SENATE DOCKET, NO. 1736        FILED ON: 1/19/2023

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1261

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Liz Miranda

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to expand equitable perinatal mental health services.

_______________

PETITION OF:

SENATE DOCKET, NO. 1736        FILED ON: 1/19/2023

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1261

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Third General Court
(2023-2024)

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An Act to expand equitable perinatal mental health services.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

Section 1. Chapter 6A of the General Laws is hereby amended by inserting after section 16CC the following section:- 

Section 16DD. (a) As used in this section, the following words shall have the following meanings:- 

“Health professional shortage area”, a specific geographic area, specific population group or specific facility federally designated as having a critical shortage of primary, dental, or mental  health care providers. 

“Medically underserved populations”, federally designated populations that have too few primary care providers, high infant mortality, high poverty or high elderly population.

“Mental or behavioral health care provider”, a health care provider in the field of mental or behavioral health, including substance use disorders, acting in accordance with the laws of the commonwealth. 

“Perinatal”, the period of time from pregnancy up until one year following birth.

“Perinatal healthcare desert”, a region where the population has inadequate access to 

perinatal healthcare.

“Perinatal mental and behavioral health care workforce”, mental or behavioral health care providers who focus on perinatal health in biological parents, birthing persons, adoptive parents, foster parents, and any other individuals involved in the gestation, birth, and custodial care of an infant.

“Secretary”, the secretary of health and human services. 

(b) The secretary may award grants to entities to establish or expand programs to grow and diversify the perinatal mental and behavioral health care workforce.

(c) Recipients of grants under this section shall use the grants to grow and diversify the perinatal mental and behavioral health care workforce by: 

(1) establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as mental or behavioral health care providers who will specialize in perinatal mental health conditions or substance use disorders; or 

(2) expanding the capacity of existing schools or programs described in paragraph (1) of this subsection, for the purposes of increasing the number of students enrolled in those schools or programs, including by awarding scholarships for students. 

(d) In awarding grants under this section, the secretary shall give priority to any entity that: 

(1) has demonstrated a commitment to recruiting and retaining students and faculty from medically underserved populations or perinatal health care deserts;

(2) has developed a strategy to recruit and retain a diverse pool of students into the perinatal mental and behavioral health care workforce program or school supported by funds received through the grant, particularly from medically underserved populations;

(3) has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area; 

(4) has developed a strategy to recruit and retain students who plan to practice in an area with significant racial, ethnic and rural disparities in perinatal health outcomes, to the extent practicable; 

(5) includes in the standard curriculum for all students within the perinatal mental and behavioral health care workforce program or school a bias, racism or discrimination training program that includes training on implicit bias and racism; or

(6) is operated by or employs providers with past lived-experience with perinatal mental health conditions or substance use disorders. 

(e) The period of a grant awarded to an entity under this section shall be up to 5 years. 

(f) To seek a grant under this section, an entity shall submit to the secretary an application at such time, in such manner and containing such information as the secretary may require. 

(g) The secretary shall provide, directly or by contract, technical assistance to entities seeking or receiving a grant under this section on the development, use, evaluation and post grant period sustainability of the perinatal mental and behavioral health care workforce programs or schools proposed, established or expanded through the grant. The secretary shall advertise or promote technical assistance for potentially eligible programs to raise awareness about the grants and the technical assistance, particularly to encourage small providers to apply.

(h) The secretary shall collaborate with the executive office of labor and workforce development to develop perinatal mental and behavioral health care workforce standards to measure the efficacy of grants awarded pursuant to this section. 

(i) As a condition of receipt of a grant under this section for a perinatal mental and behavioral health care workforce program or school, a recipient of funds shall agree to submit to the secretary an annual report on the activities conducted through the grant. The report shall include:

(1) the number and demographics of students participating in the program or school; 

(2) the extent to which students in the program or school are entering careers in health professional shortage areas designated by the commonwealth, areas with significant racial and ethnic disparities in perinatal health outcomes and perinatal health care deserts to the extent such data are available; and 

(3) whether the program or school has included in the standard curriculum for all students a bias, racism or discrimination training program that includes training on implicit bias and racism, and if so data on perinatal mental and behavioral health care outcomes for patients belonging to medically underserved populations who receive treatment from such students. 

(j) Not later than 4 years after the date of enactment of this section, the secretary shall 

prepare and submit to the governor, the clerks of the house of representatives and the senate, and make publicly available on the department’s website a report on the effectiveness of the grant program under this section, including information about:

(1) recruiting students from medically underserved populations;

(2) increasing the number of mental or behavioral health care providers specializing in perinatal mental health conditions or substance use disorders from medically underserved populations; 

(3) increasing the number of mental or behavioral health care providers specializing in perinatal mental health conditions or substance use disorders working in health professional shortage areas; and 

(4) increasing the number of mental or behavioral health care providers specializing in perinatal mental health conditions or substance use disorders working in areas with significant racial and ethnic disparities in perinatal health outcomes, as well as perinatal health care deserts and rural areas, to the extent such data are available.

(5) supporting and increasing the number of providers with past lived-experience with perinatal mental health conditions or substance use disorders.

Section 2. Chapter 6A of the General Laws is hereby amended by inserting after section 16DD the following section:-

Section 16EE. (a) As used in this section, the following words shall have the following meanings:

“Culturally congruent care”, care that is in agreement with the preferred cultural values, beliefs, worldview, language and practices of the health care consumer. 

