Wednesday, March 5, 2008

How a Bill becomes Law: Update on the Children’s Mental Health Campaign

I hate driving to Boston. Even with GPS, I get lost. And GPS doesn’t find you a parking place. Still, on the day after the Rhode Island Primary, I hopped in my care to drive into Boston to hear Mary Lou Sudders (head of MSPCC) and David DeMaso MD (head of psychiatry at Children’s) talk about the Children’s Mental Health Initiative, a bill currently winding it’s way through the Massachusetts’ legislature that complements all of the work that we are doing with the Rosie D. case. As we have said repeatedly on this blog, Rosie D. is a tremendous opportunity for change in the system for kids on MassHealth. This bill offers the opportunity to bring similar changes to the rest of the kids in Massachusetts.
So, with my car carefully parked in a quasi-legal space, I arrived late to a brilliant session on the current state of the legislation. “An Act Relative to Children’s Mental Health” was introduced into the Massachusetts legislature on 1/10/2007, and it is currently clearing the committee hurdles.
The bill is based on a premise: that there is (and shouldn’t be) a single system for mental health care, but that the key to the process is to be building bridges between the various folks who work with the kids who do the work. Partnerships, with Health Care for All, with the Parent Professional Advocacy League and Health Law Advocates, are the key to moving this process along. All of these agencies are key to this process. To emphasize the point, the two presenters alternated sentences in the presentation of the material. This partnership has led to co-sponsorship by 96 legislators, as the coalition educates the legislature on what this bill is about and assures them that this is the right thing for the legislature to do.
The bill is HB4276 and has five key elements. First, the bill creates a single voice within the government for children’s mental health, the Commissioner of Mental Health. (like the Commissioner of Public Health handles hospitals). This will be a major step in breaking down the silos. Second, the bill calls for payment of primary care doctors are paid for early screening in practice. Third, it provides for payment for the provision of collateral mental health services and collaboration. Fourth, it requires coordination of care within public agencies. There was a fifth thing, but I missed it by not typing fast enough.
The original bill also had some mental health parity law language that has been moved out of the omnibus bill into its own bill. Strategically, mental health parity is likely to need more pushing to get it through.
It has been quite a process moving the Omnibus Bill through the process. Its first committee was the Joint Committee on Mental Health and Substance Abuse. After a tremendous hearing, the bill was sent on to the Joint Committee on Health Care Finance, a committee that often doesn’t let bills out for consideration. The Bill was then sent to the Senate Ways and Means committee (in order to avoid the logjam in the House over the budget). In so doing, it was renamed;  it is now called S.2518. When the bill makes it out of Senate Ways and Means, it needs to clear the House and to go to the Governor for signature. It is quite a process, and requires those of us on the ground to continue to support the bill to keep it moving through the process.
Children’s has been pushing this within the Children’s Hospital system. They have trained speakers, developed a website, sponsored a Mental Health Advocacy Day.  MSPCC has been working with their advocacy network. So far, only two groups have come out against this: the Church of Scientology and the Mass Association of Health Plans. To make this work, they need our help. So what can we do?
1) Give voice to the stories: The folks in the State House need to hear the stories that are happening in different parts of the state. This is probably the single most important thing.
2) Get into the media: Op-Eds, letters to the editor, interviews;  all of this is good. “The most important thing is not how well you are quoted, but how badly you are mis-quoted", to quote Ms. Sudders. While there is risk involved in talking to the media, there is benefit to getting this issue out and in the open. The media keeps the mission alive.
3) Talk to your legislators: They need to hear that this is their problem, not just a problem at Children’s.
Politically, the presenters thought that this was likely to be passed this year with the right support. A group of us are planning a series on events in Worcester County around mental health month to promote this initiative. Stay tuned for the details.
Oh, and if anyone wants to join the fight, give Matt Noyes (  a holler. He’ll hook you up.

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