EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0935*
HOUSE BILL 935
J1, J5 2lr1433
CF SB 637
By: Delegate Bagnall
Introduced and read first time: February 7, 2022
Assigned to: Health and Government Operations and Appropriations
A BILL ENTITLED
AN ACT concerning 1
Health and Health Insurance – Behavioral Health Services – Expansion 2
(Behavioral Health System Modernization Act) 3
FOR the purpose of requiring the Maryland Medical Assistance Program to provide 4
reimbursement for certain behavioral health peer recovery, measurement–based 5
care, and crisis response services, subject to certain limitations; requiring the 6
Maryland Department of Health to expand access to and provide reimbursement for 7
certain behavioral health collaborative care, case management, and wraparound 8
services; requiring the Governor to include in the annual budget bill certain 9
appropriations to fund certain behavioral health services and supports; requiring 10
certain insurers, nonprofit health service plans, and health maintenance 11
organizations to provide coverage and reimbursement for certain behavioral health 12
services; and generally relating to the expansion of the provision, funding, and 13
coverage of behavioral health services. 14
BY adding to 15
Article – Health – General 16
Section 7.5–901 to be under the new subtitle “Subtitle 9. Funding for Wellness and 17
Recovery Centers, Recovery Community Centers, and Peer Recovery 18
Services”; 15–101(a–1), (a–2), and (e–1) and 15–103(a)(2)(xviii); and 15–1101 19
and 15–1102 to be under the new subtitle “Subtitle 11. Home – and 20
Community–Based Services for Children and Youth” 21
Annotated Code of Maryland 22
(2019 Replacement Volume and 2021 Supplement) 23
BY repealing and reenacting, without amendments, 24
Article – Health – General 25
Section 15–101(a) and 15–103(a)(1) 26
Annotated Code of Maryland 27
(2019 Replacement Volume and 2021 Supplement) 28
2 HOUSE BILL 935
BY repealing and reenacting, with amendments, 1
Article – Health – General 2
Section 15–101(a–1) and (a–2), 15–103(a)(2)(xvi) and (xvii), and 15–141.1 3
Annotated Code of Maryland 4
(2019 Replacement Volume and 2021 Supplement) 5
BY adding to 6
Article – Insurance 7
Section 15–717 and 15–857 8
Annotated Code of Maryland 9
(2017 Replacement Volume and 2021 Supplement) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
SUBTITLE 9. FUNDING FOR WELLNESS AND RECOVERY CENTERS, RECOVERY 14
COMMUNITY CENTERS, AND PEER RECOVERY SERVICES. 15
7.5–901. 16
THE GOVERNOR SHALL INCLUDE IN THE ANNUAL BUDGET BILL T HE 17
FOLLOWING AMOUNTS FO R WELLNESS AND RECOV ERY CENTERS , RECOVERY 18
COMMUNITY CENTERS , AND PEER RECOVERY SE RVICES: 19
(1) $15,000,000 FOR FISCAL YEAR 2024; 20
(2) $18,000,000 FOR FISCAL YEAR 2025; 21
(3) $21,000,000 FOR FISCAL YEAR 2026; AND 22
(4) $24,000,000 FOR FISCAL YEAR 2027 AND EACH FISCAL YEAR 23
THEREAFTER . 24
15–101. 25
(a) In this title the following words have the meanings indicated. 26
(A–1) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 27
EVIDENCE–BASED RESOU RCES DESIGNED TO SER VE INDIVIDUALS EXPER IENCING A 28
MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 29
(1) CRISIS CALL CENTERS A ND HOTLINE SERVICES ; 30
HOUSE BILL 935 3
(2) MOBILE CRISIS SERVICE S; AND 1
(3) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 2
(A–2) “CERTIFIED PEER RECOVE RY SPECIALIST” MEANS AN INDIVIDUAL WHO 3
HAS BEEN CERTIFIED B Y AN ENTITY APPROVED BY THE DEPARTMENT FOR THE 4
PURPOSE OF PROVIDING PEER SUPPORT SERVICE S, AS DEFINED UNDER § 7.5–101 5
