Update, April 26, 2023: HB 520 did not pass this session. While it sailed through the House with a 163-3 vote, an amended version of the bill did not receive a vote in the Senate Health and Human Services Committee. HB 520 is expected to be taken up again by the Senate next year.

The Gist

A wide-ranging mental health bill filed by a bipartisan group of legislators last week aims to address behavioral health professions’ workforce challenges, barriers for those seeking treatment, the flow of information about patients among agencies, and a host of issues not addressed in last year’s landmark Mental Health Parity Act.

What’s Happening

In a debut reminiscent of the high regard paid by lawmakers to HB 1013, the bipartisan mental health parity bill championed by late Republican House Speaker David Ralston last year, the sequel to that bill, HB 520, was announced at a press conference by his successor, Republican House Speaker Jon Burns, flanked by the bill’s bipartisan co-sponsors.  

“Today we begin the next chapter of our ongoing commitment to better mental health care in Georgia,” said Burns, who represents Newington. 

The 51-page bill includes several provisions designed to address the longstanding behavioral health workforce shortage in the state, including recruitment and retention challenges. 

HB 520 expands a student loan forgiveness program that was set up last year for people pursuing training in behavioral health professions to now include debt relief for current practitioners.

It also seeks to streamline and modernize the licensing process for many behavioral health professional licensing boards, which are currently backlogged. That would include putting more of the application and review process online, and waiving some experience requirements for providers who come to Georgia with licenses from other states and foreign countries.

“We know that workforce is the biggest challenge for mental health service providers and for families in crisis. This is true for businesses and all kinds of state, county and social service providers. The expansion of the loan forgiveness program and the need to address barriers in the licensing boards are very high priorities,” said Rep. Mary Margaret Oliver, D-Decatur, one of the bill’s co-sponsors, who also serves on the Behavioral Health Reform and Innovation Commission (BHRIC), which developed both bills. 

Gaps in the ways that Medicaid covers behavioral health care (which includes mental health care and treatment for substance abuse and addiction recovery) have been problematic for many patients and providers in Georgia. The bill mandates that by Jan. 1, 2024, Medicaid coverage must include reimbursement for psychological diagnoses; care for justice-involved youth ages 18 to 21; psychiatric and behavioral therapy for foster youth to allow them to stay in a “flexible home setting”; and a look at how Medicaid covers the diagnosis of people on the autism spectrum. 

The bill also requires the Department of Community Health (DCH) to submit a waiver request to the federal Center for Medicare and Medicaid Services to allow up to 2% of total Medicaid funds received by the state to provide housing, employment, food and education services to Medicaid recipients.

The bill does not address disparities in Medicaid reimbursement rates to providers. A study by DCH released in January showed that rates for some behavioral health providers in Georgia are lower than in some other states. But Oliver, who sits on the House Appropriations Committee, said the Legislature will address those issues. 

“The mental health bill is going to be accompanied by appropriations in a variety of ways,” Oliver said. “The Medicaid rate package is flowing through the budget process and increases to service providers’ pay reimbursement will be happening partially in fiscal year 2024, which begins, as you know, July 1.”

Much of the mental health bill is forward-looking, setting up ways for government agencies, law enforcement, providers and the private sector to study existing challenges in access to care and to collaborate on solutions.

The bill directs the Department of Behavioral Health and Developmental Disabilities (DBHDD) to develop a single shared definition of key terms including “severe mental illness,” “homeless individual” and “recidivism” in collaboration with the BHRIC, the Department of Corrections, the Department of Juvenile Justice, the Department of Community Supervision, law enforcement and other local and state agencies, to ensure accurate data collection on patients and consistency in how they are assessed and evaluated.

“This is really important because the state wants to use data to inform where we need to fix the system,” says Kim Jones, executive director of the National Alliance on Mental Illness (NAMI) in Georgia. “For years, the state has been putting Band-Aids on the system, spending money and trying to fix it without really looking at the hardcore data. And if we’re going to use data, everybody needs to be working off the same definition of what a serious mental illness is, so it’s apples to apples.”

Georgia is ranked 48^th in the U.S. for access to mental health care, according to Mental Health America, a nonprofit advocacy and research organization. Reasons for the low ranking include a deficit of behavioral workforce professionals to meet demand, and a lack of available beds in psychiatric hospitals and other facilities for people experiencing mental and behavioral health crises.

The bill sets up two task forces: One is concerned with building “a continuum of care to ensure access and appropriate use of the behavioral health system and the criminal justice system”; the other task force will examine issues relating to the impact of behavioral health on the state’s homeless population.

The issues at the heart of both task forces are intertwined, said Jones, who also serves on the BHRIC.

“We know here in Georgia that people with mental health conditions often end up in jail, unfortunately, because of the lack of services at the community level,” she said. “Many of them get into severe mental health crises and then have interactions with police. At that point, they’re often taken to jail instead of getting taken to care. When they’re released, if they still don’t receive appropriate care or support, they end up homeless.” 

Often referred to as “familiar faces” in the criminal justice community, these individuals are getting special attention in HB 520, which calls for a statewide public-private partnership to serve as a clearinghouse for best practices, information and resources to support them.

Rep. Todd Jones, R-South Forsyth, the co-sponsor of the bill, while speaking to behavioral health advocates and reporters in a video town hall last week, said, “That small part of the population with serious mental illness that is taking up so much of the state’s resources,” are  people who are going from health crisis to incarceration to homelessness, and are caught in a “triangle” pattern that he hopes to break. 

