Maryland 2024 Regular Session

Maryland Senate Bill SB988 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	sb0988
6	6
7	7	SENATE BILL 988
8	8	J1 4lr3069
9	9
10	10	By: Senator Lam
11	11	Introduced and read first time: February 2, 2024
12	12	Assigned to: Finance
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Maryland Medical Assistance Program – Self–Directed Mental Health Services – 2
19	19	Pilot Program 3
20	20
21	21	FOR the purpose of establishing the Self–Directed Mental Health Services Pilot Program 4
22	22	in the Maryland Department of Health to facilitate access to certain self–directed 5
23	23	services in the most integrated setting appropriate for certain recipients of services 6
24	24	under the Maryland Medical Assistance Program; and generally relating to the 7
25	25	Self–Directed Mental Health Services Pilot Program. 8
26	26
27	27	BY adding to 9
28	28	Article – Health – General 10
29	29	Section 15–1201 through 15–1207 to be under the new subtitle “Subtitle 12. 11
30	30	Self–Directed Mental Health Services Pilot Program” 12
31	31	Annotated Code of Maryland 13
32	32	(2023 Replacement Volume) 14
33	33
34	34	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
35	35	That the Laws of Maryland read as follows: 16
36	36
37	37	Article – Health – General 17
38	38
39	39	SUBTITLE 12. SELF–DIRECTED MENTAL HEALTH SERVICES PILOT PROGRAM. 18
40	40
41	41	15–1201. 19
42	42
43	43	(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 20
44	44	INDICATED. 21
45	45
46	46	(B) (1) “INDIVIDUAL–DIRECTED GOODS AND S ERVICES” MEANS 22
47	47	SERVICES, EQUIPMENT, ACTIVITIES, OR SUPPLIES FOR INDI VIDUALS WHO 23 2 SENATE BILL 988
48	48
49	49
50	50	SELF–DIRECT SERVICES THAT : 1
51	51
52	52	(I) RELATE TO A NEED OR G OAL IDENTIFIED IN TH E 2
53	53	PERSON–CENTERED PLAN OF SER VICE; 3
54	54
55	55	(II) MAINTAIN OR INCREASE INDEPENDENCE ; 4
56	56
57	57	(III) PROMOTE OPPORTUNITIES FOR COMMUNITY LIVING AND 5
58	58	INCLUSION; AND 6
59	59
60	60	(IV) FACILITATE ACCESS TO CLINICALLY APPROPRIA TE, 7
61	61	CULTURALLY RESPONSIV E, PERSON–CENTERED CARE . 8
62	62
63	63	(2) “INDIVIDUAL–DIRECTED GOODS AND S ERVICES” INCLUDES ALL 9
64	64	GOODS OR SERVICES AUTHORIZED BY REGULA TIONS ADOPTED OR GUI DANCE 10
65	65	ISSUED BY THE FEDERA L CENTERS FOR MEDICARE AND MEDICAID SERVICES 11
66	66	UNDER § 1915 OF THE SOCIAL SECURITY ACT. 12
67	67
68	68	(C) “PARTICIPANT” MEANS AN INDIVIDUAL SELECTED BY THE 13
69	69	DEPARTMENT UNDER § 15–1204(B) OF THIS SUBTITLE TO PARTICIPATE IN TH E 14
70	70	PILOT PROGRAM. 15
71	71
