The Massachusetts House of Representatives last week passed comprehensive legislation addressing longstanding issues with our behavioral health care delivery system. The bill focuses on acute psychiatric care and crisis response, youth behavioral health initiatives, community-based behavioral health services, investments in the workforce, and enforcement of existing behavioral health parity laws.
“I’m proud of the legislation passed by the House today that builds on our long-standing efforts to advance important reforms and substantial investments that are aimed at improving our behavioral health care delivery system,” said Speaker of the House Ronald J. Mariano (D-Quincy). “From addressing the behavioral health crisis that our young people are currently experiencing, to our efforts to alleviate emergency department boarding, to provisions that will bring us closer to treating mental and physical health equally, this legislation will benefit all residents in the Commonwealth when accessing critical health care. I would like to thank Chairman Adrian Madaro for his hard work, and for his commitment to producing a strong bill.”
“Everyone deserves access to quality mental health services, yet far too many people face unnecessary barriers to care. This bill reaffirms the House’s commitment to increasing access to behavioral health care across Massachusetts,” said Representative Adrian Madaro (D-East Boston), Chair of the Mental Health, Substance Use, and Recovery Committee. “For too long, the healthcare system has not treated behavioral health as equal to physical health, creating obstacles in addressing the mental health crisis, which has on been exacerbated by the pandemic. That’s why this timely piece of legislation makes critical steps toward prioritizing mental health services for people across the Commonwealth, including our youth who have been acutely affected, and those who face challenges in getting the care they need. These policies reflect our strong belief that behavioral health care is essential.”
Highlights of the bill include:
Initiatives to address emergency department boarding:
• Creating online portals that provide access to real-time data on youth and adults seeking mental health and substance use services, including a function that allows health care providers to easily search and find open beds
• Requiring the Health Policy Commission (HPC) to prepare and publish a report every three years on the status of pediatric behavioral health
• Codifying an expedited psychiatric inpatient admissions (EPIA) advisory council to reduce hospital emergency department boarding, including a protocol to expedite placement into appropriate care settings for patients under the age of 18
988 implementation and 911 expansion:
This legislation seeks to increase behavioral health care access across the Commonwealth through the implementation of the nationwide 988 hotline to access 24/7 suicide prevention and behavioral health crisis services. This legislation also expands 911 to bridge the gap until 988 is implemented by increasing training, funding, and capacity for regional emergency responses to behavioral health crises.
Red flag laws and Extreme Risk Protection Order:
This bill initiates a public awareness campaign on the Commonwealth’s red flag laws and Extreme Risk Protection Orders (ERPOs), passed by the Legislature in 2018, that limit access to guns for people at risk of hurting themselves or others.
Full-system accountability for parity:
This bill tackles disparities in mental health and other forms of health care by giving the state additional tools to enforce existing parity laws, such as:
• Requiring licensed mental health professionals to be available during all operating hours of an emergency department (including via telehealth)
• Codifying hospital clinical competencies and operational standards and directing the Department of Mental Health (DMH) to establish a complaint process for alleged violations
• Directing DMH to create a comprehensive plan to address access to continuing care beds, intensive residential treatment programs, and community-based programs for patients awaiting discharge from acute psychiatric hospital units
• Implementing mental health watch reforms in correctional settings, including changes to the referral to mental health process for those who are incarcerated or detained, and establishing a process for a person on mental health watch for longer than 72 hours to petition to be transferred
School-based behavioral health services and programming:
• Limiting the use of suspension and expulsion in all licensed early education and care programs
• Requiring school districts to adopt a behavioral health crisis response plan which may be based on a cost-neutral model plan to be developed by the Department of Elementary and Secondary Education
• Creating a statewide program to help schools implement school-based behavioral health services
Access points for youth for effective behavioral health treatment:
• Creating a complex care resolution panel to ensure children with complex behavioral health needs are assisted quickly and with cross-agency support and coordination
• Requiring behavioral health assessments and referrals for children entering the foster care system
• Empowering the Office of the Child Advocate (OCA) to receive complaints from children and families and to assist them in resolving issues with access to behavioral health services
Expanded insurance coverage:
This legislation requires insurance coverage of critical behavioral health services, including:
• Emergency service programs
• Services provided under psychiatric collaborative care models
• Mental health acute treatment, community-based acute treatment, and intensive community-based acute treatment without prior authorization
• Annual mental health wellness exams
This proposal builds upon the Behavioral Health Trust Fund by carving out specific grant programs for health care providers, which would finance:
• Workforce Pipeline Investments: a scholarship program to support a culturally, ethnically, and linguistically diverse behavioral health workforce, with a focus on clinicians who commit to serving high-need populations.
• Integrated Care: a grant program to expand integrated care models that enable providers to expand their practices to provide behavioral health care in primary care settings
• Support for Providers: a grant program to promote the mental health and wellbeing of providers
Behavioral health parity implementation and enforcement:
This legislation tackles the disparity by health plans to reimburse mental health services at lower rates than other forms of health care by providing the Commonwealth additional tools to enforce existing parity laws and promote compliance.
This legislation enhances oversight of parity compliance by:
• Requiring carriers to comply with annual reporting requirements
• Directing the Division of Insurance (DOI) to review and ensure insurer compliance with parity laws
• Authorizing the Office of Patient Protection (OPP) to identify and refer potential parity violations that arise during OPP grievance reviews to the DOI and the AG’s office
“An Act addressing barriers to care for mental health” (H.4879) passed the House of Representatives 155-0 after a similar version of this legislation passed in the Massachusetts State Senate. The legislation moves back to the Senate for further consideration.