This report is based, in part, on the multi-page summary of this year’s legislative session from our lobbyists, Christine Krone and Pam Metz Kasemeyer, JD; Schwartz, Metz and Wise, PA.
Interstate Social Work Licensure Compact
It is likely not news to most of you that the Social Work Licensure Compact (House Bill 34) was not passed this year by the MD Legislature. Unfortunately, although it passed through the House, the bill was never brought to a vote in the Senate Finance Committee and Senate Bill 204 faced the same fate. Despite our members strong advocacy, which included grassroots efforts, letter writing campaigns, and legislator meetings, the Chair of the Senate Finance Committee strongly felt that the Workgroup on Social Worker Requirements for Licensure (appointed through legislation passed in the 2023 session) should conclude its work and that by passing the Compact, it would be an endorsement of the unequitable ASWB exam. We will work hard during this summer and fall to figure out the best focus for additional information and contacts that may help to get the Compact passed in Maryland in 2025.
*Changes in Record-Keeping Requirements*
House Bill 149: Medical Records-Destruction-Notice and Retrieval (passed) extends the period that a provider must keep medical records. Currently in Maryland, we are required to keep records for 5 years after the last patient contact; this will increase to 7 years which is consistent with current Medicare requirements. We are currently required to keep minors’ records for 3 years after the patient turns 18; the time will be extended to keeping minors’ records for 7 years after the patient turns 18. Providers may destroy records in less time than this if proper notice is provided. Currently, “proper notice” requires public notice in a newspaper of general circulation; new provisions will allow notice to be given by email and letter. This bill goes into effect on October 1, 2024.
Revisions to Utilization Review passed
After almost two years of advocacy and negotiations, Senate Bill 791/House Bill 932: Health Insurance-Utilization Review-Revisions passed the General Assembly. After a successful interim workgroup, Vice Chair of the Senate Finance Committee Kathy Klausmeier and Vice Chair of the House Health and Government Operations Committee Bonnie Cullison introduced the bill as “consensus legislation,” with all parties agreeing to support. However, a few weeks into session, CareFirst reneged on its support and raised an issue with the reauthorization provision of the legislation. That provision would prohibit an insurer from issuing a denial upon a request for renewal of a prior authorization when the insurer previously approved the prescription drug that the patient had been treated with without interruption. The prescriber would have also attested that the drug continued to be necessary to effectively treat the patient’s condition. Equally frustrating and more importantly, the MD Dept of Budget and Management sent a letter to the committees stating the legislation would cost the State Employee Health Benefit Plan approximately $91 million. The General Assembly could not ignore this cost given the difficulty the house and senate had agreeing on a budget. The committees wound up dealing with the fiscal note by limiting the reauthorization clause to a prescription drug to treat a patient’s mental health disorder or a prescription drug that is an immune globulin. All other protections remain fully in the bill. See informative memo from our lobbyists elsewhere in this newsletter.
Board of Social Work Examiners
House Bill 755/Senate Bill 106: State Board of Social Work Examiners - Board Membership and Certified Social Worker Licenses (passed) alters the membership of the State Board of Social Work Examiners (BSWE) by authorizing the board to include at least one member who is either a licensed certified social worker or a licensed master social worker who is approved for independent practice. The bill also makes clarifying changes and removes obsolete references to certified social worker licenses. The bill took effect June 1, 2024.
Required by the Maryland Program Evaluation Act, Senate Bill 242: State Board of Social Work Examiners - Sunset Extension (passed) extends the authority of the BSWE to July 1, 2030. The BSWE is also now required to report to the Senate Finance Committee and the House Health and Government Operations (HGO) Committee the average processing time for issuing initial licenses and renewal licenses; the average length of time required to resolve a complaint; and the rate of compliance for reviewing completed applications for a license and notifying the applicant they were approved to take the appropriate exam within the required amount of time (a total of 75 days).
Enhancing the MD Insurance Administration’s Parity Enforcement Authority
Senate Bill 684/house bill 1074: Health Insurance – Mental Health and Substance Use Disorder Benefits – Sunset Repeal and Modification of Reporting Requirements (passed) enacts many of the recommendations from the MD Insurance Administration’s (MIA) report, strengthening parity compliance reporting requirements for carriers and enhancing the MIA’s parity enforcement authority. Specifically, the bill:
There were many bills that impact us, our profession, and our clients lives that we assessed what position to take during this legislative session and wrote testimony for or against. I will continue to report on these bills in subsequent newsletters.
