Judy Gallant, MD Legislation and Advocacy Committee Chair
For those holding MD licenses that need to be renewed by October 31, 2021: The current continuing education requirement for LCSW-Cs is 40 credit units of continuing education in programs and categories approved by the Board for each two-year period of licensure. Licensees must obtain at least 20 of the 40 credits in Category I. Category 1 CEUs can be obtained through virtual programs that are live and interactive at the time they are taken; recorded programs given by approved providers will receive Category II credits. All 40 credit units may be earned in Category I. Of the 40 required credit units, a licensee must obtain 3 credit units in Category I or Category II in a content area focusing on ethics and professional conduct. For those wanting to maintain their status as a Board-approved supervisor, you must take 3 CE credits focusing on supervision.
This report provides information on some bills passed during the 2021 Legislative Session in Annapolis. Please make sure you have reviewed June’s newsletter report to learn about the most important laws affecting LCSW-Cs that passed this session which address telehealth rules; LCSW-Cs being authorized to be a second signature for involuntary admission to a hospital; reducing the age an adolescent may consent to mental health treatment from 16 to 12 years old; implicit bias training that will be required for license renewal; and a reduction in supervision hours required for new LCSW-Cs.
Additional bills which will impact us:
As many of you are aware, Optum took over as the Administrative Service Organization for Maryland Medicaid and there have been significant difficulties with their administration. House Bill 919/Senate Bill 638: Maryland Insurance Commissioner – Specialty Mental Health Services and Payment of Claims – Enforcement subjects Optum to oversight by the Maryland Insurance Administration. The Budget Committees are also requiring quarterly updates from the MD Dept of Health on the functionality of the Behavioral Health Administrative Service Organization to be included in the FY 2022 Operating Budget.
Senate Bill 286.House Bill 108: Behavioral Health Crisis Response Services – Modifications change requirements for grant proposals and for awarding grants under the Behavioral Health Crisis Response Grant program. With these changes, an application must be able to serve all members of the immediate community with cultural competency and appropriate language access, commit to gathering feedback from the community on an ongoing basis, and improving service delivery continually based on this feedback. The applicant must also demonstrate strong partnerships with community services that include family member and consumer advocacy organizations and regional stakeholders, and show a plan linking individuals in crisis to peer support and family support services after stabilization.
House Bill 78/Senate Bill 52: Public Health – Maryland Commission on Health Equity (The Shirley Nathan-Pulliam Health Equity Act of 2021) creates a MD Commission on Health Equity that is charged with developing a “health equity framework” – defined as a public health framework through which policymakers and stakeholders (public and private) use a collaborative approach to improve health outcomes and reduce health inequities in the State by incorporating health considerations into decision making across all sectors and policy areas. The Commission is to assess the impact of a list of factors on the health of residents in evaluating new policies, including access to safe and affordable housing, educational attainment, opportunities for employment, economic stability, access to transportation, food insecurity and social justice.
House Bill 463/Senate Bill 172: Maryland Health Equity Resource Act (passed) establishes a framework for the establishment of Health Equity Resource Communities (HERC) in areas of the State with demonstrated health inequities and disparities. The legislation as enacted is no longer funded by an alcohol tax and the program will be administered by the Community Health Resources Commission (CHRC). The General Assembly allocated $14 million dollars from the Relief Fund legislation to the Commission to administer short term grants related to health equity priorities for two years. During that two-year period, an Advisory Committee is charged with the development of a framework for a permanent HERC program, including the identification of a permanent funding source.
Senate Bill 164/House Bill 605: Veterans – Behavioral Health Services – Mental Health First requires MDH to include mental health first aid among the behavioral health services for which MDH provides service coordination for eligible veterans.
House Bill 872/Senate Bill 550: Sheila E. Hixson Behavioral Health Services Matching Grant Program for Service Members and Veterans – Establishment creates a grant program for Service Members and Veterans administered by MDH. Beginning in FY 2022, the Governor may include an annual appropriation of $2.5 million for the program in the operating budget. The program will award competitive matching grants to local nonprofit organizations to establish and expand community behavioral health programs that serve the behavioral health needs of eligible individuals in the locality served by the nonprofit organization; integrate the delivery of mental health and substance use treatment; and connect eligible individuals to appropriate community-based care in a timely manner on discharge from the community behavioral health program.
Judy Gallant
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 2021 legislative session on Monday, April 12. There were no in-person sessions due to the pandemic – all business and votes were conducted via Zoom and YouTube. The committee voting sessions, which have previously been primarily closed-door meetings, were available to be viewed in real time by the public.
