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MARYLAND COUNCIL OF SOCIAL WORK
ORGANIZATIONS
REPORT OF THE 2005 LEGISLATIVE SESSION
“HOLDING THE LINE, BUILDING ALLIANCES”
May 2005
Alice J. Neily, Lobbyist
Betsy F. Amey, LCSW-C, Chair
Partisan rivalry dominated this legislative session (January 12-April 11). The
Governor’s Office was generally unhappy with health care professionals after his
Special Session on medical malpractice resulted in eliminating the 2% premium
tax exemption for HMOs and Managed Care Companies. Calling the measure a “new
tax,” Ehrlich vetoed the bill, leaving the Assembly angry, tired and frustrated
as they headed into their regular January session, immediately overriding the
veto. We, of course, supported the override; we had worked hard to remove the
HMO and MBHO exemptions in the 2004 session. The money generated by the tax was
earmarked for, among other things, an increase in Medicaid physician provider
fees.
The slots bill failed for the third consecutive year. The governor spent much of
the last day lobbying for the veterans' tax break. His declared “Year of the
Child” was marred by repeated investigative reports on abuse in the government
run programs and a fight over control of the Office of Children, Youth and
Families.
THE BUDGET: Because of the Governor’s drive for slots, he made
unprecedented social and health care budget cuts that will affect high-risk
populations. Some say these cuts were an effort to gather pressure against those
opposing slots. Ehrlich and Republicans fought against the elimination of 56
filled state positions, charging Democratic leaders with politically motivated
moves. Among the cuts was elimination of half of the staff positions (mostly
Ehrlich replacement appointments) in the Office of Children, Youth and Families
(OCYF) and folding OCYF’s direct program functions into other departments.
Two days before session end, a $26
billion budget was agreed upon. House leaders backed down from a property tax
reduction and instead dedicated more money to school construction and to land
preservation programs. The House and Senate agreed on budget language requiring
the governor to trim 451 (mostly vacant) positions from the state employment
rolls. State workers will see their pay raise shaved from 2 percent to 1.5
percent. However, more than half of Ehrlich’s $129 million State employees’
health benefit cuts were restored. Budget negotiators also agreed to language
prohibiting spending any money to develop new slot machine-like lottery games,
unless specifically authorized by the General Assembly.
IMPACT ON SOCIAL WORK LOBBYING: Sadly, we had little confidence that
visionary legislation bearing any added cost to the state would be supported by
the Governor and not vetoed. So this was clearly the year to stay “off the radar
screen”, but to protect what social workers have earned in past years, and to
ally with others seeking greater fairness and accountability in the health
insurance and managed care industries.
We scrutinized every piece of legislation for “hidden language” that would
affect social workers and our clients. As over 2,000 pieces of legislation were
introduced, this was no small task! We offered written and/or in-person
testimony on bills concerning the scope, protection, and safety of social work
practice, improved access for clients to quality mental health and substance
abuse services, and appropriate regulation of the insurers and managed care
companies that play such a powerful role in these areas.
Many thanks to Marsha Carow (MD-SCSW), Joel Kanter (GWSCSW), and Kate Berman
(MD-SCSW), who gave or offered in-person testimony on our issues, and to all of
you who wrote letters and emails to support us!!
OUR LEGISLATIVE ADVOCACY: In brief, here is what our “small but hearty
band” tried and what we accomplished (the complete report is on our website,
http://www.mscsw.org.)
Budget Reconciliation Act of 2005 (BRFA, for short);
Council members attended many Budget Committee hearings in both houses to object
to this provision in the Governor’s Budget Reconciliation Bill:
“AND BE IT FURTHER ENACTED that, notwithstanding the provisions of 19-206 of the health Occupations Article or any other provision of law, for fiscal year 2006, the State Board of Social Work Examiners Fund may be used for the costs of the social worker training academy within the Department of Human Resources.”
We argued the position that
transferring Board money to meet an Executive Branch need set a dangerous
precedent and was unfair to licensed social workers who are not only paying for
their license but already paying a separate surcharge by the Executive branch to
underwrite the functions of the Health Care Cost Commission. (See
http://www.mscsw.org for
details of our testimony). Legislators were sensitive to our issue but responded
to what they viewed as a greater need in Department of Human Resources (the
“Academy” was part of legislation reforming and improving Child Welfare
Services). As “our $425k” was to be used as match money for a much more generous
Federal training grant, the legislature was loath to give up the opportunity to
use these funds in DHR.
The final language was a compromise: 25% of the training money must be dedicated
to licensed social workers, and a full accounting of the expenditures must be
made to the legislature. Later in the session, we tried to get this money
directed to training LCSW-Cs to evaluate juveniles for competency/need for
treatment in judicial proceedings by attaching it to another bill.
While those efforts failed, we did
get assurances from the sponsors of the Juvenile Competency Bills that they
would help us accomplish this in the next session.
Next steps: We hope to meet with other professionals over the summer and fall,
to draft legislation preventing future diversions of Board funds. We must follow
up with the legislators interested in monitoring how the money is spent, and
pursue our proposal for competency evaluation training.