Our priority during this session of the Maryland Legislature is passing Senate Bill 204: Interstate Social Work Licensure Compact, which was heard on February 13 in the Senate Finance (FIN) Committee. Overall, the hearing went well with supporters fielding questions around reciprocity, the work of the Workgroup on Requirements for Licensure, and bias in the ASWB exam. The hearing had multiple panels of proponents, including myself, on behalf of GWSCSW, new member Starling Hathcock and lobbyist Christine Krone. Only one witness testified in opposition. We have just now learned that the chair of the Senate Finance Committee has held up progress of the Compact, and we have started a letter writing campaign to House members urging them to move the bill through the Committee, so it can be voted on by the Senate. Check your email for information about the campaign. House Bill 34, the House version of the bill passed out of the Health and Government Operations (HGO) committee unanimously after members Chana Lockerman, new member Starling Hathcock and I testified in support of the bill. In a strong show of support, all the Committee members save one signed on as sponsors of the bill in the MD House. It was passed by the House on February 21.
This report is based, in part, on the multi-page summary of this year’s legislative session from our lobbyists, Pam Metz Kasemeyer, JD and Christine Krone.
As promised, this is a final wrap-up of the bills that came before the MD 2023 Legislature that had the potential to impact our profession and our clients. See the reports in the March and June newsletters for many other bills considered by your Legislation and Advocacy Committee and our lobbyists.
Senate Bill 581 (passed) established the Behavioral Health Value-Based Purchasing Pilot Program, which will pilot person-centered, team-based services designed to assess and meet the needs of behavioral health clients needing to navigate the health- care system. $600,000 in mandated funding for the pilot must be included in the budget for each of the Fiscal Years 2025-2027.
Senate Bill 263/House Bill 573 (passed) establishes an Advisory Committee to study and make recommendations regarding access to mental health services on higher education campuses. The Committee will report its findings to the General Assembly by 12/1/23.
Senate Bill 154 (passed) requires the Department of Health to implement a public awareness campaign to encourage the use of Mental Health Advance Directives in Maryland. The goal is to identify how first responders and behavioral health crisis providers can access an advance directives database when responding to a behavioral health crisis.
Unfortunately, both House Bill 1070, which would have permitted LCSW-Cs to serve as Expert Witnesses, and House Bill 694, which would have permitted LCSW-Cs to be certified by the MD BSWE to register as a rehabilitation practitioner and perform specified services for workers’ compensation purposes, both either failed to pass out of committee (HB 1070) or never received a hearing in the senate (HB 694). Look for similar bills to be introduced in the 2024 Legislative Session.
House Bill 103/Senate Bill 145 (passed) authorizes the MD BSWE to issue a temporary license lasting no more than 180 days if a required exam was unavailable to the applicant for at least 15 days. The applicant must have already met all educational and experience requirements.
THE INTERSECTION OF SOCIAL JUSTICE AND LEGISLATION AND ADVOCACY
The MD Department of Health is working to identify individuals to serve on a legislatively-mandated “Workgroup on Black, Latino, Asian American Pacific Islander and Other Underrepresented Behavioral Health Professionals.” This group was established by HB 97 in 2022 and its effective date was extended one year by HB 615 this past session.
The Workgroup shall:
This is not a bill that the GWSCSW was specifically requested to appoint someone to serve on the Workgroup; however, they are still actively seeking people to serve in three seats that have not yet been filled. Two seats require a representative from an organization, network or association of behavioral health professionals. The third seat needs a representative from a hospital network that primarily serves underrepresented communities.
This is an opportunity to be involved in representing our Society while addressing a social justice issue. Please let Judy Gallant know (judy.gallant@verizon.net) if you are interested in serving on this workgroup.
Senate Bill 581 (passed) established the Behavioral Health Value-Based Purchasing Pilot Program, which will pilot person-centered, team-based services designed to assess and meet the needs of behavioral health clients needing to navigate the health-care system. $600,000 in mandated funding for the pilot must be included in the budget for each of the Fiscal Years 2025-2027.
