EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0988*
SENATE BILL 988
J1 4lr3069
By: Senator Lam
Introduced and read first time: February 2, 2024
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Maryland Medical Assistance Program – Self–Directed Mental Health Services – 2
Pilot Program 3
FOR the purpose of establishing the Self–Directed Mental Health Services Pilot Program 4
in the Maryland Department of Health to facilitate access to certain self–directed 5
services in the most integrated setting appropriate for certain recipients of services 6
under the Maryland Medical Assistance Program; and generally relating to the 7
Self–Directed Mental Health Services Pilot Program. 8
BY adding to 9
Article – Health – General 10
Section 15–1201 through 15–1207 to be under the new subtitle “Subtitle 12. 11
Self–Directed Mental Health Services Pilot Program” 12
Annotated Code of Maryland 13
(2023 Replacement Volume) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Health – General 17
SUBTITLE 12. SELF–DIRECTED MENTAL HEALTH SERVICES PILOT PROGRAM. 18
15–1201. 19
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 20
INDICATED. 21
(B) (1) “INDIVIDUAL–DIRECTED GOODS AND S ERVICES” MEANS 22
SERVICES, EQUIPMENT, ACTIVITIES, OR SUPPLIES FOR INDI VIDUALS WHO 23 2 SENATE BILL 988
SELF–DIRECT SERVICES THAT : 1
(I) RELATE TO A NEED OR G OAL IDENTIFIED IN TH E 2
PERSON–CENTERED PLAN OF SER VICE; 3
(II) MAINTAIN OR INCREASE INDEPENDENCE ; 4
(III) PROMOTE OPPORTUNITIES FOR COMMUNITY LIVING AND 5
INCLUSION; AND 6
(IV) FACILITATE ACCESS TO CLINICALLY APPROPRIA TE, 7
CULTURALLY RESPONSIV E, PERSON–CENTERED CARE . 8
(2) “INDIVIDUAL–DIRECTED GOODS AND S ERVICES” INCLUDES ALL 9
GOODS OR SERVICES AUTHORIZED BY REGULA TIONS ADOPTED OR GUI DANCE 10
ISSUED BY THE FEDERA L CENTERS FOR MEDICARE AND MEDICAID SERVICES 11
UNDER § 1915 OF THE SOCIAL SECURITY ACT. 12
(C) “PARTICIPANT” MEANS AN INDIVIDUAL SELECTED BY THE 13
DEPARTMENT UNDER § 15–1204(B) OF THIS SUBTITLE TO PARTICIPATE IN TH E 14
PILOT PROGRAM. 15
(D) “PERSON–CENTERED PLAN OF SER VICE” MEANS A PLAN FOR SER VICES 16
AND SUPPORTS THAT: 17
(1) IS DEVELOPED WITH A F OCUS ON THE INDIVIDU AL HAVING 18
CONTROL OVER THE SER VICES AND SUPPORTS ; 19
(2) ENSURES THAT THE INDI VIDUAL IS THE PRIMARY CONTRI BUTOR 20
TO THE PLAN AND MAY RECEIVE SUPPORT FROM OTHER PERSONS SELECT ED BY THE 21
INDIVIDUAL IN DEVELO PING THE PLAN; 22
(3) IDENTIFIES AND ADDRES SES, TO THE EXTENT PRACTI CABLE: 23
(I) THE INDIVIDUAL ’S PREFERENCES AND IN TERESTS 24
