Maryland 2022 Regular Session

Maryland Senate Bill SB637 Compare Versions

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33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
5- Underlining indicates amendments to bill.
6- Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7-amendment.
85 *sb0637*
96
107 SENATE BILL 637
118 J1, J5 2lr1432
12- CF HB 935
9+ CF 2lr1433
1310 By: Senator Augustine
1411 Introduced and read first time: February 3, 2022
1512 Assigned to: Finance
16-Committee Report: Favorable with amendments
17-Senate action: Adopted
18-Read second time: March 27, 2022
1913
20-CHAPTER ______
14+A BILL ENTITLED
2115
2216 AN ACT concerning 1
2317
2418 Health and Health Insurance – Behavioral Health Services – Expansion 2
2519 (Behavioral Health System Modernization Act) 3
2620
2721 FOR the purpose of requiring the Maryland Medical Assistance Program to provide 4
2822 reimbursement for certain behavioral health peer recovery, measurement–based 5
2923 care, and crisis response services, subject to certain limitations; requiring the 6
3024 Maryland Department of Health to expand access to and provide reimbursement for 7
3125 certain behavioral health collaborative care, case management, and wraparound 8
3226 services; requiring the Governor to include in the annual budget bill certain 9
3327 appropriations to fund certain behavioral health services and supports; requiring 10
3428 certain insurers, nonprofit health service plans, and health maintenance 11
3529 organizations to provide coverage and reimbursement for certain behavioral health 12
36-services Maryland Department of Health to review and consider options for adopting 13
37-existing programs or services to provide wraparound services to children and youth 14
38-with primary substance use disorders and review and make recommendations 15
39-regarding eligibility requirements for the 1915(i) waiver and mental health case 16
40-management; requiring the Maryland Insurance Administration, in consultation 17
41-with certain stakeholders, to study and make recommendations on certain issues 18
42-related to commercial carrier reimbursement of behavioral health clinical peer 19
43-specialists and crisis response services; and generally relating to the expansion of 20
44-the provision, funding, and coverage of and eligibility for behavioral health services. 21
30+services; and generally relating to the expansion of the provision, funding, and 13
31+coverage of behavioral health services. 14
4532
46-BY adding to 22
47- Article – Health – General 23 2 SENATE BILL 637
33+BY adding to 15
34+ Article – Health – General 16
35+Section 7.5–901 to be under the new subtitle “Subtitle 9. Funding for Wellness and 17
36+Recovery Centers, Recovery Community Centers, and Peer Recovery 18
37+Services”; 15–101(a–1), (a–2), and (e–1) and 15–103(a)(2)(xviii); and 15–1101 19
38+and 15–1102 to be under the new subtitle “Subtitle 11. Home – and 20
39+Community–Based Services for Children and Youth” 21
40+ Annotated Code of Maryland 22
41+ (2019 Replacement Volume and 2021 Supplement) 23
42+
43+BY repealing and reenacting, without amendments, 24
44+ Article – Health – General 25
45+Section 15–101(a) and 15–103(a)(1) 26
46+ Annotated Code of Maryland 27
47+ (2019 Replacement Volume and 2021 Supplement) 28
48+ 2 SENATE BILL 637
4849
4950
50-Section 7.5–901 to be under the new subtitle “Subtitle 9. Funding for Wellness and 1
51-Recovery Centers, Recovery Community Centers, and Peer Recovery 2
52-Services”; 15–101(a–1), (a–2), and (e–1) and 15–103(a)(2)(xviii); and 15–1101 3
53-and 15–1102 to be under the new subtitle “Subtitle 11. Home – and 4
54-Community–Based Services for Children and Youth” 5
55- Annotated Code of Maryland 6
56- (2019 Replacement Volume and 2021 Supplement) 7
51+BY repealing and reenacting, with amendments, 1
52+ Article – Health – General 2
53+Section 15–101(a–1) and (a–2), 15–103(a)(2)(xvi) and (xvii), and 15–141.1 3
54+ Annotated Code of Maryland 4
55+ (2019 Replacement Volume and 2021 Supplement) 5
5756
58-BY repealing and reenacting, without amendments, 8
59- Article – Health – General 9
60-Section 15–101(a) and 15–103(a)(1) 10
61- Annotated Code of Maryland 11
62- (2019 Replacement Volume and 2021 Supplement) 12
57+BY adding to 6
58+ Article – Insurance 7
59+Section 15–717 and 15–857 8
60+ Annotated Code of Maryland 9
61+ (2017 Replacement Volume and 2021 Supplement) 10
6362
64-BY repealing and reenacting, with amendments, 13
65- Article – Health – General 14
66-Section 15–101(a–1) and (a–2), 15–103(a)(2)(xvi) and (xvii), and 15–141.1 15
67- Annotated Code of Maryland 16
68- (2019 Replacement Volume and 2021 Supplement) 17
63+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
64+That the Laws of Maryland read as follows: 12
6965
70-BY adding to 18
71- Article – Insurance 19
72-Section 15–717 and 15–857 20
73- Annotated Code of Maryland 21
74- (2017 Replacement Volume and 2021 Supplement) 22
66+Article – Health – General 13
7567
76- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 23
77-That the Laws of Maryland read as follows: 24
68+SUBTITLE 9. FUNDING FOR WELLNESS AND RECOVERY CENTERS, RECOVERY 14
69+COMMUNITY CENTERS, AND PEER RECOVERY SERVICES. 15
7870
79-Article – Health – General 25
71+7.5–901. 16
8072
81-SUBTITLE 9. FUNDING FOR WELLNESS AND RECOVERY CENTERS, RECOVERY 26
82-COMMUNITY CENTERS, AND PEER RECOVERY SERVICES. 27
73+ THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL THE 17
74+FOLLOWING AMOUNTS FO R WELLNESS AND RECOV ERY CENTERS , RECOVERY 18
75+COMMUNITY CENTERS , AND PEER RECOVERY SE RVICES: 19
8376
84-7.5–901. 28
77+ (1) $15,000,000 FOR FISCAL YEAR 2024; 20
8578
86- THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL THE 29
87-FOLLOWING AMOUNTS FO R WELLNESS AND RECOV ERY CENTERS, RECOVERY 30
88-COMMUNITY CENTERS , AND PEER RECOVERY SE RVICES: 31
79+ (2) $18,000,000 FOR FISCAL YEAR 2025; 21
8980
90- (1) $15,000,000 FOR FISCAL YEAR 2024; 32
81+ (3) $21,000,000 FOR FISCAL YEAR 2026; AND 22
9182
92- (2) $18,000,000 FOR FISCAL YEAR 2025; 33
83+ (4) $24,000,000 FOR FISCAL YEAR 2027 AND EACH FISCAL YEAR 23
84+THEREAFTER . 24
9385
94- (3) $21,000,000 FOR FISCAL YEAR 2026; AND 34
86+15–101. 25
87+
88+ (a) In this title the following words have the meanings indicated. 26
89+
90+ (A–1) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 27
91+EVIDENCE–BASED RESOURCES DESI GNED TO SERVE INDIVI DUALS EXPERIENCING A 28
92+MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 29
93+
94+ (1) CRISIS CALL CENTERS A ND HOTLINE SERVICES ; 30
9595 SENATE BILL 637 3
9696
9797
98- (4) $24,000,000 FOR FISCAL YEAR 2027 AND EACH FISCAL YEAR 1
99-THEREAFTER . 2
98+ (2) MOBILE CRISIS SERVICE S; AND 1
10099
101-15–101. 3
100+ (3) CRISIS RECEIVING AND STABILIZATION SERVICES. 2
102101
103- (a) In this title the following words have the meanings indicated. 4
102+ (A–2) “CERTIFIED PEER RECOVERY SPECIALIST ” MEANS AN INDIVIDUAL WHO 3
103+HAS BEEN CERTIFIED B Y AN ENTITY APPROVED BY THE DEPARTMENT FOR THE 4
104+PURPOSE OF PROVIDING PEER SUPPORT SERVICE S, AS DEFINED UNDER § 7.5–101 5
105+OF THIS ARTICLE. 6
104106
105- (A–1) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 5
106-EVIDENCE–BASED RESOURCES DESI GNED TO SERVE INDIVI DUALS EXPERIENCING A 6
107-MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 7
107+ [(a–1)] (A–3) “Dental managed care organization” means a pre–paid dental 7
108+plan that receives fees to manage dental services. 8
108109
109- (1) CRISIS CALL CENTERS A ND HOTLINE SERVICES ; 8
110+ [(a–2)] (A–4) “Dental services” means diagnostic, emergency, preventive, and 9
111+therapeutic services for oral diseases. 10
110112
111- (2) MOBILE CRISIS SERVICE S; AND 9
113+ (E–1) “MEASUREMENT –BASED CARE” MEANS AN EVIDENCE –BASED PRACTICE 11
114+THAT INVOLVES THE SY STEMATIC COLLECTION OF DATA TO MONITOR T REATMENT 12
115+PROGRESS, ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, FROM INITIAL 13
116+SCREENING TO COMPLET ION OF CARE, THAT IS USED TO EVAL UATE: 14
112117
113- (3) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 10
118+ (1) SYMPTOMS; 15
114119
115- (A–2) “CERTIFIED PEER RECOVE RY SPECIALIST” MEANS AN INDIVIDUAL WHO 11
116-HAS BEEN CERTIFIED B Y AN ENTITY APPROVED BY THE DEPARTMENT FOR THE 12
117-PURPOSE OF PROVIDING PEER SUPPORT SERVICE S, AS DEFINED UNDER § 7.5–101 13
118-OF THIS ARTICLE. 14
120+ (2) FUNCTIONING AND SATIS FACTION WITH LIFE ; 16
119121
120- [(a–1)] (A–3) “Dental managed care organization” means a pre–paid dental 15
121-plan that receives fees to manage dental services. 16
122+ (3) READINESS TO CHANGE ; AND 17
122123
123- [(a–2)] (A–4) “Dental services” means diagnostic, emergency, preventive, and 17
124-therapeutic services for oral diseases. 18
124+ (4) THE TREATMENT PROCESS . 18
125125
126- (E–1) “MEASUREMENT –BASED CARE” MEANS AN EVIDENCE –BASED PRACTICE 19
127-THAT INVOLVES THE SY STEMATIC COLLECTION OF DATA TO MONITOR T REATMENT 20
128-PROGRESS, ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, FROM INITIAL 21
129-SCREENING TO COMPLET ION OF CARE, THAT IS USED TO EVAL UATE: 22
126+15–103. 19
130127
131- (1) SYMPTOMS; 23
128+ (a) (1) The Secretary shall administer the Maryland Medical Assistance 20
129+Program. 21
132130
133- (2) FUNCTIONING AND SATIS FACTION WITH LIFE ; 24
131+ (2) The Program: 22
134132
135- (3) READINESS TO CHANGE ; AND 25
136-
137- (4) THE TREATMENT PROCESS . 26
138-
139-15–103. 27
140-
141- (a) (1) The Secretary shall administer the Maryland Medical Assistance 28
142-Program. 29 4 SENATE BILL 637
133+ (xvi) Beginning on January 1, 2021, shall provide, subject to the 23
134+limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 24
135+by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 25
136+with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 26
137+including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 27
138+if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 28
139+and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 29