OF THIS ARTICLE. 6
[(a–1)] (A–3) “Dental managed care organization” means a pre–paid dental 7
plan that receives fees to manage dental services. 8
[(a–2)] (A–4) “Dental services” means diagnostic, emergency, preventive, and 9
therapeutic services for oral diseases. 10
(E–1) “MEASUREMENT –BASED CARE” MEANS AN EVIDENCE –BASED PRACTICE 11
THAT INVOLVES THE SY STEMATIC COLLECTION OF DATA TO MONITOR T REATMENT 12
PROGRESS, ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, FROM INITIAL 13
SCREENING TO COMPLET ION OF CARE, THAT IS USED TO EVAL UATE: 14
(1) SYMPTOMS; 15
(2) FUNCTIONING AND SA TISFACTION WITH LIFE ; 16
(3) READINESS TO CHANGE ; AND 17
(4) THE TREATMENT PROCESS . 18
15–103. 19
(a) (1) The Secretary shall administer the Maryland Medical Assistance 20
Program. 21
(2) The Program: 22
(xvi) Beginning on January 1, 2021, shall provide, subject to the 23
limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 24
by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 25
with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 26
including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 27
if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 28
and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 29
purposes in accordance with § 15–855(d) of the Insurance Article; [and] 30
4 HOUSE BILL 935
(xvii) Beginning on January 1, 2022, may not include, subject to federal 1
approval and limitations of the State budget, a frequency limitation on covered dental 2
prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 3
health exams to be provided at an interval greater than 120 days within a plan year; AND 4
(XVIII) BEGINNING ON JANUARY 1, 2023, SHALL PROVIDE , 5
SUBJECT TO THE LIMITATIONS O F THE STATE BUDGET , AND AS PERMITTED BY 6
FEDERAL LAW , REIMBURSEMENT FOR : 7
1. SERVICES PROVIDED BY CERTIFIED PEER RECOVERY 8
SPECIALISTS; 9
2. MEASUREMENT –BASED CARE PROVIDED IN 10
BEHAVIORAL HEALTH SE TTINGS, INCLUDING OUTPATIENT MENTAL HEALTH 11
CENTERS; AND 12
3. BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S. 13
15–141.1. 14
(a) [(1)] In this section [the following words have the meanings indicated. 15
(2)], “Collaborative Care Model” means an evidence–based approach for 16
integrating somatic and behavioral health services in primary care settings that includes: 17
[(i)] (1) Care coordination and management; 18
[(ii)] (2) Regular, proactive outcome monitoring and treatment for 19
outcome targets using standardized outcome measurement rating scales and electronic 20
tools, such as patient tracking; and 21
[(iii)] (3) Regular systematic psychiatric and substance use disorder 22
caseload reviews and consultation with a psychiatrist, an addiction medicine specialist, or 23
any other behavioral health medicine specialist as allowed under federal regulations 24
governing the model. 25
[(3) “Pilot Program” means the Collaborative Care Pilot Program.] 26
(b) This section may not be construed to prohibit referrals from a primary care 27
provider to a specialty behavioral health care provider. 28
[(c) There is a Collaborative Care Pilot Program in the Department. 29
HOUSE BILL 935 5
(d) The purpose of the Pilot Program is to establish and implement a 1
Collaborative Care Model in primary care settings in which health care services are 2
provided to Program recipients enrolled in HealthChoice. 3
(e) The Department shall administer the Pilot Program. 4
(f) (1) The Department shall select up to three sites at which a Collaborative 5