Some of the most important laws affecting LCSW-Cs that passed this session address telehealth rules; LCSW-Cs being authorized to be a second signature for involuntary admission to a hospital; reducing the age an adolescent may consent to mental health treatment from 16 to 12 years old; implicit bias training that will be required for license renewal; and a reduction in supervision hours required for new LCSW-Cs. Details are below. Information on additional legislation passed in 2021 will appear in the September newsletter.
Our major priority this session was to advocate for the continuation of telehealth access for patients and we were successful! There was broad support for Senate Bill 3: Preserve Telehealth Access Act of 2021 which codifies the use of telehealth that had been expanded in 2020 as a result of the pandemic. The legislation requires insurance plans (including Medicaid) to pay equally for in-person and telehealth visits with the same CPT codes. Telephone services (audio only) is now codified as telehealth in Maryland. Additionally, insurance companies will be unable to require providers and patients to use proprietary telehealth platforms in Maryland. The bill will be in effect between July 1, 2021, and June 30, 2023. During that time, the Maryland Health Care Commission (MHCC) is required to study the impact of providing telehealth services on patients and providers and must issue a report with recommendations to the General Assembly by December 1, 2022. The General Assembly will have the opportunity to make the law, and potential changes to it, permanent during the 2023 session (prior to the termination of the provisions on June 30, 2023).
The MHCC, through our lobbyist, Pam Metz Kasemeyer, has requested to meet with us in May to help them with being in touch with providers for the study. Look for updates about this in our next newsletter.
Our member, Arthur Flax, developed important legislation – House Bill 698: Mental Health-Assent to and Certificates for Admission-Licensed Certified Social worker-Clinical and Licensed Clinical Professional Counselor - which now authorizes LCSW-Cs and LCPCs to be the second signatory on a certification of involuntary admission to a state facility or VA hospital, as well as a second signatory of a voluntary admission of a minor to a child or adolescent unit of a state facility. Kudos to Arthur for identifying the need for this, identifying sponsoring legislators, helping to draft the bill, and shepherding the legislation through to enactment. We gave testimony supporting the bill, as did NASW and others.
The Senate Bill 41: Health – Mental and Emotional Disorders – Consent (Mental Health Access Initiative) lowers the age from 16 years to 12 years, at which a youth can seek mental health treatment without consent from a parent or guardian. The health care provider retains the authority to determine if the minor is mature and capable of giving informed consent, and also permits the provider to release information to a parent or guardian without the minor’s consent, unless the provider believes the disclosure will lead to harm to the minor or deter the minor from seeking care. A minor younger than 16 is not authorized to consent to the use of prescription medications to treat a mental or emotional disorder. The current provisions of law, which do not allow a minor to refuse consultation, diagnosis or treatment for a mental or emotional disorder for which a parent or guardian has given consent, remains unchanged.
House Bill 28: Public Health – Implicit Bias Training and the Office of Minority Health Disparities requires all licensed and certified health care professionals to complete an implicit bias training course that is recognized by a health occupations board or accredited by the Accreditation Council for Continuing Medical Education and approved by the Cultural and Linguistic Health Care Professional Competency Program, in conjunction with the Office of Minority Health and Health Disparities. A health care provider must attest to the completion of an implicit bias training course on the provider’s first application for license renewal after April 1, 2022. Additionally, the bill expands the reporting requirements of the Office of Minority Health and Health Disparities to include racial and ethnic data in their annual “Health Care Disparities Policy Report Card,” post the information on their website, and update the data every 6 months.
House Bill 811: State Board of Social Work Examiners – Revisions largely makes technical changes, but additionally reduces the supervision hours required for training for an LCSW-C from 144 hours to 100 hours. Virginia and DC and other jurisdictions across the country also require 100 supervision hours for their clinical licenses.
Judy Gallant, LCSW-C, is the director of the Society’s Legislation & Advocacy program, as well as chair of the Maryland Clinical Social Work Coalition, our GWSCSW legislative committee in Maryland. She maintains a private practice in Silver Spring.
Pamela Metz Kasemeyer, JD, and her firm of Schwartz, Metz & Wise, PA, represent us in Annapolis and guide our advocacy strategy. Ms. Kasemeyer is an acknowledged authority on Maryland’s health care and environmental laws and has represented a variety of interests before the Maryland General Assembly and regulatory agencies for more than 25 years.
In early January, the Maryland General Assembly started their annual 90-day legislative session. It looks to be a whirlwind of a session, as there were almost 800 bills pre-filed before the session even started! As of this writing at the end of January, we have submitted testimony on 7 bills, all in support of the bills’ aims, but for several bills our support is dependent upon the inclusion of amendments offered.
