Senate Passes ENDURE Act to Provide Relief and to Small Businesses, Support for Workers, and Investments in Infrastructure

 Bill authorizes $455 million to provide relief to communities and stimulate economic development in an effort to combat devastating impacts of the COVID-19 pandemic

The Massachusetts State Senate passed a sweeping economic recovery and development bill on Wednesday that provides much-needed support to businesses, invests in infrastructure, and creates new jobs in the wake of the COVID-19 pandemic. 

An Act to encourage new development and usher in a recovering economy (ENDURE Act) includes provisions for small business competitive grant programs, housing production, local economic development projects, capital funding for vocational schools and community colleges, and investments in infrastructure. It also provides support for the tourism and cultural sectors and restaurant industry. Further, to promote equity and protect borrowers and workers across the Commonwealth, the ENDURE Act establishes a Future of Work Commission and creates a Student Loan Bill of Rights.

"The ENDURE Act will provide a much-needed boost to our economy as it recovers from the dire effects of COVID-19," stated Senate President Karen E. Spilka (D-Ashland). "In crafting this bill, the Senate recognized the need to be bold when addressing the challenges facing restaurant and small business owners, the clean energy sector, cultural attractions and other key sectors that keep our economy humming. I am particularly pleased this bill includes the long sought-after housing production reforms that the Senate has supported for years. I want to thank Senators Lesser, Rodrigues and my colleagues for their attention to this critical bill and for acting with urgency to move it forward in the legislative process."

"Since this crisis started, more than 1 million people have applied for unemployment assistance and our economy was put into a coma to stop the coronavirus," said Senator Eric P. Lesser (D-Longmeadow), Senate Chair of the Joint Committee on Economic Development and Emerging Technologies. "Half of low-income workers at our small businesses have lost their jobs and the challenges we have faced have been even more pronounced in our Gateway Cities and for our immigrant communities. This legislation gives us the opportunity to rebuild our economy from the bottom up and from the middle out. It provides relief for small businesses, restaurants, tourism and cultural organizations; supports workforce development, vocational education, and community colleges; and invests in community and housing development. This moment calls for bold solutions that chart a path for a brighter, more inclusive future that works to benefit the entire Commonwealth and the passage of the ENDURE Act marks one modest step toward that new future."

The legislation also includes new protections for entrepreneurs by enforcing a ban on making bad faith assertions of patent infringement, a practice known as 'patent trolling.' Such claims often entangle new small businesses in costly lawsuits that hamper the companies' productivity and sap their early seed-stage funds.

To invest in the Commonwealth's infrastructure and stimulate economic activity, the ENDURE Act authorizes bonding for the following:

• $15M for the site readiness program;
• $35M for a Massachusetts Growth Capital Corporation matching grant program to community development financial institutions for small business loans and grants;
• $5M for the Massachusetts Broadband Incentive Fund;
• $10M for the expansion of the Massachusetts Manufacturing Innovation Initiative (M2I2)
• $50M for the Technology Research and Development and Innovation Fund;
• $20M for rural community development and infrastructure grants;
• $20M for a Massachusetts Growth Capital Corporation small business grant program;
• $20M for financial and capital assistance grants to restaurants impacted by the 2019 novel coronavirus;
• $10M for grants to promote marketing and advertising for in-state cultural and tourist activities during the 2019 novel coronavirus reopening process;
• $40M for a program to redevelop blighted buildings;
• $10M for regional and community assistance planning grants;
• $28M for an Employment Social Enterprise Capital Grant Program;
• $50M for local economic development projects;
• $2M for an urban agriculture grant program;
• $20M for grants to support the reopening of cultural facilities impacted by the 2019 novel coronavirus;
• $25M for transit-oriented housing developments;
• $10M for climate-resilient affordable housing developments;
• $50M for the neighborhood stabilization program;
• $5M for Gateway Cities market rate housing pilot program;
• $15M for vocational technical school expansion grants; and
• $15M for community college high-demand workforce grants.

 "As we confront a dramatically different economic landscape due to the COVID-19 pandemic, the Senate's passage of the ENDURE Act will help bolster and shape our Commonwealth's ongoing economic recovery efforts and support our workforce as we adjust to the new normal," said Senator Michael J. Rodrigues (D – Westport), Chair of the Senate Committee on Ways and Means. "I applaud Senate President Spilka for her steadfast leadership, Senator Lesser for his close collaboration and my Senate colleagues for taking action to address and respond to the challenges individuals, small businesses, and our communities are facing during this time of great uncertainty."

"Our Massachusetts economy, that just a few months ago had strength and low unemployment, is now faced with the challenge of recovering from the devastation caused by the COVID-19 pandemic. This bill responds to this situation in such a way as to leverage our strengths, increase opportunities for many to gather a stronger economic footing, and invest tax dollars efficiently to yield positive results for every corner of the Commonwealth," said Senate Minority Leader Bruce Tarr (R - Gloucester).

The ENDURE Act creates a robust commission to look at the 'Future of Work' and examine ways to ensure sustainable jobs, fair benefits and workplace safety standards for all workers in all industries.

It also gives greater protections to student loan borrowers in disputes with companies servicing their loans, requiring servicers to apply for licenses from the state, which the Commissioner of Banks could revoke if the servicer is engaged in abusive practices such as overcharging students or steering them into costlier repayment plans to make higher profits. Student loan servicers that break state licensing requirements or take advantage of students could be fined and forced to repay student borrowers under the bill.