“Eligible entity”, a: (1) community-based organization serving perinatal individuals, including organizations serving individuals from medically underserved populations and other underserved populations; (2) non-profit or patient advocacy organization with expertise in mental and behavioral health of perinatal individuals; (3) maternity care provider; (4) mental or behavioral health care provider who treats mental health conditions or substance use disorders in perinatal individuals; (5) public health agencies, including the department of public health or a local public health department; (6) federally recognized Indian tribe or tribal organization; (7) non-profit organizations with expertise in early relational health; (8) non-profit or community organizations serving perinatal individuals experiencing pregnancy or infant loss; or (9) public health agencies or non-profit or community organizations providing home visiting services for perinatal individuals; or (10) domestic violence shelter.

“Freestanding birth center”, a health facility: (1) that is not a hospital; (2) where childbirth is planned to occur away from the pregnant person’s residence; (3) that is licensed or otherwise approved by the commonwealth to provide prenatal labor and delivery or postpartum care; and (4) that complies with other requirements established by the commonwealth relating to the health and safety of individuals provided services by the facility. 

“Maternity care provider”, a health care provider who: (1) is a physician, physician assistant, certified nurse-midwife, nurse practitioner or clinical nurse specialist; and (2) has a focus on maternal or perinatal health. 

“Medically underserved populations”, federally designated populations that have too few primary care providers, high infant mortality, high poverty or high elderly population. 

“Mental or behavioral health care provider”, a health care provider in the field of mental or behavioral health, including substance use disorders, acting in accordance with the laws of the commonwealth. 

“Perinatal”, the period of time from pregnancy up until one year following birth.

“Perinatal individuals”, biological parents, birthing persons, adoptive parents, foster parents, and any other individuals involved in the gestation, birth, and custodial care of an infant.

“Secretary”, the secretary of health and human services. 

(b) The secretary shall establish a program to award grants to eligible entities to address mental health conditions and substance use disorders with respect to perinatal individuals, with a focus on medically underserved populations. 

(c) To receive a grant under this section an eligible entity shall submit to the secretary an application at such time, in such manner and containing such information as the secretary may require, including how the entity will use funds for activities described in subsection (e) that are culturally congruent. 

(d) In awarding grants under this section, the secretary shall give priority to an eligible entity that: 

(1) is partnering, or will partner, with a community-based organization to address mental health conditions or substance use disorders in perinatal individuals described in subsection (a); and 

(2) is operating in an area with high rates of adverse perinatal health outcomes or significant racial or ethnic disparities in perinatal health outcomes. 

(e) An eligible entity that receives a grant under this section shall use funds for the following: 

(1) establishing or expanding maternity care programs to improve the integration of perinatal mental health and behavioral health care services into primary care settings where perinatal individuals regularly receive health care services; 

(2) establishing or expanding group prenatal care programs or postpartum care programs; (3) expanding existing programs that improve mental health and behavioral health for perinatal individuals, with a focus on perinatal individuals from medically underserved populations; 

(4) providing services and support for perinatal individuals with perinatal mental health conditions and substance use disorders, including referrals to addiction treatment centers that offer evidence-based treatment options;

(5) addressing stigma associated with perinatal mental health conditions and substance use disorders, with a focus on medically underserved populations; 

(6) raising awareness of warning signs of perinatal mental health conditions and substance use disorders, with a focus on perinatal individuals from medically underserved populations; 

(7) establishing or expanding programs to prevent suicide or self-harm among perinatal individuals; 

(8) offering evidence-aligned programs at freestanding birth centers that provide perinatal mental and behavioral health care education, treatments, and services, and other services for perinatal individuals; 

(9) establishing or expanding programs to provide education and training to maternity care providers with respect to identifying potential warning signs for mental health conditions or substance use disorders in perinatal individuals, with a focus on individuals from medically underserved populations. In the case where such providers identify such warning signs, offering referrals to mental or behavioral health care professionals; 

(10) publicizing information about health care providers who treat perinatal mental health conditions and substance use disorders; 

(11) establishing or expanding programs in communities to improve coordination between maternity care providers and perinatal mental or behavioral health care providers who treat mental health conditions and substance use disorders in perinatal individuals, including through the use of toll-free hotlines; 

(12) establishing or expanding programs with services for individuals suffering pregnancy or infant loss;

(13) establishing or expanding programs with services to address the perinatal risks of domestic violence;

(14) establishing or expanding programs that provide home visits to address perinatal  mental health conditions and substance use disorders;

(15) establishing or expanding programs that improve early relational health;

(16) carrying out other programs aligned with evidence-based practices for addressing mental health conditions and substance use disorders for perinatal individuals, with a focus on medically underserved populations; or

(17) other similar programs.

(f) The period of a grant awarded to an entity under this section shall be up to 5 years. . 

(g) The secretary shall provide, directly or by contract, technical assistance to entities seeking or receiving a grant under this section on the development, use, evaluation and post-grant period sustainability of the program proposed, established or expanded through the grant. The secretary shall advertise or promote technical assistance for potentially eligible programs to raise awareness about the grants and the technical assistance, particularly to encourage small providers to apply.

(h) An eligible entity that receives a grant under this section shall submit annually to the secretary, and make publicly available, a report on the activities conducted using funds received through a grant under this section. Such reports shall include quantitative and qualitative evaluations of such activities, including the experience of perinatal individuals who received health care through such grant. 

(i) Not later than the end of each fiscal year that grants are awarded, the secretary shall submit to the governor, the clerks of the house of representatives and the senate, and make publicly available on the department’s website a report that includes:

(1) a summary of the reports received under subsection (h); 

(2) an evaluation of the effectiveness of grants awarded under this section; 

(3) recommendations with respect to expanding coverage of evidence-based screenings and treatments for perinatal mental health conditions and substance use disorders; and 

(4) recommendations with respect to ensuring activities described under subsection (e) continue after the end of a grant period.

Section 3. The executive office of health and human services in consultation with the executive office of labor and workforce development shall promulgate regulations for the implementation of sections 16DD and 16EE within 90 days of enactment.