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| 2 | 2 | | SENATE DOCKET, NO. 1736 FILED ON: 1/19/2023 |
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| 3 | 3 | | SENATE . . . . . . . . . . . . . . No. 1261 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | Liz Miranda |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act to expand equitable perinatal mental health services. |
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| 13 | 13 | | _______________ |
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| 14 | 14 | | PETITION OF: |
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| 15 | 15 | | NAME:DISTRICT/ADDRESS :Liz MirandaSecond SuffolkSal N. DiDomenicoMiddlesex and Suffolk2/7/2023Jason M. LewisFifth Middlesex2/7/2023Lindsay N. Sabadosa1st Hampshire2/7/2023Lydia EdwardsThird Suffolk2/8/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/8/2023Thomas M. Stanley9th Middlesex2/13/2023Michael J. BarrettThird Middlesex2/21/2023Adam GomezHampden2/21/2023Vanna Howard17th Middlesex3/2/2023Danillo A. Sena37th Middlesex3/2/2023Carlos González10th Hampden3/2/2023Joan B. LovelySecond Essex3/2/2023Patricia D. JehlenSecond Middlesex3/6/2023Patricia A. Duffy5th Hampden3/8/2023 1 of 11 |
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| 16 | 16 | | SENATE DOCKET, NO. 1736 FILED ON: 1/19/2023 |
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| 17 | 17 | | SENATE . . . . . . . . . . . . . . No. 1261 |
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| 18 | 18 | | By Ms. Miranda, a petition (accompanied by bill, Senate, No. 1261) of Liz Miranda, Sal N. |
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| 19 | 19 | | DiDomenico, Jason M. Lewis, Lindsay N. Sabadosa and other members of the General Court for |
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| 20 | 20 | | legislation to expand equitable perinatal mental health services. Mental Health, Substance Use |
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| 21 | 21 | | and Recovery. |
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| 22 | 22 | | The Commonwealth of Massachusetts |
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| 23 | 23 | | _______________ |
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| 24 | 24 | | In the One Hundred and Ninety-Third General Court |
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| 25 | 25 | | (2023-2024) |
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| 26 | 26 | | _______________ |
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| 27 | 27 | | An Act to expand equitable perinatal mental health services. |
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| 28 | 28 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 29 | 29 | | of the same, as follows: |
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| 30 | 30 | | 1 Section 1. Chapter 6A of the General Laws is hereby amended by inserting after section |
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| 31 | 31 | | 216CC the following section:- |
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| 32 | 32 | | 3 Section 16DD. (a) As used in this section, the following words shall have the following |
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| 33 | 33 | | 4meanings:- |
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| 34 | 34 | | 5 “Health professional shortage area”, a specific geographic area, specific population group |
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| 35 | 35 | | 6or specific facility federally designated as having a critical shortage of primary, dental, or mental |
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| 36 | 36 | | 7health care providers. |
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| 37 | 37 | | 8 “Medically underserved populations”, federally designated populations that have too few |
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| 38 | 38 | | 9primary care providers, high infant mortality, high poverty or high elderly population. 2 of 11 |
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| 39 | 39 | | 10 “Mental or behavioral health care provider”, a health care provider in the field of mental |
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| 40 | 40 | | 11or behavioral health, including substance use disorders, acting in accordance with the laws of the |
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| 41 | 41 | | 12commonwealth. |
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| 42 | 42 | | 13 “Perinatal”, the period of time from pregnancy up until one year following birth. |
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| 43 | 43 | | 14 “Perinatal healthcare desert”, a region where the population has inadequate access to |
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| 44 | 44 | | 15 perinatal healthcare. |
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| 45 | 45 | | 16 “Perinatal mental and behavioral health care workforce”, mental or behavioral health care |
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| 46 | 46 | | 17providers who focus on perinatal health in biological parents, birthing persons, adoptive parents, |
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| 47 | 47 | | 18foster parents, and any other individuals involved in the gestation, birth, and custodial care of an |
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| 48 | 48 | | 19infant. |
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| 49 | 49 | | 20 “Secretary”, the secretary of health and human services. |
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| 50 | 50 | | 21 (b) The secretary may award grants to entities to establish or expand programs to grow |
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| 51 | 51 | | 22and diversify the perinatal mental and behavioral health care workforce. |
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| 52 | 52 | | 23 (c) Recipients of grants under this section shall use the grants to grow and diversify the |
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| 53 | 53 | | 24perinatal mental and behavioral health care workforce by: |
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| 54 | 54 | | 25 (1) establishing schools or programs that provide education and training to individuals |
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| 55 | 55 | | 26seeking appropriate licensing or certification as mental or behavioral health care providers who |
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| 56 | 56 | | 27will specialize in perinatal mental health conditions or substance use disorders; or 3 of 11 |
