The Barrett Report
Senate votes to improve mental healthcare
For Immediate Release
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.
###
Lexington Sen. Barrett gives inside look at state’s latest climate policy
Lexington Minuteman
When did you start working on this climate package?
In June, so about seven months. I wanted to do a complete scan of the state government, because I chaired the energy committee and had noticed that state agencies all acknowledge the importance of climate change but still seem to be pursuing missions that were apart from it. I think climate has come up on us rather suddenly and caught us by surprise; the issue has been percolating for 30 years, but it suddenly seems very real. I had two priorities. One was to make sure state agencies were aligned and all pulling in the same direction. The other was making sure we set policies that would reassure all of us that we’re going to do something about this.
What aspects of the bill are most noteworthy?
I’ll tell you, I don’t completely trust the ability of the government to come clean about how well we’re doing. In the future, we’re going to be looking to governors to be reporting about their own performance. I don’t think that works, human nature doesn’t work like that. So we’re proposing an independent commission to really be the truth teller and the monitor. It would be the first in the country. I observed that information is held closely by the executive branch, even despite the fact that we’ve got a pretty good governor on this topic. I saw them basically holding back data that might reflect poorly on their performance, specifically around the climate issue. I should mention that this isn’t a problem with Governor Baker specifically, the same problem existed with Deval Patrick. Both Republican and Democratic governors don’t want to be held accountable. Again, I’m not even really blaming them, I think they’re embodying human nature, but I’m no longer willing to put up with it.
Senate Moves Trio of Climate-Change Bills
WickedLocal: Cape Cod
Emitting carbon would come with a new price in Massachusetts and the state would embark on a more aggressive timeline for reducing its greenhouse gas emissions under a bill that overwhelmingly passed the state Senate Jan. 30.
The electric vehicles bill (S 2476) directs the MBTA to limit its bus purchases and leases to zero-emissions vehicles starting in 2030 and operate an entirely zero-emissions passenger bus fleet by Dec. 31, 2040. It also makes permanent an existing rebate program for consumers buying electric cars.
The bill (S 2477) cleared the Senate on a 36-2 vote.
The energy efficiency bill (S 2478), which passed on a 35-2 vote, sets efficiency standards for a range of products, including new faucets and showerheads.
Six questions in a sequestered time
Episode 117: From Net-Zero to Hero
The Horse Race Podcast
[The bills] include, among other things, the goal of net-zero emissions by 2050, which, Sen. Barrett describes as, “a very ambitious goal.” He said, “It puts Massachusetts right where the United Nations body wants the world to be, and in that sense we are offering world leadership.”State Senate Approves Climate Policy
The Millbury-Sutton Chronicle
The Massachusetts State Senate recently 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.
Poll Surveyed Public Opinion on Climate Change
Wicked Local
The MassInc Polling Group’s survey of 2,318 Massachusetts residents was conducted between Oct. 10 and Nov. 8, 2019 and released Monday, four days after the state Senate passed climate legislation that included deadlines for the state to impose carbon-pricing mechanisms in the transportation sector, homes and commercial buildings.
After Months of Urging Senate to Take Action, Taunton Senator Lauds Passage of Climate Change Bills
Taunton Daily Gazette
All of the bills passed by a majority vote.
“Together the three really do constitute an historic new moment in the fight against climate change,” Sen. Michael Barrett (D- Lexington), who chairs the Telecommunications, Utilities and Energy Committee, said on the Senate floor Tuesday.
In Senate Climate Bills, Lawmakers SeeNew Jobs, Economic Opportunity for Western Massachusetts
MSN
Western Massachusetts lawmakers are hopeful that a set of climate change bills that passed the Senate Thursday night could bring new, innovative jobs in the energy sector to the region, if the legislation become law.
The cornerstone of Barrett’s package was the carbon pricing bill that would update the state’s 2050 target from reducing emissions by 80% of the 1990s levels to reducing emissions by 100%.