The Maryland General Assembly concluded its 2018 legislative session at midnight on April 9th. With an election on the horizon, this session saw a record number of bills introduced; 3,101 bills to be precise. The Maryland Psychiatric Society kept very active this session. MPS analyzed over 50 pieces of legislation. The legislative wrap-up below highlights MPS’s priority bills for this session.
Bills MPS Supported
SB 947/HB 1635, sponsored by Senator Jim Rosapepe (D – Montgomery County) and Delegate Dan Morhaim (D – Baltimore County), prohibit a hearing officer from ordering the release of an individual who meets the requirements for involuntary admission on the grounds that the individual was kept at an emergency facility for more than 30 hours in violation of law. This bill will take effect October 1, 2018.
The General Assembly enacted a ban on the controversial practice of conversion therapy for minors. Under SB 1028/HBl 902, entitled the Youth Mental Health Protection Act and introduced by Senator Richard Madaleno (D–Montgomery County) and Delegate Bonnie Cullison (D-Montgomery County), “conversion therapy” occurs when a licensed mental health or child care practitioner provides services that seek to change an individual’s sexual orientation or gender identity, and includes any effort to change the behavioral expression of an individual’s sexual orientation; change gender expression; or eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.
Opponents to the bill contend that the legislation infringes on certain forms of mental health counseling, particularly religious-based counseling, and may drive individuals to seek similar services from unlicensed practitioners. Proponents of the ban counter that conversion therapy is based on questionable scientific validity and on the false assumption that homosexuality is a disorder and thus needs therapy. Proponents further contend that such therapy can be very harmful to participating individuals contributing to anxiety, depression, and the possible attempts at self-harm.
After lengthy and emotional debate, the bill passed both houses with overwhelming, bipartisan support. The ban becomes law October 1, 2018.
SB 835, sponsored by Senator Richard Madaleno (D – Montgomery County) as amended and passed establishes a Collaborative Care Pilot Program, administered through the Maryland Department of Health (MDH). MDH must select up to three sites at which a collaborative care model must be established over a four-year period. The sites selected must be adult or pediatric non-specialty medical practices or health systems that serve a significant number of Medicaid enrollees. To the extent practicable, one of the sites must be located in a rural area of the State. Further, MDH must apply for an amendment to the State’s § 1115 HealthChoice Demonstration Waiver if necessary to implement the pilot program. By November 1, 2023, MDH must report to the Governor and the General Assembly on the pilot program. For fiscal 2020 through 2023, the Governor must include in the annual budget an appropriation of $550,000 for the pilot program. The bill takes effect July 1, 2018, and terminates June 30, 2024.
Sponsored by Senator Kathy Klausmeier (D – Baltimore County) and Delegate Sheree Sample-Hughes (D – Dorchester & Wicomico Counties), SB 977/HB 1517 mandate that the Behavioral Health Administration’s (BHA) annual report must include, for children and young adults according to age group and jurisdiction, the following information:
(1) the number and percentage who, during the reported year, were eligible for and used specified public behavioral health services;
(2) the total expenditure and expenditure per individual for specified services;
(3) the total cost per individual for all behavioral health services provided to the individual;
(4) the average length of time individuals spent in emergency rooms pending psychiatric inpatient hospitalization or waiting for placement in a residential treatment center;
(5) the number of 30-day readmissions at specified facilities;
(6) the average length of stay at specified facilities; and
(7) the number of discharges and residents at residential treatment centers.
In addition, the Social Services Administration (SSA) must include in it’s annual report the following information:
(1) the total number of voluntary placement agreements for children and young adults in the State that were approved, denied, and requested for specified reasons;
(2) the reason for any denials; and
(3) the type of initial placements for approved agreements. The report must group the required information into specified regions.
Both annual reports must be prepared in consultation with interested stakeholders and submitted to the Governor and the General Assembly. The bills take effect July 1, 2018.
SB 703/HB 1092, sponsored by Senator Kathy Klausmeier (D – Baltimore County) and Delegate Sandy Rosenberg (D – Baltimore City), establish a Behavioral Health Crisis Response Grant Program in the Maryland Department of Health (MDH)that will competitive grants to local behavioral health authorities to establish and expand behavioral health crisis response programs and services that (1) serve local behavioral health needs for children, adults, and older adults; (2) meet national standards; (3) integrate the delivery of mental health and substance use treatment; and (4) connect individuals to appropriate community-based care in a timely manner on discharge. Distributed funds may be used to establish or expand specified programs and services, including mobile crisis teams, on-demand walk-in services, and crisis residential beds. Grant funds must be used to supplement, and not supplant, any other funding for behavioral health crisis response programs and services.
