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					Mental Health Association (MHA)                                         (301) 424-0656
Serving Montgomery County, Maryland                                      Volume 9, Issue 2


 Access to the Public Mental Health System
 Integrated and Coordinated Early Childhood and School-Based Mental Health Services
 Juvenile Justice System Reform
 Affordable Alternative Housing Options for People with Mental Illness
 Subscription Information & Action Alert information

National Status Report
Legislative Update

      HR 1424 The Paul Wellstone Mental Health and Addictions Equity Act: The bill passed on
       March 5 by 268-148 votes. The bill requires group health insurance plans to offer benefits for
       mental health and addiction on the same terms as medical and surgical coverage. The group
       health care plans currently charge higher out-of-pocket fees with limited and restricted mental
       health care services.
      The President’s proposed budget for fiscal year 2009 continues its effort to rein in federal
       Medicaid spending. The budget would cut $1.7 billion in fiscal year 2009 and $17.4 billion over
       five years from a range of legislative initiatives. If approved by Congress, the cuts would affect
       vital services to numerous low-income beneficiaries, including people with mental illnesses, who
       rely on this federal safety net for health and mental health care. Among the proposal is reducing
       the federal contribution toward the cost of targeted case management for Medicaid recipients,
       including those with serious mental disorders. This is accomplished by shifting payment for case
       management from the service-matching rate to the administrative rate (50 percent). This move is
       projected to save the federal government $200 million in fiscal year 2009, and $1.1 billion over 5
       years. (
      U.S. Senators Benjamin L. Cardin and Barbara A. Mikulski (both D-MD) have co-sponsored
       legislation designed to ensure that Maryland and other states receive proper reimbursement from
       the federal government for medical and social services provided to children and families with
       complex health-care needs. Senate bill 2578 would place a moratorium until April 2009 on
       proposed federal regulations that limit the scope of federal health-care reimbursements, and it
       would ensure that states receive adequate funding for targeted case management. Targeted case
       management includes services designed to provide comprehensive preventive care, such as
       transporting people with disabilities to and from doctors’ appointments, managing pharmacy
       services, making sure foster-care children receive proper medical care. (Press Release, Senators
       Cardin and Mikulski, 2/1/08)
      The President’s $3-trillion spending plan for fiscal year 2009 drastically cuts community mental
       health services funding for the Center for Mental Health Services (CMHS) within the Substance
       Abuse and Mental Health Services Administration (SAMHSA). The $144 million reduction
       (nearly half of the discretionary budget) of CMHS’ Programs of Regional and National
       Significance (PRNS) would put community mental health services funding significantly below
        the levels 5 years ago, stifling innovation and restricting progress.

News and Noteworthy

       Eligibility levels for many public programs will be affected by new federal poverty level (FPL)
        guidelines published January 23, 2008. While the new numbers are effective, programs such as
        Medicaid may use a different effective date. A complete list of FPLs
        is available at
       Prompted by studies showing an increase in the number of combat veterans with PTSD and other
        psychological problems, the Navy and Marine Corps plan to include teams of mental health
        professionals in combat zones to allow Marines and sailors to get psychological help
        immediately, or connect them to someone with whom they can talk. (San Diego Union-Tribune,
       Two studies published in the Archives of General Psychiatry add to a growing understanding of
        how genetics and environment interact in the development of mental illnesses. The first found
        that adults who are abused as children and who have a variation of a gene that regulates a specific
        stress hormone are less likely than those without the variation to develop depression. Researchers
        in the second study found that children born to women who suffered major emotional losses early
        in pregnancy are more likely than other children to develop schizophrenia as adults. “It is not a
        question of genes versus environment. It is a question of how genes interact with whatever the
        environmental factors might be. And that is probably true of all the disorders that we call mental
        illness,” said National Institute of Mental Health Director Thomas Insel. (Reuters, 2/5/08)