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| 57 | 57 | | 28 (2) expanding the capacity of existing schools or programs described in paragraph (1) of |
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| 58 | 58 | | 29this subsection, for the purposes of increasing the number of students enrolled in those schools or |
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| 59 | 59 | | 30programs, including by awarding scholarships for students. |
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| 60 | 60 | | 31 (d) In awarding grants under this section, the secretary shall give priority to any entity |
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| 61 | 61 | | 32that: |
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| 62 | 62 | | 33 (1) has demonstrated a commitment to recruiting and retaining students and faculty from |
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| 63 | 63 | | 34medically underserved populations or perinatal health care deserts; |
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| 64 | 64 | | 35 (2) has developed a strategy to recruit and retain a diverse pool of students into the |
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| 65 | 65 | | 36perinatal mental and behavioral health care workforce program or school supported by funds |
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| 66 | 66 | | 37received through the grant, particularly from medically underserved populations; |
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| 67 | 67 | | 38 (3) has developed a strategy to recruit and retain students who plan to practice in a health |
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| 68 | 68 | | 39professional shortage area; |
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| 69 | 69 | | 40 (4) has developed a strategy to recruit and retain students who plan to practice in an area |
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| 70 | 70 | | 41with significant racial, ethnic and rural disparities in perinatal health outcomes, to the extent |
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| 71 | 71 | | 42practicable; |
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| 72 | 72 | | 43 (5) includes in the standard curriculum for all students within the perinatal mental and |
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| 73 | 73 | | 44behavioral health care workforce program or school a bias, racism or discrimination training |
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| 74 | 74 | | 45program that includes training on implicit bias and racism; or |
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| 75 | 75 | | 46 (6) is operated by or employs providers with past lived-experience with perinatal mental |
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| 76 | 76 | | 47health conditions or substance use disorders. |
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| 77 | 77 | | 48 (e) The period of a grant awarded to an entity under this section shall be up to 5 years. 4 of 11 |
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| 78 | 78 | | 49 (f) To seek a grant under this section, an entity shall submit to the secretary an |
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| 79 | 79 | | 50application at such time, in such manner and containing such information as the secretary may |
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| 80 | 80 | | 51require. |
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| 81 | 81 | | 52 (g) The secretary shall provide, directly or by contract, technical assistance to entities |
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| 82 | 82 | | 53seeking or receiving a grant under this section on the development, use, evaluation and post grant |
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| 83 | 83 | | 54period sustainability of the perinatal mental and behavioral health care workforce programs or |
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| 84 | 84 | | 55schools proposed, established or expanded through the grant. The secretary shall advertise or |
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| 85 | 85 | | 56promote technical assistance for potentially eligible programs to raise awareness about the grants |
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| 86 | 86 | | 57and the technical assistance, particularly to encourage small providers to apply. |
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| 87 | 87 | | 58 (h) The secretary shall collaborate with the executive office of labor and workforce |
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| 88 | 88 | | 59development to develop perinatal mental and behavioral health care workforce standards to |
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| 89 | 89 | | 60measure the efficacy of grants awarded pursuant to this section. |
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| 90 | 90 | | 61 (i) As a condition of receipt of a grant under this section for a perinatal mental and |
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| 91 | 91 | | 62behavioral health care workforce program or school, a recipient of funds shall agree to submit to |
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| 92 | 92 | | 63the secretary an annual report on the activities conducted through the grant. The report shall |
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| 93 | 93 | | 64include: |
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| 94 | 94 | | 65 (1) the number and demographics of students participating in the program or school; |
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| 95 | 95 | | 66 (2) the extent to which students in the program or school are entering careers in health |
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| 96 | 96 | | 67professional shortage areas designated by the commonwealth, areas with significant racial and |
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| 97 | 97 | | 68ethnic disparities in perinatal health outcomes and perinatal health care deserts to the extent such |
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| 98 | 98 | | 69data are available; and 5 of 11 |
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| 99 | 99 | | 70 (3) whether the program or school has included in the standard curriculum for all students |
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| 100 | 100 | | 71a bias, racism or discrimination training program that includes training on implicit bias and |
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| 101 | 101 | | 72racism, and if so data on perinatal mental and behavioral health care outcomes for patients |
