Each making a deeply personal case for improving access to mental health care, Senate President Karen Spilka and Sen. Julian Cyr helped roll out a significant reform bill Thursday that seeks to improve access to care by identifying gaps in the mental health system, enforcing equity laws and requiring insurance coverage for many emergency services.
Spilka, who called the proposal "decades in the making," shared how her own family struggled with her father's mental health decline following his service in World War II, and Cyr described the obstacles he has had to overcome as a gay man to get treatment for depression and anxiety.
The state codified "mental health parity" into the law 20 years ago, and yet for close to two decades advocates and legislators have been frustrated by stories of people struggling to gain the same access to mental health care as they can for their physical health. Many patients can't find providers and don't know where to look, Cyr said, and if they do find a provider must wait for an appointment and often struggle to afford the care.
"We have laws and we have values that say mental health must be treated the same way physical health is, and yet we don't do it," said Sen. Cindy Friedman, one of the authors of the bill.
The bill, which will be debated in the Senate next Thursday, would give the state notable new powers to enforce existing state and federal laws that require equitable access to physical and mental health care, but have fallen short on delivering on that promise.
Insurers would face more reporting requirements and audits to ensure compliance with parity laws, and the state could penalize carriers for parity violations.
The bill (S 2519), however, was largely silent on the issue of spending, which was the focus of legislation filed by Gov. Charlie Baker last year to require insurers and providers to dramatically ramp up their spending on primary, mental health and senior care.
The authors of the Senate bill noted some areas of overlap with Baker, including on the issue of credentialing mental health providers, and legislators did not rule out looking at Baker's approach as they develop a more general health care reform bill for later this year.
Their proposal would seek the establishment of a rate floor to ensure that mental health clinicians are not paid less than primary care providers for the same evaluation and management services.
Cyr said that in many instances the state does not adequately track the delivery of mental health services.
The bill, he said, would require the Center for Health Information and Analysis to collect the data necessary to establish a baseline of current spending on mental health services, and for the Health Policy Commission to specifically track mental health spending as part of its annual cost trends hearing.
The Senate legislation proposes to remove bureaucratic barriers to private providers choosing to accept health insurance and to eliminate the need for clinicians to seek prior-authorization from insurance carriers before administering mental health services to a patient in crisis.
Cyr said that by standardizing the forms providers must fill out to begin accepting health insurance and to require a review of those forms within 20 days, the system can begin to bring more providers into insurance networks.
The bill also proposes a variety of methods to encourage the development of a diverse pool of mental health professionals to meet the needs of patients who speak different languages and come from different backgrounds.
For instance, there would be a pilot program through the Department of Higher Education to support diverse candidates pursuing careers in mental health and a mental health nurse practitioner fellowship program for those who agree to work in underserved communities.
Following the Senate's passage of a prescription drug cost bill last year, Spilka said this legislation would be the second of three health reform bills the Senate will take up this session, the third to a be a more general reform bill.
The Ashland Democrat described growing up in a household with a father who had mental health issues stemming from his military service, but never received the care he needed because of the stigma associated with mental health challenges.
When they couldn't convince her father to seek help, she and her mother sought counseling, and as a teenager she would have to sneak Haldol into her father's food to treat his condition.
"Many nights I had my younger brother sleep in the room with me because I feared he wouldn't be alive in the morning if I let him sleep downstairs," Spilka said.
Cyr, the co-chair of the Joint Committee on Mental Health, Substance Use and Recovery, shared his own story on social media Wednesday night ahead of the rollout, describing his struggle in adolescence with anxiety and depression.
Cyr, who is openly gay, said he was bullied, suffered panic attacks and developed an eating disorder. He said members of the LGBT community are three times more likely to need mental health care services.
"Therapy has helped me manage my anxiety and do things I never dreamed I could, and yet I still can't get my health insurance to cover my outpatient mental health care," Cyr said. "I'm a pretty savvy consumer. If I can't navigate the barriers to access and care, imagine how many people can't get the mental health care they need."
One of the provisions of the bill would require the Office of Health Equity to study the availability of "culturally competent" mental health care providers within both public and private networks, and to identify barriers faced by cultural, ethnic, linguistic and LGBT communities.
Senate Ways and Means Chairman Michael Rodrigues said the various studies and pilot programs, including a high school tele-behavioral health pilot, would cost about $5.7 million, and would be paid for in the fiscal 2021 budget from a trust fund already set up this year and funded with $10 million.
Spilka said that close to $1 million from that fund has already been allocated for a public awareness campaign to reduce the stigma around mental health care. The Democrat said she was working with Health and Human Services Secretary Marylou Sudders to put that campaign together, and hoped to see it launch by May.
Lora Pellegrini, president of the Massachusetts Association of Health Plans, said she felt that insurers had a seat at the table during the development of the Senate bill, and supported many of its provisions.
Pellegrini said updated reporting for insurance carriers "seems reasonable," but suggested some of the specific requirements could become "administratively burdensome."
"While parity is seen as an insurance obligation, we really need to ensure that the providers are also providing care in a way that ensures parity," Pellegrini said.
The bill does propose to require emergency departments to have the capacity to evaluate and stabilize a person admitted with a mental health crisis at all times.
The Senate adopted an order during a session on Thursday giving senators until 2 p.m. on Monday to file amendments to the bill, and Spilka said senators had already received a cursory briefing on the bill prior to it being polled out of Ways and Means.
Other proposals include moving the licensing boards for social workers, psychologists and allied mental health professionals under the Department of Public Health, and directing the Health Policy Commission to study the impact of some insurance companies subcontracting mental health benefits to third-party benefit managers.
