The 441st Legislative Session of the Maryland General Assembly adjourned on April 12, marking the end of one of the most unusual sessions in Maryland history. In deference to the ongoing COVID-19 pandemic, the General Assembly implemented strict protections, including virtual hearings and voting sessions, masks and plexiglass barriers on the House and Senate Floors, and limited access to state buildings and legislators by lobbyists, advocates, and other members of the public.
Despite the physical and procedural changes, the 2021 session was jam-packed as members of the Maryland General Assembly introduced 2,344 bills, excluding local bond initiatives and 13 Joint Resolutions. The Joint Legislative Committee (JLC) of the Maryland Psychiatric Society (MPS) and the Washington Psychiatric Society (WPS) was equally as active, reviewing over 90 bills and submitting testimony on 57 of those bills. Following are highlights of some of the bills that the JLC weighed in on this session and their outcome.
2-1-1- Mental Health Services Phone Call: Senate Bill719/House Bill 812 requires the Maryland Department of Health (MDH) to make recommendations to 2-1-1 Maryland about establishing an opt-in mental health services phone call program that (1) requires a call center to make periodic calls to persons who have opted into the program and (2) attempts to connect persons with a mental health provider upon request. The Governor may include an appropriation to MDH in the annual budget bill to carry out the bill’s provisions. MDH must include this activity in its annual report to the Governor and the General Assembly. Senator Craig Zucker and Delegate Bonnie Cullison (both D – Montgomery County) championed the legislation. The bill, which the Governor has already signed, takes effect July 1, 2021.
Suicide Fatality Review Committee: Senate Bill 168/House Bill 209: Suicide Fatality Review Committee would have established the Maryland Suicide Fatality Review Committee (State team) to identify and address factors contributing to suicide deaths and facilitate changes in the State system to prevent suicide deaths. This bill died in committee. The State team would have been required to include specified members who meet at least quarterly to review suicide deaths and:
- make determinations regarding (1) issues related to individuals at risk for suicide, specifically trends, risk factors, current best practices in suicide prevention, lapses in systemic responses, and barriers to safety and well-being, and (2) strategies for the prevention of suicide deaths;
- report at least annually to the Governor and the General Assembly;
- undertake annual specified statistical studies; and
- disseminate findings and recommendations based on the studies conducted to policymakers, health care providers, health care facilities, and the public.
Senator Adelaide Eckardt (R – Caroline, Dorchester, Talbot, & Wicomico) and Delegate Lisa Belcastro (D – Baltimore County) will likely introduce this legislation again next session.
Workgroup on Underrepresented Mental Health Professionals: Newly appointed Delegate, Marlon Amprey (D – Baltimore City), introduced House Bill 915 to establish the Workgroup on Black, Latino, Asian American Pacific Islander, and Other Underrepresented Behavioral Health Professionals. The University System of Maryland and the Maryland Department of Health would have been jointly required to staff the Workgroup to identify and study the shortage of behavioral health professionals who are Black, Latino, Asian American Pacific Islander, or otherwise underrepresented. The Workgroup would then assess and make recommendations on incentives, or other methods to increase the number of (1) specified or underrepresented students who study at an institution of higher education in the State to be behavioral health professionals and (2) specified or underrepresented behavioral health professionals who provide behavioral health services in the State, especially in underserved communities. The bill passed the House but failed to move after its Senate hearing. This bill will more than likely be reintroduced next session.
Pharmacists Administering Maintenance Injectables: Senator Ronald Young (D – Frederick County) and Delegate Karen Lewis Young (D – Frederick County) presented for a second time and passed Senate Bill 84/House Bill 135 to allow licensed pharmacists to administer a maintenance injectable medication that is not a biological product and: (1) was prescribed by an authorized prescriber, and the prescriber had not ordered the initial dose be administered by a prescriber; (2) administered in accordance with a standing order issued by an authorized public health official; or (3) administered in accordance with a drug therapy management protocol. The bill defines “maintenance injectable medication” as a medication that is administered by injection other than intravenously and treats a chronic need, condition, or disorder, which includes medication for treatment of a psychiatric or substance use disorder, contraception, and vitamins. The bill is an emergency bill and will become law immediately upon approval of the Governor.