Care Model shall be established over a 4–year period. 6
(2) The sites selected by the Department shall be adult or pediatric 7
nonspecialty medical practices or health systems that serve a significant number of 8
Program recipients. 9
(3) To the extent practicable, one of the sites selected by the Department 10
under paragraph (1) of this subsection shall be located in a rural area of the State. 11
(g) The sites selected by the Department under subsection (f) of this section shall 12
ensure that treatment services, prescriptions, and care management that would be 13
provided to an individual under the Pilot Program are not duplicative of specialty 14
behavioral health care services being received by the individual. 15
(h) The Department shall provide funding to sites participating in the Pilot 16
Program for: 17
(1) Infrastructure development, including the development of a patient 18
registry and other monitoring, reporting, and billing tools required to implement a 19
Collaborative Care Model; 20
(2) Training staff to implement the Collaborative Care Model; 21
(3) Staffing for care management and psychiatric consultation provided 22
under the Collaborative Care Model; and 23
(4) Other purposes necessary to implement and evaluate the Collaborative 24
Care Model. 25
(i) The Department shall: 26
(1) Collaborate with stakeholders in the development, implementation, 27
and outcome monitoring of the Pilot Program; and 28
(2) Collect outcomes data on recipients of health care services under the 29
Pilot Program to: 30
(i) Evaluate the effectiveness of the Collaborative Care Model, 31
including by evaluating the number of and outcomes for individuals who: 32
6 HOUSE BILL 935
1. Were not diagnosed as having a behavioral health 1
condition before receiving treatment through the Pilot Program; 2
2. Were not diagnosed as having a behavioral health 3
condition before being referred to and treated by a specialty behavioral health provider; 4
3. Received behavioral health services in a primary care 5
setting before receiving treatment through the Pilot Program; and 6
4. Received specialty behavioral health care services before 7
being identified as eligible to receive treatment through the Pilot Program; and] 8
[(ii)] (C) [Determine whether to] THE DEPARTMENT SHALL 9
implement AND PROVIDE REIMBURS EMENT FOR SERVICES P ROVIDED IN 10
ACCORDANCE WITH the Collaborative Care Model statewide in primary care settings that 11
provide health care services to Program recipients. 12
[(j) The Department shall apply to the Centers for Medicare and Medicaid 13
Services for an amendment to the State’s § 1115 HealthChoice Demonstration waiver if 14
necessary to implement the Pilot Program. 15
(k) For fiscal year 2020, fiscal year 2021, fiscal year 2022, and fiscal year 2023, 16
the Governor shall include in the annual budget an appropriation of $550,000 for the Pilot 17
Program. 18
(l) On or before November 1, 2023, the Department shall report to the Governor 19
and, in accordance with § 2–1257 of the State Government Article, the General Assembly 20
on the Department’s findings and recommendations from the Pilot Program.] 21
SUBTITLE 11. HOME– AND COMMUNITY–BASED SERVICES FOR CHILDREN AND 22
YOUTH. 23
15–1101. 24
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 25
INDICATED. 26
(B) “FAMILY–CENTERED TREATMENT ” MEANS AN EVIDENCE –BASED 27
PRACTICE USED TO STA BILIZE YOUTH IN THE HOME BY ADDRESSING U NDERLYING 28
FUNCTIONS OF BEHAVIO R IN ORDER TO REDUCE DISRUPTIONS I N THE HOME , 29
SCHOOL, AND COMMUNITY . 30
