21st Century Cures: Tackling the Growing Problem of Mental Health and Substance Use Disorders

by McDermott Will & Emery
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McDermott Will & Emery

In Depth

On December 7, 2016, the US Congress approved the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment and facilitating innovation review and approval processes, among other things. The massive bill also serves as a vehicle for a variety of other health-related measures, including portions of the Helping Families in Mental Health Crisis Reform Act of 2016, which was approved by the US House of Representatives in July 2016 but not advanced by the Senate. 

A substantial portion of the 900+-page legislation relates to mental health and substance use disorders, in line with the rise in mental health and substance use disorder awareness over the last several years. The Act reflects a shift in thinking about the treatment of such disorders, which in the past was typically offered separate from other types of health care treatment, but now is more commonly integrated into physical care settings. The Cures Act calls for enhanced cooperation among agencies, provides funding for the development of innovative evidence-based models of treatment, provides for additional resources within the US Department of Health and Human Services (HHS), and includes a variety of provisions addressing mental health and substance use disorders within the context of law enforcement and judicial proceedings. The Act also enhances opportunities available under Medicaid waiver programs regarding mental health and substance use disorder treatment.

Most notably from a reimbursement perspective, the Cures Act reflects a concern that the expected parity in reimbursement for mental health treatment (per the Mental Health Parity and Addiction Equity Act of 2008) has not been achieved. The Act includes substantial requirements that HHS, the US Department of the Treasury and the US Department of Labor (DOL) develop compliance guidance (including detailed examples) related to the manner in which health plans address quantitative and non-quantitative limits related to behavioral health. The Act calls for increased “consumer friendliness” regarding parity expectations for mental health and substance use disorder treatment. Finally, the Cures Act allocates substantial funding ($1 billion over two years) to assist states in combatting the opioid and heroin abuse epidemic. The Cures Act does not make substantial changes in federal privacy laws or other controlling data use provisions, however, and therefore data sharing initiatives to coordinate the care of patients dealing with mental health or substance use disorders with other types of care may remain frustrated.

Increased Reimbursement and Funding for Mental Health and Substance Use Disorder Services

Medicaid Mental Health Coverage (Sections 12001 to 12006)

The Cures Act enhances Medicaid reimbursement for services related to mental health and substance use disorders. Chiefly, the Act clarifies that separate payment for the provision of mental health and primary care services provided to an individual on the same day is not prohibited under Medicaid, and, effective January 1, 2019, children receiving Medicaid-covered inpatient psychiatric hospital services are eligible for the full range of early and periodic screening, diagnostic and treatment services.

Additionally, the Act requires the Administrator of the Centers for Medicare and Medicaid Services (CMS) to take specific actions relating to mental health and substance use disorder treatment. First, the Administrator must conduct a study and submit a report to Congress within three years of the enactment of the Act on the provision of care to adults aged 21 to 65 enrolled in Medicaid managed care plans who are receiving treatment for a mental health disorder in an Institution for Mental Diseases. Second, within one year of enactment of the Act, the CMS Administrator must issue a State Medicaid Director letter on opportunities to design innovative service delivery systems to improve care for individuals with serious mental illness or serious emotional disturbance. Third, the CMS Administrator must collect, analyze and—no later than two years after enactment of the Cures Act—report on data from states that participated in the Medicaid Emergency Psychiatric Demonstration Project established under Section 2707 of the Affordable Care Act.

Mental Health Parity (Sections 13001 to 13007)

The Cures Act takes steps to strengthen enforcement of mental health parity laws in a number of ways. First, it requires the HHS, DOL and Treasury to release compliance program guidance with illustrative examples of past findings of compliance and noncompliance with existing mental health parity requirements, including disclosure requirements and both quantitative and non-quantitative treatment limitations. Second, it requires HHS to issue guidance to assist health plans in complying with mental health parity requirements. Finally, the Act provides the Secretaries of HHS, Labor and Treasury with the authority to audit health plans to assess their compliance with mental health parity laws.

To ensure measurable success in enforcement of mental health parity laws, the Act requires HHS to produce an action plan for improved federal and state coordination related to the enforcement of mental health parity requirements. The action plan is expected to build on the recommendations of President Obama’s Mental Health and Substance Use Disorder Parity Task Force Final Report released in October 2016. Specifically, the action plan must identify strategic objectives regarding how the various federal and state agencies charged with enforcement of mental health parity and substance use disorder equity requirements will collaborate to improve enforcement, and must provide a timeline for when such objectives shall be met and examples of how they will be met. Further, the Act requires the US Government Accountability Office (GAO), within three years of enactment of the Act, to conduct a study on the enforcement of existing mental health parity requirements, including compliance with non-quantitative treatment limitations; an assessment of how the Secretary has used its authority to conduct audits; a review of how the various federal and state agencies responsible for enforcing mental health parity requirements have improved enforcement; and recommendations for additional enforcement, education and coordination activities.

