Professional Documents
Culture Documents
COMMITTEE CHAIRS
REPRESENTATIVES
Liz Malia (D-11th Suffolk), Chair
Angelo M. Scaccia (D-14th Suffolk), Vice Chair
Ruth B. Balser (D-12th Middlesex)
Michael S. Day (D-31st Middlesex)
Diana DiZoglio (D-14th Essex)
Tricia Farley-Bouvier (D-3rd Berkshire)
Carole A. Fiola (D-6th Bristol)
Randy Hunt (R-5th Barnstable)
Dennis A. Rosa (D-4th Worcester)
Jose F. Tosado (D-9th Hampden)
Susannah M. Whipps Lee (R-2nd Franklin)
SENATORS
Jennifer L. Flanagan (D-Worcester & Middlesex), Chair
Joan B. Lovely (D-2nd Essex), Vice Chair
Kenneth J. Donnelly (D-4th Middlesex)
Linda Dorcena Forry (D-1st Suffolk)
James B. Eldridge (D-Middlesex & Worcester)
Richard J. Ross (R-Norfolk, Bristol, & Middlesex)
STAFF
House: Rebecca Kaye, Legal Counsel
Yelena Tsilker, Research Analyst
Senate: Shannon Moore, Legislative and Budget Director to Senator Flanagan
January 2017
Dear Colleagues,
The Joint Committee on Mental Health and Substance Abuse (herein Committee) had a very successful
2015-2016 Legislative Session. As Committee Chairs, we are pleased to report the Committee has
continued the legislatures commitment to addressing mental health and substance use and has worked to
educate members and the public on a multitude of issues under the Committees purview.
Eight-six bills were referred to the Committee in this legislative session, three of which were discharged
to other committees. The number of Committee bills represents a significant increase from the sixty-two
bills referred last session, emphasizing the significant need for behavioral health reforms in the
Commonwealth.
The Committee held thirteen bill hearings, five informational hearings, and two oversight hearings. The
informational hearings focused on: mental health, substance abuse, geriatric mental health, innovative
programming related to opioid abuse, and Hepatitis C and harm reduction. The first oversight hearing was
an update from the Baker Administration on the progress of previously passed legislation and other efforts
to combat the opioid crisis. The second was dedicated to reforms at Bridgewater State Hospital.
Several bills considered by the Committee were signed into law by Governor Charles Baker, including:
An Act Regarding Proportional Payments of the Massachusetts Child Psychiatry Access Project (FY
2017 budget), An Act Relative to Improved Medication Adherence (FY 2016 closeout supplemental
budget), and An Act Relative to the Ellen Story Commission on Postpartum Depression in recognition of
Representative Ellen Story's tireless efforts on the existing Commission and issues around postpartum
depression. We are thankful for her important work and wish her the best in her retirement.
The most notable item the Committee considered, which was redrafted by the Committee and ultimately
became law, was An Act Relative to Substance Use, Treatment, Education and Prevention (The STEP
Act). Governor Baker signed Chapter 52 of the Acts of 2016 into law on March 9, 2016. Key provisions
of this comprehensive legislation to combat addiction include: creating a new best practice by requiring
hospitals to conduct a substance abuse evaluation of individuals presenting in an emergency room
following an apparent overdose within 24 hours of admission, limiting first-time opiate prescriptions for
adults and all opiate prescriptions for minors to a seven day supply with exceptions, and requiring verbal
substance abuse screening tools for students in the public school system. Considered to be first-in-the-
nation, this opioid legislation demonstrates Massachusetts position as a leader in the addressing our
public health crisis.
We share our successes with the many consumers, providers, advocates, and coalitions who worked with
us. We hope this report will inform not only of recent successes but also the areas where more work is
imperative. Our goal continues: to make Massachusetts a world class leader of care for those who live
with the challenges of mental illness and substance use disorder.
Legislative Highlights.. 1
Legislative Accomplishments Before the Committee (including The STEP Act)
Budgetary Accomplishments
Other Legislative Accomplishments
1. An Act Relative to Substance Use, Treatment, Education and Prevention (The STEP Act),
Chapter 52 of the Acts of 2016:
The first law of its kind in the nation, the STEP Act enhances education and prevention
initiatives and increases treatment options for substance use disorder across the
Commonwealth. Originally filed by Governor Baker, the final legislation, which has a
focus on youth and those who have recently overdosed, incorporates aspects of other
Committee bills to create the comprehensive changes needed to combat the opioid
epidemic.
Prevention and intervention provisions include:
o Limits initial opiate prescriptions to no more than a 7-day supply and limits all
opiate prescriptions for minors to no more than a 7-day supply, with exceptions.
o Establishes a verbal substance use screening tool for students in public schools
(similar to An Act Relative to Preventing Adolescent Substance Abuse by
Expanding SBIRT).
o Requires prescribers to check the Prescription Monitoring Program (PMP) each
time a prescription for a narcotic drug in Schedule II or Schedule III is issued.
o Empowers patients to fill a lesser amount of an opiate prescription (similar to An
Act Creating Patient Choice and Education in the Dispensing of Opiate Drugs)
and to complete a voluntary directive indicating they should not be prescribed or
given an opiate.
o Establishes a Drug Stewardship Program, currently being developed by the
Department of Public Health (DPH), for the collection and disposal of unwanted
prescription medications (similar to An Act Relative to Responsible Stewardship
by Drug Manufacturers).
o Requires a prescriber to have a conversation with a patient before issuing a
prescription for a long-acting opiate and to enter into a written pain management
treatment agreement with a patient for long-term pain management that utilizes an
opioid (similar to An Act Relative to High Volume and High Risk Prescriptions).