Jones said a study on current access to inpatient behavioral health beds and crisis services, included in the bill, will be an important step in helping the state figure out how to increase capacity in psychiatric facilities.  

Jones said he is frequently approached by people distressed because no treatment facility will take their loved one. “There is not a week that goes by — and I can speak for Representative Oliver and myself — when we literally have at least one or two Georgians contact us personally and say, ‘My son, my daughter, my cousin, what am I supposed to do? They can’t find a bed,’” Jones said.

Securing more affordable housing and wraparound services for people who are in treatment, in recovery or reentering society after being incarcerated is also a priority in the bill. 

It amends laws relating to housing authorities and low-income rental properties to make it illegal to refuse to rent to a person who has been convicted of one or more criminal offenses, unless their offenses are “related to their fitness as a tenant.”

The task force to be created around behavioral health and homelessness would identify all state and local agencies, nonprofit organizations, charities and others providing services and expending funds to help the homeless population. It would also make recommendations on how to better coordinate all the parties to share data on the people they serve, and to collaborate on funding strategies and services.   

“What the bill does is outline a work plan for the new [DBHDD] commissioner [Kevin Tanner], that allows him, if it’s in the statute, to get specific money,” said Oliver. “There’s some private philanthropic interests that want to help us.  Through this plan we can alert the philanthropic community that … we’re doing studies with a four- to six-month timetable, and we need their participation and their support financially.”

Oliver said the task force will also provide much-needed clarity around homeless relief funds.

“I’m asked all the time by colleagues, ‘Where’s the money coming from? How many different streams of finances are there?’ And because … much of the homeless relief money is federal money that goes through DCA [Department of Community Affairs], that’s a hard question to answer. So it’s feasible for us to do this short-term work plan, understand all the funding streams available, and have a six-month opportunity to implement a plan.”

Jeff Breedlove, communications and policy chief at the Georgia Council for Recovery, said, “This legislation includes a great combination of practical measures to build the behavioral health workforce today, as well as visionary elements that will carry us forward to make sure peers are getting the services we need and deserve.”  He also noted that “peers” are people who are now experiencing “or have lived in addiction or a mental health condition, or are in recovery.” He counts himself among them.

Breedlove said that providing loan cancellation to current practitioners, for instance, “will have an immediate effect. Georgians who are dedicating their professional lives to serve others are going to get the ability to get some financial relief for themselves and their families.  And that’s going to motivate them to want to stay in service to me and my community.” 

He said he was happy to see that HB 520 adds two peer support specialists to the Behavioral Health Reform and Innovation Commission, bringing its membership up to 26. HB 520 also  directs the BHRIC to develop a plan to expand the use of forensic peer monitors, people in long-term recovery who are certified to help others who are actively dealing with mental health and addiction issues.

Why It Matters

Georgia is ranked 48^th in the U.S. for access to mental health care, according to Mental Health America, a nonprofit advocacy and research organization. Reasons for the low ranking include a deficit of behavioral workforce professionals to meet demand, and a lack of available beds in psychiatric hospitals and other facilities for people experiencing mental and behavioral health crises.

Earlier this month, DBHDD Commissioner Kevin Tanner reported to the House Appropriations Human Resources Subcommittee that 15% of adult crisis beds and 28% of children and adolescent beds managed by the state were “offline” in January due to “severe staffing shortages.” Tanner said behavioral health crisis centers are experiencing high turnover rates among doctors, psychologists and nurses, who remain difficult to recruit and retain, due to current compensation levels.

And getting newly trained therapists and other behavioral health professionals into service is hindered by inefficiencies at some of the state licensing boards within the secretary of state’s office. Many of the licensing boards are understaffed and using outdated technology and practices, including handwritten application forms, said Oliver. This has resulted in a backlog of hundreds or thousands of applications at some licensing boards.

The Georgia Composite Board of Professional Counselors, Social Workers, Marriage & Family Therapists had a backlog of 2,554 applications as of the end of January. Among members of the Licensed Professional Counselors Association seeking credentials, about 400 people were still waiting for their applications to be processed by the composite board, said Jones. According to the Association, most applicants in 2022 waited from two months to more than a year to receive their licenses. 

“So with that backlog, we have 400 [qualified] people ready to go, waiting to meet with people who need their help, but they can’t because of the licensing issue,” said Jones.

What’s Next

HB 520 is expected to go to the House Public Health Committee for consideration this week, and then to receive a floor vote in the House. It must pass out of the House by “Crossover Day,” March 6, to be considered by the Senate.

If you or someone you know is in crisis, please call the 988 Suicide and Crisis Lifeline, which has trained listeners standing by and ready to help. Visit 988lifeline.org for crisis chat services or for more information.

Related:

https://stateaffairs.com/georgia/qa-kevin-tanner-talks-improving-mental-health-access-in-georgia/

https://stateaffairs.com/georgia/mental-health-georgia-depression-bill-lawmakers/

Have questions, comments or tips about Georgia’s behavioral health system? Contact Jill Jordan Sieder on Twitter @JOURNALISTAJILL or at [email protected].

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Header photo: House Speaker Jon Burns announces the new mental health bill, HB 520, along with its bipartisan sponsors and supporters Todd Jones, Mary Margaret Oliver, James Beverly, Sharon Cooper, Kim Schofield and Gregg Kennard. (Credit: Office of the House of Representatives)