Federal legislation and appropriations impacting the SUD field - PowerPoint Presentation

Federal legislation and appropriations impacting the SUD field Addiction Professionals of North Carolina (APNC) 2019 Policy SummitRaleigh, NCMay 8, 2019 Robert Morrison, Executive Director/Director of Legislative Affairs

Topics to Cover Intro to NASADAD Recent legislative milestones Comprehensive Addiction and Recovery Act of 2016 21st Century Cures Act of 2016Family First Prevention Services Act of 2018SUPPORT for Patients and Communities Act of 2018Federal budget and appropriations Final appropriations for FY 2019 Budget and appropriations for FY 2020What to expect next 2

Overview of Mission: To promote effective and efficient State substance use disorder prevention, treatment, and recovery systems. Office in Washington, D.C. with Policy Department and Research Department. Research Department houses component groups: prevention, treatment, women’s services, and SOTAs Governed by Board of Directors Cassandra Price (GA), PresidentMark Stringer (MO), Public Policy Chair3

Role of State Alcohol & Drug Agencies Placement in State government – varies by State May be in Departments of Health, Human Services, Social Services, etc.Develop annual State plans to provide prevention, treatment, and recovery services Ensure service effectiveness, quality, improvement and coordinationCollaborate with other State agencies Child welfare; criminal justice; drug courts; medical system; transportation; job training/placement, etc.Represent key link to substance use disorder provider communityConvene stakeholder meetingsManage the Federal Substance Abuse Prevention and Treatment (SAPT) Block GrantManage STR Grant and SOR Grant 4

Substance Abuse Prevention and Treatment (SAPT) Block Grant $1.8 billion formula grant administered by SAMHSA Supports treatment for 1.5 million Americans per year 20% set-aside for primary prevention Flexible program that allows each State to direct resources for prevention, treatment and recovery to meet their own needsInfrastructure for efficient and effective management and allocation of funds5

Without any significant funding increases over the past decade, the SAPT Block Grant has lost 24% of its purchasing power 6   -24% or $444 million

Recap: CARA, CURES, and FFPSASeries of legislative milestones impacting SUD field

CARA of 2016 CARA signed into law on July 22, 2016. Provisions related to prevention and education, treatment, recovery, law enforcement, and services for women, families, and veterans, among others. Provisions that NASADAD tracked closely: Improving Treatment for Pregnant and Postpartum Women Opioid Use Disorder Treatment Modernization (Buprenorphine Prescribing)CARA did not include funding for treatment of opioid use disorders.8

21 st Century Cures Act21 st Century Cures ActOriginally focused on expanding innovations in medical research Became vehicle for other legislation: Funding for opioids MH reform; SAMHSA reauthorizationSTOP Act9

Grants to States to address the opioid crisis CURES authorized account for State Targeted Response (STR) to the Opioid Crisis Grants: $500 million in FY 2017 (year 1)$500 million in FY 2018 (year 2) 10 Additionally, in FY 2018, appropriators allocate, above and beyond year 2 of STR, "$1 billion in new funding for grants to States to address the opioid crisis"--the State Opioid Response ( SOR) grants.$1 billion in FY 2018$1.5 billion in FY 2019Administration and House Appropriations L-HHS Subcommittee recommend $1.5 billion (level funding) for SOR in FY 2020

Child Welfare Provisions in 2018 Budget Deal Family First Prevention Services Act was included in the Bipartisan Budget Act that passed in March of 2018 Addresses issues related to child welfare and substance use. Was included as part of 21 st Century Cures Act of 2017, but removed prior to passage. Alters the allowable uses of Title IV-E [foster care] funding so it can be used to pay for services before children need to be removed from their home. Allows foster care maintenance payments to be made for children who live with a parent while the parent is in residential treatment for SUD. Amends the Regional Partnership Grant (RPG) program…11