Education provisions include:
o Mandates additional training for practitioners who prescribe controlled substances
about substance use disorders and risks of opiate misuse, including appropriate
prescribing amounts, prior to the practitioner obtaining or renewing their license.
o Requires medical schools and other health professional training programs to
create a consistent safe prescribing and pain management curriculum.
o Requires all public schools to develop a policy regarding substance use
prevention and education and to include substance use education in high school
sports trainings and driver training education.
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Treatment provisions include:
o Provides for substance abuse evaluations within 24 hours of an individual arriving
at a hospital or other facility due to an overdose or after being administered
naloxone.
o Establishes civil liability protection for the administration of naloxone to those
suspected of experiencing an overdose.
o Increases transparency in insurance denials to further parity for behavioral health
treatment.
o Establishes a commission to study the effectiveness and quality of state-licensed
addiction treatment centers (similar to Resolve Establishing a Commission to
Investigate State Licensed Addiction Treatment Centers).
2. An Act Relative to Civil Commitments for Alcohol and Substance Use Disorders, Chapter 8
of the Acts of 2016
Ensures that women with substance use disorder will no longer be civilly committed to
MCI Framingham, a correctional facility, and will instead receive appropriate treatment.
3. An Act Relative to the Ellen Story Commission on Postpartum Depression, Chapter 350 of
the Acts of 2016
In recognition of the invaluable work done by Representative Ellen Story in addressing
postpartum depression, renames the legislative commission on postpartum depression the
Ellen Story Commission on Postpartum Depression.
Budgetary Accomplishments
Budgets for fiscal years 2016 and 2017 included critical funding for behavioral health services
and provisions to ensure treatment access.
The Bureau of Substance Abuse Services (BSAS) saw a significant increase in funding$125.7
million in the Fiscal Year (FY) 2017 budget, up from $98.2 million in FY 2016. This funding
increase provides for an estimated 125 additional residential treatment beds. Recent 9C cuts
reduced this funding by $1.9 million. The Department of Mental Health (DMH) maintained its
overall budget of $761.1 million in FY 2017, up slightly from $740.5 million in FY 2016. Both
BSAS and DMH funds ensure that Massachusetts residents with the most severe mental health
and substance use disorder needs receive appropriate case management and treatment services.
Several other crucial changes in policy passed in outside sections of annual and supplemental
operating budgets:
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Prescription Monitoring Program Requirement, Section 89 (similar to An Act Preventing
Prescription Drug Abuse by Closing the Pharmacy Shopping Loophole)
o Requires pharmacies to submit data to the PMP every 24 hours, rather than every
seven days.
Access to Medication-Assisted Treatment and Clinical Stabilization Services, Section 105
(similar to An Act Relative to Medication Assisted Treatment for Opioid)
o Requires MassHealth to provide coverage for all FDA-approved drugs for the
treatment of opioid or alcohol dependence and to establish billing codes and rates
of payment for licensed clinical stabilization services (CSS).
Extended-Release Injectable Naltrexone Pilot Program, Section 158
o Allows DPH and BSAS to establish two pilot programs for two years. The
program allows the use of extended-release injectable naltrexone, a type of
treatment for opioid use disorder, before discharge at the CSS level of care.
Medication Adherence, Section 10 of Chapter 283 of the Acts of 2016 (similar to An Act
Relative to Improved Medication Adherence)
o Allows a registered pharmacist, at the discretion of a prescribing practitioner, to
administer medication for the treatment of mental health and substance use
disorders.
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Special Commission on Behavioral Health Promotion and Upstream Prevention, Section
193 (Similar to Resolve Establishing a Special Commission on Behavioral Health
Promotion and Upstream Prevention)
o Creates a special commission to investigate evidence-based practices, programs,
and systems to prevent behavioral health disorders and promote access.
Needle Exchange Program, Section 215
o Removes the cap on the number of needle exchange programs DPH can fund and
defines local approval (previously undefined) as local boards of public health.
Needle exchange programs distribute and exchange syringes to people using
injection drugs. These programs are an effective harm reduction tool that decrease
transmission of HIV/AIDS and Hepatitis C and engage people in treatment. These
changes allow areas of the Commonwealth facing the greatest need to have more
access to these necessary services.
1. An Act Relative to Motor Vehicle License Suspension, Chapter 64 of the Acts of 2016
Repeals a law that automatically suspended the drivers license of anyone convicted of a
drug offense. This change ensures that individuals struggling with substance use disorder
do not face unnecessary financial or transportation barriers when reentering the
community, seeking employment, or obtaining treatment.
2. An Act Relative to the Trafficking of Fentanyl, Chapter 136 of the Acts of 2015
Increases the penalty for the possession and distribution of Fentanyl, an opioid that is 30
to 50 times more powerful than heroin and may be contributing to the rising level of
lethal overdoses in the Commonwealth.
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BILLS REFERRED AND HEARD
Bills Referred
Eighty-six (86) bills were referred to the Joint Committee on Mental Health and Substance
Abuse, of which three (3) were discharged to another committee.
Bills reviewed by the Committee generally focused on preventing and treating opioid use
disorder, improving the civil commitment process, and ensuring patients are able to obtain
mental health and substance use disorder treatment. Specific issues addressed in bills included
expanding medical insurance and MassHealth coverage, ensuring access to each level of
behavioral health care, and childrens behavioral health.