The Cures Act specifically aims to help men and women with eating disorders. This is the first time Congress has passed a bill that directly addresses eating disorders and their resultant harms. The Act dictates that group plans or individual health insurers that provide coverage for eating disorder benefits, including residential treatment, must provide such coverage consistent with mental health parity requirements. The Act also allows HHS, through the Director of the Office on Women’s Health, to update resource lists and fact sheets related to eating disorders, and to increase public awareness of the following:

  • Types of eating disorders;
  • Seriousness of eating disorders (i.e., prevalence, comorbidities and health consequences);
  • Methods to identify, intervene, refer and treat eating disorders;
  • Discrimination and bullying;
  • Effects of media on eating disorders; and
  • Signs and symptoms of eating disorders and treating individuals with eating disorders.

Further, the Act allows HHS to facilitate the identification of model programs and materials for educating and training health professionals in effective strategies to identify individuals with eating disorders, provide early intervention services, refer patients to appropriate treatment, prevent the development of eating disorders and provide appropriate treatment to individuals with eating disorders. 

State Response to the Opioid Abuse Crisis (Section 1003)             

A focal point in the diagnosis, treatment and prevention of substance use disorders has been the United States’ opioid abuse crisis. The Cures Act provides $1 billion over two years for grants to states to supplement opioid use prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, developing and providing training to health care providers, and expanding access to opioid treatment programs. The Act also attempts to provide accountability without increased burden on states by requiring grantees to report on activities funded by the grant in a substance use disorder block grant report.

Mental Health and Safe Communities (Sections 14001 to 14029)

The Cures Act provides several initiatives to increase community awareness, prevention and treatment of mental health and substance use disorders. Consistent with the thematic changes throughout the Act, the Cures Act shifts the focus from criminalization to crisis intervention and prevention. As part of that shift, the Act amends the Byrne Justice Assistance Grant Program to allow law enforcement to use funds for the creation of mental health response and corrections programs, including police crisis intervention teams. It also provides increased funding to train and educate state and federal law enforcement personnel and first responders on crisis de-escalation. Such initiatives include funding the federal Drug Court Grant Program to be used for the training of drug court professionals to identify and respond to these co-occurring disorders, and authorizing funding for the US Department of Justice (DOJ) VALOR Initiative to provide crisis response training and active-shooter training for federal, state and local law enforcement officials. To analyze the effectiveness of these training and education efforts, the GAO is required to submit a report to Congress detailing (1) the practices and procedures that federal first responders, tactical units and corrections officers are trained to use in responding to individuals with mental illness; (2) the application of evidence-based practices in criminal justice settings; and (3) recommendations on how the DOJ can improve information sharing and dissemination of best practices.

The Act provides for an increase in the data used in the criminal justice system to analyze the prevalence of offenders with mental health and substance use disorders. Specifically, the Act amends the America’s Law Enforcement and Mental Health Project Act to allow state and local governments to use funds for the creation and deployment of behavioral health risk and needs assessments for mentally ill individuals in the criminal justice system. The Act also requires the Attorney General to collect and disseminate data regarding the involvement of mental illness in all homicides, as well as in deaths or serious bodily injuries involving law enforcement officers. Further, the Act requires the Comptroller General of the United States to submit a report to Congress detailing the federal, state and local costs of imprisonment for individuals with serious mental illness, including the number and types of crimes committed by mentally ill individuals.

The Act establishes funding for various community-based initiatives aimed at preventing and treating mental health and substance use disorders. The Act reauthorizes and amends the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) to allow state and local governments to use existing authorized grant funds for the operation of Forensic Assertive Community Treatment (FACT) Initiatives. FACT Initiatives provide high-intensity community-based services for individuals with mental illness who are involved in the criminal justice system. The amendment to the MIOTCRA also authorizes funds to award grants to nonprofit organizations for the creation of a National Criminal Justice and Mental Health Training and Technical Assistance Center, which would coordinate best practices for responding to mental illness in the criminal justice system and would provide technical assistance to governmental agencies that wish to implement these best practices.

The Act also amends the Residential Substance Abuse Treatment grant program to allot funds for the purpose of developing and implementing specialized residential substance abuse treatment programs that provide treatment to individuals with co-occurring mental health and substance use disorders.

Shifts in the National Approach to Mental Health and Substance Use Disorder Treatment

As noted previously, the Act demonstrates a change in language and attitudes regarding substance use disorders and behavioral health. In the legislation, Congress has shifted from using the term “substance abuse” to the term “mental health and substance use disorder.” This is not merely a change in nomenclature, but places substantive emphasis on the medical (disorder) as opposed to the criminal (abuse). Also, as discussed in further detail below, the Act encourages the integration of mental health and substance use disorder treatment into primary care.

