(Testimony from prior years is under ‘2020’ or the ‘Archive’ section). See the links to MDDCSAM testimony. MDDCSAM’s position is indicated by ‘Support,’ ‘Oppose,’ or ‘Letter of Information.’ Any oral testimony can be viewed at the Maryland General Assembly's website. A plain English summary is generally available under the “Fiscal and Policy Note” for each bill.
- Retains coverage for audio-only telehealth in Medicaid and commercial markets at the same rate as in-person services through June 2021.
- Removes all originating and distant site restrictions.
- Expands the definition of telehealth to include remote patient monitoring services.
- Allows reimbursement of behavioral health programs for telehealth services delivered by peers and paraprofessionals.
- Provides that commercial insurers may not deny coverage for an in-person behavioral health service solely because that service may also be provided by telehealth.
- Maryland Department of Health is required to revise Medicaid telehealth regulations to ensure parity compliance. (Currently, prior authorization for telehealth is required for behavioral health but not for somatic health services, etc.).
- The Maryland Insurance Administration will study how telehealth can support adequate provider networks and how to take telehealth into account when measuring adequate networks.
Allows telehealth services, including audio-only, to be reimbursed when performed by alcohol and drug counseling for trainees.
A similar bill, HB 32, also did not pass. The bill would legalize recreational use of marijuana and promote social equity in the legal cannabis industry. Our testimony noted that we are not opposed to legalization per se, but that non-commercial models of legalization can minimize potential harms of both legalization and of prohibition, e.g., through production and marketing by non-profits, buyers’ clubs, co-ops, home cultivation and/or a public authority. Otherwise, industry consolidation, product design, marketing, public relations, lobbying, and “regulatory capture” can be expected as has occurred in tobacco and alcohol markets. We indicated that we support all decriminalization & expungement provisions and noted that the primary potential harm from legalization is an increase in rates of cannabis use disorder occurs which now occurs in about 10% of cannabis users, with significant functional impairment similar to other addictions. We also called for a public health framework led by an agency with a mandate to minimize cannabis use, with mechanisms to avoid industry influence on policy. Finally, we called for taxation based on THC content to avoid products with ever higher THC concentrations.
In January 2020 when Optum was chosen as the new Administrative Service Organization (ASO) to administer Medicaid behavioral health payments, it was unable to process claims, creating a crisis for providers and leaving patients at risk. The problem is still ongoing “with no end in sight.” The bill gives the Maryland Insurance Administration the authority enforce the contract and fine and charge interest for failing to pay clean claims as required by law. It also withholds $1 million of BHA funding until providers receive a comprehensive claims history in an uploadable 835 format with standardized denial codes, the original submission date of each claim, any reprocessing and denials, with the corresponding check number and date for the full or partial amount paid on the claim.
Marylanders are currently subject to criminal prosecution for obtaining clean needles from legal and life-saving Syringe Service Programs (SSPs), or from pharmacies, to avoid re-using or sharing needles, unless they can prove they are enrolled in an SSP. SSPs prevent infectious diseases, reduce healthcare expenditures, and effectively link people to treatment. Existing laws result in syringes being discarded in public places because possession can lead to arrest. Unfortunately, the Maryland States Attorney’s Association testified that they feel they need the leverage of arrest and incarceration to coerce people into treatment despite the fact that this approach causes considerable harm and is not supported by evidence.
Passed in the House, but not in the Senate. The bill would increase, from 10 grams to 1 ounce, the amount of marijuana below which possession is a civil offense, rather than a criminal offense. For possession of less than 1 ounce, the bill would also require actual evidence of ‘intent to distribute’ beyond simply the quantity of cannabis in possession. Currently a charge of “possession with intent to distribute” can be made without any evidence beyond possession of small amounts, and is a felony subject to 5 years of imprisonment and/or a $15,000 fine.
Though cannabis possession up to 10 grams has been decriminalized in Maryland (but still punishable by civil fines), cannabis possession between 10 grams and 1 ounce is currently punishable by up to 6 months in jail and/or a fine of up to $1,000. Racial minorities are impacted at dramatically greater rates than whites despite similar rates of use, with significant harms with no clear societal benefit. The American Public Health Association and World Health Organization both recommend decriminalization of drug use to improve the social determinants of health for marginalized groups. Most states have decriminalized or legalized up to one ounce, and several states have decriminalized larger amounts.
The bill decriminalizes possession of small amounts of all drugs similar to a successful model in Portugal, and recently in Oregon. (MedChi supported the bill for the first time this year.)