Bill to authorize reimbursement for teletherapy on a permanent basis
We offered testimony supporting Senate Bill 393, which would authorize reimbursment for telehealth for MH and SUD services (including audio only services) to continue on a permanent basis following the public health emergency for the Maryland Medical Assistance Program and Health Insurance. As mentioned in Laura Groshong’s article elsewhere in this newsletter, states must take action to prevent insurance companies from discontinuing reimbursement for these services in their State, and Maryland is being proactive in introducing this bill.
Addressing issues around health disparities
We supported 2 bills having to do with addressing health disparities of racial and ethnic minorities as a result of their social determinants of health. One bill, House Bill 78, will create a Maryland Commission on Health Equity, which would examine ways for State and local government agencies to collaborate to implement policies that will positively impact the health of residents of Maryland. House Bill 28 would establish a requirement for all license health care professionals to complete a one-time implicit bias training course. The amendment we requested was to move the effective date of the bill from October 1, 2021, to April 1, 2022. Licensees would need to complete the required course by their first license renewal after the effective date.
Mental Health First Aid training to support Veterans and their families
Senate Bill 164 would incorporate “Mental Health First Aid” training into the services veterans and their families are entitle to receive in Maryland. Veterans have a high incidence of mental health and substance use disorders, but they and their families may not recognize or know how to respond to their behavioral health needs or know how to access services. We supported offering this training for veterans and their families, which can help enable them to identify and respond to mental health issues and improve the quality of their lives.
Task force to study mental health care in higher education
We presented testimony in support (with amendment) of House Bill 244 which creates a Task Force to study access to Mental Health Care in Higher Education. The Task Force is to be charged with studying policies and procedures related to the treatment on mental illness in higher education students and would make recommendations regarding issues that will enhance access and appropriate response to the mental health care needs of students by their institutions. We recommended changes to the proposed make-up of the Task Force to include a minimum of two students and one clinical social worker during our testimony, which were received positively, and our proposed language is to be added to the bill.
Increased funding and expansion of mobile crisis response teams
Testimony we presented regarding House Bill 108 supports increasing and extending funding for Maryland’s Behavioral Health Crisis Response Grant Program. The bill includes important requirements for crisis response services that will serve to minimize law enforcement interaction for individuals in crisis by expanding the use of 24/7 mobile crisis teams, which is a team including a licensed mental health professional and peer support specialist, to respond to people in crisis in the community, rather than having police respond. In our testimony, we emphasized the importance of the provision of follow-up coordination and connection to services-provided by the increased financial support, in order to decrease avoidable incarcerations, emergency room visits, hospitalizations and readmissions.
Committee to review suicides in Maryland
We supported a bill creating a Maryland Suicide Fatality Review Committee, with an amendment to include a greater range of clinical expertise necessary to appropriately review medical records relevant to identified suicide fatalities, while additionally needing the process for identifying cases and medical records to be revised to ensure that there is appropriate protection of the privacy of records.
Last but not least, possible temporary license to practice social work proposed
This is legislation advanced by NASW to allow for the issuance of a temporary license for BSWs and MSWs, pending their passage of their exam. It is intended to address both the shortage of social workers that agencies can hire, as well as new graduates’ inability to find employment, which has been exacerbated by delays as a result of COVID in administering exams to students who have completed all other required training. Initially, NASW asked that LCSW’s and LCSW-C’s also be given temporary licenses, but as a result of push-back, dropped that request. Although BSWE is opposing the bill, other professional boards, both in Maryland and in other states, have already created the ability to practice with temporary licenses. We will continue to monitor.
We are currently monitoring 26 bills of interest to clinical social workers in Maryland. Look for our June newsletter for final decisions on these and other bills.
Although the Maryland Legislative session does not start until January, there have been several issues that have demanded time and attention recently.
In August, I again provided verbal testimony to the Maryland Commission to Study Mental and Behavioral Health (see our September newsletter for testimony provided in June of this year). I stressed, as I had previously, the need for Maryland to enact laws that will make reimbursement for telehealth services permanent. I also raised the need for jurisdictions to permanently relax regulations in order to allow practitioners to treat clients via telehealth irrespective of jurisdictional licensure. I have been very impressed with Lt. Governor Rutherford’s responsiveness to my comments, as well as his responsiveness to others who testified on a variety of mental health issues, and his command of the issues being addressed.