Regional Partnership Grants RPG program is managed by the Administration for Children and Families (ACF) within HHS. Originally created to support regional partnerships that improve the well-being, permanency, and outcomes of children who are in, or at risk of, out-of-home placement as a result of a parent’s or caregiver’s methamphetamine use. SSA historically listed as an optional partner in the regional partnerships with State child welfare agencies.Grants address a variety barriers to optimal family outcomes (e.g. parental engagement/retention in treatment, professional training, coordinating timeframes for outcomes across agencies, etc.) How did the Budget Act change RPG?Language updated to reflect current opioid/heroin crisis. Requires the SSA to be a mandatory partner for the RPG, in addition to State CW agency. 12

Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act signed into law in October 2018

SUPPORT Act covers a range of issues… State Targeted Response to the Opioid Crisis (STR) reauthorization Comprehensive Opioids Recovery Centers (CORCs) Recovery coaches in ERs Student loan repayment for SUD treatment professionals Recovery housingPPW reauthorizationPatient limit for buprenorphine prescribing14DATA waiverIMD exclusion PDMPs ONDCP reauthorization Medicare and MAT Regional Centers of Excellence in SUD Education Loan Repayment Program within HRSA

Grants to States to address the opioid crisis (Sec. 7181) 21st Century Cures Act of 2016 authorized grants to States to address the opioid crisis Title : State Targeted Response to the Opioid Crisis grant administered by SAMHSA Eligible applicants: State alcohol & drug agenciesSUPPORT Act reauthorized this grant program$500 million for each of FY 2019-20215% set-aside for tribesUp to 15% set-aside for States and Tribes with highest age-adjusted mortality rate15

Loan Repayment for Substance Use Disorder Treatment Providers (Sec. 7071) Authorizes the Secretary of HHS, acting through HRSA Administrator, to carry out a loan repayment program for eligible professionals providing SUD treatment services. Services must be delivered in SUD treatment facilities that are in “mental health” shortage areas or counties where the drug overdose death rate is higher than the national average. Eligible professionals: master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals and physicians, physician assistants, and nurses.Maximum total amount of repayment by the program is $250,000 per individual.16

HRSA’s NHSC SUD Workforce Loan Repayment Program   17

HRSA NHSC Workforce Loan Repayment Program: Further informationFor a 2-page Fact Sheet on the program: https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/nhsc-sud-workforce-lrp-fact-sheet.pdf For general information and an opportunity to sign up for email alerts when the new application cycle opens: https://nhsc.hrsa.gov/loan-repayment/nhsc-sud-workforce-loan-repayment-program.html For the application period that opened December 2018 and closed February 2019: https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/sud-lrp-application-guidance.pdf 18

IMD Exclusion (Sections 5051, 5052)Overview : Allows State Medicaid programs to apply, under a State Plan Amendment, to receive federal reimbursement for up to 30 days of care for patients in an IMD “…but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.” Time period for program : October 1, 2019 to September 30, 2023 Eligible individual (definition): is enrolled for medical assistance under the State plan or a waiver of such plan; at least 21 and under 65 years of age; and has at least 1 substance use disorder19

IMD ExclusionEligible Institutions for Mental Diseases (definition) :“follows reliable, evidence-based practices”“offers at least 2 forms of medication-assisted treatment for substance use disorders on-site, including, in the case of medication-assisted treatment for opioid use disorder, at least one antagonist and at least one partial agonist” Process: “Not less than 8 months after the date of enactment…Secretary shall establish a process…” E.g. “Dear State Medicaid Director” letter?20

Program to Support Emergency Room Discharge and Care Coordination for Drug Overdose Patients (Sec. 7081) Builds upon the “Anchor ED” recovery coaching model from Rhode Island. Authorizes the Sec. of HHS to identify of facilitate the development of best practices for: emergency treatment of known or suspected drug overdose; the use of recovery coaches, as appropriate, to encourage individuals who experience a non-fatal overdose to seek treatment for substance use disorder and to support coordination and continuation of care; coordination and continuation of care and treatment, including, as appropriate, through referrals, of individuals after a drug overdose; and the provision or prescribing of overdose reversal medication, as appropriate.$10 million for each of FY 2019-202321Eligible applicants include: a State alcohol and drug agency; an Indian Tribe or tribal organization; or an entity that offers treatment or other services for individuals in response to a drug overdose, such as an emergency department, in consultation with a State substance abuse agency.