RELATED TO AC HIEVING THE INDIVIDU AL’S DESIRED LIFESTYLE ; 25
(II) THE SUPPORTS REQUIRED TO ACHIEVE THE INDIV IDUAL’S 26
DESIRED LIFESTYLE THAT WILL BE PROVIDED IN A MANNER THAT ENABLES THE 27
INDIVIDUAL TO HAVE C ONTROL OVER THE INDI VIDUAL’S DAILY LIFE AND 28
MAINTAINS THE INDIVI DUAL’S HEALTH AND WELFARE ; 29
(III) THE SERVICES AND SUPP ORTS REQUIRED TO PRE VENT, 30 SENATE BILL 988 3
MITIGATE, AND MANAGE A MENTAL HEALTH, SUBSTANCE USE , OR SOMATIC HEALTH 1
CRISIS IN THE LEAST RESTRICTIVE SETTING APPROPRIATE TO AN IN DIVIDUAL’S 2
NEEDS, INCLUDING PAYMENT FO R PEER RESPITE , IN–HOME RESPITE , OR OTHER 3
COMMUNITY –BASED CRISIS SERVICE ; AND 4
(IV) THE SUPPORTS AND SERV ICES AN INDIVIDUAL M AY NEED 5
TO SUPPORT THE INDIVIDUAL’S DECISION MAKING IN T HE EVENT THE INDIVIDUAL 6
IS UNABLE TO MAKE OR CO MMUNICATE THE INDIVIDUAL’S OWN DECISIONS DUE TO 7
DISABILITY, SUCH AS COMPLETION O F SUPPORTED DECISION –MAKING 8
AGREEMENTS , PSYCHIATRIC ADVANCED DIRECTIVES, AND IDENTIF ICATION OF 9
NATURAL SUPPORTS ; AND 10
(4) ALIGNS SERVICES AND S UPPORTS TO ENSURE TH AT THE 11
INDIVIDUAL HAS ACCES S TO THE FULL BENEFI TS OF COMMUNITY LIVI NG IN A 12
MANNER THAT EMPHASIZ ES THE INDIVIDUAL ’S QUALITY OF LIFE, WELL–BEING, AND 13
INFORMED CHOICE . 14
(E) “PILOT PROGRAM” MEANS THE SELF–DIRECTED MENTAL HEALTH 15
SERVICES PILOT PROGRAM. 16
(F) (1) “SELF–DIRECTED SERVICES ” MEANS SERVICES : 17
(I) OVER WHICH PARTICIPANTS O R THEIR REPRESENTATI VES 18
HAVE DECISION –MAKING AUTHORITY ; 19
(II) FOR WHICH PARTICIPANT S OR THEIR REPRESENTATIVES 20
TAKE DIRECT RESPONSI BILITY FOR MANAGEMEN T OF THE SERVICES WI TH THE 21
ASSISTANCE OF AVAILA BLE SUPPORTS CHOSEN BY THE PARTICIPANT O R THE 22
PARTICIPANT’S REPRESENTATIVE ; AND 23
(III) THAT ARE PROVIDED IN A MANNER THAT : 24
1. FURTHERS THE RIGHT OF INDIVIDUALS TO MA KE 25
CHOICES ABOUT AND DI RECT ALL ASPECTS OF THEIR LIVES, INCLUDING BY 26
CHOOSING AND CONTROL LING THE DELIVERY OF MENTAL HEALTH AND 27
SUBSTANCE–RELATED SUPPORT SERV ICES, WHO PROVIDES THE SER VICES, AND 28
HOW SERVICES ARE PRO VIDED; AND 29
2. RECOGNIZES THAT ALL IN DIVIDUALS HAVE THE 30
CAPACITY TO MAKE CHO ICES AND MAY BE SUPP ORTED IN MAKING CHOI CES WHEN 31
GIVEN ADEQUATE SUPPO RT. 32
(2) “SELF–DIRECTED SERVICES ” INCLUDES SERVICES TH AT: 33 4 SENATE BILL 988
(I) PROVIDE AN INDIVIDUAL WITH: 1
1. THE DECISION –MAKING AUTHORITY TO RECRUIT, 2
HIRE, TRAIN, SUPERVISE, AND DISMISS SERVICE PROVIDERS AND VENDOR S WHO 3
PROVIDE THE INDIVIDUAL ’S SERVICES; AND 4
