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Joint Committee on

Mental Health and Substance Abuse

2015-2016 Biennial Session Report

COMMITTEE CHAIRS

LIZ MALIA JENNIFER L. FLANAGAN

HOUSE CHAIR SENATE CHAIR


Governor Charlie Baker signs legislation expanding education, prevention, and treatment
programming for opioid use disorder in the Commonwealth.
THE COMMONWEALTH OF MASSACHUSETTS
JOINT COMMITTEE ON MENTAL HEALTH AND SUBSTANCE ABUSE
2015-2016

The Joint Committee on Mental Health and Substance Abuse


It shall be the duty of the Committee on Mental Health and Substance Abuse to consider all matters
concerning behavioral health, drug detoxification, homeless mentally ill, Mental Health Department
oversight, mental illness, mentally ill services and such other matters as may be referred.

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.

LIZ MALIA JENNIFER L. FLANAGAN


House Chair Senate Chair
TABLE OF CONTENTS

Legislative Highlights.. 1
Legislative Accomplishments Before the Committee (including The STEP Act)
Budgetary Accomplishments
Other Legislative Accomplishments

Bills Referred and Heard... . 5

Informational and Oversight Hearings . 23


Mental Health
Substance Abuse
Geriatric Mental Health
Update from the Administration: Substance Abuse
Innovative Programming: Substance Abuse
Hepatitis C and Harm Reduction
Bridgewater State Hospital
LEGISLATIVE HIGHLIGHTS
Legislative Accomplishments Before the Committee
Several bills considered by the Joint Committee on Mental Health and Substance Abuse were
signed into law by Governor Charlie Baker during the 2015-2016 Legislative Session. Listed
below are several highlights. For a more complete summary, please contact Committee staff.

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:

1. FY 2016 Budget Accomplishments:


Municipal Naloxone Bulk Purchase Trust, Sections 48 and 192
o Creates a Municipal Naloxone Bulk Purchase Trust Fund to enable communities
to purchase naloxone a life-saving tool that reverses opioid overdose for first
responders in bulk and provides DPH the authorization to promulgate regulations
or guidelines. In FY 2016, municipalities purchased 11,050 doses of naloxone and
saved approximately $186,000 through the bulk purchasing program.

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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.

2. FY 2017 Budget Accomplishments:


Massachusetts Child Psychiatry Access Project (MCPAP), Chapter 160 of the Acts of
2016 (similar to An Act Regarding Proportional Payments of the Massachusetts Child
Psychiatry Access Project)
o Codifies language relating to MCPAP, which allows for commercial insurance
companies to be charged for the cost of serving their members. For over a decade,
MCPAP teams have provided behavioral health consultation to primary care
providers who are treating children and adolescents, with a recent expansion to
mothers struggling with postpartum depression. In FY 2015, similar language
resulted in approximately $1.8 million in revenue from commercial insurers,
representing over 50% of the consultations provided by MCPAP.
Medication-Assisted Treatment Pilot Program, Section 178
o Directs the Health Policy Commission to establish a 2-year pilot program to test a
model of medication-assisted treatment initiated in Emergency Departments
(EDs). This provision supplements the STEP Act, which requires individuals who
present to the ED following an overdose to have a substance abuse evaluation.
Medication-Assisted Treatment and Psychotropic Medication Use at Specialty Courts,
Section 183
o Requires the trial courts to develop a statewide policy regarding medication-
assisted treatment and psychotropic drugs for specialty courts and prohibits judges
from requiring abstinence to utilize the programs. This change ensures greater
access to specialty courts and prohibits exclusion on the basis of evidenced-based
medications.

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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.

Other Legislative Accomplishments


Several other critical reforms affecting individuals struggling with substance use disorder were
enacted by the Commonwealth. A summary of these bills can be found below:

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

H1786, An Act to Ensure Behavioral Health Integration


Sponsor: Representative Mark Cusack
Summary:
Requires the Health Planning Council to map behavioral health services, formalizes
the role of the Health Policy Commission (HPC) in monitoring the integration of
behavioral health services, and adds the integration of behavioral health services to
the requirements of HPCs patient-centered medical homes model.
Requires certain public and private insurance providers to provide coverage for
pediatric behavioral health screening.
Requires that certain health insurance carriers assist in conducting searches for
inpatient mental health or substance use disorder placement. In the event that a patient
is boarded in an Emergency Department (ED) for more than 24 hours, requires the
carrier to cover out of network services if none are available in network. Establishes
reimbursement for providers at twice and thrice the contracted rate if a patient is
boarded 24 hours and 48 hours after the decision to admit, respectively.