State Status Report
Legislative Update

       The State of Maryland Total Budget for FY 2009 is $31.5 billion, an increase over the current
        year of $1.9 billion (5.9%). The General Fund Budget for FY 2009 is $15.2 billion, an increase
        over the current year of $0.8 billion (5.3%). “General Funds” are the monies available for the
        state to use for most of its functions without restrictions. They come mostly from income and
        sales taxes. General funds do not include payments to the state from the federal government, or
        fund sources that are restricted for specific purposes, such as transportation or environmental
        programs (“special funds”). Like 49 of the 50 states, Maryland is required to balance its budget.
        For the past several years, Maryland has been budgeting with a “structural deficit,” which means
        that ongoing expenses exceeded ongoing revenues. The budget has been balanced by restraining
        the growth of expenditures, spending down fund balances and taking advantage of one-time
        revenue sources and temporary savings. In the fall of 2007, the Governor developed a multi-
        faceted fiscal plan affecting most major sources of state revenue, as well as slowing the planned
        growth of public school aid. The revenue increases by the special session held in November 2007
        added about $1.2 billion in revenue towards the budget solution. Since some of the tax increases
        took effect in January 2008, the revenues collected in January through June of this fiscal year will
        help fund fiscal year 2009 expenses. The bulk of new revenue comes from sales tax and tobacco
        tax increases. (The Regular Person’s Guide to the Budget, Maryland Budget & Tax Policy
        Institute, 2/2008)

Legislation pertaining to access to the Public Mental Health System

       SB 210/HB 372 Maryland Veterans Behavioral Health: The bill requires Maryland
        Department of Health and Mental Hygiene (DHMH) to provide veterans with up-to-date
       information about behavioral health services and resources through a web-based resource
       program and provide temporary behavioral health services. Hearing: 2/19/08
      SB 242/ HB 210DHMH – Developmental Disabilities and Mental Health Services – Cost of
       Living Adjustment: The bill requires DHMH to make annual adjustments to reimbursement
       rates paid to a community developmental disabilities provider or community mental health
       provider. Hearing 2/13/08
      SB 305 – Community Services Reimbursement Rate Commission – Termination Date
       Extension and Modifications: The bill authorizes the Governor with advice from Senate to
       appoint a specified number of members to the Commission; the Commission will alter charges in
       wages paid by providers and assess level/changes in wages paid by providers and direct workers
       support. Hearing February 13.
      HB 37 Medicare Part D “Donut Hole” Tax Assistance Act: Creates a subtraction modification
       under the state income tax for 50% of the qualified prescription drug expenses incurred by an
       individual who is eligible for Medicare Part D and Senior Prescription Drug Assistance Program.
       Hearing: 2/6/08
      HB 499 Health Insurance – Primary Care Physicians – Reimbursement for Treatment of
       Psychiatric Disorders: Clarifies that in certain cases a primary care physician is entitled to
       reimbursement for treatment of a psychiatric disorder. Hearing 2/14
      HB 984 Veterans of Afghanistan and Iraq Mental Health Pilot Program: The bill establishes
       the Veterans of Afghanistan and Iraq Mental Health Pilot Program at the Montgomery County
       General Hospital in Montgomery County. The program will coordinate and provide inpatient and
       outpatient mental health services to specified veterans and to the spouses and dependents of these
       veterans. Requires the Governor to include an appropriation in the State budget in fiscal year
       2010. In the House Health and Government Operations Committee. The bill is scheduled for a
       hearing on March 11, 2008 at 1:00 p.m.
      HB 1125 Maryland Universal Health Care Plan: The bill is in the House, Health and
       Government Operations Committee. A hearing is scheduled for March 13, 2008.
      HB 1262 Department of Health and Mental Hygiene – Behavioral Health Services for
       Veterans of War in Iraq or Afghanistan: The bill requires the Department of Health and
       Mental Hygiene to establish a program to provide behavioral health services for veterans who
       served in the war in Iraq or Afghanistan. The bill is in the House Health and Government
       Operations Committee, and a hearing is scheduled for March 11, 2008 at 1:00 p.m.
      HB 1339 Mental Health – Psychiatric Medication –Administration without Consent: The bill
       alters the reason for which an individual who is involuntarily hospitalized may be administered
       psychiatric medication when the individual refuses medication. In the Health and Government
       Operations Committee. A hearing is scheduled for February 29, 2008 at 1:00 p.m.