72	72	(D) “PERSON–CENTERED PLAN OF SER VICE” MEANS A PLAN FOR SER VICES 16
73	73	AND SUPPORTS THAT: 17
74	74
75	75	(1) IS DEVELOPED WITH A F OCUS ON THE INDIVIDU AL HAVING 18
76	76	CONTROL OVER THE SER VICES AND SUPPORTS ; 19
77	77
78	78	(2) ENSURES THAT THE INDI VIDUAL IS THE PRIMARY CONTRI BUTOR 20
79	79	TO THE PLAN AND MAY RECEIVE SUPPORT FROM OTHER PERSONS SELECT ED BY THE 21
80	80	INDIVIDUAL IN DEVELO PING THE PLAN; 22
81	81
82	82	(3) IDENTIFIES AND ADDRES SES, TO THE EXTENT PRACTI CABLE: 23
83	83
84	84	(I) THE INDIVIDUAL ’S PREFERENCES AND IN TERESTS 24
85	85	RELATED TO AC HIEVING THE INDIVIDU AL’S DESIRED LIFESTYLE ; 25
86	86
87	87	(II) THE SUPPORTS REQUIRED TO ACHIEVE THE INDIV IDUAL’S 26
88	88	DESIRED LIFESTYLE THAT WILL BE PROVIDED IN A MANNER THAT ENABLES THE 27
89	89	INDIVIDUAL TO HAVE C ONTROL OVER THE INDI VIDUAL’S DAILY LIFE AND 28
90	90	MAINTAINS THE INDIVI DUAL’S HEALTH AND WELFARE ; 29
91	91
92	92	(III) THE SERVICES AND SUPP ORTS REQUIRED TO PRE VENT, 30 SENATE BILL 988 3
93	93
94	94
95	95	MITIGATE, AND MANAGE A MENTAL HEALTH, SUBSTANCE USE , OR SOMATIC HEALTH 1
96	96	CRISIS IN THE LEAST RESTRICTIVE SETTING APPROPRIATE TO AN IN DIVIDUAL’S 2
97	97	NEEDS, INCLUDING PAYMENT FO R PEER RESPITE , IN–HOME RESPITE , OR OTHER 3
98	98	COMMUNITY –BASED CRISIS SERVICE ; AND 4
99	99
100	100	(IV) THE SUPPORTS AND SERV ICES AN INDIVIDUAL M AY NEED 5
101	101	TO SUPPORT THE INDIVIDUAL’S DECISION MAKING IN T HE EVENT THE INDIVIDUAL 6
102	102	IS UNABLE TO MAKE OR CO MMUNICATE THE INDIVIDUAL’S OWN DECISIONS DUE TO 7
103	103	DISABILITY, SUCH AS COMPLETION O F SUPPORTED DECISION –MAKING 8
104	104	AGREEMENTS , PSYCHIATRIC ADVANCED DIRECTIVES, AND IDENTIF ICATION OF 9
105	105	NATURAL SUPPORTS ; AND 10
106	106
107	107	(4) ALIGNS SERVICES AND S UPPORTS TO ENSURE TH AT THE 11
108	108	INDIVIDUAL HAS ACCES S TO THE FULL BENEFI TS OF COMMUNITY LIVI NG IN A 12
109	109	MANNER THAT EMPHASIZ ES THE INDIVIDUAL ’S QUALITY OF LIFE, WELL–BEING, AND 13
110	110	INFORMED CHOICE . 14
111	111
112	112	(E) “PILOT PROGRAM” MEANS THE SELF–DIRECTED MENTAL HEALTH 15
113	113	SERVICES PILOT PROGRAM. 16
114	114
115	115	(F) (1) “SELF–DIRECTED SERVICES ” MEANS SERVICES : 17
116	116
117	117	(I) OVER WHICH PARTICIPANTS O R THEIR REPRESENTATI VES 18
118	118	HAVE DECISION –MAKING AUTHORITY ; 19
119	119
120	120	(II) FOR WHICH PARTICIPANT S OR THEIR REPRESENTATIVES 20
121	121	TAKE DIRECT RESPONSI BILITY FOR MANAGEMEN T OF THE SERVICES WI TH THE 21
122	122	ASSISTANCE OF AVAILA BLE SUPPORTS CHOSEN BY THE PARTICIPANT O R THE 22
123	123	PARTICIPANT’S REPRESENTATIVE ; AND 23
124	124