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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

H1788, An Act Establishing a Behavioral Health Workforce Development Trust Fund


Sponsor: Representative Josh Cutler
Summary: Establishes the Massachusetts Behavioral Health Workforce Development
Trust Fund, which would be spent on a competitive grant system for clinical supervision
of behavioral health providers and mental health professional development opportunities.
Action: Favorable

H1789, An Act Relative to Substance Abuse Accountable Care Organizations


Sponsor: Representative Diana DiZoglio
Summary:
Creates a substance use disorder accountable care organization (ACO) under the
HPC. The goal of the substance use disorder ACO includes creating recovery
programs for the purpose of improving access to mental health services.
Requires HPC to identify unmet mental health and substance abuse community needs
and develop a plan to address such needs through the ACO. The unmet community
needs include waiting lists for services, length of hospital stays, and difficulties with
inpatient admission. The comprehensive plan must include prevention measures,
client assessment, case coordination, and crisis and emergency services.
Makes the substance use disorder ACO responsible for managing high-risk prescribed
medications used within sober homes and requires HPC to establish rules and
regulations on high-risk prescribed medications within the sober home.
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

H1791, An Act Relative to Regulating Oxycodone


Sponsor: Representative Robert Fennell
Summary: Changes the controlled substance classification of substances containing
oxycodone, moving them from Class B to Class A. This would increase criminal
penalties for those found to be illegally manufacturing, distributing, dispensing, or
possessing with intent to manufacture, distribute, or dispense oxycodone.
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

H1794, An Act Related to Transport Under Section 12(a)


Sponsor: Representative Kay Khan
Summary: Currently, if a certain clinical provider believes, after examining an individual,
he or she creates a likelihood of serious harm, the provider may determine hospitalization
is necessary and apply to have the individual hospitalized for three days. If an
examination is not possible because of the emergency nature and because the persons
refusal to consent to such examination, the provider may still determine hospitalization is
necessary and apply for hospitalization. This bill permits the provider to apply to have an
individual hospitalized if an examination is not possible because of the emergency nature
of the case or because of the refusal of the person to consent to such examination.
Action: Study

H1795, An Act to Further Define Medical Necessity Determinations (Accompanied by S1044,


Sponsor: Senator Thomas Kennedy)
Sponsor: Representative Kay Khan

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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

H1798, An Act Relative to Juvenile Mental Health


Sponsor: Representative Kay Khan
Summary: Requires DMH to pilot the program explained below in Springfield Juvenile
Court and issue a report on its successes or failures.
Directs DMH, in collaboration with the Department of Youth Services (DYS) and
DPH, to conduct a review of mental health and substance abuse needs of adolescents
in care of a juvenile court. The review shall examine alternatives to detention for
providing mental health and substance abuse services to juveniles, unmet needs of
juveniles in the justice system, and recommendations for addressing those needs.
Defines diagnostic assessment in court cases involving juveniles with mental health
or substance abuse problems.
o Assessments will have the aim of determining if there is any alternative to
detention that would allow the juvenile to remain in the community during
court proceedings.
o Such assessments must be held in the least restrictive setting and may not
revoked on the basis that the juvenile fails to meet assessment requirements.
They can be revoked only if the court finds there is a substantial risk that the
juvenile is dangerous or would not appear for hearings.
o Outlines procedures and protections for the assessment process, which include
time frame and information given to the defense counsel.
o Requires the generation of a report, which must include recommendations on
what services the juvenile will require to stay in the community during
proceedings. The court may also use this report to determine if there is a
reasonable alternative to detention after proceedings are complete. If such a
finding is made, pursuant to funding, an intervention plan will be created to
help the juvenile receive the needed services.
Requires DMH to provide mental health and substance abuse services to juveniles
undergoing or awaiting assessment. DMH is instructed to contact eligible providers to
ensure there are services available to meet such needs. DMH will be required to file a
report containing the extent to which actions taken have failed to comply with
requirements, unmet mental health and substance abuse needs, demonstration of the

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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

H1800, An Act to Improving Access to Emergency Treatment Plans


Sponsor: Representative Kay Khan
Summary: This bill primarily pertains to the Probate and Family Court and its treatment
plans for minors and/or individuals deemed incapacitated. This bill establishes a system
for overseeing treatment of incapacitated persons. Specifically, this bill:
Ensures that a treatment plan be issued and a treatment monitor assigned within 14
days after an initial petition is filed to substitute judgment in consent for antipsychotic
medication.
Requires a treatment monitor to issue a report within 30 days after appointment. The
report would include the mental, physical, and social condition of the incapacitated
person, a statement by the provider regarding treatment delivery and compliance,
recommendations for monitoring, and plans for future care.
If the monitor determines the incapacitated person or provider is not complying with
the treatment plan, the monitor shall petition a hearing to the court. Following the
petition, the individual will be provided counsel and scheduled a hearing. If the court
finds that the incapacitated person or provider have not complied with the treatment
plan, the treatment monitor would provide recommendations to the court.
Allows the superintendent of a facility or medical director of Bridgewater State
Hospital (BSH) to petition the court to monitor a patient after an order of commitment
and allows appointment of a treatment monitor and plan.
Action: Study