In response to a member’s concern expressed on our listserv about her treatment by the Maryland Board of Social Work Examiners upon her submission of her license renewal, I surveyed our members about experiences they have had with the BSWE. I was dismayed by the number of complaints people had about rudeness of staff, lack of responsiveness, and the incompetence they experienced. Our lobbyist is trying to arrange a meeting with the Executive Director, Dr. Stanley Weinstein, to discuss our concerns.
We have also just become aware that BSWE is proposing a bill to change some language and provisions regarding the practice of social work in Maryland. We understand that the Board plans to send a copy of the proposed changes to the current statute to all licensees, and will have meetings with stakeholders to discuss the proposed changes. Keep your eyes open for communications from the Board.
Impact of extending PHE on Maryland
As we know, the Federal public health emergency (PHE) was extended on July 23rd for 90 days. This is the second time it has been extended, and we don’t know what will happen after October 23rd. This has the impact of extending the allowing of treatment via teletherapy through that time. This includes payment through Medicare and Medicaid in MD, and likely through private insurances as well. It also extends the waivers of regulation around telehealth platforms, which permits providers to use platforms which are not HIPAA compliant, such as FaceTime. Remember that once the PHE is no longer in effect, the requirement to use a HIPAA compliant platform (such as Doxy.me or the professional level of Zoom) will likely return.
GWSCSW presents written testimony on COVID-19’s impact on mental health treatment
On June 23, the Commission to Study Mental and Behavioral Health, headed by Maryland’s Lt. Governor Boyd Rutherford, met specifically to discuss the pandemic’s impact on mental health treatment in Maryland. We sent written testimony about telehealth to be heard at that meeting, which is now part of the public record. The testimony was also sent to the Maryland Insurance Administration Commissioner, the Behavioral Health Administration Commissioner, and the Secretary of the Department of Health.
On behalf of the Maryland Clinical Social Work Coalition (MdCSWC) and the members the Greater Washington Society for Clinical Social Work (GWSCSW), I am writing to ask that the Commission to Study Mental and Behavioral Health advise Governor Hogan, DHMH Secretary Robert Neall, and MIA Secretary Kathleen Birrane of the urgent need for insurance companies to continue to reimburse providers for telemental health services beyond 60-90 days following the end of Maryland’s State of Emergency. Additionally, I would urge increasing accessibility to audio-only teletherapy through requiring all insurance companies practicing in Maryland to reimburse providers for these services at the same rates as in-person psychotherapy. Providers of mental health therapy responded quickly to the need to change the way we deliver services when the state of emergency was declared. Through video conferencing, we have been able to continue life-saving treatment for most of our patients, and to help combat the sense of isolation that exacerbates many of the conditions we treat. There are still some patients who, without access to the technology or broadband at home that permits videoconferencing to occur, have been unable to continue their treatment except through audio-only phone contact. While Medicaid has been reimbursing providers, thanks to Governor Hogan’s order, most other insurance companies have not followed suit, and have left some patients without access to their clinician during this highly stressful time. Patients and therapists alike have found video-conferencing to be a safe and effective way to engage in therapy for the large majority of diagnoses. They have expressed great concern about resuming in-person sessions in an enclosed office space where safe social distancing or protective air filtration or circulation may not be possible, and before vaccination of most of the population can take place. This is especially critical for patients and therapists who are immunocompromised, or who live with or care for someone who is immunocompromised. While there are some patients who require in-person therapy, the vast majority continue to require treatment via video-conferencing, or audio-only telephone contact. We thank the Governor and his Administration for their pro-active care of Marylanders during this health crisis. We know that the pandemic is sparking an increased need for mental health services. We are hopeful that Maryland can lead the way in ensuring these services are more easily accessible to our citizens for the long term, to help keep people productive and able to experience greater satisfaction with their lives, especially during this particularly difficult time. Judith Gallant, LCSW-CChair, MdCSWCDirector, Legislation and Advocacy, GWSCSW
On behalf of the Maryland Clinical Social Work Coalition (MdCSWC) and the members the Greater Washington Society for Clinical Social Work (GWSCSW), I am writing to ask that the Commission to Study Mental and Behavioral Health advise Governor Hogan, DHMH Secretary Robert Neall, and MIA Secretary Kathleen Birrane of the urgent need for insurance companies to continue to reimburse providers for telemental health services beyond 60-90 days following the end of Maryland’s State of Emergency. Additionally, I would urge increasing accessibility to audio-only teletherapy through requiring all insurance companies practicing in Maryland to reimburse providers for these services at the same rates as in-person psychotherapy.