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| 102 | 102 | | 73belonging to medically underserved populations who receive treatment from such students. |
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| 103 | 103 | | 74 (j) Not later than 4 years after the date of enactment of this section, the secretary shall |
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| 104 | 104 | | 75 prepare and submit to the governor, the clerks of the house of representatives and the |
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| 105 | 105 | | 76senate, and make publicly available on the department’s website a report on the effectiveness of |
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| 106 | 106 | | 77the grant program under this section, including information about: |
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| 107 | 107 | | 78 (1) recruiting students from medically underserved populations; |
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| 108 | 108 | | 79 (2) increasing the number of mental or behavioral health care providers specializing in |
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| 109 | 109 | | 80perinatal mental health conditions or substance use disorders from medically underserved |
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| 110 | 110 | | 81populations; |
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| 111 | 111 | | 82 (3) increasing the number of mental or behavioral health care providers specializing in |
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| 112 | 112 | | 83perinatal mental health conditions or substance use disorders working in health professional |
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| 113 | 113 | | 84shortage areas; and |
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| 114 | 114 | | 85 (4) increasing the number of mental or behavioral health care providers specializing in |
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| 115 | 115 | | 86perinatal mental health conditions or substance use disorders working in areas with significant |
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| 116 | 116 | | 87racial and ethnic disparities in perinatal health outcomes, as well as perinatal health care deserts |
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| 117 | 117 | | 88and rural areas, to the extent such data are available. |
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| 118 | 118 | | 89 (5) supporting and increasing the number of providers with past lived-experience with |
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| 119 | 119 | | 90perinatal mental health conditions or substance use disorders. 6 of 11 |
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| 120 | 120 | | 91 Section 2. Chapter 6A of the General Laws is hereby amended by inserting after section |
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| 121 | 121 | | 9216DD the following section:- |
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| 122 | 122 | | 93 Section 16EE. (a) As used in this section, the following words shall have the following |
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| 123 | 123 | | 94meanings: |
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| 124 | 124 | | 95 “Culturally congruent care”, care that is in agreement with the preferred cultural values, |
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| 125 | 125 | | 96beliefs, worldview, language and practices of the health care consumer. |
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| 126 | 126 | | 97 “Eligible entity”, a: (1) community-based organization serving perinatal individuals, |
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| 127 | 127 | | 98including organizations serving individuals from medically underserved populations and other |
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| 128 | 128 | | 99underserved populations; (2) non-profit or patient advocacy organization with expertise in |
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| 129 | 129 | | 100mental and behavioral health of perinatal individuals; (3) maternity care provider; (4) mental or |
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| 130 | 130 | | 101behavioral health care provider who treats mental health conditions or substance use disorders in |
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| 131 | 131 | | 102perinatal individuals; (5) public health agencies, including the department of public health or a |
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| 132 | 132 | | 103local public health department; (6) federally recognized Indian tribe or tribal organization; (7) |
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| 133 | 133 | | 104non-profit organizations with expertise in early relational health; (8) non-profit or community |
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| 134 | 134 | | 105organizations serving perinatal individuals experiencing pregnancy or infant loss; or (9) public |
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| 135 | 135 | | 106health agencies or non-profit or community organizations providing home visiting services for |
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| 136 | 136 | | 107perinatal individuals; or (10) domestic violence shelter. |
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| 137 | 137 | | 108 “Freestanding birth center”, a health facility: (1) that is not a hospital; (2) where |
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| 138 | 138 | | 109childbirth is planned to occur away from the pregnant person’s residence; (3) that is licensed or |
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| 139 | 139 | | 110otherwise approved by the commonwealth to provide prenatal labor and delivery or postpartum |
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| 140 | 140 | | 111care; and (4) that complies with other requirements established by the commonwealth relating to |
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| 141 | 141 | | 112the health and safety of individuals provided services by the facility. 7 of 11 |
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| 142 | 142 | | 113 “Maternity care provider”, a health care provider who: (1) is a physician, physician |
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| 143 | 143 | | 114assistant, certified nurse-midwife, nurse practitioner or clinical nurse specialist; and (2) has a |
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| 144 | 144 | | 115focus on maternal or perinatal health. |
