New law makes critical strides to ensure equitable access to mental health
On August 10, Governor Charlie Baker signed into law An Act addressing barriers to care for mental health – also known as the Mental Health ABC Act – comprehensive legislation championed by Senator Sal DiDomenico and his colleagues to reform of the way mental health care is delivered in Massachusetts, with the goal of ensuring that people get the mental health care they need when they need it. The Mental Health ABC Act (now Chapter 177 of the Massachusetts General Laws) is driven by the recognition that mental health is as important as physical health for every resident of the Commonwealth and should be treated as such. The law includes a wide variety of reforms to ensure equitable access to mental health care and remove barriers to care by supporting the behavioral health workforce.
“For far too long in our state and across the nation, mental health has not received the attention it deserves, making this care too expensive or too burdensome for many Massachusetts residents to access,” said Senator DiDomenico, who is the Assistant Majority Leader of the Massachusetts Senate. “This law will transform our mental health care system and ensure people can access and afford mental health care just like other forms of medical care. I am thrilled to see this historic mental health reform signed into law and I would like to thank Senate President Spilka, Senator Julian Cyr, Senator Cindy Friedman and all my colleagues for their dedication to get this game-changing bill passed.”
“One moment, many years ago, I made the split-second decision to share the story of my family’s struggle with mental illness—a moment of vulnerability and honesty that has become a movement, as more and more people stand up and speak up for accessible, high quality mental health care,” stated Senate President Karen E. Spilka (D-Ashland). “We all deserve to have access to the mental health care we need, when we need it, and I am thrilled to see comprehensive mental and behavioral health care reform signed into law. I’d like to thank my colleagues in the Senate—especially Senators Cyr and Friedman—Speaker Mariano and our partners in the House, and Governor Baker, as well as the countless individuals, families, advocates, providers and others who have stood up for the idea that mental health is just as important as physical health, and to everyone who has fought for mental health care reform in Massachusetts and never gave up.”
Below are features of the new law:
- Guaranteeing annual mental health wellness exams: mandates insurance coverage for an annual mental health wellness exam, comparable to an annual physical.
- Enforcing mental health parity laws: provides the state with better tools to implement and enforce parity laws by creating a clear structure for state agencies to receive and investigate parity complaints and ensure their timely resolution.
- Initiatives to address Emergency Department boarding: creates online portals that provide access to real-time data on youths and adults seeking mental health and substance use services and includes a search function that allows health care providers to easily find open beds using several criteria; requires the Health Policy Commission (HPC) to prepare and publish a report every three years on the status of pediatric behavioral health as the youth boarding crisis is particularly acute; requires the Center for Health Information and Analysis (CHIA) to report on behavioral health needs; updates the Expedited Psychiatric Inpatient Admissions (EPIA) protocol and creates an expedited evaluation and stabilization process for patients under 18.
- 988 implementation and 911 expansion: increases access to on-demand behavioral health care through the implementation of the nationwide 988 hotline that will provide 24/7 suicide prevention and behavioral health crisis services – and expands 911 to bridge the gap until 988 is implemented.
- Extreme risk protection orders (ERPOs): initiates a public awareness campaign on ERPOs (also known as “red flag laws”) that limit access to guns for people at risk of hurting themselves or others.
- Reimbursing mental health providers equitably: requires an equitable rate floor for evaluation and management services that is consistent with primary care.
- Reforming medical necessity and prior authorization requirements: mandates coverage and eliminates prior authorization for mental health acute treatment and stabilization services for adults and children and ensures that if a health insurance company intends to change its medical necessity guidelines, the new guidelines must be easily accessible by consumers on the health insurance company’s website.
- Creating a standard release form: directs the development of a standard release form for exchanging confidential mental health and substance use disorder information to facilitate access to treatment by patients with multiple health care providers.
- Increasing access to statewide Emergency Services Program (ESP): requires health insurance companies to cover ESPs – community-based and recovery-oriented programs that provide behavioral health crisis assessment, intervention and stabilization services for people with behavioral health needs.
- Expanding access to the evidence-based collaborative care model: expands access to psychiatric care by requiring the state-contracted and commercial health plans to cover mental health and substance use disorder benefits offered through the psychiatric collaborative care model.
- Reviewing the role of behavioral health managers: directs HPC, in consultation with the Division of Insurance, to study and provide updated data on the use of contracted behavioral health benefit managers by insurance carriers – often referred to as “carve-outs.”
- Tracking and analyzing behavioral health expenditures: directs CHIA to define and collect data on the delivery of behavioral health services to establish a baseline of current spending; directs HPC to begin tracking behavioral health care expenditures as part of its annual cost trends hearings.
- Establishing an Office of Behavioral Health Promotion: establishes an Office of Behavioral Health Promotion within the Executive Office of Health and Human Services (EOHHS) to coordinate all state initiatives that promote mental, emotional and behavioral health and wellness for residents.
- Increasing access to care in geographically isolated areas: directs the Department of Mental Health (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.
- Enhancing school-based behavioral health services and programming: enhances school-based behavioral health supports, increases access points for effective behavioral health treatment by limiting the use of suspension and expulsion in all licensed early education and care programs and public schools and creates a statewide technical assistance program to help schools implement school-based behavioral health services.
- Increasing access points for youngsters for effective behavioral health treatment: requires behavioral health assessments and referrals for children entering the foster care system and establishes an interagency review team to ensure young people with complex behavioral health needs are assisted quickly and with cross-agency support and coordination.
- Expanding insurance coverage for vulnerable populations: ensures individuals over 26 years old who live with disabilities can remain on their parents’ health insurance.
- Creating a roadmap on access to culturally competent care. Under this provision, an interagency health equity team under the Office of Health Equity, working with an advisory council, will make annual recommendations for the next three years to improve access to, and the quality of, culturally competent mental health services. Paired with the legislature’s American Rescue Plan Act (ARPA) investment of $122 million in the behavioral health workforce through loan repayment assistance programs, this roadmap will make great strides toward building a robust workforce reflective of communities’ needs.
- Allows for an interim licensure for Licensed Mental Health Counselors (LMHCs): creates an interim licensure level for LMHCs so that they can be reimbursed by insurance for their services while obtaining supervised practice hours towards full licensure and be eligible for state and federal grant and loan forgiveness programs.
- Expanding mental health billing: allows clinicians practicing under the supervision of a licensed professional and working towards independent licensure to practice in a clinic setting.
• Updating the Board of Registration of Social Workers: updates the membership of the Board of Registration of Social Workers to clarify that designees from the Department of Children and Families (DCF) and Department of Public Health (DPH) be licensed social workers.