Under the bill, the Governor must include the following appropriations in the State operating budget for the program: (1) $3.0 million for fiscal 2020; (2) $4.0 million for fiscal 2021; (3) $5.0 million for fiscal 2022; and (4) $8.0 million for fiscal 2023. The bill takes effect July 1, 2018.
SB 704/HB 1652, sponsored by Senator Kathy Klausmeier (D – Baltimore County ) and Delegate Sheree Sample-Hughes (D – Dorchester & Wicomico Counties), require that, if the Maryland Department of Health (MDH) specifies by regulation the types of health care providers eligible to receive reimbursement for Medicaid telemedicine services, the types of providers must include psychiatrists providing assertive community treatment (ACT) or mobile treatment services (MTS) in a home or community-based setting. The bill also specifies that ACT and MTS, for purposes of reimbursement and any fidelity standards established by MDH, are equivalent to the same health care service when provided through in-person consultation. The bill takes effect July 1, 2018
Delegate Geraldine Valentino-Smith (D-Prince George’s County) introduced HB 1302, which establishes procedures by which specified health professionals, a law enforcement officer, or any other interested person may petition the court to obtain an “extreme risk prevention order” on a respondent who poses an immediate and present danger of causing personal injury to themselves, the petitioner, or another by possessing a firearm and that the extreme risk prevention order is necessary to prevent personal injury to the respondent, the petitioner, or another.
A petition may be filed with district court, circuit court, or, when neither court is open for business, a law enforcement agency for presentation to a circuit or district court duty judge. A petitioner who, in good faith, files a petition for an extreme risk prevention order is not civilly or criminally liable for filing the petition. Similar to the protective order process, the court may issue temporary or final extreme risk prevention orders. A person who fails to comply with the provisions of a temporary or a final extreme risk prevention order is guilty of a misdemeanor and subject to maximum penalties of a $1,000 fine and/or 90 days imprisonment for a first offense. For a second or subsequent offense, the court may impose a $2,500 fine and/or one year imprisonment. Finally, a law enforcement officer must arrest with or without a warrant and take into custody a person who the officer has probable cause to believe is in violation of a temporary or a final extreme risk prevention order in effect at the time of the violation.
The bill eventually passed both chambers on Sine Die after the House accepted the lengthy Senate amendments to the bill. The bill will become effective on October 1, 2018.
SB 104/HB 1479, sponsored by Senator Wayne Norman and Delegate David Fraser-Hildalgo (D- Montgomery County), would have prohibited a “critical incident stress management team member” from (1) disclosing any communication or information received or acquired in confidence from a law enforcement officer, correctional officer, or emergency responder in the course of providing “critical incident stress management services” or (2) being compelled to testify in any administrative proceeding or any investigation by a governmental unit about any such communication or information The bill would have established a similar privilege for an individual who participates in or is present during the provision of critical incident stress management services. Sadly, Senator Norman passed away during the 2018 session and his bill was left without a sponsor. Delegate Fraser-Hildalgo withdrew his bill seemingly out of respect for Senator Norman who was the driving force behind this bill.
Senator Stephen Waugh (R – Calvert & St. Mary’s Counties) sponsored SB 211, which would have required the regulations governing behavioral health programs to include a provision authorizing a behavioral health program located in a federally designated health professional shortage area to satisfy any regulatory requirement that the medical director be on site through the medical director’s use of telehealth. The bill was assist small business outpatient mental health centers in federally designated shortage areas to be able to more easily recruit and retain psychiatrists to serve as medical directors. The bill was passed out of its chamber of origin, the Maryland Senate. On the final day of session, the House Health and Government Operations Committee gave the bill a favorable vote. The bill failed to pass, however, because the entire House chamber was unable to cast a vote on the bill.