125	125	(III) THAT ARE PROVIDED IN A MANNER THAT : 24
126	126
127	127	1. FURTHERS THE RIGHT OF INDIVIDUALS TO MA KE 25
128	128	CHOICES ABOUT AND DI RECT ALL ASPECTS OF THEIR LIVES, INCLUDING BY 26
129	129	CHOOSING AND CONTROL LING THE DELIVERY OF MENTAL HEALTH AND 27
130	130	SUBSTANCE–RELATED SUPPORT SERV ICES, WHO PROVIDES THE SER VICES, AND 28
131	131	HOW SERVICES ARE PRO VIDED; AND 29
132	132
133	133	2. RECOGNIZES THAT ALL IN DIVIDUALS HAVE THE 30
134	134	CAPACITY TO MAKE CHO ICES AND MAY BE SUPP ORTED IN MAKING CHOI CES WHEN 31
135	135	GIVEN ADEQUATE SUPPO RT. 32
136	136
137	137	(2) “SELF–DIRECTED SERVICES ” INCLUDES SERVICES TH AT: 33 4 SENATE BILL 988
138	138
139	139
140	140
141	141	(I) PROVIDE AN INDIVIDUAL WITH: 1
142	142
143	143	1. THE DECISION –MAKING AUTHORITY TO RECRUIT, 2
144	144	HIRE, TRAIN, SUPERVISE, AND DISMISS SERVICE PROVIDERS AND VENDOR S WHO 3
145	145	PROVIDE THE INDIVIDUAL ’S SERVICES; AND 4
146	146
147	147	2. AUTHORITY OVER HOW FU NDS IN AN INDIVIDUAL ’S 5
148	148	SELF–DIRECTED SERVICES BUDGET ARE SPENT WIT HIN THE TOTAL APPROV ED 6
149	149	ANNUAL BUDGET ; 7
150	150
151	151	(II) MAXIMIZE THE OPPORTUN ITIES OF AN INDIVIDU AL TO LIVE 8
152	152	AS INDEPENDENTLY AS POSSIBLE IN THE MOST INCLUSIVE COMMUNITY –BASED 9
153	153	SETTING OF THE INDIV IDUAL’S CHOICE; 10
154	154
155	155	(III) EMPOWER AN INDIVIDUAL TO EXERCISE CHOICE A ND 11
156	156	CONTROL OVER NEEDED SERVICES AND SUPPORTS ; AND 12
157	157
158	158	(IV) HELP TO MAINTAIN AND IMPROVE THE INDIVIDU AL’S 13
159	159	HEALTH AND QUALITY O F LIFE IN THE INDIVIDUAL’S COMMUNITY . 14
160	160
161	161	(G) “SUPPORT BROKER ” MEANS A PERSON WHO W ORKS AT THE DIRECTIO N 15
162	162	OF AND FOR THE BENEF IT OF AN INDIVIDUAL WHO USES SELF–DIRECTED SERVICES , 16
163	163	INCLUDING BY ASSISTI NG THE INDIVIDUAL OR ANOTHER INDIVIDUAL C HOSEN BY 17
164	164	THE INDIVIDUAL WITH : 18
165	165
166	166	(1) MAKING INFORMED DECIS IONS IN ARRANGING FO R, DIRECTING, 19
167	167	AND MANAGING SERVICE S THE INDIVIDUAL REC EIVES, INCLUDING DECISIONS 20
168	168	RELATED TO PERSO NNEL REQUIREMENTS AN D RESOURCES NEEDED T O MEET THE 21
169	169	REQUIREMENTS ; 22
170	170
171	171	(2) ACCESSING AND MANAGIN G IDENTIFIED SUPPORT S AND 23
172	172	SERVICES FOR THE IND IVIDUAL; AND 24
173	173
174	174	(3) PERFORMING OTHER TASK S AS ASSIGNED BY THE INDIVIDUAL 25
175	175	AND AS AUTHORIZED BY THE DEPARTMENT . 26
176	176
177	177	15–1202. 27
178	178
179	179	THERE IS A SELF–DIRECTED MENTAL HEALTH SERVICES PILOT PROGRAM 28
180	180	IN THE DEPARTMENT . 29
181	181
182	182	15–1203. 30 SENATE BILL 988 5