H1801, An Act to Increase Access to Mental Health Services


Sponsor: Representative Kay Khan
Summary: Allows psychiatric nurse mental health clinical specialists to write
prescriptions, order and interpret tests, and order therapeutic treatments.
Action: Study

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

H1803, An Act to Combat the Opioid Addiction Epidemic


Sponsor: Representative James Lyons

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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

H1804, An Act to Protect Childrens Mental Health Services


Sponsor: Representative Liz Malia
Summary: Creates, subject to appropriation or receipt of federal funds, a statewide
Childrens Mental Health Ombudsman Program (CMHOP) under the Child Advocate.
CMHOP would advocate on behalf of children with behavioral health disorders
identifying barriers to effective treatment and proposing solutions, monitoring
compliance with relevant policies, and resolving complaints regarding activities or
omissions that may have an adverse effect on the child.
Each month, the ombudsman would send a report to each government agency about
complaints received during the past month, meet regularly with the Child Advocate,
Secretary of the Executive Office of Health and Human Services (EOHHS), Director
of the Office of Medicaid, Commissioner of Mental Health, and the Secretary of the
Department of Education, and report on any system-wide problems and potential
solutions. The Child Advocate would report annually to the Governor, the House, and
the Senate on the activities of the CMHOP.
Action: Favorable

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

H1807, An Act Relative to Health Policy Commission Oversight of Insurer Transactions


Sponsor: Representative Liz Malia
Summary: Currently, HPC requires that every provider or provider organization submit
notice to the commission, the Attorney General, and the Center for Health Information
and Analysis (CHIA) if it is making any material change to its operations or governance
structure, not fewer than 60 days prior. This bill requires carriers or behavioral health
managers to meet the same requirements and includes mergers or acquisitions within the
definition of material changes.
Action: Favorable

H1808, An Act Relative to Behavioral Health Access


Sponsor: Representative Liz Malia
Summary: Requires that the Secretary of EOHHS monitor access to behavioral health
services for MassHealth members for two years. Also requires EOHHS to file a report
semiannually, reporting benchmarks, complaints, and grievances.
Action: Favorable

H1809, An Act Relative to Medication Assisted Treatment for Opioid Addiction


Sponsor: Representative Liz Malia
Summary: Requires MassHealth to cover all FDA-approved drugs for the treatment of
opioid dependence and establish billing codes and payments for methadone clinics.
Action: Favorable; included, in part, in the FY 2016 Budget

H1810, An Act Relative to Behavioral Health Telemedicine


Sponsor: Representative Liz Malia
Summary: Requires MassHealth and certain other insurers to provide coverage for
telemedicine behavioral health services where office visits are not within a reasonable
distance, due to, for example, geography or linguistic or cultural capacities.
Action: Favorable

H1811, An Act Relative to Addictions Training


Sponsors: Representative Liz Malia and Representative Denise Garlick
Summary: Creates an Addiction Residency Training grant under DPH to provide one-
year medical education for two physician trainees during their residency. Graduates of
the program will be eligible for loan-forgiveness if they practice in designated
underserved areas of the Commonwealth.
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

H1813, An Act Relative to Department of Mental Health Citizen Boards


Sponsor: Representative James ODay
Summary: Creates a Mental Health Citizen Board for the Worcester Recovery Center and
Hospital and lays out certain requirements for the make-up and functioning of the Board.
Action: Study; included, in part, in the FY 2015 Supplementary Budget

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

H1819, An Act to Require Equitable Payment from the Commonwealth


Sponsor: Representative Angelo Scaccia
Summary: Ensures that network hospitals are compensated at their full negotiated rate for
all behavioral health services they provide to MassHealth patients who are clients of
agencies within the EOHHS, provided that the hospital can document that it engaged in
good faith efforts to place clients in a suitable alternative setting.
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

H1823, An Act Creating a Special Commission on Applied Behavior Analysis


Sponsor: Representative John Scibak
Summary: Creates a special commission to investigate and make recommendations on
laws and regulations regarding the right to effective treatment and behavioral treatment in
public agencies and private agencies receiving public funding or subsidies from the
Commonwealth. The investigation would include the format and content of behavioral
plans and procedures on implementing and reviewing behavior plans.
Action: Favorable

H1824, An Act Relative to the Administration of Naloxone


Sponsor: Representative Timothy Whelan
Summary: Allows doctors who administer naloxone for an opiate-related overdose to
involuntarily hold a patient for up to three hours, if it is medically necessary.
Action: Study

H3265, An Act Relative to Psychotropic Drugs


Sponsor: Representative Shaunna OConnell
Summary: Addresses the use of psychoactive medication (defined as any medication used
for managing behavior, sleep disorders, stabilizing mood, or treating psychiatric
disorders) on patients in certain facilities for the delivery of health services.
Requires that, prior to administering or increasing the dosage of a psychoactive
medication, facilities must obtain written consent from the patient or their legal
representative. The facility would not be required to obtain written consent if there is
an imminent and serious risk of harm to the patient or others and either time or
distance precludes obtaining written consent. In such a circumstance, the facility must
still obtain oral consent, which would last for two days, and then written consent must
be obtained. If the patient is incapacitated and the facility has been unable to make
contact with the legal representative, despite a good faith effort, the facility would be
allowed to administer the drug for two days before written consent is required. All
such written consent would be invalid after three months.
Directs DPH to make forms for such written consent available on its website.
Action: Study

