	Introduction

The 21 st Century Cures Act ( P.L. This report provides information on Division B of the law. Summary of Provisions

Division B begins before Title VI with the short title (Section 6000), "Helping Families in Mental Health Crisis Reform Act of 2016." Title VI—Strengthening Leadership and Accountability

		Subtitle A—Leadership

Subtitle A makes changes to the leadership, organization, and responsibilities of the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency within the Department of Health and Human Services (HHS) that has primary responsibility for increasing access to community-based services to prevent and treat mental disorders and substance use disorders. Subtitle B—Oversight and Accountability

Subtitle B creates new planning and evaluation requirements, changes reporting and accounting requirements for state-designated protection and advocacy systems, and requires a report by the Comptroller General on programs funded by SAMHSA's Protection and Advocacy for Individuals with Mental Illness (PAIMI) grants. Title VII—Ensuring Mental and Substance Use Disorders Prevention, Treatment, and Recovery Programs Keep Pace with Science and Technology

Title VII establishes within SAMHSA a "National Mental Health Policy Laboratory," codifies SAMHSA's National Registry of Evidence-based Programs and Practices (which was not previously explicitly authorized in statute), and authorizes appropriations for SAMHSA's Programs of Regional and National Significance (for which authorizations of appropriations had expired). 114-255 . Title VIII—Supporting State Prevention Activities and Responses to Mental Health and Substance Use Disorder Needs

Title VIII focuses on SAMHSA's two biggest programs: the Community Mental Health Services Block Grant (MHBG, $533 million in FY2016) and the Substance Abuse Prevention and Treatment Block Grant (SABG, $1.9 billion in FY2016). Title IX—Promoting Access to Mental Health and Substance Use Disorder Care

		Subtitle A—Helping Individuals and Families

			Changes to Existing Programs and Activities

				Treatment Systems for Homeless

PHSA Section 506 authorizes a SAMHSA-administered program commonly known as Treatment Systems for Homeless. It included various other requirements (e.g., application, allowable uses of funds, and reporting). It authorized appropriations through FY2003. Subtitle B—Strengthening the Health Care Workforce

			Changes to Existing Programs and Activities

				Mental and Behavioral Health Training Grants

PHSA Section 756 authorizes a program commonly known as Mental and Behavioral Health Training Grants, which is administered by the Health Resources and Services Administration (HRSA). The section also requires the Secretary to sponsor an annual conference on mental and behavioral health on college campuses. Title X—Strengthening Mental Health and Substance Use Disorder Care for Children and Adolescents

			Changes to Existing Grant Programs

				Children's Mental Health Services

PHSA Title V, Part E (Sections 561–565), authorizes a SAMHSA-administered program commonly known as Children's Mental Health Services. It also makes technical edits. Clarification of Permitted Uses and Disclosures of Protected Health Information

Title XI (Section 11003) requires OCR, not later than one year after enactment, to issue guidance clarifying the circumstances—consistent with the HIPAA privacy standards—under which health care providers (and other HIPAA-covered entities) may communicate with family members, caregivers, and law enforcement about individuals seeking or receiving treatment for mental health or substance use disorders. Development and Dissemination of Model Training Programs

Title XI (Section 11004) requires the Secretary, not later than one year after enactment, to develop, disseminate, and periodically update model programs for training health care providers, lawyers, and patients and their families on the permitted uses and disclosures of PHI of individuals seeking or receiving treatment for mental health or substance use disorders, consistent with the HIPAA privacy and security standards. Title XII (Section 12001) addresses Medicaid's same-day services prohibition. The letter should include opportunities for demonstration projects under the SSA Section 1115 waiver authority to improve care for such individuals. Study and Report on Medicaid Emergency Psychiatric Demonstration Project

Medicaid's IMD exclusion limits the circumstances under which federal Medicaid matching funds are available for inpatient mental health care. Electronic Visit Verification System for Personal Care Services and Home Health Care Services

Federal Medicaid law requires states to cover certain populations and benefits, but states have discretion to cover other optional populations and services. Title XIII—Mental Health Parity

Title XIII includes provisions related to mental health parity and provisions related to eating disorders, as well as one provision applying mental health parity to eating disorder benefits. Changes to Existing Grant Programs

Subtitle A amends the authorizing legislation for several Department of Justice (DOJ) programs and one Department of Homeland Security (DHS) grant program. Broadly, the amendments made by Subtitle A expand the scope of these programs to allow funds to be used to assist people with mental illness, substance use problems, or co-occurring substance abuse and mental health issues. Subtitle B—Comprehensive Justice and Mental Health