Further, the ENDURE Act:

• Addresses the critical need for housing by enabling municipalities through a simple majority to address building opportunities through zoning reform;
• Authorizes an additional 2800 megawatts of offshore wind development;
• Extends the state and local permits held by a real estate developer unable to proceed with the project due to COVID-19 disruptions for one year;
• Allows farmer brewers and farmer distillers to sell, and provide samples of, their alcoholic beverages at agricultural events and farmers markets;
• Extends protections for cranberry growers under c.61A out to 2023;
• Mandates equitable opportunities in state contracts by expanding an affirmative marketing program that elevates hiring firms owned by women and people of color;
• Reduces onerous and unnecessary regulations for hair braiders;
• Excludes forgiven PPP loans from Massachusetts taxable income for the purposes of personal income taxes; and
• Enables MassDevelopment to better deploy its resources and tools under the TDI program.

The final version of this bill will now be negotiated by the House and Senate before going to the governor's desk for his consideration.

Senate Passes ENDURE Act to Provide Relief

Live reporting: Budget Hearing #1

F. Hearings

FY 2018 Budget Hearing

status quo budget but doesn't address needs of growing community

schools also use $2.8M funds that are one-time so that will need to be address for the FY 2019 budget

police down 4 policemen

DPW still now up to where they had been

the EPA stormwater rules were appealed but that is hung up and will eventually need to be addressed

the Clerk will read the Town Council to vote numbers

if you want to hold, call it out, and they'll address those at the end

holds

HR salaries, Mercer

replacement working for less, also including part timer ro help cover

Technology expenses, Mercer

why 25% increase?

all the licensing fees increased (Google email, etc.), e-permiting, etc

increased fees to cover the increase in

was in capital program earlier, now in regular budget

.

Public Property Buildings, Dellorco

why no increases? actually an increase of 150,000

actually water and sewer was part of the increases, water for the town fields

Police expenses, Dellorco

do you have everything yo need?

we are 4 short and in anticipation of more residents, we do need more officers

how many on the midnight shift?

I'd rather not put that out there, it is down from where it was

Nutting, we'll need to come up with a game plan for how to address FY 2019

if we don't get some more revenue we are not even going to keep what we have for 19

Padula, part of that is luck to be a safe community, this isn't going to be something we'll address by talking

I can ask, but the real question is how are we going to pay for it

we did get overtime to help keep the shifts operational

Fire, Kelly

ambulances?

we would need to add about 12 to 16 FTE to staff a third ambulance

last year was the busiest call year, I'll beat that next week

when we are out of resources, we are luck to not get another call

part of what we are asking for it additional management support for the call volume

for 2-3 times per day, for 2-3 hours we are out of resources

the complexity of our world is changing things

who would ever think we had a meth lab in Franklin?

we are making headway on the assisted living facilities, some are holding, some are down

if you don't get me resources, then the only thing I can do is reduce the calls we get 

central dispatch contracts signed, construction will start soon and take about 14 months

Gary Premo is the executive (formerly with the Police Dept)

Plainville, Wrentham, Norfolk and Franklin are the four regional participants

when you call 911 on a cell phone you get State police, that should change when we get the regional center

Regional Dispatch, Padula

this is for training of the new regional center 

the inter-municipal agreement is based upon call volume

there are technical options for remote support

there are issues with safe havens

folks are working on the game plan for next years budget

Schools, Mercer

Town Council doesn't have control over the line items of the school budget

using reserve funds to help maintain programs, the end of these funds must be nearing

$2,8 M in revolving funds as one time use

refer to the budget presentation for the details

keeping the same level of service, no additional positions

we are using $6.3 million from recurring, $2.8 is one time funding

one of the big unknowns is special education, could you share some of those concerns

15% special ed enrollment, it is not about numbers but about the intensity of needs

79 are not kept in our schools, these are served elsewhere; $5M this year but 6+ next year; some funding is reimbursed from the State but it doesn't cover the expense

Federal funding is at risk and that would force decisions locally, i.e development of training of teachers among other items

there are Federal mandates and State mandates, but not funded

it is recognized that the Council needs to advocate for the funding of the mandates 

enrollment, what is the current projections

the high school is at about 1800, it was built for 1600

families are moving here for the high school

declining at the elementary, middle school growing, students coming back from Charter

apartments up by Garelick Farms, we'll be looking at their residential impact

students in the apartments are tending to be more high cost, i.e. 

did build some accounts in anticipation of these needs

(similar to the enterprise accounts - water, sewer)

redistricting can't be a knee jerk reaction, you need to see where the students are

even if is done well, no one is happy

the last one worked out well as we have not had to make changes to it

7 years later we are getting less funding from the State

we have worked hard to control our costs

the FEA has been an amazing partner, have been using interest based bargaining the last several years and it is a more sustainable contract with lower growth

Regional, Kelly

Councilor Jones will be refraining from voting on the regional high budget

Library, Kelly, Mercer, Dellorco

31 libraries needed a waiver this year, Franklin was one of them

if it opens in Sept/Oct it would only be funded for part of the year

we are funding at 85% and next year could be at 100% and not need a waiver

once open, there might be additional requests but they'll need to evaluate based upon the operations

11 currently

adding 3 part time, in wait and see move

Library expenses, Mercer

any of these expenses to be incorporated in the Library project?

no, these were for circulation items and operational costs

the Capital requests were not part of the Town Budget, part of the building project

Recreation, Jette

100% are self funded, but we need the start up funding and it is recovered in the fees

Safe Schools Package = unfunded mandates

Senator Spilka Votes in Favor of Safe Schools Package

BOSTON - 03/11/10 - Senator Spilka voted on Thursday to advance a pair of bills aimed at promoting a safe, healthy and productive learning environment for all students through banning bullying and updating nutritional standards in schools.

