Equal Treatment Maryland 2023 Post Session Report
Prior to the session the Maryland Behavioral Health Coalition launched Equal Treatment Maryland, a new campaign to ensure access to quality mental health and substance use care when and where needed. Campaign partners rallied successfully this year around the 2023 Behavioral Health Crisis Prevention Platform – a set of community-based reforms and workforce initiatives designed to improve behavioral health outcomes, save money, and keep people out of crisis.
Collaborative Care Model
Most people will never seek or receive behavioral health treatment from a specialty provider. Instead, most individuals with mild to moderate depression and anxiety first seek to address these concerns with their primary care provider, a situation that is increasingly common given an ongoing and persistent behavioral health workforce shortage.
Unfortunately, behavioral health treatment delivered in primary care settings is often suboptimal, with individuals poorly diagnosed and treated, or not identified at all.
The Collaborative Care Model (CoCM) helps. Validated in over 90 randomized controlled trials, CoCM is a patient-centered approach for integrating physical and behavioral health care in primary care settings. The model has been shown to improve health outcomes and save money, mostly via a reduction in unnecessary hospitalization and higher intensity levels of care.
SB 101/HB 48 (passed) will unleash the potential of this model in Maryland by expanding CoCM coverage to Medicaid recipients. Already covered by Medicare and commercial health insurers, this new service expansion will incentivize primary care practices to offer CoCM broadly across their patient populations, ensuring this best practice in care integration is equitably available to all citizens in need.
Certified Community Behavioral Health Clinics
Certified Community Behavioral Health Clinics (CCBHCs) are federally designated, proven models that provide a comprehensive range of outpatient mental health and substance use treatment, care coordination with other providers and services, and connection to other systems and supports. They are based on the federally qualified health center (FQHC) model, providing services regardless of insurance status or ability to pay.
States implementing the model broadly have seen increased access to care, reduced emergency department and inpatient utilization, a mitigation of behavioral health workforce challenges, higher engagement post discharge from hospitals, improved utilization of medication assisted treatment for opioid use disorders, and greater integration with physical care.
Maryland currently has very limited CCBHC coverage, with just a few programs funded by federal grants they applied for directly. These programs, however, are seeing similarly positive results. Sheppard Pratt’s CCBHC program, for example, has reduced hospital stays by nearly 50% and reduced the average per client emergency room visit cost by 80%. SB 362 (passed) will build on this momentum to expand Maryland’s network of CCBHCs. The bill requires the Maryland Department of Health (MDH) to apply for both a federal CCBHC planning grant in FY25 and for inclusion in the CCBHC demonstration program in FY26.
Behavioral Health Workforce Investment Fund
Maryland is battling a persistent and longstanding behavioral health workforce shortage. Federal data released earlier this year found that Maryland has 63 federally designated mental health professional shortage areas (HPSAs), including 11 entire counties. These shortage areas, in which less than 20 percent of residents are getting their mental health needs met, impact over 1.7 million Marylanders. Another indicator from the University of Wisconsin found that 17 of Maryland’s 24 jurisdictions come in below the national average (350:1) in terms of population to behavioral health providers.
There are many ideas and strategies for growing the behavioral health workforce – stipends and scholarships, enhanced training programs, loan repayment, paid internships – but it is not clear how much funding should be directed toward these different strategies nor how it should be targeted across the multitude of behavioral health professionals and paraprofessionals.
SB 283/HB 418 (passed) creates an infrastructure and a process to answer and act on these questions. The bill establishes a Behavioral Health Workforce Investment Fund to reimburse for costs associated with educating, training, certifying, recruiting, placing, and retaining behavioral health professionals and paraprofessionals. Funding is left discretionary initially to allow for a workforce needs assessment that will (1) determine the immediate, intermediate, and long-term unmet need and capacity of Maryland’s behavioral health workforce; (2) calculate the total number of behavioral health professionals and paraprofessionals needed over the next 5 years, 10 years, and 20 years; and (3) make specific findings and recommendations regarding the types of workforce assistance programs and funding necessary to meet the need across all sectors of the behavioral health workforce.
With the passage of each Equal Treatment Maryland 2023 Behavioral Health Crisis Prevention Platform priority, we have made great strides forward as a community to ensure all Marylanders have access to mental health and substance use care when and where needed. As implementation begins, we look forward to continuing this important work with advocates, providers, and consumers alike.
In addition to the Equal Treatment Maryland platform, members of the Maryland Behavioral Health Coalition successfully advocated for critically important legislation to support Marylanders in need of mental health and substance use care.
Maryland 9-8-8
SB 3/HB 271 allocates an additional $12M to the 988 Trust Fund in FY25 to ensure call centers have the resources they need to effectively handle the influx of new calls
Telehealth
SB 534 extends for two years certain time-limited provisions requiring Medicaid and commercial insurance coverage for audio-only telehealth and telehealth reimbursement for providers at the same rate as in-person services.
Value-Based Purchasing Pilot Program
SB 581 establishes a three-year pilot program to provide intensive care coordination using value-based purchasing (VBP) in the specialty behavioral health system. The pilot will serve at least 500 individuals whose behavioral health needs place them at risk of emergency department utilization or inpatient hospitalization.
Commission on Behavioral Health Care Treatment and Access
SB 582/HB 1148 establishes the 38-member Commission on Behavioral Health Care Treatment and Access to make recommendations to provide appropriate, accessible, and comprehensive behavioral health services that are available on demand to Marylanders across the behavioral health continuum.
Trans Health Equity Act
SB 460/HB 283 modernizes Maryland Medicaid’s coverage of gender affirming care. Introduced initially in 2022, it requires Medicaid to cover all medically necessary gender affirming care as prescribed by a licensed health care provider.
High Fidelity Wraparound
HB 322/SB 255 expands access to high fidelity wraparound, the gold standard for treating youth with behavioral health needs, in Maryland. It will increase reimbursement to encourage more provider participation, provide more access to families with commercial health insurance, and require a state review and recommendations for expanding eligibility, particularly as it relates to children and youth with substance use disorders.
Mental Health Advanced Directives
SB 154 requires the Department of Health to develop and implement a public awareness campaign to encourage the use of mental health advanced directives. It also requires the Behavioral Health Administration and the Maryland Health Care Commission (MHCC) to study how first responders and behavioral health crisis providers can best access the MHCC advanced directive database when responding to a behavioral health crisis. The results of this study will complement the continued expansion of 988 and other crisis related efforts.
Good Samaritan Immunity
SB 546/HB427 extends Good Samaritan immunity to protect the person experiencing the overdose from being sanctioned from parole and probation violations.
Jaelynn’s Law
SB 858 modifies firearm storage requirements and requires the Department of Health to develop a youth suicide prevention and firearm storage guide which must be posted on its website and made available to families, health and social services providers, and other interested entities.
Access to Mental Health in Institutions of Higher Education
SB 263/HB 573 establishes a committee to study and make recommendations regarding access to mental health services on higher education campuses, review best practices for accessing services, and identify the best models for providing services.