140+purposes in accordance with § 15–855(d) of the Insurance Article; [and] 30
141+ 4 SENATE BILL 637
143142
144143
144+ (xvii) Beginning on January 1, 2022, may not include, subject to federal 1
145+approval and limitations of the State budget, a frequency limitation on covered dental 2
146+prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 3
147+health exams to be provided at an interval greater than 120 days within a plan year; AND 4
145148
146- (2) The Program: 1
149+ (XVIII) BEGINNING ON JANUARY 1, 2023, SHALL PROVIDE , 5
150+SUBJECT TO THE LIMIT ATIONS OF THE STATE BUDGET , AND AS PERMITTED BY 6
151+FEDERAL LAW , REIMBURSEMENT FOR : 7
147152
148- (xvi) Beginning on January 1, 2021, shall provide, subject to the 2
149-limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 3
150-by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 4
151-with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 5
152-including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 6
153-if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 7
154-and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 8
155-purposes in accordance with § 15–855(d) of the Insurance Article; [and] 9
153+ 1. SERVICES PROVIDED BY CERTIFIED PEER RECOVERY 8
154+SPECIALISTS; 9
156155
157- (xvii) Beginning on January 1, 2022, may not include, subject to federal 10
158-approval and limitations of the State budget, a frequency limitation on covered dental 11
159-prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 12
160-health exams to be provided at an interval greater than 120 days within a plan year; AND 13
156+ 2. MEASUREMENT –BASED CARE PROVIDED IN 10
157+BEHAVIORAL HEALTH SE TTINGS, INCLUDING OUTPATIENT MENTAL HEALTH 11
158+CENTERS; AND 12
161159
162- (XVIII) BEGINNING ON JANUARY 1, 2023, SHALL PROVIDE , 14
163-SUBJECT TO THE LIMIT ATIONS OF THE STATE BUDGET , AND AS PERMITTED BY 15
164-FEDERAL LAW , REIMBURSEMENT FOR : 16
160+ 3. BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S. 13
165161
166- 1. SERVICES PROVIDED BY CERTIFIED PEER RECOV ERY 17
167-SPECIALISTS; 18
162+15–141.1. 14
168163
169- 2. MEASUREMENT –BASED CARE PROVIDED IN 19
170-BEHAVIORAL HEALTH SETTIN GS, INCLUDING OUTPATIENT MENTAL HEALTH 20
171-CENTERS; AND 21
164+ (a) [(1)] In this section [the following words have the meanings indicated. 15
172165
173- 3. BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S. 22
166+ (2)], “Collaborative Care Model” means an evidence–based approach for 16
167+integrating somatic and behavioral health services in primary care settings that includes: 17
174168
175-15–141.1. 23
169+ [(i)] (1) Care coordination and management; 18
176170
177- (a) [(1)] In this section [the following words have the meanings indicated. 24
171+ [(ii)] (2) Regular, proactive outcome monitoring and treatment for 19
172+outcome targets using standardized outcome measurement rating scales and electronic 20
173+tools, such as patient tracking; and 21
178174
179- (2)], “Collaborative Care Model” means an evidence–based approach for 25
180-integrating somatic and behavioral health services in primary care settings that includes: 26
175+ [(iii)] (3) Regular systematic psychiatric and substance use disorder 22
176+caseload reviews and consultation with a psychiatrist, an addiction medicine specialist, or 23
177+any other behavioral health medicine specialist as allowed under federal regulations 24
178+governing the model. 25
181179
182- [(i)] (1) Care coordination and management; 27
180+ [(3) “Pilot Program” means the Collaborative Care Pilot Program.] 26
183181
184- [(ii)] (2) Regular, proactive outcome monitoring and treatment for 28
185-outcome targets using standardized outcome measurement rating scales and electronic 29
186-tools, such as patient tracking; and 30
182+ (b) This section may not be construed to prohibit referrals from a primary care 27
183+provider to a specialty behavioral health care provider. 28
187184
188- [(iii)] (3) Regular systematic psychiatric and substance use disorder 31
189-caseload reviews and consultation with a psychiatrist, an addiction medicine specialist, or 32 SENATE BILL 637 5
185+ [(c) There is a Collaborative Care Pilot Program in the Department. 29
186+ SENATE BILL 637 5
190187
191188
192-any other behavioral health medicine specialist as allowed under federal regulations 1
193-governing the model. 2
189+ (d) The purpose of the Pilot Program is to establish and implement a 1
190+Collaborative Care Model in primary care settings in which health care services are 2
191+provided to Program recipients enrolled in HealthChoice. 3
194192
195- [(3) “Pilot Program” means the Collaborative Care Pilot Program.] 3
193+ (e) The Department shall administer the Pilot Program. 4
196194
197- (b) This section may not be construed to prohibit referrals from a primary care 4
198-provider to a specialty behavioral health care provider. 5
195+ (f) (1) The Department shall select up to three sites at which a Collaborative 5