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| 145 | 145 | | 116 “Medically underserved populations”, federally designated populations that have too few |
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| 146 | 146 | | 117primary care providers, high infant mortality, high poverty or high elderly population. |
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| 147 | 147 | | 118 “Mental or behavioral health care provider”, a health care provider in the field of mental |
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| 148 | 148 | | 119or behavioral health, including substance use disorders, acting in accordance with the laws of the |
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| 149 | 149 | | 120commonwealth. |
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| 150 | 150 | | 121 “Perinatal”, the period of time from pregnancy up until one year following birth. |
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| 151 | 151 | | 122 “Perinatal individuals”, biological parents, birthing persons, adoptive parents, foster |
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| 152 | 152 | | 123parents, and any other individuals involved in the gestation, birth, and custodial care of an infant. |
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| 153 | 153 | | 124 “Secretary”, the secretary of health and human services. |
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| 154 | 154 | | 125 (b) The secretary shall establish a program to award grants to eligible entities to address |
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| 155 | 155 | | 126mental health conditions and substance use disorders with respect to perinatal individuals, with a |
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| 156 | 156 | | 127focus on medically underserved populations. |
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| 157 | 157 | | 128 (c) To receive a grant under this section an eligible entity shall submit to the secretary an |
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| 158 | 158 | | 129application at such time, in such manner and containing such information as the secretary may |
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| 159 | 159 | | 130require, including how the entity will use funds for activities described in subsection (e) that are |
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| 160 | 160 | | 131culturally congruent. |
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| 161 | 161 | | 132 (d) In awarding grants under this section, the secretary shall give priority to an eligible |
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| 162 | 162 | | 133entity that: 8 of 11 |
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| 163 | 163 | | 134 (1) is partnering, or will partner, with a community-based organization to address mental |
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| 164 | 164 | | 135health conditions or substance use disorders in perinatal individuals described in subsection (a); |
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| 165 | 165 | | 136and |
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| 166 | 166 | | 137 (2) is operating in an area with high rates of adverse perinatal health outcomes or |
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| 167 | 167 | | 138significant racial or ethnic disparities in perinatal health outcomes. |
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| 168 | 168 | | 139 (e) An eligible entity that receives a grant under this section shall use funds for the |
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| 169 | 169 | | 140following: |
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| 170 | 170 | | 141 (1) establishing or expanding maternity care programs to improve the integration of |
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| 171 | 171 | | 142perinatal mental health and behavioral health care services into primary care settings where |
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| 172 | 172 | | 143perinatal individuals regularly receive health care services; |
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| 173 | 173 | | 144 (2) establishing or expanding group prenatal care programs or postpartum care programs; |
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| 174 | 174 | | 145(3) expanding existing programs that improve mental health and behavioral health for perinatal |
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| 175 | 175 | | 146individuals, with a focus on perinatal individuals from medically underserved populations; |
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| 176 | 176 | | 147 (4) providing services and support for perinatal individuals with perinatal mental health |
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| 177 | 177 | | 148conditions and substance use disorders, including referrals to addiction treatment centers that |
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| 178 | 178 | | 149offer evidence-based treatment options; |
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| 179 | 179 | | 150 (5) addressing stigma associated with perinatal mental health conditions and substance |
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| 180 | 180 | | 151use disorders, with a focus on medically underserved populations; |
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| 181 | 181 | | 152 (6) raising awareness of warning signs of perinatal mental health conditions and |
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| 182 | 182 | | 153substance use disorders, with a focus on perinatal individuals from medically underserved |
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| 183 | 183 | | 154populations; 9 of 11 |
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| 184 | 184 | | 155 (7) establishing or expanding programs to prevent suicide or self-harm among perinatal |
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| 185 | 185 | | 156individuals; |
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| 186 | 186 | | 157 (8) offering evidence-aligned programs at freestanding birth centers that provide perinatal |
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| 187 | 187 | | 158mental and behavioral health care education, treatments, and services, and other services for |
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| 188 | 188 | | 159perinatal individuals; |
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| 189 | 189 | | 160 (9) establishing or expanding programs to provide education and training to maternity |
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| 190 | 190 | | 161care providers with respect to identifying potential warning signs for mental health conditions or |