As many of you may have read on our listserve, Senate Bill 871, Social Workers – Sunset Extension, Notification of Complete Application, and Workgroup on Social Worker Requirements for Licensure, which, in part, addressed licensing requirements for social workers, was revised from its original form, which included suspending the requirement of passing the ASWB test as a requirement for licensure. The bill that passed was supported by our Society and establishes a Workgroup to be staffed by the Maryland Department of Health as well as many stakeholders. The workgroup will study whether ASWB testing should continue to be a requirement of different levels of licensure, and membership of the group is intended to be diverse, including one member from GWSCSW appointed by the President. Members of leadership asked our President, Karla J. Abney, if she would serve in that position, and she graciously accepted. See the Home Page of our website for her comments about this role and her decision to be our representative.
A number of you expressed interest in the Workgroup. Karla has requested that members “read the final version of HB871 and the requirements for the Workgroup and provide me with your thoughts, questions, and suggestions for possible discussion during Workgroup meetings. As there is the possibility of the formation of subgroups, or the need for an Alternate GWSCSW member, I ask anyone interested in serving, especially anyone from the groups adversely affected by the ASWB exam (e.g., African Americans, Persons over 50, the Deaf Community, and the ESL Community) to contact me [karla.j.abney@gmail.com] and let me know of your interest.”
There is another important Workgroup that will be reporting back to the MD General Assembly which we have an opportunity to serve on and are looking for volunteers willing to serve in that capacity. The MD Department of Health is working to identify individuals to serve on a legislatively-mandated Workgroup on Black, Latino, Asian American Pacific Islander and Other Underrepresented Behavioral Health Professionals.” This group was established by HB 97 in 2022 and its effective date was extended one year by HB 615 this past session.
(1) identify and study the shortage of behavioral health professionals in the State who are Black, Latino, Asian American Pacific Islander, or otherwise underrepresented in the behavioral health profession; and
(2) assess and make recommendations on incentives or other methods to increase the number of underrepresented minorities.
This is not a bill that the GWS was specifically requested to appoint someone to serve on the Workgroup; however, they are now actively seeking people to serve in seats that have not yet been filled:
This is another opportunity to be involved in a Social Justice issue with the Society. Please let Judy Gallant know (judy.gallant@verizon.net) if you are interested in serving on this workgroup.
Insurance Issues
As I mentioned in the March News & Views article (which more fully explains Step Therapy), we collaborated with over 50 organizations to support bills that would limit insurance company review practices that impact mental health treatment. Unfortunately, Senate Bill 308/House Bill 305: Health Insurance-Utilization Review-Revisions failed to pass this session. These bills would have changed the UR process, including prohibiting the need for reauthorizing a prescription drug if a patient is doing well on the medication. As you can imagine, these bills were opposed by the insurance industry, but House and Senate Committees committed to work with advocates during the course of this year, in anticipation of similar legislation returning next session.
The General Assembly did pass Senate Bill 515/House Bill 785: Health Insurance-Step Therapy of Fail-First Protocol and Prior Authorization-Revisions which will become effective on 1/1/2024. This bill requires insurance plans to adopt a policy to approve a step therapy exception request if the provider believes the step therapy drug would be harmful to the patient. It also requires the Pharmacy Benefits Manager must then authorize coverage for the drug without going through prior authorization.
Another bill that our support helped pass was the “Preserve Telehealth Access Act of 2023,” Senate Bill 534, which extends coverage and reimbursement for telehealth, including audio-only telephone conversations at the same rates as in-person sessions through June 30, 2025. Although not the permanent fix that we hoped for, this does gives us 2 more years to provide these services to our patients. During this time, the Department of Health will also be examining information about the efficacy of these services.
Behavioral Health
Senate Bill 283/House Bill 418: Mental Health-Workforce Development- Fund Established was passed, and creates the Behavioral Health Workforce Investment Fund to provide reimbursement for costs associated with educating, training, certifying, recruiting, placing, and retaining behavioral health professionals and paraprofessionals. The Maryland Health Care Commission (MHCC), in coordination with stakeholders, must conduct a comprehensive behavioral health workforce needs assessment. The assessment will recommend an initial allocation to the fund and identify which programs the allocation will support, and is to be submitted to the General Assembly by October 15, 2024.