News and Noteworthy

      Gov. Martin O’Malley has proposed legislation to close gaps in federal care for returning service
       members (SB 210; HB 372). During the week of February 18 lawmakers began work on the bills
       by hearing testimony from veterans. In Maryland, many veterans return home to rural areas
       where mental health services for them can be hours away. DHMH Secretary John M. Colmers
       said the proposed program would help veterans find the services they need. (Philip Rucker,
       Washington Post, 2/22/08)
      In a public-private partnership to help thousands of seniors struggling to pay for prescription
       drugs, Gov. Martin O’Malley was to announce on February 15 a deal with CareFirst BlueCross
       BlueShield to cover those caught in a Medicare gap. The agreement would help seniors bridge
       the “donut hole,” a cost-saving measure built into the Medicare prescription drug benefit passed
       by Congress in 2003. The program covers annual prescription costs up to a certain amount and
           costs above a higher threshold, but not those costs in between, leaving a hole in the middle of the
           plan. (Laura Smitherman, Baltimore Sun, 2/15/08)

County Status Report
Budget Update

           Montgomery County Executive Isiah Leggett announced on February 19 a major reorganization
            within County government aimed at improving accountability, providing a sharper focus on
            customer service and environmental protection, and elevating the role of homeland security and
            emergency management. If approved by the County Council, the changes are expected to
            become effective July 1, 2008. (Release from the office of County Executive 2/19/08)

Action Needed

          The FY09 County Budget may have up to $400 million in cuts! The Saint Mark’s Coalition
           along with many other nonprofit and faith based organizations need your help to take a stand for
           Montgomery County’s most vulnerable citizens – children and adults with mental illness. The
           mental health system continues to lack needed funding for vulnerable citizens and any additional
           cuts to mental health could have a drastic affect. We ask that you send a letter to the County
           Executive urging him to hold harmless mental health services during this difficult fiscal time.

National Status Report
Legislative Update

          HR 687 and SB 382 The Keeping Families Together Act: The bill would establish a State
           family support grant program to end the practice of parents giving legal custody of their seriously
           emotionally disabled children to State agencies for the purposes of obtaining mental health
           services for those children. The House referred the bill to the Subcommittee on Health in early
           February 2007. In the Senate, the bill was read twice and referred to the Committee on Health
           Education, Labor, and Pensions.
          HR 171 The Student Support Act: The legislation would direct the Secretary of Education to
           make grants to states for assistance in hiring additional school-based mental health and student
           service providers. Referred to the House Committee on Education and Labor in January 2007.
          S 1375 and HR 20 The Melanie Stokes Postpartum Depression Act: The bill will help to
           ensure that new mothers and their families are educated about postpartum depression, screened
           for symptoms, and provided with essential services, and to increase research at the National
           Institutes of Health on postpartum depression. Received in the Senate and read twice and referred
           to the Committee on Health, Education, Labor, and Pensions.

Budget Update

          The President’s 2008 budget includes a 29 percent cut in mental health programs targeted to meet
           the special emotional needs of children and adults and holds at 2006 funding levels the Children’s
           Mental Health Services Program and the Community Mental Health Services Block grant, which
           support comprehensive community-based systems of care for children with serious emotional
           disturbances. (Source: Children’s Defense Fund)
State Status Report
Legislative Update

