Appointment of Assistant Secretary, Deputy Assistant Sectary and Chief Medical Officer of SAMHSA

Subtitle A within Title VI is appropriately titled “Leadership” because it changes the leadership, responsibilities and structure within both SAMHSA and HHS generally. To strengthen leadership, Title VI of the Cures Act provides for the presidential appointment of a new position, Assistant Secretary for Mental Health and Substance Abuse (“Assistant Secretary”), which will be granted all duties that were previously vested in the Administrator of SAMHSA. Title VI of the Cures Act also gives the Assistant Secretary power to appoint a Deputy Assistant Secretary to help carry out activities of SAMHSA. Responsibilities assigned to the Assistant Secretary largely hinge on collaborating with other federal departments and other agencies within HHS.

Title VI directs the Assistant Secretary to appoint a Chief Medical Officer to serve within SAMHSA. The Chief Medical Officer must meet certain academic qualifications and have experience working with mental or substance use disorder programs. The duties of the Chief Medical Officer will include: (i) serving as a liaison between the SAMHSA and providers of mental and substance use disorders prevention, treatment and recovery services; (ii) assisting the Assistant Secretary with programs operated by SAMHSA; (iii) promoting evidence-based best practices that take into account culturally and linguistically appropriate measures to enhance prevention and treatment of mental illness and serious emotional disturbances; (iv) participating in regular strategic planning with SAMHSA; (v) coordinating with the Assistant Secretary for Planning and Evaluation to assess the use of performance metrics to improve activities related to mental illness and substance use disorders; and (vi) coordinating with the Assistant Secretary to ensure mental and substance use disorders grant programs consistently utilize appropriate performance metrics and evaluation designs.

In addition to appointing stronger leadership, the Cures Act provides that when any peer review group is reviewing a grant, cooperative agreement or contract related to mental illness treatment, not less than half of the members shall be licensed and experienced professionals in prevention diagnosis or treatment of mental illness or co-occurring mental illness and substance use disorders and have a relevant advanced degree.

Improving the Quality of Behavioral Health Programs

The Assistant Secretary is required to maintain a Center for Behavioral Health Statistics and Quality (“Center”) that is to be headed by a Director who is appointed by the Secretary of HHS (“Secretary”). The Director must have experience and academic qualifications in research and analysis in behavioral health or related fields. The Director will coordinate with the Assistant Secretary, the Assistant Secretary for Planning and Evaluation and the Chief Medical Officer, as appropriate, to improve the quality of services and evaluation of activities carried out by SAMHSA.

In addition, the Center for Mental Health Services is required to collaborate with the Director of the National Institute of Mental Health and the Chief Medical Officer to develop a system to disseminate information (including research findings) for incorporation into SAMHSA’s programs and for providers to use in rendering prevention and treatment services.

Strategic Plan

The Cures Act mandates the Secretary to develop a Strategic Plan for the planning and operation of activities carried out by SAMHSA no later than September 30, 2018 and every four years thereafter. Every two years, the Assistant Secretary is to report to Congress on: (i) the progress toward meeting the objectives set forth in the strategic plan; (ii) how service gaps are being addressed; and (iii) the coordination with other departments and parties. The Strategic Plan must take into consideration the findings and recommendations of the Assistant Secretary for Planning and Evaluation of the Helping Families in Mental Health Crisis Reform Act of 2016 and the report of the Interdepartmental Serious Mental Illness Coordinating Committee under that act. The Strategic Plan must also: (i) identify strategic priorities, goals and measurable objectives for mental and substance use disorders, activities and programs, including priorities to prevent or eliminate the burden of mental and substance use disorders; (ii) identify ways to improve the quality of services for individuals with mental and substance use disorders and reduce homelessness, arrest, incarceration and violence; (iii) ensure that programs provide, as appropriate, access to effective and evidence-based prevention, diagnosis, intervention, treatment and recovery services, including culturally and linguistically appropriate services; (iv) identify opportunities to collaborate with the Health Resources and Services Administration to encourage individuals to pursue careers in behavioral health professions and improve the recruitment, training and retention of a workforce for the treatment of individuals with mental or substance use disorders or co-occurring disorders; (v) identify opportunities to improve collaboration with state, local and tribal governments and communities; and (vi) specify a strategy to disseminate evidence-based and promising best practices related to prevention, diagnosis, early intervention, treatment and recovery services related to mental illness. The Assistant Secretary must prepare and submit a biennial report concerning activities and progress of SAMHSA. The Strategic Plan will be available on SAMHSA’s website.

Oversight and Accountability

Subtitle B within Title VI requires the Assistant Secretary of Planning and Evaluation (“ASPE”) to develop strategies to ensure efficient and effective planning and evaluation of mental and substance use disorders prevention and treatment programs, recovery support services and related activities are conducted on a regular basis. The plan and evaluation must include co-occurring disorders across agencies and address areas such as the reduction of homelessness and incarceration among individuals with a mental or substance use disorder. Additionally, the ASPE must have a plan for assessing the use of performance metrics to evaluate activities carried out by entities receiving grants, contracts or cooperative agreements related to mental and substance use disorders prevention and treatment services. Recommendations should be made to the Secretary, the Assistant Secretary for Mental Health and Substance Use and Congress on improving the quality of prevention and treatment disorders.

Interdepartmental Serious Mental Illness Coordinating Committee

Subtitle C within Title VI provides for the establishment of an Interdepartmental Serious Mental Illness Coordinating Committee (the “Committee”). The Committee shall meet at least twice per year and submit a report to Congress and other relevant federal agencies that will include: (i) a summary of advances in serious mental illness and serious emotional disturbances research related to the prevention and treatment of serious mental illness and serious emotional disturbances; (ii) an evaluation of the effect federal programs related to mental illness have on public health outcomes such as rates of suicide, suicide attempts, incidence and prevalence of serious mental illnesses, serious emotional disturbances and substance use disorders, increased rates of employment and enrollment in educational and vocational programs, and quality of mental and substance use disorders treatment services; and (iii) specific recommendations for actions that agencies can take to better coordinate the administration of mental health services for adults with a serious mental illness or children with a serious emotional disturbance.

Practical Takeaways

Strengthening the leadership and accountability within the SAMSHA agency will help improve the delivery and effectiveness of prevention, treatment and recovery support services. Given the support expected from the federal government as a result of this push for mental health reform, behavioral health providers should:

  • Evaluate current response and prevention practices to determine strengths and weaknesses;
  • Consider how to integrate behavioral health and primary care to expand treatment;
  • Evaluate payer contracts to determine how to best negotiate rates for behavioral health and primary care integration; and
  • Evaluate staffing needs to accommodate changes in programs and services.