Residential Treatment for Pregnant and Postpartum Women ( PPW) (Sec. 7062) SUPPORT Act reauthorizes PPW program within SAMHSA/ CSAT$29 million for FY 2019- FY 2023Family-based services for women in residential settingsPilot program in non-residential settings for State alcohol and drug agencies of up to 25 percent of the residential PPW program referenced above (originally created in CARA)Initial 3 pilots in MA, VA and NYImportant messaging: Pilot is a supplement and not replacement – the PPW residential program is vitalTarget populations: Low-income women, age 18 and over, who are pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who have limited access to quality health services22

Bupe Cap (Sections 3201 and 3202)Adds to the category of “qualifying practitioner” clinical nurse specialists, certified nurse anesthetists, and certified nurse midwifes. Allows qualifying practitioners to treat up to 100 patients (instead of 30) in the first year of holding a DATA waiver if: at least one year after the practitioner submitted the initial notification, the practitioner submits a second notification to the HHS Secretary of the need and intent of the practitioner to treat up to 100 patients; the practitioner holds additional credentialing (board certification in addiction medicine or addiction psychiatry); orthe practitioner provides MAT in a qualified practice setting.Allows qualifying practitioners to treat up to 275 patients if they meet certain requirements, such as having maintained the 100-patient limit waiver for at least 1 year.Cap was already raised to 275 patients by regulation in 2016

Federal Budget and Appropriations Process 24

President’s Proposed Budget Typically in February , the President submits to Congress a detailed budget request for the coming fiscal year, which begins on October 1. Budget outlines the Administration’s overarching priorities for federal programs Budget must recommend funding levels for annually appropriated programs (aka discretionary programs).These discretionary programs fall under the jurisdiction of the House and Senate Appropriations Committees.President does not need to make recommendations for mandatory funding (e.g. mandatory/entitlement programs and taxes)25

Budget and Appropriations Process Congress holds hearings in February and March to ask Administration officials about their budget requests and, then Congress develops its own budget plan, called a “budget resolution.”Budget resolution sets overall spending targets for other congressional committees (e.g. Appropriations Committee) that can propose legislation that directly provides spending. Outlines how much Congress is supposed to spend in each spending category, and how much total revenue the government will collect.26

12 Appropriations Subcommittees with jurisdiction over particular agencies 1. Agriculture, Rural Development, Food and Drug Administration, and Related Agencies; 2. Commerce, Justice, Science, and Related Agencies;3. Defense;4. Energy and Water Development, and Related Agencies; 5. Financial Services and General Government; 6. Homeland Security; 7. Interior, Environment, and Related Agencies;8. Labor, Health and Human Services, Education, and Related Agencies (“Labor-H”);9. Legislative Branch;10. Military Construction, Veterans Affairs, and Related Agencies;11. State, Foreign Operations, and Related Programs; and12. Transportation, Housing and Urban Development, and Related Agencies.27

Labor-HHS Subcommittees have jurisdiction over… …and more. 28

Final Steps After passing the subcommittee level , Labor-HHS bill is considered by the full Appropriations Committee. All 12 appropriations bills are supposed to be passed in “regular order” —full passage through both House and Senate and signed by the President by the start of the federal fiscal year on October 1st. In recent years, failure to provide appropriations by that date have resulted in continuing resolutions (CRs)—stopgap funding bills that keep the government funded at the previous fiscal year’s funding levels.FY 2019 spending bill passed before the fiscal year began on Oct. 1, 201829

FY 2019 funding In September 2018, Congress passed final FY 2019 (10/1/18-9/30/19) Labor, Health & Human Services (HHS), Education, and Related Agencies (L-HHS) appropriations bill 30