Senate Bill 101/House Bill 48: Maryland Medical Assistance Program-Collaborative Care Model Services-Implementation and Reimbursement Expansion(passed) requires Medicaid reimbursement for behavioral health services delivered in primary care settings. The “collaborative care model” is a patient-centered, evidence based approach for care coordination and care management, integrating physical and behavioral health care services in the primary care setting. This will include regular outcome monitoring, systemic behavioral health caseload review, and consultation for patients.
Senate Bill 362/House Bill 1249: Certified Community Behavioral Health Clinics (CCBHCs)-Planning Grant Funds and Demonstration Application(passed) will expand Maryland’s network of CCBHCs. CCBHCs provide services to the underserved, regardless of ability to pay. They must provide nine core services, including case management; somatic screening; veterans’ services; 24/7 crisis intervention peer support; psych rehab; screening, dx and assessment; treatment planning; and OP MH and Substance Use treatment.
There were many bills that impact us, our profession, and our clients lives that we assessed what position to take during this legislative session and wrote testimony for or against. I will continue to report on these bills in the September newsletter.
Yesterday, April 24, 2023, Maryland Governor Wes Moore signed HB 871 - Social Workers - Sunset Extension, Notification of Complete Application, and Workgroup on Social Worker Requirements for Licensure. A requirement of the Bill is to establish a Workgroup to determine several issues including:
HB 871 specified the makeup of the Workgroup which includes one person from the GWSCSW chosen by the President. I have had a request by leadership to serve as a member of the Workgroup. As a Black female Social Worker over the age of 50, I am honored to represent the GWSCSW. I ask a few things of members. Please read the final version of HB871 and the requirements for the Workgroup and provide me with your thoughts, questions, and suggestions for possible discussion during Workgroup meetings.
As there is the possibility of the formation of subgroups, or the need for an Alternate GWSCSW member, I ask anyone interested in serving, especially anyone from the groups adversely affected by the ASWB exam (e.g., African Americans, Persons over 50, the Deaf Community, and the ESL Community) to contact me a let me know of your interest.
As always, please feel free to contact me directly.
Karla J. Abney, MSW, MSN, LMSW
President - GWSCSW
karla.j.abney@gmail.com
I write this update the day after attending the MD Mental Health Association’s Legislative Briefing and Reception. Our new Governor, Wes Moore, spoke of prioritizing the accessibility of mental health care to Marylanders, and has acknowledged that in his proposed budget by earmarking $1.4 billion to mental health efforts. He was an inspiring and dynamic speaker, discussing the need to “relegate to the past this idea that the largest mental health provider in our country and in our state is our prison system,” and declaring that we can no longer deal with our mental health crisis by criminalizing it.
During another part of the evening, Kathleen Birrane, the Commissioner of the Maryland Insurance Administration (appointed in 2020), spoke honestly about the difficulty past Administrations have had of holding insurance companies accountable for breaking parity laws and enforcing penalties for not observing network adequacy requirements. She has slowly but surely begun to put insurance companies on notice when their published health plans have not complied with parity laws and given them a chance to correct the issues. When she has not seen significant changes in their resubmissions to meet the requirements of the parity law, the MIA has begun holding them accountable with stiff financial penalties.
Although Governor Moore did not speak about abortion at this event, he has also laid out his goal of strengthening abortion access, protecting abortion providers and those who seek abortions in Maryland. One of his proposed measures would create a shield law to protect abortion providers and patients from out-of-state legal, criminal or administrative action. Another proposed bill would give Maryland voters a choice in 2024 to place the right to an abortion in the Maryland Constitution.
Telehealth
One of our Society’s highest priorities this legislative session is to advocate to allow telehealth, including audio-only telephone conversations, to continue to be reimbursed at the same rates as in-person sessions. The “Preserve Telehealth Access Act of 2023,” Senate Bill 534, would extend coverage and reimbursement for these services through June 30, 2025. Although not the permanent fix that we would hope for, if passed, this does give us two more years to provide these services to our patients. During this time, the Department of Health will also be receiving more information about the efficacy of these services.
