Bill Summary – FastDemocracy

FILED ON: 11/22/2021
       SENATE . . . . . . . . . . . . . . No. 2584
                                The Commonwealth of Massachusetts
                                                      _______________
                                    In the One Hundred and Ninety-Second General Court
                                                        (2021-2022)
                                                      _______________
     An Act addressing barriers to care for mental health.
              Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
     of the same, as follows:
         SECTION 1. Chapter 6A of the General Laws is hereby amended by striking out section
 16P, as appearing in the 2020 Official Edition, and inserting in place thereof the following 2
  sections:-
         Section 16P. (a) For the purposes of this section, the following words shall have the
 following meanings unless the context clearly requires otherwise:
         “Awaiting residential disposition”, waiting not less than 72 hours to be moved from an
 acute level of psychiatric care to a less intensive or less restrictive, clinically-appropriate level of
 psychiatric care.
         “Boarding”, waiting not less than 12 hours to be placed in an appropriate therapeutic
 setting after: (i) being assessed; (ii) determined to be in need of acute psychiatric treatment, crisis
 stabilization unit placement, community-based acute treatment, intensive community-based acute
 treatment, continuing care unit placement or post-hospitalization residential placement; and (iii)
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 receiving a determination from a licensed health care provider to be medically stable without
 needing urgent medical assessment or hospitalization for a physical condition.
        “Children and adolescents”, individuals who are not more than 22 years of age.
        (b) The secretary of health and human services shall facilitate the coordination of services
 for children and adolescents awaiting clinically-appropriate behavioral health services by
 developing and maintaining a confidential and secure online portal that enables health care
 providers, health care facilities, payors and relevant state agencies to access real-time data on
 children and adolescents who are boarding, awaiting residential disposition or in the care or
 custody of a state agency and are awaiting discharge to an appropriate foster home or a
 congregate or group care program. The online portal and information contained in the online
 portal shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or under
 chapter 66.
        (c) The online portal shall include, but not be limited to, the following data: (i) the total
 number of children and adolescents boarding, including a breakdown, by location, of where the
 children and adolescents are boarding, which shall include, but not be limited to, hospital
 emergency rooms, emergency services sites, medical floors after having received medical
 stabilization treatment or their homes; (ii) the total number of children and adolescents awaiting
 residential disposition, including a breakdown, by facility type, of where children and
 adolescents are awaiting residential disposition and the level of care or type of placement sought;
 and (iii) the total number of children and adolescents in the care or custody of a state agency who
 are hospitalized and have waited not less than 72 hours for discharge to an appropriate foster
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 home or a congregate or group care program after having been determined to no longer need
 hospital-level care.
        (d) For each category of data included under subsection (c), the online portal shall
 include: (i) the average wait time for discharge to the appropriate level of care or placement; (ii)
 the level of care required as determined by a licensed health care provider; (iii) the primary
 behavioral health diagnosis and any co-morbidities relevant for the purposes of placement; (iv)
 the primary reason for boarding, awaiting residential disposition or, for children and adolescents
 in the care or custody of a state agency, for having waited not less than 72 hours for discharge to
 an appropriate foster home or a congregate or group care program after an assessment that
 hospital-level care is no longer necessary; (v) whether the children and adolescents are in the
 care or custody of the department of children and families or the department of youth services or
 are eligible for services from the department of mental health or the department of
 developmental services; (vi) data on the insurance coverage type for the children and
 adolescents; and (vii) data on the ages, race, ethnicity, preferred spoken languages and gender of
 the children and adolescents.
        (e) The online portal shall include information on the specific availability of pediatric
 acute psychiatric beds, crisis stabilization unit beds, community-based acute treatment beds,
 intensive community-based acute treatment beds, continuing care beds and post-hospitalization
 residential beds. The online portal shall also enable a real-time bed search within a specified
 geographic region that shall include, but not be limited to: (i) the total number of beds licensed
 by the department of mental health, the department of public health and the department of early
 education and care; (ii) the total number of available beds, broken down by location, licensing
 authority, age ranges and the distance, in miles, from where a child or adolescent currently
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 resides and is boarding; (iii) the average daily bed availability, broken down by licensing
 authority and age ranges; (iv) daily bed admissions, broken down by licensing authority and age
 ranges; (v) the facility or location in which a child or adolescent was admitted; (vi) daily bed
 discharges, broken down by licensing authority and age ranges; and (vii) the average length of
 stay in a bed, broken down by licensing authority and age ranges.
