A Summary of this Year

A Summary of this Year's Legislative Activities

By Steven R. Daviss, M.D.

[Summer 2000; Vol. 27, No. 1; Pg 10-11, 16]

The Maryland General Assembly (MGA), session was very busy this year and many health-related bills were heard. The Legislative Committee met every two weeks during the 90-day session and had the critical help of Carol Allen-- who tirelessly checked the MGA website every day and kept our roster up to date-- and Jennifer Gajewski. Franklin Goldstein, our lobbyist, helped us target messages effectively and lobbied for our interests.

We looked at several hundred bills and took positions on 29. The legislature voted in “our” direction on 23 of the 29 bills (79%), while only 6 were in the direction opposite from our position. We supported 18 bills, of which 13 (72%) passed. We opposed 11 bills, and all but one failed to pass. See the table below for a listing of those bills. You can also get the full text of bills from the MGA website at http://www.mlis.state.md.us.

Note that 7 of the bills affected managed care, while many of the other bills we took positions on also affected our patients’ ability to freely access and receive health care. As a committee, we choose to take positions on bills which affect the quality of medical care provided to Marylanders, discriminate against those with brain-based illnesses, and protect the private and confidential relationship that exists between a physician and her patient.

BILL TITLE	EFFECT OF BILL	NOTES
MPS-SUPPORTED BILLS WHICH PASSED = 13
HB5 HMO—Responsibility for & Regulation of Downstream Risk Assumption Contracts-Member & Provider Protection	Defines administrative costs vs. cost of care. Holds Insurance company responsible if carve-out fails or goes bankrupt (eg, Doctor’s Health)	This bill was at the request of the provider coalition. Chapter 323 Effective June 1, 2000
HB59 Health Ins.—Adverse Decisions—Notification Requirements	Tightened Appeals & Grievances code to include more information.	Passed. Insurance Commissioner really means business. Chapter 329 Effective October 1, 2000
HB101 MD Domestic Violence Unit Fund	Provides fund to help counties develop domestic violence units and to keep track of ex parte and protective orders.	Passed. Chapter 572 Effective October 1, 2000
HB304/SB275 Health Insurance —Preauthorized Health Care Services—Denials of Reimbursements By Carriers	Prevents carrier from denying reimbursement for previously approved services, except under certain conditions.	Thank you Delegate Donoghue. Chapter 355Effective June 1, 2000
HB405/ SB164 Health Insurance —Internal Appeal & Grievance Processes	Strengthened Appeals & Grievances process.	A WIN for our patients! Chapter 371Various Effective Dates
HB559/SB295 Health Insurance —Requirements for Providers to Serve on Provider Panels	“No Cramdown Bill.” Prohibits carriers from forcing participating providers to accept all of that carrier’s insurance products.	Protects patients and providers from certain types of managed care strong arm tactics. Chapter 254 Effective October 1, 2000
HB1016 Health Insurance —Discrimination—Specified Diseases or Diagnoses	Prohibits carriers from making benefits for treatment of a specified disease or diagnosis subject to different co-payment amounts, coinsurance, deductibles, or specified maximum limits than those that apply to all other diseases or diagnoses unless otherwise provided by law.	Passed with amendments. Hopefully we can expand from this to fully eliminate discrimination against those who have mental illness. Chapter 449 Effective October 1, 2000
HB1205/SB743 Substance Abuse Treatment Outcomes Partnership	Creates fund to help pay for drug treatment.	Passed. Chapter 675Effective October 1, 2000
SB189/HB138 MD Health Care Commission—Modifications and Clarifications	Repealed authority of Md. Health Care Commission to develop health care payment system, and instead had it publish practitioner charges.	Passed. Chapter 64 Effective July 1, 2000
SB274/HB305 Health Insurance-Retroactive Denial of Reimbursement to Health Care Provider	Clarified that carriers may retroactively deny payments already made only under certain circumstances.	Passed. Chapter 248 Effective October 1, 2000