Senate anti-bullying legislation prohibits physical, verbal and written acts that threaten or cause harm to another student, including Internet "cyber-bullying," while a separate school nutrition bill establishes new standards for fresh food options in school cafeterias and vending machines.

"Both of these bills will help create a secure, healthy and beneficial school environment," stated Senator Karen Spilka.  "Kids need to know that the adults in their lives will back them up when they participate in positive behaviors, like healthy eating, and won't tolerate deplorable behaviors, like bullying.  These bills go a long way towards setting new and important standards for a productive learning setting.

"These two bills working together will make a dramatic difference in our school environment," Senate President Therese Murray (D-Plymouth) said. "We all know there's a strong connection between health and safety and learning. By striking out fear and improving nutrition, we're going to provide students with a more valuable and rewarding educational experience."

The anti-bullying bill requires all school districts, charter schools and non-public schools to develop prevention and intervention plans by December 31, 2010 that include procedures for investigating bullying incidents, notifying parents and determining appropriate disciplinary actions.

"The anti-bullying legislation passed today provides a framework for schools to adequately address the damaging impacts of bullying in all its forms," said Senator Robert O'Leary (D-Barnstable), Senate chairman of the Joint Committee on Education. "Equipping teachers, students and parents with more information and education on bullying and outlined steps on how to handle it provides a community solution to a community problem."

Senator Jamie Eldridge (D-Acton) said: "This is comprehensive, prevention-oriented legislation that will work to end the persistent cycle of bullying we've seen in the Commonwealth's schools for years,

leading to tragedies like those in South Hadley, Springfield and too many other communities. Every student deserves to feel safe in their own schools, and this bill is a strong step in that direction."

The bill requires school principals to notify local law enforcement of bullying incidents if there is reason to believe criminal charges may be pursued. It also allows Individualized Education Programs for children with special needs to include provisions that will help them handle and respond to incidents of bullying. The bullying ban extends to all school facilities, school-sponsored functions, school buses and bus stops.

The Senate also passed a bill establishing new nutritional standards in schools to address the problem of childhood obesity in the Commonwealth. Food and beverages in school cafeterias, vending machines and other locations in public schools separate from federal meal programs must be

in compliance.

"The fact that the current generation of children may have a shorter life expectancy than their parents is simply unacceptable," said Senator Susan Fargo (D-Lincoln), lead sponsor of the bill. "Families demand and deserve that their children be offered food that is healthy, wholesome and safe. The School Nutrition Bill makes certain that parents have the final word on what children eat at school and makes it a requirement that schools maintain healthy standards in the cafeterias."

The standards, to be implemented by the 2012-13 school year, will be developed by the Department of Public Health and the Department of Elementary and Secondary Education and include requirements for the availability of free drinking water, fresh fruits and vegetables, and nutritional information for non-packaged foods. The use of deep fryers is banned.

The regulations do not apply to bake sales, concession stands and other school-sponsored events.

The nutrition bill also requires issues of nutrition and exercise to be included in the educational curriculum, and it establishes a commission to make recommendations related the management of childhood obesity, type 2 diabetes and eating disorders.

"I applaud the Senate for taking an important step in combating what has become a childhood obesity epidemic in the Commonwealth, and across our nation," said Sen. Richard T. Moore (D-Uxbridge), Senate chairman of the Joint Committee on Health Care Financing. "By limiting the availability

of unhealthy foods and promoting the infusion of locally grown fresh fruits and vegetables, we're not only curbing bad habits among our children, but improving the general, healthy outlook of wellness in

Massachusetts."

As a way to further promote wholesome food options and locally grown products, the bill encourages statewide adoption of the successful "Farm-to-School" program, which creates contracts between local farms and public schools to provide fresh fruits, vegetables and ingredients.

The bill also adds state colleges and universities to the requirement that state agencies or authorities give preferential treatment to local farms when purchasing agricultural products.

Finally, capitalizing on the fresh food trend, the bill requires the study of Boston's "Chefs in Schools" program, which teaches schools to create healthy, cost-effective meals that kids like to eat, to see how it could be effectively implemented in other school districts.

The bill now goes back to the House of Representatives for further action.

I would prefer to see more of a focus on how to cook and prepare good meals. Jamie Oliver's talk and the actions he proposed I think would be a better longer term solution than "unfunded mandates."

Why?
The State is addressing a major issue (societal obesity) via a mechanism it can control (school lunches) that doesn't get to the heart of the matter (the family dinner table).

MA Senate Passes Mental Health ABC Act: Addressing Barriers to Care

Today (2/13/20), the Massachusetts Senate unanimously passed the Mental Health ABC Act, comprehensive legislation aimed at reforming the mental health care system in Massachusetts. Senate Bill 2519, An Act Addressing Barriers to Care for Mental Health, serves as the first step toward developing a more integrated system of mental health care delivery to better meet the needs of individuals and families.

Massachusetts residents have historically experienced difficulty accessing mental health services due to health inequities and persistent barriers to care—leaving many without the treatment they need and deserve. According to a 2018 report by the Blue Cross Blue Shield Foundation of Massachusetts, over half of a representative sample of fully insured adults who sought mental health care services reported difficulty finding services.

The Mental Health ABC Act seeks to increase access by removing barriers to timely quality care, providing the state with more effective tools to enforce existing mental health parity laws, and investing in the mental and behavioral health workforce pipeline. The legislation builds on progress made through state mental health parity laws passed in 2000 and 2008, and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 at the federal level.

