Bill expands access to mental health care, boosts workforce, and strengthens quality of coverage
On February 14, 2020 the Massachusetts Senate unanimously passed the Mental Health ABC Act, comprehensive legislation aimed at reforming the mental health care 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 health care 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, over half of a representative sample of fully insured adults who sought mental health care services reported difficulty finding services.
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.
“Too many people in Massachusetts struggle to access the mental health services they desperately need and deserve,” said Senator Julian Cyr (D-Truro), co-chair of the Joint Committee on Mental Health, Substance Use and Recovery. “The reasons are many and complicated: mental health care is treated differently than physical health, it is often not covered by insurance, it is difficult to access, and it is hard to talk about. By passing this bill, the Massachusetts Senate is living up to our promise to begin to transform how the Commonwealth addresses mental health. I am grateful to Senate President Karen Spilka for her leadership and example, and to Senators Rodrigues and Friedman for their partnership in this endeavor.”
”The response to this bill has been overwhelming, and reinforces our assertion that mental health care needs to be for everyone in Massachusetts,” stated Senate President Karen E. Spilka (D-Ashland). “I would like to thank everyone involved in this effort, especially Senator Julian Cyr, Senator Cindy Friedman, and Senator Michael Rodrigues—as well as the countless advocates, activists and residents who have fought for better access to quality mental health care. We still have a ways to go to end the stigma and achieve true parity, but if any state can do it, I know that Massachusetts can. I’m excited to see us move forward.”
“The Mental Health ABC Act will expand access to mental health care for everyone that needs and deserves it,” said Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “The cost of action on this issue is far less than the cost of inaction, both financially and for the wellbeing of all residents of the Commonwealth. I applaud Senate President Spilka for her consistent leadership on this, and Senators Cyr and Friedman for their diligent work and collaboration in putting forward a bill to reform our mental health care delivery system.”
“For far too long, mental health has been a forgotten component of our health care system, resulting in a broken system that has continually left patients without the critical care they need,” said Senator Cindy F. Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing. “This bill lays an important foundation for creating a system that is accessible and equitable, and provides the state with better tools to ensure that someone with a mental health condition has the same access to care as someone with physical health needs. I want to sincerely thank Senate President Spilka for recognizing the urgency of this issue and committing to a bold step forward with the passage of this bill. I also want to thank Senator Cyr, Senator Rodrigues and all of the advocates involved in crafting this bill for their thoughtful collaboration and shared commitment to reforming our mental health care system so that it works for everyone.”
“The Senate has taken decisive steps to put us on a path to reform, revive and redouble our efforts in taking an increasingly fragmented system and helping it to connect people experiencing a mental health condition with a health care system of credentialed professionals that functions effectively to provide timely care,” said Senator Bruce E. Tarr (R- Gloucester), Senate Minority Leader.
“Senate President Spilka, Health Care Financing Committee Chair Friedman, Mental Health, Substance Use and Recovery Committee Chair Cyr, and Ways and Means Chair Rodrigues are to be commended for mental healthcare reform legislation that prominently prioritizes improved access to effective care,” said Danna Mauch, President and CEO, Massachusetts Association for Mental Health (MAMH). “MAMH applauds the Senate’s actions today. Senate Bill 2519 – An Act to Address Barriers to Care for Mental Health is a significant step forward to implement the promise of parity and frame fairer terms for insurance coverage, benefits administration, provider reimbursement and plan reporting.”
“The Mental Health ABC Act acknowledges the realities that parents of children with behavioral health needs face every day in ensuring their child's safety and wellbeing,” said Mary McGeown, Executive Director, MSPCC, on behalf of the Children's Mental Health Campaign. “The Act takes steps to uncomplicate access to care by allowing both physical and behavioral health treatment to be provided in the same day, and by creating a path to that clinical decisions are made by clinicians rather than insurance companies.”
“The Mental Health ABC Act is a comprehensive bill that will have a tremendous positive impact on Massachusetts families,” said Lydia Conley, CEO, Association for Behavioral Healthcare (ABH). “This bill will help ABH member organizations better serve their communities by lifting barriers to accessing care, expanding coverage of critical behavioral health services, and providing new tools to attract the clinical workforce needed to deliver high-quality care.”
