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LEGISLATIVE UPDATE - MARYLAND -
June 2008
The efforts of the Legislative Council (the long-standing coalition of the
Maryland Society for Clinical Social Work and the Greater Washington Society for
Clinical Social Work) focus on policy initiatives and legislation in support of
accessible quality mental health care for all Maryland citizens. The Council is
also involved in practice issues (proposed changes in licensing regulations,
insurance concerns, reimbursement) that impact on quality and accessibility of
care.
Following are summaries of some of the bills of concern to during this past
session:
Legislation Concerning Practice and BSWE Issues
SB 243 / HB 965: These child abuse and neglect bills would have added to the list of mandated reporters, and, on the Senate side, created criminal penalties for failure to report. The Legislative Council took the lead in opposing this bill; the medical societies joined in. We argued that criminalization would ultimately lead to defensive reporting, noting that the threat of loss of one’s professional license should be sufficient deterrence. We also recommended that the respective licensing boards take a look at the reporting process is and address the perception that there is under-reporting of abuse by social workers.
This very emotional bill died in the House, but will probably be re-introduced and pass the Senate next year. Member contact with Senators would be useful during this Interim.
SB 84: The State Board of Social Work Examiners (BSWE) will be increased in number by one licensed social worker who is primarily engaged in social work education at an accredited social work program, nominated from a list of names submitted by the deans and directors of the Maryland social work education programs. The BSWE will now consist of 12 members; at least four must be licensed certified social workers-clinical.
HB 811 / SB 764: In the long run, this bill, the outgrowth of an acrimonious debate between factions of dentistry, may have significant ramifications for the BSWE. It creates a Task Force on the Discipline of Health Care Professionals and Improved Patient Care, tasked with making recommendations to the Legislature by December 2008 regarding practices and procedures to enhance the fair, consistent, and speedy resolution of reports concerning substandard, illegal, or unethical practices by health care professionals.HB 730: This Health Occupations bill would have created an exemption from any oversight by the state for any delivery of any health care treatments or advice except for traditional physician acts. Arguments for the bill centered on the right to choose one’s own form of health care; proponents asserted that any opposition was based on money and turf. The bill died in the House, under the weight of arguments centered on the lack of protection of the patient, lack of oversight protections, confusion of the public on what constitutes qualified providers, the undermining of the current health provider licensing system and the lack of authority to discipline those who provide unsafe services.
Legislation Concerning Reimbursement Practices and Obstacles
An important focus of the Legislative Council during this session has been to promote opportunities for third party reimbursement and to weaken barriers to reimbursement. Through the office of our lobbying firm, Capital Consultants, information is available to members who seek (1) clarification of the reimbursement and practice law or regulations, (2) guidance for accessing new reimbursement opportunities, and (3) resources for challenging barriers to adequate reimbursement. Recognized as an interested party in the deliberations of the Task Force on Reimbursement, the Legislative Council has been gathering data on the concerns of clinical social workers across the State.
The following are reimbursement bills which were introduced to remedy problems that currently exist between carriers and health providers:
HB 709 / SB 469: This bill would have prohibited carriers from denying reimbursement for any service, procedure, or report for which a special services, procedures, or reports code exists in the current procedural and terminology (CPT) code book, as adopted by the American Medical Association. This bill received an unfavorable report in the Senate and was heard only once in the House. (Could this be the route to getting marital and family therapies covered by insurers?)HB 815: This bill requires insurance carriers to provide a provider, on request, with a written copy of a schedule of applicable fees for up to fifty of the most common services billed by a health care practitioner in that specialty, plus, if applicable, a description of the coding guidelines used by the carrier to increase or reduce the practitioner’s level of reimbursement and/or provide a bonus or other incentive–based compensation to the practitioner.
HB1161 / SB 719: Fierce debate about this bill resulted in regulations on provider network adequacy being published by the Maryland Insurance Commission on April 11, 2008, for public comment. The bill sought to require carriers to include adequate numbers of licensed providers in its panels to increase access to services in all areas of the state.
HB 1219: Known as the “Cram-down Bill,” this measure restricts insurers from requiring that providers, as a condition of participating on a panel, provide services in other panels which reimburse at a lower rate. It also requires carriers to disclose all schedules of applicable fees for up to the 20 most common services billed. A provider may terminate participation on a provider panel by notifying the carrier at least 90 days before the date of termination; for at least 90 days after the date of the notice of termination, the provider must continue to furnish health care services to an enrollee of the carrier. This was a Herculean bill which has great impact upon certain providers who have affiliated with United Health Care and others.
HB 594 / SB 595: This bill was hotly contested, and resulted in a detailed compromise. What is at issue is reimbursement for services provided after application to a panel but before acceptance or non-acceptance by that panel (which, as we know, could be months later. Anyone with questions about this should contact Capital Consultants for specific, which go on for pages!
HB 1468: The effort to eliminate tiered co-payments for outpatient mental health (eg, first five visits at 80%, next 20 at 65%, etc.) resulted in establishment of a Study; members will have an opportunity for input on this issue.
The reimbursement bills were a hotbed of activity in the legislature. They have been the source of endless hours of debate between ALL of the licensed health care providers and the insurance industry. Resolution was difficult; some bills resulted in amendments which were accepted as compromises, others were tabled until next session.
Other legislation relating to clinical social work - in the areas of taxes for designated treatment services, authority for emergency volunteer practitioners to practice, PTSD, Community Services reimbursement rates for mental health providers, treatment services for returning veterans, and involuntary commitment - these will be studied this Interim. GWSCSW members will have the opportunity for input as individuals and/or through the Legislative Council.
Alice Neily Mutch of Capital Consultants of Maryland is the lobbyist for the Maryland Legislative Council of Social Work Organization.