196+Care Model shall be established over a 4–year period. 6
199197
200- [(c) There is a Collaborative Care Pilot Program in the Department. 6
198+ (2) The sites selected by the Department shall be adult or pediatric 7
199+nonspecialty medical practices or health systems that serve a significant number of 8
200+Program recipients. 9
201201
202- (d) The purpose of the Pilot Program is to establish and implement a 7
203-Collaborative Care Model in primary care settings in which health care services are 8
204-provided to Program recipients enrolled in HealthChoice. 9
202+ (3) To the extent practicable, one of the sites selected by the Department 10
203+under paragraph (1) of this subsection shall be located in a rural area of the State. 11
205204
206- (e) The Department shall administer the Pilot Program. 10
205+ (g) The sites selected by the Department under subsection (f) of this section shall 12
206+ensure that treatment services, prescriptions, and care management that would be 13
207+provided to an individual under the Pilot Program are not duplicative of specialty 14
208+behavioral health care services being received by the individual. 15
207209
208- (f) (1) The Department shall select up to three sites at which a Collaborative 11
209-Care Model shall be established over a 4–year period. 12
210+ (h) The Department shall provide funding to sites participating in the Pilot 16
211+Program for: 17
210212
211- (2) The sites selected by the Department shall be adult or pediatric 13
212-nonspecialty medical practices or health systems that serve a significant number of 14
213-Program recipients. 15
213+ (1) Infrastructure development, including the development of a patient 18
214+registry and other monitoring, reporting, and billing tools required to implement a 19
215+Collaborative Care Model; 20
214216
215- (3) To the extent practicable, one of the sites selected by the Department 16
216-under paragraph (1) of this subsection shall be located in a rural area of the State. 17
217+ (2) Training staff to implement the Collaborative Care Model; 21
217218
218- (g) The sites selected by the Department under subsection (f) of this section shall 18
219-ensure that treatment services, prescriptions, and care management that would be 19
220-provided to an individual under the Pilot Program are not duplicative of specialty 20
221-behavioral health care services being received by the individual. 21
219+ (3) Staffing for care management and psychiatric consultation provided 22
220+under the Collaborative Care Model; and 23
222221
223- (h) The Department shall provide funding to sites participating in the Pilot 22
224-Program for: 23
222+ (4) Other purposes necessary to implement and evaluate the Collaborative 24
223+Care Model. 25
225224
226- (1) Infrastructure development, including the development of a patient 24
227-registry and other monitoring, reporting, and billing tools required to implement a 25
228-Collaborative Care Model; 26
225+ (i) The Department shall: 26
229226
230- (2) Training staff to implement the Collaborative Care Model; 27
227+ (1) Collaborate with stakeholders in the development, implementation, 27
228+and outcome monitoring of the Pilot Program; and 28
231229
232- (3) Staffing for care management and psychiatric consultation provided 28
233-under the Collaborative Care Model; and 29
230+ (2) Collect outcomes data on recipients of health care services under the 29
231+Pilot Program to: 30
234232
235- (4) Other purposes necessary to implement and evaluate the Collaborative 30
236-Care Model. 31
237-
238- (i) The Department shall: 32 6 SENATE BILL 637
233+ (i) Evaluate the effectiveness of the Collaborative Care Model, 31
234+including by evaluating the number of and outcomes for individuals who: 32
235+ 6 SENATE BILL 637
239236
240237
238+ 1. Were not diagnosed as having a behavioral health 1
239+condition before receiving treatment through the Pilot Program; 2
241240
242- (1) Collaborate with stakeholders in the development, implementation, 1
243-and outcome monitoring of the Pilot Program; and 2
241+ 2. Were not diagnosed as having a behavioral health 3
242+condition before being referred to and treated by a specialty behavioral health provider; 4
244243
245- (2) Collect outcomes data on recipients of health care services under the 3
246-Pilot Program to: 4
244+ 3. Received behavioral health services in a primary care 5
245+setting before receiving treatment through the Pilot Program; and 6
247246
248- (i) Evaluate the effectiveness of the Collaborative Care Model, 5
249-including by evaluating the number of and outcomes for individuals who: 6
247+ 4. Received specialty behavioral health care services before 7
248+being identified as eligible to receive treatment through the Pilot Program; and] 8
250249
251- 1. Were not diagnosed as having a behavioral health 7
252-condition before receiving treatment through the Pilot Program; 8
250+ [(ii)] (C) [Determine whether to] THE DEPARTMENT SHALL 9