Led by the Maryland Health Care for All Coalition, as drafted the bill would have been funded by a 1 per cent increase in the alcohol tax, which itself is known to significantly reduce alcohol-related harms. This was borne out in in 2011 in Maryland when this coalition helped enact the successful Health Enterprise Zones project funded by an alcohol tax increase. The current bill would provide grants, tax incentives, and loan repayment assistance to health care providers locating in areas with poor health outcomes. Although the alcohol tax increase was to be post-dated by two years, unfortunately this funding mechanism was removed. $14 million of funding was identified to establish a program leading to a permanent Health Equity Resource Community Program in the Maryland Department of Health in 2023. In the future, public health advocates will likely again pursue an increased alcohol tax as a permanent source of funding.
Establishes the Commission on Trauma-Informed Care to coordinate a statewide initiative to prioritize the trauma-informed delivery of State services, staffed by the Governor’s Office of Crime Prevention, Youth, and Victim Services (GOCPYVS). In consultation with MDH, the commission implements screening for ACEs (Adverse Childhood Events) with evidence-based interventions, establishes training and accreditation for program providers, explores third-party reimbursement, establishes evaluation metrics, and disseminate best practices among agencies for preventing and mitigating trauma. Two staff members of each state agency receive annual training and advise their agency on trauma responsiveness. MDDCSAM’s amendment recommended that a state agency other than GOCPYVS staff the commission, but was not adopted.
Public Health - Maryland Commission on Health Equity (The Shirley Nathan–Pulliam Health Equity Act of 2021): MDDCSAM Testimony (PASSED, HAS BECOME LAW) HB 78 / SB 52. Del Pena-Melnyk, et al. Sen Washington. SUPPORT.
Establishes the Maryland Commission on Health Equity to bring together leadership from over 20 state agencies to examine the impact of social determinants on the health of Maryland residents and provide recommendations to reduce health disparities in alignment with other statewide planning activities. These activities will include ways for units of state and local government to collaborate and implement policies, to set goals for health equity and prepare a state plan.
Public Health – Implicit Bias Training and the Office of Minority Health Disparities: MDDCSAM Testimony (PASSED, HAS BECOME LAW) HB 28 / SB 5. Del. Joseline Pena-Melnyk, et al, Sen. Melony Griffith, et al. SUPPORT.
Requires applicants for a new or renewed license or certificate issued by a health occupations board to attest to completion of an approved implicit bias training program one time. Requires the Office of Minority Health and Health Disparities to publish updated health data that includes race and ethnicity; includes an appropriation of at least $1.7 million for the office; requires the Cultural and Linguistic Health Care Professional Competency Program to identify and approve implicit bias training programs.
Public Health - Data - Race and Ethnicity Information: MDDCSAM Testimony (PASSED, HAS BECOME LAW) HB 309 / SB 565. Del. Joseline Pena-Melnyk et al. SUPPORT.
Requires the Office of Minority Health and Health Disparities (OMHHD) to improve the collection of information on race and ethnicity of persons served and of the health care workforce, in coordination with the Maryland Health Care Commission and the Maryland Department of Health.
Budget Bill (Fiscal Year 2022): MDDCSAM Testimony (PASSED, HAS BECOME LAW) HB 588. The Speaker. LETTER OF INFORMATION.
Effective Jan 1, 2021, state funding for community mental health and substance use treatment increased by 3.5%. We expressed appreciation to Governor Hogan for early implementation this scheduled increase. MDDCSAM also noted that needs are still unmet and that third-quarter data from the Maryland Department of Health shows a 14% increase in the number of opioid overdose deaths in 2020, over the same period the year before.
Authorizing the establishment of an Overdose and Infectious Disease Prevention Services Program by a community-based organization to provide a place for the consumption of preobtained drugs, provide sterile needles, administer first aid, and provide certain other services; providing that the Maryland Department of Health may approve not more than six programs, with two in urban areas, two in suburban areas, and two in rural areas, that operate at a single location in an area with a high incidence of drug use; etc.
Would allow bars, restaurants, and taverns, to deliver alcoholic beverages to purchasers at least 21 years of age, subject to authorization by the local liquor board. Opposed also by the Maryland Public Health Association, the Public Health Clinic of the U of M School of Law, and others, who pointed out that alcohol is the fourth leading cause of preventable death, alcohol consumption and drunk driving fatalities have increased in the pandemic along with the increase in mental health and substance use disorders, restaurants already fail to check ID in the majority of mystery shoppers, and a temporary circumstance (the pandemic) should not be the basis for permanent changes in laws with potential public health impacts.
Alcoholic Beverages - Manufacturer's Licenses and Off-Site Permits: (PASSED, SIGNED INTO LAW) HB1232 / CH0360. Del. Brooks. OPPOSE.
Expands the existing brewery promotional event permit to authorize brewers, wineries, and distillers to use off-site permits to sell their own alcoholic beverage products, and allows these entities to deliver alcoholic beverages.
The bill would have allowed beer and wine licenses for food or grocery establishments with the dubious rationale of combating food deserts by supporting grocery retailers.
The marketing of flavorings in tobacco and vaping products is used by manufacturers to increase their use, particularly among youth. Rates of nicotine addiction among youth and young adults have grown dramatically through vaping products.
