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].

• The 2021 Report on the Health Care Appeals and Grievances Law (released December 1, 2022) reports that carriers rendered 81,143 adverse decisions (e.g., denials of health care services based on the carrier’s decision that the health care service was not medically necessary rather than the judgment of the treating practitioner).
• In 2022, the Maryland Insurance Administration (MIA) modified or reversed the carrier’s decision (or the carrier reversed it during the course of investigation), 72.4% of the time on filed complaints, up from 70.5% in 2021. This means that in more than 7 out of 10 cases, the MIA ruled that the carrier was wrong, and that the patient should have received the health care service.
• In 2021, the American Medical Association conducted a survey on the impact that prior authorizations have on physicians and patients and found that:  93% of physicians reported delays in access to necessary care; 82% of physicians reported that patients abandoned their recommended course of treatment because of prior authorization denials; 73% of physicians reported that criteria used by carriers for determining medical necessity was questionable; 30% of physicians reported that it is rarely or never evidence-based and 43% only sometimes evidence-based.

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 6^th.

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.