Providers of mental health therapy responded quickly to the need to change the way we deliver services when the state of emergency was declared. Through video conferencing, we have been able to continue life-saving treatment for most of our patients, and to help combat the sense of isolation that exacerbates many of the conditions we treat. There are still some patients who, without access to the technology or broadband at home that permits videoconferencing to occur, have been unable to continue their treatment except through audio-only phone contact. While Medicaid has been reimbursing providers, thanks to Governor Hogan’s order, most other insurance companies have not followed suit, and have left some patients without access to their clinician during this highly stressful time.
Patients and therapists alike have found video-conferencing to be a safe and effective way to engage in therapy for the large majority of diagnoses. They have expressed great concern about resuming in-person sessions in an enclosed office space where safe social distancing or protective air filtration or circulation may not be possible, and before vaccination of most of the population can take place. This is especially critical for patients and therapists who are immunocompromised, or who live with or care for someone who is immunocompromised. While there are some patients who require in-person therapy, the vast majority continue to require treatment via video-conferencing, or audio-only telephone contact.
We thank the Governor and his Administration for their pro-active care of Marylanders during this health crisis. We know that the pandemic is sparking an increased need for mental health services. We are hopeful that Maryland can lead the way in ensuring these services are more easily accessible to our citizens for the long term, to help keep people productive and able to experience greater satisfaction with their lives, especially during this particularly difficult time.
Judith Gallant, LCSW-CChair, MdCSWCDirector, Legislation and Advocacy, GWSCSW
Finally, to wrap up my report on the shortened Legislative Session of the MD General Assembly of 2020 (begun in the report of the June, 2020, News & Views, information about a couple of bills passed which will be of interest to some (taken from our lobbyist, Pam Metz Kasemeyer’s 2020 Session Final Report):
House Bill 1121: Maryland Mental Health and Substance Use Disorder Registry and Referral System (passed) establishes the Maryland Mental Health and Substance Use Disorder Registry and Referral System in MDH. The purpose of this Registry is to provide a statewide system through which health care providers can identify and access available inpatient and outpatient mental health and substance use services for patients in a seamless manner. It also creates an Advisory Committee to advise the Department on the development and implementation of the System.
Senate Bill 305/House Bill 607: Public Safety – Crisis Intervention Team Center of Excellence (passed) establishes a Crisis Intervention Team Center of Excellence (CITCE) in the Governor’s Office of Crime Prevention, Youth and Victim Services to provide technical support to local governments, law enforcement, public safety agencies, behavioral health agencies, and crisis service providers. The CITCE is also to develop and implement a “crisis intervention model program.” By December 1, annually, CITCE must report to the General Assembly on its activities and related criminal justice efforts.
This report is based, in part, on the multi-page summary of this year’s legislative session from our lobbyist, Pam Metz Kasemeyer, JD. Additional information about the 2020 session will appear in the September newsletter.
To state the obvious, the impact of the global pandemic has been profound, for each of us individually, for our clients, for our country, and for the State of Maryland. The changes that Executive Orders, given by the President and by our Governor, that have had a tremendous impact on our practices are covered in the Toolkit for Virtual Practice, above in this newsletter.
Changes to fight the pandemic
The shape of lawmaking during the yearly session of the Maryland General Assembly changed dramatically this year, as the session ended 3 weeks earlier than scheduled. The Covid-19 pandemic necessitated quick changes to the Maryland budget for Fiscal Year 2021. The State has spent nearly $2 billion responding to the Corona virus so far.
Some other actions taken during the shortened session:
Senate Bill 245/House Bill 527: Health Occupations – Social Workers – Scope of Practice, Supervision, and Application Decision Appeal Process (passed) was introduced to clarify language in a bill passed in a previous year that governs our practice. It was enacted with amendments requested by MdCSWC. The bill clarifies that “practice social work” includes counseling for alcohol and drug use and addictive behavior. For an individual licensed as an LGSW or LCSW, the bill further clarifies that “practice social work” includes treatment of biopsychosocial conditions under the supervision of an LCSW-C, an amendment offered by MdCSWC.
ACA and Parity issues
Concern over the fate of the federal Affordable Care Act (ACA) prompted legislators to pass House Bill 959/Senate Bill 872: Health Insurance – Consumer Protections (passed). The bill is an emergency bill which codifies the patient protections contained in the ACA rather than simply referencing them in a cross-reference to the federal statute. During the 2019 Session, the Maryland Health Insurance Coverage Protection Commission was required to establish a workgroup to (1) monitor the appeal of the decision regarding the ACA and the implications of the decision for the State; (2) monitor federal enforcement of the ACA; and (3) determine the most effective manner of ensuring that Maryland consumers can obtain and retain quality health insurance. This bill generally implements the recommendations of the workgroup.