(C) “FUNCTIONAL FAMILY THE RAPY” MEANS A FAMILY –BASED 31
PREVENTION AND INTER VENTION PROGRAM FOR HIGH–RISK YOUTH THAT 32 HOUSE BILL 935 7
ADDRESSES COMPLEX AN D MULTIDIMENSIONAL P ROBLEMS THROUGH CLIN ICAL 1
PRACTICE THAT IS FLE XIBLY STRUCTURED AND CULTURALLY SENSITIVE . 2
(D) “MENTAL HEALTH CASE MA NAGEMENT PROGRAM ” MEANS A PROGRAM 3
THAT PROVIDES AN IDE NTIFIED SUBSET OF WR APAROUND SERVICES . 4
(E) “1915(I) MODEL” MEANS THE 1915(I) INTENSIVE BEHAVIORAL HEALTH 5
SERVICES FOR CHILDREN, YOUTH, AND FAMILIES PROGRAM ESTA BLISHED UNDER 6
TITLE 10, SUBTITLE 9, CHAPTER 89 OF THE CODE OF MARYLAND REGULATIONS. 7
(F) “WRAPAROUND SERVICES ” MEANS SERVICES PROVI DED TO CHILDREN 8
AND YOUTH WITH INTEN SIVE MENTAL HEALTH N EEDS AND THEIR FAMIL IES IN 9
THEIR COMM UNITIES, INCLUDING: 10
(1) INTENSIVE CARE COORDI NATION; 11
(2) CHILD AND FAMILY TEAM MEETINGS; AND 12
(3) PLANS OF CARE THAT AR E INDIVIDUALIZED TO EACH FAMILY AND 13
INCLUDE: 14
(I) FORMAL SUPPORTS , INCLUDING INDIVIDUAL AND FAMILY 15
THERAPY; AND 16
(II) INFORMAL SUPPORTS , INCLUDING INTENSIVE IN–HOME 17
SERVICES, RESPITE CARE, MOBILE CRISIS RESPON SE AND STABILIZATION , FAMILY 18
PEER SUPPORT , EXPERIENTIAL THERAPI ES, AND FLEXIBLE FUNDS F OR GOODS AND 19
SERVICES THAT ARE ID ENTIFIED IN THE PLAN OF CARE. 20
15–1102. 21
(A) THE DEPARTMENT SHALL ENSU RE THAT CARE COORDIN ATORS 22
DELIVERING SERVICES UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE 23
MANAGEMENT PROGRAM R ECEIVE TRAINING IN T HE DELIVERY OF WRAPA ROUND 24
SERVICES. 25
(B) THE DEPARTMENT SHALL PROV IDE REIMBURSEMENT FO R: 26
(1) WRAPAROUND SERVICES DELI VERED BY CARE COORDI NATORS 27
UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE MANAGEMENT PROGRAM 28
THAT IS COMMENSURATE WITH INDUSTRY STANDA RDS FOR THE REIMBURS EMENT 29
OF THE DELIVERY OF W RAPAROUND SERVICES ; AND 30
8 HOUSE BILL 935
(2) INTENSIVE IN–HOME SERVICES DELIVERED B Y PROVIDERS USING 1
FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 2
EVIDENCE–BASED PRACTICES UNDE R THE 1915(I) MODEL THAT IS COMMEN SURATE 3
WITH INDUSTRY STANDA RDS FOR THE REIMBURS EMENT OF THE DELIVER Y OF 4
FAMILY–CENTERED TRE ATMENT, FUNCTIONAL FAMILY TH ERAPY, AND OTHER 5
EVIDENCE–BASED PRACTICES . 6
(C) BEGINNING IN FISCAL Y EAR 2023, THE BEHAVIORAL HEALTH 7
ADMINISTRATION SHALL FUND 100 SLOTS IN THE MENTAL HEALTH CASE 8
MANAGEMENT PROGRAM F OR CHILDREN OR YOUTH WHO ARE NOT ELIGIBLE FOR 9
PROGRAM SERVICES AND AT RISK OF OUT–OF–HOME PLACEMENT . 10
(D) THE GOVERNOR SHALL INCLUD E IN THE ANNUAL OPER ATING BUDGET 11
BILL THE FOLLOWING A MOUNTS TO FUND CUSTO MIZED GOODS AND SERV ICES FOR 12
YOUTH RECEIVING SERV ICES UNDER THE 1915(I) MODEL OR MENTAL HEAL TH CASE 13
MANAGEMENT PROGRAM : 14
(1) $150,000 FOR FISCAL YEAR 2024; 15
(2) $250,000 FOR FISCAL YEAR 2025; AND 16
(3) $350,000 FOR FISCAL YEAR 2026 AND EACH FISCAL YEAR 17
THEREAFTER . 18
Article – Insurance 19
15–717. 20
(A) IN THIS SECTION, “CERTIFIED PEER RECOVERY SPECIALIST” MEANS AN 21
INDIVIDUAL WHO HAS B EEN CERTIFIED BY AN ENTITY APPROVED BY T HE 22
MARYLAND DEPARTMENT OF HEALTH FOR THE PURPOS E OF PROVIDING PEER 23
SUPPORT SERVICES , AS DEFINED UNDER § 7.5–101 OF THE HEALTH – GENERAL 24
ARTICLE. 25
(B) THIS SECTION APPLIES TO: 26
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 27
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 28
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 29
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 30
HOUSE BILL 935 9
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 1