House Bill 1577: Human Services – Family Navigation Services – Provision and Funding – Withdrawn by Sponsor
HB 1577, sponsored by Delegate Clarence Lam (Baltimore & Howard Counties) would have required the Governor’s Office for Children (GOC) to fund family navigation services, which were to be provided by family navigators as determined by local management boards (LMBs). A “family navigator” was defined as a parent or caregiver of a child or youth with behavioral health needs or developmental disabilities who is familiar with State and local resources and has received training to support, educate, and assist other parents and caregivers. GOC must fund family navigation services to support parents and other caregivers of children or youth with behavioral health needs or developmental disabilities and address one or more of the following priorities: (1) reducing the impact of parental incarceration on children, families, and communities; (2) preventing youth between the ages of 16 and 24 from becoming disconnected youth; (3) reducing childhood hunger; and (4) preventing youth homelessness. Under the bill, LMBs would have had the option to choose whether to provide family navigation services based on local needs. Finally, the bill mandated yearly minimum appropriation of $1,665,915 for family navigation services.
House Bill 666: Health Insurance – Associations – Definitions – Withdrawn by Sponsor
This bill would have expanded the definition of “association” or “bona fide association” to include an association that have been formed and maintained for the purpose of obtaining insurance. MPS supported HB 666 in the hopes that this change in insurance law would have allowed members of a professional association, such as MPS, to purchase group insurance. Many private practice psychiatrists are solo practitioners and struggle to find affordable health care coverage for themselves in the individual insurance market. The sponsor of the bill, Delegate Krill Reznik (D – Montgomery County) withdrew the bill after the House Government Operations Committee gave the bill a tepid response.
Delegate Bilal Ali (D- Baltimore City) surprisingly withdrew this bill before it ever received a hearing. The bill would have established the Mental Health and Substance Abuse Offender Reentry Support Program in the Maryland Department of Health (MDH). Under the bill, MDH would have had to select at least one local behavioral health authority for each correctional facility to develop case plans and provide services for certain criminal offenders.
Bills MPS Supported with Amendments
HB 33, sponsored by Delegate Clarence Lam (Baltimore & Howard Counties), authorizes a disabled person may apply for voluntary admission to a facility for the treatment of a mental disorder if the person submits the required written application and certification that (1) the disabled person has the capacity to execute the application and (2) the disabled person understands the criteria for voluntary admission and the procedure for requesting discharge from the facility. MPS was able to amend the bill to provide uniformity to the law defining psychiatric admissions by requiring that certification may be given only by (1) a physician and psychologist; (2) two physicians; or (3) a physician and psychiatric nurse practitioner. A certificate for voluntary admission of a disabled person must be in the required form and based on the personal examination of the health care practitioner who signs the certificate.
A certificate must include an opinion that (1) the disabled person has a mental disorder; (2) the mental disorder is susceptible to care or treatment; (3) the disabled person understands the nature of the admission request; and (4) the disabled person is able to give continuous assent to retention by the facility.
Finally, a facility must notify the guardian of the disabled person if the disabled person is admitted to the facility or requests to be discharged from the facility. A facility must also discharge a disabled person if the facility believes the person no longer meets the criteria for voluntary admission, unless the person’s status has been changed to an involuntary admission and the relevant commitment proceeding is held. A disabled person’s application for voluntary admission does not diminish the rights, duties, or responsibilities of a guardian of the person nor confer any additional power or authority for a guardian of the person that a court has not otherwise conferred under law.
A series of four bills, entitled The School Safety Act, with one focusing on “Anticipation”, the next focusing on “Prevention” , another focusing on “Deterrence”, and the last focusing on “Protection” reflected a bipartisan effort of the Maryland Senate to address school safety issues, particularly those related to school shootings. The original bills were sponsored by Senator Katherine Klausmeier (D-Baltimore County), Senator Steve Waugh (R-Calvert and St. Mary’s Counties), & Senator J. B. Jennings (R-Baltimore and Harford Counties) and all had an influential co-sponsor, Senate President Thomas V. Mike Miller, Jr. (D-Prince George’s and Calvert Counties). The bills were eventually refined in to one bill, SB 1265, The Maryland Safe to Learn Act of 2018. The bill as amended and passed makes comprehensive changes designed to improve the safety of the State’s public schools as well as to help those students who may need meaningful mental health services.
First, the bill enhances the presence of school resource officers (SROs) and/or local law enforcement in or near public schools and requires SROs to complete specialized training.
