Lessons From Massachusetts Behavioral Healthcare Policy Reforms During COVID-19

A case study of emergency policy reforms in Massachusetts published in Psychiatric Services offers key insights for supporting patients with serious mental illness during the ongoing coronavirus disease (COVID-19) pandemic. Policy, regulatory, and payment reforms can shore up community-based health organizations to meet the needs of patients with serious mental illness, including schizophrenia and bipolar disorder.

Stephen J. Bartels, MD, from Harvard Medical School and Massachusetts General Hospital, and colleagues examined the coordinated emergency response of the state of Massachusetts to the COVID-19 pandemic. Community-based providers collaborated with the Executive Office of Health and Human Services to develop changes in guidance, regulations, and funding to provide support to patients, clinicians, and staff.

For example, Massachusetts has set up a temporary policy preventing termination of individual Medicaid coverage during the crisis. The state has also increased telehealth assessments and treatments for patients with psychiatric disorders through state Medicaid, third party, and federal Medicare and HIPAA waivers. Waivers on the restricted amount of medication stored on site have helped group homes maintain supply of critical medications. Pharmacies have also been allowed to distribute larger amounts of prescribed medications and refills.

For cases requiring in person blood draws and labs before filling prescriptions such as clozapine, hospitals and community organizations have formed academic-community working groups to develop guidance about how to manage dispensation consistent with national Risk Evaluation and Mitigation Strategy guidance.

The Boston Health Care for the Homeless program has partnered with government agencies and other community stakeholders to implement front door symptom screening at local shelters, expedited COVID-19 testing, isolation of homeless persons in alternate care settings, and dedicated COVID-19 care units for people without homes. The Massachusetts Medicaid 1115 Waiver Delivery System Reform Incentive program and Medicaid Accountable Care Organizations provided additional long term support for basic housing and food.

To help organizations, Massachusetts will provide “financial life-lines” to behavioral health providers, which will give temporary distribution of a portion of historically billed Medicaid payments released from fee-for-service direct visits. Massachusetts also committed $104 million in funds, including monthly interim payments from April to July, equaling 50% of providers’ historical behavioral health revenue and a 10% increase for clinical support, acute treatment, residential support, child behavioral health, and opioid treatment services.

The researchers concluded that the policy measures “could subsequently translate to downstream reforms in how we care for these populations during more ordinary times.”

Reference

Bartels SJ, Baggett TP, Freudenreich O, Bird BL. Case study of Massachusetts COVID-19 emergency policy reforms to support community-based behavioral health and reduce mortality of people with serious mental illness [published online April 16, 2020]. Psychiatr Serv. doi:10.1176/appi.ps.202000244