2. AUTHORITY OVER HOW FU NDS IN AN INDIVIDUAL ’S 5
SELF–DIRECTED SERVICES BUDGET ARE SPENT WIT HIN THE TOTAL APPROV ED 6
ANNUAL BUDGET ; 7
(II) MAXIMIZE THE OPPORTUN ITIES OF AN INDIVIDU AL TO LIVE 8
AS INDEPENDENTLY AS POSSIBLE IN THE MOST INCLUSIVE COMMUNITY –BASED 9
SETTING OF THE INDIV IDUAL’S CHOICE; 10
(III) EMPOWER AN INDIVIDUAL TO EXERCISE CHOICE A ND 11
CONTROL OVER NEEDED SERVICES AND SUPPORTS ; AND 12
(IV) HELP TO MAINTAIN AND IMPROVE THE INDIVIDU AL’S 13
HEALTH AND QUALITY O F LIFE IN THE INDIVIDUAL’S COMMUNITY . 14
(G) “SUPPORT BROKER ” MEANS A PERSON WHO W ORKS AT THE DIRECTIO N 15
OF AND FOR THE BENEF IT OF AN INDIVIDUAL WHO USES SELF–DIRECTED SERVICES , 16
INCLUDING BY ASSISTI NG THE INDIVIDUAL OR ANOTHER INDIVIDUAL C HOSEN BY 17
THE INDIVIDUAL WITH : 18
(1) MAKING INFORMED DECIS IONS IN ARRANGING FO R, DIRECTING, 19
AND MANAGING SERVICE S THE INDIVIDUAL REC EIVES, INCLUDING DECISIONS 20
RELATED TO PERSO NNEL REQUIREMENTS AN D RESOURCES NEEDED T O MEET THE 21
REQUIREMENTS ; 22
(2) ACCESSING AND MANAGIN G IDENTIFIED SUPPORT S AND 23
SERVICES FOR THE IND IVIDUAL; AND 24
(3) PERFORMING OTHER TASK S AS ASSIGNED BY THE INDIVIDUAL 25
AND AS AUTHORIZED BY THE DEPARTMENT . 26
15–1202. 27
THERE IS A SELF–DIRECTED MENTAL HEALTH SERVICES PILOT PROGRAM 28
IN THE DEPARTMENT . 29
15–1203. 30 SENATE BILL 988 5
THE PURPOSE OF THE PILOT PROGRAM IS TO FACILITATE ACCESS TO 1
CLINICALLY APPROPRIA TE, PERSON–CENTERED, CULTURALLY RESPONSIV E, AND 2
TRAUMA–INFORMED SELF–DIRECTED SERVICES IN THE MOST INTEGRATED SETTING 3
APPROPRIATE TO AN IN DIVIDUAL’S NEEDS. 4
15–1204. 5
(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM. 6
(B) (1) THE DEPARTMENT SHALL IDEN TIFY 100 ADULTS TO PARTICIPATE 7
IN THE PILOT PROGRAM: 8
(I) WHO ARE RECIPIENTS UNDER THE MARYLAND MEDICAL 9
ASSISTANCE PROGRAM; AND 10
(II) WHOSE BEHAVIORAL HEALTH NE EDS INDICATE THAT TH E 11
INDIVIDUAL MAY BENEFIT FROM RECEIVING SELF–DIRECTED SERVICES . 12
(2) WHEN SELECTING INDIVI DUALS TO PARTICIPATE IN THE PILOT 13
PROGRAM, THE DEPARTMENT SHALL GIVE PRIORITY TO INDIVIDU ALS: 14
(I) WHO HAVE BEEN EXCLUDE D FROM OR UNSUCCESSF UL IN 15
ASSERTIVE COMMUNITY TREATMENT OR OTHER SERVICES OFFERED IN THE PUBLIC 16
BEHAVIORAL HEALTH SY STEM; 17
(II) WITH MULTIPLE DISABIL ITIES; 18
(III) WITH SEVERE MENTAL ILLNESS WITH TRAUMA–RELATED 19
DISORDERS; 20
(IV) WHOSE CULTURAL NEEDS ARE UNSERVED IN THE PUBLIC 21
BEHAVIORAL HEALTH SYSTEM; OR 22
(V) AT RISK FOR INSTITUTI ONALIZATION. 23
(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD. 24