Comprehensive Care Model (Section 9003)

To date, the health care system has been largely fractured between physical health and behavioral health. The Cures Act takes steps to bridge this gap. Specifically, the Act reauthorizes grants for comprehensive care models through the appropriation of $51.878 million for each of fiscal years 2018–2022. As part of this grant funding, the Act requires grant applicants to submit a plan to provide integrated services to patient populations with substance use disorders.

Compassionate Communication on HIPAA (Sections 11001 to 11004)

Per the Act, the sense of Congress is that the health care community is unsure of the permissible uses and disclosures of mental health and substance use disorder-related health information to family members and caregivers, and traces such confusion to the HIPAA regulations. The Act indicates that certain stakeholders feel that these HIPAA regulations have hindered the appropriate communication of health care information or treatment preferences. The sense of Congress is that clarification is necessary regarding existing permitted uses and disclosures of health information by health care professionals to caregivers of adults with serious mental illness, in order to facilitate care decisions in situations where serious mental health illness may affect the capacity of an individual to determine a course of treatment without assistance. The Cures Act requires the Director of the Office of Civil Rights to issue guidance that clarifies, among other things, the circumstances under which a health care provider may disclose protected health information of adults or minor patients to family members, caregivers, other individuals involved in the care of such patients, and law enforcement, particularly in situations where patients present a serious and imminent threat of harm to themselves or others.

HIPAA does not distinguish between different types of health information (except for psychotherapy notes as defined in 2 CFR 164.501), although state law and other federal laws often impose different regulatory obligations depending on the type of health information involved—for example, mental health and substance use disorder records. Although HIPAA imposes its own obligations that can be confusing or difficult to meet, in many cases the regulatory hurdle to sharing information about a patient’s mental health and substance use disorder stems not from HIPAA but from state law and the federal law specifically addressing substance use disorder information. The Cures Act proposes no changes, however, to the relevant provision of the Public Health Services Act pursuant to which the Part 2 regulations are promulgated. Although the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency that enforces Part 2, has recently sought to modify the regulations to facilitate data sharing by and among health care providers, care coordinators, health plans and other stakeholders, any proposed regulatory changes are limited to what the statute would permit.

Instead of attempting to modify the underlying statute, the Act proposes that the Secretary convene relevant stakeholders one year after promulgation of the final modifications to Part 2 to determine the effect of the regulations on patient care, health outcomes and patient privacy. To fully realize mental health and substance use disorder parity, patients suffering from these conditions must be able to access the same integrated patient outreach and care coordination efforts as patients with other medical disorders. The eventual Part 2 final rule may help advance this cause, but further legislative action may still be necessary. This working group may assist in maximizing what can be achieved by regulation and may help to guide further congressional action in balancing efforts to reckon with the particular privacy risks posed by the unauthorized sharing of information related to an individual’s mental health and/or substance use disorder diagnosis or treatment with enabling such information to be shared sufficiently to ensure that the health care system’s approaching to caring for such patients is not hindered. In the interim, developers of digital health tools seeking to serve this patient population will need to develop and implement innovative consent models to comply with federal law.

Changes to Enhance Coordination Among Various Agencies (Sections 6002 and 6031)

With the understanding that it will take input from many stakeholders to help solve the growing problem of mental health and substance use disorders, the Cures Act provides for increased collaboration between state and federal agencies and local communities. As part of the collaborative effort, the Act creates a coordinating committee charged with evaluating federal programs related to serious mental illness and providing recommendations to better coordinate mental health services for people with serious mental illness. The committee is made up of HHS, CMS, DOJ, DOL, the US Department of Veterans Affairs (VA), the US Department of Defense (DOD), the US Department of Housing and Urban Development (HUD), the US Department of Education and the Social Security Administration, as well as patients, health care providers, researchers, a judge and a law enforcement officer. The committee will make recommendations to Congress for better coordination of mental health services for people with serious mental illness and serious emotional disorders. The committee sunsets six years after the enactment of the Act. Further, the Assistant Secretary of SAMHSA is required to collaborate with other federal departments, including the DOD, VA, HUD and DOL, to improve care for veterans and support programs addressing homelessness. 

Strengthening Leadership and Accountability (Sections 6001 to 6009, and 6021 to 6023)

The Cures Act provides for several changes to the leadership and functions of SAMHSA to ensure that programs related to the prevention and treatment of mental illness and substance use disorders, and the promotion of mental health and recovery, are carried out in a manner that reflects the best available evidence-based practices. Specifically, the Cures Act establishes an Assistant Secretary for Mental Health and Substance Use to head SAMHSA and a Chief Medical Officer (CMO) within SAMHSA to (1) assist the Assistant Secretary in evaluating, organizing, integrating and coordinating programs within SAMHSA; (2) promote evidence-based best practices regarding the prevention and treatment of mental health and substance use disorders; and (3) assess the use of performance metrics to evaluate programs and activities, and ensure that such metrics are used to evaluate grant programs. 