      SB 65 Health Insurance – Small Group Market – Coverage of Child Dependents: The
       legislation requires the Maryland Health Care Commission to include specified coverage of child
       dependents in the Comprehensive Standard Health Benefit Plan. A hearing was held on January
       23 at 1:30 p.m.
      SB 78 Task Force to Study System Variables that Impact Student Achievement in
       Underperforming Public Schools: The bill establishes the membership, purposes, and
       staffing of the Task Force. The Bill is in the Senate, First Reading Education, Health and
       Environmental Affairs Committee, where a hearing was held on January 23. No action
       has been taken since that time.
      HB 499 Health Insurance – Primary Care Physicians – Reimbursement for Treatment of
       Psychiatric Disorders: The bill provides primary care physicians entitlement to health insurance
       reimbursement for treatment of psychiatric disorders. Bill is in the House – First Reading, Health
       and Government Operations. Heard February 14, 2008.
      HB 910 Health Care Providers – Disclosure of Medical Records – Children in Need of
       Assistance Proceedings: The bill authorizes health care providers to disclose specified medical
       records without the authorization of persons of interest in accordance with compulsory process in
       Children in Need of Assistance proceedings. In the House Judiciary Committee, scheduled for a
       hearing on March 20, 2008 at 1:00 pm.
      HB 1404 Eliminating Barriers to Enrollment Act: The bill requires the Maryland Medical
       Assistance Program and the Maryland Children’s Health program to provide guaranteed
       eligibility to specified enrollees for up to 12 months and to provide presumptive eligibility to
       specified enrollees. In the House Health and Government Operations Committee. A hearing is
       scheduled for March 13, 2008.
      HB 285 and SB 96 - Education – Truancy Rates – Positive Behavioral Interventions and
       Support Programs and Behavior Modification Programs: The bill requires a county board of
       education to require a school that has a truancy rate that exceeds specified standards to implement
       a positive behavioral interventions and support program or an alternative research based positive
       and effective behavior modification program in collaboration with the State Department of
       Education. On February 18, the Senate had a third reading of the bill, and passed it 46-1. A first
       reading of the bill was scheduled in the House Ways and Means committee on February 19.
      HB 536 and SB 473 - Public Schools – Youth Risk Behavior Surveillance System – Passive
       Parental Consent. The bill would allow passive parental consent to the Youth Behavior
       Surveillance System survey, which measures youth behavior that puts them at risk. A hearing is
       scheduled for Tuesday, February 26, at 1:00 p.m. in the Senate education, Health and
       Environmental Matters Committee. A hearing in the House Ways and Means Committee is
       scheduled for Marcy 11, 2008 at 1:00 p.m.

Child Welfare

      HB 965 Child Abuse and Neglect – Additional Professions Required to Report: The bill
       expands the list of individuals who are required to notify the appropriate authorities in a specified
       manner if the individual, acting in a professional capacity in the State, has reason to believe a
       child has been subjected to abuse or neglect. In the House Judiciary Committee, scheduled for a
       first reading hearing on March 6, 2008 at 1:00 p.m.
Budget Update

      Montgomery County continues to advocate for educational expenses including school
       construction projects and Geographic Cost of Education Index. (Reznik Report from Annapolis,
       February 2008)

National Status Report
News and Noteworthy

      The President signed an Executive Order for an Interagency Working Group on Youth Programs
       on February 7. The Interagency Working Group on Youth Programs will have the following
       goals: publications for those interested in implementing and providing effective programming for
       at-risk youth; identification and distribution of evidence-based strategies; and enhance
       collaboration with the government on a federal, state, and local level. There are two websites
       available to provide updated information on the interagency working groups and resources to
       assist with the transition for interagency collaborations: Helping America’s Youth and
       Community Guide to Helping America’s Youth. (National Alliance to End Homelessness,
      Juvenile Mental Health Courts Initiative: The National Center for Youth Law (NCYL) reports
       that an estimated 50-90% of youth detained suffer from a form of mental illness. A congressional
       study found approximately 2,000 youth are detained every day due to lack of community mental
       health services. The Juvenile Mental Health Courts Initiative is currently in more than 10
       jurisdictions country wide and has developed a focus on problem-solving to divert mentally ill
       youth from detention facilities to community-based mental health services. (,
      The Archives of Pediatricians and Adolescent Medicine has published a study concluding that the
       impact of bullying is linked to psychological problems. The study found that “bullying” can lead
       to depression and anxiety. (Mental Health America, February 11, 2008)