Continued concern over network adequacy issues in behavioral health prompted House Bill 455/Senate Bill 334: Health Insurance – Mental Health Benefits and Substance Use Disorder Benefits – Reports on Nonquantitive Treatment Limitations and Data (passed). This bill requires carriers to submit two reports (in 2022 and 2024) to the Insurance Commissioner to demonstrate compliance with the federal Mental Health Parity and Addiction Equity Act and provide information on benefits. With regard to the latter, this report is limited to the frequency, reported by number and rate, with which the health benefit plan received, approved, and denied prior authorization requests and the number of claims submitted for mental health benefits, substance use disorder benefits, and medical and surgical benefits in each Parity Act classification during the immediately preceding calendar year.
Education issues
You may remember that last year I wrote about efforts to pass legislation to create guidelines on a trauma informed approach in Maryland schools. Although the efforts failed last year, this year those efforts to develop guidelines for schools on a trauma-informed approach succeeded with the passage of House Bill 277/Senate Bill 367: State Department of Education – Guidelines on Trauma-Informed Approach. The Maryland State Department of Education (MSDE) must create guidelines in consultation with MDH and the Department of Human Services, and MSDE must distribute the guidelines to local school systems and publish the guidelines on its website. A “trauma-informed approach” is defined as a method for understanding and responding to an individual with symptoms of chronic interpersonal trauma or traumatic stress. A “trauma-informed school” is a school that: acknowledges the widespread impact of trauma and understands the potential paths for recovery; recognizes the signs and symptoms of trauma in students, teachers, and staff; integrates information about trauma into policies, procedures, and practices; and actively resists re-traumatizing a student, teacher, or staff member who has experienced trauma.
As you may remember from the article by Katie Smeltz in our last issue of News and Views, the Kirwan Commission on Innovation and Excellence in Education was charged with setting new education funding formulas and developing recommendations to transform the state’s public education system. After more than two years of deliberation, the Commission’s recommendations were reflected in House Bill 1300: Blueprint for Maryland’s Future – Implementation (passed), which was enacted by the General Assembly and awaits signature by the Governor. The legislation includes a comprehensive set of strategies for enhancing school-based behavioral health services, which have been shown to improve student health and education outcomes.
The bill dedicates staff at the Maryland State Department of Education (MSDE) to coordinate with school behavioral health services coordinators, requires training of school personnel in protocols to support students in need of behavioral health services, and requires each local school system to develop and implement systematic screening to identify students with behavioral health needs.
The $4 billion bill plans many additional changes, including establishing a Consortium to develop and fund community-partnered school behavioral health programs across the state, provide free pre-kindergarten statewide, boost teacher pay and standards, and give extra money to schools with large populations of economically disadvantaged students. However, the State’s response to the Coronavirus and the anticipated decrease in revenue is putting the funding for the plan in jeopardy. Although the bill passed both the Senate and the House with a veto-proof majority, it is unfortunately not clear that the funding will be available to move forward with the plan in the coming year.
Ruling: Physical incapacity includes cognitive deficits
Early in May, the MD Court of Appeals (our highest court) unanimously held that the phrase "physical incapacity" includes cognitive deficits. The ruling was narrow but the precedent is broad. Interpreted maximally, the Court said that mental illness, PTSD, & brain injury are "now known to be manifestations of a physical incapacity."
Released quietly during a pandemic, this ruling is a major win for those who fight for mental health parity, for service-disabled veterans, and victims of brain injury. (This information is courtesy of MD State Senator Jeff Waldstreicher.)
In early January, the Maryland General Assembly started their annual 90-day legislative session. As of this writing at the very beginning of February, we have submitted testimony on two bills, both in support of the bills’ aims.
We presented testimony in support of Senate Bill 245, clarifying language from the social work licensing bill passed in 2017. In particular, the bill clarifies that social workers are entitled to treat alcohol, drug use and addictive behavior, as well as use technology as set forth in regulations. We also requested language clarifying that any treatment by an LMSW or an LCSW of biopsychosocial conditions must be done under the supervision of an LCSW-C. Although these are currently in our scope of practice, this makes the language unambiguous in the law. I am grateful to Dan Buccino for his input re. our position on this bill.
Testimony we presented regarding Senate Bill 324 supports efforts to provide services to veterans and their families, specifically Mental Health First Aid programs, through requiring Maryland’s Department of Health to coordinate with the Veterans [no apostrophe] Administration.
