On November 17, Senator Jason Lewis recently joined his colleagues in the Massachusetts Senate to unanimously pass An Act addressing barriers to care for mental health (Mental Health ABC Act), which is comprehensive legislation with the goal of ensuring that all Massachusetts residents can access the mental health care they need when they need it. This legislation builds on previous mental health reforms made by the state legislature, and it comes at the same time that the Senate is proposing to invest $400 million of American Rescue Plan Act (ARPA) funds to strengthen Massachusetts’s behavioral health system.
This legislation 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 bill proposes a wide variety of reforms to ensure equitable access to mental health care, and to remove barriers to care by supporting and growing the behavioral health workforce.
“Health care should be a basic human right, but too many people in Massachusetts right now struggle to access high quality, affordable, and timely mental health care,” said Lewis. “I’m very pleased that the state Senate has prioritized improving access to mental health care through the passage of this critical legislation, and I’m grateful to all the constituents and advocates who have shared with me their heartbreaking struggles in accessing the care that they or a loved one desperately need.”
“The need and demand for mental health services has soared as a result of the pandemic, and anyone who has tried to find help for mental health concerns will vouch for the many barriers that still exist,” said Massachusetts Association for Mental Health (MAMH) President/CEO Danna Mauch. “This bill tackles some of our most difficult challenges. These challenges include insurance company policies that make it hard to pay for care, a lack of providers across the Commonwealth but especially in communities of color, and care that too often is fragmented and siloed. The bill’s provisions provide creative, practical steps toward addressing these issues and it looks ahead to creation of a comprehensive system of effective crisis services.”
Key provisions in this sweeping legislation include:
- Guaranteeing annual mental health wellness exams: The idea that a person’s mental health is just as important as a person’s physical health is the cornerstone of this reform. This bill would codify this principle by mandating coverage for an annual mental health wellness exam – comparable to an annual physical.
- Enforcing mental health parity laws: Mental health parity as a concept is simple: Insurance coverage for mental health care should be equal to insurance coverage for any other medical condition. This concept 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 every bit as critical to managing their health as treatment for diabetes or heart disease. This bill provides the state with better tools to implement and enforce its parity laws by creating a clear structure for the Division of Insurance to receive and investigate parity complaints to ensure their timely resolution. Other tools include parity enforcement for commercial, state-contracted and student health insurance plans, greater reporting and oversight of insurance carriers’ mental health care coverage processes and policies, and reasonable penalties and alternative remedies for when an insurance company does not comply with the law.
- Addressing the Emergency Department boarding crisis: For many adults and children in the grips of a mental health crisis, the fastest way to get help is to go to a hospital emergency department (ED). Sadly, when they need to be admitted to an inpatient psychiatric unit, it can be days, weeks or even months before they’re admitted. Meanwhile, the person must often wait in the ED, receiving little to no psychiatric care. This is referred to as “ED boarding,” and it has increased up to 400% since the COVID-19 pandemic began. The bill takes multiple steps to address and reduce ED boarding.
- Reimbursing mental health providers equitably: 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.
- Reforming medical necessity and prior authorization requirements: When an adult or child arrives in an ED in the throes of acute mental health crises requiring immediate treatment in an appropriate setting, clinical determinations should be made by the treating clinician. However, in practice, insurance carriers impose too many restrictions on providers’ clinical judgement in terms of prior approval and concurrent review requirements for mental health services. The bill mandates coverage and eliminates prior authorization for mental health acute treatment and stabilization services for adults and children, and it takes other steps to streamline access to care.
- Removing barriers to care by supporting the behavioral health workforce: Lack of adequate mental health providers constrains access to care, so the bill includes multiple initiatives to better support and grow the behavioral health workforce, such as allowing for interim licensure for licensed mental health counselors.
- Establishing an Office of Behavioral Health Promotion: Current behavioral health services are spread across state agencies. This dilutes the responsibility for mental health promotion and focus on the issues and undermines the important work being done. This bill would establish 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.
Having passed the State Senate, this legislation goes to the Massachusetts House of Representatives for consideration.