Lawmakers consider bills to bolster mental health care access

Against the backdrop of what behavioral health experts say is a worsening crisis in the COVID-19 pandemic, state lawmakers are weighing a number of bills to increase access to mental health care in Michigan.

Bills pending in Lansing would require Medicaid to reimburse care providers treating alcohol use disorder, allow for temporary crisis units to treat patients, and enter Michigan into a multi-state consortium allowing psychologists to treat patients who are out of state via telehealth.

Another would allow advanced practice professionals — physician assistants, certified nurse practitioners and certified clinical nurse specialists — to conduct patient mental health exams and issue a certification needed to admit a patient to an inpatient psych unit.

The bill, S.B. 826, would bring Michigan’s Mental Health Code that dates back to 1974 in  line with the Public Health Code so advanced practice professionals can practice at the same scope in mental health as they do in medical care.

“Over the past four decades, advanced practice registered nurses such as nurse practitioners and clinical nurse specialists have proven that they can improve the access, cost, and quality in the delivery of mental health services,” Margaret Keeler, a nurse practitioner in Lansing, said in Oct. 13 testimony to lawmakers. “The inclusion of nurse practitioners and clinical nurse specialists in Michigan’s Mental Health Code will positively impact the provision of comprehensive services for people with mental illness.”

The legislation offers one way to address a shortage of mental health professionals in the state during a crisis “which has only been stressed further during this pandemic,” said bill sponsor Sen. Curt VanderWall, R-Ludington.

The state Senate in late September voted unanimously to adopt the legislation and sent it for consideration in the House. The House Health Policy Committee held its first hearing on the bill last month.

‘You could not pass this bill fast enough’

Legislators are considering S.B. 826 and other bills as incidence rates of mental illness and substance use increase sharply in the pandemic.

Bret Jackson, president of the Economic Alliance for Michigan, considers rising incidence rates as “the second wave of the COVID crisis, which is the mental health crisis that we’re facing.” Jackson cited data showing addiction cases in Michigan increased 40 percent since February, post-traumatic stress disorder cases grew 50 percent, social anxiety disorder cases increased 80 percent, general anxiety disorder cases doubled, and depression cases grew 140 percent.

“Our health care system had a shortage of professionals prior to COVID and today the system is simply underwater,” Jackson told the Health Policy Committee. “You could not pass this bill fast enough.”

Jackson told MiBiz that he’s hopeful the committee and full House will adopt the bill in the lame duck legislative session.

In other legislation, the House Health Policy Committee unanimously backed H.B. 5408, which would require the Michigan Department of Health and Human Services to draft fee-for-service Medicaid payments for alcohol use disorder. The bill also would allow non-physician care providers to treat alcohol use disorder and receive Medicaid reimbursement.

Providing Medicaid reimbursement for the disorder would not affect the state financially, said Dr. Cara Poland, a physician with the Spectrum Health Medical Group in Grand Rapids who is board certified in addiction medicine. She cited a U.S. Surgeon General report on substance use disorder that said the health care system saves $4 for every $1 spent on treatment.

“If we treat addiction upstream, the health care system as a whole saves,” Poland said.

The bill is pending in the House Ways and Means Committee.

Expanding telehealth

In legislation that unanimously cleared the state Senate on Sept. 30 and is now under review by the House Health Policy Committee, Michigan would join 14 other states in a consortium in which psychologists could treat patients outside of Michigan through telehealth.

Bill sponsor Sen. Peter MacGregor, R-Rockford, said the Psychology Interjurisdictional Compact “is intended to create that continuum of care for patients who are experiencing crisis while out of the home or away from the home.”

In testimony to lawmakers, Dr. Judith Kovach — a Southfield psychologist representing the Michigan Psychological Association — described a situation early in the pandemic in which an elderly patient who lives in Florida part of the year started to experience anxiety attacks.

“Because of the special circumstances in the pandemic, I was able to talk with them, but in normal circumstances I would not have been able to help them, and they are long-term patients,” Kovach said. “They don’t necessarily want to start seeing somebody new.”

S.B. 758 would provide “a mechanism to set rules for future telepsychology services” and allow psychologists to practice across state lines without having to go through the process of obtaining a license in other states.

“The last several months have shown us the importance of telepsychology services to assist the citizens of Michigan in accessing mental health care. Virtually all mental health services have been delivered by telephone and video sites,” Kovach said. “The results have been very effective in meeting the state’s mental health needs.”

However, the bill faces opposition from the state Department of Licensing and Regulatory Affairs (LARA), which in general worries about Michigan becoming part of multi-state medical licensing compacts that are led by an independent commission.

“We have broad concern about the implications of subjecting Michigan and its licensed professionals to an unelected commission that has the authority to adopt rules and policies that have the effect of law in Michigan,” said Derek Sova, an analyst in LARA’s Office of Policy and Legislative Affairs.

A psychologist outside of Michigan also would not have to adhere to the same licensing requirements as professionals based in the state, Sova said. 

He cited examples of state law requiring professionals in each licensing cycle to complete continuing education courses in pain management and identifying human trafficking victims.

“I certainly understand and appreciate the goals of this legislation, but I believe it’s worth considering that there’s more to these compacts than just their claimed benefits,” Sova said.

If a psychologist in another state wants to practice in Michigan, LARA can expedite licensing as it did early in the pandemic, Sova said.

Crisis stabilization units

Under another bill working through the state Legislature, mental health care providers could set up crisis stabilization units to treat people for up to 72 hours.

The units have been used in other states “to provide a clinically and cost effective crisis treatment option in secure therapeutic settings that are less intensive than hospitals,” Beverly Ryskamp, chief operating officer at mental health care agency Network180 in Grand Rapids, said in testimony to the Senate Health Policy and Human Services Committee.

Quite often it takes more than a day for a person experiencing an episode to get admitted to a psychiatric facility as an inpatient, Ryskamp said. That can leave them sitting in a hospital ER, or in some cases even jail, as they await transfer, she said.

“Crisis stabilization units will reduce the number of individuals who end up in jail or an emergency department when they need to be in a treatment setting,” Ryskamp said. “The focus on immediate treatment means crisis stabilization units can provide a better experience for the individual (with) fewer steps and quicker care.”

The bill — H.B. 5832, sponsored by Rep. Mary Whiteford, R-Casco Township in Allegan County — passed the state House in June on a near unanimous vote. The Senate Health Policy and Human Services Committee in late September passed the bill, which now awaits action by the full Senate.