We will be looking closely at two bills scheduled to be introduced by the Parity Coalition. One will require more rigorous network adequacy compliance reporting by insurers and the other will address out of network costs for individuals who are unable to receive in-network care due to inadequate networks.
We continue working in collaboration with our friends at the Maryland Behavioral Health Coalition at the MHA in supporting efforts to restore behavioral health funding in the proposed Fiscal Year 2021 budget to the levels required by both the 2019 minimum wage bill and the bi-partisan HOPE Act of 2017. The proposed budget slashes mandatory funding increases from 4% to 2%, under-funding public mental health and substance use treatment by nearly $25 million. The additional State funding is necessary to support increasing reimbursement rates for community behavioral health workers. (This does not impact insurance reimbursement rates; it specifically affects Maryland’s public mental health system.) Over 260,000 Marylanders rely on the state’s public behavioral health system for their mental health and substance use treatment needs, and without the additional funding, Community Mental Health Centers could be forced to reduce or eliminate services. Additionally, the legislature is working to fund strategies, recommended in the Kirwan report, that will help our schools. These budgetary issues are always difficult, and all the more so when a Republican governor works at cross-purposes to the largely Democratic legislators.
Interested in any of these topics? Please contact Judy Gallant at judy.gallant@verizon.net or sign up to volunteer to help our legislative committee on-line at our website at GWSCSW.org. We’re stronger working together.
Please feel free to contact me any time at judy.gallant@verizon.net.
Attendees at our annual Legislation and Advocacy luncheon on October 27 heard from our lobbyist, Pam Metz Kasemeyer, that there will be changes in the Maryland legislature during the upcoming legislative session, with shifts in leadership and Committee Chairmanships that can make a difference.
The Maryland Speaker of the House of Delegates, Michael Busch, died in April, and has been replaced by Adrienne Jones (Democrat from Baltimore Co.). Senate President Mike Miller is battling cancer, and announced he will step down from his position in January, 2020. Senator Bill Ferguson (Democratic from Baltimore City) has been elected by fellow Senators as their next president.
Bill Ferguson is a liberal democrat who is committed, in particular, to increasing school funding. Delegate Kirill Reznik of Montgomery County, who has spoken to our group in the past, has been appointed to be the House Chair of the Joint Committee on Behavioral Health and Opioid Use Disorders. Delegate Ariana Kelly, another Democrat from Montgomery County, is the House Chair of the Joint Committee on Children, Youth and Families. These leadership posts can help hold up or move legislation forward, and these two committees work on many of the bills that are important to our Society.
We will be monitoring bills that go before these committees and others and can always use your help.
Martin Schnuit, LCSW-C, Appointed to MD Board of Social Work Examiners
We extend our hearty congratulations to our member Martin Schnuit, who, backed by a recommendation from GWSCSW, was appointed by Maryland Governor Larry Hogan to the position on July 1, 2019. Mr. Schnuit received his MSW from the University of Maryland in 1995 and has worked in a variety of settings. For over 20 years he has maintained a private practice in both Anne Arundel County and Baltimore City. He specializes in the treatment of anxiety disorders, phobias, and obsessive compulsive disorder. As a Board-approved supervisor, he has mentored and provided clinical supervision to MSW's for years. In addition to his GWSCSW membership, Martin is also a member of NASW, and is a clinical fellow of the Anxiety & Depression Association of America. We wish you great success in your new position, Marty!
We continue our reporting on bills from the 2019 Maryland General Assembly, begun in our June newsletter article:
Substance Use Disorder Issues
House Bill 116/Senate Bill 846: Public Health – Correctional Services – Opioid Use Disorder Examinations and Treatment (passed) establishes specified programs of “opioid use disorder” screening, evaluation, and treatment in local correctional facilities and in the Baltimore Pre-trial Complex. The program begins in four counties and phases-in to include all counties and the Baltimore Pre-trial Complex. The State must fund the programs of opioid use disorder screening, examination, and treatment of inmates, and the bill establishes requirements for screening and treatment.
House Bill 599/Senate Bill 631: Health Insurance – Coverage for Mental Health Benefits and Substance Use Disorder Benefits – Treatment Criteria (passed) was heavily amended by the committees. Initially, the bill required carriers to submit two extensive reports to the Maryland Insurance Administration on how the carrier complied with federal mental health parity and addiction equity laws and on the carrier’s data for mental health benefits, substance use disorder benefits, and medical/surgical benefits by parity act classifications. The committees amended the bill to only require carriers to use the American Society of Addiction Medicine criteria for all medical necessity and utilization management determinations for substance use disorder benefits. The bill also repeals the limitation on a carrier charging a co-payment for methadone maintenance treatment that is greater than 50% of the daily cost for methadone maintenance treatment.