31 Program  FY 16  FY 17  FY 18 Omnibus  President’s FY 19 Request FY 19 Request vs. FY 18 Final FY 19FY 19 vs. FY 18 SAPT Block Grant $1,858, 079,000 $1,858,079,000 $1,858,079,000 $1,858,079,000 Level  $1,858,079,000  Level  Substance Abuse Prevention and Treatment (SAPT) Block Grant   House Appropriations Subcommittee and Full Committee recommended an increase of $500 million for the SAPT Block Grant during the FY 2019 appropriations process. This proposal was not in the final agreement.

Additional Opioids Allocation   Program  FY 17  FY 18 Omnibus  President’s FY 19 Request FY 19 Request vs. FY 18 Final FY 19FY 19 vs. FY 18 State Targeted Response (STR) to the Opioid Crisis Grants  $500,000,000  $500,000,000  $1,000,000,000  +$500,000,000  Not funded  N/A  State Opioid Response ( SOR ) Grants  N/A  $1,000,000,000 Not funded  -$1,000,000,000  $1,500,000,000 +$500,000,000 Senate Appropriations Committee Report to Accompany FY 2019 funding : “The Committee recognizes the work moving forward under the SOR program and the State Targeted Response to the Opioid Abuse Crisis grant program. The Committee directs SAMHSA to ensure these resources are aligned with the State plan developed by each State’s alcohol and drug agency as defined by the agency that manages the SAPT Block Grant. This will ensure continuity of funding and coordination of efforts within each State system.” STR; SOR – critical message: Congress and the Administration support significant resources to States to address the opioid crisis. 32

Program  FY 17  FY 18 Omnibus  President’s FY 19 Request  FY 19 Request vs. FY 18  FY 2019 FY 19 vs. FY 18 CSAT TOTAL $354,427,000$403,427,000$255,318,000 -$148,109,000  $458,677,000 +$55,250,000 Addiction Technology Transfer Centers (ATTCs)  $9,046,000  $9,046,000  $9,046,000  Level  $9,046,000  Level  Building Communities of Recovery  $3,000,000  $5,000,000  $3,000,000  -$2,000,000  $6,000,000  +$1,000,000  Children and Families  $29,605,000  $29,605,000  $29,605,000  Level  $29,605,000  Level  Criminal Justice Activities  $78,000,000  $89,000,000  $78,000,000  -$11,000,000  $89,000,000  Level       Drug Courts  $60,000,000  $70,000,000  $60,000,000  -10,000,000  $70,000,000  Level  First Responder Training*  $12,000,000  $36,000,000  $12,000,000  -$24,000,000   $36,000,000  Level       Rural Focus*  N/A  $18,000,000  Not funded  -$18,000,000  $18,000,000  Level  Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths*  $12,000,000  $12,000,000  $12,000,000  Level  $12,000,000  Level  SAMHSA’s Center for Substance Abuse Treatment (CSAT)   *First Responder Training program, Rural Focus, and Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths were previously funded within CSAP (FY 2017-FY 2018) 33

Improving Access to Overdose Treatment   $1,000,000  $1,000,000  $1,000,000  Level  $1,000,000 Level Minority AIDS $65,570,000 $65,570,000 Not funded -$65,570,000  $65,570,000  Level  Minority Fellowship  $3,539,000  $4,539,000  Not funded  -$4,539,000  $4,789,000  Level  Opioid Treatment Programs/Regulatory Activities  $8,724,000  $8,724,000  $8,724,000  Level  $8,724,000  Level  Pregnant and Postpartum Women ( PPW )  $19,931,000  $29,931,000  $19,931,000  -$10,000,000  $29,931,000  Level  Recovery Community Services Program  $2,434,000  $2,434,000  $2,434,000  Level  $2,434,000  Level  Screening, Brief Intervention, and Referral to Treatment ( SBIRT )  $30,000,000  $30,000,000  Not funded  -$30,000,000  $30,000,000  Level  Targeted Capacity Expansion (TCE) General  $67,192,000  $95,192,000  $67,192,000  -$28,000,000  $100,192,000  +$5,000,000       Medication-Assisted Treatment for          Prescription Drug and Opioid Addiction   $56,000,000  $84,000,000  $56,000,000  -$28,000,000  $89,000,000  +$5,000,000  Treatment Systems for Homeless  $36,386,000  $36,386,000  $36,386,000  Level  $36,386,000  Level  CSAT Program  FY 17  FY 18 Omnibus  President’s FY 19 Request  FY 19 Request vs. FY 18  FY 2019  FY 19 vs. FY 18  CSAT Funding (continued) 34

