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Mental Health

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RCPA provided some late updates yesterday on the Federal funding freeze, and late last evening, the National Council for Mental Wellbeing provided members a legal interpretation on the rescinding of the Office of Management and Budget (OMB) M-25-13 and the issuance of the new memorandum M-25-14.

The following is from the National Council:

On Wednesday afternoon, the White House Office of Management and Budget issued a new memorandum—M-25-14 — that rescinded the pause to federal funding contemplated in a previous memorandum first issued on Monday night.

The new memorandum, which was directed to “heads of executive departments and agencies,” features a two-sentence statement reading: “OMB Memorandum M-25-13 is rescinded. If you have questions about implementing the President’s Executives Order, please contact your agency General Counsel.”

In the short term, M-25-14 certainly relieves some of the confusion and anxiety that swept across the federal grants world since Monday night. Our previous client alerts have chronicled the chaos that emerged late Monday and throughout the day on Tuesday.

However, in our review, there are still five key Executive Orders issued by the Trump Administration not affected by the rescission of M-25-13. Those EOs include:

While the upheaval following the issuance of M-25-13 may have prompted the Trump Administration to change course and move away from pausing all federal funding, we certainly anticipate that federal grants in the above-listed areas will remain subject to a comprehensive review and new standards. Federal grantees with programs in these specific areas should undertake a detailed review and be prepared for future agency actions.

Federal grantees should continue to keep apprised of the Administration’s actions, orders, and statements relating to federal funding — as the rescinded memorandum likely foretells future clashes as the Administration attempts to exert control over federal spending.

Chuck Ingoglia
President & CEO
Strategic Leadership
National Council for Mental Wellbeing

In addition, ANCOR sent the following information last night:

In what’s turning from a whirlwind couple of days into a whirlwind week, there were notable updates today on the OMB memo on the freeze of certain federal funding issued earlier in the week. 

Today OMB withdrew the memo with a simple rescission statement after a federal judge temporarily blocked the funding freeze for open awards and current spending. The order remains in effect until February 3 when a hearing is scheduled to determine next steps.  

As you may have seen, later in the day, Press Secretary Karoline Leavitt posted to X, “[t]his is NOT a rescission of the federal funding freeze. It is simply a rescission of the OMB memo. Why? To end any confusion created by the court’s injunction. The President’s EO’s on federal funding remain in full force and effect, and will be rigorously implemented.” Without further specificity regarding the implicated executive orders, the situation remains fluid with the potential for later memos or other interpretive guidance which the White House maintains is authority held within the executive branch.

In other litigation, U.S. District Judge Jack McConnell made statements in court today indicating that another restraining order may be coming. With the memo rescinded, the Department of Justice Special Counsel argued the case is no longer relevant. However, the judge did not appear persuaded and asked for a draft protective order for response and consideration. 

We’ll continue to keep you posted as we know more and hope to see you Friday (1/31) for our extended Members-Only Weekly Briefing at 12:30 pm ET to provide updates and review all available information together. See login information below:
Join Zoom Meeting: ancor-org.zoom.us/j/… 
Meeting ID: 870 2745 7284 
Passcode: 977618 

In recent communications from the OMB, these actions will not impact programs that provide direct benefits to individuals and are explicitly excluded from the pause and exempted from this review process. In addition to Social Security and Medicare, already explicitly excluded in the guidance, mandatory programs like Medicaid and SNAP will continue without pause.

RCPA will continue to communicate new developments with members as they emerge. If you have any questions, please contact your RCPA Policy Director.

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The Erie Coalition for a Trauma-Informed Community (ECTIC) is hosting its Resilience Conference on Wednesday, February 19. The conference theme, “Back to Basics: Moving Policy and Practice Forward,” emphasizes returning to foundational principles to create meaningful change. By focusing on practical strategies and actionable insights, the conference aims to empower individuals and organizations to advance trauma-informed policies and practices that foster resilience across our communities.

The daylong virtual conference is free. Conference registration, session information, and other details are available online.

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RCPA continues its efforts to update members on the White House funding freeze while partnering with the National Council for Mental Wellbeing and ANCOR in examining the implications stemming from the White House Office of Management and Budget’s (OMB) January 27 memorandum temporarily freezing federal disbursements to many federal programs.

The National Council has provided the following update:

Federal agencies have been directed to fill out a spreadsheet as part of an analysis by Feb. 7 to ensure compliance with the president’s most recent executive orders. This is a breakdown of which health programs are included in this latest action.

Notably, we recognize conflicting guidance has been issued. While the above report identifies Medicaid programs, a Q&A document from the administration notes that Medicaid will continue without pause. As of Tuesday morning, all 50 states reported outages of their Medicaid online portals, and the Trump administration has stated they are aware of the outages and expect the portals to be back online shortly.