”The response to this bill has been overwhelming, and reinforces our assertion that mental health care needs to be for everyone in Massachusetts,” stated Senate President Karen E. Spilka (D-Ashland). “I would like to thank everyone involved in this effort, especially Senator Julian Cyr, Senator Cindy Friedman, and Senator Michael Rodrigues—as well as the countless advocates, activists and residents who have fought for better access to quality mental health care. We still have a ways to go to end the stigma and achieve true parity, but if any state can do it, I know that Massachusetts can. I’m excited to see us move forward.”

“The Mental Health ABC Act will expand access to mental health care for everyone that needs and deserves it,” said Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “The cost of action on this issue is far less than the cost of inaction, both financially and for the wellbeing of all residents of the Commonwealth. I applaud Senate President Spilka for her consistent leadership on this, and Senators Cyr and Friedman for their diligent work and collaboration in putting forward a bill to reform our mental health care delivery system.”

“Too many people in Massachusetts struggle to access the mental health services they desperately need and deserve,” said Senator Julian Cyr (D-Truro), co-chair of the Joint Committee on Mental Health, Substance Use and Recovery. “The reasons are many and complicated: mental health care is treated differently than physical health, it is often not covered by insurance, it is difficult to access, and it is hard to talk about. By passing this bill, the Massachusetts Senate is living up to our promise to begin to transform how the Commonwealth addresses mental health. I am grateful to Senate President Karen Spilka for her leadership and example, and to Senators Rodrigues and Friedman for their partnership in this endeavor.”

“For far too long, mental health has been a forgotten component of our health care system, resulting in a broken system that has continually left patients without the critical care they need,” said Senator Cindy F. Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing. “This bill lays an important foundation for creating a system that is accessible and equitable, and provides the state with better tools to ensure that someone with a mental health condition has the same access to care as someone with physical health needs. I want to sincerely thank Senate President Spilka for recognizing the urgency of this issue and committing to a bold step forward with the passage of this bill. I also want to thank Senator Cyr, Senator Rodrigues and all of the advocates involved in crafting this bill for their thoughtful collaboration and shared commitment to reforming our mental health care system so that it works for everyone.”

“The Senate has taken decisive steps to put us on a path to reform, revive and redouble our efforts in taking an increasingly fragmented system and helping it to connect people experiencing a mental health condition with a health care system of credentialed professionals that functions effectively to provide timely care,” said Senator Bruce E. Tarr (R- Gloucester), Senate Minority Leader.

“Senate President Spilka, Health Care Financing Committee Chair Friedman, Mental Health, Substance Use and Recovery Committee Chair Cyr, and Ways and Means Chair Rodrigues are to be commended for mental healthcare reform legislation that prominently prioritizes improved access to effective care,” said Danna Mauch, President and CEO, Massachusetts Association for Mental Health (MAMH). “MAMH applauds the Senate’s actions today. Senate Bill 2519 – An Act to Address Barriers to Care for Mental Health is a significant step forward to implement the promise of parity and frame fairer terms for insurance coverage, benefits administration, provider reimbursement and plan reporting.”

“The Mental Health ABC Act acknowledges the realities that parents of children with behavioral health needs face every day in ensuring their child's safety and wellbeing,” said Mary McGeown, Executive Director, MSPCC, on behalf of the Children's Mental Health Campaign. “The Act takes steps to uncomplicate access to care by allowing both physical and behavioral health treatment to be provided in the same day, and by creating a path to that clinical decisions are made by clinicians rather than insurance companies.”

“The Mental Health ABC Act is a comprehensive bill that will have a tremendous positive impact on Massachusetts families,” said Lydia Conley, CEO, Association for Behavioral Healthcare (ABH). “This bill will help ABH member organizations better serve their communities by lifting barriers to accessing care, expanding coverage of critical behavioral health services, and providing new tools to attract the clinical workforce needed to deliver high-quality care.”

“An Act Addressing Barriers to Care for Mental Health is an incredibly progressive and forward-thinking piece of legislation that will benefit social workers working in mental and behavioral health and the clients and communities served by social workers across the Commonwealth,” said Rebekah Gewirtz, Executive Director of the National Association of Social Workers, MA Chapter. “As the crisis of mental health access has escalated both nationally and here in Massachusetts, we applaud the Senate’s proactive and comprehensive approach that will help us to finally achieve mental health parity in our state”.

“The Massachusetts Medical Society appreciates the efforts of the Senate, and applauds Senate President Karen Spilka, Senator Julian Cyr, Senator Cindy Friedman and Senator Michael Rodrigues for putting forth legislation that reforms mental health care in the Commonwealth, strengthening existing mental health parity laws and ensuring that our patients will have access to quality, comprehensive mental health care,” said Dr. David A. Rosman, Mass. Medical Society President Elect.

“This bill is a tremendous step forward in the ongoing effort to enable the residents of Massachusetts gain access to the appropriate mental health care they need and deserve, said Gary Chinman, Immediate Past President, Massachusetts Psychiatric Society. “Senate President Spilka, Senator Friedman, Senator Cyr, and Senator Rodrigues deserve our gratitude and admiration for the insight, compassion and respect with which they crafted this historic legislation.”

“Massachusetts hospitals have long sought parity in coverage between behavioral health and medical/surgical care,” said Steve Walsh, President & CEO, Massachusetts Health & Hospital Association (MHA). “I applaud the Senate for their leadership on an issue so critical and personal to our patients and their families. This legislation is an important step forward in ensuring that every Massachusetts resident has access to the mental health services they need and deserve.”

“Blue Cross strongly supports the Senate’s landmark mental health legislation,” said Michael Caljouw, Vice President of Government, and Regulatory Affairs for Blue Cross Blue Shield of Massachusetts. “We believe mental health is as central to our members’ needs as their physical health, so it’s critically important to us that they be able to find comprehensive, effective, and affordable care when they need it. This bill is another important step toward that goal. We pledge to continue to work together across the state to help improve access and ensure that our members get the high-quality care they need.”

