State Senator Mike Barrett

Senate votes to improve mental healthcare

Bill expands access to mental healthcare, boosts workforce, and strengthens quality of coverage

(BOSTON – 02/14/2020) The State Senate unanimously passed the Mental Health ABC Act, a comprehensive bill aimed at reforming the mental healthcare system in Massachusetts.  Senate Bill 2519, An Act Addressing Barriers to Care for Mental Health, serves as the first step toward developing a more integrated system of mental healthcare delivery to better meet the needs of individuals and families.

Massachusetts residents have historically experienced difficulty accessing mental health services due to health inequities and persistent barriers to care — leaving many without the treatment they need and deserve.  According to a 2018 report by the Blue Cross Blue Shield Foundation of Massachusetts, more than half of a representative sample of fully-insured adults who sought mental healthcare services reported difficulty finding services.

“You only need to visit a Massachusetts prison to realize that parity between physical healthcare and mental healthcare is cruelly elusive,” said local State Senator Mike Barret.  “It’s time to rebalance our out-of-balance system. Thank you to my neighbor and colleague Senator Cindy Friedman for her championship of this legislation.”

The Mental Health ABC Act seeks to increase access by removing barriers to timely quality care, providing the state with more effective tools to enforce existing mental health parity laws, and investing in the mental and behavioral health workforce pipeline.  The legislation builds on progress made through state mental health parity laws passed in 2000 and 2008, and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 at the federal level.

The bill is driven by the recognition that mental health is just as important as physical health for every resident of the Commonwealth — and reflects the Senate’s overall goal of improving access to mental healthcare for all.  The Senate has prioritized efforts in the current legislative session to improve the delivery of mental health services in the following ways: appropriating record funding levels for mental health services in the FY20 budget; creating and funding a $10 million Behavioral Health Outreach, Access and Support Trust Fund; ensuring that health insurer’s provider network directories are accurate and up-to-date by eliminating so-called ‘ghost networks’; and protecting clinicians from unreasonable retroactive claims denials, or ‘clawbacks’ of payments for services, from insurance providers.

More on the bill:  

The Mental Health ABC Act provides the state with better tools to implement and enforce mental health parity laws, which require that insurance coverage for mental health benefits be equal to and no more restrictive than coverage for physical health benefits.  Mental health parity has been codified in federal and state law for decades, but enforcement of the law has been challenging.  As a result, inequities persist and patients are often denied coverage for mental health treatment that is just as critical to managing their health as treatment for conditions such as diabetes or heart disease.  As such, this legislation includes quicker evaluation and resolution of parity complaints, greater reporting and oversight of insurance carriers’ processes and policies related to mental healthcare coverage, and penalties and alternative remedies for when an insurance company does not comply with the law.

Every day throughout the Commonwealth, adults and children arrive in emergency departments in the throes of acute mental health crises requiring immediate treatment in an appropriate setting.  Due to complex and restrictive medical necessity and prior authorization review processes imposed by insurance companies, many patients experience barriers, and delays, in treatment – creating a dysfunctional system that allows insurance companies to have more leverage in determining a patient’s course of treatment than healthcare providers.  As such, the bill mandates coverage and eliminates prior authorization for mental health acute treatment for adults and children experiencing acute mental health crises, effectively placing treatment decisions in the hands of the treating clinician in consultation with the patient rather than an insurance company.

In an effort to address the mental health workforce crisis that often limits patient access to care, the bill creates a pilot program through the Department of Higher Education aimed at creating a workforce pipeline to encourage and support individuals from diverse backgrounds to work toward careers in mental health.  In addition, the bill creates an interim licensure program for Licensed Mental Health Counselors so that they can be reimbursed by insurance for their services and be eligible for state and federal grant and loan forgiveness programs, increasing the number of licensed providers able to serve patients.

The bill also calls for an academic study conducted by the Office of Health Equity to review the availability of culturally competent mental healthcare providers within networks of both public and private health care payers, as well as to identify potential barriers to care for underserved cultural, ethnic and linguistic populations and the LGBTQ community.  The bill further directs an interagency health equity team under the Office of Health Equity to improve access to, and the quality of, culturally competent mental health services.

The bill creates a Psychiatric Mental Health Nurse Practitioner Fellowship Pilot Program in community health centers to offer additional support and training to psychiatric nurse practitioners who agree to work in community settings with underserved populations.  The program will be designed to encourage these professionals to continue working in a community setting where mental health providers are sorely needed.