Bills Heard
H1784, An Act Relative to Increasing Access to Psychological Services
Sponsor: Representative Ruth Balser
Summary: Requires MassHealth to cover treatment, diagnostic evaluations, assessment,
testing, and supervisory services provided by licensed psychologists.
Action: Favorable with Changes
H1785, An Act Regarding Proportional Payments of the Massachusetts Child Psychiatry Access
Project
Sponsors: Representative Ruth Balser and Senator Jennifer Flanagan
Summary: Directs the Department of Mental Health (DMH) to create or utilize a
statewide program to provide mental health consultations regarding persons under 19 and
women who are showing signs of postpartum depression by phone to pediatricians,
family physicians, nurse practitioners, and primary care providers. DMH will obtain
payments as a condition of licensure from insurance companies for the use of the
Massachusetts Child Psychiatry Access Project based on DMH regulations.
Action: Favorable; included, in part, in the FY 2017 Budget
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Requires coverage of an alternative reimbursement plan if provider-recommended
behavioral health services are not covered and requires that all medically necessary
behavioral health services be reimbursed regardless of where services are provided.
Requires that DMH provide assistance with discharge planning for patients going to
DMH continuing care facilities.
Directs various groups to develop recommendations on DMH access to patient flow
data, a bed-finder tool, and behavioral health integration.
Action: Favorable
H1787, An Act Relative to Expanding Access and Safety of Mental Health Services
Sponsor: Representative Josh Cutler
Summary:
Currently, only a physician, qualified psychologist, psychiatric nurse mental health
clinical specialist, or licensed independent clinical social worker can apply to have an
individual hospitalized for three days if, after examining the individual, they believe
the individual presents a likelihood of serious harm. This bill allows licensed mental
health counselors to make this application and also extends immunity for civil
liability to licensed mental health counselors for related damages.
Allows licensed mental health counselors to petition for an order of commitment of a
person who they believe to be an alcohol or substance abuser.
Action: Favorable
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H1790, An Act Relative to Safe In-Patient Alcoholism or Substance Abuse Treatment
Sponsor: Representative Diana DiZoglio
Summary: Ensures that individuals committed under Section 35 of Chapter 123 (Section
35) for alcoholism or substance abuse will be provided treatment in an inpatient
treatment facility, separate from a house of correction or prison.
Action: Study
H1792, An Act Relating to Creating a Difficult to Manage Unit within the Department of Mental
Health
Sponsor: Representative Patricia Haddad
Summary: Creates difficult to manage units for men and women under DMH. The units
would be consistent with the former difficult to manage unit at Taunton State Hospital.
Action: Study
H1793, An Act Relative to Creating a Pilot Program to Transfer High Acuity Behavioral Health
and Dual Diagnosis Patients Away from Overcrowded Emergency Departments
Sponsor: Representative Patricia Haddad
Summary: Creates a two year pilot program at Taunton State Hospital to accept high
acuity behavioral health and dual diagnosis patients in the Southeast region who have
been boarding in an ED. In the programs second year, DMH would be required to file a
report evaluating the impact of the program on ED overcrowding.
Action: Favorable
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Summary: Makes the determination of Medically Necessary Services for mental health
treatment be determined by treating clinicians in consultation with the patient.
Action: Favorable
H1797, An Act Relative to the Civil Commitment of Women for Alcoholism and Substance Abuse
to MCI Framingham
Sponsor: Representative Kay Khan
Summary: Prohibits the correctional facility in Framingham from being a placement
option for women committed under Section 35. In order to meet the requirements of
Section 35, the Department of Public Health (DPH) will be required to establish and
maintain the necessary number of secure treatment beds for women. The bill further
requires that, within 24 hours of completed detoxification, a committed person will
receive a full mental health evaluation. Requires DPH to file annual reports.
Action: Study
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effectiveness of the programs on reducing detention rate, and the impact of the
program on DMHs other forensic mental health service requirements.
Action: Favorable
H1802, An Act Relative to the Discharge of Persons Incompetent to Stand Trial (Accompanied
by S1039, Sponsor: Senator John Keenan)
Sponsor: Representative Jay Livingstone
Summary: Currently, a person deemed incompetent to stand trial may be committed to
BSH by the court. This bill requires the superintendent or medical director of BSH or a
similar correctional facility to give notice to the district attorney when a person tried by
that district attorney, having been found incompetent to stand trial, is discharged. The
required notice would include the intended placement or local address of the person upon
discharge.
Action: Favorable
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Summary: Sets the rate for adult residential behavioral health and addiction treatment at
no less than $125 per day.
Action: Study
H1805, An Act Providing Equitable Access to Behavioral Health Services for MassHealth
Consumers
Sponsor: Representative Liz Malia
Summary: Requires that all health insurers, health plans, health maintenance
organizations (HMOs), and behavioral health management firms that contract with
MassHealth provide comparable access to behavioral health services in providing
medical assistance.
Action: Favorable with Changes
H1806, An Act Relative to Diversion to Substance Abuse Treatment for Non-Violent Drug
Offenders
Sponsor: Representative Liz Malia
Summary: Allows a stay of court proceedings for an individuals first and second non-
violent drug offenses, with the following requirements:
The individual or court may request for the individual to be evaluated by a licensed
addiction specialist to determine if they are drug-dependent and would benefit from
treatment. If the individual is found to be drug-dependent, the individual may request
assignment to a drug treatment facility. If a treatment facility is not available, the stay
of court proceedings will remain until appropriate treatment is available.
If the addiction specialist determines that the individual is not a drug dependent
person who would benefit from treatment, the individual is entitled to request a
hearing to make such a determination.