State Report
Legislative Update

      SB 1 Maryland Legislative Youth Advisory Council: The bill establishes the Maryland
       Legislative Youth Advisory Council, including membership, terms, and duties, as well as the
       staffing. The Council would hold meetings, conduct public hearings, propose legislation, and
       conduct a public awareness campaign. The bill was passed on the third reading of the Education,
       Health, and Environmental Affairs Committee, 43-3. It is now having a first reading in the House
       Ways and Means Committee.
      SB 240 Residential Child Care Programs – Behavior Management Intervention: Withdrawn
       - The bill prohibits the use of specified behavior management interventions on children in
       specified residential child care programs. Currently the bill is in the Education, Health, and
       Environmental Affairs Committee.
      HB 90 and SB 57 Child Welfare – Permanency Planning and Interstate Placement of Foster
       Children: The bill changes the factors a juvenile court is required to consider in making findings
       in permanency planning and review hearings; increases, from 7 to 10, the number of days’ notice
       a local department of social services is required to give to specified persons before permanency
       planning and review hearings; requiring the court to consult with the child on the record in an age
       appropriate manner at least every 12 months at a permanency planning or review hearing. The
       Senate Judicial Committee passed the bill with amendments on its third reading, 46-0 on
       February 1. On February 4, the House Judiciary Committee held a first reading.
      HB 392 Juvenile Services – Mental Health and Substance Abuse Screenings for Detained
       Youth: The bill authorizes youth detained by the Department of Juvenile Services to receive to
       mental health and substance abuse screenings without parental consent. The bill is in the House
       and received an unfavorable report in the Judiciary Committee.
      HB 622 Evidence Based Practices for Delinquent Youth – Expansion of Services –
       Redirection Pilot Program and Plan: The bill establishes the Redirection Pilot Program in the
       Department of Juvenile Services, and requires the Department to use an appropriate assessment
       tool to determine eligibility for specified therapies. In the House Judiciary Committee. Hearing
       was held February 14, 2008.
      HB 651 Department of Juvenile Services Educational Programs – Private Residential
       Rehabilitative Institutions Repeal: The bill repeals the requirement for private residential
       rehabilitative institutions to develop and implement a specified educational program. The House
       Ways and Means Committee has scheduled a hearing for March 4, 2008 at 1:00 p.m.
      HB 732 Bullying, Harassment, and Intimidation – School Policy: The bill will require the
       board of education to establish a policy prohibiting bullying, harassment, and intimidation;
       require county’s to develop specific educational programming; and require the State
       Superintendent of Schools to publish a copy of the policy in the student handbooks by a specified
       date. Hearing 2/20 at 2pm.

Budget Update

      The Department of Juvenile Services (DJS) FY09 Budget may receive an additional $30 million
       for their operating budget from $248.2 million. DJS staffing budget has increased by $25 million
       due to the replacement of contractors to full-time employees. The increase in funds is in the
       Governors FY09 Budget proposal. (The Gazette, February 22, 2008)

National Status Report
Budget Update

      The HUD FY09 Budget was presented at a hearing at the House on February 13 to discuss not
       only keeping funding as is, but indicated the need for an increase in the FY09 HUD Budget. The
       Secretary of HUD testified and members of congress supported the McKinney Homeless
       Assistance Grants. (National Alliance to End Homelessness 2/2008)

News and Noteworthy

      The U.S. Department of Health and Human Services Administration is accepting applications
       for the Basic Center Program. The Basic Center Program provides youth with emergency
       shelter, food, and clothing for up to15 days.

State Status Report
Legislative Update

      HB 38 Heroes' Housing Fund of 2008: The bill will establish the Housing Program for First
       Responders and Teachers and leverage current Housing and Community Development funds to
       offer competitive loans and terms.
       HB 946 Montgomery County - Housing Opportunities Commission - Service Contracts MC
        814-08: The bill strengthens the protection of outsourcing Housing Opportunity Jobs. The
        revamped administrative procedures include: the Executive Director have specific certifications;
        compare costs under specific circumstances; and receive approval to submit a proposal for
        solicitations. The Montgomery County House and Senate have passed the bill and it will now be
        read by the General Assembly on March 6 at 1pm.

     Legislative information compiled by Colleen Fee, Jennifer Gauthier, Pat Crist and Jim Vurpillot

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