The bill would ensure that local laws regulating the sale and distribution of tobacco products would not be pre-empted by state law. Preemption of local laws has been a long-term tactic of ‘Big Tobacco’ and ‘Big Alcohol’ to prevent regulation. “Non-preemption” of such laws is a well-known public health principle.
Would establish a workgroup to study the conditions for which a pregnant or nursing woman may use medical cannabis, and related topics. Our letter suggested that creating such a workgroup would be counter-productive.
The requirement for involuntary commitment requires an opinion that the individual needs inpatient care or treatment, and that they present a danger to the life or safety of themselves or others. Unlike the case with mental disorders, these requirements can be applied far too broadly to people with a substance use disorder because SUD very commonly entails risks of overdose. The evidence indicates that, unfortunately, efforts to coerce a person with SUD into treatment is more likely to harm than help and may paradoxically increase the risk of fatal overdose.
Would have expanded certain immunities against arrest and prosecution for bystanders seeking medical assistance for an individual experiencing an overdose.
Currently, a person who seeks, assists with, or provides medical assistance for a person believed to be experiencing a medical emergency due to alcohol or drugs is immune from arrest for certain specified violations if the evidence was obtained solely as a result of this activity. The bill intends to increase the likelihood that people will call for help in such emergencies by extending this immunity to the person experiencing the medical emergency, and also by extending the list of violations covered. The additional immunity under the bill would also apply to distributing, possession with intent to distribute, underage possession of alcohol, or having an outstanding warrant for another nonviolent crime, again, if the contact with the subject or the evidence was obtained solely as a result of this activity.
For patients who need an emergency evaluation, rather than requiring that the police be involved in every case, the bill gives the clinician/petitioner (who may be working in a mobile unit) the option of either involving or not involving the police, since the petition may be safely served, and the patient transported, by the petitioner in some cases. This may reduce unnecessary and potentially harmful interactions with police. Included amendments were suggested by the Maryland Psychiatric Society, and are acceptable to the sponsors, to require police to respond when requested, to reduce liability for the petitioner, and to resist adding additional petitioner categories.
Requires that pregnant incarcerated women be routinely screened for substance use disorder, and offered treatment.
Since OTP patients with transportation challenges are often required to attend treatment daily, OTP providers frequently complete the MTA’s application for the Disability Reduced (bus) Fare Program. All patients qualify because OUD qualifies as a disability for this purpose. Currently, each patient has to hand-deliver the completed form to the MTA office to get an ID card, which is a burden and an additional barrier to care. The bill allows OTPs to elect to provide the cards to the patient at the program.
Items of Interest
(2020) Maryland Mental Health and Substance Use Disorder Registry and Referral System (The Governor's 2020 veto was overridden in 2021) HB 1121 / CH 0029. Del. Vallderama, et al.
Establishes a statewide mental health and SUD Registry, which would also function as an electronic Referral System through CRISP, including a searchable inventory of any providers. Providers will have the capability to update information including real-time availability of services. Hospitals will be required to assist patients in accessing available mental health and SUD services. There will be an initial pilot in at least two jurisdictions including an evaluation of the feasibility and necessity of mandating all inpatient and outpatient mental health and SUD providers to update registry information in real-time. A funding plan for state-wide implementation will need to be developed.
Maryland Behavioral Health and Public Safety Center of Excellence – Establishment (SIGNED INTO LAW) HB 1280. Del. Pena-Melnyk.
Establishes the Maryland Behavioral Health and Public Safety Center of Excellence within the Governor’s Office of Crime Prevention, Youth, and Victim Services (GOCPYVS) to implement system changes to divert individuals with serious mental health and substance use disorders away from the criminal justice system, with a focus on reducing racial disparities in the criminalization of individuals with behavioral health disorders. The center’s activities include planning, technical assistance, facilitation of train-the-trainer courses for the “Sequential Intercept Model” (SIM). The center must develop a statewide model for law enforcement-assisted diversion and community crisis intervention services other than law enforcement. There must be a statewide strategic plan by December 1, 2022, and annually thereafter.
Behavioral Health Crisis Response Grant Funding: Extends grant funding, allocating an additional $5 million per year through FY25. (PASSED, HAS BECOME LAW). HB 108 / SB 286. Del. Charkoudian. Sen. Augustine.
Behavioral Health Crisis Response Services - Modification. Modifies and extends the crisis response grants and requires local behavioral health authorities to make certain information available to the public for each service or program awarded. A grant and a certain proportion of the appropriation is to award grants for mobile crisis teams.
Recovery for the Economy, Livelihoods, Industries, Entrepreneurs, and Families (RELIEF) Act (SIGNED INTO LAW) SB 496. The President (By Request - Administration).
Includes $15 million for crisis response services included in the state COVID relief package.