Madaro’s Comprehensive Mental Health Bill Passes in the House

Since being named Chair of the House’s Mental Health, Substance Use, and Recovery Committee, Rep Adrian Madaro has been of the opinion that every resident deserves access to quality mental health care when they need it. Yet, far too many people face unnecessary barriers to getting the help they need.

During this legislative season, Rep. Adrian Madaro and his colleagues got to work on a comprehensive mental health reform bill.

House passes comprehensive
Mental Health bill spearheaded by Rep. Adrian Madaro.

The bill that Madaro helped craft addresses longstanding issues with the state’s behavioral health care delivery system.

The bill, which unanimously passed the House last week, focuses on acute psychiatric care and crisis response, youth behavioral health initiatives, community-based behavioral health services, investments in the workforce, and enforcement of existing behavioral health parity laws.

“Everyone deserves access to quality mental health services, yet far too many people face unnecessary barriers to care,” said Madaro. “This bill reaffirms the House’s commitment to increasing access to behavioral health care across Massachusetts.”

Madaro said for too long, the healthcare system has not treated behavioral health as equal to physical health, creating obstacles in addressing the mental health crisis, which has on been exacerbated by the pandemic.

“That’s why this timely piece of legislation makes critical steps toward prioritizing mental health services for people across the Commonwealth, including our youth who have been acutely affected, and those who face challenges in getting the care they need,” said Madaro. “These policies reflect our strong belief that behavioral health care is essential.”

Madaro thanked House Speaker Ron Mariano for allowing him the opportunity to lead the debate on this essential work as well as the rest of the Committee on Mental Health, Substance Use, and Recovery for their contributions and good ideas.

“I’m proud of the legislation passed by the House today that builds on our long-standing efforts to advance important reforms and substantial investments that are aimed at improving our behavioral health care delivery system,” said Speaker Mariano (D-Quincy). “From addressing the behavioral health crisis that our young people are currently experiencing, to our efforts to alleviate emergency department boarding, to provisions that will bring us closer to treating mental and physical health equally, this legislation will benefit all residents in the Commonwealth when accessing critical health care. I would like to thank Chairman Adrian Madaro for his hard work, and for his commitment to producing a strong bill.”

Highlights of the bill include creating online portals that provide access to real-time data on youth and adults seeking mental health and substance use services, including a function that allows health care providers to easily search and find open beds.

The bill requires the Health Policy Commission (HPC) to prepare and publish a report every three years on the status of pediatric behavioral health.

Madaro said his legislation codified an expedited psychiatric inpatient admissions (EPIA) advisory council to reduce hospital emergency department boarding. This includes a protocol to expedite placement into appropriate care settings for patients under the age of 18.

Madaro added the bill also seeks to increase behavioral health care access across the Commonwealth through the implementation of the nationwide 988 hotline to access 24/7 suicide prevention and behavioral health crisis services.

“This legislation also expands 911 to bridge the gap until 988 is implemented by increasing training, funding, and capacity for regional emergency responses to behavioral health crises,” said Madaro.

In the wake of the Uvalde School Shooting the bill will initiate a public awareness campaign on the Commonwealth’s red flag laws and Extreme Risk Protection Orders (ERPOs), passed by the Legislature in 2018, that limit access to guns for people at risk of hurting themselves or others.

Madaro said the bill also tackles disparities in mental health and other forms of health care by giving the state additional tools to enforce existing parity laws by:

Requiring licensed mental health professionals to be available during all operating hours of an emergency department (including via telehealth)

Codifying hospital clinical competencies and operational standards and directing the Department of Mental Health (DMH) to establish a complaint process for alleged violations

Directing DMH to create a comprehensive plan to address access to continuing care beds, intensive residential treatment programs, and community-based programs for patients awaiting discharge from acute psychiatric hospital units

Implementing mental health watch reforms in correctional settings, including changes to the referral to mental health process for those who are incarcerated or detained, and establishing a process for a person on mental health watch for longer than 72 hours to petition to be transferred.

Other Highlights of Rep. Madaro’s Mental Health Bill Includes:

School-based behavioral health services and programming

• Limiting the use of suspension and expulsion in all licensed early education and care programs

• Requiring school districts to adopt a behavioral health crisis response plan which may be based on a cost-neutral model plan to be developed by the Department of Elementary and Secondary Education

• Creating a statewide program to help schools implement school-based behavioral health services

Access points for youth for effective behavioral health treatment:

• Creating a complex care resolution panel to ensure children with complex behavioral health needs are assisted quickly and with cross-agency support and coordination

• Requiring behavioral health assessments and referrals for children entering the foster care system

• Empowering the Office of the Child Advocate (OCA) to receive complaints from children and families and to assist them in resolving issues with access to behavioral health services

• Expanded insurance coverage:

• This legislation requires insurance coverage of critical behavioral health services, including:

• Emergency service programs

• Services provided under psychiatric collaborative care models

• Mental health acute treatment, community-based acute treatment, and intensive community-based acute treatment without prior authorization

• Annual mental health wellness exams

Workforce investments:

• This proposal builds upon the Behavioral Health Trust Fund by carving out specific grant programs for health care providers, which would finance: 

• Workforce Pipeline Investments: a scholarship program to support a culturally, ethnically, and linguistically diverse behavioral health workforce, with a focus on clinicians who commit to serving high-need populations.

• Integrated Care: a grant program to expand integrated care models that enable providers to expand their practices to provide behavioral health care in primary care settings

• Support for Providers: a grant program to promote the mental health and wellbeing of providers

Behavioral health parity implementation and enforcement:

• This legislation tackles the disparity by health plans to reimburse mental health services at lower rates than other forms of healthcare by providing the Commonwealth additional tools to enforce existing parity laws and promote compliance.

• This legislation enhances oversight of parity compliance by:

• Requiring carriers to comply with annual reporting requirements

• Directing the Division of Insurance (DOI) to review and ensure insurer compliance with parity laws

• Authorizing the Office of Patient Protection (OPP) to identify and refer potential parity violations that arise during OPP grievance reviews to the DOI and the AG’s office

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