EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW. [Brackets] indicate matter deleted from existing law. Underlining indicates amendments to bill. Strike out indicates matter stricken from the bill by amendment or deleted from the law by amendment. *sb0212* SENATE BILL 212 J1 4lr0153 (PRE–FILED) CF HB 1048 By: Chair, Finance Committee (By Request – Departmental – Health) Requested: September 13, 2023 Introduced and read first time: January 10, 2024 Assigned to: Finance Committee Report: Favorable with amendments Senate action: Adopted Read second time: February 11, 2024 CHAPTER ______ AN ACT concerning 1 Behavioral Health Advisory Council and Commission on Behavioral Health 2 Care Treatment and Access – Alterations 3 FOR the purpose of altering the membership and terms of members of the Behavioral 4 Health Advisory Council; requiring the Commission on Behavioral Health Care 5 Treatment and Access to meet jointly with the Council; requiring the Commission, 6 in coordination with the Council, to make recommendations regarding the 7 continuation of the State’s behavioral health carve–out and the financing structure 8 and quality oversight necessary to integrate somatic and behavioral health services 9 and ensure compliance with the Mental Health Parity and Addiction Equity Act in 10 the Maryland Medical Assistance Program; and generally relating to the Behavioral 11 Health Advisory Council and the Commission on Behavioral Health Care Treatment 12 and Access. 13 BY repealing and reenacting, without amendments, 14 Article – Health – General 15 Section 7.5–301 and 13–4801(a) and (c) 16 Annotated Code of Maryland 17 (2023 Replacement Volume) 18 BY repealing and reenacting, with amendments, 19 Article – Health – General 20 Section 7.5–303, 7.5–305, 13–4802, 13–4803(f), 13–4805, 13–4806, and 13–4807 21 Annotated Code of Maryland 22 2 SENATE BILL 212 (2023 Replacement Volume) 1 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 2 That the Laws of Maryland read as follows: 3 Article – Health – General 4 7.5–301. 5 In this subtitle, “Council” means the Behavioral Health Advisory Council. 6 7.5–303. 7 (a) (1) The Council consists of the following members: 8 (i) One member of the Senate of Maryland, appointed by the 9 President of the Senate; 10 (ii) One member of the House of Delegates, appointed by the Speaker 11 of the House; 12 (iii) Five representatives of the Department, including: 13 1. The Secretary, or the Secretary’s designee; 14 2. The Deputy Secretary for Behavioral Health, or the 15 Deputy Secretary’s designee; 16 3. The [Director of the Behavioral Health Administration, or 17 the Director’s designee] DEPUTY SECRETARY FOR DEVELOPMENTAL DISABILITIES, 18 OR THE DEPUTY SECRETARY’S DESIGNEE; 19 4. The Executive Director of the Maryland Health Benefit 20 Exchange, or the Executive Director’s designee; and 21 5. The Deputy Secretary for Health Care Financing, or the 22 Deputy Secretary’s designee; 23 (iv) The Secretary of Aging, or the Secretary’s designee; 24 (v) The Secretary of Budget and Management, or the Secretary’s 25 designee; 26 (vi) The Secretary of Disabilities, or the Secretary’s designee; 27 (vii) The Secretary of Housing and Community Development, or the 28 Secretary’s designee; 29 SENATE BILL 212 3 (viii) The Secretary of Human Services, or the Secretary’s designee; 1 (ix) The Secretary of Juvenile Services, or the Secretary’s designee; 2 (x) The Secretary of Public Safety and Correctional Services, or the 3 Secretary’s designee; 4 (xi) The [Deputy Director of the Division of Children and Youth of 5 the Governor’s Office of Crime Prevention, Youth, and Victim Services, or the Deputy 6 Director’s designee] SECRETARY OF LABOR, OR THE SECRETARY’S DESIGNEE; 7 (xii) The Executive Director of the Governor’s Office of Crime 8 Prevention, Youth, and Victim Services, or the Executive Director’s designee; 9 (xiii) The Executive Director of the Governor’s Office of the Deaf and 10 Hard of Hearing, or the Executive Director’s designee; 11 (xiv) The Public Defender of Maryland, or the Public Defender’s 12 designee; 13 (xv) Two representatives