Behavioral Health Programs: Safety and Community Relations Plans: Senator Cory McCray (D – Baltimore City) reintroduced and this time passed Senate Bill 96: Behavioral Health Programs: Safety and Community Plans. Community perception of and concerns over neighborhood methadone programs were the main catalyst of this bill. Effective October 1, 2021, the bill mandates the Behavioral Health Administration (BHA) to develop regulations related to licensure that require a behavioral health program to establish and implement a safety plan for the individuals it serves. In addition, if a behavioral health program is required to adopt a community relations plan as part of its accreditation, the program must submit the plan to BHA. Before approving a facility or granting a license, the Maryland Department of Health (MDH), must require a facility to establish and implement a safety plan and, if required by the facility’s accreditation organization, a community relations plan. BHA and MDH may authorize a program or facility to satisfy the safety plan requirement by implementing a safety plan established for another purpose, including an emergency plan. MDH may authorize a facility to satisfy the community relations plan requirement by implementing a plan required by an accreditation organization.
Mental and Emotional Disorders – Consent: Senate Bill 41/House Bill 132, reintroduced by Senator Malcolm Augustine (D – Prince George’s County) and Delegate Heather Bagnall (D – Anne Arundel County), establishes that a minor who is at least age 12 and is determined by a health care provider to be mature and capable of giving informed consent, has the same capacity as an adult to consent to consultation, diagnosis, and treatment of a mental or emotional disorder by the health care provider or a clinic. A minor younger than age 16, however, may not consent to the use of prescription medications to treat a mental or emotional disorder. Supporters of the bill argued that this policy allows young people to seek help from trained professionals before they reach a point of crisis. Opponents to the legislation pointed out that almost every effective strategy at treating younger children with mental illness benefits from the involvement of the parent or guardian. Parent or guardian involvement undisputedly increases the effectiveness of most therapies and some interventions require such participation to even occur. After an emotional and extended floor debate, the bill eventually passed. The capacity imparted under the bill becomes effective October 1, 2021 should the Governor not veto the bill.
Involuntary Admissions/Emergency Evaluation – Substance Use Disorders: House Bill 29: Involuntary Admissions/Emergency Evaluation – Substance Use Disorders would have allowed individuals with a substance use disorder to receive a certificate for involuntary admission to a facility or Veterans’ Administration hospital. The sponsor, Delegate Julian Ivey (D – Prince George’s County), was seeking to provide greater access to treatment for those with a substance use disorder diagnosis. The bill failed to advance, however, when many groups who advocate on behalf of these same individuals the bill seeks to help highlighted the unintended consequences of this legislation and differences in treatment modalities for SUD versus mental health disorders.
Preserve Telehealth Access Act of 2021: Senator Melony Griffith (D – Prince George’s County) and Delegate Joseline Pena-Melnyk (D – Arundel & Prince George’s Counties) sponsored Senate Bill 3/House Bill 123 to expand the definitions of “telehealth” as well as the coverage and reimbursement requirements for health care services provided through telehealth for both Medicaid and private insurance. Telehealth includes (1) synchronous and asynchronous interactions; (2) an audio-only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service and that occurs between July 1, 2021, and June 30, 2023; and (3) remote patient monitoring services. Additionally, the bill clarifies that Medicaid’s telehealth coverage must include counseling and treatment for substance use disorders and mental health conditions. With the exception of the temporary provision for audio-only discussed above, “telehealth” does not include the provision of health care services solely through an audio-only telephone conversation, an email message, or a facsimile transmission. Carriers must reimburse for a covered service appropriately provided through telehealth. The bill takes effect July 1, 2021; the bill’s insurance provisions apply to all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after that date.
