Senate leaders present package of bills to better prevent and treat mental illness
STATE HOUSE — The Rhode Island Senate unveiled a package of legislation intended to improve mental health in Rhode Island. President of the Senate M. Teresa Paiva Weed joined the Health and Human Services Committee and other members of the Senate at a news conference to present a report and recommendations prepared by the committee, as well as a package of 14 bills.
The legislation is aimed at improving mental illness prevention and early intervention, access to treatment, and the overall mental health care system. The legislation follows months of hearings by the Senate Health and Services Committee, chaired by Senator Joshua Miller.
“The Senate’s legislation takes important, proven steps to improve the health of our state,” said President Paiva Weed. “It is an investment in the mental health of Rhode Islanders, and it is an investment that will benefit individuals, our communities, and our economy. Prevention works. Treatment works. So we need to be sure that all Rhode Islanders can access preventative services and treatment.”
A study by The Lancet, cited in the committee’s report, shows that the most prevalent mental health disorders lead to large losses in work participation and productivity. Treatment of common mental disorders leads to significant improvements in economic production and health outcomes. Each dollar invested in treatment yields $3.30 to $5.70 in savings, according to the study.
“Mental health is an issue that demands our attention. It is also an issue for which there are proven, effective remedies,” said Chairman Miller.
He continued, “The goal of our hearings was to outline the constraints to improved mental health services in our state and to discuss solutions that would remedy each concern. The bills we will be submitting take a multi-pronged approach to address mental health from the earliest ages, through school and adulthood, including individuals who are homeless or incarcerated. They lay a solid foundation upon which to build a healthier Rhode Island.”
The bills address prevention and early intervention through programs such as voluntary home visiting for at-risk babies, services in schools, and after school programs. They improve access to treatment for mental health care by taking steps such as expediting insurance coverage, implementing post-emergency room discharge plans, and improved state investments in needed services. Finally, the bills make improvements to the state’s overall system of mental health care, working to reduce unreasonable prior authorizations and insurer non-compliance with Rhode Island’s mental health parity laws, better training options for law enforcement and correctional officers, and ensuring staffing is adequate at the offices of the Mental Health Advocate and the Child Advocate.
Also speaking at the event was A. Kathryn Power, regional administrator of the US Substance Abuse and Mental Health Services Administration, who provided a national perspective on the Rhode Island Senate’s proposals.
Director Power said, "With today’s set of recommendations, Rhode Island has clearly set its sight on the importance of coordinated behavioral health services, across a continuum of care, over the lifespan. Rhode Island has a unique history of compassion, wise use of evidence-based practices, and a willingness to change with the times. Of special note, these recommendations include: prevention, workforce development, criminal justice diversion, the reduction of homelessness, and strong compliance with the federal Mental Health Parity Law. At SAMHSA, we stand ready to assist you, as these are our priorities as well."
The 14 pieces of legislation are:
Prevention and Early Intervention
Children in Rhode Island face greater economic, social, and familial risks for developing mental health and substance use disorders than children in other New England states and the nation. Bills to address prevention include:
1. Substance Abuse & Suicide Prevention Education
This act would require the Department of Elementary and Secondary Education (RIDE), in consultation with the Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH), to consider incorporating evidenced-based substance abuse and suicide prevention education into their health education curriculum. 2017-S-0306 is sponsored by Sen. Adam J. Satchell.
2. Mental Health Services on College Campuses
This bill requires CCRI, RIC and URI to develop and implement policies to meet the mental health needs of students in a timely fashion, including identifying and addressing the needs of a student exhibiting suicidal tendencies or behaviors. 2017-S-0300 is sponsored by Sen. V. Susan Sosnowski.
3. Marijuana fines to fund youth prevention
This bill would direct 50% of the current fines collected as civil penalties for marijuana offenses to BHDDH for youth substance abuse prevention and treatment programs. Current law requires a portion of these funds go to youth programming, but that investment is not being met. 2017-S-0337 is sponsored by Sen. James A. Seveney.
4. Fund Preventative After-school Programs for Youth
This act would provide the Department of Health’s Health Equity Zones with funding for evidence-based after-school educational and recreational programs to decrease mental health problems in children and teens. 2017-S-0302 is sponsored by Sen. Elizabeth A. Crowley.
5. Home Visiting Program Expansion
This act requests that the Department of Health develop a plan to expand the reach of the existing evidence-based family home visiting programs in Rhode Island. The goal is to gradually expand upon this service to eventually offer voluntary access to all eligible at-risk families in the state, beginning with increased funding for pregnant and parenting teens in FY 2018. 2017-S-0324 is sponsored by President Paiva Weed.