Second, the bill establishes a School Safety Subcabinet (subcabinet), which also serves as the governing board for the Maryland Center for School Safety (MCSS) The MCSS was made an independent unit within Maryland State Department of Education under this bill. The subcabinet is primarily charged with (1) collaborating with stakeholders to provide a comprehensive, coordinated approach to school safety; (2) initiating collaborative partnerships and facilitating coordination among stakeholders to leverage existing resources to deliver school safety services uniformly to local school systems; and (3)
distributing grants from the Safe Schools Fund. The Safe Schools Fund established by this bill will be used to make grants to local school systems to assist in implementing the bill’s various mandates.
Third, by September 1, 2018, the subcabinet must develop a model policy for the establishment of an assessment team(s) in each local school system. The model policy must include specified provisions generally related to (1) the identification of, and intervention with, students or other individuals who may pose a threat to school safety; (2) the composition and appropriate number of assessment teams within local school systems; and (3) training for the assessment teams. Then by September 1, 2019, each local school system must adopt a policy for the establishment of assessment teams that is consistent with the model policy. Local policies must include the following: (1) a process for regular assessment and intervention, including diversion and de-escalation, if an individual exhibits behavior that may pose a threat to school safety; (2) standards for timely response and procedures for coordination among members of the team, including referral of relevant information to appropriate authorities; (3) and standards and procedures for the referral of an individual for evaluation, services, or treatment when appropriate.
Fourth, each local school system must designate a school safety coordinator, who will serve as the liaison between the local school system, local law enforcement, and MCSS. By June 15, 2019, and regularly thereafter, each local school system must conduct a physical safety evaluation of each school to (1) identify and, if necessary, develop solutions for physical safety concerns and (2) identify and evaluate any patterns of safety concerns on school property or at school-sponsored events.
Finally, by September 1, 2018, each local school system must appoint a mental health services coordinator to coordinate existing mental health services and referral procedures within the local school system. The coordinator must (1) ensure that a student who is referred for mental health services obtains the necessary services; (2) maximize external funding for mental health and wraparound services; and (3) develop plans for delivering behavioral health and wraparound services to students who exhibit specified behaviors of concern.
Bills MPS Opposed
SB 864/HB 1392, sponsored by Senatr Delores Kelley (Baltimore County) and Delegate Clarence Lam (Baltimore & Howard Counties), require a health care provider to disclose legal and medical records, including mental health records, without the authorization of an individual to a public defender who states in writing that the Office of the Public Defender (OPD) represents the individual in an involuntary admission or release proceeding under the Health-General Article or a commitment or release proceeding under the Criminal Procedure Article. Records relating to an involuntary admission proceeding under the Health-General Article must be provided within 24 hours after the certification of involuntary admission and only if the individual has not yet retained private counsel. In addition, the bills also require emergency facilities to notify OPD within 30 hours of completing an application for the involuntary admission of an emergency evaluee and notify OPD of an individual’s change in admission status from voluntary to involuntary within 24 hours of the change in status
SB 361/HB 202 were originally drafted to authorize a court to order the administration of medication to a criminal defendant who has been found incompetent to stand trial (IST) or not criminally reposnsible (NCR). After significant push back from MPS and others, the sponsors, Senator Justin Ready (R – Carroll County) and Delegate Dan Morhaim (D – Baltimore County), heavily amended and passed the bills to reflect the following:
If a court commits a defendant to a mental facility pursuant to a finding that the defendant is IST or NCR and, because of a mental disorder, is a danger to self or the person or property of another, the court may order MDH, as soon as possible after the defendant’s admission, but not to exceed 48 hours, to:
- evaluate the defendant;
- develop a prompt plan of treatment for the defendant under § 10-706 of the Health-General Article; and
- evaluate whether there is a substantial likelihood that, without immediate treatment, including medication, the defendant will remain a danger to self or the person or property of another.
Under the amended bill, a clinical review panel must convene within nine days after an individual’s refusal of medication for a period of at least 72 hours if the individual was committed to a hospital because of a mental disorder and the individual’s treatment plan indicates that there is a substantial likelihood that, without immediate treatment, the individual will remain a danger to self or the person or property of another.
Finally, the Behavioral Health Administration within MDH must develop and conduct training on the clinical review procedures outlined in statute to ensure compliance at all State facilities. The training is mandatory for all clinical directors and all individuals who are eligible to serve on a panel.