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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

H3461, An Act Relative to Improving Mental Health Care Through Innovation


Sponsor: Representative Paul McMurty
Summary: Requires DMH to establish a program and standards for research, technology,
design, and development of technologies for improved treatment of support for people
with mental illnesses and brain-based disorders.
Action: Favorable

H3811, An Act Regulating Oxycontin Prescriptions for Minors


Sponsor: Representative Diana DiZoglio
Summary: Prohibits providers from prescribing OxyContin to minors.
Action: Study

H3898, Resolve Establishing a Special Commission on Behavioral Health Promotion and


Upstream Prevention
Sponsor: Representative James Cantwell
Summary: Creates a special commission/task force to investigate evidence-based
practices, programs, and systems to prevent behavioral health disorders and promote
access.
Action: Favorable as Redrafted; included, in part, in the FY 2017 Budget

H3926, An Act Relative to Substance Use, Treatment, Education and Prevention


Sponsor: Governor Charles Baker
Summary: Takes numerous steps to educate the public on substance use disorder,
prevent, screen for, and minimize the improper use of opioids and other illicit substances
particularly among youth, and ensure access to treatment. For a more comprehensive
summary, please see the Legislative Highlights section.
Action: Favorable as Redrafted; signed into law

H4062, An Act Relative to Benzodiazepines and Non-Benzodiazepine Hypnotics


Sponsor: Representative Paul McMurty
Summary: Requires DPH to promulgate regulations establishing protocols for individuals
who are stopping or reducing the use of benzodiazepines and non-benzodiazepine
hypnotics (benzos) to minimize patients symptoms of withdrawal. Further requires

15
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

H4356, An Act Relative to Classification of Certain Controlled Substances


Sponsors: Representative Timothy Whelan and Representative Paul Tucker
Summary: Modifies the technical definition of cocaine.
Action: Study

S284, An Act Relative to Preventing Adolescent Substance Abuse by Expanding SBIRT


(Accompanied by H1796, Sponsor: Representative Kay Khan)
Sponsor: Senator Jennifer Flanagan
Summary: Includes a substance abuse screening in physical examinations for students in
all public schools and in private schools in which the parent/guardian makes such a
request. The screenings would be conducted at least once per year in grades 8 or 9 and
11. The bill requires results to be reported to DPH, without identifying information.
Action: Favorable; included, in part, in the STEP Act

S1025, An Act Regarding the Department of Mental Healths Citizen Boards


Sponsor: Senator Harriette Chandler
Summary: Creates a Mental Health Citizen Board for the Worcester Recovery Center and
Hospital and lays out certain requirements for the make-up and functioning of the Board.
Action: Study; included, in part, in the FY 2015 Supplementary Budget

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

S1030, An Act to Provide Critical Community Health Services


Sponsor: Senator Kenneth Donnelly
Summary: Creates a new process to involuntarily commit an individual to mental health
services. Along with a petition for mental health services, a petitioner could also file a
petition for critical community health services.
DMH, any adult who lives with the individual, certain family members,
superintendent of any public or private facility or mental health hospital, or the
director of BSH would be able to file a petition with the courts to section an
individual who meets the following criteria:
o Mentally ill
o Over the age of 18 years old
o Gravely disabled - the individual has a condition which is a result of a mental
disorder that puts them at substantial risk of inflicting serious harm to himself or
others and has shown an inability to provide for basic physical needs
o Has a history of lack of compliance with treatment for mental illness

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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

S1031, An Act Relative to Improved Medication Adherence


Sponsor: Senator Jennifer Flanagan
Summary: Allows pharmacists in conjunction with a supervising physician to administer
injectable medications that were prescribed by said physician.
Action: Favorable; included, in part, in the FY 2016 Supplemental Budget

S1032, An Act Banning the Prescription of Opioids in the Commonwealth


Sponsor: Senator Robert Hedlund
Summary: Bans pharmacies from issuing prescriptions for any opioids.
Action: Study

S1033, Resolve Establishing a Commission to Investigate State License Addiction Treatment


Centers
Sponsor: Senator Robert Hedlund
Summary: Creates a special commission to investigate and study state licensed addiction
treatment centers. The commission will gather information from treatment providers
regarding their programing effectiveness and will submit their report to the legislature.
Action: Study; included, in part, in the STEP Act

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

S1035, An Act Relative to the Drug Salvinorin


Sponsor: Senator Brian Joyce
Summary: Adds three substances to the list of Class C drugs.
Action: Study