“We applaud the Senate and, in particular Senate President Karen Spilka, for today’s action to pass this important legislation and for her unmatched commitment and leadership in seeking to end the stigma associated with mental health treatment,” said Lora Pellegrini, President and CEO of the Massachusetts Association of Health Plans (MAHP). “This bill will help to ensure that all individuals get the care they need. We also applaud Senate leadership, including Senator Cindy Friedman, Chair of the Joint Committee on Health Care Financing, Senator Julian Cyr, Chair of the Joint Committee on Mental Health, Substance Use, and Recovery, and Senator Michael Rodrigues, Chair of the Senate Ways and Means Committee for their work in developing this comprehensive legislation.”

The Mental Health ABC Act is driven by the recognition that mental health is just as important as physical health for every resident of the Commonwealth—and reflects the Senate’s overall goal of improving access to mental health care for all. The Senate has prioritized efforts in the 2019–2020 legislative session to improve the delivery of mental health services in the Commonwealth in the following ways: appropriating record funding levels for mental health services in the FY20 budget; creating and funding a $10 million Behavioral Health Outreach, Access and Support Trust Fund; ensuring that health insurer’s provider network directories are accurate and up-to-date by eliminating so-called ‘ghost networks’; and protecting clinicians from unreasonable retroactive claims denials, or ‘clawbacks’ of payments for services, from insurance providers.

Despite these achievements, there is a lot more to do. The Mental Health ABC Act builds on the Senate’s efforts to improve the Commonwealth’s mental health care system by addressing issues related to mental health parity, workforce needs, and access to care.

More on the bill:

The Mental Health ABC Act provides the state with better tools to implement and enforce mental health parity laws, which require that insurance coverage for mental health benefits be equal to and no more restrictive than coverage for physical health benefits. Mental health parity has been codified in federal and state law for decades, but enforcement of the law has been challenging. As a result, inequities persist and patients are often denied coverage for mental health treatment that is just as critical to managing their health as treatment for

conditions such as diabetes or heart disease. As such, this legislation includes quicker evaluation and resolution of parity complaints, greater reporting and oversight of insurance carriers’ processes and policies related to mental health care coverage, and penalties and alternative remedies for when an insurance company does not comply with the law.

Every day throughout the Commonwealth, adults and children arrive in emergency departments in the throes of acute mental health crises requiring immediate treatment in an appropriate setting. Due to complex and restrictive medical necessity and prior authorization review processes imposed by insurance companies, many patients experience barriers, and delays, in treatment – creating a dysfunctional system that allows insurance companies to have more leverage in determining a patient’s course of treatment than health care providers. As such, the bill mandates coverage and eliminates prior authorization for mental health acute treatment for adults and children experiencing acute mental health crises, effectively placing treatment decisions in the hands of the treating clinician in consultation with the patient rather than an insurance company.

In an effort to address the mental health workforce crisis that often limits patient access to care, the bill creates a pilot program through the Department of Higher Education aimed at creating a workforce pipeline to encourage and support individuals from diverse backgrounds to work toward careers in mental health. In addition, the bill creates an interim licensure program for Licensed Mental Health Counselors so that they can be reimbursed by insurance for their services and be eligible for state and federal grant and loan forgiveness programs, increasing the number of licensed providers able to serve patients.

The bill also calls for an academic study conducted by the Office of Health Equity to review the availability of culturally competent mental health care providers within networks of both public and private health care payers, as well as to identify potential barriers to care for underserved cultural, ethnic and linguistic populations and the LGBTQ community. The bill further directs an interagency health equity team under the Office of Health Equity to improve access to, and the quality of, culturally competent mental health services.

The bill creates a Psychiatric Mental Health Nurse Practitioner Fellowship Pilot Program in community health centers to offer additional support and training to psychiatric nurse practitioners who agree to work in community settings with underserved populations. The program will be designed to encourage these professionals to continue working in a community setting where mental health providers are sorely needed.

Currently, mental health and primary care providers are reimbursed at different rates for the same service. The bill seeks to level the playing field for reimbursement to mental health providers by requiring an equitable rate floor for evaluation and management services that is consistent with primary care.

The Mental Health ABC Act takes meaningful steps to improve access to care by prohibiting insurers from denying coverage for mental health services and primary care services solely because they were delivered on the same day in the same facility. This will remove a significant financial barrier to the integration of primary care and mental health.

Additionally, the bill requires emergency departments to have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times, and to refer them to appropriate treatment or inpatient admission.

This bill authorizes the DPH, the Department of Mental Health (DMH), and the Department of Elementary and Secondary Education (DESE) to collaborate on authorizing three pilots for tele-behavioral health services in public high schools in the Commonwealth. This pilot is based on an existing and successful model between a hospital and several school districts in western Massachusetts.

Finally, the bill directs the DMH to consider factors that may present barriers to care—such as travel distance and access to transportation—when contracting for services in geographically isolated and rural communities.

Through debate today in the Senate, the following are some of the sections added by amendment to the bill:

• A pediatric mental health care task force.
• Inclusion of veterans and aging adult populations for considerations in the cultural competency study.
• An amendment to study the further screening of adverse childhood experiences (ACEs).
• A comprehensive behavioral workforce commission.
• An expedited admission protocol for children under 22 who present in an emergency department with mental health needs.
• An examination of ways to ease communications, within the context of privacy laws, between health care providers.

The Mental Health ABC Act now moves to the House of Representatives for consideration.

