2015 Laws Took Effect in October
The MPS Legislative Committee took action on the following bills that were enacted during the 2015 General Assembly. All three become effective October 1, 2015. Please click on the links for details.
HB 367- Public Health – Maryland Behavioral Health Crisis Response System – This bill altered the name of the Mental Health Crisis Response System (MHCRS) to be the Behavioral Health Crisis Response System (BHCRS) and expands the content and scope of authorized services. MPS considered this bill and submitted testimony in support because of the increase in services. (Public Act 416)
SB 157- Consultation, Diagnosis, and Treatment of Mental and Emotional Disorders – Consent by Minors – This bill established that a minor who is age 16 or older has the same capacity as an adult to consent to consultation, diagnosis, and treatment of a mental or emotional disorder by a “health care provider.” The bill defines “health care provider” as an individual licensed under the Health Occupations Article and acting within the scope of the individual’s license to diagnose and treat mental and emotional disorders (previously limited to physician or psychologist). MPS supported this bill as an appropriate expansion of access to mental health care. (Public Act 327)
SB 195- Mental Health – Voluntary and Involuntary Admissions – Assent and Certification by Psychiatric Nurse Practitioners – Although the MPS opposed SB195, it passed. This bill allows for physicians and nurse practitioners to assent to voluntary and involuntary admissions of a minor for treatment of a mental disorder. We opposed, but were advised early on that this bill was going to pass. NPs already were authorized to do Emergency Petitions which may result in involuntary admission of the individual. We did not strongly lobby against given that Senator Eckhardt (sponsor) is a perennial ally for MPS and the bill had strong support. (Public Act 330)
2015 MPS Legislative Session Review
The Maryland General Assembly ended at midnight on April 13. This year 2,248 bills and resolutions were considered by the General Assembly; the MPS reviewed 98 bills, taking positions on 12 of them and testifying on 6. For details on the bills below, use the following link to the Home Page for the Maryland General Assembly http://mgaleg.maryland.gov/webmga/frm1st.aspx?tab=home. In the space beside Find Legislation By Number, type in either HB and the bill number or SB and the bill number. Click the arrow to go to all of the information related to that particular bill.
Starting off with HB3, the Prescription Drug Monitoring Program would have required physicians to query the PDMP (e CRISP) program before prescribing or dispensing any medications. It received an unfavorable report by Health and Government Operations.
Although the MPS opposed SB195, it passed. This bill allows nurse practitioners to assent to voluntary and involuntary admissions of a minor for treatment of a mental disorder. SB162/HB451 was to establish a task force to study regulation of Teletherapy. The MPS opposed these bills because there was already a task force for Telemedicine and there was concern that two different set of rules could be established. Both bills were withdrawn. Lynette’s Law, SB617/HB908 as proposed, was to prohibit counselors and therapists from engaging in sexual activity within two years of treatment. The bill received an unfavorable report from both the House and the Senate. The Death with Dignity Act, SB607/HB1021 had multiple flaws from the perspective of psychiatry: lack of a psychiatric assessment, no mechanism to challenge a competency assessment, and lack of notification of the patient’ family’s regarding intent thereby possibly preventing a capacity assessment. The bill stalled in committee without a vote, and an interim workgroup may be convened to discuss aid with dying legislation.
Nurses Practitioners were able to secure significant changes to their authority to practice with SB723/HB999 that allows new NPs to have a mentoring relationship with a doctor or experienced NP for at least 18 months, and specifies that NPs who do not collaborate would be subject to discipline for their failure to do so. The mentoring relationship was proposed by MedChi, based on the assertion that the attestation requirement is not enforced.
The assignment of health insurance benefits, which was to sunset this year, was made permanent in SB92/HB230. SB90/HB293 addressed Mental Health Directives that allow individuals to document their preferences regarding future psychiatric treatment. Maryland law provided for the revocation of those instructions at any time. While the original bills allow for a 72 hour window for revocation, this was amended to allow the individual, when making these Mental Health Directives, to waive the right to revoke during periods of incapacity.
SB157/HB662 passed and will increase access and remove barriers for 16 and 17 year olds to consent to treatment with any health care provider who is licensed and certified to diagnose and treat mental and emotional disorders. The Task Force to Study Maternal Mental Health, SB74 passed. The report will be presented to the General Assembly on or before December 31, 2015. The perennial child abuse and neglect-failure to report received an unfavorable report in the Senate and was withdrawn in the House. HB534 was supported by the MPS with testimony. This legislation would have specified a procedure that provides for coverage of the brand name prescription drugs prescribed for the treatment of a mental disease if the equivalent generic drug has been ineffective.
Other legislation of interest:
SB834/HB990 was a comprehensive bill to address issues related to network adequacy and prescription coverage under Qualified Health Plans on the Exchange. Although it did not pass, the director of the exchange is convening a workgroup to study and make recommendations related to network adequacy.
SB586/HB1010 would have required insurance carriers to submit annual reports certifying and outlining how their plans comply with state and federal parity laws. The MPS supported this legislation and worked with APA, which sent a letter in support. However, continued opposition from insurance carriers and the Maryland Insurance Administration prevented the passage of these bills. The Senate Finance Committee Chairman requested that the Insurance Commissioner conduct market surveys to verify compliance.
HB1109 and SB174/HB1262 provided further framework for the continued integration of services for individuals with mental health and substance use disorders. SB174 merges the Maryland Advisory Council on Mental Hygiene and the State Drug and Alcohol Abuse Council into a more inclusive Behavioral Health Advisory Council.
In HB72 (The Budget Reconciliation and Financing Act of 2015) language was added that extends the timeframe for renewing CDS licensure from two to three years, consistent with the timeframe for DEA licensure.
The final days of the 2015 Session had a budget division between the Democratically controlled House and Senate and Governor Larry Hogan. Governor Hogan’s budget was cut and the General Assembly wanted to have the deleted monies used for education, healthcare expenditures including an improvement to Medicaid reimbursement rate for doctors, and State employee COLA increases, as well as the restoration of some monies for community mental health provider rates, psychiatrist evaluation and management rate cuts, and expansion of substance disorder treatment for individuals with heroin addiction. The Governor, so far, has returned these monies that were cut to the State’s general fund and may or may not appropriate them for the priorities of the General Assembly. The monies may remain unspent.