        (f) Quarterly, not later than 14 days after the end of the preceding quarter, the secretary
 shall report on the status of children and adolescents who are boarding, awaiting residential
 disposition or in the care or custody of a state agency and awaiting discharge to an appropriate
 foster home or a congregate or group care program. The report shall include a summary and
 assessment of the data published on the online portal under subsections (c) to (e), inclusive, for
 the immediately preceding quarter and may include a summary and assessment of the data over
 several quarters; provided, however, that the report shall present the data in an aggregate and de-
 identified form. The report shall be submitted to the children’s behavioral health advisory
 council established in section 16Q, the office of the child advocate, the health policy
 commission, the clerks of the senate and the house of representatives, the joint committee on
 health care financing, the joint committee on mental health, substance use and recovery, the joint
 committee on children, families and persons with disabilities and the senate and house
 committees on ways and means.
        Section 16P½. (a) For the purpose of this section, “adults” shall mean individuals who
 are not less than 23 years of age.
        (b) The secretary of health and human services shall facilitate psychiatric and substance
 use disorder inpatient admissions for adults seeking to be admitted from an emergency
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  department or hospital medical floor by developing and maintaining a confidential and secure
  online portal that enables health care providers, health care facilities and payors to conduct a
  real-time bed search for patient placement. The online portal shall provide real-time information
  on the specific availability of all licensed psychiatric and substance use disorder inpatient beds
  that shall include, but not limited to: (i) location; (ii) care specialty; and (iii) insurance
  requirements. The online portal and information contained in the online portal shall not be a
  public record under clause Twenty-sixth of section 7 of chapter 4 or under chapter 66.
          SECTION 2. Said chapter 6A is hereby further amended by inserting after section 16DD
  the following section:-
          Section 16EE. (a) There shall be an office of behavioral health promotion within the
  executive office of health and human services. The office shall be under the supervision and
  control of a director of behavioral health promotion who shall be appointed by and report to the
  secretary of health and human services.
          (b) The office shall facilitate the coordination of all executive office, state agency,
  independent agency and state commission activities that promote behavioral health and wellness.
  The office shall set goals for the promotion of behavioral health and substance use disorder
  services and programming. The office shall fully integrate health equity principles and apply a
  health equity framework to all its duties and obligations. The office shall prepare and implement
  an annual plan for the promotion of behavioral health. The office shall collaborate with the
  executive office of health and human services, the executive office of education, the executive
  office of elder affairs, the department of mental health, the department of public health, the
 department of children and families, department of youth services, the department of veterans’
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 services, the department of early education and care, the department of elementary and
 secondary education, the office for refugees and immigrants, the office of health equity, the
 office of the child advocate and any other relevant office, agency or commission. The office shall
 facilitate communication and partnership between relevant entities to develop promote
 understanding of the intersections between entity activities and behavioral health promotion.
           (c) The office shall: (i) facilitate the development of interagency initiatives that: (A) are
 informed by the science of promotion and prevention; (B) advance health equity and trauma-
 informed care; and (C) address the social determinants of health; (ii) develop and implement a
 comprehensive plan to strengthen community and state-level promotion programming and
 infrastructure through training, technical assistance, resource development and dissemination and
 other initiatives; (iii) advance the identification and dissemination of evidence-based practices
 designed to further promote behavioral health and the provision of supportive behavioral health
 services and programming to address substance use conditions and associated disability and to
 prevent violence through trauma-specific intervention and rehabilitation; (iv) collect and analyze
 data measuring population-based indicators of behavioral health from existing data sources,
 track changes over time and make programming and policy recommendations to address the
 needs of populations at greatest risk; (v) coordinate behavioral health promotion and wellness
 programs, campaigns and initiatives; (vi) provide staffing support for the commission on
 community behavioral health promotion established in section 219 of chapter 6; and (vii)
 ascertain the mental health needs of veterans. The office may enter into service agreements with
 the department of mental health or the department of public health to fulfill the obligations of the
 office.