Recap: Strong Towns event fostering discussion across rather than within a vertical and reframing a question to get at the issue

Quick Recap:

• Multi-level discussion around how to create sustainable communities. Lots of participation from area communities as well as a good representation of State legislators
• This is a time with the infrastructure bill to help correct some of the imbalance in the liabilities local communities face. Parallel noted to what was done with infrastructure spending coming out of the World War II period to help the economy shift gears from war production to goods production.
• To fix a problem it maybe important to reframe the question to address the broader issue. An example of this is around congestion. If we consider that "Congestion is a demand to be in a place", then congestion is a good thing, so let's create alternatives to get there. Let's not always use auto transportation as the first approach. Parking is heavily subsidized. Consider walking and biking as more than 'exercise'.
• A good start to enabling the conversation we need to have. Consider going across rather than always staying in a vertical approach. Need to be aware of issues with being able to utilize the grants and programs coming. The timeline and resource requirements for such may not be enough to utilize them all due to other economic constraints (i.e. supply chain issues).

-------

As with most meetings in this pandemic period, I took my notes via Twitter while I participated in the event at THE BLACK BOX. 
 
The Twitter hashtag #st1115 can be found online The thread begins with https://twitter.com/FranklinMatters/status/1460255606804201475

 

Photos from the event can be found in one album:  https://photos.app.goo.gl/T8ZRubvQKEE6Ab5x6

• Strong Towns event getting underway here at @BLACK_BOXonline with Town Councilor Cobi Frongillo, State Rep Jeff Roy, Congressman Auchincloss and Charles Marohn from Strong Towns #st1115
  
• Little note of interest in that in Cobi's prep for running for the open spot last year he found Strong Towns in the bio of Congressman Auchincloss. #st1115
  
• Both Cobi and Rep Roy remark on the collaboration among the three levels of government as key to getting things done and particularly here in Franklin #st1115
  
• Congressman Auchincloss participating remotely as he needed to be in WDC for the signing of the infrastructure bill later today #st1115  part of the wonders of tech to make this happen with Franklin TV live streaming the event
  
• Charles Marohn talks of the choices to build infrastructure in the post WWII era as a way to avoid going back into the depression of the 30's. The parallel is there to what can be done today #st1115
  
• We have responsibilities to address the liabilities created at the local level. The macro economy needs to serve the needs of the local leaders. What does it look like? Pipes in the ground; walking, exercise opportunity  #st1115
• This is a moment where we can connect the macro level to the local leadership #st1115
  
• Question: how do we address messaging around what Newton saw where single family housing was proposed to restricted? #st1115 foster a mixed neighborhood and intergenerational existence
  
• Lets look at how we can allow folks to remain in their house and to gain additional income to do what they need, i.e. fix their roof #st1115
  
• Question: on how to address infrastructure and schooling costs when faced with new development? #st1115 we have lost capacity to address needs at an intermediate step or approach, need to find a way to neighborhood level growth
  
• Question: on unfunded mandates, how do we break that cycle? #st1115  infrastructure bill trying to square up with this funding to cover local liabilities. "subject to appropriation" language added to bills to ensure funding
• Auchincloss advocates looking to find more of education at a national level, special Ed is probably the largest MA local requirement #st1115  a more broad approach could create more equality in the delivery
  
• Question: what do you do to include public engagement? #st1115 four step plan mentioned (will add link to more on this later) a humble approach to address issues, cities are a co-creation, not something someone else does
  
• Question: from Attleboro resident, how do deal with nodes of congestion; #st1115 how do we connect the rest of the Town to the downtown? "Congestion is a demand to be in a place" or congestion is good, let's create alternatives to get there
  
• "No neighborhood should have radical change, nor should any neighborhood be exempt from change" #st1115
  
• Question: Rehoboth no public water, a right to farm community, no master plan and rapid growth residentially #st1115 not a sustainable process, protection of farms to avoid turnover, (master plan?)
  
• Question: from a MassBike advocate on transportation, how do we move away from an 'alternative' and 3 years out from disabilities act; #st1115 reliability of public transportation we need to make it dependable and resilient
  
• To the extent that we subsidize parking is an issue, until we change that we won't make progress; biking and walking is not just exercise, needs to be a policy shift #st1115
  
• Question on the grant requirements and capacity of being able to get things done and recognize that it will take time to do, across state and local levels; thought to make it easier to build things? #st1115
  
• Let's look to more coordination across the local levels rather than at a grant single focus level. It is a burden #st1115 Brookline Q - can't ink development with MBTA and developers bifurcation between state and local levels
  
• Q - how do we deal with an unnamed online retailer who has brought in distribution, warehouses, etc. #st1115 how do we communicate the quality of life associated with it? Need to have the local discussion
  
• Q - what about the sustainability of transit? The train station is permanently subsidized, it is not likely sustainable, only bus transportation comes close to sustainable for a node like ours. What about the regional context? Franklin got to be what it is due to problems created in other Boston neighborhoods  that got folks to move out here
• Thanks around from Rep Roy, etc. #st1115
  

More about Strong Towns can be found online -> https://www.strongtowns.org/
 

Cobi Frongillo talked about the Strong Towns four step approach in his interview preparing for the local election in Nov 2021:

A lot of people around me might hear me talk about a group called Strong Towns. I like a lot of what they say, but I particularly like their four-step approach to community leadership. The first step is to humbly observe where people struggle in your community. Second step is figure out the next small thing you can do to fix that struggle. Third is do that thing, do it right away. And the fourth is repeat that process. I do think that that's the strongest approach to public policy.