251+implement AND PROVIDE REIMBURSEMEN T FOR SERVICES PROVIDE D IN 10
252+ACCORDANCE WITH the Collaborative Care Model statewide in primary care settings that 11
253+provide health care services to Program recipients. 12
253254
254- 2. Were not diagnosed as having a behaviora l health 9
255-condition before being referred to and treated by a specialty behavioral health provider; 10
255+ [(j) The Department shall apply to the Centers for Medicare and Medicaid 13
256+Services for an amendment to the State’s § 1115 HealthChoice Demonstration waiver if 14
257+necessary to implement the Pilot Program. 15
256258
257- 3. Received behavioral health services in a primary care 11
258-setting before receiving treatment through the Pilot Program; and 12
259+ (k) For fiscal year 2020, fiscal year 2021, fiscal year 2022, and fiscal year 2023, 16
260+the Governor shall include in the annual budget an appropriation of $550,000 for the Pilot 17
261+Program. 18
259262
260- 4. Received specialty behavioral health care services before 13
261-being identified as eligible to receive treatment through the Pilot Program; and] 14
263+ (l) On or before November 1, 2023, the Department shall report to the Governor 19
264+and, in accordance with § 2–1257 of the State Government Article, the General Assembly 20
265+on the Department’s findings and recommendations from the Pilot Program.] 21
262266
263- [(ii)] (C) [Determine whether to] THE DEPARTMENT SHALL 15
264-implement AND PROVIDE REIMBURS EMENT FOR SERVICES P ROVIDED IN 16
265-ACCORDANCE WITH the Collaborative Care Model statewide in primary care settings that 17
266-provide health care services to Program recipients. 18
267+SUBTITLE 11. HOME– AND COMMUNITY–BASED SERVICES FOR CHILDREN AND 22
268+YOUTH. 23
267269
268- [(j) The Department shall apply to the Centers for Medicare and Medicaid 19
269-Services for an amendment to the State’s § 1115 HealthChoice Demonstration waiver if 20
270-necessary to implement the Pilot Program. 21
270+15–1101. 24
271271
272- (k) For fiscal year 2020, fiscal year 2021, fiscal year 2022, and fiscal year 2023, 22
273-the Governor shall include in the annual budget an appropriation of $550,000 for the Pilot 23
274-Program. 24
272+ (A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 25
273+INDICATED. 26
275274
276- (l) On or before November 1, 2023, the Department shall report to the Governor 25
277-and, in accordance with § 2–1257 of the State Government Article, the General Assembly 26
278-on the Department’s findings and recommendations from the Pilot Program.] 27
275+ (B) “FAMILY–CENTERED TREATMENT ” MEANS AN EVIDENCE ‐BASED 27
276+PRACTICE USED TO STA BILIZE YOUTH IN THE HOME BY ADDRESSI NG UNDERLYING 28
277+FUNCTIONS OF BEHAVIO R IN ORDER TO REDUCE DISRUPTIONS IN THE HOME, 29
278+SCHOOL, AND COMMUNITY . 30
279279
280-SUBTITLE 11. HOME– AND COMMUNITY–BASED SERVICES FOR CHILDREN AND 28
281-YOUTH. 29
282-
283-15–1101. 30
284-
285- (A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 31
286-INDICATED. 32 SENATE BILL 637 7
280+ (C) “FUNCTIONAL FAMILY THE RAPY” MEANS A FAMILY ‐BASED 31
281+PREVENTION AND INTER VENTION PROGRAM FOR HIGH–RISK YOUTH THAT 32 SENATE BILL 637 7
287282
288283
284+ADDRESSES COMPLEX AN D MULTIDIMENSIONAL P ROBLEMS THR OUGH CLINICAL 1
285+PRACTICE THAT IS FLE XIBLY STRUCTURED AND CULTURALLY SENSITIVE . 2
289286
290- (B) “FAMILY–CENTERED TREATMENT ” MEANS AN EVIDENCE –BASED 1
291-PRACTICE USED TO STA BILIZE YOUTH IN THE HOME BY ADDRESSING UNDERLYING 2
292-FUNCTIONS OF BEHAVIO R IN ORDER TO REDUCE DISRUPTIONS IN THE H OME, 3
293-SCHOOL, AND COMMUNITY . 4
287+ (D) “MENTAL HEALTH CASE MA NAGEMENT PROGRAM” MEANS A PROGRAM 3
288+THAT PROVIDES AN IDE NTIFIED SUBSET OF WR APAROUND SERVICES . 4
294289
295- (C) “FUNCTIONAL FAMILY THE RAPY” MEANS A FAMILY –BASED 5
296-PREVENTION AND INTER VENTION PROGRAM FOR HIGH–RISK YOUTH THAT 6
297-ADDRESSES COMPLEX AN D MULTIDIMENSIONAL P ROBLEMS THROUGH CLIN ICAL 7
298-PRACTICE THAT IS FLE XIBLY STRUCTURED AND CULTURALLY SENSITIVE . 8
290+ (E) “1915(I) MODEL” MEANS THE 1915(I) INTENSIVE BEHAVIORAL HEALTH 5
291+SERVICES FOR CHILDREN, YOUTH, AND FAMILIES PROGRAM ESTA BLISHED UNDER 6
292+TITLE 10, SUBTITLE 9, CHAPTER 89 OF THE CODE OF MARYLAND REGULATIONS. 7
299293
300- (D) “MENTAL HEALTH CASE MA NAGEMENT PROGRAM ” MEANS A PROGRAM 9
301-THAT PROVIDES AN IDE NTIFIED SUBSET OF WR APAROUND SERVICES . 10
294+ (F) “WRAPAROUND SERVICES ” MEANS SERVICES PROVI DED TO CHILDREN 8
295+AND YOUTH WITH INTEN SIVE MENTAL HEA LTH NEEDS AND THEIR FAMILIES IN 9
296+THEIR COMMUNITIES , INCLUDING: 10
302297
303- (E) “1915(I) MODEL” MEANS THE 1915(I) INTENSIVE BEHAVIORAL HEALTH 11
304-SERVICES FOR CHILDREN, YOUTH, AND FAMILIES PROGRAM ESTA BLISHED UNDER 12
305-TITLE 10, SUBTITLE 9, CHAPTER 89 OF THE CODE OF MARYLAND REGULATIONS. 13
298+ (1) INTENSIVE CARE COORDI NATION; 11
306299
307- (F) “WRAPAROUND SERVICES ” MEANS SERVICES PROVI DED TO CHILDREN 14
308-AND YOUTH WITH INTEN SIVE MENTAL HEALTH NEEDS AND THE IR FAMILIES IN 15