The Cures Act also codifies the existing Center for Behavioral Health Statistics and Quality to improve the quality of services provided by SAMHSA. The Act amends current law regarding the advisory councils for SAMHSA, Center for Substance Abuse Treatment (CSAT), Center for Substance Abuse Prevention (CSAP) and Center for Mental Health Services (CMHS) to (1) include the CMO and the Directors of the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute of Alcohol Abuse and Alcoholism as members of the applicable advisory councils; (2) ensure that at least half of the appointed advisory council members for CMHS have a medical degree, doctoral degree in psychology, or an advanced degree in nursing or social work, and specialize in mental health; and (3) ensure that at least half of the appointment advisory council members for CSAP and CSAT have a medical degree, doctoral degree or an advanced degree in nursing, public health, behavioral or social sciences, or social work, or are a certified physician assistant, and have relevant experience. 

The Act also creates the Interdepartmental Serious Mental Illness Coordinating Committee to evaluate federal programs related to serious mental illness and provide recommendations to better coordinate mental health services for people with serious mental illness. The committee is made up of the Secretary of HHS, the Assistant Secretary for Mental Health and Substance Use, the Attorney General, the Secretary of Veterans Affairs, the Secretary of Defense, the Secretary of Housing and Urban Development, the Secretary of Education, the Secretary of Labor, the CMS Administrator and the Commissioner of Social Security, as well as patients, health care providers, researchers, a judge and a law enforcement officer. As part of its oversight activities, the Committee must, no later than one year after the date of enactment of the Act and five years thereafter, submit to Congress a report evaluating, summarizing and making recommendations regarding advances in serious mental illness and serious emotional disturbance research. The Committee will sunset six years after enactment of the Cures Act.

SAMHSA is required to develop a strategic plan no later than September 30, 2018, and every four years thereafter, for the planning and operation of activities carried out by SAMHSA, including evidence-based programs to increase access to quality services for individuals with mental and substance use disorders, and is required to collaborate with state and local government. The demand for mental health services is growing nationally, and with it there is an increasing shortage of mental health providers. To address this shortage, SAMHSA’s strategic plan must including a strategy for encouraging individuals to pursue careers as mental health professionals and for improving the recruitment, training and retention of the mental health workforce. SAMHSA must make biennial reports available to Congress containing a review of SAMHSA’s progress toward strategic priorities, goals and objectives identified in the strategic plan, as well as an assessment of programs and a description of coordination activities. The Cures Act also requires the Assistant Secretary to consult with stakeholders to improve community-based and other mental health services and improve the recruitment and retention of mental health and substance use disorder professionals. 

The Cures Act provides for an increase in the oversight and accountability of mental health and substance use disorder programs. The Act establishes peer review groups made up of licensed and experienced professionals in the prevention, diagnosis, treatment of, or recovery from, mental illness or co-occurring mental illness and substance use disorders, that are charged with reviewing grants, cooperative agreements or contracts related to mental illness treatment. The Act also outlines the roles and responsibilities of the Assistant Secretary for Planning and Evaluation at HHS, which include developing a strategy for conducting ongoing evaluations of key programs across the agency within 180 days of enactment of the Helping Families in Mental Health Crisis Reform Act of 2016. Additionally, the GAO must conduct a study on programs funded under the Protection and Advocacy for Individuals with Mental Illness Act to review, among other things, (1) the programs carried out by states and private nonprofit organizations, (2) compliance with statutory and regulatory responsibilities, (3) responsibilities related to prospective clients or their family members, (4) availability of adequate medical and behavioral health treatment, and (5) denial of rights for individuals with mental illness.

Numerous Pilot Projects and Studies Established or Reauthorized to Support Initiatives Related to Mental Health and Substance Use Disorders (Sections 7001 to 7005, 8001 to 8004, and 9001 to 9003)

Many of the efforts in the Cures Act to address mental health and substance use disorders are facilitated through various pilot programs and focus on mental health and substance use disorder awareness, prevention, treatment and intervention. As it pertains to the various pilot programs and studies, the Cures Act: 