Also, several groups have taken action to block this funding freeze. As of this writing, several Democratic state attorneys general said they would ask a court to block the freeze from taking effect. Several groups representing nonprofits, public health professionals and small businesses have already filed suit in D.C. asking the court to prevent the freeze from continuing. On Tuesday evening, U.S. District Court Judge Loren L. AliKhan issued a temporary stay on the funding freeze until Feb. 3 at 5:00 pm ET.

The funding freeze may lead to project delays or cancellations, resulting in layoffs of workers involved in these programs, and may ultimately increase the unemployment rate, making it vital lawmakers understand the impact of this freeze on communities across the country.

Most notable are the concerns with the intersects of Medicaid funding though the information that has been released. The Q&A document states:

Q: Is this a freeze on benefits to Americans like SNAP or student loans?

A: No, any program that provides direct benefits to Americans is explicitly excluded from the pause and exempted from this review process. In addition to Social Security and Medicare, already explicitly excluded in the guidance, mandatory programs like Medicaid and SNAP will continue without pause.

RCPA will continue to communicate new developments with members as they emerge. If you have any questions, please contact your RCPA Policy Director.

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A federal judge has halted President Donald Trump’s freeze on federal aid programs, ruling that the courts need more time to consider the potentially far-reaching ramifications of his order.

Minutes before the directive from Trump’s budget office was to take effect Tuesday, U.S. District Judge Loren AliKhan blocked the Trump administration from implementing it for now.

AliKhan’s order will expire February 3 at 5:00 pm. The Trump administration cannot suspend disbursement of any congressionally-appropriated funds until then. The judge described the move as a “brief administrative stay” intended to maintain the status quo while further litigation can play out.

“I think there is the specter of irreparable harm,” said AliKhan, an appointee of President Joe Biden.

The ruling is a win for nonprofit and public health groups who said even a brief implementation of Trump’s freeze could cause devastating outcomes for people who rely on federal funds for services, as well as the workers who provide them. The nonprofits also argued the order from the Office of Management and Budget intrudes on First Amendment rights by seeking to block funding for groups that engage in “DEI programs” or promote “Gender Ideology Extremism,” concepts targeted in Trump’s initial round of executive orders.

Justice Department attorney Daniel Schwei had argued that the groups had failed to show that they needed an immediate halt to the order issued by Trump’s budget office and set to take effect at 5:00 pm Tuesday. He said additional guidance offered by the Trump administration should alleviate concerns about the OMB directive cutting off essential programs.

“They request sweeping relief… not tethered to any identified grant programs,” Schwei said. “It would be appropriate to allow these issues to be addressed on a more orderly timeframe.

RCPA will continue to update members as we work with our national partners to gain greater clarification on this Federal action. If you have further questions, please contact your RCPA Policy Director.

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Each year at the National Council for Mental Wellbeing Conference (NatCon25), RCPA and sponsors host the Pennsylvania Reception. This reception is extremely well-attended and is a highlight of the conference for PA registrants, National Council staff, and other invited guests. We are excited to have the conference held in our Keystone State of Pennsylvania on May 5 – 7, 2025. The PA Reception will be held on Tuesday, May 6, 2025. As we near the event, additional details will be provided.

The success of this event has been from the support of our dedicated sponsors. The reception offers food, drink, entertainment, and special name recognition of the supporting organizations. Please contact Tina Miletic if you are interested in sponsoring the PA Reception or if you have any questions.

RCPA thanks all previous sponsors, and we hope we can count on your continued support!

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The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) are jointly hosting the quarterly Statewide Positive Approaches & Practices meeting. This meeting aims to provide the most recent research and resources for people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities to live an everyday life.

Date: February 20, 2025
Time: 10:00 am – 3:00 pm
Location: Online – Zoom Webinar
Register Here

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Separate Notice of Proposed Rulemaking Would Completely Eliminate In-Person Evaluation for Prescribed Medications

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA) this month released three new prescribing-related telehealth rules.

The Final Rule On the Expansion of Buprenorphine Treatment Via Telemedicine Encounter authorizes DEA-registered practitioners to prescribe Schedule III-V controlled substances, including buprenorphine, for opioid use disorder, through an audio-only encounter for an initial six-month supply (split among multiple prescriptions over six calendar months). Although the rule has been published in the Federal Register and is set to take effect February 18, 2025, President Trump issued a regulatory freeze pending review that requires executive departments and agencies to consider postponing the rule’s effective date for 60 days to review “any questions of fact, law, and policy that the rules may raise.”

Under this final rule, practitioners must first review the patient’s prescription drug monitoring program data for the state in which the patient is located during the telemedicine encounter. Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act, or after an in-person medical evaluation is conducted. SAMHSA advises practitioners to check with their state medical boards about what specific telemedicine practices are currently authorized for prescribing controlled medications after this six-month period. RCPA has reached out to the Pennsylvania Department of State to determine whether there are telemedicine pathways in place to enable prescribing beyond the initial six-month period without an in-person examination.

This regulation also requires the pharmacist to verify the identity of the patient prior to filling a prescription. This final rule does not apply to practitioners who have already evaluated their patient in person.