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| 191 | 191 | | 162substance use disorders in perinatal individuals, with a focus on individuals from medically |
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| 192 | 192 | | 163underserved populations. In the case where such providers identify such warning signs, offering |
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| 193 | 193 | | 164referrals to mental or behavioral health care professionals; |
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| 194 | 194 | | 165 (10) publicizing information about health care providers who treat perinatal mental health |
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| 195 | 195 | | 166conditions and substance use disorders; |
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| 196 | 196 | | 167 (11) establishing or expanding programs in communities to improve coordination |
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| 197 | 197 | | 168between maternity care providers and perinatal mental or behavioral health care providers who |
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| 198 | 198 | | 169treat mental health conditions and substance use disorders in perinatal individuals, including |
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| 199 | 199 | | 170through the use of toll-free hotlines; |
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| 200 | 200 | | 171 (12) establishing or expanding programs with services for individuals suffering |
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| 201 | 201 | | 172pregnancy or infant loss; |
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| 202 | 202 | | 173 (13) establishing or expanding programs with services to address the perinatal risks of |
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| 203 | 203 | | 174domestic violence; 10 of 11 |
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| 204 | 204 | | 175 (14) establishing or expanding programs that provide home visits to address perinatal |
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| 205 | 205 | | 176mental health conditions and substance use disorders; |
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| 206 | 206 | | 177 (15) establishing or expanding programs that improve early relational health; |
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| 207 | 207 | | 178 (16) carrying out other programs aligned with evidence-based practices for addressing |
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| 208 | 208 | | 179mental health conditions and substance use disorders for perinatal individuals, with a focus on |
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| 209 | 209 | | 180medically underserved populations; or |
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| 210 | 210 | | 181 (17) other similar programs. |
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| 211 | 211 | | 182 (f) The period of a grant awarded to an entity under this section shall be up to 5 years. . |
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| 212 | 212 | | 183 (g) The secretary shall provide, directly or by contract, technical assistance to entities |
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| 213 | 213 | | 184seeking or receiving a grant under this section on the development, use, evaluation and post- |
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| 214 | 214 | | 185grant period sustainability of the program proposed, established or expanded through the grant. |
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| 215 | 215 | | 186The secretary shall advertise or promote technical assistance for potentially eligible programs to |
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| 216 | 216 | | 187raise awareness about the grants and the technical assistance, particularly to encourage small |
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| 217 | 217 | | 188providers to apply. |
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| 218 | 218 | | 189 (h) An eligible entity that receives a grant under this section shall submit annually to the |
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| 219 | 219 | | 190secretary, and make publicly available, a report on the activities conducted using funds received |
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| 220 | 220 | | 191through a grant under this section. Such reports shall include quantitative and qualitative |
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| 221 | 221 | | 192evaluations of such activities, including the experience of perinatal individuals who received |
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| 222 | 222 | | 193health care through such grant. 11 of 11 |
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| 223 | 223 | | 194 (i) Not later than the end of each fiscal year that grants are awarded, the secretary shall |
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| 224 | 224 | | 195submit to the governor, the clerks of the house of representatives and the senate, and make |
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| 225 | 225 | | 196publicly available on the department’s website a report that includes: |
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| 226 | 226 | | 197 (1) a summary of the reports received under subsection (h); |
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| 227 | 227 | | 198 (2) an evaluation of the effectiveness of grants awarded under this section; |
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| 228 | 228 | | 199 (3) recommendations with respect to expanding coverage of evidence-based screenings |
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| 229 | 229 | | 200and treatments for perinatal mental health conditions and substance use disorders; and |
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| 230 | 230 | | 201 (4) recommendations with respect to ensuring activities described under subsection (e) |
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| 231 | 231 | | 202continue after the end of a grant period. |
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| 232 | 232 | | 203 Section 3. The executive office of health and human services in consultation with the |
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| 233 | 233 | | 204executive office of labor and workforce development shall promulgate regulations for the |
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| 234 | 234 | | 205implementation of sections 16DD and 16EE within 90 days of enactment. |
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