by Joe Adams, M.D. Chair, MDDCSAM Public Policy Committee
April 12, 2018

The following are from the Maryland General Assembly in 2018, unless otherwise noted.

House Bill 88 / Senate Bill 1083 Public Health - Prescription Drug Monitoring Program - Revisions - FAILED
The bill failed since different versions were passed in the House and Senate which were not reconciled.
MDDCSAM provided oral and written testimony in SUPPORT WITH AMENDMENTS. 
Briefly, MDDCSAM wanted to see current law strengthened so that the PDMP data could be utilized more effectively to address the opioid epidemic by reducing over-prescribing. Maryland is unusual among the states in the number of barriers preventing utilization of PDMP data. MDDCSAM wanted to slightly limit the role of the Technical Advisory Committee (TAC) so that failure of the capacity of the TAC to review each case would not necessarily prevent reporting to professional boards. Other provider organizations wanted to change a standard of "possible breach of professional standards" to "probable breach..." in some circumstances, which MDDCSAM opposed. MDDCSAM attempted to allow the program to use "patterns of prescribing strongly associated with overdose deaths" as a basis for possible feedback and education to prescribers, instead of just "possible misuse or abuse" of controlled substances, i.e. doctor shopping on the part of patients. MDDCSAM agreed with other provider groups (1) in opposing reporting of PDMP data to the Office of Controlled Substances Administration (OCSA, which is like the state's version of the DEA, staffed by pharmacists, with jurisdiction over CDS licenses), (2), in opposing reporting of PDMP data to local health officers, and (3) in opposing unsolicited reporting of PDMP data to law enforcement.

HOUSE BILL 161 Budget Reconciliation and Financing Act of 2018 - PASSED
Appropriations Committee
MDDCSAM provided oral and written testimony in the Appropriations Committee to SUPPORT WITH AMENDMENT to restore the 3.5% funding increase for community behavioral health programs, which had been originally enacted in last year’s HOPE act. 
This level of funding was restored.

HB 922 Maryland Department of Health – “Pill Mill” Tip Line - PASSED
MDDCSAM provided oral and written testimony to SUPPORT with a minor amendment. Originally the bill would direct the MD Dept of Health to establish a Tip Line for anonymous reporting of possible over-prescribing to be investigated by the appropriate licensing board. As passed, the Department will identify a method for establishing a Tip Line for this purpose, with the information forwarded to the appropriate licensing board. The bill passed with two additional amendments: (1) the Secretary of Health will conduct an extensive review of data on individuals who suffered fatal overdoses involving opiates and other controlled substances, utilizing the records of numerous state agencies, and report the findings, including utilization of various services, with recommendations, every year beginning in July 2019.
And (2) that the MD Dept of Health examine the feasibility of establishing a Hub and Spoke model program in the state, and report findings by January 2019.

HB 1092 / SB 703 Behavioral Health Crisis Response Grant Program – Establishment - PASSED
MDDCSAM provided oral and written testimony in SUPPORT.
The final bill directs the MD Dept of Health to award grants to local behavioral health authorities to expand and develop behavioral health crisis response programs, with funds to supplement, not supplant, other funding, with $3 million, $4 million, and $5 million per year for three years: 2020 to 2022.

SB 835 Maryland Medical Assistance Program - Collaborative Care Pilot Program - PASSED
MDDCSAM provided oral and written testimony in SUPPORT WITH AMENDMENT.
Provides $550,000 per year for four years to establish a Collaborative Care Pilot Program by the MD Dept of Health for Health Choice patients in primary care, in up to 3 sites. The original bill established psychiatric reviews and consultation by a psychiatrist. Our recommended amendment was essentially adopted, providing for psychiatric and substance use disorder reviews and consultation by a psychiatrist, an addiction medicine specialist, or other behavioral health medicine specialists.

HB 1744 Child Abuse and Neglect – Substance Exposed Newborns – Reporting - PASSED
MDDCSAM offered oral and written testimony OPPOSED
The bill removes the current exemption in which women who deliver substance-exposed babies do not need to be reported to Social Services if they are getting MAT for SUD.
This expanded reporting is now required by federal law. MDDCSAM, with other advocates, proposed amendments providing that an investigation/home visit by the local Dept of Social Services would not be required in certain cases, but the amendment was not adopted. Takes effect June 2018. (Treatment providers should ideally inform pregnant women about this routine reporting to the local Dept of Social Services, and encourage them to remain in treatment. Providers should also probably reach out to their local DSS office to make sure they understand the use of MAT).