183	183
184	184
185	185
186	186	THE PURPOSE OF THE PILOT PROGRAM IS TO FACILITATE ACCESS TO 1
187	187	CLINICALLY APPROPRIA TE, PERSON–CENTERED, CULTURALLY RESPONSIV E, AND 2
188	188	TRAUMA–INFORMED SELF–DIRECTED SERVICES IN THE MOST INTEGRATED SETTING 3
189	189	APPROPRIATE TO AN IN DIVIDUAL’S NEEDS. 4
190	190
191	191	15–1204. 5
192	192
193	193	(A) THE DEPARTMENT SHALL ADMI NISTER THE PILOT PROGRAM. 6
194	194
195	195	(B) (1) THE DEPARTMENT SHALL IDEN TIFY 100 ADULTS TO PARTICIPATE 7
196	196	IN THE PILOT PROGRAM: 8
197	197
198	198	(I) WHO ARE RECIPIENTS UNDER THE MARYLAND MEDICAL 9
199	199	ASSISTANCE PROGRAM; AND 10
200	200
201	201	(II) WHOSE BEHAVIORAL HEALTH NE EDS INDICATE THAT TH E 11
202	202	INDIVIDUAL MAY BENEFIT FROM RECEIVING SELF–DIRECTED SERVICES . 12
203	203
204	204	(2) WHEN SELECTING INDIVI DUALS TO PARTICIPATE IN THE PILOT 13
205	205	PROGRAM, THE DEPARTMENT SHALL GIVE PRIORITY TO INDIVIDU ALS: 14
206	206
207	207	(I) WHO HAVE BEEN EXCLUDE D FROM OR UNSUCCESSF UL IN 15
208	208	ASSERTIVE COMMUNITY TREATMENT OR OTHER SERVICES OFFERED IN THE PUBLIC 16
209	209	BEHAVIORAL HEALTH SY STEM; 17
210	210
211	211	(II) WITH MULTIPLE DISABIL ITIES; 18
212	212
213	213	(III) WITH SEVERE MENTAL ILLNESS WITH TRAUMA–RELATED 19
214	214	DISORDERS; 20
215	215
216	216	(IV) WHOSE CULTURAL NEEDS ARE UNSERVED IN THE PUBLIC 21
217	217	BEHAVIORAL HEALTH SYSTEM; OR 22
218	218
219	219	(V) AT RISK FOR INSTITUTI ONALIZATION. 23
220	220
221	221	(C) THE PILOT PROGRAM SHALL BE OPER ATIONAL FOR A 3–YEAR PERIOD. 24
222	222
223	223	(D) THE DEPARTMENT SHALL PROVIDE TO A PARTICIPANT: 25
224	224
225	225	(1) INDIVIDUAL–DIRECTED GOODS AND S ERVICES IN AN AMOUNT 26
226	226	BASED ON THE AVAILABILITY OF FUNDS AND THE RECIPIENT ’S NEEDS AS 27
227	227	CALCULATED ON AN ANN UAL BASIS, AND INCLUDED IN THE RECIPIENT’S 28 6 SENATE BILL 988
228	228
229	229
230	230	PERSON–CENTERED PLAN OF SERVICES, INCLUDING REIMBURSEM ENT FOR: 1
231	231
232	232	(I) CLINICAL MENTAL HEALT H SERVICES; 2
233	233
234	234	(II) MEDICATIONS AND MEDIC ATION CO–PAYS; 3
235	235
236	236	(III) AUXILIARY AIDS AND SE RVICES; 4
237	237
238	238	(IV) TRANSPORTATION ; 5
239	239
240	240	(V) VOCATIONAL TRAINING A ND SUPPORTS ; 6
241	241
242	242	(VI) TECHNOLOGY ; 7
243	243
244	244	(VII) GOODS AND SERVICES NE EDED TO ASSIST WITH MEAL 8
245	245	PREPARATION ; 9
246	246
247	247	(VIII) HOMEMAKER SERVICES ; 10
248	248
249	249	(IX) TENANCY–SUSTAINING SUPPORTS , INCLUDING RENTAL 11
250	250	ASSISTANCE; 12
251	251
252	252	(X) COMMUNITY–BASED CRISIS SUPPORT S, INCLUDING PEER 13