35 Program FY 16 FY 17 FY 18 Omnibus President’s FY 19 RequestFY 19 Request vs. FY 18FY 2019FY 19 vs. FY 18 CSAP TOTAL $211,219,000 $223,219,000 $248,219,000 $220,885,000 -$27,334,000 $205,469,000 -$42,750,000 Center for the Application of Prevention Technologies (CAPT) $7,493,000 $7,493,000 $7,493,000 $7,493,000 Level $7,493,000 Level Mandatory Drug Testing $4,894,000 $4,894,000 $4,894,000 $4,894,000 Level $4,894,000 Level Minority AIDS $41,205,000 $41,205,000 $41,205,000 Not funded -$41,205,000 $41,205,000 Level Minority Fellowship $71,000 $71,000 $71,000 Not funded -$71,000 $321,000 +$250,000 Science and Service Program Coordination $4,072,000 $4,072,000 $4,072,000 $4,072,000 Level $4,072,000 Level Sober Truth on Preventing Underage Drinking (STOP Act) $7,000,000 $7,000,000 $7,000,000 $7,000,000 Level $8,000,000 +$1,000,000 National Adult-Oriented Media Public Service Campaign N/A N/A N/A N/A N/A $1,000,000 +$1,000,000 Strategic Prevention Framework-Partnerships for Success $109,484,000 $109,484,000 $119,484,000 $58,426,000 -$61,058,000 $119,484,000 Level Strategic Prevention Framework Rx $10,000,000 $10,000,000 $10,000,000 $10,000,000 Level $10,000,000 Level Tribal Behavioral Health Grants $15,000,000 $15,000,000 $15,000,000 $15,000,000 Level $20,000,000 +$5,000,000 SAMHSA’s C enter for Substance Abuse Prevention ( CSAP )

Program FY 16 FY 17 FY 18 Omnibus President’s FY 19 Request FY 19 Request vs. FY 18FY 2019 FY 19 vs. FY 18 DEA $2,080,000,000 $2,102,976,000 $2,609,900,000 $2,441,500,000 -$168,400,000 $2,687,703,000 +$77,803,000 Office of Justice Programs: Research, Evaluation, and Statistics $116,000,000 $89,000,000 $90,000,000 $77,000,000 -$13,000,000 $80,000,000 -$10,000,000 State and Local Law Enforcement Assistance $1,408,500,000 $1,258,500,000 $1,677,500,000 $1,132,000,000 -$545,500,000 $1,723,000,000 +$45,500,000 Byrne Justice Assistance Grants $347,000,000 $334,600,000 $339,600,000 $331,100,000 -$8,500,000 $329,600,000 -$10,00,000 Drug Courts $42,000,000 $43,000,000 $75,000,000 $43,000,000 -$32,000,000 $77,000,000 +$2,000,000 Mentally Ill Offender Act $10,000,000 $12,000,000 $30,000,000 $10,000,000 -$20,000,000 $31,000,000 +$1,000,000 Residential Substance Abuse Treatment (RSAT) $12,000,000 $14,000,000 $30,000,000 $12,000,000 -$18,000,000 $30,000,000 Level Second Chance Act/Offender Reentry $68,000,000 $68,000,000 $85,000,000 $58,000,000 -$27,000,000 $87,500,000 +$2,500,000 Veterans Treatment Courts $6,000,000 $7,000,000 $20,000,000 $6,000,000 -$14,000,000 $22,000,000 +$2,000,000 Prescription Drug Monitoring $13,000,000 $14,000,000 $30,000,000 $12,000,000 -$18,000,000 $30,000,000 Level Juvenile Justice Programs $270,160,000 $247,000,000 $282,500,000 $229,500,000 -$53,000,000 $287,000,000 +$4,500,000 Opioid Affected Youth -- -- $8,000,000 Not funded -$8,000,000 $9,000,000 +$1,000,000 Community Oriented Policing Systems (COPS) $212,000,000 $221,500,000 $275,500,000 $99,000,000 -$176,500,000 $303,500,000 +$28,000,000 D epartment of Justice (DOJ) – Select Programs 36