  • Establishes the National Mental Health and Substance Use Policy Laboratory within SAMHSA and appropriates $14 million in grant funding for the period of fiscal years 2018–2020 to promote evidence-based practices and service delivery models through evaluation of models that would benefit from further development, and through expanding, replicating or scaling evidence-based programs across a wider area
  • Reauthorizes the Priority Mental Health Needs of Regional and National Significance Program through the appropriation of $394.550 million for fiscal years 2018–2022 to support prevention, treatment and rehabilitation of mental health services and other programs to target responses based on mental health needs
  • Reauthorizes the Priority Substance Use Disorder Treatment Needs of Regional and National Significance Program through the appropriation of $333.806 million for fiscal years 2018–2022 to improve the quality and availability of treatment and rehabilitation services for substance use disorder services in targeted areas
  • Reauthorizes the Community Mental Health Services Block Grant through the appropriation of $532.571 million for fiscal years 2018–2022 to provide community mental health services for adults with serious mental illness and children with serious emotional disorders
  • Reauthorizes the Substance Abuse Prevention and Treatment Block Grant through the appropriation of $1.858079 billion for fiscal years 2018–2022 to ensure ongoing training for substance use disorder prevention and treatment professionals on recent trends in drug abuse in the state, evidence-based practices for substance use disorder services, performance-based accountability, and data collection and reporting requirements
  • Reauthorizes and makes technical updates to grants for treatment and recovery for homeless individuals to support mental health and substance use disorder services through the appropriation of $41.304 million for each of fiscal years 2018–2022
  • Reauthorizes and makes technical updates to develop and implement jail diversion grant programs to divert individuals with mental illness from the criminal justice system to community-based services through the appropriation of $4.269 million for each of fiscal years 2018–2022
  • Reauthorizes and makes updates to grants for states to provide services to homeless individuals who are suffering from serious mental illness, or co-occurring serious mental illness and substance use disorders, through the appropriation of $64.635 million for each of fiscal years 2018–2022
  • Requires the Secretary of HHS to conduct a study and submit a report to Congress within two years of enactment of the Cures Act on whether funding for the mental health and substance abuse block grants is being distributed to states and territories according to need, and to recommend changes if necessary
  • Requires the Secretary of HHS to continue the National Suicide Prevention Lifeline program, including (1) coordinating a network of crisis centers to provide suicide prevention and crisis intervention services; (2) maintaining a suicide prevention hotline to link callers to local emergency, mental health and social services resources; and (3) consulting with the Secretary of Veterans Affairs to ensure that veterans calling the suicide prevention hotline have access to a specialized veterans’ suicide prevention hotline
  • Authorizes the Secretary of HHS to award grants to state and local governments, Indian tribes and tribal organizations to strengthen community-based crisis response systems or to develop, maintain or enhance a database of beds at inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential substance use disorder treatment facilities, and appropriates  $12.5 million for each of fiscal years 2018–2022
  • Reauthorizes the Garrett Lee Smith Memorial Act, which (1) codifies the suicide prevention technical assistance center to provide information and training for suicide prevention, surveillance and intervention strategies for all ages, particularly among groups at high risk; (2) appropriates $5.988 million for each of fiscal years 2018–2022; and (3) reauthorizes the Youth Suicide Early Intervention and Prevention Strategies grants to states and tribes through the appropriation of $30 million for each of fiscal years 2018–2022
  • Establishes an Adult Suicide Prevention grant for individuals aged 25 years or older to raise awareness of suicide, establish referral processes, and improve care and outcomes for such individuals who are at risk of suicide, by appropriating $30 million for the period of fiscal years 2018–2022
  • Reauthorizes $14.963 million in grant funding for each of fiscal years 2018–2022 to states, political subdivisions of states, Indian tribes, tribal organizations and nonprofit private entities to train teachers, appropriate school personnel, emergency services personnel and others, as appropriate, to recognize the signs and symptoms of mental illness, to become familiar with resources in the community for individuals with mental illnesses, and for the purpose of the safe de-escalation of crisis situations involving individuals with mental illness
  • Requires the Secretary to disseminate information and provide technical assistance on evidence-based practices for mental health and substance use disorders in older adults
  • Encourages the Director of the Centers for Disease Control and Prevention to improve, particularly through the inclusion of other states, the existing National Violent Death Reporting System
  • Increases and extends authorization for the Assisted Outpatient Treatment grant program and appropriates funding of $15 million in fiscal year 2017, $20 million for fiscal year 2018, $19 million for each of fiscal years 2019 and 2020, and $18 million for each of fiscal years 2021 and 2022
  • Establishes the grant funding of $5 million for the period of fiscal years 2018–2022 to establish, maintain or expand assertive community treatment programs for adults with serious mental illness

Specific to efforts to increase and strengthen the health care workforce dedicated to mental health and substance abuse disorders, the Act: 

  • Reauthorizes Mental and Behavioral Health Education and Training grants to institutions of higher education or accredited professional training programs to support the recruitment and education of mental health care providers; creates a priority for programs that train psychology, psychiatry and social work professionals to work in integrated care settings, and for programs for paraprofessionals that emphasize the role of the family and the lived experience of the consumer and family-paraprofessional partnerships; appropriates funding as may be necessary for fiscal years 2017–2021; and appropriates $50 million for each of fiscal years 2018–2022
  • Authorizes the Secretary to establish a training demonstration program within the Health Resources and Services Administration (HRSA) to award five-year minimum grants for (1) medical residents and fellows to practice psychiatry and addiction medicine in underserved, community-based settings; (2) nurse practitioners, physician assistants, health service psychologists and social workers to provide mental and substance use disorder services in underserved community-based settings; and (3) establishment, maintenance or improvement of academic programs that provide training to improve the ability to recognize, diagnose and treat mental and substance use disorders
  • Codifies the Minority Fellowship Program for the Secretary to increase the number of professionals who provide mental or substance use disorder services to underserved, minority populations, and to improve the quality of mental and substance use disorder prevention and treatment for ethnic minorities, and authorizes appropriations of $12.669 million for each of fiscal years 2018–2022
  • Requires SAMHSA and HRSA to issue a report on national and state-level projections for the supply and demand of mental health and substance use disorder health workers and trends within the mental health and substance use disorder provider workforce
  • Requires the Comptroller General to study peer-support specialist programs in states receiving grants from SAMHSA and report to Congress on (1) hours of formal work or volunteer experience related to mental health and substance use disorders conducted, (2) types of peer support specialist exams and codes of ethics required for such programs, and (3) recommended skill sets and requirements for continuing education