Access to Treatment for Mental Health Care
Individuals in Rhode Island are more likely to report unmet need for behavioral healthcare services than adults in any other New England State. One in five Rhode Island Medicaid beneficiaries hospitalized for a mental illness had no follow-up mental health treatment 30 days after discharge. Rhode Island has fewer behavioral health and substance abuse counselors per capita than other New England states. The ACI houses approximately 500 inmates with severe mental illness. Bills to address access to treatment include:
6. Residential Treatment Insurance Coverage
This legislation seeks to ensure equal treatment for behavioral health inpatient and residential treatment as exists for persons with physical illness. Patients could be admitted in an emergency situation, and presumed eligible for continued inpatient or residential stays based on an appropriate assessment and treatment plan. Currently, behavioral health services may be subject to an authorization process that may interrupt needed care. 2017-S-0329 is sponsored by Chairman Miller.
7. Expanding the Use of Advanced Practice Nurses
As one means to address the shortage of psychiatrists, this act would allow licensed advanced practice registered nurses who are certified in psychiatric/mental health, to recommend mental health treatment in emergencies and for the purposes of civil court certifications. 2017-S-0326 is sponsored by Sen. Gayle L. Goldin.
8. Health Insurance Provider Approval to Treat Patients
This bill would improve the insurer approval process so that physicians can become eligible for insurance reimbursement and treat patients without the current lengthy delays. The bill standardizes “credentialing” application requirements and imposes a 45 day limit on the issuance of a decision. 2017-S-0145 is sponsored by Sen. Goldin.
9. Medicaid Waiver to Fund Overall Access and to aid Homeless Individuals
This act would direct and authorize EOHHS to apply for any necessary federal waivers to improve overall access to MH/BH services. In addition, waivers could ensure that individuals who are homeless have access to supportive housing services and mobile MH/BH services. 2017-S-0331 is sponsored by Sen. Jeanine Calkin.
10. Patient Planning to Ensure Adequate Care Post-Emergency Room Discharge
This bill will require the EOHHS to prepare standards for emergency room discharge planning to ensure that persons with a primary mental health diagnosis are referred to appropriate services to receive the community care needed. This will decrease re-admissions and further deterioration of health. 2017-S-0332 is sponsored by Chairman Miller.
Health Care System Improvement
Numerous barriers to care exist, including many patients’ and families’ feeling of shame and stigma, a shortage of mental health service professionals and community services, a lack of integrated physical and behavioral care, and the need to continuously train first-responders and educators to identify mental health crises. Bills to improve the mental health care system include:
11. Leadership Role of the Executive Office of Health and Human Services (EOHHS)
This resolution requests that EOHHS submit a report to address identified mental health service needs, including plans to: improve screening and treatment of depression; raise awareness of early childhood adversity; raise the entry level wages of behavioral health direct care workers; increase capacity of Crisis Stabilization Units; clarify regulations to facilitate provider referrals; streamline license reciprocity with other states to address the shortage of MH professionals; support housing initiatives and mobile outreach efforts; expand the Emergency Department opioid standards to other behavioral health patients; and expand the forensics unit at the Eleanor Slater Hospital to avoid inappropriate ACI use. 2017-S-0328 is sponsored by Sen. James C. Sheehan.
12. Importance of the state Mental Health Advocate and Child Advocate
This resolution requests that the Department of Administration conduct a comprehensive study of the staffing needs of the Offices of Child Advocate and the Mental Health Advocate to fulfill their respective missions to advocate for Rhode Islanders and for system improvements. 2017-S-0336 is sponsored by Sen. Erin Lynch Prata.
13. OHIC Findings and Recommendations on MH parity
This legislation requires OHIC to submit recommendations based on preliminary findings and observations from their market conduct examination to ensure insurance providers are complying with mental health parity provisions. These recommendations must include strategies to reduce unreasonable prior authorizations, and remediate areas of insurer non-compliance. OHIC will also propose guidelines that require payors to develop adequate telemedicine reimbursement rates and propose innovative cost sharing procedures to reduce co-payment barriers for MH/BH patients. 2017-S-0330 is sponsored by Sen. Cynthia A. Coyne.
14. Law Enforcement Training Funds
This would authorize the appropriation of $2,000,000 to the Rhode Island State Police Municipal Academy for law enforcement mental health training for correctional officers and an array of other public safety officers at the state and local level. 2017-S-0322 is sponsored by Sen. Louis P. DiPalma.
The committee’s report can be accessed on the General Assembly website, www.rilegislature.gov, under the “Reports” tab, or directly here: http://www.rilegislature.gov/Reports/FINAL%20MH%20Report%202017.pdf.
For more information, contact:
Greg Pare, Press Secretary for the Senate
State House Room 314
Providence, RI 02903