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LEGISLATIVE UPDATE - MARYLAND -
9/07 - Alice Neily Mutch
A kinder and gentler legislative arena prevailed this year, with the supportive
influence of the new Governor and the infusion of many new legislators whose
participation was welcomed in the 2007 legislative session.
In his budget, Governor O’Malley conveyed that access to health care should be a
right – not a privilege – and that health care should be affordable for all
Marylanders. His budget took the first step in implementing the Administration’s
forward-looking plan to provide quality and affordable health care to all
families. Despite current fiscal constraints, several Administration health
priorities were proposed including increased support for vulnerable populations,
stem cell research, drug abuse treatment, senior prescription drug costs, and
physician Medicaid payment rates.
At the same time, the legislature was criticized for not trimming more out of
the budget: the bottom line is that this coming year will see one the leanest
budgets that the State has ever had.
A $1.5 billion gap to close
What is now estimated is a $1.5 billion gap between spending and projected revenue, and as a “first step,” the Governor has directed his department heads to shave more than $200 million from their budgets.
Of considerable concern to clinical social workers is the news that the Department of Health and Mental Hygiene has been asked to make the largest reductions, cutting $46.6 million, or 1.26 percent of the agency’s total budget. This will include reductions in Medicaid reimbursements and aid to nursing homes.
Resolution on the 2006 issue of diagnosing mental retardation
The passage of HB 358/SB 723 - known as “Certified Social Workers-Clinical-Practice Definition” - was a special victory for our Legislative Council, for NASW-Maryland, and for clinical social workers. Our thanks go to Senators Conway, Dyson, and Kelley, and to Delegates Donoghue, Mizeur, V. Turner, Pena-Melnyk, Oaks, Montgomery, and Nathan-Pulliam, who sponsored these bills, which resolved the issue that arose in the 2006 legislative session around whether or not social workers could diagnose [or, by extension work with] mental retardation. The bill authorizes LCSW-Cs to “practice social work by evaluating, diagnosing, and treating specified mental and emotional conditions and impairments in addition to specified other conditions and disorders.”
The work of the coalition of Clinical Social Work Societies
Outlined below are the other bills on which the Legislative Council of Social Work Organizations (the coalition of the Greater Washington and Maryland Clinical Societies) focused during the 2007 session, as being most important to the wellbeing of clinical social workers and their clients.
On Access to Health Care
Despite considerable grassroots and legislative support for HB 754 - Children and Working Families Health Care Act of 2007, the bill passed the House but died in the Senate. This “ACCESS” bill was the aggregation of the many other bills about access to health care introduced in the House. It would have expanded the reach of the Maryland Medical Assistance Program, established a Health Care Coverage Fund; required each health insurance policy or contract issued in the State to allow an insured to elect to continue coverage for a” child dependent” beyond the limiting age of the plan. These efforts would be funded primarily by a$1.00 increase in the tobacco tax. The Health Care for All advocacy movement is still optimistic that this system of health care will be effected soon, but it was blocked this year by the Senate leadership.
Bill HB 524 -Workgroup on Cultural Competency and Workforce Development for Mental Health Professionals – passed. A Workgroup of representatives from the relevant professional licensing boards, mental health care provider groups, consumer groups, advocacy groups and others will be established. Such issues as barriers to access to appropriate mental health services affecting Maryland’s diverse population and barriers to licensure or certification of foreign–born and foreign–trained mental health professionals will be examined.
HB 281 / SB 791 - Mental Health – Incarcerated Individuals with Mental Illness passed, and will enable reimbursement of contractual mental health providers for providing mental health assessments to those with serious mental illness within three months of discharge, as well as provision of a 30-day supply of psychotropic medications before discharge. In addition, it requires the Mental Hygiene Administration to develop a plan for the State to divert individuals with serious mental illnesses who come in contact with the criminal justice system to inpatient or outpatient mental health services if such services are more appropriate than confinement of the individual in a correctional facility.
HB 519 / SB 263 Health Insurance - Carrier Provider Panels - Nonphysician Specialists passed. Under this bill, health insurance carriers must implement a procedure for members to request a referral to an out-of-network non physician specialist if the carrier does not have such a specialist in its provider panel, when such treatment is warranted by the member’s medical condition.
On Reimbursement Rates and Policies
“When physicians and other providers do not receive adequate compensation for the services they provide, it threatens the quality and effectiveness of our healthcare system.” Governor O’Malley 2007
HB 138 / SB 107 passed, establishing a Task Force on Health Care Access and Reimbursement is comprised of legislators and administration leaders. Interested groups will be invited to present testimony to the task force on a variety of physician and health care provider reimbursement issues. (GWSCSW was instrumental in having health care providers included along with physicians in this bill.) The report will be due to the General Assembly by December 2007.
Other successful bills affecting clinical practice addressed issues such as retroactive denial of claims and simplification of the credentialing process for provider panels. A description of these bills can be found in the full legislative report on the web at http://www.gwscsw.org.
On Health Policy
The FY 2008 Budget included $25 million for Stem Cell research – a 66% increase over last year's appropriation; the restoration of Medicaid healthcare benefits to legal immigrant families, including 3,000 children; and over $100 million to strengthen our provider systems by increasing reimbursement rates for doctors and other providers participating in our State's Medicaid Program.
The sunset extension of the Medicaid Managed Care Pilot Program did not pass. Instead, negotiations will continue between the federal government and the State, and Department of Health and Mental Hygiene (DHMH) Secretary Colmers was granted authority by the legislature to abandon the mental health waiver as he develops a new strategy.This places the mental health population at great risk of being included in a new long term care managed care system.
As it passed, HB 594 - Maryland Medical Assistance Program - Long-Term Care Services for Cognitive and Functional Impairments requires DHMH, in consultation with interested stakeholders, to conduct an analysis of the options that may be available to the State to increase access to long–term services, including home– and community–based services such as adult medical day care, for individuals at high risk of institutionalization because of cognitive impairments, mental illness, traumatic brain injury, or other conditions, who meet financial eligibility criteria. The report to the legislature is due Oct 1, 2007.
Quality of Care
HB 640 / SB 646 - Mental Hygiene Facilities - Patient Rights, which passed, prohibits locked door seclusions and certain types of physical restraints or holds for a mentally ill individual in a facility and expands the rights of individuals in State-operated psychiatric facilities.
Scope of Practice
The LCSW-C definition bill passed! This bill clarifies that an LCSW-C is authorized to evaluate, diagnose and treat mental and emotional conditions and impairments. This clarification was needed to pursue the opportunities for Clinical Social Workers to perform competency evaluations on juveniles.
As mentioned above, HB 672 - Petition for Guardianship of Disabled Person - Certificate of Competency by Licensed Certified Social Worker-Clinical – passed, adding LCSW-Cs to the health care professionals who may issue the certificates of competency that must be included in a petition for guardianship of a disabled person. Thanks are due to the Conference Committee chair Senator Forehand and members Senators Raskin and Jacobs and Delegates Rosenberg, Schuler, and McConkey.
Meanwhile, House and Senate bills to expand the scope of practice for licensed clinical professional counselors and therapists, by allowing them to use certain instruments without first completing training equivalent to that of a licensed psychologist qualified to administer the same type of instruments, were withdrawn. There have been years of conflict between the psychologists and counselors over the particulars of this issue; in these days of more serious health policy issues, there is little tolerance of “turf” battles.
Lobbyist Alice Neily Mutch, of
Capital Consultants of Maryland, works with our Maryland Legislative Council of
Social Work Organizations, advocating in Annapolis for social work issues and
guiding the Council’s legislative and grassroots efforts.