Strengthening Mental Health and Substance Use Disorder Care for Specific Vulnerable Populations (Sections 10001 to 10006, and 14001 to 14029)

The Cures Act increases funding and initiatives aimed at certain vulnerable populations, including children, adolescents, women and non-violent offenders who suffer from mental health or substance use disorder issues. The Act reauthorizes and updates programs to provide comprehensive community mental health services to children with serious emotional disorders and provides for $119.026 million in funding for fiscal years 2018–2022. The Act also authorizes HRSA to award grants to promote behavioral health integration in pediatric primary care, including establishing eligibility requirements for statewide or regional pediatric mental health care telehealth programs in order to receive grant funding. As applicable to telehealth programs, the Act requires the state receiving the grant to match at least 20 percent of the federal funds. Further, the Act establishes a grant program to develop, maintain or enhance mental health prevention, intervention and treatment programs for infants and children at significant risk of developing or showing early signs of mental disorders, including serious emotional disorders, or social or emotional disability. Grant funding of $20 million for the period of fiscal years 2018–2022 is available for mental health prevention, intervention and treatment programs for infants and children; however, states that receive the grant funding must match at least 10 percent of the federal funds.

The Act reauthorizes and makes technical updates to grants for substance use disorder treatment and early intervention for children and adolescents to provide early identification and services, and appropriates $29.6 million for each of fiscal years 2018–2022. The Act also reauthorizes the National Child Traumatic Stress Initiative (NCTSI), which supports a national network of child trauma centers, including university, hospital and community-based centers and affiliate members. As part of the NCTSI, the Act encourages collaboration between NCTSI and HHS to disseminate evidence-based and trauma-informed interventions, treatments and other resources to appropriate stakeholders, and provides for $46.9 million for each of fiscal years 2018–2022 to support such collaboration.

The Act also provides for grant funding aimed at women who suffer from mental health disorders. Specifically, the Act establishes a grant program for states to establish, improve or maintain programs for screening assessment and treatment services for women who are pregnant, or who have given birth within the preceding 12 months, for maternal depression.

Consistent with the shift from criminalization to crisis prevention and intervention, the Act provides funding and initiatives to the criminal justice system to mitigate the criminalization of non-violent offenders with mental health and substance use disorders. The Act allows federal mental health court grant funds to be used for the creation of court-ordered outpatient treatment programs to prevent the escalation of mental health crises. Additionally, the Act requires the Attorney General and the Director of the Administrative Office of US Courts to create a Drug and Mental Health Court pilot program in at least one federal judicial district. As part of this program, low-level offenders who are mentally ill or addicted to narcotics would be eligible for diversion from prison if they comply with an intensive court-mandated treatment program. Many state and local governments operate similar problem-solving court programs, which have had success diverting eligible offenders, but under the current law, funding for such programs is allowable only for addressing substance abuse issues. Therefore, the Act updates the Treatment Alternative to Incarceration Program to allow state and local governments to use grant funds for these diversion programs for offenders with mental illness and co-occurring disorders. As part of the full spectrum of mental health and substance abuse disorder intervention, the Act amends the Second Chance Act to allow state and local governments to use re-entry demonstration project grant funds for the provision of mental health services, and to coordinate transitional services (including housing) for individuals re-entering society with mental illness, substance abuse problems or chronic homelessness. The initiatives aimed at non-violent offenders would likely reduce the risk of recidivism when a mentally ill offender is released.

 

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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  • Our Website may offer you the opportunity to share information through our Website, such as through Facebook's "Like" or Twitter's "Tweet" button. We offer this functionality to help generate interest in our Website and content and to permit you to recommend content to your contacts. You should be aware that sharing through such functionality may result in information being collected by the applicable social media network and possibly being made publicly available (for example, through a search engine). Any such information collection would be subject to such third party social media network's privacy policy.
  • Your information may also be shared to parties who support our business, such as professional advisors as well as web-hosting providers, analytics providers and other information technology providers.
  • Any court, governmental authority, law enforcement agency or other third party where we believe disclosure is necessary to comply with a legal or regulatory obligation, or otherwise to protect our rights, the rights of any third party or individuals' personal safety, or to detect, prevent, or otherwise address fraud, security or safety issues.
  • To our affiliated entities and in connection with the sale, assignment or other transfer of our company or our business.

