MHA is a longtime champion of behavioral health parity – treating mental health and substance abuse conditions on par with physical injuries and illnesses. This is not a new effort, but it sometimes struggles for broader visibility, both in Massachusetts and across the country. I'd like to take advantage of the fact that May is National Mental Health Month to highlight a bill now moving through the state legislature that MHA and our member hospitals strongly support, and that I believe will help repair our broken behavioral health system.
Yes, broken. Right now, too many patients experiencing behavioral health issues do not have adequate access to non-emergency treatment for their conditions. And once their situations escalate to crisis-level, these individuals are subject to administrative delays and barriers that range from notice/authorization requirements to a lack of available inpatient beds for adults and adolescents that can mean a patient must "board" in a hospital emergency room to await treatment – sometimes for days. It would be unthinkable to make a patient with a broken bone wait days for treatment. The same should be true of patients needing behavioral healthcare.
HB905, "An Act Expanding Coverage and Access to Behavioral Health Services" is a big step in the right direction. Developed in concert with a broad array of behavioral health providers and sponsored by Rep. Elizabeth Malia (D-Jamaica Plain) and Sen. John Keenan (D - Quincy), it is a sweeping bill that would, among other things:
- Implement parity provisions that remove certain prior authorization requirements for inpatient mental health services provided to patients enrolled in Medicaid and private insurance plans;
- Clarify that an Emergency Department (ED) physician has the authority to assess if a patient has the mental capacity to enter into an inpatient mental health setting;
- Expand community-based crisis stabilization services to help care for patients, as an alternative to coming to hospital EDs, which would help reduce emergency department boarding;
- Require insurers to develop access to a live person, 24-7-365, to help providers find a placement for the plan's patients when they are waiting in the ED with no available inpatient behavioral health placement options;
- Direct all insurers (including Medicaid) to pay providers at the inpatient contracted rate for each 24-hour period that a patient remains boarded in the ER, which could spur insurers to help find placements;
- Fund the development of a specific adolescent behavioral health unit; and
- Expand private insurer coverage for community-based behavioral health services for children and adolescents that are currently only covered by Medicaid through the Children’s Behavioral Health Initiative.
While it's true that healthcare reform is a never ending process, it is also true that behavioral healthcare in the commonwealth is the biggest unmet challenge in our rapidly evolving health system. This comprehensive bill would take specific needed steps to help move the system more closely toward true parity for behavioral health patients. True parity is about equality, fairness, and respect. It is what all patients deserve and too many behavioral health patients are still waiting to receive.