The Massachusetts Senate will debate a sweeping bill Thursday to tackle inequities and inefficiencies within the state’s mental health care system.
The Mental Health Addressing Barriers to Care Act would overhaul a lack of parity between mental and physical health care, as its legislators say the latter is prone to receiving more resources and attention. Released by the Senate last week, the bill would reform insurance policies and create new programs to increase accessibility to mental health services.
For Senate president Karen Spilka, the issue is personal. Spilka said her father experienced mental illness while she was growing up, but did not obtain the help he needed.
“I grew up in a family where things were tough, particularly during my adolescent years,” Spilka said. “We can increase access to care for people. We can look at what can we do to get more people into the mental health system when they need it.”
Mental health parity laws have existed in Massachusetts for two decades, mandating that insurance coverage for mental health care equals insurance coverage for any other medical condition. Yet, Spilka said, that has not been the case.
This new bill aims to address parity complaints quicker and implement more rigorous oversight of insurance carriers’ processes and policies relating to coverage of mental health care. It would also enforce penalties and offer remedies when these carriers fail to provide fair treatment.
Sen. Julian Cyr, co-chair of the Senate Joint Committee on Mental Health, Substance Use and Recovery, has seen these issues since adolescence, when he began struggling with anxiety and depression. Besides lacking coverage by insurance companies, Cyr said, many barriers obstruct the road to mental health care access.
“And then add to these logistical obstacles, those needing mental health care must navigate their own shame, social stigma and sometimes, fear of outright discrimination,” Cyr said. “So this is the approach that we bring to this. We’re really trying to, as a start, treat mental health care as health care.”
One current hurdle to fast treatment is prior authorization, a review process that requires patients request and wait for approval before a health plan will cover the financial costs of treatment. The Mental Health ABC Act would eliminate such requirements and establish a commission to help outline a universal set of criteria for insurance providers to use regarding mental health services.
If passed, it would also track and establish a baseline for mental health care spending to encourage level investment in the provision of these services, as well as ensure room in emergency departments for victims of mental health emergencies and require insurance carriers cover same-day care.
Spilka said the bill would prohibit carriers from denying coverage for medical services and behavioral health services offered on the same day, which poses an issue in today’s health care system.
“Right now, if you go see your primary care physician, and then the same day you go to see a behavioral health therapist or something and even if it’s part of that same PCP,” Spilka said, “the therapist will not get paid for the service. The doctor, the medical services, will.”
Sen. Cindy Friedman, co-chair of the Senate Joint Committee on Health Care Financing, said there is also a “significant” difference in how much mental health care providers are paid for their services compared to many physical health care physicians.
“They are usually lower than primary care,” Friedman said. “[But] there’s not a one-to-one correlation between somebody in primary care offices and somebody that’s delivering mental health care.”
Under the Mental Health ABC Act, a rate floor would reimburse mental health providers in a way that is consistent with primary care. Insurance carriers in the state must also use one standard credentialing form for all health care providers, speeding up the hiring process.
Other initiatives within the mental health workforce, Spilka said, include permitting interim licensure for licensed mental health counselors.
“Right now, they don’t get the licensures so they can’t get payment, but they’re providing services,” Spilka said. “So we have a licensure program, an interim, so that they can start providing services that can be reimbursed.”
Somerville resident Izzy Ouellette, 25, said she believes mental health is “extremely important” because it is linked to physical health.
“I feel like health insurance covers a lot more of physical health,” Oullette said, “as opposed to mental health.”
Arwa Almutabagani, 20, of Brookline said she thinks mental health care is almost more important than physical health.
“If your mental health is bad, then it’s going to affect your physical health,” Almutabagani said. “I feel like mental health isn’t given enough importance as it should be.”
71-year-old South End resident Rudy Mitchell said both mental and physical health should be on equal footing because each is necessary to overall wellbeing.
“Sometimes, there is a stigma to problems of mental health,” Mitchell said. “It’s seen in a different way as a [physical] illness.”