The General Assembly passed SB 233/HB 111, introduced by Senator Thomas “Mac” Middleton (D–Charles County) and Delegate Erek Barron (D–Prince George’s County), which require a court, upon a finding that a defendant is incompetent to stand trial (IST) and is a danger to themselves or others, or upon a verdict that a defendant is not criminally responsible (NCR), to enter an order of commitment that requires the Maryland Department of Health (MDH) to commit the defendant to a either a State facility; a State forensic residential center; or a hospital or private residential facility under contract with MDH. MDH must place defendants, as soon as possible, but no later than 10 business days after it receives the court order. If MDH fails to timely place the defendant in a facility, the court may impose any sanction reasonably designed to compel compliance, including requiring MDH to reimburse a detention facility for costs incurred as a result of delayed placement. It should be noted that these bills were originally drafted to mandate the immediate commitment of an IST or NCR defendant, but MPS was successfully able to lobby against that proposal. The bills as described above will take effect October 1, 2018.
SB 132/HB 500 as originally drafted would have made it a misdemeanor for a worker to knowingly fail to provide a required notice or make a required report of suspected child abuse or neglect if the worker (1) has actual knowledge of the abuse or neglect or (2) witnesses the act of the abuse or neglect. A mandatory reporter who would have violated this bill would have been guilty of a misdemeanor and subject to a maximum penalty of up to six months imprisonment and/or a $1,000 fine. The bill would have only applied to a failure to report child abuse that occurs during the time the child is a minor.
The sponsor of SB 132, Chairman Bobby Zirkin (D – Baltimore County), amended his bill to only penalize ”actual knowledge” of abuse or neglect, which arguably already includes the second prong, witnessing of abuse or neglect. SB 132 was able to pass the Senate, but both bills died in the House Judiciary Committee, where neither bill received a vote.
These bills would have authorized the State to petition to delay the dismissal of criminal charges against a defendant found incompetent to stand trial in order to protect a victim or potential victim who is a minor. The bills were sponsored by Senator Susan Lee (D- Montgomery County) and Delegate Kathleen Dumais (D – Montgomery County). HB 1030 received an unfavorable report from the House Judiciary Committee; SB 579 was withdrawn in response to that vote.
Delegate Shelly Hettleman (D – Baltimore County) presented HB 1628, which she eventually withdrew for consideration after significant push back from MPS and others. HB 1628 would have circumvented the psychiatrist-patient privilege by requiring a psychiatrist to testify about suspected child abuse or neglect of their child patient if that child patient was the subject of a divorce, custody, guardianship, adoption, protective order, or any other civil proceeding under the Family Law Article and the court determined that testimony was in that child’s best interest to disclose.
SB 527/HB 499, sponsored by Senator John Astle (D – Anne Arudenl County) and Delegate Nic Kikpke (R – Anne Arundel County), would have essentially converted psychiatric units in to substance abuse rehabilitation facilities. SB 527/HB 499 would have altered both the criteria for involuntary admission to an inpatient facility or Veterans’ Administration hospital and the criteria for a petition for an emergency evaluation to allow admission or a petition if an individual otherwise meets specified criteria and (1) is not a minor; (2) has experienced a drug overdose; and (3) has health insurance coverage as a dependent under the individual’s parent’s health insurance plan. The House sponsor withdrew his bill after a somewhat rocky hearing before the House Health and Government Operations Committee. The Senate bill never received a vote from the Senate Finance Committee despite the sponsor being the vice chair of that committee.
This bill was submitted on behalf of the Maryland Department of Health (MDH). This departmental bill specified that if a court orders the MDH to examine a defendant to determine whether the defendant is incompetent to stand trial (IST) or to commit an IST defendant to a facility, the court must determine eligibility for and conditions of pretrial release in accordance with the Maryland Rules, unless the defendant is charged with a crime of violence. Additionally, MDH would have had to admit an IST defendant to an appropriate facility within 21 days after the date of commitment and in accordance with MDH’s facility and admission policy. The bill also specifies that a court must hold a hearing
to determine the defendant’s continued eligibility for commitment within 21 days after MDH sends a report that the defendant no longer qualifies. HB 385 received an unfavorable report from the House Judiciary Committee.