The full interview audio (and edited text) can be found ->   https://www.franklinmatters.org/2021/09/fm-611-town-council-candidate-cobi.html

 

Audio recording of meeting to be available in couple of days

 

Town Councilor Cobi Frongillo, State Rep Jeff Roy, and Charles Marohn from Strong Towns; Congressman Auchincloss attended remotely

Senate Unveils Mental Health ABC Act: Addressing Barriers to Care

Senate Unveils Mental Health ABC Act: 

Addressing Barriers to Care

Bill will expand access to mental health care, boost workforce, and strengthen quality of coverage

Today (02/05/2020), the Massachusetts Senate unveiled An Act Addressing Barriers to Care for Mental Health, a comprehensive mental health care reform bill. This legislation is the first step toward putting the Commonwealth on a pathway to developing a more integrated system of mental health care delivery to better meet the needs of patients. The Mental Health ABC Act removes barriers to timely quality care, provides the state with more effective tools to enforce existing mental health parity laws, and invests in the mental and behavioral health workforce pipeline.

The legislation builds on progress made through state mental health parity laws passed in 2000 and 2008, and the 'Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008' at the federal level.

"In Massachusetts, we believe that mental health care is for everyone," stated Senate President Karen E. Spilka (D-Ashland). "There is no area of our economic, civic and personal lives that is not touched by the need for mental and behavioral health and wellness, and the whole Commonwealth will be adversely affected if we do not take concrete steps to ensure that quality mental health care is available to all of our residents, and eventually integrated into our health care system as a seamless continuum of care. My father struggled with mental illness, and our whole family was affected. This legislation is a major step forward towards helping every resident touched by the need for quality mental health care in some way."

"Simply put, too many people in Massachusetts struggle to access the mental health services they desperately need and deserve," said Senator Julian Cyr (D-Truro), co-chair of the Joint Committee on Mental Health, Substance Use and Recovery. "The reasons are many and complicated: mental health care is treated differently than physical health, it is often not covered by insurance, it is difficult to access, and it is hard to talk about. With this bill, the Massachusetts Senate is living up to our promise to begin to transform how the Commonwealth addresses mental health. I am grateful to Senate President Karen Spilka for her leadership and example, and to Senators Rodrigues and Friedman for their partnership in this endeavor."

"For far too long, mental health has been a forgotten component of our healthcare system despite our statutory parity mandate that calls for equitable coverage between medical and surgical treatment and mental health treatment," said Senator Cindy F. Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing. "This bill serves as a first step forward in addressing the persisting inequities in our delivery of mental health services that keep patients from accessing the care they need, and will provide a framework for the state to better enforce our mental health parity laws. I want to thank Senate President Spilka, Chair Rodrigues, and Senator Cyr for their thoughtful collaboration on this initiative and shared commitment to reforming our mental health care system so it is accessible, affordable, and equitable for all."

"This bill builds off of the Senate's work this session to comprehensively address barriers to mental health care and improve access to care," said Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. "I applaud Senate President Spilka for her long-standing leadership on the issue of mental health parity and Senators Cyr and Friedman for their diligent work to reform the state's mental health care delivery system to ensure it works for everyone."

Currently, access to mental health care in Massachusetts is inadequate by nearly any measure. Patients who need to access these services are often unable to find a provider who takes their insurance and face significant wait times before they receive care. A 2019 report by the Blue Cross Blue Shield Foundation of Massachusetts found that 54.6% of a representative sample of fully-insured adults who sought mental health care services reported difficulty finding services.

The Senate's Mental Health ABC Act: Addressing Barriers to Care (ABC) is comprehensive legislation to begin to reform mental health care in Massachusetts. This legislation is the first step towards putting the Commonwealth on a pathway to developing a more integrated system of mental health care delivery so Massachusetts residents can access the care they need and deserve. The Mental Health ABC Act removes barriers to timely quality care, provides the state with more effective tools to enforce existing mental health parity laws, and invests in the mental and behavioral health workforce pipeline.

This legislation is driven by the recognition that mental health is as important as physical health for every resident of the Commonwealth, and should be treated as such. The Senate has prioritized efforts in the 2019–2020 legislative session to improve the delivery of mental health services in the Commonwealth in the following ways: appropriating record funding levels for mental health services in the FY20 budget; creating and funding a $10 million Behavioral Health Outreach, Access and Support Trust Fund; ensuring that health insurer's provider network directories are accurate and up-to-date by eliminating so-called 'ghost networks'; and protecting clinicians from unreasonable retroactive claims denials, or 'clawbacks' of payments for services, from insurance providers.

Despite these achievements, there is a lot more to do. The Mental Health ABC Act builds on the Senate's work towards reforming mental health care so it functions better for everyone by addressing issues related to mental health parity, workforce needs, and access to care.

Included in the bill:

PARITY AND INSURANCE REFORMS

Enforcing Mental Health Parity Laws. Mental health parity as a concept is simple: insurance coverage for mental health care should be equal to insurance coverage for any other medical condition. This concept has been codified in federal and state law for decades, but enforcement of the law has been challenging. As a result, inequities persist and patients are often denied coverage for mental health treatment that is every bit as critical to managing their health as treatment for conditions such as diabetes or heart disease. This bill provides the state with better tools to implement and enforce our parity laws, including quicker evaluation and resolution of parity complaints, greater reporting and oversight of insurance carriers' processes and policies related to mental health care coverage, and reasonable penalties and alternative remedies for when an insurance company does not comply with the law.

Reforming Medical Necessity and Prior Authorization Requirements. Every day throughout the Commonwealth, adults and children arrive in emergency departments in the throes of acute mental health crises requiring immediate treatment in an appropriate setting. These clinical determinations should be made by the treating clinician, but in practice insurance carriers impose too many restrictions on providers' clinical judgement in terms of prior approval and concurrent review requirements for mental health services.