309-THEIR COMMUNITIES , INCLUDING: 16
300+ (2) CHILD AND FAMILY TEAM MEETINGS; AND 12
310301
311- (1) INTENSIVE CARE COORDI NATION; 17
302+ (3) PLANS OF CARE THAT AR E INDIVIDUALIZED TO EACH FAMILY AND 13
303+INCLUDE: 14
312304
313- (2) CHILD AND FAMILY TEAM MEETINGS; AND 18
305+ (I) FORMAL SUPPORTS , INCLUDING INDIVID UAL AND FAMILY 15
306+THERAPY; AND 16
314307
315- (3) PLANS OF CARE THAT AR E INDIVIDUALIZED TO EACH FAMILY AND 19
316-INCLUDE: 20
308+ (II) INFORMAL SUPPORTS , INCLUDING INTENSIVE IN–HOME 17
309+SERVICES, RESPITE CARE, MOBILE CRISIS RESPON SE AND STABILIZATION , FAMILY 18
310+PEER SUPPORT , EXPERIENTIAL THERAPI ES, AND FLEXIBLE FUNDS F OR GOODS AND 19
311+SERVICES THAT ARE ID ENTIFIED IN THE PLAN OF CARE . 20
317312
318- (I) FORMAL SUPPORTS , INCLUDING INDIVIDUAL AND FAMIL Y 21
319-THERAPY; AND 22
313+15–1102. 21
320314
321- (II) INFORMAL SUPPORTS , INCLUDING INTENSIVE IN–HOME 23
322-SERVICES, RESPITE CARE, MOBILE CRISIS RESPON SE AND STABILIZATION , FAMILY 24
323-PEER SUPPORT , EXPERIENTIAL THERAPI ES, AND FLEXIBLE FUNDS F OR GOODS AND 25
324-SERVICES THAT ARE ID ENTIFIED IN THE PLAN OF CARE. 26
315+ (A) THE DEPARTMENT SHALL ENSU RE THAT C ARE COORDINATORS 22
316+DELIVERING SERVICES UNDER THE 1915(I) MODEL OR A MENTAL HEALTH CASE 23
317+MANAGEMENT PROGRAM RECEIVE TRAI NING IN THE DELIVERY OF WRAPAROUND 24
318+SERVICES. 25
325319
326-15–1102. 27
320+ (B) THE DEPARTMENT SHALL PROVIDE R EIMBURSEMENT FOR: 26
327321
328- (A) THE DEPARTMENT SHALL ENSU RE THAT CARE COORDIN ATORS 28
329-DELIVERING SERVICES UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE 29
330-MANAGEMENT PROGRAM R ECEIVE TRAINING IN T HE DELIVERY OF WRAPA ROUND 30
331-SERVICES. 31
322+ (1) WRAPAROUND SERVICES DELIVERED BY CARE COORDIN ATORS 27
323+UNDER THE 1915(I) MODEL OR A MENTAL HEALTH CASE MANAGEMENT PROG RAM 28
324+THAT IS COMMENSURATE WITH IN DUSTRY STANDARDS FOR THE REIMBURSEMENT 29
325+OF THE DELIVERY OF WRAPAROUND SERVICES; AND 30
332326 8 SENATE BILL 637
333327
334328
335- (B) THE DEPARTMENT SHALL PROVIDE R EIMBURSEMENT FOR : 1
329+ (2) INTENSIVE IN–HOME SERVICES DELIVERED BY PROVIDE RS USING 1
330+FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 2
331+EVIDENCE–BASED PRACTICES UNDER THE 1915(I) MODEL THAT IS COMMENSURATE 3
332+WITH INDUSTRY STANDA RDS FOR THE REIMBURSEMENT OF THE DELIVERY OF 4
333+FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 5
334+EVIDENCE–BASED PRACTICES . 6
336335
337- (1) WRAPAROUND SERVICES D ELIVERED BY CARE COO RDINATORS 2
338-UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE MANAGEMENT PROGRAM 3
339-THAT IS COMMENSURATE WITH INDUSTRY STANDA RDS FOR THE REIMBURS EMENT 4
340-OF THE DELIVERY OF W RAPAROUND SERVICES; AND 5
336+ (C) BEGINNING IN FISCAL YEAR 2023, THE BEHAVIORAL HEALTH 7
337+ADMINISTRATION SHALL FUND 100 SLOTS IN THE MENTAL HEALTH CASE 8
338+MANAGEMENT PROGRAM F OR CHILDREN OR YOUTH WHO ARE NOT EL IGIBLE FOR 9
339+PROGRAM SERVICES AND AT RISK OF OUT–OF–HOME PLACEMENT . 10
341340
342- (2) INTENSIVE IN–HOME SERVICES DELIVE RED BY PROVIDERS USI NG 6
343-FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 7
344-EVIDENCE–BASED PRACTICES UNDE R THE 1915(I) MODEL THAT IS COMMEN SURATE 8
345-WITH INDUSTRY STANDA RDS FOR THE REIMBURSEMENT OF THE DELIVERY OF 9
346-FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 10
347-EVIDENCE–BASED PRACTICES . 11
341+ (D) THE GOVERNOR SHALL INCLUD E IN THE ANNUAL OPER ATING BUDGET 11
342+BILL THE FOLLOWING A MOUNTS TO FUND CUSTOMIZED GOODS AND SERVICES FOR 12
343+YOUTH RECEIVING SERVICES U NDER THE 1915(I) MODEL OR MENTAL HEALTH CAS E 13
344+MANAGEMENT PROGRAM : 14
348345
349- (C) BEGINNING IN FISCAL Y EAR 2023, THE BEHAVIORAL HEALTH 12
350-ADMINISTRATION SHALL FUND 100 SLOTS IN THE MENTAL HEALTH CASE 13
351-MANAGEMENT P ROGRAM FOR CHILDREN OR YOUTH WHO ARE NOT ELIGIBLE FOR 14
352-PROGRAM SERVICES AND AT RISK OF OUT–OF–HOME PLACEMENT . 15
346+ (1) $150,000 FOR FISCAL YEAR 2024; 15
353347
354- (D) THE GOVERNOR SHALL INCLUD E IN THE ANNUAL OPER ATING BUDGET 16
355-BILL THE FOLLOWING A MOUNTS TO FUND CUSTO MIZED GOODS AND SERV ICES FOR 17
356-YOUTH RECEIVIN G SERVICES UNDER THE 1915(I) MODEL OR MENTAL HEAL TH CASE 18
357-MANAGEMENT PROGRAM : 19
348+ (2) $250,000 FOR FISCAL YEAR 2025; AND 16
358349
359- (1) $150,000 FOR FISCAL YEAR 2024; 20
350+ (3) $350,000 FOR FISCAL YEAR 2026 AND EACH FISC AL YEAR 17
351+THEREAFTER . 18
360352
361- (2) $250,000 FOR FISCAL YEAR 2025; AND 21
353+Article – Insurance 19
362354
363- (3) $350,000 FOR FISCAL YEAR 2026 AND EACH FISCAL YEAR 22
364-THEREAFTER . 23
355+15–717. 20
365356
366-Article – Insurance 24
357+ (A) IN THIS SECTION, “CERTIFIED PEER RECOVERY SPECIAL IST” MEANS AN 21
358+INDIVIDUAL WHO HAS B EEN CERTIFIED BY AN ENTITY APPROVED BY T HE 22
359+MARYLAND DEPARTMENT OF HEALTH FOR THE PURPOS E OF PROVIDING PEER 23
360+SUPPORT SERVICES, AS DEFINED UNDER § 7.5–101 OF THE HEALTH – GENERAL 24
361+ARTICLE. 25
367362
368-15–717. 25
363+ (B) THIS SECTION APPLIES TO: 26
369364
