Policy wins and the X waiver: MHA recaps the 117th congressional session

As the new 118th Congress session begins, Mental Health America wants to take a moment to appreciate the major legislative victories in the last congressional session and highlight one new policy in particular, the X-waiver repeal.

Mental Health America affiliates and advocates participated in meetings, calls, and days of action, sharing their stories of lived experience with Congress and were able to secure many wins, including:

New Medicare coverage of certified peer specialists in integrated behavioral settings and as part of mobile crisis interventions.
Authority and funding for peer support services for veterans, birthing individuals, and individuals at risk of justice involvement.
A $150 million increase in the Mental Health Block Grant, bringing its total to over $1 billion for the first time in its history.
A set-aside for crisis services in the Mental Health Block Grant as well as over half a billion dollars for the 988 Suicide and Crisis Lifeline and a new crisis coordinating center at the Substance Abuse and Mental Health Services Administration (SAMHSA).
Over $1 billion in funding for school-based mental health professionals and a pipeline to increase this workforce’s diversity.
Millions in dollars funding youth mental health awareness and training for school personnel to detect and respond to mental health issues and connect school-aged youth to services.
New Medicare coverage of marriage and family therapists, licensed counselors, and expansion of psychiatric training residencies.
Elimination of the redundant X-waiver requirement to prescribe buprenorphine for substance use disorders.

X-waiver elimination

The Mainstreaming Addiction Treatment (MAT) Act, which eliminates the X waiver, was introduced and led by Rep. Paul Tonko (D-NY). Mental Health America is pleased that more individuals, whether in rural or urban areas, will have an improved ability to get treatment for opioid use disorder (OUD). Under Section 1262 of the Consolidated Appropriations Act, health providers no longer need to submit a Notice of Intent, or have a waiver, to prescribe certain medications, like buprenorphine, for the treatment of OUD. The Drug Enforcement Administration (DEA) and SAMHSA subsequently put out notices eliminating the additional X- waiver registration requirement, effective immediately.

The elimination of the X-Waiver requirement means that:

All prescriptions for buprenorphine for OUD now require only a standard DEA registration number.
SAMHSA is no longer accepting Notices of Intent to prescribe buprenorphine for opioid use disorder (i.e., X-waiver applications).
There are no longer any limits on the number of patients a prescriber may treat for OUD with buprenorphine.
All practitioners must still comply with applicable state laws and regulations.

All health care providers with a DEA registration that includes Schedule III medications can begin to prescribe buprenorphine for OUD. However, some state laws, such as in Kentucky, require providers to have the X-waiver to treat OUD with buprenorphine, also known as naloxone. Thus, advocates in states will need to conduct additional education of policymakers to ensure the repeal of any laws based on the X-waiver requirement to make sure consumers have broad access to OUD medications as federal lawmakers intended.

MHA continues to support the bipartisan work in Congress to address substance use disorders (SUDs), which most often co-occur with mental health conditions. The Health Subcommittee recently conducted a hearing on additional issues of importance in combating the opioid crisis, including legislation that would begin to ramp up surveillance of fentanyl trafficking, address cybersecurity threats associated with 988, and prohibit federal health plans from using quality- adjusted life year (QALY) in payment determinations.

To learn more about our recommendations to federal policymakers on SUD issues, visit the Partnership to Amend 42 CFR Part 2 coalition’s website, which just submitted comments to the administration on a rule aligning 42 CFR Part II with HIPAA.

While much progress was made, there is still much to do in the 118 th Congress to educate and promote early intervention and prevention, a livable wage for peer specialists, and equitable access to mental health and SUD services for Black, Indigenous, and people of color and LGBTQ+ populations. We are also working to hold technology companies accountable for the harms of social media overuse through the Kids Online Safety Act. Read more about our 2023 priorities and encourage a loved one to join our Advocacy Network to ramp up the number of voices that are part of our grassroots pressure on Congress and the Administration to design better policies.