S1036, An Act Relative to the Definition of Methylenedioxy Methamphetamine


Sponsor: Senator Brian Joyce
Summary: Offers a technical change to the definition of how to prepare four substances
to make them Class B drugs.
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

S1038, An Act Relative to Updating the Drug Class A Schedule


Sponsor: Senator Brian Joyce
Summary: Adds three substances to the list of Class A drugs.
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

S1041, An Act Relative to High Volume and High Risk Prescriptions


Sponsor: Senator John Keenan
Summary:
Directs DPH to create regulations that would create a prescribing specialty for
providers prescribing extended-release long-acting opioid drugs. Only prescribers
with this specialty designation would be allowed to prescribe such drugs.
Prohibits pharmacists from filling prescriptions from prescribers whose specialty
designation could not be verified.
Prohibits EDs from prescribing extended-release long-acting opioid drugs.
Limits all opioid prescriptions to a 15-day supply. If a prescriber intends to write a
prescription that would exceed a 30-day supply within a 60-day window, they would
need to evaluate the patients risk factors for substance abuse and current
medications, determine that other pain management treatments are inadequate, utilize
the Prescription Monitoring Program (PMP), and enter into a pain management
treatment agreement with the patient. Prescribers would also need to check the
patients PMP record before each prescription of a high risk prescription. Lastly,
prescribers would to need to document the patients high risk prescriptions for the
patients medical file.
Directs DPH to conduct a bi-annual audit of high risk prescriptions to ensure that
prescribers are using the PMP as required when prescribing high risk drugs.
Violations would be reported to the corresponding licensure boards.
Action: Study

S1042, An Act Relative to Responsible Stewardship by Drug Manufacturers


Sponsor: Senator John Keenan
Summary:

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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

S1047, An Act to Increase Access to Mental Health Services


Sponsor: Senator Joan Lovely
Summary: Allows psychiatric nurse mental health clinical specialists to write
prescriptions, order and interpret tests, and order therapeutic treatments.
Action: Study

S1049, An Act Regulating Synthetic Heroin


Sponsor: Senator Michael Moore
Summary: Makes two different types of synthetic heroin, Acetyl Fentanyl and
Alphaprodine, Class B controlled substances.
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

S1053, An Act to Criminalize the Attempted Production of Class B Drugs


Sponsor: Senator Bruce Tarr
Summary: Expands the definition of intent to manufacture Class B drugs to include
possession of the constituent ingredients of a Class B drug with the intent to manufacture.
Possession alone cannot be used as proof or presumption of intent to manufacture.
Action: Study

S1054, An Act Protecting Minors from the Harmful Effects of Marihuana


Sponsor: Senator Bruce Tarr
Summary: Raises the age at which possession of 1 ounce or less of marijuana is subject to
a fine of $100 and forfeiture of the drug from 18 to 21. Persons under 21 may be arrested
and receive a fine of not more than $100 for a first offense and $150 for any subsequent
offenses and 90-day suspension of their driving license. Any person under 21 who is not
offered pretrial diversion and without a prior drug conviction will be offered probation.
Upon successful completion of probation the case will be dismissed and the records
sealed. Also eliminates the drug awareness class currently required for minors found in
possession of 1 ounce or less of marijuana.
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

S2458, An Act Relative to the Ellen Story Commission on Postpartum Depression


Sponsor: Senator Joan Lovely
Summary: Names the legislative commission on postpartum depression, established in
chapter 313 of the acts of 2010, the Ellen Story Commission on Postpartum
Depression.
Action: Favorable; signed into law

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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.

Mental Health May 28, 2015


The Committee held an informational hearing on mental health issues on May 28, 2015 at 1pm
in Hearing Room B-1 in the State House. Speakers provided an overview of their respective
agencies and organizations and highlighted several policy issues, including boarding of
psychiatric patients in Emergency Departments, the lack of parity between physical and
behavioral health services, the need for care integration, and essential reforms at BSH.

The Committee received testimony from the below speakers. Their comments are summarized
here:

Joan Mikula, Commissioner, Department of Mental Health (DMH)


Commissioner Mikula emphasized the importance of integrating physical and mental health care,
giving examples of model DMH programs. She provided statistics on how most mental illness
manifests in childhood and is associated with significantly lower life expectancy. She
emphasized the importance of parity in insurance coverage for physical and behavioral health
conditions and expressed concern that we do not have true parity. She suggested strong
enforcement of parity laws. Commissioner Mikula further provided an overview of DMH
programming, which includes case management, clubhouses, clinic and emergency services,
inpatient beds, and forensic evaluation. She highlighted programs with goals of ending
homelessness, jail diversion, suicide prevention, and early intervention for psychosis.

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.

