Senate unveils major mental health bill

LEADERS IN THE Massachusetts Senate on Tuesday unveiled a comprehensive mental health bill, which would set a floor for the rates insurers must pay for mental health services, address the emergency department boarding crisis, and require insurers to cover more mental health services, including an annual wellness exam. 

“We believe this important bill would put policies into place to ensure that people get the mental health care that they need when they need it and provide a national model for how we can create an integrated and comprehensive health care system that ultimately treats mental health the same as physical health,” Senate President Karen Spilka said in a call with reporters. 

Many of the same provisions were included in a mental health bill that the Senate passed in February 2020, but which was waylaid by the pandemic and never became law. The Senate plans to debate the bill next week, before lawmakers break for the rest of the year. The earliest the House could take it up would be next year. 

The Senate is also voting on a spending bill this Wednesday, which allocates federal money from the American Rescue Plan Act and includes a $400 million investment in mental health, with a focus on shoring up the mental health workforce. 

Both the House and Senate are attempting to marry the ARPA spending bill – which lawmakers hope to reach a compromise on by Thanksgiving – with policy changes in health care. The House is focused on helping community hospitals by curbing certain hospital expansions, while the Senate wants to focus on improving the mental health system. Both those bills will ultimately have to be negotiated between the bodies, an effort likely to take up much of next year. 

One core theme of the Senate bill is creating true mental health parity. Although state and federal laws already require mental health services be treated by insurers in the same way as physical health services, in practice that does not always occur. 

The bill would require insurance to cover an annual mental health wellness exam, similar to the way insurers must now cover an annual physical. Colorado passed a similar mandate in July, but no other state has done so.  

The bill would create new ways for the state to enforce existing mental health parity laws – by enhancing penalties on insurers that treat mental and physical health differently, creating a clear structure for the Division of Insurance to investigate parity complaints, and instituting additional reporting requirements. The bill would also create a “rate floor” to standardize how much primary care doctors and mental health clinicians receive from insurers for basic evaluation and health management services. 

Lawmakers acknowledged that it can be difficult to enforce parity when the services are different. For example, a diagnostic visit to a primary care doctor can last 15 minutes, while a diagnostic visit to a psychologist can last 45 minutes. Cyr said that makes the discussion around reimbursement rates difficult. “The challenge when you look at rates more broadly is there’s not as many apples to apples comparisons,” Cyr said.    

The bill also focuses on reducing emergency room wait times. Today, psychiatric patients can wait days in the ER for an inpatient bed. It would create a portal where emergency room clinicians can search in real time to find a facility with an available bed. Now clinicians can spend hours calling facilities, and a state database relies on spreadsheets that are not updated in real time.  

It would create a new panel tasked with resolving issues pertaining to children with complex medical needs – for example, determining which state agency pays if a child is involved with multiple agencies. It would require all hospitals to have a qualified behavioral health clinician available to evaluate and stabilize behavioral health patients whenever the emergency department is open. 

The bill would also remove some regulatory barriers to mental health facilities seeking to open new beds.  

Several of the newer provisions in this bill, those not in the February 2020 bill, are those related to emergency department boarding, as the state has seen a surge in boarding due to the effects of the COVID pandemic. 

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said the insurers’ association supports many of the bill’s provisions, including insurance coverage for an annual mental health wellness exam, and several provisions aimed at reducing emergency department boarding. With regards to efforts to better enforce insurance laws, she said, every part of the system needs to be involved. “In order to achieve our shared goals of parity in the delivery of health care services, the entire health care system, not simply health plans, must be held accountable,” Pellegrini said.