This results in barriers to, and delays in, treatment for patients who need immediate care, creating a dysfunctional system that allows insurance companies to have more leverage in determining a patient's course of treatment than health care providers.

This bill mandates coverage and eliminates prior authorization for mental health acute treatment for adults and children experiencing acute mental health crises, effectively placing treatment decisions in the hands of the treating clinician in consultation with the patient rather than an insurance company.

This bill also establishes a special commission to bring all stakeholders to the table to study and make recommendations on the creation of a common set of medical necessity criteria to be used by health care providers and insurance carriers for mental health services.

Reimbursing Mental Health Providers Equitably. Mental health and primary care providers are reimbursed at different rates for the same service. The bill seeks to level the playing field for reimbursement to mental health providers by requiring an equitable rate floor for evaluation and management services that is consistent with primary care.

Reviewing the Role of Behavioral Health Managers. Most insurance companies have subcontracted mental health benefits to specialty utilization management companies for years with mixed results. The bill directs the Health Policy Commission, in consultation with the Division of Insurance, to study and provide updated data on the use of contracted mental health benefit managers by insurance carriers, often referred to as "carve-outs."

WORKFORCE

Studying Access to Cultural Competent Care. The bill calls for an academic study conducted by the Office of Health Equity to review the availability of culturally competent mental health care providers within networks of both public and private health care payers, as well as to identify potential barriers to care for underserved cultural, ethnic and linguistic populations and the LGBTQ community. The bill further directs an interagency health equity team under the Office of Health Equity to improve access to, and the quality of, culturally competent mental health services.

Standardizing Credentialing Forms. The bill requires all insurance carriers to use one standard credentialing form for health care providers. It also requires a quicker turnaround time for approval of a completed credentialing request. This will be enormously beneficially to patients, providers, and health systems, as it will speed up the time it takes for new hires to be approved for inclusion in an insurance network.

Moving Licensing Boards under DPH. The bill moves the licensing boards for social workers, psychologists, and allied mental health professionals from the Division of Professional Licensure, where they currently operate alongside other licensing boards, including landscape architects, plumbers, and accountants, to the Department of Public Health (DPH). This will leverage DPH's health care experience and expertise to streamline the licensing process for these critically important health care professionals.

Allowing Interim Licensure for Licensed Mental Health Counselors (LMHC). The bill creates an interim licensure program for LMHCs so that they can be reimbursed by insurance for their services and be eligible for state and federal grant and loan forgiveness programs, increasing the number of licensed providers able to serve patients.

Creating a Psychiatric Mental Health Nurse Practitioner Fellowship Pilot Program. The bill authorizes a Psychiatric Mental Health Nurse Practitioner Fellowship Pilot Program in community health centers to offer additional support and training to psychiatric nurse practitioners who agree to work in community settings with underserved populations. The program will be designed to encourage these professionals to continue working in a community setting where mental health providers are sorely needed.

Creating a Mental Health Workforce Pipeline. The bill authorizes a pilot program through the Department of Higher Education, in consultation with the Department of Mental Health, aimed at creating a workforce pipeline to encourage and support individuals from diverse backgrounds to work towards careers in mental health. With this initiative we hope to send a message to young people that this is valued and important work.

ACCESS TO CARE

Requiring Coverage for Same Day Care. This bill makes critical changes around how providers are allowed to bill for services. Specifically, the bill prohibits insurers from denying coverage for mental health services and primary care services solely because they were delivered on the same day in the same facility. This will remove a significant financial barrier to the integration of primary care and mental health.

Ensuring Capacity in Emergency Departments. The bill requires emergency departments to have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times, and to refer them to appropriate treatment or inpatient admission. The bill directs the Department of Public Health to issue regulations for an expedited process for individuals under 22 years old.

Requiring Coverage for Psychiatric Emergency Service Programs. The bill requires commercial insurance carriers to cover community-based services for individuals experiencing a psychiatric emergency. Currently, these services are only paid for by MassHealth.

Tracking and Analyzing Mental and Behavioral Health Expenditures. The bill directs the Center for Health Information and Analysis (CHIA) to define and collect data on the delivery of mental health services to establish a baseline of current spending, and further directs the Health Policy Commission (HPC) to begin tracking mental health care expenditures as part of its annual cost trends hearings. This is a fundamental, critical first step to future efforts to incentivize greater investments in mental health care within the analysis of statewide health care cost growth.

Creating a Tele-behavioral Health Pilot Program. This bill authorizes the Department of Public Health, the Department of Mental Health, and the Department of Elementary and Secondary Education to collaborate on authorizing three pilots for tele-behavioral health services in public high schools in the Commonwealth. This pilot is based on an existing and successful model between a hospital and several school districts in western Massachusetts.

Increasing Access to Care in Geographically Isolated Areas. The bill directs the Department of Mental Health to consider factors that may present barriers to care – such as travel distance and access to transportation – when contracting for services in geographically isolated and rural communities.

The Senate is scheduled to debate the Mental Health ABC Act next week.

Download a copy of this press release
https://drive.google.com/file/d/0B0wjbnXDBhczVUktNHVaSWg2QVBJcjhHQ0s3aXdvRzVFR2s4/view?usp=sharing

Download a copy of the ABC Fact Sheet
https://drive.google.com/file/d/0B0wjbnXDBhczUVlrdEFNemhBYVBxVVZYMnBjNXJIX2Zfai1F/view?usp=sharing

Link to the Senate Legislation proposal  https://malegislature.gov/Bills/191/S2519

Senate Unveils Mental Health ABC Act: Addressing Barriers to Care