MPS-SUPPORTED BILLS WHICH PASSED continued
SB371 Medical Records—Confidentiality	Added some confidentiality protections, including preventing process notes from being discovered, under certain circumstances.	Passed. See prior articles for details. Chapter 270Effective July 1, 2000
SB405 HMOs—Subscribers and Enrollees—Private Contracts for Health Care Services	Requires HMOs to reimburse non-participating providers under certain conditions. Allows for private contracting.	House version (HB365) was withdrawn. Senate version passed. Chapter 275 Effective October 1, 2000
SB742/HB694 Advisory Council on Attention Deficit Hyperactivity Disorder	Established an advisory council	Passed. Chapter 84 Effective July 1, 2000
MPS-SUPPORTED BILLS WHICH DID NOT PASS = 5
HB3 Health Ins. For All Marylanders Act	Creates new single-payer system for Md. Grassroots effort which hopes to pass after a few more attempts.	Passed with amendments in House!Failed in Senate Finance Committee
HB858 Voluntary Admission To Mental Health Facilities—Applications by Health Care Agents	Allowed substituted consent for psych hospitalization.	Amendments sponsored by Morhaim were referred to interim study; expect action next session. NAMI support.
HB862/SB421 Criminal Injuries Compensation—Counseling for Family Members—Motor Vehicle	Allowed family members living with certain victims to receive compensation for mental health counseling.	HB862 Passed House – died in Judicial Proceedings Committee. SB 421 Failed in Judicial Proceedings Committee.
SB372 Practice of Medicine—Definition [Hollinger]	Made “determination of medical necessity” part of the practice of medicine. Would have allowed BPQA sanction against reviewers and required Md. licensure.	Passed Senate; Killed in House Environmental Matters Committee 13-6 MedChi & MPS pushed hard for this one. Killed in this committee last year also. Let those who voted against it know of your dissatisfaction.
SB485 Health Ins.—Patient Rights—The No More Run Around Act of 2000 [Della]	Required carriers to reimburse participating providers who render care which is within the provider's lawful scope of practice.	A feel-good bill with no chance of passing as it guts managed care in one paragraph.
MPS-OPPOSED BILLS WHICH PASSED = 1
HB886/SB693 Maryland Social Workers Act—Revision [Hollinger]	Relaxed education and supervision requirements; allowed therapy at lower levels of education; removed the restriction against the practice of medicine. Amendments addressed most of these concerns except practice of medicine (e.g., “medical psychotherapy”).	Passed House with amendments. Board of SW tried to sell this as merely a housekeeping bill, but original bill had significant scope of practice expansion. A number of MPS physicians went to Annapolis to testify in opposition. Chapter 554 Effective October 1, 2000

MPS-OPPOSED BILLS WHICH DID NOT PASS = 12
HB82/SB29 Alcohol/Drug Abuse—Prevention, Treatment, & Rehab Programs—Demonstration Of Need Prior to Approval or Certification	“Not-In-My-Backyard” bill, that would make it harder for new treatment programs to open.	Failed in committee
HB297 Health Ins.—Small Group Market—Modifications	Removed some parity provisions from sole proprietor insurance policies.	Bill Legat caught this one.
HB367/SB325 HMO—Pt. Access to Choice of Provider	Allowed Nurse Practitioners to be designated the “Primary Care Provider”.	Died in House Environmental Matters Committee without a vote.
HB746 Mental Hygiene—Involuntary Adm. & Emergency Evaluation—Clinical Social Worker	Allowed patients to be hospitalized involuntarily after being evaluated by a clinical social worker and 1 physician. Also allowed patients to be taken to the ER on Emergency Petition by an LCSW only.	Killed in House Environmental Matters Committee
HB943/SB9 Managed Care Entities—Health Care Treatment Decisions—Liability	Established liability regarding the making of health care treatment decisions, but did so in such a way as to be meaningless in many circumstances.	Failed Economic Matters Committee.We supported the bill only with proposed amendments, which did not pass.
HB969 Health Ins.—Mental Health Treatment—Authorization Procedures [Klausmeier]	Intent was to make it easier to get authorizations for treatment. As written, however, it made the insurance co. the gatekeeper, so that pt. choice of provider was removed (had to use central number for referral, as opposed to the full directory of providers).	Withdrawn by the sponsor
HB1101/SB822 Nurse Psychotherapists—Authority To Prescribe Medications in Pro Bono Programs not adequately served by Physician Volunteers	Authorized master’s level non-nurse practitioners with advanced training in psychotherapy to prescribe psychotropic medications in free clinics with volunteer staff.	Senate EEA comm. did not vote on it (Hollinger is vice-chair of this comm.)House ENV comm. killed it 19-2.APA, SMPS, Med-Chi, MPS, and BPQA all testified against this bill. The executive director of the Pro Bono Counseling Project testified in support of this bill; we later learned that authorization from the PBCP board of directors for such testimony was never sought. The President of Pro Bono is also the President of the Md. chapter of psychiatric nurses.
HB1207 Hospital Or Related Insitutions—Staff—Licensed Certified Social Workers—Clinical	Required hospitals to grant clinical privileges to LCSWs.	Died in House Environmental Matters Committee – no vote taken
HB1313 Workers’ Comp.-Permanent Impairment-Behavioral or Mental Disorder	Required that Workers’ Comp claim involving mental illness could only be evaluated by a psychologist.	Killed in House Environmental Matters Committee
SB337 Sexually Violent Predators	Required extended institutionalization in treatment facility after release from jail until individual is considered safe. No requirement of treatment while still incarcerated.	Unfavorable report by Judicial Proceedings Committee