253	253	RESPITE, IN–HOME RESPITE , AND PERSONAL ASSISTANCE SERVICES; AND 14
254	254
255	255	(XI) CARE COORDINATION , PEER SUPPORT , AND ADVOCACY 15
256	256	SERVICES; 16
257	257
258	258	(2) A SUPPORT BROKER TO HELP THE PARTICIPANT: 17
259	259
260	260	(I) CREATE A PERSON–CENTERED PLAN ; 18
261	261
262	262	(II) IDENTIFY AND OBTAIN GOODS, SERVICES, AND SUPPORTS , 19
263	263	INCLUDING CASE MANAGEMENT AND FISCAL INTERMEDIARY SERVICES; AND 20
264	264
265	265	(III) OBTAIN PAYMENT FOR GOODS, SERVICES, AND SUPPORTS ; 21
266	266
267	267	(3) SUPPORT BROKER SERVIC ES THAT ARE AUTHORIZ ED BY THE 22
268	268	STATE AND SELECTED BY THE PARTICIPANT; 23
269	269
270	270	(4) A BUDGET FOR SELF –DIRECTED SERVICES TH AT PROVIDES THE 24
271	271	PARTICIPANT WITH THE ABILITY TO USE F UNDS FROM THE PARTICIPANT’S 25
272	272	APPROVED ANNUAL BUDG ET FOR THE PURPOSE O F FUNDING ALL SERVIC ES NEEDED 26 SENATE BILL 988 7
273	273
274	274
275	275	TO CREATE, MANAGE, AND IMPLEMENT A PART ICIPANT’S PERSON–CENTERED PLAN ; 1
276	276	AND 2
277	277
278	278	(5) FISCAL INTERMEDIARY AND ADMINISTRATIVE SUPPO RT. 3
279	279
280	280	(E) THE DEPARTMENT MAY NOT DETERMINE HO W A PARTICIPANT’S 4
281	281	BUDGET IS USED WITH RESPECT TO GOODS AND SERVICES THAT ARE: 5
282	282
283	283	(1) RELATED TO THE PERSON –CENTERED PLAN ; AND 6
284	284
285	285	(2) NECESSARY FOR THE HEA LTH AND SAFETY OF TH E PARTICIPANT. 7
286	286
287	287	(F) THE DEPARTMENT MAY NOT REQUIRE A PARTICIPANT TO 8
288	288	DEMONSTRATE COMPETEN CY OR COMPLIANCE WITH M ENTAL HEALTH TREATME NT 9
289	289	TO BE ELIGIBLE TO RECEI VE OR TO CONTINUE RE CEIVING SELF–DIRECTED 10
290	290	SERVICES. 11
291	291
292	292	(G) THE DEPARTMENT , IN CONSULTATION WITH STAKEHOLDERS , SHALL 12
293	293	ESTABLISH AND PROVID E TRAINING MATERIALS TO CORE SERVICE AGEN CIES AND 13
294	294	COMMUNITY PROVIDERS SPECIFICALLY ADDRESSING THE SELF –DIRECTED 14
295	295	SERVICES MODEL OF SE RVICES, INCLUDING ELIGIBILIT Y CRITERIA FOR 15
296	296	SELF–DIRECTED SERVICES , REFERRAL PROCEDURES , POLICIES, AND RESOURCES . 16
297	297
298	298	(H) AS PART OF THE PROCES S OF DEVELOPING A PE RSON–CENTERED PLAN 17
299	299	OF SERVICE FOR A PARTICIPANT, A COORDINATOR OF COM MUNITY SERVICES SHAL L 18
300	300	EDUCATE THE PARTICIPANT ON ALL MODELS OF SER VICE AVAILABLE TO THE 19
301	301	PARTICIPANT, INCLUDING SELF –DIRECTED SERVICES , TRADITIONAL SERVICES , 20
302	302	AND PROVIDER –MANAGED SERVICES , TO ASSIST THE PARTICIPANT IN MAKING AN 21
303	303	INFORMED CHOICE ON W HICH SERVICES THE PARTICIPANT WOULD LIKE TO 22
304	304	RECEIVE: 23
305	305
306	306	(1) WHEN THE PARTICIPAN T BEGINS RECEIVING SER VICES FROM A 24