370- (A) IN THIS SECTION, “CERTIFIED PEER RECOV ERY SPECIALIST” MEANS AN 26
371-INDIVIDUAL WHO HAS B EEN CERTIFIED BY AN ENTITY APPROVED BY T HE 27
372-MARYLAND DEPARTMENT OF HEALTH FOR THE PURPOS E OF PROVIDING PEER 28
373-SUPPORT SERVICES , AS DEFINED UNDER § 7.5–101 OF THE HEALTH – GENERAL 29
374-ARTICLE. 30
375-
376- (B) THIS SECTION APPLIES TO: 31
365+ (1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 27
366+PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 28
367+ON AN EXPENSE –INCURRED BASIS UNDER HEALTH I NSURANCE POLICIES OR 29
368+CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 30
377369 SENATE BILL 637 9
378370
379371
380- (1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 1
381-PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 2
382-ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 3
383-CONTRACTS THA T ARE ISSUED OR DELI VERED IN THE STATE; AND 4
372+ (2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 1
373+HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 2
374+CONTRACTS THAT ARE I SSUED OR DELIV ERED IN THE STATE. 3
384375
385- (2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 5
386-HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 6
387-CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 7
376+ (C) IF A POLICY OR CONTRACT SUBJECT TO THIS SECTI ON PROVIDES FOR 4
377+REIMBURSEMENT FOR A SERVICE THAT IS WITH IN THE LAWFUL SCOPE OF 5
378+ACTIVITIES OF A CERTIFIED PEER RECOVERY SPECIA LIST PROVIDING SERVICES 6
379+UNDER THE SUPERVISIO N OF A BEHAVIORAL HEALTH PROGRAM LICENS ED BY THE 7
380+SECRETARY OF HEALTH UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE, 8
381+THE INSURED OR ANY O THER PERSON COVERED BY THE POLICY OR C ONTRACT IS 9
382+ENTITLED TO REIMBURS EMENT FOR THE SERVIC E. 10
388383
389- (C) IF A POLICY OR CONTRA CT SUBJECT TO THIS SECTION P ROVIDES FOR 8
390-REIMBURSEMENT FOR A SERVICE THAT IS WITH IN THE LAWFUL SCOPE OF 9
391-ACTIVITIES OF A CERT IFIED PEER RECOVERY SPECIALIST PROVIDING SERVICES 10
392-UNDER THE SUPERVISIO N OF A BEHAVIORAL HE ALTH PROGRAM LICENSE D BY THE 11
393-SECRETARY OF HEALTH UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE, 12
394-THE INSURED OR ANY O THER PERSON COVERED BY THE POLICY OR CON TRACT IS 13
395-ENTITLED TO REIMBURS EMENT FOR THE SERVIC E. 14
384+15–857. 11
396385
397-15–857. 15
386+ (A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 12
387+INDICATED. 13
398388
399- (A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 16
400-INDICATED. 17
389+ (2) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 14
390+EVIDENCE–BASED SERVICES DESIGNED TO SERVE INDIVIDUALS EXPERIENCING A 15
391+MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 16
401392
402- (2) “BEHAVIORAL HEALTH CRISI S RESPONSE SERVICES ” MEANS 18
403-EVIDENCE–BASED SERVICES DESIG NED TO SERVE INDIVID UALS EXPERIENCING A 19
404-MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 20
393+ (I) CRISIS CALL CENTERS AND HOTLINE SERVICES; 17
405394
406- (I) CRISIS CALL CENTERS AND HOTLINE SERVICES ; 21
395+ (II) MOBILE CRISIS SERVIC ES; AND 18
407396
408- (II) MOBILE CRISIS SERVIC ES; AND 22
397+ (III) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 19
409398
410- (III) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 23
399+ (3) “MEASUREMENT –BASED CARE ” MEANS AN EVIDENCE –BASED 20
400+PRACTICE THAT INVOLV ES THE SYSTEMATIC CO LLECTION OF DATA TO MONITOR 21
401+TREATMENT PROGRESS, ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, 22
402+FROM INITIAL SCREENI NG TO COMPLETION OF CARE, THAT IS USED TO EVAL UATE: 23
411403
412- (3) “MEASUREMENT –BASED CARE ” MEANS AN EVIDENCE –BASED 24
413-PRACTICE THAT INVOLV ES THE SYSTEMATIC CO LLECTION OF DATA TO MONITOR 25
414-TREATMENT PROGRESS , ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, 26
415-FROM INITIAL SCREENING TO COM PLETION OF CARE , THAT IS USED TO EVAL UATE: 27
404+ (I) SYMPTOMS; 24
416405
417- (I) SYMPTOMS; 28
406+ (II) FUNCTIONING AND SATI SFACTION WITH LIFE ; 25
418407
419- (II) FUNCTIONING AND SATI SFACTION WITH LIFE ; 29
408+ (III) READINESS TO CHANGE ; AND 26
420409
421- (III) READINESS TO CHANGE ; AND 30
410+ (IV) THE TREATMENT PROCESS. 27
422411
423- (IV) THE TREATMENT PROCES S. 31 10 SENATE BILL 637
412+ (B) THIS SECTION APPLIES TO: 28
413+ 10 SENATE BILL 637
424414
425415
416+ (1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT ISSUE 1
417+OR DELIVER HEALTH INSURANCE POL ICIES OR CONTRACTS I N THE STATE; AND 2
426418
427- (B) THIS SECTION APPLIES TO: 1
419+ (2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 3
420+COVERAGE TO INDIVIDUALS OR GR OUPS UNDER CONTRACTS THAT ARE ISSUED OR 4
421+DELIVERED IN THE STATE. 5
428422
429- (1) INSURERS AND NONPROFIT HEALTH SER VICE PLANS THAT ISSU E 2
430-OR DELIVER HEALTH IN SURANCE POLICIES OR CONTRACTS IN THE STATE; AND 3
423+ (C) AN ENTITY SUBJECT TO THIS SECTION SHALL P ROVIDE COVERAGE FOR : 6
431424
432- (2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 4