Currently, mental health and primary care providers are reimbursed at different rates for the same service.  The bill seeks to level the playing field for reimbursement to mental health providers by requiring an equitable rate floor for evaluation and management services that is consistent with primary care.

The Mental Health ABC Act takes meaningful steps to improve access to care by prohibiting insurers from denying coverage for mental health services and primary care services solely because they were delivered on the same day in the same facility.  This will remove a significant financial barrier to the integration of primary care and mental health.

Additionally, the bill requires emergency departments to have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times, and to refer them to appropriate treatment or inpatient admission.

This bill authorizes the DPH, the Department of Mental Health (DMH), and the Department of Elementary and Secondary Education (DESE) to collaborate on authorizing three pilots for tele-behavioral health services in public high schools in the Commonwealth.  This pilot is based on an existing and successful model between a hospital and several school districts in western Massachusetts.

Finally, the bill directs the DMH to consider factors that may present barriers to care—such as travel distance and access to transportation—when contracting for services in geographically isolated and rural communities.

Through debate today in the Senate, the following are some of the sections added by amendment to the bill:

• A pediatric mental healthcare task force.
• Inclusion of veterans and aging adult populations for considerations in the cultural competency study.
• An amendment to study the further screening of adverse childhood experiences (ACEs).
• A comprehensive behavioral workforce commission.
• An expedited admission protocol for children under 22 who present in an emergency department with mental health needs.
• An examination of ways to ease communications, within the context of privacy laws, between healthcare providers.

The Mental Health ABC Act now moves to the House of Representatives for consideration.

###

MASSACHUSETTS STATE SENATE APPROVES NEXT GENERATION CLIMATE POLICY

(Boston – 01/30/2020) The Massachusetts State Senate on Thursday advanced three bills that boldly tackle the contributing factors of climate change, chart one of the most aggressive courses of action against global warming in the country, and pave the way for a clean energy future for all of its residents.

An Act Setting Next Generation Climate Policy and two companion bills — one dealing with electrifying fleets and another updating energy efficiency standards for appliances  —  passed overwhelmingly and with bi-partisan support.

“I am proud of the Senate for acting quickly on this legislation which takes a historic step in our fight to reduce harmful emissions that hurt our planet and our residents,” said Senate President Karen E. Spilka (D-Ashland). “I commend Senator Barrett for his diligence in crafting a thorough legislative package that takes concrete steps to combat climate change by providing a plan to create a greener, healthier and more sustainable future. I would like to thank Senator Barrett and Senator Michael Rodrigues for their contributions to this next generation climate leadership.”

“The Next Generation Climate package that the Senate passed today will allow the Commonwealth to reduce our carbon footprint and boldly confront the impacts of climate change,” said Senator Michael J. Rodrigues, Chair of the Senate Committee on Ways and Means (D-Westport). “These bills will help us achieve net-zero carbon emissions by 2050 and transform our energy delivery system to benefit our climate and future generations. I applaud Senate President Spilka and Senator Barrett for their leadership on this issue, and I thank my colleagues in the Senate for their collaboration in confronting perhaps the most important issue of our time.”

“We’ve written the strongest climate statute in the nation,” said Senator Mike Barrett (D-Lexington), Senate Chair of the Utilities and Energy Committee and the bill’s chief author.  “The bills started out strong. Then they got better as debate went on.  More protection for low and moderate income families.  Special sensitivity to the climate challenges facing small towns and rural areas.  Retraining for people who may need to change jobs as we green the economy. In the fight against climate change, this lifts Massachusetts to the next level. My thanks to President Spilka and Chairman Rodrigues for conducting a model of the lawmaking process.”

Key provisions of the climate policy package include:

• Setting a statewide greenhouse gas limit for the year 2050 of “net zero” emissions.  To achieve this, An Act Setting Next-Generation Climate Policy requires the state to hit near-term limits in 2025, 2030, and every five years thereafter; set sub-limits for transportation, buildings, solid waste, natural gas distribution, and other major sectors; and make implementation plans that are “clear, comprehensive, and specific.”

• Establishing the Massachusetts Climate Policy Commission.  The commission would be a new, independent public watchdog to oversee government’s handling of the unfolding crisis of climate change.  Commissioners will be charged with offering a nonpartisan, science-based view of the problem as it plays out in Massachusetts with its attendant natural, economic, and demographic impacts and risks.