Subtitle B makes several changes to the Justice and Mental Health Collaboration program. The amendments largely expand the scope of the program so grants may be used for additional purposes to help respond to people involved in the criminal justice system who have substance abuse, mental health, or co-occurring disorders.
This report summarizes the Helping Families in Mental Health Crisis Reform Act of 2016, enacted on December 13, 2016, as Division B of the 21st Century Cures Act (P.L. 114-255). Division B comprises Title VI through Title XIV. The first five titles in Division B (Title VI – Title X) deal primarily with the Substance Abuse and Mental Health Services Administration (SAMHSA) within the Department of Health and Human Services (HHS). SAMHSA is the federal agency with primary responsibility for increasing access to community-based services to prevent and treat mental disorders and substance use disorders. The next four titles in Division B (Title XI – Title XIV) deal with confidentiality of patient records, Medicaid, mental health parity, and criminal justice programs.
Title VI "Strengthening Leadership and Accountability"
Within Title VI, Subtitle A makes changes to HHS and SAMHSA's leadership, structure, and responsibilities. Subtitle B creates new planning and evaluation requirements, changes reporting and accounting requirements for state-designated protection and advocacy systems, and requires a Government Accountability Office (GAO) report on programs funded by SAMHSA's Protection and Advocacy for Individuals with Mental Illness grants. Subtitle C requires the HHS Secretary to establish an Interdepartmental Serious Mental Illness Coordinating Committee.
Title VII "Ensuring Mental and Substance Use Disorders Prevention, Treatment, and Recovery Programs Keep Pace with Science and Technology"
Title VII establishes within SAMHSA a "National Mental Health Policy Laboratory," codifies SAMHSA's existing National Registry of Evidence-based Programs and Practices (which was not previously explicitly authorized in statute), and authorizes appropriations for SAMHSA's Programs of Regional and National Significance (for which authorizations of appropriations had expired).
Title VIII "Supporting State Prevention Activities and Responses to Mental Health and Substance Use Disorder Needs"
Title VIII focuses on SAMHSA's two biggest programs: the Community Mental Health Services Block Grant (MHBG, $533 million in FY2016) and the Substance Abuse Prevention and Treatment Block Grant (SABG, $1.9 billion in FY2016). It makes various changes—some increasing flexibility, some imposing additional requirements, and some codifying current practice. It also requires a study on the formulas for distributing MHBG and SABG funds.
Title IX "Promoting Access to Mental Health and Substance Use Disorder Care"
Within Title IX, Subtitle A reauthorizes and modifies various programs and activities (most of which are administered by SAMHSA), codifies existing SAMHSA-administered programs and activities, authorizes new SAMHSA-administered programs and activities, and repeals statutory authorities for programs that have never been funded. Subtitle B focuses on the mental health and substance use disorder workforce—authorizing, reauthorizing, or amending several programs and activities, most of which are administered by the Health Resources and Services Administration (HRSA) within HHS. Subtitle C authorizes or reauthorizes SAMHSA-administered programs and activities focused on mental health on college campuses.
Title X "Strengthening Mental and Substance Use Disorder Care for Children and Adolescents"
Title X focuses on expanding access to community mental and behavioral health services for youth. It reauthorizes and modifies several SAMHSA-administered programs and activities. It also establishes several new grant programs.
Title XI "Compassionate Communication on HIPAA"
Title XI focuses on confidentiality of patient records and the circumstances under which health care providers (and other entities) may communicate with family members, caregivers, and law enforcement about individuals seeking or receiving treatment for mental disorders or substance use disorders. It requires dissemination of model programs for training health care providers, lawyers, and patients and their families on permitted disclosures.
Title XII "Medicaid Mental Health Coverage"
Title XII focuses on Medicaid. It includes a rule of construction related to same-day services. It requires studies and reports related to Medicaid managed care regulation and (separately) Medicaid's Emergency Psychiatric Demonstration Project. It requires a letter from the Centers for Medicaid & Medicare Services to State Medicaid Directors regarding opportunities for innovation under the Social Security Act (SSA) Section 1115 waiver authority. It requires the use of an electronic visit verification system for personal care services and home health care services under Medicaid.
Title XIII "Mental Health Parity"
Title XIII focuses on mental health parity and (separately) eating disorders, as well as the application of parity to eating disorder benefits. It amends federal parity law to include provisions aimed at improving compliance and requires a GAO report on compliance. It authorizes activities to educate the public and health professionals about eating disorders.
Title XIV "Mental Health and Safe Communities"
Title XIV amends the authorizing legislation for several Department of Justice (DOJ) programs and one Department of Homeland Security (DHS) grant program. Broadly, the amendments made by Subtitle A expand the scope of these programs to allow funds to be used to assist people with mental illness, substance use problems, or co-occurring substance abuse and mental health issues. Subtitle B makes several changes to the Justice and Mental Health Collaboration program. The amendments largely expand the scope of the program, so grants may be used for additional purposes to help respond to people involved in the criminal justice system who have substance abuse, mental health, or co-occurring disorders.