Separate Proposed Rule Would Completely Eliminate In-Person Evaluation for Prescribed Medications

However, a separate proposed rule on Special Registrations for Telemedicine and Limited State Telemedicine Registrations would establish special registrations that will permit a patient to receive prescribed medications through telemedicine visits without ever having an in-person medical evaluation from a medical provider. According to the DEA, the special registration is available to medical providers who treat patients for whom they will prescribe Schedule III-V controlled substances. An Advanced Telemedicine Prescribing Registration is available for Schedule II medications when the medical practitioner is board certified in one of the following specialties: psychiatrists; hospice care physicians; physicians rendering treatment at long term care facilities; and pediatricians for the prescribing of medications identified as the most addictive and prone to diversion to the illegal drug market. This regulation allows specialized medical providers to issue telemedicine prescriptions for Schedule II-V medications.

DEA is seeking public comment by March 18, 2025, on additional medical specialists that should be authorized to issue Schedule II medications. Public comments will also be requested on additional patient protections for the prescribing of Schedule II medications by telemedicine, including whether the special registrant should be physically located in the same state as the patient being prescribed Schedule II medications; whether to limit Schedule II medications by telemedicine to medical practitioners whose practice is limited to less than 50 percent of prescriptions by telemedicine; and the appropriate duration needed for the rules’ provisions to be enacted.

For the first time, online platforms that facilitate connections between patients and medical providers that result in the prescription of medications will be required to register with DEA. This is critical, as DEA has found some unscrupulous medical providers on online platforms have used flexible telemedicine rules to put profit ahead of the well-being of patients.

The special registration rule will also require the establishment of a national PDMP to help the health industry protect against abuse and the diversion of controlled substances into the illegal drug market. A national PDMP will provide pharmacists and medical practitioners with visibility of a patient’s prescribed medication history.

Additionally, a Final Rule on Continuity of Care Via Telemedicine for Veterans Affairs (VA) patients was issued, allowing practitioners acting within the scope of their VA employment to prescribe controlled substances via telemedicine to a VA patient with whom they have not conducted an in-person medical evaluation. VA practitioners are permitted to prescribe controlled substances to VA patients if another VA practitioner has, at any time, previously conducted an in-person medical evaluation of the VA patient, subject to certain conditions.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) has released updated National Behavioral Health Crisis Care Guidance aimed at enhancing the nation’s response to mental health and substance use crises. This effort is part of an ongoing initiative to address record-high rates of suicide and overdose, while also building on the transition to the 988 Suicide & Crisis Lifeline in 2022.

The updated National Behavioral Health Crisis Care Guidance is comprised of three key documents. These are the 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care, Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services, and a draft Mobile Crisis Team Services Implementation Toolkit, which is open for public comment until March 21, 2025. Together, these resources set forth a framework for reshaping community crisis care systems and ensuring timely access to care.

SAMHSA’s framework is built on three foundational pillars essential to an integrated crisis care system:

  1. Someone to Contact — The 988 Lifeline and other hotlines provide immediate, accessible support for individuals in crisis.
  2. Someone to Respond — Mobile crisis teams are a critical component, delivering rapid, on-site assistance to de-escalate crises and connect people with appropriate care.
  3. A Safe Place for Help — Stabilization services offer facilities where individuals in crisis can access care, resolve crises, and transition to ongoing treatment when necessary.

The new guidance emphasizes scalability and sustainability for these systems, equipping state, tribal, local, and territorial governments with the tools needed to design and improve crisis care services. It also provides practitioners with actionable steps for delivering quality care.

The 988 Suicide & Crisis Lifeline, launched nationwide in 2022, represents a significant shift in behavioral health crisis response. The easy to remember three digit number aims to provide individuals with immediate access to trained crisis counselors, significantly reducing reliance on law enforcement and emergency departments for mental health emergencies. The updated guidance builds on this progress while addressing the urgent need for comprehensive crisis care systems.

The guidance reflects substantial input collected through listening sessions, expert consultations, and public feedback. Crucially, it underscores the importance of a coordinated, flexible, and compassionate approach to behavioral health crises at a time when the nation continues to grapple with increasing demand for services.

With public comments being sought on the draft Mobile Crisis Team Services Implementation Toolkit, SAMHSA aims to refine and finalize tools that advance the capacity of crisis teams to stabilize situations and connect individuals with long-term support. Please forward your comments to RCPA COO and Mental Health Services Director Jim Sharp for inclusion in the RCPA response to SAMHSA. This will addressed in the February 18, 2025, RCPA 988/Crisis Services meeting. You can register for the meeting here.

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The Post on Policy (POP) OCYF Newsletter was designed to inform and update on all things policy in the Office of Children, Youth, and Families Bureau of Programs, Policy and Operations/Division of Policy. This quarterly newsletter highlights policy updates, work group activity, staff contacts, upcoming changes, and special events.

Please contact RCPA Policy Associate Emma Sharp with any questions.

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