As the State Senate begins its budget deliberations this week, MHA is advocating for its 13 priority amendments to the budget, two of which are dedicated to helping alleviate the behavioral health boarding crisis.
Each Monday, emergency departments (ED) report figures that show approximately 300 patients with behavioral health issues “boarding” in emergency departments as they wait for an inpatient psychiatric bed to open. That 300 number does not include reporting from the 22 hospitals in what the state designates as Region 4 (Boston and nearby suburbs of the city), meaning that the weekly boarding number could be closer to 500. In turn, many individuals with behavioral health issues that are in those inpatient beds are stuck in them as they await discharge to a continuing care bed, which have decreased in number due to appropriate COVID-19 related infection control measures and an increase in patients from forensic settings. Hospitals and the state have been expanding the number of behavioral health beds in recent years, but the staff for those beds – from psychiatrists to support staff that don't possess a college degree – is in very short supply.
"The historic behavioral health boarding problem has been made even worse by the pandemic, as behavioral health diagnoses and acuity increases, in-person services have been more difficult to access, and pressures on emergency departments have risen,” said Leigh Simons Youmans, MHA’s senior director of healthcare policy. “Behavioral health has become the epidemic within the pandemic.”
The MassHealth program has taken significant steps to address the issue. MassHealth rate increases and dedicated capital funds for bed expansions have helped. MHA’s budget amendments, one of which passed the House last month, seek to further improve the situation.
Amendment 129 filed by Sen. Brendan Crighton (D-Lynn) would direct the Department of Mental Health (DMH) to collect and publicly report on the availability of adult and pediatric beds at inpatient continuing care facilities operated by or contracted by DMH. It would increase DMH funding for community-based mental health services by $5 million and would increase funding to stand up additional continuing care beds by $6.6 million. The amendment directs DMH and the Trial Courts to assess alternative methods for treating forensic patients that do not rely upon and require placement in continuing care beds, and would also study the feasibility of establishing a forensic treatment setting that does not rely on those beds. The amendment would also direct EOHHS, MassHealth, and relevant providers to establish and implement an enhanced rate to support the provision of psychiatric services for highly acute psychiatric patients and to assess the need to establish additional intensive units to treat highly acute psychiatric patients across the state.
Amendment 545 filed by Sen. Joan Lovely (D-Salem), would continue the FY21 budget’s creation of a new $5 million line item to address emergency department boarding through staffing investments and rate incentives to fully operationalize inpatient mental health acute care beds, intensive inpatient psychiatric beds, community-based acute treatment, and partial-hospitalization programs through a grant program administered by EOHHS. As a result of these and other FY21 funds, more than 250 much-needed inpatient psychiatric beds are anticipated to come online this calendar year. This new line item would allow funds to be expended on additional innovative approaches to fully operationalize new and existing services in the behavioral health continuum of care. Funds would be directed toward staffing investments and rates to ensure both workforce and financial sustainability of these new and existing services.
The FY2023 MassHealth RFA – the main contract between the state and hospitals treating Medicaid patients – is being drafted and it, along with EOHHS’ recently released Roadmap for Behavioral Health Reform, aim at sweeping reform of the behavioral health system. But in the time between that RFA becoming effective and full implementation of the Roadmap and now, help is needed to tackle the boarding problem.
“The boarding problem is widespread with no easy answers to resolve it,” Youmans said. “But Amendments 129 and 545 take the key steps of allowing us to gather the necessary data and make the necessary short-term investments that will ease the burden for behavioral health patients and the people who care for them.” Another MHA Amendment, #111 filed by Senator Brendan Crighton (D-Lynn), aims to address boarding by studying the feasibility of using the federal Hospital at Home program for inpatient psychiatric treatment.
Behavioral health is a major point of emphasis for MHA and member hospitals during the 2021-2022 legislative session. Legislation that Rep. Marjorie Decker (D-Cambridge) filed, An Act to strengthen and expand access to behavioral healthcare, is a priority bill for the association and helps address the boarding crisis by establishing a Behavioral Health Investment Trust Fund, creating a Behavioral Health Rate Task Force, and expanding coverage for medically necessary mental health services across all insurers, among other things.