If the defendant requests assignment to treatment and the addiction specialist
determines they would benefit, the court must stay the court proceedings and assign
the individual to a drug treatment facility.
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Action: Favorable
H1812, An Act to Promote Accessibility and Affordability of Behavioral Health and Substance
Abuse Services for Recipients of MassHealth
Sponsor: Representative James ODay
Summary: Requires any entities under contract or subcontract with MassHealth, or any
HMOs, to provide to certain executive agencies a copy of any agreements with other
entities for purposes of administering or managing behavioral health services or benefits.
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This includes copies of agreements with private equity entities, loan agreements, and
investment interests. Also requires all entities under contract or subcontract with
MassHealth, which administer or manage behavioral health services, to provide a
statement of the total compensation or income of its 10 highest paid executives,
employees, partners, or shareholders.
Action: Favorable
H1814, An Act Regarding Rights of Persons Receiving Services from Programs or Facilities of
the Department of Mental Health
Sponsor: Representative Denise Provost
Summary: Creates a new process for DMH clients who seek redress for violations of their
statutorily enumerated rights:
Requires all persons alleging a violation to file a written request to DMH and outlines
requirements for the request.
Lays out a timeline for a hearing and the hearing officer decision. During the hearing,
both DMH and the client may be represented, and both will be given the chance to
present and examine adverse evidence and to examine and cross examine witnesses.
Action: Favorable
H1815, An Act Providing Opportunity for Youth with Substance Abuse Needs
Sponsors: Representative Tom Sannicandro and Representative Liz Malia
Summary: Provides for $1,200,000 to be appropriated from the General Fund to
reimburse cities, towns, and regional school districts for the cost of transporting students
of the Recovery High School. Also provides that a municipality is responsible for
transporting students enrolled in a Recovery High School and is entitled to state
reimbursement for the amount expended. The municipality is not required to pay for
students who must remain in the vehicle for more than one hour each way.
Action: Favorable
H1817, An Act Relative to the Civil Commitment of Mentally Ill Persons to Bridgewater State
Hospital
Sponsor: Representative Angelo Scaccia
Summary: Changes the definition of BSH to make it no longer a place of detention.
Further prohibits BSH from filing petitions seeking the civil commitment of patients to
their facility. Also provides the medical director at BSH with the authority to file a
petition to seek commitment to DMH of a patient who no longer has any criminal
involvement because charges have been dismissed or the sentence has been completed.
Action: Favorable
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H1818, An Act Relative to Applications for Temporary Involuntary Hospitalization
Sponsor: Representative Angelo Scaccia
Summary: Requires that if a person committed to a hospital as a danger to himself or
others needs to be placed in restraints, the authorization to do so would expire in 12 hours
after restraint has been initiated. Also makes the use of restraints non-renewable.
Action: Favorable
H1820, An Act Relative to Services for Persons with Mental Illness who are Living with Older
Family Members or Primary Caretakers
Sponsor: Representative Angelo Scaccia
Summary: Addresses care options for DMH clients living with a family member or
primary caretaker who has an extenuating medical condition or other circumstances that
create stresses that lead to an unsafe or detrimental condition. This bill allows the option
of residential and day services to such patients and families.
Action: Favorable
H1821, An Act to Provide Services for Medically Ill and Mentally Ill Persons
Sponsor: Representative Angelo Scaccia
Summary:
Requires that at least the first 12.5% of any placements of persons in new DMH adult
community residential programs are provided in programs with medical/nursing care
components for persons requiring long-term mental health services and at least
intermediate nursing care services, until such time as at least 160 such placements
exist. If this number of beds is not adequate, DMH shall provide additional beds.
Requires that, for each inpatient bed closed during a fiscal year at any DMH inpatient
unit composed mostly of clients with certain nursing care needs, an amount equal to
the per diem cost of operating such beds multiplied by the number of days of the
fiscal year during which the bed is closed shall be transferred from the DMH 5095-
0015 account to the 5046-0000 account for the purpose of funding community
residential programs to serve persons with such needs.
DMH is instructed to create a master plan to develop at least 160 community
residential placements with medical/nursing care components, assuming five-year
implementation, starting with fiscal year 2017, and requiring the development of at
least 32 placements per year, subject to appropriation. DMH will also be required to
keep a waiting list of persons waiting for such placements.
Action: Favorable
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H1822, An Act Relative to Providing Appropriate Medical Care for Persons in Mental Health
Facilities
Sponsor: Representative Angelo Scaccia
Summary: Currently, patients under DMH care must undergo a physical examination
once every 12 months. This bill changes the language regarding the physical
examination to a comprehensive physical examination and requires the examination to
occur at the time of admission and within every 12 month period. It further requires that,
upon any physical examination and on a continuing basis, the physician will identify
people who need nursing services, chronic disease hospital care, or rehabilitation hospital
services. Each such person will be given an individual service plan within 30 days. DMH
must keep statistics on this population.
Action: Favorable
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H3459, An Act Providing for Efficient Access to Mental Health Services
Sponsors: Representative Marjorie Decker
Summary:
Requires health insurance coverage provided by certain groups for behavioral health
treatment to continue for an existing patient regardless of non-renewal of contracts
with providers, until such treatment is no longer medically necessary. The continued
coverage must be consistent with the terms of the coverage prior to the non-renewal.
Requires at least 180 days notice to providers of behavioral health treatment of any
decision not to renew a contract with the provider. In the event of non-renewal, the
insurer must show cause and demonstrate that any lawful communication concerning
regulations and statutes that impact service delivery was not a factor for nonrenewal.