Program  FY 16  FY 17  FY 18 Omnibus  President’s FY 19 Request  President vs. FY 18 FY 2019 FY 19 vs. FY 18 Office of National Drug Control Policy*  $379,857,000  $388,145,000  $415,493,000  $29,240,000  -$386,253,000  $416,727,000 +$1,234,000      Drug Free Communities (DFC)  $95,000,000  $97,000,000  $99,000,000  Not funded within ONDCP  -$99,000,000  $100,000,000  +1,000,000       High-Intensity Drug Trafficking Area (HIDTA) Program  $250,000,000  $254,000,000  $280,000,000  Not funded within ONDCP  -$280,000,000  $280,000,000  Level  Office of National Drug Control Policy (ONDCP)   37

FY 2020 Budget and appropriations 38

Delayed FY 2020 budget Administration typically releases budget in early February.Due to the 35-day partial government, many employees of the Office of Management and Budget (OMB) were furloughed and unable to finalize the proposed budget on time. FY 2020 budget was released in mid-March. 39

SAMHSA Programs $1.858 billion for the Substance Abuse Prevention and Treatment (SAPT) Block Grant (level compared to FY 2019)$1.5 billion for the State Opioid Response (SOR) Grant (level) $430 million for the Center for Substance Abuse Treatment (CSAT), a $30 million cut $144 million for Programs of Regional and National Significance (PRNS) within the Center for Substance Abuse Prevention ( CSAP ), a $61 million cut40

Program FY 17 FY 18 FY 2019 President’s FY 20 Request FY 20 Request vs. FY 19 CSAT TOTAL $354,427,000 $403,427,000 $460,677,000 $429,888,000 -$30,789,000 Addiction Technology Transfer Centers (ATTCs) $9,046,000 $9,046,000 $9,046,000 $9,046,000 Level Building Communities of Recovery $3,000,000 $5,000,000 $6,000,000 $6,000,000 Level Children and Families $29,605,000 $29,605,000 $29,605,000 $29,605,000 Level Criminal Justice Activities $78,000,000 $89,000,000 $89,000,000 $89,000,000 Level Drug Courts $60,000,000 $70,000,000 $70,000,000 $70,000,000 Level First Responder Training* $12,000,000 $36,000,000 $36,000,000 $36,000,000 Level Rural Focus* N/A $18,000,000 $18,000,000 $18,000,000 Level Grants to Develop Curricula for DATA Act Waivers N/A N/A N/A $4,000,000 +$4,000,000 Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths* $12,000,000 $12,000,000 $12,000,000 $12,000,000 Level Improving Access to Overdose Treatment $1,000,000 $1,000,000 $1,000,000 $1,000,000 Level Minority AIDS $65,570,000 $65,570,000 $65,570,000 $65,570,000 Level Minority Fellowship $3,539,000 $4,539,000 $4,789,000 Not funded -$4,789,000 Opioid Treatment Programs/Regulatory Activities $8,724,000 $8,724,000 $8,724,000 $8,724,000 Level Pregnant and Postpartum Women (PPW) $19,931,000 $29,931,000 $29,931,000 $29,931,000 Level Recovery Community Services Program $2,434,000 $2,434,000 $2,434,000 $2,434,000 Level Screening, Brief Intervention, and Referral to Treatment (SBIRT) $30,000,000 $30,000,000 $30,000,000 Not funded -$30,000,000 Targeted Capacity Expansion (TCE) General $67,192,000 $95,192,000 $100,192,000 $100,192,000 Level Medication-Assisted Treatment for Prescription Drug and Opioid Addiction (MAT-PDOA) $56,000,000 $84,000,000 $89,000,000 $89,000,000 Level Treatment Systems for Homeless $36,386,000 $36,386,000 $36,386,000 $36,386,000 Level 41 SAMHSA’s C enter for Substance Abuse Treatment ( CSAT )