of the State Superintendent of Schools, or 14 the Superintendent’s designee, and the Assistant State Superintendent of the Division of 15 Rehabilitation Services, or the Assistant State Superintendent’s designee; 16 (xvi) Two representatives of the Maryland Judiciary, a District Court 17 judge, and a circuit court judge, appointed by the Chief Justice of the Supreme Court of 18 Maryland; 19 (xvii) The [President of the Maryland Association of Core Service 20 Agencies, or the President’s designee] EXECUTIVE DIRECTOR OF THE MARYLAND 21 ASSOCIATION OF BEHAVIORAL HEALTH AUTHORITIES, OR THE EXECUTIVE 22 DIRECTOR’S DESIGNEE; 23 (xviii) The President of the Maryland Association of County Health 24 Officers, or the President’s designee; 25 (xix) Four representatives from county behavioral health advisory 26 councils, one from each region of the State; 27 (xx) One representative, appointed by the Secretary of Health, from 28 each of the following organizations: 29 1. Community Behavioral Health Association; 30 4 SENATE BILL 212 2. [Drug Policy and Public Health Strategies Clinic, 1 University of Maryland Carey School of Law] MARYLAND CENTER OF EXCELLENCE ON 2 PROBLEM GAMBLING; 3 3. Maryland Addictions Director’s Council; 4 4. Maryland Association for the Treatment of Opioid 5 Dependence; 6 5. Maryland Black Mental Health Alliance; 7 6. Maryland Coalition of Families; 8 7. [Maryland Disability Law Center] DISABILITY RIGHTS 9 MARYLAND; 10 8. Maryland Recovery Organization Connecting 11 Communities; 12 9. Mental Health Association of Maryland; 13 10. National Alliance on Mental Illness of Maryland; 14 11. National Council on Alcoholism and Drug Dependence of 15 Maryland; 16 12. On Our Own of Maryland; and 17 13. Maryland Association of Boards of Education; and 18 (xxi) Two individuals representing the mental health and substance 19 use disorder treatment community, appointed by the Governor from each of the following: 20 1. Academic or research professionals who are not State 21 employees; 22 2. Medical professionals; 23 3. Individuals formerly or currently in receipt of behavioral 24 health services; 25 4. Family members of individuals with mental health or 26 substance use disorders; 27 5. A parent of a young child with behavioral health disorders; 28 SENATE BILL 212 5 6. A youth with a behavioral health disorder who is between 1 the ages of 16 and 25 years; and 2 7. Individuals active in behavioral health issues within their 3 community. 4 (2) Additional representatives or individuals designated by the Council 5 shall be appointed by the Secretary. 6 (b) Members appointed by the Governor under subsection (a)(1)(xxi) of this 7 section shall be representative, to the extent practicable, of: 8 (1) Geographic regions of the State; 9 (2) At–risk populations; 10 (3) Ethnic, gender, across–the–lifespan, and cultural diversity; and 11 (4) Balanced representation from areas of mental health and substance use 12 disorders. 13 (c) The Council shall appoint a chair from among the membership of the Council. 14 (d) (1) Members appointed by the Governor under subsection (a)(1)(xxi) of this 15 section: 16 (i) Serve a [3–year] 4–YEAR term; 17 (ii) May serve for a maximum of two consecutive terms; 18 (iii) After at least 6 years have passed since serving, may be 19 reappointed for terms that comply with items (i) and (ii) of this paragraph; 20 (iv) At the end of a term, continue to serve until a successor is 21 appointed and qualifies; and 22 (v) If appointed after a term has begun, serve only for the rest of the 23 term and until a successor is appointed and qualifies. 24 (2) Ex officio members serve as long as the member holds the specified 25 office or designation. 26 (3) Notwithstanding any other provisions of this subsection, all members 27 serve at the pleasure of the Governor. 28 (e) With the consent of the Council, the chair may designate additional 29 individuals with relevant expertise to serve on a committee or task force. 30 6 SENATE BILL 212 SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 1 as follows: 2 Article – Health – General 3 7.5–305. 