Action: Study
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DPH to provide pharmacies with written materials to distribute to consumers regarding
risks of taking benzos. Also requires prescribers to obtain patients written informed
consent prior to prescribing a benzo. Further requires pharmacists ensure a cautionary
statement is on the label of a benzo prescription. Also prohibits the refilling of a written
prescription for benzos for less than a 10 day supply. Further requires written benzo
prescriptions to be written on brightly colored paper and include a cautionary statement.
Action: Study
S1026, An Act Requiring Victims to be Notified of Certain Hearings Concerning the Custodial
Status of Individuals Adjudged Not Guilty of a Crime by Reason of Mental Illness or After Being
Found Not Competent to Stand Trial
Sponsor: Senator Cynthia Stone Creem
Summary: Currently, when a person applies to a superior court to end medical treatment
or confinement of a court-deemed mentally-ill person (i.e. discharge that person), they
should provide the names of persons interested in his discharge. Victims, family
members, advocates, etc. may also be notified of the hearing and possible release. In the
case of individuals adjudged to be not guilty of a crime by reason of mental illness or
after being found not competent to stand trial, this bill changes the person to be notified
from the provided names to the district attorney for the district in which the person was
adjudicated. It also adds the district attorney, the victim, and the victims family members
to those to be notified of a hearing. Finally, it requires notification of victims by an
individual's commitment facility when the person is released, moved to a lower security
facility, or escapes from the facility.
Action: Study
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S1027, An Act to Require Health Care Coverage for the Emergency Psychiatric Services
Sponsor: Senator Kenneth Donnelly
Summary: Requires commercial insurers to pay for behavioral health services provided
by emergency service providers. Currently, only individuals on MassHealth are covered
by emergency service providers.
Action: Favorable
S1028, An Act to Provide More Timely Treatment of Inpatient Mental Health Care
(Accompanied by H1799, Sponsor: Representative Kay Khan)
Sponsor: Senator Kenneth Donnelly
Summary:
Requires DMH to promulgate regulations regarding evening and night coverage
for hospitals.
Expedites the timeline for independent medical examinations for civilly
committed individuals, commitment proceedings, Rogers orders (involuntary
antipsychotic medication treatment), and emergency orders for guardianship
hearings.
Requires Department of Children and Families and the Childs Advocates Office
to develop a facilitated process and time frame to administer antipsychotic
medications for youths in their custody who are hospitalized in inpatient facilities.
Action: Favorable as Changed
S1029, An Act to Improve Access to Child and Adolescent Mental Health Services
Sponsor: Senator Kenneth Donnelly
Summary: Adds licensed educational psychologist to the list of licensed mental health
professionals for insurance coverage. Currently, school districts are unable to use
insurance to cover services provided by licensed educational psychologists, and school
districts have to pay for these services.
Action: Favorable
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The hearing will commence within four days of filing the petition. If the court decides
that an individual does need critical community supports, they will order an
appropriate mental health professional to supervise the treatment plan.
The mental health professional will routinely submit reports to the court on treatment
progress and may file a petition with the court if the individual is not complying with
the treatment plan. If the court finds that an individual is not complying, the court can
amend the treatment plan as they deem necessary.
Action: Study
S1034, An Act Ensuring Parity for Mental Health and Substance Abuse Treatment
Sponsor: Senator Brian Joyce
Summary: Allows health care consumers to file lawsuits against insurance companies for
parity violations. If it is found that the company violated parity laws, the consumer may
recover damages, court costs, attorney fees and other equitable relief.
Action: Study
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S1037, An Act Relative to Updating the Definition of Cocaine
Sponsor: Senator Brian Joyce
Summary: Modifies the technical definition of cocaine.
Action: Study
S1040, An Act Creating Patient Choice and Education in the Dispensing of Opiate Drugs
Sponsor: Senator John Keenan
Summary: Allows individuals to partially fill Schedule II or III prescriptions at the
pharmacy. Pharmacists would be responsible for counseling individuals on this right.
This bill also ensures that insurance companies provide coverage for such partially filled
prescriptions, with a cost sharing schedule that allows for reductions in cost.
Action: Study; included, in part, in the STEP Act
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Requires pharmaceutical companies to create a Drug Stewardship Program, by
which they collect and dispose of unwanted medications, and lays out requirements
for these programs. Every three years, each program will be reviewed by the DPH.
Establishes procedures for DPH to enforce Drug Stewardship Program requirements
among manufacturers who do not comply, with procedures for the manufacturer to
appeal before any penalty is issued.
Makes clear that this bill does not require retail pharmacists to participate in the Drug
Stewardship Program.
Requires that DPH promulgate regulations to ensure that Drug Stewardship Programs
do not conflict with federally approved Risk Evaluation and Mitigation Strategies.
Action: Study; included, in part, in the STEP Act
S1045, An Act Preventing Prescription Drug Abuse by Closing the Pharmacy Shopping
Loophole
Sponsor: Senator Eric Lesser
Summary: Requires pharmacies to submit data to the PMP every 24 hours. Under current
law, they are only required to submit data once every week.
Action: Study; included, in part, in the FY 2016 Budget
S1046, An Act to Ensure Full and Equal Access to Services from the Department of Mental
Health for Individuals with Autism Spectrum Disorders and Related Conditions who Otherwise
Meet the Eligibility Criteria for DMH Services
Sponsor: Senator Eric Lesser
Summary:
Creates a definition for Autism Spectrum Disorder and certain related conditions to
be used within DHM.
