Prepared by Joe Adams, M.D., Chair, MDDCSAM Public Policy Committee
Letters & Resolutions Endorsed by MDDCSAM in 2020
Comment on Network Adequacy of mental health and substance use services. In collaboration with the Maryland Parity Coalition, August 18, 2020. Signed by MDDCSAM.
Emergency recommendations on the Delivery of Mental Health and Substance Use Disorder Treatment via Telehealth to Aid Maryland’s Recovery from COVID-19. From the Parity At 10 Coalition and the MD Behavioral Health Coalition, July 14, 2020. Signed by MDDCSAM.
Letter from the Public Justice Center to Governor Hogan for continuation of temporary Covid-related rent relief. July 2, 2020. Signed by MDDCSAM.
Letter regarding behavioral health funding to MD Congressional Delegation. June 25, 2020. Urges their assistance in directing federal funding to community behavioral health providers and in ensuring the continuation of increased flexibility in the delivery of telehealth and medication for opioid use disorder. Signed by MDDCSAM.
Resolution for a 1 per cent increase in state alcohol taxes to fund the Health Equity Resource Communities Initiative of the Maryland Citizens’ Health Initiative. This is modeled after the Health Enterprise Zones (HEZ) pilot which operated through 2016 reportedly demonstrated to have reduced ED visits and inpatient stays with significant cost savings greater than the amount invested. Signed by MDDCSAM.
BILLS FROM THE 2020 MD GENERAL ASSEMBLY SESSION FOR WHICH MDDCSAM PROVIDED TESTIMONY
See also MDDCSAM’s written testimony posted on this site. You can look up state legislation and hear oral testimony at http://mgaleg.maryland.gov/mgawebsite/.
CANNABIS AND DECRIMINALIZATION
Cannabis - Personal Use Amount – Legalization. HB 1506. Del. Moon. Failed.
Changed certain personal use amounts to a civil offense. “Legalization” in the title refers to decriminalization of possession. MDDCSAM provided written and oral testimony in support with amendment to further reduce the amount of civil fines for possession and use.
Cannabis - Legalization, Taxation, and Regulation. HB 1400. Del. Moon et al. Failed.
MDDCSAM expressed it’s support of the sections on decriminalization and expungement but opposes legalization of cannabis manufacture, distribution and marketing. MDDCSAM testimony noted that non-commercial legalization could potentially minimize harms of both full commercial legalization and of prohibition. MDDCSAM provided written and oral testimony in opposition.
Public And Nonpublic Schools - Medical Cannabis - Policy For Administration During School Hours And Events. SB 604 / HB617 Sen Feldman et al, Del Steve Johnson, Kipke, et al. PASSED.
Authorizing additional caretakers in addition to a parent or legal guardian of an underage medical cannabis patient. Caretakers are authorized to administer medical cannabis in school. MDDCSAM communicated to the sponsor it’s support with the sponsor’s amendment.
Public Schools – Medical Cannabis – Guidelines for Administration to Students (Connor’s Courage). HB 331 Del Lisant, et al. PASSED.
Requiring the Dept of Education and the Cannabis Commission to develop guidelines for public schools re: cannabis administration, with technical assistance provided to schools. MDDCSAM provided a written Letter of Information regarding the risks and lack of evidence for use of medical cannabis in minors.
Criminal Law - Use or Possession of a Controlled Dangerous Substance - De Minimis Quantity. HB 193 / SB 325 Del Cardin, et al. Failed.
Would have decriminalized possession of personal use amounts of a variety of illegal substances. MDDCSAM provided written and oral testimony in support.
Criminal Law - Kratom – Prohibition. HB 283 (SB 147) Del. Ken Kerr, Senator Young. Failed.
MDDCSAM provided written Testimony in opposition to the original bill which designated Kratom as a Schedule I drug with onerous penalties for possession or use. An amended bill passed on the Senate Floor, which would have imposed graduating civil fines for purchase or sale to a minor, but there was no hearing in the House of Delegates. MDDCSAM was not opposed to the amended version.
Health Care Practitioners - Telehealth and Shortage. HB 448/SB 402 Del. Rosenberg et al, Senators Kagen & Lam. PASSED.