(D) THE DEPARTMENT SHALL PROVIDE TO A PARTICIPANT: 25
(1) INDIVIDUAL–DIRECTED GOODS AND S ERVICES IN AN AMOUNT 26
BASED ON THE AVAILABILITY OF FUNDS AND THE RECIPIENT ’S NEEDS AS 27
CALCULATED ON AN ANN UAL BASIS, AND INCLUDED IN THE RECIPIENT’S 28 6 SENATE BILL 988
PERSON–CENTERED PLAN OF SERVICES, INCLUDING REIMBURSEM ENT FOR: 1
(I) CLINICAL MENTAL HEALT H SERVICES; 2
(II) MEDICATIONS AND MEDIC ATION CO–PAYS; 3
(III) AUXILIARY AIDS AND SE RVICES; 4
(IV) TRANSPORTATION ; 5
(V) VOCATIONAL TRAINING A ND SUPPORTS ; 6
(VI) TECHNOLOGY ; 7
(VII) GOODS AND SERVICES NE EDED TO ASSIST WITH MEAL 8
PREPARATION ; 9
(VIII) HOMEMAKER SERVICES ; 10
(IX) TENANCY–SUSTAINING SUPPORTS , INCLUDING RENTAL 11
ASSISTANCE; 12
(X) COMMUNITY–BASED CRISIS SUPPORT S, INCLUDING PEER 13
RESPITE, IN–HOME RESPITE , AND PERSONAL ASSISTANCE SERVICES; AND 14
(XI) CARE COORDINATION , PEER SUPPORT , AND ADVOCACY 15
SERVICES; 16
(2) A SUPPORT BROKER TO HELP THE PARTICIPANT: 17
(I) CREATE A PERSON–CENTERED PLAN ; 18
(II) IDENTIFY AND OBTAIN GOODS, SERVICES, AND SUPPORTS , 19
INCLUDING CASE MANAGEMENT AND FISCAL INTERMEDIARY SERVICES; AND 20
(III) OBTAIN PAYMENT FOR GOODS, SERVICES, AND SUPPORTS ; 21
(3) SUPPORT BROKER SERVIC ES THAT ARE AUTHORIZ ED BY THE 22
STATE AND SELECTED BY THE PARTICIPANT; 23
(4) A BUDGET FOR SELF –DIRECTED SERVICES TH AT PROVIDES THE 24
PARTICIPANT WITH THE ABILITY TO USE F UNDS FROM THE PARTICIPANT’S 25
APPROVED ANNUAL BUDG ET FOR THE PURPOSE O F FUNDING ALL SERVIC ES NEEDED 26 SENATE BILL 988 7
TO CREATE, MANAGE, AND IMPLEMENT A PART ICIPANT’S PERSON–CENTERED PLAN ; 1
AND 2
(5) FISCAL INTERMEDIARY AND ADMINISTRATIVE SUPPO RT. 3
(E) THE DEPARTMENT MAY NOT DETERMINE HO W A PARTICIPANT’S 4
BUDGET IS USED WITH RESPECT TO GOODS AND SERVICES THAT ARE: 5
(1) RELATED TO THE PERSON –CENTERED PLAN ; AND 6
(2) NECESSARY FOR THE HEA LTH AND SAFETY OF TH E PARTICIPANT. 7
(F) THE DEPARTMENT MAY NOT REQUIRE A PARTICIPANT TO 8
DEMONSTRATE COMPETEN CY OR COMPLIANCE WITH M ENTAL HEALTH TREATME NT 9
TO BE ELIGIBLE TO RECEI VE OR TO CONTINUE RE CEIVING SELF–DIRECTED 10
SERVICES. 11
(G) THE DEPARTMENT , IN CONSULTATION WITH STAKEHOLDERS , SHALL 12
ESTABLISH AND PROVID E TRAINING MATERIALS TO CORE SERVICE AGEN CIES AND 13
COMMUNITY PROVIDERS SPECIFICALLY ADDRESSING THE SELF –DIRECTED 14
SERVICES MODEL OF SE RVICES, INCLUDING ELIGIBILIT Y CRITERIA FOR 15
SELF–DIRECTED SERVICES , REFERRAL PROCEDURES , POLICIES, AND RESOURCES . 16
(H) AS PART OF THE PROCES S OF DEVELOPING A PE RSON–CENTERED PLAN 17