4 The Council shall: 5 (1) Promote and advocate for: 6 (i) Planning, policy, workforce development, and services to ensure 7 a coordinated, quality system of care that is outcome–guided and that integrates 8 prevention, recovery, evidence–based practices, and cost–effective strategies that enhance 9 behavioral health services across the State; and 10 (ii) A culturally competent and comprehensive approach to publicly 11 funded prevention, early intervention, treatment and recovery services that support and 12 foster wellness, recovery, resiliency, and health for individuals who have behavioral health 13 disorders and their family members; and 14 (2) Submit, IN COORDINATION WITH THE COMMISSION ON 15 BEHAVIORAL HEALTH CARE TREATMENT AND ACCESS, an annual report to the 16 Governor and, in accordance with § 2–1257 of the State Government Article, the General 17 Assembly on or before December 31 of each year. 18 13–4801. 19 (a) In this subtitle the following words have the meanings indicated. 20 (c) “Commission” means the Commission on Behavioral Health Care Treatment 21 and Access. 22 13–4802. 23 There is a Commission on Behavioral Health Care Treatment and Access, WHICH 24 SHALL MEET JOINTLY W ITH THE BEHAVIORAL HEALTH ADVISORY COUNCIL. 25 13–4803. 26 (f) The Commission shall meet at least three times per year at the times and 27 places determined JOINTLY by the Commission AND THE BEHAVIORAL HEALTH 28 ADVISORY COUNCIL. 29 13–4805. 30 SENATE BILL 212 7 The Commission shall: 1 (1) Conduct an assessment of behavioral health services in the State to 2 identify needs and gaps in services across the continuum, including community–based 3 outpatient and support services, crisis response, and inpatient care; 4 (2) Examine the methods for reimbursing behavioral health care services 5 in the State and make recommendations on the most effective forms of reimbursement to 6 maximize service delivery; 7 (3) Compile findings of State–specific needs assessments related to 8 behavioral health care services; 9 (4) Review recommendations and reports of State c ommissions, 10 workgroups, or task forces related to behavioral health care services; 11 (5) Conduct a needs assessment on the State’s behavioral health care 12 workforce to identify gaps and make recommendations to ensure an adequate, culturally 13 competent, and diverse workforce across the behavioral health care continuum; 14 (6) Review trends and best practices from other states regarding policy and 15 reimbursement strategies that support access to a comprehensive array of services and 16 ensure quality of care; 17 (7) Examine and make recommendations related to the behavioral health 18 of the geriatric and youth populations in the State; 19 (8) Examine and make recommendations to provide appropriate and 20 adequate behavioral health services to individuals with developmental disabilities and 21 complex behavioral health needs, specifically youth; 22 (9) Assess the health infrastructure, facilities, personnel, and services 23 available for the State’s forensic population and identify deficiencies in resources and 24 policies needed to prioritize health outcomes, increase public safety, and reduce recidivism; 25 (10) Make recommendations on expanding behavioral health treatment 26 access for the State’s court–ordered population; 27 (11) Make recommendations on action plans regarding the behavioral 28 health care system’s capacity to prepare for and respond to future challenges affecting the 29 entire State or particular regions or populations in the State, including pandemics and 30 extreme weather events; 31 (12) Make recommendations to ensure that behavioral health treatment is 32 provided in the appropriate setting, including methods to divert behavioral health patients 33 from emergency departments by using the Maryland Mental Health and Substance Use 34 8 SENATE BILL 212 Disorder Registry and Referral System established under § 7.5–802 of this article and 1 2–1–1; 2 (13) Examine and review the use of harm reduction strategies to facilitate 3 access to care; [and] 4 (14) Examine methods to assist consumers in accessing behavioral health 5 services; AND 6 (15) MAKE, IN COORD INATION WITH THE BEHAVIORAL HEALTH 7 ADVISORY COUNCIL, RECOMMENDATIONS REGA RDING THE CONTINUATION OF THE 8 STATE’S BEHAVIORAL HEALTH CARVE–OUT AND THE FINANCING STRUCT URE AND 9 QUALITY OVERSIGHT NE CESSARY TO INTEGRATE SOMATIC AND BEHAVIOR AL 10 HEALTH SERVICES AND ENSURE COMPLIANCE WIT H THE MENTAL HEALTH PARITY 11 AND ADDICTION EQUITY ACT IN THE MARYLAND MEDICAL ASSISTANCE PROGRAM. 