David J. Matteodo, Executive Director, Massachusetts Association of Behavioral Health


Systems (MABHS) and Greg Brownstein, CEO of Westwood Lodge Hospital
David Matteodo provided an overview of MABHS, which represents 44 inpatient behavioral
health facilities in MA, the majority of such providers in the state. MABHS members have 2,400
acute care beds and admit over 60,000 patients annually. Mr. Matteodo discussed MABHSs
policy priorities, which include the need for regular and adequate rate adjustments from
MassHealth, maintenance of benefits and timely access to services to improve patient flow from
EDs to inpatient units to community services, and monitoring of new payment models from all
sectors to ensure the inclusion of behavioral health services.

Panel: Childrens Mental Health Campaign (CMHC)


Speakers: Kate Ginnis, Childrens Hospital Boston, Mary McGeown, President and CEO,
Massachusetts Society for Prevention of Cruelty to Children, Lisa Lambert, Executive
Director, Parent/Professional Advocacy League (PPAL)
A written submission from Courtney Chelo, Manager of the CMHC, laid out the Campaigns
broad priorities, which are ensuring access to services, prevention and early intervention, child
welfare, court-involved youth, and assessment and evaluation. Specific concerns include ED
boarding, substance abuse screening and treatment for adolescents, infant and early childhood
mental health, implementation of recommendations from the Child Welfare League of America
report regarding youth in state custody, and expanding data collection for behavioral health 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.

Jane Martin, President, National Alliance on Mental Illness (NAMI) of Massachusetts,


Cambridge Chapter
Ms. Martin provided an overview of NAMI, a national grassroots mental health organization
dedicated to building better lives for the millions of Americans affected by mental illness. She
discussed NAMI MAs policy priorities, which include adequate funding for DMH, jail diversion
for people with mental illness (including mental health training for police), transferring BSH
from DOC to DMH, and increasing MassHealth reimbursement for inpatient psychiatric care.

Cassie Cramer, Co-Chair, Massachusetts Aging and Mental Health Coalition


Ms. Cramer largely focused on the need for in-home mental health services for older adults. She
discussed research and professional experiences showing that older adults with mental health
conditions face poor outcomes and higher rates of institutionalization, which is much more
expensive than community care. She stated that community mental health treatment prevents
institutionalization, leads to positive individual outcomes, and presents significant cost savings to
the state. She also discussed a federal grant opportunity that could fund such services and said
that the MA Aging and Mental Health Coalition had submitted a proposal.

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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.

Margaret Harvey, Associate Clinical Director of Psychiatry, Harvard Medical School


Dr. Harvey discussed the needs of veterans, who often return to the United States struggling with
mental health and substance abuse. Dr. Harvey made several recommendations, including the
need for more community education on veterans behavioral health needs, providing mental
health and substance abuse care in combination, including family members in treatment, and the
need for more veterans in the behavioral health provider workforce.

Substance Abuse May 7, 2015


The Committee held an informational hearing on substance issues on May 7, 2015 at 1pm in
Hearing Room A-2 at the State House. Speakers largely focused on the opioid crisis, with
suggested solutions including responsible prescribing of opioids (while ensuring that patients
who need opioids for pain can obtain them), treatment availability (particularly of medication-
assisted treatment), and addiction training for physicians. Speakers also mentioned difficulties
caused when Long Island closed, which limited substance abuse and homelessness services.

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.

Daniel Mumbauer, President and CEO, High Point Treatment Center


Mr. Mumbauer discussed current substance abuse treatment needs. He stated that the state needs
to ensure the proper amount of treatment beds in the right areas. He further suggested that the
state participate in the federal transitional support services (TSS) program, as currently, the state
alone pays for TSS. He also suggested evaluation of detox for those with a dual diagnosis of
mental illness and substance abuse, as this level of care is currently unrecognized by the
Commonwealth and not covered by MassHealth. Further, he suggested that Vivitrol be available
in clinical stabilization services (CSS) without prior authorization.

Jonathan Scott, President, Victory Programs


Mr. Scott described the addiction treatment programs offered by Victory Programs, which
largely include recovery homes. In 2014, they served 2,289 clients, who were primarily indigent,
homeless, and struggling with addiction. He said that, in 40 years, he has never seen their waiting
lists slow down. Mr. Scott discussed the increased potency of heroin, its higher ease of use, and
the need to use higher doses of Narcan to reverse an overdose. Mr. Scott made the following
policy recommendations: new financing programs to help nonprofits buy properties for Recovery
Homes, raising reimbursement rates to match real costs, financing services beyond the
Department of Public Health (e.g. federal Medicaid matching funds), restoration of services lost
when Long Island closed, and rebuilding the bridge to Long Island.

Emily Stewart, Executive Director, Casa Esperanza


Ms. Stewart stressed the need to end the cycle of people cycling through detox facilities, often
due to a lack of follow-up services, by ensuring long-term treatment. She discussed the need to
address both mental illness and substance use disorder among those with dual diagnoseswhen
Casa Esperanza began to address both in treatment, their success rate increased from 20% to
40%. She also recommended that the state work to reopen Long Island.

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.

