Every year, all federal agencies prepare a budget request they send to the President. These requests include a budget justification, or the “what” and “why” of funding the request. It lays out what programs they want funded, and more importantly, why those programs deserve funding. Because of this process, the final Presidential budget proposal provides a window into the White House views of the programs and what value they provide.
In the 2019 fiscal year (FY19) Health Resources & Services Administration (HRSA) budget justification, staff laid out the benefits of the Behavioral Health Workforce Education and Training (BHWET) Program. The 21st Century Cures Act previously expanded this workforce training program to include occupational therapy. This allowed occupational therapy educational programs to apply for and receive grants to provide or improve fieldwork placements in mental and behavioral health settings. In the FY19 HRSA justification, for the first time, the federal government included occupational therapy as a profession in the behavioral health workforce. This inclusion bolsters AOTA’s continued efforts to have OT reimbursed for mental health services at the state level, to be included in future mental and behavioral health programs, and to be recognized as a mental health provider in all 50 states.
Congress funded BHWET at $50 million in both FY17 and FY18. Both the House and Senate Appropriations Committees passed FY19 funding bills that included substantial increases for BHWET—up to $75 million in the Senate, and $82.5 million in the House.
In addition to this increase, the Senate bill added occupational therapy to a second separate, but similar, workforce training program. The Mental and Behavioral Health Education Training (MBHET) program’s funding level was around $9 million over the past several years, but the FY19 Senate Appropriations bill increased its funding to nearly $37 million. This made occupational therapy eligible for two mental and behavioral health focused workforce training programs totaling nearly $112 million, a 124% increase over current funding. However, the House version of the bill completely eliminated funding for the MBHET program.
Discussions with appropriations committee staff have indicated there is a desire to combine the two training programs, both of which are administered by HRSA. This would allow HRSA to save the administrative costs of running two separate, but almost identical, programs. AOTA isn’t advocating to maintain both programs, or to combine them into a single program. What is most important is that occupational therapy remain eligible for the full amount of funding available, and that that funding is as close to the Senate level as possible.
The expectation is the Senate will act on the Labor-HHS bill sometime this summer, with the House following shortly thereafter. The two bills will become one when a conference committee meets to negotiate on the final version. While possible, this is unlikely to happen prior to September 30th, when the FY18 funding runs out, so a continuing resolution is expected to ensure that the government is funded at least through the elections in November, or even into next year.
UPDATE: The full Senate has passed the FY19 bill, and no cuts to any of the programs listed above were included. We now await House action, followed by a conference committee made up of members of both the House and Senate to work out the differences between the two bills to make one bill that both chambers can then pass. Both chambers of Congress must pass identical bills (down to the punctuation) before it can go to the President to be signed or vetoed. There is a chance that this all could occur before the September 30th deadline when government funding runs out.
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