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 2
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 3
(C) IF A POLICY OR CONTRA CT SUBJECT TO THIS S ECTION PROVIDES FOR 4
REIMBURSEMENT FOR A SERVICE THAT IS WITH IN THE LAWFUL SCOPE OF 5
ACTIVITIES OF A CERTIFIED PEER RECOVERY SPECIA LIST PROVIDING SERVI CES 6
UNDER THE SUPERVISIO N OF A BEHAVIORAL HE ALTH PROGRAM LICENSE D BY THE 7
SECRETARY OF HEALTH UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE, 8
THE INSURED OR ANY O THER PERSON COVERED BY THE POLICY OR CON TRACT IS 9
ENTITLED TO REIMBURS EMENT FOR THE SERVIC E. 10
15–857. 11
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEAN INGS 12
INDICATED. 13
(2) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 14
EVIDENCE–BASED SERVICES DESIG NED TO SERVE INDIVID UALS EXPERIENCING A 15
MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 16
(I) CRISIS CALL CENTERS AND HOTLINE SERVICES ; 17
(II) MOBILE CRISIS SERVICE S; AND 18
(III) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 19
(3) “MEASUREMENT –BASED CARE ” MEANS AN EVIDENCE –BASED 20
PRACTICE THAT INVOLV ES THE SYSTEMATIC CO LLECTION OF DATA TO MONITOR 21
TREATMENT PROGRESS , ASSESS OUTCOMES , AND GUIDE TRE ATMENT DECISIONS , 22
FROM INITIAL SCREENI NG TO COMPLETION OF CARE, THAT IS USED TO EVAL UATE: 23
(I) SYMPTOMS; 24
(II) FUNCTIONING AND SATI SFACTION WITH LIFE ; 25
(III) READINESS TO CHANGE ; AND 26
(IV) THE TREATMENT PROCES S. 27
(B) THIS SECTION APPLIES TO: 28
10 HOUSE BILL 935
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT ISSUE 1
OR DELIVER HEALTH IN SURANCE POLICIES OR CONTRACTS IN THE STATE; AND 2
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 3
COVERAGE TO INDIVIDU ALS OR GROUPS UNDER CONTRACTS THAT ARE I SSUED OR 4
DELIVERED IN THE STATE. 5
(C) AN ENTITY SUBJECT TO THIS SECTION SHALL P ROVIDE COVERAGE FOR : 6
(1) BEHAVIORAL HEALTH CR ISIS RESPONSE SERVIC ES; AND 7
(2) MEASUREMENT –BASED CARE PROVIDED IN A BEHAVIORAL 8
HEALTH SETTING . 9
SECTION 2. AND BE IT FURTHER ENACTED , That: 10
(a) (1) On or before December 1, 2022, the Maryland Department of Health 11
shall obtain any federal authority necessary to implement a plan for the expansion of 12
certified community behavioral health clinics in the State, including applying to the 13
Centers for Medicare and Medicaid Services for an amendment to any of the State’s 1115 14
waivers or the State plan. 15
(2) The Department’s implementation plan shall ensure access to certified 16
community behavioral health clinics in all counties in the State. 17
(b) The Maryland Department of Health shall review and consider options for 18
expanding the services provided under § 15–1102 of the Health – General Article, as 19
enacted by Section 1 of this Act, or adopting other existing programs or services to provide 20
wraparound services to children and youth with primary substance use disorders. 21
(c) On or before December 1, 2023, the Maryland Department of Health shall 22
review current eligibility requirements for the model established under § 1915(i) of the 23
Social Security Act, and mental health case management generally, and submit 24
recommendations for expanding eligibility and enrollment in these programs to the General 25
Assembly, in accordance with § 2–1257 of the State Government Article. 26
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 27
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 28
after January 1, 2023. 29
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 30
October 1, 2022. 31