SB 765 / HB 772 MD Medical Assistance Program - Clinical Services Provided by Certified Peer Recovery Specialists Workgroup and Report - PASSED
MDDCSAM provided oral and written testimony in SUPPORT of the original bill which would have had the Medical Assistance Program provide clinical services by Certified Peer Recovery Specialists. As amended, the bill directs the Secretary of Health to convene a stakeholder workgroup to make recommendations related to reimbursement of certified peer recovery specialists, with a report by December 2018.

SB 288 Public Health - Overdose and Infectious Disease Prevention Supervised Drug Consumption Facility Program - FAILED
MDDCSAM provided oral and written testimony in SUPPORT.
Would have provided for community-based organizations to be able to establish Overdose and Infectious Disease Prevention Supervised Drug Consumption Facility Programs, in which people with SUD would bring in their own drugs to use in a supervised setting. MDDCSAM felt that this would help decrease overdoses, would decrease stigma, and would help some participating people to be successfully referred to SUD treatment, in this difficult-to-reach population.

HB1452  Controlled Dangerous Substances Registration - Authorized Providers - Continuing Medical Education - PASSED
MDDCSAM: Submitted written testimony to SUPPORT WITH AMENDMENTS.
The original bill would have required CDS registrants (Controlled & Dangerous Substances) to provide evidence of 2 hours of CME related to CDS with each CDS license renewal. Concerns expressed within the MDDCSAM Public Policy Committee included potential conflicts of interest of groups providing CME, and the quality of the CME, considering that CME can be influenced by Pharma even if accredited by ACCME (Accreditation Council for CME). MDDCSAM offered amendments limiting somewhat the organizations that could provide CME. These amendments were not adopted. The bill was passed, amended to require attestation of 2 hours of CME related to CDS before only the initial CDS license application, or the first renewal if registration was before Oct 2018.

HB 1207 Public Health - Ibogaine Treatment Study Program - FAILED
MDDSAM provided oral and written testimony OPPOSED. (MDDSAM was the only group to provide oral testimony in opposition).
The bill would have provided funds for the MD Department of Health to provide $250,000 per year for two years to an academic medical institution to study of ibogaine treatment.

HB 771 Public Health - Opioid Overdoses - Prohibition and Rehabilitation Order - FAILED
MDDCSAM provided oral and written testimony OPPOSED. The bill would have criminalized overdose by requiring first responders to issue a citation with a referral to treatment, and failure to follow through would result in a fine up to $50. If not paid, the individual could be imprisoned.

HB 499 Health - Standards for Involuntary Admissions and Petitions for Emergency Evaluation – Modification - FAILED
MDDCSAM provided oral and written testimony in the form of a Letter of Information without taking a formal position.
MDDCSAM expressed its understanding of the reasons behind the bill, but felt that involuntary admissions after an overdose would likely be ineffective, unaffordable, and could have deleterious effects.

Washington D.C. Parity Law: Dr. Alvanzo, on behalf of MDDCSAM, along with ASAM, submitted a letter in support to the D.C. City Council. B22-0597 would require all health benefit plans offered by an insurance carrier to meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and submit an annual report to the Department of Health Care Finance.

RE: Council Bill 18-0184 Zoning - Use Regulation - Health-Care Clinics
Land Use and Transportation Committee, Baltimore City Council
MDDCSAM provided oral and written testimony in the Baltimore City Council to OPPOSE this bill which would change the current zoning law to require that health care clinics locating in commercial zoning districts be approved for conditional use by ordinance of the Mayor and City Council, rather than the Board of Municipalities and Zoning Appeals (BMZA). In other words, any health clinic would need to go through the Mayor and City Council before opening in Baltimore. This bill was clearly aimed at OTPs. We believe it would contribute to discrimination and stigma of SUD, would limit access to health care services, especially for SUD, and would be an unprecedented approach to approving the location of health care clinics.