Program FY 17 FY 18 FY 2019 President’s FY 20 Request FY 20 Request vs. FY 19 CSAP TOTAL $223,219,000 $248,219,000 $205,469,000 $144,090,000 -$61,379,000 Center for the Application of Prevention Technologies ( CAPT ) $7,493,000 $7,493,000 $7,493,000 $7,493,000 Level Federal Drug-Free Workplace/Mandatory Drug Testing $4,894,000 $4,894,000 $4,894,000 $4,894,000 Level Minority AIDS $41,205,000 $41,205,000 $41,205,000 $41,205,000 Level Minority Fellowship $71,000 $71,000 $321,000 Not funded -$321,000 Science and Service Program Coordination $4,072,000 $4,072,000 $4,072,000 $4,072,000 Level Sober Truth on Preventing Underage Drinking (STOP Act) $7,000,000 $7,000,000 $8,000,000 $8,000,000 Level National Adult-Oriented Media Public Service Campaign N/A N/A $1,000,000 N/A N/A Strategic Prevention Framework-Partnerships for Success $109,484,000 $119,484,000 $119,484,000 $58,426,000 -$61,058,000 Strategic Prevention Framework Rx $10,000,000 $10,000,000 $10,000,000 $10,000,000 Level Tribal Behavioral Health Grants $15,000,000 $15,000,000 $20,000,000 $20,000,000 Level Program FY 17 FY 18 FY 2019 President’s FY 20 Request FY 20 Request vs. FY 19 Drug Free Communities (DFC)* $97,000,000  $99,000,000  $100,000,000  $100,000,000  Level SAMHSA’s C enter for Substance Abuse Prevention ( CSAP )

Program  FY 17  FY 18 FY 2019 President’s FY 20 Request FY 20 Request vs. FY 19 Office of National Drug Control Policy*  $388,145,000  $415,493,000  $415,493,000 $28,501,000 -$386,992,000      Drug Free Communities (DFC)  $97,000,000  $99,000,000  $100,000,000  Not funded within ONDCP  -$100,000,000       High-Intensity Drug Trafficking Area (HIDTA) Program  $254,000,000  $280,000,000  $280,000,000  Not funded within ONDCP  -$280,000,000  43 Office of National Drug Control Policy (ONDCP)   *President’s FY 2020 proposed total for ONDCP includes $16,400,000 for operations, and $12,101,000 for other federal drug control programs.  

