Lack of comprehensive mental health care has serious consequences for our country and our Commonwealth.
According to a 2018 report from the Blue Cross Blue Shield of Massachusetts Foundation, nearly 1 in 4 adults sought mental health or substance use disorder care for themselves or a family member, and over half experienced difficulty obtaining that care. That is unacceptable, and would never be tolerated for traditional medical or surgical services.
There is virtually no area of our economic, civic, and personal lives that is not touched by the need for mental health and wellness care. We should know; each of us has grappled with these issues in our own lives and families. That’s why the Massachusetts State Senate will debate Mental Health: An act addressing barriers to care for mental health (ABC) on Thursday.
The Mental Health ABC Act begins the process of integrating mental health care into routine health care, starting with enforcing existing parity laws. Parity as a concept is simple: Insurance coverage for mental health care should be equal to, and no more restrictive than, coverage for any other medical condition. Real differences persist, however, leaving many without the treatment they need and deserve. As such, this bill gives the state’s Division of Insurance necessary oversight and enforcement tools, including the leverage of reasonable penalties for insurance companies found not to be in compliance with the law.
The Mental Health ABC Act also removes prior authorization for people who need acute psychiatric inpatient care. Every day, adults and children arrive in our emergency departments with acute mental health crises requiring immediate treatment in an appropriate setting, but a confluence of factors, including insurance restrictions on mental health treatment, can result in frustrating delays. Removing prior authorization ensures treatment decisions are made by treating clinicians and patients.
To further ensure timely care, the bill requires emergency departments to be able to evaluate and stabilize individuals with a serious mental illness and refer them to appropriate treatment. It also seeks to increase access to care in a variety of other ways, such as:
Expand coverage for psychiatric emergency service programs.
Require same-day coverage for behavioral health and primary care services.
Increase access to care in geographically isolated areas.
Create a tele-behavioral health pilot program for our public schools.
Understanding how mental health care figures into our overall health care system is vital. As such, the bill directs the Center for Health Information and Analysis — for the first time — to define and collect data on the delivery of mental health services in order to establish a baseline of current spending. It also directs the Health Policy Commission to track mental health care expenditures across all providers and payers as part of its annual cost trends hearings. These are critical first steps to incentivize greater investments in mental health care.
We must also invest in the people who deliver care as we seek to build a mental health care system that works for everyone. We know that systemic biases exist in health care, so an important step is to review the availability of culturally competent mental health care providers throughout the system. We must also identify potential barriers to care for underserved cultural, ethnic, and linguistic populations and the LGBTQ community.
The bill would also bolster our pipeline of providers, allowing interim licensure for mental health counselors — who, unlike social workers, cannot currently practice while going through the licensing process. It would create a psychiatric mental health nurse practitioner fellowship pilot program in community health centers, establishing a mental health workforce pipeline through the Department of Higher Education and streamlining the licensing process for mental health professionals.
Finally, the bill seeks to remove an administrative burden on providers by requiring all insurance carriers to use one standard credentialing form for health care providers. Currently, a provider must fill out a separate credentialing form for each form of insurance he or she wants to accept. This results in providers spending a lot of time on paperwork and less time with patients. The bill also requires a quicker turnaround time for approval of a completed credentialing request. This will be enormously beneficial to patients, providers, and the system overall, as it will speed up the time it takes for new hires to be approved for inclusion in an insurance network.
In Massachusetts, mental health care should be accessible for everyone. With the Mental Health ABC Act, the Senate is taking steps to turn that goal into reality.
Senator Karen E. Spilka is the president of the Massachusetts State Senate. Senator Julian Cyr is the Senate chair of the Joint Committee on Mental Health, Substance Use, and Recovery. Senator Cindy F. Friedman is the Senate chair of the Joint Committee on Health Care Financing.