“An Act Addressing Barriers to Care for Mental Health is an incredibly progressive and forward-thinking piece of legislation that will benefit social workers working in mental and behavioral health and the clients and communities served by social workers across the Commonwealth,” said Rebekah Gewirtz, Executive Director of the National Association of Social Workers, MA Chapter. “As the crisis of mental health access has escalated both nationally and here in Massachusetts, we applaud the Senate’s proactive and comprehensive approach that will help us to finally achieve mental health parity in our state”.
“The Massachusetts Medical Society appreciates the efforts of the Senate, and applauds Senate President Karen Spilka, Senator Julian Cyr, Senator Cindy Friedman and Senator Michael Rodrigues for putting forth legislation that reforms mental health care in the Commonwealth, strengthening existing mental health parity laws and ensuring that our patients will have access to quality, comprehensive mental health care,” said Dr. David A. Rosman, Mass. Medical Society President Elect.
“This bill is a tremendous step forward in the ongoing effort to enable the residents of Massachusetts gain access to the appropriate mental health care they need and deserve, said Gary Chinman, Immediate Past President, Massachusetts Psychiatric Society. “Senate President Spilka, Senator Friedman, Senator Cyr, and Senator Rodrigues deserve our gratitude and admiration for the insight, compassion and respect with which they crafted this historic legislation.”
“Massachusetts hospitals have long sought parity in coverage between behavioral health and medical/surgical care,” said Steve Walsh, President & CEO, Massachusetts Health & Hospital Association (MHA). “I applaud the Senate for their leadership on an issue so critical and personal to our patients and their families. This legislation is an important step forward in ensuring that every Massachusetts resident has access to the mental health services they need and deserve.”
“Blue Cross strongly supports the Senate’s landmark mental health legislation,” said Michael Caljouw, Vice President of Government, and Regulatory Affairs for Blue Cross Blue Shield of Massachusetts. “We believe mental health is as central to our members’ needs as their physical health, so it’s critically important to us that they be able to find comprehensive, effective, and affordable care when they need it. This bill is another important step toward that goal. We pledge to continue to work together across the state to help improve access and ensure that our members get the high-quality care they need.”
“We applaud the Senate and, in particular Senate President Karen Spilka, for today’s action to pass this important legislation and for her unmatched commitment and leadership in seeking to end the stigma associated with mental health treatment,” said Lora Pellegrini, President and CEO of the Massachusetts Association of Health Plans (MAHP). “This bill will help to ensure that all individuals get the care they need. We also applaud Senate leadership, including Senator Cindy Friedman, Chair of the Joint Committee on Health Care Financing, Senator Julian Cyr, Chair of the Joint Committee on Mental Health, Substance Use, and Recovery, and Senator Michael Rodrigues, Chair of the Senate Ways and Means Committee for their work in developing this comprehensive legislation.”
“We applaud Senator’s Spilka, Friedman and Cyr for their commitment to elevating behavioral health and reducing barriers to care,” said Susan Coakley, Northeast Regional President, Beacon Health Options. “We are supportive of reform efforts that drive a more integrated mental health care system and we look forward to collaborating with other stakeholders to improve access, ensure parity and expand the behavioral health workforce. We look forward to being actively involved in this historic process which will help lead to the further destigmatization of mental health illness and substance use disorders."
The Mental Health ABC Act 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 health care for all. The Senate has prioritized efforts in the 2019–2020 legislative session to improve the delivery of mental health services in the Commonwealth 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.
Despite these achievements, there is a lot more to do. The Mental Health ABC Act builds on the Senate’s efforts to improve the Commonwealth’s mental health care system by addressing issues related to mental health parity, workforce needs, and access to care.
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 health care 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 health care 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 health care 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 in the Senate, the following are some of the sections added by amendment to the bill:
- A pediatric mental health care 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 health care providers.
The Mental Health ABC Act now moves to the House of Representatives for consideration.
Senator Cyr speech at a rally with advocates for the Mental Health 'ABC' Act
Senator Cyr speaking at a rally with advocates for the Mental Health 'ABC' Act
Rally with advocates for the Mental Health 'ABC' Act