News & Views | June 2020

Monday, June 01, 2020 8:45 PM | Anonymous

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. 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.)

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.
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