OF SERVICE FOR A PARTICIPANT, A COORDINATOR OF COM MUNITY SERVICES SHAL L 18
EDUCATE THE PARTICIPANT ON ALL MODELS OF SER VICE AVAILABLE TO THE 19
PARTICIPANT, INCLUDING SELF –DIRECTED SERVICES , TRADITIONAL SERVICES , 20
AND PROVIDER –MANAGED SERVICES , TO ASSIST THE PARTICIPANT IN MAKING AN 21
INFORMED CHOICE ON W HICH SERVICES THE PARTICIPANT WOULD LIKE TO 22
RECEIVE: 23
(1) WHEN THE PARTICIPAN T BEGINS RECEIVING SER VICES FROM A 24
COORDINATOR OF COMMU NITY SERVICES; AND 25
(2) AT LEAST ONCE EACH YE AR THAT THE PARTICIPANT IS 26
RECEIVING SERVICES F ROM A COORDINATOR OF COMMUNITY SERVICES . 27
(I) EACH COORDINATOR OF COMMU NITY SERVICES SHALL REPORT TO THE 28
DEPARTMENT , IN THE FORM AND MANN ER REQUIRED BY THE DEPARTMENT , THAT 29
THE COORDINATOR PROV IDED INFORMATION ON SELF–DIRECTED SERVICES , 30
TRADITIONAL SERVICES , AND PROVIDER –MANAGED SERVICES TO AN INDIVIDUAL IN 31
ACCORDANCE WITH THIS SECTION. 32
8 SENATE BILL 988
(J) THE DEPARTMENT SHALL: 1
(1) COLLECT OUTCOMES DATA ON PILOT PROGRAM PARTICIPANTS; 2
(2) COLLECT UTILIZATION D ATA ON PILOT PROGRAM 3
PARTICIPANTS; 4
(3) ASSESS THE EFFICACY OF SELF –DIRECTED SERVICES RE LATIVE 5
TO TRADITIONAL SERVI CES USING A MATCHED PAIRS ANALYSIS; 6
(4) ASSESS THE COST OF EX PANDING SELF –DIRECTED SERVICES TO 7
ALL INDIVIDUALS ELIG IBLE FOR SERVICES TH ROUGH THE MARYLAND MEDICAL 8
ASSISTANCE PROGRAM; AND 9
(5) IDENTIFY THE FEASIBIL ITY OF OBTAINING A MEDICAID WAIVER 10
TO SUPPORT FURTHER I MPLEMENTATION OF SEL F–DIRECTED MENTAL HEAL TH 11
SERVICES IN THE STATE. 12
15–1205. 13
THE DEPARTMENT SHALL APPL Y TO THE CENTERS FOR MEDICARE AND 14
MEDICAID SERVICES FOR ANY DEMONSTRATION OR OTH ER WAIVER OR AN 15
AMENDMENT TO A WAIVER OR THE STATE PLAN NECESSARY TO IMPLEME NT THE 16
PILOT PROGRAM. 17
15–1206. 18
FOR EACH OF FISCAL YE ARS 2026 THROUGH 2028, THE GOVERNOR SHALL 19
INCLUDE IN THE ANNUA L BUDGET BILL AN APP ROPRIATION OF $1,000,000 FOR THE 20
PILOT PROGRAM. 21
15–1207. 22
ON OR BEFORE NOVEMBER 1, 2028, THE DEPARTMENT SHALL REPO RT TO 23
THE GOVERNOR AND , IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 24
ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND 25
RECOMMENDATIONS FROM THE PILOT PROGRAM. 26
SECTION 2. AND BE IT FURTHER ENACTED, That this Act sh all take effect 27
October 1, 2024. It shall remain effective for a period of 4 years and 9 months, at the end of 28
June 30, 2029, this Act, with no further action required by the General Assembly, shall be 29
abrogated and of no further force and effect. 30