How We Protect Your Information

JD Supra takes reasonable and appropriate precautions to insure that user information is protected from loss, misuse and unauthorized access, disclosure, alteration and destruction. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. You should keep in mind that no Internet transmission is ever 100% secure or error-free. Where you use log-in credentials (usernames, passwords) on our Website, please remember that it is your responsibility to safeguard them. If you believe that your log-in credentials have been compromised, please contact us at privacy@jdsupra.com.

Children's Information

Our Website and Services are not directed at children under the age of 16 and we do not knowingly collect personal information from children under the age of 16 through our Website and/or Services. If you have reason to believe that a child under the age of 16 has provided personal information to us, please contact us, and we will endeavor to delete that information from our databases.

Links to Other Websites

Our Website and Services may contain links to other websites. The operators of such other websites may collect information about you, including through cookies or other technologies. If you are using our Website or Services and click a link to another site, you will leave our Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We are not responsible for the data collection and use practices of such other sites. This Policy applies solely to the information collected in connection with your use of our Website and Services and does not apply to any practices conducted offline or in connection with any other websites.

Information for EU and Swiss Residents

JD Supra's principal place of business is in the United States. By subscribing to our website, you expressly consent to your information being processed in the United States.

  • Our Legal Basis for Processing: Generally, we rely on our legitimate interests in order to process your personal information. For example, we rely on this legal ground if we use your personal information to manage your Registration Data and administer our relationship with you; to deliver our Website and Services; understand and improve our Website and Services; report reader analytics to our authors; to personalize your experience on our Website and Services; and where necessary to protect or defend our or another's rights or property, or to detect, prevent, or otherwise address fraud, security, safety or privacy issues. Please see Article 6(1)(f) of the E.U. General Data Protection Regulation ("GDPR") In addition, there may be other situations where other grounds for processing may exist, such as where processing is a result of legal requirements (GDPR Article 6(1)(c)) or for reasons of public interest (GDPR Article 6(1)(e)). Please see the "Your Rights" section of this Privacy Policy immediately below for more information about how you may request that we limit or refrain from processing your personal information.
  • Your Rights
    • Right of Access/Portability: You can ask to review details about the information we hold about you and how that information has been used and disclosed. Note that we may request to verify your identification before fulfilling your request. You can also request that your personal information is provided to you in a commonly used electronic format so that you can share it with other organizations.
    • Right to Correct Information: You may ask that we make corrections to any information we hold, if you believe such correction to be necessary.
    • Right to Restrict Our Processing or Erasure of Information: You also have the right in certain circumstances to ask us to restrict processing of your personal information or to erase your personal information. Where you have consented to our use of your personal information, you can withdraw your consent at any time.

You can make a request to exercise any of these rights by emailing us at privacy@jdsupra.com or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

You can also manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard.

We will make all practical efforts to respect your wishes. There may be times, however, where we are not able to fulfill your request, for example, if applicable law prohibits our compliance. Please note that JD Supra does not use "automatic decision making" or "profiling" as those terms are defined in the GDPR.

  • Timeframe for retaining your personal information: We will retain your personal information in a form that identifies you only for as long as it serves the purpose(s) for which it was initially collected as stated in this Privacy Policy, or subsequently authorized. We may continue processing your personal information for longer periods, but only for the time and to the extent such processing reasonably serves the purposes of archiving in the public interest, journalism, literature and art, scientific or historical research and statistical analysis, and subject to the protection of this Privacy Policy. For example, if you are an author, your personal information may continue to be published in connection with your article indefinitely. When we have no ongoing legitimate business need to process your personal information, we will either delete or anonymize it, or, if this is not possible (for example, because your personal information has been stored in backup archives), then we will securely store your personal information and isolate it from any further processing until deletion is possible.
  • Onward Transfer to Third Parties: As noted in the "How We Share Your Data" Section above, JD Supra may share your information with third parties. When JD Supra discloses your personal information to third parties, we have ensured that such third parties have either certified under the EU-U.S. or Swiss Privacy Shield Framework and will process all personal data received from EU member states/Switzerland in reliance on the applicable Privacy Shield Framework or that they have been subjected to strict contractual provisions in their contract with us to guarantee an adequate level of data protection for your data.

California Privacy Rights

Pursuant to Section 1798.83 of the California Civil Code, our customers who are California residents have the right to request certain information regarding our disclosure of personal information to third parties for their direct marketing purposes.

You can make a request for this information by emailing us at privacy@jdsupra.com or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

Some browsers have incorporated a Do Not Track (DNT) feature. These features, when turned on, send a signal that you prefer that the website you are visiting not collect and use data regarding your online searching and browsing activities. As there is not yet a common understanding on how to interpret the DNT signal, we currently do not respond to DNT signals on our site.