Massachusetts Hospital Association (MHA)


Representatives of MHA stated that they have created best practices and standards for opioid
management across the Commonwealth, and they provided one such document entitled, MHA
Guidelines for Emergency Department Opioid Management. They also stressed the importance

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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.

John Renner and Greg Harris, Massachusetts Psychiatry Society


Dr. Renner and Dr. Harris largely discussed the need for mandatory physician training on
addiction issues. They stated that all doctors should have a residency around addiction treatment
and that voluntary training would result in the physicians who most need training not receiving
it. They stated that detox alone does not work, but medication-assisted treatment does work.
They stressed how difficult it can be for people to afford or obtain care from psychiatrists.

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.

John McGahan, President/CEO, Gavin Foundation


Mr. McGahan stressed the importance of evidence-based practices for addressing substance use
disorder in schools. He suggested that the PMP be expanded to include additional substances that
may be abused. He also discussed the importance of criminal justice interventions, such as drug
courts and jail diversion programs.

Annie Parkinson, Massachusetts Organization for Addiction Recovery (MOAR), Mike


Duggan, Wicked Sober Inc.
Ms. Parkinson and Mr. Duggan discussed various avenues for improving treatment and recovery
services for those with substance use disorder. They stated they are still working on educating
the public on the Good Samaritan law. They further praised recovery high schools. They also
discussed the continuum of care and that service availability decreases down the line. They
suggested that that more good sober homes be available, so that people could be moved out of
recovery homes, and that Licensed Alcohol and Drug Clinicians be insurance reimbursed.

Brendan Abel, Legislative Counsel, Massachusetts Medical Society (MMA)


In a written statement, the MMA stressed that opioids are clinically necessary for many patients
Mr. Abel stated that MMA is dedicated to helping address the opioid crisis, that diversion is a
concern, and that he wants to limit prescriptions getting into the wrong hands, such as through a
bill that allows patients to partially fill an opioid prescription and an MMA educational campaign

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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.

Stanley Pollack, Executive Director, Center for Teen Empowerment


Mr. Pollack stressed the importance of substance use prevention and leadership programming for
youth. He said that the substance use crisis and the availability of programming have worsened
in recent years. He discussed the comprehensive tobacco prevention programs and leadership
trainings held in the 1990s, which often paid youth for their participation, and the resulting
decrease in violence and deaths among youth. After that funding was cut, he stated that hundreds
of young people lost their jobs and violence spiked again. He also discussed youth programming
in Somerville that was developed in response to an epidemic of OxyContin use and teen suicides.

Geriatric Mental Health September 29, 2015


In conjunction with the Joint Committee on Elder Affairs, the Committee held an informational
hearing regarding geriatric mental health on September 29, 2015 at 10am in Hearing Room B-1
at the State House. Speakers from state agencies, medical providers, localities, and advocates
discussed services offered by the state, housing and legal needs, diseases, substance abuse, and
suicide prevention as these relate to older adults. For more detailed information, please contact
the Joint Committee on Elder Affairs.

Update from the Administration: Substance Abuse October 13, 2015


In conjunction with the Joint Committee on Public Health, the Committee held an oversight
hearing where members of the administration provided updates on the Commonwealths efforts
to address substance abuse on October 12, 2015 at 10am in Hearing Room A-1 at the State
House. Speakers from executive agencies discussed actions being taken by the administration to
address the opioid crisis, such as the Prescription Monitoring Program, treatment for incarcerated
inmates, and health insurance oversight.

The Committee received testimony from the below speakers. Their comments are summarized
here:

Marylou Sudders, Secretary, Executive Office of Health and Human Services


Secretary Sudders said the administrations focus in addressing substance abuse is treatment,
rather than incarceration. She provided an overview of actions taken and in progress. She said
that the Opioid Working Group had made recommendations, resulting in an Action Plan by the
Governor. The administration had also ensured that licensed addiction treatment programs accept
patients on medication-assisted treatment, held trainings on Neonatal Abstinence Syndrome, and
contracted with a vender for a new PMP. She said the administration was working on restoring
treatment beds lost when Long Island closed, ensuring MassHealth coverage for those leaving
Department of Correction custody, and contracting with an entity to accredit Sober Homes. She
stated that Governor Baker would be filing legislation to address opioid use disorder that week.

Monica Bharel, Commissioner, Department of Public Health (DPH)


Commissioner Bharel discussed DPHs role in prevention and treatment for substance use
disorder. She stated that the Drug Formulary Commission had already begun working on
developing a list of substitutions for certain opiates with a heightened level of public health risk.

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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.

Joan Mikula, Commissioner, Department of Mental Health


Commissioner Mikula discussed DMHs role in combatting substance use disorder, which
includes creating a program at Taunton State Hospital for women committed for substance use
disorder under Section 35. She further stated that 40% of DMH clients have substance abuse
issues, and DMH is working with DPH to address these clients needs. Finally, she discussed a
grant received by MassHealth, DMH, and DPH to create community centered behavioral health
centers.