Authorizing health care practitioners to use synchronous and asynchronous telehealth. MDDCSAM provided written and oral testimony in support
Telehealth - Mental Health and Chronic Condition Management Services - Coverage and Pilot Program. HB1208/SB502 Del Shetty et al, Sen Hershey et al. PASSED.
Allows mental health services via telehealth to Medicaid clients in their homes; requires the MD Dept of Health (MDH) to apply for a federal waiver for a pilot to provide chronic condition management services via telehealth to Medicaid clients regardless of their location; and requires MDH to study whether SUD services may be appropriately provided through telehealth to a patient in their home setting. MDDCSAM provided written and oral testimony in support with amendment to include treatment of SUD in the home.
TELEHEALTH NOTES: Despite these new laws, telehealth for behavioral health services will remain extremely limited. Temporary Covid-related expansion of these services has demonstrated that telehealth greatly improves access, especially to underserved populations who face barriers to in-person care. Efforts to maintain the expansion of telehealth for behavioral health services beyond the Covid emergency are described elsewhere in this section.
The ability to continue in-home services appears to be within Maryland Medicaid’s authority, but issues related to audio-only services and relaxed HIPAA compliance require continuation of federal waivers and are scheduled to expire at the end of the federal COVID-19 emergency.
ADDICTION TREATMENT NIMBY BILLS
Behavioral Health - Opioid Treatment Services Programs - Medical Director. SB521 Sen McCray. Failed.
Would have required an OTP (Opioid Treatment Program) medical director to be physically on-site at least 20 hours per week. This was a high priority for defeat for the addiction treatment community as it would have made it very difficult for OTPs to operate. MDDCSAM provided written testimony in opposition.
Behavioral Health Programs - Opioid Treatment Services - Limitation on Licenses. SB520 Sen McCray. Failed.
Would have limited any jurisdiction to no more than five licenses for opioid use disorder services. A letter from the AG advises the bill would violate Americans with Disabilities Act. MDDCSAM provided written testimony in opposition.
Public Health - Behavioral Health Programs and Health Care Facilities - Safety and Community Relations Plans. SB519 Sen McCray. PASSED.
Passed with amendments to require internal safety plans be filed with the state, and any community relations plans required by an accrediting body also be filed with the state. MDDCSAM provided written testimony in support with agreed upon amendments.
BEHAVIORAL HEALTH PARITY
Health Insurance - Mental Health Benefits and Substance Use Disorder Benefits - Reports on Nonquantitative Treatment Limitations and Data. HB 455/SB 334 Del Kelly et al/Sen Augustine & Hester. PASSED with amendments.
The original bill would have required regular reports from insurance carriers to make it possible to meaningfully determine whether or not they are complying with laws requiring parity between access to behavioral health and somatic health services. The bill was weakened to an extent that the Parity at 10 Coalition / Legal Action Center withdrew their support. As passed it will require two compliance reports from carriers, two years apart, with limited data. The Maryland Insurance Administration will draft regulations. MDDCSAM provided written testimony in support of the original bill.
Health Insurance - Provider Panels - Coverage for Nonparticipating Providers. HB1165/SB 484 Dels Sample-Hughes et al/Sen Klausmeier. Failed.
Did not receive a vote in either chamber, and was not considered at the subcommittee level. The bill would have addressed insurance carriers’ non-compliance with network adequacy standards, part of the law requiring parity between accessibility of behavioral health and somatic health services. There was a commitment by legislators to continue work on the issue during the Interim with a new Network Adequacy Workgroup of the House Health and Government Operations Committee. MDDCSAM provided written testimony in support.
TOBACCO AND E-CIGARETTES
Electronic Smoking Devices, Other Tobacco Products, and Cigarettes – Taxation and Regulation. SB 3: Sen McCray. Failed.
Would have increased taxation of cigarettes and other tobacco products including e-cigarettes. MDDCSAM provided written testimony in support.
Business Regulation - Tobacco Products - Electronic Smoking Devices, Prohibition on Flavoring, and Sales to Military Members. HB 3 / SB 233. Del. Davis, the President of the Senate by request of the AG Office. Passed in the House, Failed in the Senate.