Requires DMH to provide specialized emergency, crisis, acute care, and ongoing
treatment for people who both meet the eligibility criteria for DMH services and are
diagnosed with an Autism Spectrum Disorder or related conditions.
Instructs DMH and the Department of Developmental Services to work together to
determine which agency is responsible for delivery of service in such cases.
Action: Study
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S1050, An Act Relative to Restrictions on Persons Committed as Incompetent to Stand Trial or
Not Guilty by Reason of Mental Illness
Sponsor: Senator Michael Moore
Summary: Requires the superintendent of a DMH facility to obtain leave of court and
notify the district attorney before lifting restrictions placed upon a person committed after
being found incompetent to stand trial or not guilty by reason of mental illness.
Action: Study
S1051, An Act Relative to Creating a Pilot Program to Transfer High Acuity Behavioral Health
and Dual Diagnosis Patients Away from Overcrowded Emergency Departments
Sponsor: Senator Marc Pacheco
Summary: Creates a two year pilot program at Taunton State Hospital to accept high
acuity behavioral health and dual diagnosis patients in the Southeast region who have
been boarding in an ED. Also requires DMH to file a report evaluating the impact of the
program on ED overcrowding in the programs second year.
Action: Favorable
S1052, An Act Relative to the Civil Commitment for Alcoholism or Substance Abuse at Certain
Facilities
Sponsor: Senator Karen Spilka
Summary: Prohibits individuals from being civilly committed for rehabilitative purposes
to the correctional facilities at Bridgewater or Framingham or seeking voluntary
treatment at either facility. Further requires that all people being considered for
commitment under Section 35 be assessed using a standardized evaluation tool. Finally,
directs DMH and DPH to study and report on the budgetary needs to provide enough
secure treatment beds required under this bill.
Action: Study
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S1055, An Act Relative to the Classification of the Street Drug Molly
Sponsor: Senator James Timilty
Summary: Moves the drug known as Molly to Class B, which would increase the
severity of criminal charges for this drug.
Action: Study
S1502, An Act Providing Access to Full Spectrum Addiction Treatment Services (Accompanied
by H3264, An Act Relative to Rehabilitation Periods for Substance Abusers, Sponsor:
Representative Michael Brady; H3460, An Act Requiring Insurance Providers Cover a Minimum
of 30 days for In-patient Substance Abuse Treatment, Sponsor: Representative Thomas Golden)
Sponsor: Senator John Keenan
Summary: In 2014, Chapter 258 was enacted to ensure that certain insurance plans cover
up to 14 days of medically necessary acute treatment services and CSS without prior
authorization. This bill extends the required days covered to 28 days. It also expands
mandated coverage to include the transitional support services (TSS) level of care. Lastly,
it requires the Division of Insurance to conduct a network adequacy and patient access
review and report their finding to the legislature.
Action: Favorable as Changed
S2320, An Act to Establish the Center of Excellence in Community Policing and Behavioral
Health
Sponsor: Senator Jason Lewis
Summary: Establishes, under DMH and through a partnership with the Executive Office
of Public Safety (EOPSS), EOHHS, DPH, and the National Alliance on Mental Illness
(NAMI), a Center of Excellence in community policing and behavioral health. The
Center would serve as a centralized resource for cost-effective and evidence-based
mental health and substance use crisis response training for municipal police officers.
Action: Study
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INFORMATIONAL AND OVERSIGHT HEARINGS
The Joint Committee on Mental Health and Substance Abuse held seven (7) informational and
oversight hearings during the 2015-2016 Legislative Session to educate Committee members,
legislators, and members of the public about the challenges facing those struggling with mental
illness and substance use disorder in the Commonwealth. Of these, two were held jointly with
the Committee on Public Health and one was held jointly with the Committee on Elder Affairs.
The first hearing focused on mental health, the second on substance abuse, the third on geriatric
mental health, the fourth on updates from the administration on addressing the opioid crisis, the
fifth on innovative programming in the substance abuse field, the sixth on Hepatitis C, and the
seventh on efforts to reform Bridgewater State Hospital (BSH).
The Committee invited individuals from the administration, consumer groups, providers, and
advocates to testify. Both oral and written testimonies were permitted. A summary of the content
of each of these hearings is outlined below.
The Committee received testimony from the below speakers. Their comments are summarized
here:
Christie Hager, Emma Stanton, Lauren Falls, and Moira Muir, Beacon Health Options
Beacon Health Options (Beacon) and the Massachusetts Behavioral Health Partnership
(MBHP; owned by Beacon) are the behavioral health carve-outs for MassHealth, the Group
Insurance Commission, and several other Commonwealth health plans. They discussed a white
paper they have authored on the opioid issue, which discusses opioid use disorder as a chronic
condition and makes several recommendations to address the crisis, including mid-level
prescribers, expanded Narcan access, and more community-based treatment options. They also
provided an overview of Beacon and MBHPs services, including targeting potential high-risk
members.
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Mark Pearlmutter, Chief of Emergency Medicine at St. Elizabeths Hospital
Dr. Pearlmutter is a practicing Emergency Department (ED) physician. He stated that the ED is
the last hope for many people with mental health needs, as they see patients regardless of
insurance or ability to pay. Dr. Pearlmutter discussed ED boarding, the lack of parity in mental
health, and the need for specialty units for those with comorbid issues (e.g. aggressive behavior).
Dr. Pearlmutter also recommended the creation of a 24/7 hotline for behavioral health issues, the
elimination of behavioral health carve-outs, a uniform system across acute care hospitals to
evaluate patient needs, and other ways to address ED boarding and improve care.