Access/Correct/Update/Delete Personal Information

For non-EU/Swiss residents, if you would like to know what personal information we have about you, you can send an e-mail to privacy@jdsupra.com. We will be in contact with you (by mail or otherwise) to verify your identity and provide you the information you request. We will respond within 30 days to your request for access to your personal information. In some cases, we may not be able to remove your personal information, in which case we will let you know if we are unable to do so and why. If you would like to correct or update your personal information, you can manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard. If you would like to delete your account or remove your information from our Website and Services, send an e-mail to privacy@jdsupra.com.

Changes in Our Privacy Policy

We reserve the right to change this Privacy Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our Privacy Policy will become effective upon posting of the revised policy on the Website. By continuing to use our Website and Services following such changes, you will be deemed to have agreed to such changes.

Contacting JD Supra

If you have any questions about this Privacy Policy, the practices of this site, your dealings with our Website or Services, or if you would like to change any of the information you have provided to us, please contact us at: privacy@jdsupra.com.

JD Supra Cookie Guide

As with many websites, JD Supra's website (located at www.jdsupra.com) (our "Website") and our services (such as our email article digests)(our "Services") use a standard technology called a "cookie" and other similar technologies (such as, pixels and web beacons), which are small data files that are transferred to your computer when you use our Website and Services. These technologies automatically identify your browser whenever you interact with our Website and Services.

How We Use Cookies and Other Tracking Technologies

We use cookies and other tracking technologies to:

  1. Improve the user experience on our Website and Services;
  2. Store the authorization token that users receive when they login to the private areas of our Website. This token is specific to a user's login session and requires a valid username and password to obtain. It is required to access the user's profile information, subscriptions, and analytics;
  3. Track anonymous site usage; and
  4. Permit connectivity with social media networks to permit content sharing.

There are different types of cookies and other technologies used our Website, notably:

  • "Session cookies" - These cookies only last as long as your online session, and disappear from your computer or device when you close your browser (like Internet Explorer, Google Chrome or Safari).
  • "Persistent cookies" - These cookies stay on your computer or device after your browser has been closed and last for a time specified in the cookie. We use persistent cookies when we need to know who you are for more than one browsing session. For example, we use them to remember your preferences for the next time you visit.
  • "Web Beacons/Pixels" - Some of our web pages and emails may also contain small electronic images known as web beacons, clear GIFs or single-pixel GIFs. These images are placed on a web page or email and typically work in conjunction with cookies to collect data. We use these images to identify our users and user behavior, such as counting the number of users who have visited a web page or acted upon one of our email digests.

JD Supra Cookies. We place our own cookies on your computer to track certain information about you while you are using our Website and Services. For example, we place a session cookie on your computer each time you visit our Website. We use these cookies to allow you to log-in to your subscriber account. In addition, through these cookies we are able to collect information about how you use the Website, including what browser you may be using, your IP address, and the URL address you came from upon visiting our Website and the URL you next visit (even if those URLs are not on our Website). We also utilize email web beacons to monitor whether our emails are being delivered and read. We also use these tools to help deliver reader analytics to our authors to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

Analytics/Performance Cookies. JD Supra also uses the following analytic tools to help us analyze the performance of our Website and Services as well as how visitors use our Website and Services:

  • HubSpot - For more information about HubSpot cookies, please visit legal.hubspot.com/privacy-policy.
  • New Relic - For more information on New Relic cookies, please visit www.newrelic.com/privacy.
  • Google Analytics - For more information on Google Analytics cookies, visit www.google.com/policies. To opt-out of being tracked by Google Analytics across all websites visit http://tools.google.com/dlpage/gaoptout. This will allow you to download and install a Google Analytics cookie-free web browser.

Facebook, Twitter and other Social Network Cookies. Our content pages allow you to share content appearing on our Website and Services to your social media accounts through the "Like," "Tweet," or similar buttons displayed on such pages. To accomplish this Service, we embed code that such third party social networks provide and that we do not control. These buttons know that you are logged in to your social network account and therefore such social networks could also know that you are viewing the JD Supra Website.

Controlling and Deleting Cookies

If you would like to change how a browser uses cookies, including blocking or deleting cookies from the JD Supra Website and Services you can do so by changing the settings in your web browser. To control cookies, most browsers allow you to either accept or reject all cookies, only accept certain types of cookies, or prompt you every time a site wishes to save a cookie. It's also easy to delete cookies that are already saved on your device by a browser.

The processes for controlling and deleting cookies vary depending on which browser you use. To find out how to do so with a particular browser, you can use your browser's "Help" function or alternatively, you can visit http://www.aboutcookies.org which explains, step-by-step, how to control and delete cookies in most browsers.

Updates to This Policy

We may update this cookie policy and our Privacy Policy from time-to-time, particularly as technology changes. You can always check this page for the latest version. We may also notify you of changes to our privacy policy by email.

Contacting JD Supra

If you have any questions about how we use cookies and other tracking technologies, please contact us at: privacy@jdsupra.com.

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