Would have prohibited manufacturing, shipping, importing, or selling flavored tobacco products, including electronic devices, in the state. The bill is a priority of the Maryland Legislative Black Caucus. MDDCSAM provided written testimony in support.
Taxation - Tobacco Tax, Sales and Use Tax, and Digital Advertising Gross Revenues Tax. House Bill 732. Del Luedtke and Pena-Melnyk. PASSED; VETOED.
The bill would have increased the tax on a pack of cigarettes by $1.75 and increase or add taxes on other tobacco products, including electronic smoking devices. MDDCSAM was in support. There is an effort by the MD Tobacco-Free Coalition to advocate for overturning this veto.
BRFA: Budget Reconciliation and Financing Act of 2020. HB 152 / SB 192.
Included was a proposal by the administration to reduce by half the scheduled 4% increase in Medicaid reimbursement to behavioral health and some other providers. MDDCSAM and other stakeholders provided written testimony in opposition to this reduction. The legislature rejected the Governor’s proposal and retained the scheduled 4% increase. After the General Assembly session there was an effort in the Board of Public Works to reduce these funds. MDDCSAM co-signed a letter along with 175 organizations, coordinated by the Maryland Behavioral Health Coalition (BHC) to retain the funding increase, and these funds were retained in the 2021 budget. However, with projected budget shortfalls, it is anticipated that the behavioral health community will need to continue to advocate for adequate behavioral health services.
Maryland Mental Health and Substance Use Disorder Registry and Referral System. HB 1121. Del. Joseline Pena-Melnyk et al. PASSED, VETOED by Governor Hogan.
Establishes a robust behavioral health services registry and referral system in the Department of Health to facilitate identification of and access to these services. MDDCSAM supported (without testimony).
Public Health - Overdose and Infectious Disease Prevention Services Program. HB 464/SB 990. Del Hettleman et al. Failed.
Would have established OD / ID Prevention Svcs Programs aka “supervised consumption spaces,” aka “safe injection spaces.” Supported by the Maryland and Baltimore Harm Reduction Coalitions and many others. The bills did not receive a vote in either chamber, despite successful hearings. There appears to be growing support in the House, but opposition in the Senate remains strong, based largely on community fears. MDDCSAM provided oral and written testimony in support.
Criminal Procedure - Medical Emergency - Immunity (Good Samaritan Expansion). HB 738 / SB 849 Dels J. Lewis & Cardin, Sens Sydnor & Smith. Failed.
(Did not receive a vote in either chamber.) Would have expanded the existing Good Samaritan law related to overdoses to provide immunity for possession with intent to distribute, all misdemeanor offenses, or having an outstanding warrant for a non-violent offense. MDDCSAM provided oral and written testimony in support.
Opioid-exposed newborns 'I'm Alive'. HB1518. Del McKay. Failed.
A bill that would have stigmatized new mothers in treatment for SUD by requiring them to use an app to periodically report that they are still conscious. It is unclear what would happen if they did not check in, if their phone was out of power, out of minutes, etc. MDDCSAM provided written testimony in opposition.
Opioid Restitution Fund - Office of the Chief Medical Examiner. HB422 Del. Rosenberg. Failed in committee.
Would have added to the allowable uses of funds support to the Office of the Chief Medical Examiner for increased caseloads due to opioid overdose deaths. MDDCSAM provided written testimony in support.
Correctional Services - Pregnant Incarcerated Individuals - Substance Abuse Assessment and Treatment. HB 524 / SB 255. Del. W Fisher et al, Sen West. Failed.
Would have required that certain pregnant incarcerated individual be screened for SUD, be referred to a behavioral health and a reproductive health provider, and that certain medication be continued under certain circumstances. MDDCSAM provided written testimony in support.
Health Insurance - Provider Panels - Definitions of Provider and Health Care Services. SB 113 Chair, Finance Committee et al. Failed.
Defines the terms "health care services" and "provider" which would require health insurance carriers to meet statutory deadlines in processing credentialing applications for providers. MDDCSAM provided written testimony in support.