Daniel Bennett, Secretary, Executive Office of Public Safety and Security


Secretary Bennet discussed the scope of mental health and substance abuse issues among DOC
inmates. He stated that involuntary commitments for substance abuse (Section 35) were up,
resulting in more people being placed in correctional, rather than treatment, facilities. He
highlighted the Governors efforts to ensure women committed under Section 35 are sent to
treatment. He also discussed a new DOC program providing inmates with Vivitrol prior to
release, which they were trying to get funds to study, and a new Transitional Treatment Program
for inmates about to reenter the community. He also spoke about efforts to partner with federal
agents to address drug trafficking in the Commonwealth.

Daniel Judson, Commissioner, Division of Insurance (DOI)


Commissioner Judson stated that, within DOI, the Health Care Access Bureau is responsible for
health insurance oversight. He discussed Chapter 258, which prohibits prior authorization for
medically necessary treatment or denial of access to acute treatment services or CSS prior to the
15th day. He also spoke about listening sessions DOI held and stated that DOI, DPH, and DMH
issued a bulletin to clarify requirements for coverage of substance use disorder treatment. He
emphasized that DOI does not have authority over government plans, self-insured employment-
sponsored plans, or health plans issued in other states covering MA residents.

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.

Innovative Programming: Substance Abuse November 2, 2015


In conjunction with the Joint Committee on Public Health, the Committee held an informational
hearing regarding innovative programming on November 2, 2015 at 1pm in Hearing Room A-1
at the State House. To encourage collaboration and the exchange of ideas on how to best address
the opioid crisis, we heard from a variety of programs related to all aspects of prevention,
intervention, treatment, and recovery. Speakers addressed screening for substance use disorder in
schools, connection to treatment at the police department, needle exchanges as a harm reduction
approach, and recovery coaches as part of continuing recovery.

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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

Hepatitis C and Harm Reduction May 3, 2016


The Committee held an informational hearing on Hepatitis C on May 3, 2016 at 11am in the
Members Lounge at the State House. Speakers gave an overview of Hepatitis C and stressed the
importance of needle exchanges as a harm reduction strategy that limits the spread of Hepatitis C
and HIV and can connect clients to substance use treatment.

The Committee received testimony from the below speakers. Their comments are summarized
here:

Kevin Cranston, Assistant Commissioner, Director, Bureau of Infectious Disease and


Laboratory Sciences, DPH
Mr. Cranston provided an overview of the Hepatitis C virus (HCV) in MA. He gave an overview
of the virus and described its effect on the body, which may include liver damage and cancer. He
also gave an overview of treatment types and effectiveness. He stated that an estimated 200,000
MA residents are living with chronic HCV infection. Mr. Cranston also gave a brief overview of
HIV infections in MA. He warned that the opioid epidemic and intravenous drug use are fueling
the incidence of HCV and present the potential for resurgence of HIV infection.

Employee and Client, AIDS Action Committee


AIDS Action discussed the work done at their Cambridge needle exchange, which also attempts
to engage those struggling with substance use disorders in treatment. The employee discussed the
populations they see at the exchange, other harm reduction strategies like Narcan, and needle
exchange rates. A client with lived experience of substance use disorder discussed the positive
impact of the needle exchange in their life.

Bridgewater State Hospital September 13, 2016


The Committee held an oversight hearing regarding Bridgewater State Hospital (BSH) at 1pm in
Hearing Room A-1 at the State House. Speakers spoke about efforts to transition BSH from a
correctional facility to a mental health facility in order to address abuses of civilly committed
patients, and advocates stressed the need for further reforms.

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.

Panel: Executive Office of Health and Human Services


Speakers: Marylou Sudders, Secretary, EOHHS and Joan Mikula, Commissioner, DMH
In a joint written statement, Secretary Sudders and Commissioner Mikula provided an overview
of the populations served at BSH, particularly civilly committed men, and DMHs role in the
facility. They discussed the Interagency Service Agreement and Memorandum of Understanding
between DOC and DMH in operating BSH. They also stated that the FY 2017 capital budget
includes $500,000 for DMH for a feasibility study for potential future locations for treatment of
civilly committed men, though any change in location would require statutory changes. Secretary
Sudders emphasized an expanded role for DMH in the facility, which will remain under DOC
control.

Panel 1: Legal Advocates


Speakers: Christine Griffin, Executive Director, Disability Law Center (DLC) and Jim
Pingeon, Litigation Director, Prisoners Legal Services (PLS)

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.

Panel 3: Family Members Panel


Speakers: Former Patient and Sister of Current Patient
The panelists discussed their own experiences and those of family members at BSH. According
to one panelist, because BSH is a prison and not a hospital, it is the worst place in the world to
send someone suffering from a mental health issue. They discussed patients who were assaulted
while at BSH, inadequate medical care and staff neglect, poor communication with family
members, the need for real treatment, and the need to transfer the facility from DOC to DMH.

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