Why Reforming Utilization Review and Step Therapy is Needed
Health insurance carriers engage in “utilization review” where the carrier reviews a practitioner’s request that a patient receive a certain health care service to determine if the service is medically necessary. The two most common types are “prior authorization” (needing to request approval in advance from the carrier) and “step therapy” [the patient must try and fail on (often less expensive) medications before being allowed to “step up” to another, potentially more effective medication].
We came together with a group of almost 50 organizations to strongly support two bills, one of which (House Bill 305/Senate Bill 308) will limit insurance carriers ability to remove authorization from a previously approved medication that continues to treat the patient successfully. The other bill (Senate Bill 515) exempts prescription drugs treating a mental disorder from step therapy protocols (meaning that someone has to fail to improve on one drug before another drug can be tried). This can potentially have a big impact on the patients we work with, as they may be able to recover their ability to function more quickly when they are able to receive the correct medicine without unnecessary delays.
A late-breaking concern: Senate Bill 871
We just learned about this bill entitled Social Workers – Licensure Examinations – Moratorium and Workgroup, which was “dropped” (introduced to the legislature) on February 6th.
This bill would remove licensure examination requirements for all Social Workers in Maryland, Including LCSW-Cs. It would also require the MD Department of Health to establish a workgroup, after eliminating examination requirements, to identify alternatives to exams for MSW, LCSW, and LCSW-C licenses and develop recommendations for an assessment method to replace the exam requirement.
Position of the GWSCSW Executive Committee:
We oppose Senate Bill 871 as it is currently written, which would remove licensure examination requirements for all Social Workers in Maryland, including LCSW-Cs. Eliminating licensure exams without an alternative method of testing is of great concern to us because of the potential impact the passage of the bill could have. To our knowledge, no other medical professional in Maryland can receive a license without passing an exam. We would not want a doctor or physical therapist to treat us without being tested on their knowledge.
The elimination of licensing exams could lead to insurance providers based in Maryland discontinuing reimbursement for our services. We have made strides in being respected for our knowledge of diagnosis and treatment of mental health conditions. Passage of this bill would be a step backward in the evolution of our profession. In addition, it would put at risk Maryland’s ability to participate in the Social Work Interstate Compact, expected to be released on February 27. (See CSWA article elsewhere in this newsletter.)
In support of our opposition to this Bill, we reprise a public statement that the MD Board of SW Examiners has posted on their website regarding the ASWB Licensing Exams. It says, in part:
“Requests that we, as a regulatory board, choose not to rely on the ASWB licensing examinations
do not address the larger societal issues that can impact candidates long before they take a social work licensing exam. Prerequisites to licensure are set in law, serve as an essential component of public protection, and cannot simply be ignored nor waived. The ASWB examination program, due to its rigorous standards, is a defensible measure of competency and can be relied upon by government as one requirement for licensure as a social worker.”
There is no doubt that there are significant problems with the ASWB exams. ASWB is partnering with a number of Social Work organizations (including CSWA) to examine and eliminate racial bias issues within the exams. This will take some time and there is not a quick fix. And although some legislators believe that passage of this bill would be a quick fix, there would likely be unintended consequences that could be extremely damaging to our profession, our clients and to our ability to make a living.
Please stay tuned and watch for updates on our listserve. I will put out a call to action for Maryland members to contact your State Legislators if this bill appears it is moving forward for a vote.
Judy Gallant, Chair, MD Legislation and Advocacy Committee
Although the Maryland General Assembly doesn’t start it’s legislative session until January 11, 2023, we have collaborated with the MD Behavioral Health Coalition to support and prioritize Equal Treatment Maryland, as well as the 2023 Behavioral Health Crisis Prevention Platform. Currently, two-thirds of Maryland’s counties qualify as federally designated mental health professional shortage areas. Commercial health insurance companies in Maryland reimburse behavioral health providers nearly 20% less than other doctors for similar procedures, Maryland ranked 7th worst in the nation last year for opioid death rates, and MD has seen a 46% increase in children accessing hospital ERs for suicide attempts.