Involuntary Admission Application – LCSWs: Senate Bill 466/House Bill 689: Certificates for Involuntary Admission – Licensed Certified Social Worker – Clinical, sponsored by Senator Chris West (R – Baltimore County) and Delegate McComas (R – Harford County), authorizes a licensed certified social worker-clinical (LCSW-C) or a licensed clinical professional counselor (LCPC), in conjunction with a physician, to (1) certify an individual for involuntary admission to a facility or a Veterans’ Administration (VA) hospital and (2) assent to the voluntary admission of a minor to the child or adolescent unit of a State facility. Currently, psychologists and psychiatric nurse practitioners can sign such certificates so long as they are joined by a licensed physician. This bill would add the highest level of professional social workers to the list of people authorized to join with doctors in signing such a certificate. The bill becomes effective on October 1, 2021.
Specialty Mental Health Services Claims: Senate Bill 638/House Bill 919 passed as an emergency bill that will become law as soon as the Governor signs it. By way of background, in January 2020, the Maryland Department of Health transitioned administrative management of the public behavioral health system to a new vendor – Optum Maryland. Optum’s IT system failed immediately, and the vendor never truly rebounded as basic claims still go unprocessed. The bill requires the Maryland Insurance Commissioner to enforce a provision that governs clean claims to the specialty mental health services delivery system for Medicaid managed care organization (MCO) enrollees that is administered by the administrative services organization (ASO), currently Optum. The bill also specifically subjects an ASO to (1) pay interest on unpaid clean claims; (2) fines and penalties for certain violations of clean claims requirements; and (3) the Insurance Commissioner’s enforcement authority in connection with any investigation of potential violations. The bill specifies certain actions the Insurance Commissioner must take related to complaints and imposition of interest and penalties relating to an ASO. The ASO may not use State funds or pass on to the State any expenses related to the Insurance Commissioner’s examination. The bill has a sunset provision that terminates it two years from the date of enactment.
Mental Health Law – Reform & Delivery of Service
Senate Bill 928/House Bill 1344, a byproduct of the Commission to Study Mental and Behavioral Health in Maryland chaired by Lieutenant Governor Boyd Rutherford, sought to “develop a clear and unambiguous standard for determining when individuals in crisis pose a danger to themselves and others.” The bill’s sponsors, Senator Justin Ready (R – Carroll County) and Delegate Nic Kipke (R – Anne Arundel County), noted that Maryland is only one of only five states whose civil commitment law offers no guidance as to what “danger to self or others” truly means. The sponsors contended that police, emergency responders, clinicians, and administrative law judges interpret the phrase differently and ultimately too narrowly. The bill, therefore, would have modified the standard for involuntary admission to require that an individual is reasonably expected, if not hospitalized, to present a danger to the life or safety of the individual or of others rather than that the individual presents a danger to the life or safety of the individual or of others. After considerable pushback, the House sponsor ultimately withdrew the bill in deference to the Behavioral Health Administration (BHA), which convened an Involuntary Commitment Stakeholders Workgroup (Workgroup) to review and revise the definition of “danger to self and others.” The Workgroup is comprised of representatives from the Commission to Study Mental and Behavioral Health’s Youth and Family subcommittee, the Maryland Department of Disabilities, BHA, individuals with lived experiences, family, advocacy organizations, hospitals, courts, forensic psychiatrists, and behavioral health provider organizations. Erik Roskes, M.D. represents the MPS. The Workgroup is examining involuntary commitment statutes from other states, reviewing recommendations from advocacy organizations, and considering the potential disparate impact of any changes. The BHA anticipates that this work will conclude prior to the next legislative session.
