Mental health highlights of the 2023 legislative session
Despite contentions during the 2023 legislative session on issues like tax cuts and education, legislators and Gov. Kevin Stitt largely agreed on important reforms and policies related to mental health and substance use.
The 2023 regular session concluded May 26, with the Legislature available through June 30 for the Senate and July 31 for the House. These extra days allow for additional business that may include overriding vetoes and passing special session bills that remain unheard.
Highlights of the session include:
- Passage of Healthy Minds' four priority bills, which will greatly increase access to care
- Creation of new workforce development funds to recruit and retain behavioral health professionals to Oklahoma
- Adoption of critical policies to improve substance use treatment and overdose prevention
- A 5.6% budget increase for the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
Healthy Minds’ priorities
Access to care
Two bills approved by the Legislature and signed by Gov. Stitt are the result of Healthy Minds’ landmark study of commercial insurance networks in Oklahoma. SB 254, authored by Sen. Jessica Garvin and Rep. Jeff Boatman, requires commercial insurers to arrange behavioral health care for plan subscribers if they cannot find timely care on their own. Consumers cannot pay more for services provided by an out-of-network clinician than those provided by an in-network provider if an insurer arranged the care.
SB 442, by Sen. John Michael Montgomery and Rep. Chris Sneed, directly takes on the issue of “ghost networks” – insurance networks that appear robust on paper but are in fact made up of inaccessible providers. Incorrect information in directories of in-network providers significantly hampers access to mental health for consumers who rely on provider directories when choosing a health plan without knowing the extent of their inaccuracies.
While not a direct result of Healthy Minds' work, a related bill by Sen. John Michael Montgomery and Rep. Chris Sneed, SB 557, requires that insurers utilize claims reviewers who have mental health and substance use disorder insurance treatment experience when analyzing claims.
Oklahoma faces workforce shortages across industries, with the lack of mental health providers approaching near-crisis levels. Legislators developed multiple solutions to this behavioral workforce challenge. Rep. Cynthia Roe and Sen. Paul Rosino's HB 2175 and Rep. Jeff Boatman and Sen. John Haste's HB 2036 create the Behavioral Health Workforce Development Fund and the Oklahoma State University Medical Authority Behavioral Health Workforce Development Fund, respectively. These funds aim to expand Oklahoma’s behavioral health workforce by investing in early-career pathways, retaining existing professionals, and supporting clinicians who want to advance their careers.
One way to maximize Oklahoma’s behavioral health workforce is to enable practitioners to utilize their licenses to the fullest. SB 444, by Sen. Montgomery and Rep. Miller, activates medical billing codes that reimburse primary care doctors, psychiatrists, and mental health practitioners who collaborate to treat patients. This model, known as Collaborative Care, allows primary care doctors to expand their service offerings in an office that is already familiar to their patients. Primary care providers are uniquely positioned to identify risk for suicide and intervene: among people who died by suicide, 50% had seen a primary care provider in the last month of their life. In this model, psychiatrists can support primary care doctors and consult on cases, and mental health practitioners can support both positions while also often providing therapy services right down the hall.
Other mental health bills
Veterans mental health
Legislators recognized Oklahoma’s high rate of veteran suicide by passing HB 1036, authored by Rep. Jacob Rosecrants and Sen. Chris Kidd. The bill creates the Veteran Suicide Prevention Task Force to recommend prevention strategies that reduce the number of veteran suicides in Oklahoma. A related bill, SB 234, by Sen. Michael Bergstrom and Rep. Jay Steagall, declares Sept. 22 as Veteran Suicide Awareness Day.
Providers moving to Oklahoma must delay practicing until they are licensed in the state. SB 575, by Sen. Blake Stephens and Rep. Randy Randleman, enacts the Counseling Compact into law and requires the governor to enter a compact on behalf of the state. The Counseling Compact facilitates the interstate practice of licensed professional counselors while also protecting public health and safety through state regulations.
Legislators passed and Gov. Stitt signed a measure that scales back some of the criminal justice reforms voters approved through State Question 780 in 2016. HB 2153 re-criminalizes drug possession as a felony after the fourth conviction within a 10-year period. It also provides an option for for the defendant to pursue a diversion program for the second and third charges within a 10-year period. These changes do not apply to marijuana possession cases.
Rising rates of methamphetamine and co-use with opioids have resulted in a marked increase in overdose deaths during the past few years. Several measures aim to decrease overdose. A slate of bills primarily authored by Sen. Paul Rosino including SB 710 (with Rep. Baker), SB 711 (with Rep. Boatman), and SB 712 (with Rep. McEntire) increase access to opioid antagonists, or overdose reversal medication, in schools, jails, and hospitals. Gov. Stitt vetoed SB 711 and SB 712, but the Legislature overrode both vetoes. HB 1987, by Rep. Dollens and Sen. Rader, removes fentanyl test strips from the list of drug paraphernalia so people who use drugs can test them to ensure there is no fentanyl. Finally, HB 2424, by Rep. Stan May and Sen. Blake Stephens, allows pharmacies to dispense or sell any opioid antagonist approved by the FDA without a prescription if a pharmacist dispenses it. This increases over-the-counter access to lifesaving medication.
Transporting people to care
Within SB 12X, which creates and funds the Mental Health Transport Revolving Fund, the Legislature made changes to procedures for transporting a person who needs mental health treatment. These changes require law enforcement officers to transport individuals for initial assessment when a facility is within 30 miles of the officer’s operational center. Facilities and ODMHSAS must arrange other transportation when needed. When a consumer needs transportation, Sen. Howard and Rep. Roe’s SB 286 prohibits ODMHSAS or their contractors from using mechanical restraints during transport. HB 2746, by Rep. Miller and Sen. Kirt, allows for the transportation of a ward – someone under an order of guardianship – to an inpatient facility with a court order.
Gov. Stitt vetoed more than 50 bills this session. One of those vetoes was of SB 552, by Sen. Haste and Rep. Worthen. The bill would have changed Oklahoma’s system for evaluating and restoring the competency of criminal defendants. The veto message reasoned that county jails were not yet ready to provide restorative treatment and may not be the right environment. The governor’s veto message urged stakeholders to work together to find solutions to meet the needs of those who need services and the system at large.
There are several dormant bills that the Legislature may continue to act on next year. Those bills include measures to increase access to mental health services in schools (HB 2827), increase mental health services available to teachers (HB 1424), create a licensing compact for psychologists (HB 1345), make it easier to open psychiatric and substance use treatment facilities (HB 1960 and HB 2276), and improve mental health awareness among law enforcement officers (SB 379 and HB 2157).
Appropriations and funding
Oklahoma’s next fiscal year begins on July 1, 2023, and runs through June 30, 2024. With a total of $12.8 billion appropriated by legislators, the Oklahoma Department of Mental Health and Substance Abuses Services (ODMHSAS) is set to receive just over $359 million, an increase of 5.6% over the previous fiscal year. The governor did not sign the bill but allowed it to become law without his signature. Although ODMHSAS is not the only state agency receiving funding for mental health, it is the agency dedicated to the treatment and prevention of mental health and substance use issues across the state.
The largest contributors to ODMHSAS’ budget increase are funds for the Mental Health Transport Revolving Fund (SB 12X) and money generated from the cost savings because of State Question 780. Although SB 27X did not pass the House, the $12.5 million set to be allocated to the County Community Safety Investment Fund will go toward mental health and substance use treatment programs, pretrial diversion programs, employment programs, education programs, or housing programs as set out in SB 844.