The 2023 Behavioral Health Crisis Prevention Platform emphasizes the great increase in the need for community mental health and substance use care and asks that the MD Department of Health be required to develop and advance a plan to expand the state’s network of Certified Community Behavioral Health Clinics in order to help keep people out of crisis. In addition, a sufficient provider workforce must exist to accomplish accessibility to services. Through supporting Equal Treatment Maryland and the Behavioral Health Coalition, we are also requesting that a Behavioral Health Workforce Investment Fund be established. A behavioral health workforce assessment is required to figure out the best usage for such a fund. Sixteen counties are designated mental health professional shortage areas, and less than 20% of individuals in these areas get their mental health needs met. Additionally, staff vacancies exist in over 80% of Maryland’s child-serving community behavioral health programs.
During our last legislative session, we supported passage of the Behavioral Health System Modernization Act which would have expanded comprehensive treatment by expanding Maryland’s network of Community Behavioral Health Clinics. Care for children and youth would have improved by increasing the availability of home- and community-based wraparound services. It also sought to reduce reliance on law enforcement and ERs by ensuring stable reimbursement for Maryland’s network of crisis call centers, mobile crisis teams and crisis stabilization facilities. It is not uncommon for vitally important changes to our behavioral health system such as these take years to become law. Our support this year of Equal Treatment Maryland continues what was begun in previous years.
Within the past couple of weeks, we joined with other organizations to advocate that the Hogan administration take action on two specific issues. As part of the MD Behavioral Health Coalition, we asked that Governor Hogan direct his health department to apply for a federal planning grant to sustain and expand Maryland’s network of Certified Community Behavioral Health Clinics. We explained: “Passage of the federal Bipartisan Safer Communities Act has made available $40 million for planning grants and technical assistance to states interested in implementing Certified Community Behavioral Health Clinics (CCBHCs). The legislation also includes four years of enhanced Medicaid match for CCBHC services. These planning grants were released late last month, and applications are due in December.” We received the response that Maryland Medicaid decided not to apply in this cycle for the $1 million CCBHC planning grant. Given this, a legislative proposal is being developed to expand Maryland’s network of CCBHCs.
Another letter was sent to the current Secretary of the Department of Health, Dennis Shrader, requesting that a Request for Proposals for the behavioral health Administrative Service Organization contract be issued before the end of 2022. The current contract ends in 2024, and in order to avoid the horrible mismanagement of the current contractor, Optum, in processing Medicaid claims in Maryland, “the next vendor must have adequate time to ensure that all systems are operational.” We joined forces with MedChi, the Mid-Atlantic Association for Community Health Centers, the MD Chapter of the American College of Emergency Physicians, and NASW-MD.
Late-breaking news: the Interstate Social Work Compact is scheduled to be released to states by the Council of State Governments at the beginning of January, 2023! This makes it possible that legislatures will be able to pass the Compact into becoming law in their State during the 2023 Legislative Session. Remember that seven states must pass the Compact into law before an administrative body can be formed to create a functioning compact between those states. In the near future, we will share ways you could become involved through contacting your state representatives and asking for their support on this exciting possibility.
Judy Gallant, MD Legislation and Advocacy Chair
This report is based, in part, on the multi-page summary of this year’s legislative session from our lobbyist, Pam Metz Kasemeyer, JD.
The Maryland General Assembly completed its 2022 legislative session on Monday, April 11.
Budget Issues
The only legislation required to pass each year is a budget, and that job was made easier this year with a surplus larger than the State has seen in its history, thanks to federal funds sent down through COVID-19 relief legislation and the Build Back Better infrastructure monies.
The budget committees have instructed State agencies to submit reports on various issues. One of specific interest to the practice of social work is the report on Optum.
Optum-Medicaid Specialty Mental Health System: Budget language was adopted which withholds $1 million from the Maryland Department of Health (MDH) pending a report on the actual amount of overpayments outstanding, recoupment and forgiveness of overpayments, the total number and total amount of claims still in dispute, and more. Since Optum assumed the ASO contract, its implementation has been catastrophic, and the provider community continues to look for avenues to address the total chaos regarding claims management. (The ASO is the Administrative Service Organization for the specialty mental health contract carved out under Medicaid’s HealthChoice program.) The report on the Optum issue is due from the MDH on August 1, 2022.