“We want this commission to be an independent guardian of the future, notably the future of younger generations, insulated from political pressure and consisting of the most authoritative and credible Massachusetts voices we can find,” stated Senator Barrett.  “Job one for the Commission is to tell us if we’re on track in bringing down emissions.  Job two is to advise us on what to do next.  The commission will give us objective information about the performance of both government and the private sector and will pay special attention to the impact on low-income and other disadvantaged communities.  If the commission works as intended, it will be a new voice, standing apart from politics as usual and committed to shedding light on a very hard problem.”

• Reflecting the price of carbon.  Under the bill, the Administration would be free to choose among various market based forms of pricing carbon—including a revenue-neutral fee or a regional “cap and trade” system similar to the Transportation Climate Initiative (TCI)—but he or she would have to do so by Jan. 1, 2022, for transportation; Jan. 1, 2025, for commercial, industrial and institutional buildings; and Jan. 1, 2030, for residential buildings.  Any mechanism would be implemented so as to minimize the impact on low-income households, disadvantaged communities, and vulnerable manufacturing sectors.

• Providing legislative direction to the Department of Public Utilities (DPU), the state’s primary energy oversight agency, for the first time.  Compensating for a decades-long omission, the bill assigns the DPU a mission statement.  It requires the agency to balance six priorities: reliability of supply, affordability, public safety, physical and cyber security, equity, and, significantly, reductions in greenhouse gas emissions.

• Jumpstarting efforts to supply low-cost solar electricity to low-income communities.  To reverse the failure of state programs to incentivize solar energy projects in low-income neighborhoods, as well as spur job creation, the bill requires the Department of Energy Resources (DOER) to set aside future solar allocations for such neighborhoods.

• Letting cities and towns adopt a “net zero” stretch energy code.  The bill allows the state to support communities that choose on their own to move away from fossil fuels as the source of heating for new buildings.  The state’s contribution is to promulgate a “net zero” energy code, so that localities have the option available if they want to use it.  The bill shifts responsibility for the code’s development from the Board of Building Regulations and Standards to the DOER.

“When it comes to bringing down emissions, buildings are the toughest nut to crack,” Barrett says.  “We need to move on multiple fronts.”

• Nudging natural gas utilities to adapt.  The bill authorizes utilities to test technology and pipelines that generate and transport “renewable thermal energy,” an emissions-free way to heat buildings that draws on the relative warmth of temperatures below ground.

• Strengthening executive branch oversight of MassSave.  The bill directs the Secretary of Energy and Environmental Affairs (EEA) to set emissions reduction goals, in advance, for each three-year plan the utilities formulate for MassSave.  It requires the DPU, at the conclusion of each three-year plan, to certify how much the plan actually contributed to meeting the Commonwealth’s greenhouse gas emission limits.

• Tightening the alignment between MassSave and emissions limits.  The bill requires electric utilities to include an explicit value for emissions reductions whenever they calculate the cost-effectiveness of a MassSave offering.

• Setting a deadline for converting MBTA buses to all-electric power.  An Act to Accelerate the Transition of Cars, Trucks, and Buses to Carbon Free Power directs the MBTA to limit bus purchases and leases to zero-emissions vehicles beginning in 2030, and to aim for an all-zero-emissions fleet by 2040, to reduce transportation-related emissions in city neighborhoods.

• Offsetting the Trump Administration’s efforts to slow progress on efficient appliances.  An Act Relative to Energy Savings Efficiency updates Massachusetts appliance standards to improve energy and water efficiency standards for common household and commercial appliances, helping to conserve energy and save consumers and businesses money.

Other provisions include:

• Assembling the state’s first-ever database of energy use in large buildings.

• Adding two building efficiency experts and an expert in advanced building technology to the membership of the Board of Building Regulations and Standards, which will retain responsibility for the base energy building code.

• Authorizing the Massachusetts Clean Energy Center (MassCEC) to fund energy innovation pilots, and to take actions addressing health effects associated with the distribution and consumption of fossil fuels such as natural gas.

• Directing the DPU to consider the impact on emissions when it reviews electric and natural gas rates, prices, charges, and contracts.

• Directing state government to limit purchases and leases of vehicles to zero emissions vehicles only, beginning in 2024, if affordable replacements are available.

• Conducting a study of the opportunities to electrify vehicles owned or leased by municipalities, regional school districts, and regional transit authorities, taking into account costs and possible sources of financial help from state and federal government.

• Providing permanent statutory authorization for the “MOR-EV” program, the Commonwealth’s system of financial incentives for purchasers of zero emission vehicles.

During debate on the Senate floor, the bill was strengthened through amendments that, among others, requires regional equity in carbon pricing and ensures equity is a component of The Department of Public Utilities mission statement.

The bills now go to the House of Representatives for consideration.

###