433-COVERAGE TO INDIVIDU ALS OR GROUPS UNDER CONTRACTS THAT ARE I SSUED OR 5
434-DELIVERED IN THE STATE. 6
425+ (1) BEHAVIORAL HEALTH CRISIS RESPON SE SERVICES; AND 7
435426
436- (C) AN ENTITY SUBJECT TO THIS SECTION SHALL P ROVIDE COVERAGE FOR : 7
427+ (2) MEASUREMENT –BASED CARE PROVIDED IN A BEHAVI ORAL 8
428+HEALTH SETTING . 9
437429
438- (1) BEHAVIORAL HEALTH CR ISIS RESPONSE SERVIC ES; AND 8
430+ SECTION 2. AND BE IT FURTHER ENACTED, That: 10
439431
440- (2) MEASUREMENT –BASED CARE PROVIDED IN A BEHAVIORAL 9
441-HEALTH SETTING . 10
432+ (a) (1) On or before December 1, 2022, the Maryland Department of Health 11
433+shall obtain any federal authority necessary to implement a plan for the expansion of 12
434+certified community behavioral health clinics in the State, including applying to the 13
435+Centers for Medicare and Medicaid Services for an amendment to any of the State’s 1115 14
436+waivers or the State plan. 15
442437
443- SECTION 2. AND BE IT FURTHER ENACTED, That: 11
438+ (2) The Department’s implementation plan shall ensure access to certified 16
439+community behavioral health clinics in all counties in the State. 17
444440
445- (a) (1) On or before December 1, 2022, the Maryland Department of Health 12
446-shall obtain any federal authority necessary to implement a plan for the expansion of 13
447-certified community behavioral health clinics in the State, including applying to the 14
448-Centers for Medicare and Medicaid Services for an amendment to any of the State’s 1115 15
449-waivers or the State plan. 16
441+ (b) The Maryland Department of Health shall review and consider options for 18
442+expanding the services provided under § 15–1102 of the Health – General Article, as 19
443+enacted by Section 1 of this Act, or adopting other existing programs or services to provide 20
444+wraparound services to children and youth with primary substance use disorders. 21
450445
451- (2) The Department’s implementation plan shall ensure access to certified 17
452-community behavioral health clinics in all counties in the State. 18
446+ (c) On or before December 1, 2023, the Maryland Department of Health shall 22
447+review current eligibility requirements for the model established under § 1915(i) of the 23
448+Social Security Act, and mental health case management generally, and submit 24
449+recommendations for expanding eligibility and enrollment in these programs to the General 25
450+Assembly, in accordance with § 2–1257 of the State Government Article. 26
453451
454- (b) (a) The Maryland Department of Health shall review and consider options for 19
455-expanding the services provided under § 15–1102 of the Health – General Article, as 20
456-enacted by Section 1 of this Act, or adopting other existing programs or services to provide 21
457-wraparound services to children and youth with primary substance use disorders. 22
452+ SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 27
453+policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 28
454+after January 1, 2023. 29
458455
459- (c) (b) On or before December 1, 2023, the Maryland Department of Health shall 23
460-review current eligibility requirements for the model established under § 1915(i) of the 24
461-Social Security Act, and mental health case management generally, and submit 25
462-recommendations for expanding eligibility and enrollment in these programs to the General 26
463-Assembly, in accordance with § 2–1257 of the State Government Article. 27
464-
465- SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 28
466-policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 29
467-after January 1, 2023. 30
468-
469- SECTION 2. AND BE IT FURTHER ENACTED, That: 31
470- SENATE BILL 637 11
471-
472-
473- (a) The Maryland Insurance Administration, in consultation with carriers, 1
474-behavioral health providers, advocates, and other stakeholders, shall conduct a study on 2
475-operational issues related to commercial carrier reimbursement of behavioral health 3
476-clinical peer specialists and crisis response services and make recommendations for how to 4
477-address these issues. 5
478-
479- (b) On or before November 15, 2022, the Maryland Insurance Administration 6
480-shall report the findings and recommendations of the study required under subsection (a) 7
481-of this section to the General Assembly, in accordance with § 2–1257 of the State 8
482-Government Article. 9
483-
484- SECTION 4. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 10
485-October June 1, 2022. 11
486-
487-
488-
489-
490-Approved:
491-________________________________________________________________________________
492- Governor.
493-________________________________________________________________________________
494- President of the Senate.
495-________________________________________________________________________________
496- Speaker of the House of Delegates.
456+ SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 30
457+October 1, 2022. 31