The relevant Committees in the House and Senate have been very engaged in gathering information on the Optum controversy and have expressed an interest in making MDH accountable for resolving the problems. A bill failed that was introduced to address the challenges providers have faced in resolving claims with Optum, in part due to strong pushback by Optum and MDH and the inability to determine the actual fiscal impact of the bill. The legislation’s failure was especially disheartening to the behavioral health community, given the continued challenges we face. Perhaps the directives by the budget committees will provide a pathway to resolution of these issues, although they will not provide the immediate relief necessary. These recoupment plans are moving forward despite the lack of reliable data to reconcile historical payments and services.
Health Insurance Coverage
House Bill 912/Senate Bill 707: Health Insurance-Provider Panels-Coverage for Nonparticipation: This bill passed and will require a carrier to ensure that service provided by a nonparticipating specialist (including those licensed for treatment of mental health or substance use disorders) are provided at no greater cost than if the covered benefit were provided by a practitioner on the carrier’s provider panel. (Managed Care Organizations [MCOs] are exempt from this requirement.) Each carrier must inform members of the procedure to request a referral to a specialist or non-physician specialist, and the Consumer Education and Advocacy Program must provide public education to inform consumers of these procedures. By December 31, 2022, each health occupations board that regulates mental health or substance use disorder providers must report to the General Assembly on their progress in developing a process for providing information to carriers for the purpose of carriers reaching out to providers regarding participation in provider panels.
Early Intervention for Children
House Bill 725/Senate Bill 506: Therapeutic Child Care Grant Program-Establishment: This bill creates a Therapeutic Child Care Program and mandates an appropriation in the Governor’s annual budget to fund the Program. Therapeutic Child Care Programs provide specialized childcare and early childhood education to children under the age of 6 who have developmental delays, including physical disabilities or delays in social, emotional or behavioral functioning. This bill takes effect July 1, 2022.
Health Crisis Response Services
House Bill 293/Senate Bill 241: 9-8-8 Trust Fund: This bill establishes the 9-8-8 Trust Fund in order to provide reimbursement for costs associated with designating and maintaining 9-8-8 as the universal telephone number for a national suicide prevention and mental health crisis hotline and developing and implementing a Statewide initiative for the coordination and delivery of the continuum of behavioral health crisis response services in the State. In 2020, Congress passed the National Suicide Designation Act of 2020, which establishes 9-8-8 as a universal number for mental health crises and suicide prevention. In July 2022, 9-8-8 will go live. All phone companies will then route 9-8-8 calls to local crisis call centers that are part of the Lifeline network. Local crisis call centers provide 24/7 free, confidential emotional support to individuals calling for help. Our State bill included $5 million for FY 2023 and $5.5 million in funding for the FY 2024 budget.
Unfortunate failed advocacy efforts
Many of the bills we advocated for this year, including the Behavioral Health System Modernization Act, and a number of bills related to the practice of social work, did not pass to become law during this legislative session. We will report further on those in our next newsletter report.
In late September, 2021, Pam Metz Kasemeyer (our Maryland lobbyist) and I met via zoom with Stanley Weinstein, Executive Director of the MD Board of Social Work Examiners (BSWE). At the meeting, we raised concerns with Dr. Weinstein that our members have expressed for a long time: slow responsiveness, apathy, unprofessional behavior and unhelpfulness of staff to inquiries; problems with applications for licensure not being acted on in a timely way; and the great contrast of Maryland’s BSWE with Boards of Social Work of other states and jurisdictions. Although our membership has been frustrated for a number of years, our discussion was also in the context of the pandemic. At that time, staff was working in a hybrid manner, coming to the office just 3 days/week, working from home the rest of the time. Prior to July, staff was working virtually 5 days/week.
What I found most illuminating was Dr. Weinstein’s discussion of how the Board operates in terms of staffing and budget. The State (Governor and Legislature) controls how much money is spent on the Boards, and the Department of Health assigns who gets hired as staff. They have only 15 staff members to deal with 18,000 applications for all levels of licensure/year. By contrast, when Dr. Weinstein began his position 7 years prior, 10,000 applications were processed by the same number of staff.