12 13–4806. 13 (a) The Commission shall establish the following workgroups: 14 (1) Geriatric behavioral health; 15 (2) Youth behavioral health, individuals with developmental disabilities, 16 and individuals with complex behavioral health needs; 17 (3) Criminal justice–involved behavioral health; and 18 (4) Behavioral health workforce development, infrastructure, coordination, 19 and financing. 20 (b) The workgroups established under subsection (a) of this section shall meet at 21 least two times per year at the times and places determined by the workgroup. 22 (c) The workgroups established under subsection (a) of this section shall include 23 members of the Commission and may include individuals invited by the Commission OR 24 THE BEHAVIORAL HEALTH ADVISORY COUNCIL to serve on the workgroup. 25 (d) On or before [December] JULY 1 each year, beginning in [2023] 2024, the 26 workgroups established under subsection (a) of this section shall report and make 27 recommendations to the Commission AND THE BEHAVIORAL HEALTH ADVISORY 28 COUNCIL. 29 13–4807. 30 (a) (1) On or before January 1 each year, beginning in 2024, the Commission, 31 IN COORDINATION WITH THE BEHAVIORAL HEALTH ADVISORY COUNCIL, shall 32 SENATE BILL 212 9 report to the Governor and, in accordance with § 2–1257 of the State Government Article, 1 the General Assembly on the Commission’s findings and recommendations, including 2 funding and legislative recommendations, that are consistent with providing appropriate, 3 accessible, and comprehensive behavioral health services that are available on demand to 4 individuals in the State across the behavioral health continuum. 5 (2) Any legislative recommendations included in the report required under 6 paragraph (1) of this subsection that require funding shall include an estimate of the 7 funding required to implement the recommendation and information that supports the 8 funding estimate. 9 (b) The report required on or before January 1, 2024, shall include the findings of 10 the needs assessments required under § 13–4805 of this subtitle. 11 (C) THE REPORT REQUIRED O N ON OR BEFORE JANUARY 1, 2025, SHALL 12 INCLUDE JULY 1, 2025, THE COMMISSION, IN COORDINATION WITH THE 13 BEHAVIORAL HEALTH ADVISORY COUNCIL, SHALL REPORT TO THE GOVERNOR 14 AND, IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE 15 GENERAL ASSEMBLY ON THE COMMISSION’S FINDINGS AND RECOM MENDATIONS 16 REGARDING THE CONTINUATION OF THE STATE’S BEHAVIORAL HEALTH CARVE–OUT 17 AND THE FINANCING STRUCT URE AND QUALI TY OVERSIGHT NECESSA RY TO 18 INTEGRATE SOMATIC AN D BEHAVIORAL HEALTH CARE SERVICES IN THE MARYLAND 19 MEDICAL ASSISTANCE PROGRAM. 20 SECTION 3. AND BE IT FURTHER ENACTED, That it is the intent of the General 21 Assembly that the Maryland Department of Health shall: 22 (1) evaluate the Innovation in Behavioral Health Model announced by the 23 Centers for Medicare and Medicaid Services on January 18, 2024; and 24 (2) consider applying to the Centers for Medicare and Medicaid Services to 25 participate in the Innovation in Behavioral Health Model. 26 SECTION 3. 4. AND BE IT FURTHER ENACTED, That this Act shall take 27 effect July 1, 2024. Section 2 of this Act shall remain effective until the taking effect of the 28 termination provision specified in Section 8 of Chapters 290 and 291 of the Acts of the 29 General Assembly of 2023. If that termination provision takes effect, Section 2 of this Act, 30 with no further action required by the General Assembly, shall be abrogated and of no 31 further force and effect. Section 2 of this Act may not be interpreted to have any effect on 32 that termination provision. 33