307	307	COORDINATOR OF COMMU NITY SERVICES; AND 25
308	308
309	309	(2) AT LEAST ONCE EACH YE AR THAT THE PARTICIPANT IS 26
310	310	RECEIVING SERVICES F ROM A COORDINATOR OF COMMUNITY SERVICES . 27
311	311
312	312	(I) EACH COORDINATOR OF COMMU NITY SERVICES SHALL REPORT TO THE 28
313	313	DEPARTMENT , IN THE FORM AND MANN ER REQUIRED BY THE DEPARTMENT , THAT 29
314	314	THE COORDINATOR PROV IDED INFORMATION ON SELF–DIRECTED SERVICES , 30
315	315	TRADITIONAL SERVICES , AND PROVIDER –MANAGED SERVICES TO AN INDIVIDUAL IN 31
316	316	ACCORDANCE WITH THIS SECTION. 32
317	317	8 SENATE BILL 988
318	318
319	319
320	320	(J) THE DEPARTMENT SHALL: 1
321	321
322	322	(1) COLLECT OUTCOMES DATA ON PILOT PROGRAM PARTICIPANTS; 2
323	323
324	324	(2) COLLECT UTILIZATION D ATA ON PILOT PROGRAM 3
325	325	PARTICIPANTS; 4
326	326
327	327	(3) ASSESS THE EFFICACY OF SELF –DIRECTED SERVICES RE LATIVE 5
328	328	TO TRADITIONAL SERVI CES USING A MATCHED PAIRS ANALYSIS; 6
329	329
330	330	(4) ASSESS THE COST OF EX PANDING SELF –DIRECTED SERVICES TO 7
331	331	ALL INDIVIDUALS ELIG IBLE FOR SERVICES TH ROUGH THE MARYLAND MEDICAL 8
332	332	ASSISTANCE PROGRAM; AND 9
333	333
334	334	(5) IDENTIFY THE FEASIBIL ITY OF OBTAINING A MEDICAID WAIVER 10
335	335	TO SUPPORT FURTHER I MPLEMENTATION OF SEL F–DIRECTED MENTAL HEAL TH 11
336	336	SERVICES IN THE STATE. 12
337	337
338	338	15–1205. 13
339	339
340	340	THE DEPARTMENT SHALL APPL Y TO THE CENTERS FOR MEDICARE AND 14
341	341	MEDICAID SERVICES FOR ANY DEMONSTRATION OR OTH ER WAIVER OR AN 15
342	342	AMENDMENT TO A WAIVER OR THE STATE PLAN NECESSARY TO IMPLEME NT THE 16
343	343	PILOT PROGRAM. 17
344	344
345	345	15–1206. 18
346	346
347	347	FOR EACH OF FISCAL YE ARS 2026 THROUGH 2028, THE GOVERNOR SHALL 19
348	348	INCLUDE IN THE ANNUA L BUDGET BILL AN APP ROPRIATION OF $1,000,000 FOR THE 20
349	349	PILOT PROGRAM. 21
350	350
351	351	15–1207. 22
352	352
353	353	ON OR BEFORE NOVEMBER 1, 2028, THE DEPARTMENT SHALL REPO RT TO 23
354	354	THE GOVERNOR AND , IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 24
355	355	ARTICLE, THE GENERAL ASSEMBLY ON THE DEPARTMENT ’S FINDINGS AND 25
356	356	RECOMMENDATIONS FROM THE PILOT PROGRAM. 26
357	357
358	358	SECTION 2. AND BE IT FURTHER ENACTED, That this Act sh all take effect 27
359	359	October 1, 2024. It shall remain effective for a period of 4 years and 9 months, at the end of 28
360	360	June 30, 2029, this Act, with no further action required by the General Assembly, shall be 29
361	361	abrogated and of no further force and effect. 30