I raised the issue of denials of Continuing Education credits because of staff’s lack of knowledge of the applicability of a specific course to clinical social work. He acknowledged that one member of the CE department at that time was not a clinical social worker, and indicated that licensees can ask to go before the CE Committee if they feel an incorrect decision was made about a training they have taken. The Maryland Board of Social Work Examiners accepts continuing education units offered by Association of Social Work Boards, National Association of Social Workers, and Board Authorized Sponsors.
Dr. Weinstein indicated they were reassessing how they operate, esp. via telework, and that he would be reviewing all staffing. We agreed to stay in touch.
New Information
In December 2021, there was a cyber attack on the MD Department of Health which affected the professional licensing Boards, the hospital system and health clinics. As a result, BSWE has had additional difficulty functioning, since BSWE has been unable to use their old computers, cannot print licenses, and cannot deposit checks. They now use a mobile hot spot from Verizon and have gotten a few new computers, but there are not enough for all staff. They are extremely frustrated that the Department of Health has downplayed this and that the public has little information about what is going on. I know several of our members have had problems with license applications, reaching the Board for other business, and have been extremely frustrated by the complete lack of responsiveness. While we know about the historical difficulties the BSWE has had with their responsiveness, this has decreased their response times even further. At this writing, we are planning to join with other organizations to write to the Department of Health and to Governor Hogan.
In early January, the Maryland General Assembly started their annual 90-day legislative session. As of this writing in February, we have submitted testimony on 11 bills, supporting the bills’ aims, but for several bills our support is dependent upon the inclusion of amendments offered.
Bills addressing insurance reimbursement
As some of you already know, Optum, the administrative services organization (ASO) that administers the delivery of specialty mental health services under the Maryland Medicaid Program, has an abysmal record of paying claims in a timely manner. Senate Bill 549 is a direct result of the inability of the State’s ASO to process claims or pay health care providers for services rendered since inception on January 1, 2020. As a result, the Maryland Department of Health has had to resort to making advanced but estimated payments to health care providers, based on historic 2019 billing data that did not account for the impacts of the COVID-19 pandemic. This has now placed health care providers in the precarious position of having to pay back the difference between the estimated payments and the claims amount submitted.
Senate Bill 549 requires Optum to give health care providers the tools needed to substantiate the processing of claims. Our testimony in support of the bill argued that health care providers should not be disadvantaged due to the failure of Optum (and the State) to employ a workable billing and claims processing system.
House Bill 912 addresses health care coverage of non-participating providers. In our testimony supporting this bill, we stated: ensuring that individuals have access to critical mental health and substance use disorder treatment services continues to be an area of concern to the clinical social work community. … House Bill 912…ensures that the insured has coverage for mental health or substance use disorder services at no greater cost to the member than if the services were provided in-network by allowing an insured to go out of network if the carrier’s provider panel has an insufficient number or type of participating specialist or non-physician specialist for the required services.
Addressing issues around Health Care staffing shortages
HB 625 would establish a Commission to study the health care workforce crisis in Maryland. In our testimony supporting the bill, we emphasized the importance of examining the additional support the Department of Health could give to the Boards to assist with workloads, overhead, improved staffing and technology improvement. We expressed concern that BSWE has been unable to respond in a timely way to licensing issues of our members, which is greatly impacted by the tremendous workload the inadequate number of staff is attempting to handle.
HB 407 would authorize the Secretary of Health to declare a health care staffing shortage emergency in the State and require each health occupations board to establish processes for the issuance of initial licenses, temporary licenses, and temporary practice letters on an expedited basis for such an emergency. The bill would relax licensure standards to bolster the current health care workforce, specifically targeting (1) an applicant for an initial health occupation license; (2) an individual who holds a valid, unexpired health occupation license issued in another state; (3) an inactive licensee; (4) a retired health care practitioner; and (5) a nursing graduate. We expressed support of the bill provided that amendments would be offered that will allow the health occupation boards more discretion in how to expedite licenses.
We are currently monitoring many other bills of interest to clinical social workers in Maryland. Look for our June newsletter for final decisions on these and other bills.
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