Lisa Lambert provided information on PPAL, which works with 8,000 families each year. She
discussed ED boarding, the need for more acute care and outpatient services, and the rising use
of 51A reports (suspected abuse or neglect) with children being boarded in EDs, which may be
happening inappropriately. She said that many families are obtaining MassHealth as a secondary
insurer to access services due to limited private coverage, which shifts the cost to the state. She
also stated that schools need more training on how to address mental health issues in children.
Mary McGeown stated that childrens needs are different from those of adults. She emphasized
the need for prevention, access to an array of services for children, and more outpatient services.
Kate Ginnis focused on ED boarding and stated that funds spent on boarding these youth could
be used for other things. She said that children across insurance carriers have difficulty accessing
acute care services, leading to ED boarding.
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Stanley J. Eichner, Executive Director, Disability Law Center (DLC)
Mr. Eichner discussed the DLCs report on BSH, negotiations with the state on reforms, and
DLCs role in monitoring reform implementation. He stated that the use of restraints and solitary
confinement has decreased, but these numbers are not sustainable unless staffing is increased,
staff receive training, and the overall environment is improved. He recommended that these
patients be in a secure DMH facility and said that MA is one of two states that has the
Department of Correction (DOC) serve this population.
Timothy OLeary, Deputy Director, Massachusetts Association for Mental Health (MAMH)
Mr. OLeary gave an overview of MAMH, a nonprofit engaged in educational outreach and
advocacy focused on mental health and community based services. They also help individuals
with mental illness access services. Their legislative priorities are based on two principles:
people with mental illness do better when there is a strong mental health authority, and
behavioral health is part of general health and should be part of any health care system or health
policy. Accordingly, they support a strong DMH budget, rental assistance for DMH clients, and
integration of primary and behavioral health care. The importance of housing was stressed. He
also discussed the role of Medicaid and the need for telemedicine reimbursement.
Phillip Kassel, Executive Director, Mental Health Legal Advisors Committee (MHLAC)
Mr. Kassel gave a overview of MHLAC, an agency under the Supreme Judicial Court that
provides legal and policy advocacy for persons with mental health concerns. His testimony
focused on several policy priorities, with an emphasis on BSH. Mr. Kassel stated that MHLAC
was monitoring implementation of a Structural Agreement at BSH providing relief from abusive
practice but described this Agreement as a stop gap and emphasized the need for long-term
changes, including transferring BSH from DOC to DMH and funding for more clinicians. Mr.
Kassel also discussed ending incarceration of those committed under Section 35 at correctional
facilities, enforcement of patient rights, ensuring disability parity, decreasing student arrests for
non-violent conduct, and ending discrimination against parents with mental illness in courts.
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Lisa Baron, Program Director, Connecting With Care, Alliance for Inclusion and Prevention
(AIP)
Ms. Baron discussed her work at AIP, which is a nonprofit childrens mental health and special
education organization that provides services to urban youth with behavioral health challenges.
The work she discussed included integrating mental health clinicians into schools and helping
teachers use mental health-related language. She stated that AIP had received a grant through the
Attorney General, but that funding for their programming remained uncertain. She said they
were hoping to expand and were looking for help through the budget.
The Committee received testimony from the below speakers. Their comments are summarized
here:
Marylou Sudders, Secretary, Executive Office of Health and Human Services (EOHHS)
Secretary Sudders largely focused on the opioid crisis and the work of the Opioid Working
Group, which was charged with making tangible recommendations to address the opioid
epidemic to the Governor. She provided data on fatal overdoses and discussed the
administrations public health strategy, which involves prevention, intervention, treatment, and
recovery. She also highlighted three current EOHHS initiatives: resolving the civil commitment
of women at Framingham State Prison, MassHealth revising its pharmacy management policies
on opioids, and improving the Prescription Monitoring Program (PMP).
Michael Caljouw and Ken Duckworth, Blue Cross Blue Shield (BCBS)
Mr. Caljouw and Mr. Duckworth discussed the work BCBS is doing to prevent and treat
substance abuse among their members. To prevent substance abuse, they have a prescribing
program intended to decrease the number of opioids prescribed, which has resulted in a
significant reduction. They have behavioral health clinicians on-staff to ensure members get
needed treatment, have case managers for members in detox, and are looking to contract with
more behavioral health providers (especially licensed drug and alcohol counselors). They also
have an outpatient program called Bridge, which works with members who have received
inpatient care several times and attempts to find them community supports.
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Vic DiGravio, President and CEO, Association for Behavioral Healthcare
Mr. DiGravio largely discussed existing services and gaps in care. He stated that we need to stop
the bottle neck of services for substance abuse treatment, and that insurance reimbursement rates
need to be improved. He also stated that Suboxone coverage will be increasing. Further, Mr.
DiGravio described two federal initiatives, specialty health homes and certified Behavioral
Health Centers, which he believes could be another tool to address addiction.
Michael Melendez, Associate Bureau Director for Behavioral Health, Boston Public Health
Commission (BPHC)
Mr. Menendez provided an overview of the addiction-related services BPHC provides, which
can generally be split into two parts: clinical treatment services and non-clinical programming
(largely prevention). He also discussed some of the risk reduction programs offered by BPHC,
such as drug take back programs at police stations, needle exchanges, and overdose reversals
with Narcan. He stated that BPHCs programs are based on available research.
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of patient education, and said that the providers they work with have parents read information on
opioids and then have a conversation with patients about the prescription.