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        (d) Annually, not later than July 1, the office shall report on its progress, and the overall
 progress of the commonwealth, toward promoting behavioral health and wellness and preventing
 substance use conditions and violence. When possible, the report shall use quantifiable measures
 and comparative benchmarks. The report shall be filed with the governor, the clerks of the senate
 and house of representatives and the joint committee on mental health, substance use and
 recovery. The report shall be posted on the official website of the commonwealth.
        Section 16FF. (a) As used in this section, the following words shall have the following
 meanings unless the context requires otherwise:
        “Community behavioral health centers”, organizations that are designated by the
 executive office of health and human services, licensed clinics that hold a contract with the
 department of mental health to provide community-based mental health services and other
 licensed clinics designated by the department of public health.
        “Community crisis stabilization program”, a program providing crisis stabilization
 services with the capacity for diagnosis, initial management, observation, crisis stabilization and
 follow-up referral services to all persons in a home-like environment, including, but not limited
 to, emergency service providers and restoration centers.
        (b) The secretary of health and human services shall designate at least one 988 crisis
 hotline center that shall operate 24 hours a day, 7 days a week to provide crisis intervention
 services and crisis care coordination to individuals accessing the federally-designated 988
 suicide prevention and behavioral health crisis hotline.
        (c) A 988 crisis hotline center shall: (i) meet the United States Department of Health and
 Human Services’ Ambulatory Behavioral Health System standards and the National Suicide
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 Prevention Lifeline requirements and best practices guidelines for operational and clinical
 standards; (ii) provide data, report and participate in evaluations and related quality improvement
 activities as required by the United States Department of Health and Human Services’; (iii)
 utilize technology, including, but not limited to, chat and text capabilities, that is interoperable
 between and across crisis and emergency response systems and services, including 911 and 211,
 as necessary; (iv) have the authority to deploy crisis and outgoing services, including mobile
 behavioral health crisis responders, and coordinate access to crisis triage, evaluation and
 counseling services, community crisis stabilization programs or other resources as appropriate;
 (v) maintain standing partnership agreements with community behavioral health centers and
 other behavioral health programs and facilities, including programs led by individuals who are or
 were consumers of mental health or substance use disorder supports or services; (vi) coordinate
 access to crisis evaluation, counseling, receiving and stabilization services for individuals
 accessing the 988 suicide prevention and behavioral health crisis hotline through appropriate
 information sharing regarding availability of services; (vii) have the capability to serve high-risk
 and specialized populations including, but not limited to, people with co-occurring substance use
 and mental health conditions and people with autism spectrum disorders or intellectual or
 developmental disabilities; (viii) have the capability to serve people of diverse races, ethnicities,
 ages, sexual orientations and gender identities with linguistically and culturally competent care;
 (ix) have the capability to provide crisis and outgoing services within a reasonable time period in
 all geographic areas of the commonwealth; and (x) provide follow-up services to individuals
 accessing the 988 suicide prevention and behavioral health crisis hotline.
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        (d) (1) There shall be a state 988 commission within the executive office of health and
 human services to provide ongoing strategic oversight and guidance in all matters regarding 988
 service in the commonwealth.
        (2) The commission shall review national guidelines and best practices and make
 recommendations for implementation of a statewide 988 suicide prevention and behavioral
 health crisis system, including any legislative or regulatory changes that may be necessary for
 988 implementation and recommendations for funding that may include the establishment of user
 fees. The commission shall also advise on promoting the 988 number including, but not limited
 to, recommendations for including information about calling 988 on student identification cards
 and on signage in locations where there have been known suicide attempts.
        (3) The commission shall consist of: the secretary of health and human services or the
 secretary’s designee, who shall serve as chair; the secretary of public safety and security or the
 secretary’s designee; the commissioner of mental health or the comminssioner’s designee; the
 commissioner of public health or the commissioner’s designee; the executive director of the
 Massachusetts Behavioral Health Partnership or the executive director’s designee; the executive
 director of the state 911 department or the executive director’s designee; the executive director of
 Mass 2-1-1 or the executive director’s designee; a representative designated by the
 Massachusetts Chapter of the National Association of Social Workers, Inc.; a 911 dispatcher
 designated by the Massachusetts Chiefs of Police Association Incorporated; an emergency
 medical technician or first responder nominated by the Massachusetts Ambulance Association,
 Incorporated; and the following members to be appointed by the chair: 1 rep