There are few things more wrenching than the call of a parent or caregiver asking for help for a child who’s in the throes of a mental health crisis. The ravages and trauma of the pandemic have exacerbated access to a system that’s already way over capacity, leaving children and families without options and providers stretched thin.
While our team will continue our work on behalf of constituents—family by family—working with social workers, school districts, mental health providers, insurance companies, and more, doing our best to help find a necessary resolve, last week the Senate took a leap forward on system-level change needed now more than ever by passing S. 2572, “An Act addressing barriers to care for mental health,” known as the Mental Health ABC Act.
It’s a sweeping bill, which, combined with the Senate’s proposed $400 million of American Rescue Plan Act (ARPA) funding dedicated to mental and behavioral health (which the Senate passed unanimously two weeks ago), would begin to transform mental health care in the Commonwealth.
Here’s a short summary of the challenges in our mental health system that this bill addresses :
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 has been both challenging and complex. 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 our parity laws by creating a clear structure for the Division of Insurance to receive and investigate parity complaints to ensure their timely resolution. I filed an amendment. which was successfully adopted, to ensure the Attorney General’s Office receives this information as well, so we can expect much greater state enforcement of parity laws if this legislation becomes law.
Addressing the Emergency Department Boarding Crisis. For many adults and children in the grips of a mental health crisis, often the fastest way to get help is to go to a hospital emergency department (ED). Sadly, if there are no beds available in 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.
Given the severity and urgency of the state’s ED boarding crisis, this bill tackles the issue in several ways, by:
- Creating an online portal that enables access to real-time data on available beds, including a search function that allows health care providers to easily find open beds based on specific criteria.
- Establishing a complex case resolution panel to help resolve barriers to care for children with complex mental and/or behavioral health needs. The panel includes representatives from several state and local health and education agencies working together to ensure a child’s mental and/or behavioral health needs are met in a timely manner.
- Requiring all hospital EDs to have a qualified behavioral health clinician available to evaluate and stabilize a person admitted to a hospital ED with a behavioral health presentation during all operating hours.
- Directing the Office of the Child Advocate to produce an annual report on child ED boarding.
- Tasking the Health Policy Commission with conducting a statewide pediatric behavioral health assessment every five years to inform future policymaking.
Increasing Access to Care in Geographically Isolated Areas. This bill would direct the Department of Mental Health 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. This is critical for our region, where we have a severe shortage of mental health beds, and as a result, families may need to drive hours to visit a loved one who has accepted the first bed that came available.
Reimbursing Mental Health Providers Equitably. Mental health and primary care providers are still 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 Prior Authorization Requirements. When an adult or child arrives in an emergency department in the throes of acute mental health crises requiring immediate treatment in an appropriate setting, a clinician shouldn’t need to make determinations about care based upon what they think will be covered by insurance. This bill eliminates prior authorization requirements for mental health acute treatment and stabilization services for adults and children.
Access to Culturally Competent Care. Under this provision, an interagency health equity team would make annual recommendations for the next three years to improve access to, and the quality of, culturally competent mental health services. Paired with the Senate’s ARPA investment of $122 million in the behavioral health workforce through loan repayment assistance programs, these initiatives will make great strides toward building a diverse robust workforce reflective of communities’ needs.
The bill also includes $10 million for the rapid creation of new inpatient mental health acute care beds, particularly new beds for children, adolescents and underserved communities, as well as $3 million for a loan repayment assistance program to recruit and retain child and adolescent psychiatrists at community mental health and health centers.
The Mental Health ABC Act will need to be taken up by the House, and the ARPA funding bill is being reconciled with the House-passed version. I know colleagues in the House feel a similar urgency to deal directly and proactively with this crisis—for our region and its people.