We testified on the following bills:
Three bills with the Maryland Mental Health Coalition:
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HB 796/SB 544 – Joint Legislative Oversight Committee on Access to Mental Health Care for the Privately Insured. Passed and signed by the Governor. As soon as we know who will be on this committee, we shall begin to send your “horror stories” directly to them.
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HB 458/SB 542 – Psychological and Neuropsychological Testing. Adds this testing to the mental health mandate. Passed and signed by the Governor.
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HB 1597 – Health Insurance - Payment of Claims for Reimbursement. Requires an insurance carrier to reprocess an erroneously denied provider’s claim upon discovery, without requiring the provider to resubmit the claim, and without regard to timely submission deadlines (up to a year later). Passed and signed by the Governor.
Other bills:
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HB 254 – Disclosure of Information – Hospitals and Birthing Centers. Passed and signed by the Governor.
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HB627/SB716 – Community Health Care Access and Safety Net Act, passed and signed by the Governor. This year’s most comprehensive health legislation places emphasis upon access to specialty services, presumably including psychotherapy services by LCSW-Cs. The Act creates a task force on Universal Access to Quality and Affordable Health Care, a Physician Fee Study, a new Medicaid eligibility system, a Maryland Community Health Resources Commission, makes changes to the Maryland Primary Care Program Waivers, and requires economic support of public benefit programs by Kaiser and CareFirst, extension of Pharmacy Assistance to poor non-Medicare beneficiaries, and financial assistance policies by hospitals. We shall want to monitor how all these changes are implemented, and be ready to offer “social worker friendly” assistance to the task force and the Commission. For example, we will encourage the Hospital and the Mental Health Services Cost Commissions (to which some of our licensing fees go) to assess the problems of levels of reimbursement of ALL providers, not only physicians, by commercial payers and Medicare.
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HB802/SB616 – Juvenile Competency, passed and signed. We worked very hard to have LCSW-Cs included among potential evaluators, but the sponsors feared that amending the bill in this way would threaten its passage. We supported it anyway, and so Delegate Dumais and Senator Grosfeld offered to help us draft legislation affirming the right of clinical social workers to evaluate competency next year.
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HB 294, Reimbursement rates, passed. Made the law by which an HMO must pay a claim for a covered service rendered to an enrollee by any other noncontracting health care provider at the greater of (1) 125% of the rate the HMO pays in that geographic area to an in-network provider; or (2) the rate the HMO paid as of January 1, 2000 to an out-of-network provider.
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HB 839, Integration of Child Welfare and Substance Abuse Services, passed and signed by the Governor. We need to make sure that the “qualified addiction specialists in all child welfare offices” can include appropriately trained clinical social workers.
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HB 990, Benefits and Services for Individuals who are Incarcerated or Institutionalized, passed and signed by the Governor. Allows suspension, not termination, of Medicaid/Medicare benefit for these individuals, so they do not have to re-apply when released to the community, and workers can do adequate discharge planning.
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SB 790, Fair Share Health Care, passed, was vetoed by the Governor. We hope to stand with other progressive organizations in Maryland (including the AFL-CIO) in supporting a veto override at the beginning of next year.
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HB 955/SB 769, HMO and MCO Repeal of Premium Tax, withdrawn by sponsors. We, of course, opposed these bills.
Disappointments:
The following bills we supported did not pass:
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HB 747/SB 543 – Public Mental Health Safety Net Act of 2005 – would have restored public mental health system access for privately insured individuals on a sliding scale; died in committee.
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SB 713, Health Insurance Coverage for Outpatient Behavioral Health Care Services. Would have added case management, in home services and crisis services to the mental health mandate; died in committee.
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HB 1289, Evaluation of Permanent Disability, Social Workers, died in committee. Since the psychologists efforts in this area were successful, perhaps we can firm up our rights to do this work next year.
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HB 925, Credentialing and Clean Claims, died in committee. Would have made retroactive the payment of services delivered between the date of application for credentialing and actual credentialing. We should work with the sponsor to try again next year.
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HB 847/SB649, Recovery Housing Programs, died in committee, but a Housing Study Group will be formed. We should get some members into that group.
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HB 1557, Task Force on Men’s Health, died in committee, but we strengthened our alliance with Delegate Murray by supporting it.
There were other laws passed which
may affect clinical social workers, but which we did not advocate for or
against. For example, SB 690 clarified the exact circumstances under which a
subpoena requesting confidential medical records should be honored. In the next
newsletter, and on this Legislative News page, we shall describe some of these.
We are also looking into the Licensed Professional Counselor’s licensure law,
which requires an LCSW-C to gain additional certification from the LCPC
licensing board in order to supervise counselors in a drug and alcohol treatment
facility. Clinical Social Workers have, for many years, supervised and directed
such clinical programs, and there is no reason to require additional
certification beyond our clinical licensure. We will ask your help in bringing
this challenge.
Please let us know if anyone is interested in participating in making important
connections this summer and fall and in planning for next year.
A NOTE FROM BETSY AMEY:
As a Clinical Social Work Guild member, I have been meeting with the AFL-CIO
lobbyists and individual union leaders. Several want to work with us this summer
and next year. This would be easier if we had more guild members in Maryland.
Please think about joining!
With continued enthusiasm and persistent vigilance,
Betsy F. Amey, Chair, Maryland Legislative Council of Social Work Organizations