Program FY 17 FY 18 FY 2019 President’s FY 20 Request FY 20 Request vs. FY 19 Drug Enforcement Administration $2,102,976,000 $2,609,900,000 $2,687,703,000 $2,976,295,000 +288,592,000 Office of Justice Programs ( OJP ): Research, Evaluation, and Statistics $89,000,000 $90,000,000 $90,000,000 $94,500,000 +$4,500,000 OJP : State and Local Law Enforcement Assistance $1,258,500,000 $1,677,500,000 $1,723,500,000 $1,482,200,000 -$241,300,000 Byrne Justice Assistance Grants $334,600,000 $339,600,000 $329,600,000 $308,100,000 -$21,500,000 Comprehensive Opioid Abuse Program ( COAP ) $13,100,000 $145,110,000 $157,000,000 $145,000,000 -$12,000,000 Drug Courts $43,000,000 $75,000,000 $77,000,000 $75,000,000 -$2,000,000 Justice and Mental Health Collaboration Program (Mentally Ill Offender Act [MIOTCRA]) $12,000,000 $30,000,000 $31,000,000 $30,000,000 -$1,000,000 Residential Substance Abuse Treatment (RSAT) $14,000,000 $30,000,000 $30,000,000 $30,000,000 Level Second Chance Act/Offender Reentry $68,000,000 $85,000,000 $88,000,000 $85,000,000 -$3,000,000 Veterans Treatment Courts $7,000,000 $20,000,000 $22,000,000 $20,000,000 -$2,000,000 Prescription Drug Monitoring $14,000,000 $30,000,000 $30,000,000 $30,000,000 Level Community Oriented Policing Systems (COPS)** $221,500,000 $275,500,000 $303,500,000 N/A N/A Juvenile Justice Programs $247,000,000 $282,500,000 $287,800,000 $239,800,000 -$48,000,000 Opioid Affected Youth -- $8,000,000 $9,000,000 $5,000,000 -$4,000,000 High-Intensity Drug Trafficking Area (HIDTA)* $254,000,000  $280,000,000  $280,000,000  $254,000,000 -$26,000,000 44 D epartment of Justice (DOJ) – Select Programs * HIDTA program has historically been funded under ONDCP (FY 16 – FY 19) **Administration proposes moving the COPS program to OJP

“Dear Colleague” letter on SAPT BGCongressmen Paul Tonko (D-NY) and Brian Fitzpatrick (R-PA) led sign-on letter to colleagues in the U.S. House of Representatives.Letter urged appropriators to recommend a $500 million increase to the SAPT Block Grant in FY 2020 . Total of 57 members of Congress signed on45

What’s next?

Interest from Freshmen offices 100 newly-elected freshmen in House and SenateHigh interest in addressing opioids specifically, and addiction more broadly In House, Rep. David Trone (D-MD) is leading Freshmen Addiction Working Group ~60 freshmen Members of Congress “What can we do to address SUDs?”Background on CARA, CURES, SUPPORTEducation about publicly-funded systemImportance of full continuum: prevention, treatment, and recoveryCongress has accomplished a lot legislatively, and now States are in implementation mode (especially with STR/SOR)

Focus on all substances of concern Recognition of the importance of focusing on SUDs more broadly—including and beyond opioid use disorders Prior to facing potential fiscal cliff for opioid-specific programs, gradually transition federal funds from drug specific to the SAPT Block Grant

Importance of Primary Prevention Education on existing programs (SAPT BG, SPF- PFS, DFC) that support primary SUD preventionInterest from Congressional offices in strengthening school-based programs for SUD prevention Concept of grant program to State alcohol and drug agencies to create evidence-based SUD prevention programs in elementary and secondary schools; and Promote school-based prevention programming across the State through coordination with relevant stakeholders, including the State educational agency.

CARE Act The Comprehensive Addiction Resources Emergency (CARE) Act Sponsored by Rep. Elijah Cummings (D-MD) in the House, and Senator Elizabeth Warren (D-MA) in the Senate Re-introduced this week – most likely May 9th Proposes Ryan White HIV/AIDS program model for substance use disorders: $100 billion over next 10 years Grants to States, local entities, and tribes

On the horizon FY 2020 appropriations process: full House Appropriations Committee markup; Senate L-HHS subcommittee on May 8Year 1 supplemental funding for SOR allocated last month Year 2 of SOR grant dollars will be allocated later this fiscal yearSeeking funding for/implementation of Comprehensive Addiction and Recovery Act (CARA) 21 st Century Cures ActSUPPORT Act

Questions? rmorrison@nasadad.org www.Nasadad.org(202) 293-0090 52