Laura Pellegrini, President and CEO, Massachusetts Association of Health Plans (MAHP)
Ms. Pellegrini stated that she has ensured that all member plans cover methadone for opioid use
disorder treatment. She also discussed MAHPs white paper on opioid use disorder. In the white
paper, MAHP states that, while MA has the full spectrum of care for substance use disorder,
access and availability depend on where the patient goes, service accreditation, and proper
referrals. MAHP recommends further integrating behavioral health care and primary care and
providing educational support on service availability and how to access services.
Barbara Herbert, Treatment Provider in the Comprehensive Addiction Program, St. Elizabeths
Medical Center
Dr. Herbert cautioned against inappropriately limiting opioid prescriptions to those who need the
medication. She stated that, due to variance in brain functioning across persons, some people
may need more opioids to address pain than others. She discussed stigma and gave an analogy
that, when people with diabetes get in accidents due this condition, they are treated differently
than those with addiction.
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for patients on how to store and dispose of opioids. They are also taking part in a task force on
opioids. He praised the overhaul of the PMP and suggested analyzing data in the PMP.
The Committee received testimony from the below speakers. Their comments are summarized
here:
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She also said that DPH had created an online list of drop boxes for old prescription medications,
and that DPH has provided 96 grants across the state for prevention. She also discussed opening
new detox and CSS beds to expand treatment access.
Chris Barry-Smith, First Assistant Attorney General, Office of the Attorney General
Mr. Barry-Smith discussed the roles of pharmaceutical companies, doctors, pharmacists, and
patients in addressing the opioid crisis. He stated that the Office of the Attorney General is
working on addressing unlawful prescribing, behavioral health parity, and breaking down
barriers to treatment access. He also stated that the state would be obtaining settlement funds
from the manufacturers of Narcan that week.
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Speakers included:
Marian Ryan, District Attorney, Middlesex County
Leonard Campanello, Police Chief, Gloucester Police Department
Susan Hillis, Treatment Director, AdCare Hospital
Deborah Ekstrom, President & CEO, Community Health Link
Ray Tamasi, CEO, Gosnold on Cape Cod
Liz Whynott, Needle Exchange Program Director, Tapestry Health
Meghan Hynes, Needle Exchange Program Manager, AIDS Action Committee
Daniel Mumbauer, President & CEO, High Point Treatment Center
Sam Wong, Director, Hudson Public & Community Health Services
Karen Jarvis-Vance, Director of Health Services, Health Education, and Safety,
Northampton Public School
The Committee received testimony from the below speakers. Their comments are summarized
here:
The Committee received testimony from the below speakers. Their comments are summarized
here:
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Panel: Executive Office of Public Safety and Security (EOPSS)
Speakers: Daniel Bennett, Secretary, EOPPSS, Thomas Turco, Commissioner, DOC, and
Carol Mici, Deputy Commissioner, DOC
EOPSS representatives discussed actions being taken to transition BSH into more of a mental
health facility, a process being done through collaboration between DOC and EOHHS (with
DMH in an advisory role). They discussed a two-step plan: first, separating state-sentenced
inmates from civilly convicted inmates, and, second, removing DOC correctional officers from
the hospital and replacing them with mental health professionals, with a higher clinical staff to
patient ratio. They released an RFR for a private vendor to operate these new psychiatric
services, and correctional officers would continue to cover the exterior of the facility. Other
planned changes included improvements in patient safety, having trained observers to provide
oversight, adding coverage on nights and weekends, and increasing services for patients.
Ms. Griffin stated that, in 2014, DLC conducted an investigation of BSH and found that there
were not enough staff, staff were untrained, the facility needed serious improvements, and the
culture was that of a correctional and not a mental health facility. They called for BSH to be
removed from DOC. Over the next 1.5 years, DLC continued to monitor the facility and noted
the same issues. She stated that, while the current leadership is the best they have seen in BSH,
she believes DMH needs a larger role, particularly in oversight of clinicians.
Mr. Pingeon has represented patients at BSH for 30 years. He stressed that BSH is not licensed
or accredited as a hospital, and that people with serious mental illness cannot recover in a prison
thats called a hospital. He praised the removal of correctional officers from within the facility,
as he stated that officers commonly mistreat patients and intimidate clinical staff from reporting.
However, he was critical of the current plan, as it would not turn BSH into a real hospital. He
said that BSH should comply with DMH licensing requirements, and that DMH should have
oversight and regular monitoring of the facility.
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Panel 2: Mental Health Advocates
Speakers: Lauri Martinelli, National Alliance on Mental Illness (NAMI), Phil Kassel,
Executive Director, Mental Health Legal Advisors Committee (MHLAC) and Danna Mauch,
President and CEO, Massachusetts Association for Mental Health (MAMH)
Ms. Martinelli stated that a formal advisory committee of government agencies and advocates for
BSH would be a good idea.
Mr. Kassel stated that the focus of his work has been preventing the segregation of those with
mental illness in facilities, and that this is a concern with BSH. He discussed the tension between
DOCs mission and the treatment needs of this population and said that, in this context,
punishment always trumps treatment. He stated that DOC uses solitary confinement
disproportionately on those with mental illnesses. He is disappointed that BSH will not be
transferred out of DOC and stressed that BSH must be under the control of a medical director.
Ms. Mauch expressed support for a robust clinical staff at BSH. She also urged for parallel and
urgent action to respond to the needs of people struggling with mental illness in the community,
which DMH could do if properly funded. She stated that, as long as there is a deficit in the civil
system, we will continue to direct people to the forensic system.
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