Trauma-Informed Care and Adverse Childhood Experiences: In the wake of similar legislation passing in Baltimore City, the MGA proposed several bills to establish programs to address the impact of trauma and adverse childhood experiences (ACEs) on individuals in the State. Senator Jill Carter (D – Baltimore City) and Delegate Robbyn Lewis (D – Baltimore City) sponsored and passed Senate Bill 299/House Bill 548 to establish the Commission on Trauma-Informed Care as an independent commission in the Department of Human Services (DHS) to coordinate a statewide initiative to prioritize the trauma-responsive and trauma-informed delivery of State services that affect children, youth, families, and older adults. The Governor’s Office of Crime Prevention, Youth, and Victim Services must provide staff. The Commission, in consultation with specified entities, must also study and implement an ACEs Awareness program. The bill takes effect July 1, 2021. With similar intent but a different approach that was ultimately unsuccessful, Senator Malcolm Augustine (D – Prince George’s County) and Delegate Pam Queen (D – Montgomery County) sponsored Senate Bill 425/House Bill 783 to establish a commission on ACEs specifically and House Bill 774, which would have established a screening and training program for ACEs. These bills failed to progress and died on Sine Die.
Further information, including the MPS positions on bills please see the list below.
HB135/SB84: Pharmacists – Administration of Self-Administered Medications and Maintenance Injectable Medications
HB200/SB479: Public Safety – Access to Firearms – Storage Requirements (Jaelynn’s Law)
HB209/SB168: Public Health – Maryland Suicide Fatality Review Committee
HB271: Public Safety – Law Enforcement Diversion Programs
HB496: Primary and Secondary Education – Mental Health Services – Expansion (Counselors Not Cops Act)
HB731: Telehealth Services – Expansion
HB774: Public Health – Adverse Childhood Experience Screening – Requirement and Practitioner Training Program
HB812/SB719: Maryland Department of Health – 2-1-1 Maryland – Mental Health Services Phone Call Program
HB915: Workgroup on Black, Latino, and Other Underrepresented Mental Health Professionals
SB74/HB88: Police Officers – Mental Health – Employee Assistance Programs
SB161/HB244: Task Force to Study Access to Mental Health Care in Higher Education
SB164/HB605: Veterans – Behavioral Health Services – Mental Health First Aid
SB299/HB548: Human Services – Trauma-Informed Care – Commission and Training
SB393/HB551: Maryland Medical Assistance Program and Health Insurance – Coverage and Reimbursement of Telehealth Services
SB520: Behavioral Health Services and Voluntary Placement Agreements – Children and Young Adults – Report Modifications
SB550: Sheila E. Hixson Behavioral Health Services Matching Grant Program for Service Members and Veterans – Establishment
SB0567/HB073: Telehealth Services – Expansion
SB638/HB919: Maryland Insurance Commissioner – Specialty Mental Health Services and Payment of Claims – Enforcement
HB29: Standards for Involuntary Admissions and Petitions for Emergency Evaluation – Substance Use Disorder
SB41/HB132: Health – Mental and Emotional Disorders – Consent (Mental Health Access Initiative)
SB355: Family Law – Custody Evaluators – Qualifications and Training
HB461: Student Attendance – Excused Absences for Mental Health Needs
HB851: Corrections – Restrictive Housing – Serious Mental Illness
HB917: Corrections – Restrictive Housing – Prohibition
SB96: Behavioral Health Programs and Health Care Facilities – Safety and Community Relations Plans
Support With Amendment
HB108/SB286: Behavioral Health Crisis Response Services – Modifications
HB191/SB56: Maryland Medical Assistance Program – Psychiatrist and Psychiatric Nurse Practitioner Telemedicine Reimbursement – Sunset Termination
HB377: Commission on Student Behavioral Health and Mental Health Treatment
HB442/SB557: Suicide Treatment Improvements Act
HB1121/SB905: Juvenile Services – Workgroup to Develop Evidence-Based, Research-Based, and Culturally Competent Practices
HB1166: Education – Physical Restraint and Seclusion – Requirements, Reporting, and Training
SB3/HB123: Preserve Telehealth Access Act of 2021
SB398/HB537: Mental Health Law – Petitions for Emergency Evaluation – Procedures
SB446/HB689: Certificates for Involuntary Admission – Licensed Certified Social Worker–Clinical
SB928/HB1344: Mental Health Law – Reform of Laws and Delivery of Service