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LEGISLATION – Maryland
Alice Nealy
The bad news is that we can expect the upcoming January 2005 legislative
session to be highly influenced by political maneuvering. The good news is that
this will afford social workers opportunities to make a difference.
The primary legislative focus this summer and fall has been on the Department of
Health and Mental Hygiene (DHMH) new proposal for a managed care system to
affect long-term care, primary services and acute care services for Medicaid
recipients and for those who are eligible for both Medicare and Medicaid.
The proposed system includes all specialty mental health services (inpatient
psychiatric services, community mental health programs and prescription drugs)
and all long-term care services (nursing home, chronic hospital, personal care
and medical day care, and hospice care).
2004 legislation with consumer-driven safeguards vetoed by Governor
You may remember that the Governor vetoed the very popular 2004 legislation that provided consumer-driven safeguards for any future managed long-term care system. Since then, DHMH, despite ongoing concerns raised at stakeholder sessions and regional testimony, has moved forward with a proposal that ignores the critical safeguards specified in the legislation.
Consumers, consumer advocates and providers alike have expressed their concerns that this DHMH proposal, which includes removing the mental health “carve out”, is being processed far too fast and leaves too many issues unresolved. The unintended impact could be irrevocable harm to many individuals with serious mental health issues, removing their access to the residential programs, rehabilitation programs and other services on which they rely.
More than 5,000 people with dual eligibility currently use the public mental health system (PMHS) and are currently living in the community with the help of services such as psychiatric rehabilitation. Thousands more, age 65 and over, are eligible for Medical Assistance and also use mental health services. They are already in the PMHS, which is a managed care system with extensive mechanisms in place to pre-approve care and determine type, frequency and duration of services based on medical necessity and available resources. Current PMHS community services are very effective in delivering lower cost alternatives to institutional care to highly vulnerable individuals.
Forcing individuals into new "community care organizations" would not only increase fragmentation and duplication but would endanger the very community tenure the new system hopes to promote. How ironic that instead of what Senate Bill 819 called the "Community Choice" program, we may create a program that denies choice to thousands of Marylanders with psychiatric disabilities.
There seems to be interest among legislators in over-riding the Governor’s veto or pressuring the Executive branch to make this managed care proposal into a pilot study that would take place in Baltimore city and one rural area. At the same time, however, now that the issue has come on the radar screen, managed care companies have hired lobbyists and instituted a full court press supporting the DHMH plan.
Our Maryland Legislative Council of Social Work Organizations has joined with the Coalition for Real Community Choice in recommending that DHMH withdraw the proposal for the time being and assess other possibilities for fiscal savings. We’ve also joined the Medicaid Matters-Maryland Coalition to advocate actively for protection of the affected consumers under the DHMH plan.
Your Legislative Council lobbies in Annapolis, but it is equally important that concerned clinical social workers speak up on this issue and let DHMH know you protest these changes. Urge that PMHS users be exempted outright, or at least be given the choice to opt out.
On Medical Malpractice
A Special Senate Committee on Medical Malpractice Liability Insurance continued hearings throughout the summer. Rumor is that a special session to deal with this issue is to take place immediately. The Council is represented on the Health Provider Coalition (health care lobbyists and leaders of professional organizations who have historically taken an active part in legislative reform), which will be focusing attention on proposed malpractice legislation.
Access to Health Care for All Consumers
Legislation to cover the uninsured died in the final minute of the 2004 session, but legislators intend to bring access to health care for all consumers back in the 2005 session. Funding for this initiative would come from canceling the tax exemption for managed care companies.
The ONLY provider organization testifying in favor of this bill in the 2004 session was the Legislative Council of Social Work Organizations, represented by Kate Berman; this scored many “points” with the bill’s sponsor, Chairman Sheila Hixon.
As issues arise, I will email Action Alerts and hope that you will be prepared to act fast to register your concerns with your legislators. http://www.capitalconsultantsofmd.com has detailed information and resources for you.
Alice J. Neily of Capital
Consultants is the lobbyist for the Legislative Council of Social Work
Organizations for Maryland. Carol Santucci is our GWSCSW representative to the
Council.