Child Advocacy Centers Expansion and OP Civil Commitment Pilot Program Revisions
House Bill 1007/Senate Bill 739: Child Advocacy Centers – Expansion (passed) alters and establishes numerous requirements for child advocacy centers in the State. The Governor’s Office of Crime Control and Prevention must ensure that every child in the State has access to a child advocacy center. The bill also requires the Governor to include at least $300,000 in the annual budget bill for child advocacy centers.
House Bill 427/Senate Bill 403: Behavioral Health Administration – Outpatient Civil Commitment Pilot Program – Revisions (passed) requires the Behavioral Health Administration (BHA) within the Maryland Department of Health (MDH) to allow an eligible individual to request enrollment in, and allow an immediate family member of an eligible individual to request voluntary enrollment for the individual, in an existing authorized pilot program for outpatient civil commitment. BHA must include specified information in its annual report for individuals admitted into the program, both voluntarily and involuntarily.
As always, do not hesitate to contact Judy Gallant at judy.gallant@verizon.net with input on the laws discussed above, or other issues in Maryland mental health policy.
The Maryland General Assembly adjourned its 439th Session on Monday, April 8th, ending a session that began with 60 new legislators. The Legislature debated major issues, including increasing the minimum wage, implementing the Kirwan Commission report recommendations having to do with school funding, addressing opioid use, and stabilizing the health insurance market.
School trauma, impact on minors and what we can do about it
In our last newsletter, I had written about the enlightened approach some legislators were proposing to create a pilot program to evaluate guidelines on a trauma-informed approach in schools. The pilot program, which we supported, was designed to assist schools in dealing with trauma experienced by both students and staff, with the hope of minimizing the impact of trauma on student learning, but the bill to create a pilot program in some schools failed in this year’s session.
In early in May, I attended a day-long conference looking at trauma and schools and heard one of the bill’s sponsors, Delegate Janelle Wilkins. She reassured conference goers that she will re-submit a bill to the MD General Assembly in 2020 for passage. Additionally, Peter Fonagy, PhD, Director of the Anna Freud Centre for Children and Families in London, spoke about the impact of trauma on children and society. He said that trauma is not an “event,” but rather an experience associated with the event. Adversity becomes traumatic for a child when the child experiences him- or herself as being alone. A world-renowned psychoanalyst, Dr. Fonagy presented a strong case for the community to create a sense of trust for children attending school, and that a whole-school response is needed to address the impact of trauma there. His presentation suggests to me that a community response should be supported by legislation such as Delegate Wilkins proposed. This is where GWSCSW clinicians can present the strongest case to support legislation to improve children’s mental health by discussing our clinical experience and knowledge with legislators.
Another law impacting minors that passed is the Child Advocacy Centers-Expansion. This bill alters and establishes numerous requirements for child advocacy centers in the State. The Governor’s Office of Crime Control and Prevention must ensure that every child in the State has access to a child advocacy center. The bill also requires the Governor to include at least $300,000 in the annual budget bill for child advocacy centers.
Criminal Law issues
This Session established two new laws that create misdemeanors for those who violate them, with implications for clinicians. See MARYLAND SOCIAL WORKERS: AVOID 3 YEARS IN PRISON!! for major news on the criminalization of failure to report child abuse and neglect by mandated reporters.
A law we supported that passed with hopefully a more positive impact was “Grace’s Law,” which deals with electronic harassment and bullying. The bill redefines “electronic communication” to mean the act of transmitting any information, data, writing, image, or communication by the use of a computer or any other electronic means, including a communication that involves the use of email, an instant messaging service, an Internet website, a social media application, a network call, a facsimile machine, or any other Internet-based communication tool. A person may not maliciously engage in electronic conduct if the conduct has the effect of intimidating, harassing, causing physical injury or serious emotional distress to a minor, or if the person intends to impact the minor in any of those ways. The most serious penalty of violating the statute is reserved for someone who intends to induce a minor to commit suicide through electronic means. In this case, the convicted person would be guilty of a misdemeanor and subject to imprisonment not exceeding 10 years or a fine not exceeding $10,000 or both.
Stay tuned for additional information about the 2019 Session in the September newsletter. As always, do not hesitate to contact Judy Gallant at judy.gallant@verizon.net with input on the laws discussed above, or other issues relating to Maryland mental health policy.
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