Anne Arundel Medical Center Gets State Approval to Build New Psychiatric Hospital

The Maryland Health Care Commission this week authorized Anne Arundel Medical Center (AAMC) to move forward with plans to build a new $25 million, 56,000-square-foot psychiatric hospital. The AAMC Mental Health Hospital will house 16 beds and offer both in-patient and out-patient treatment for a host of mental health conditions.

According to the Baltimore Business Journal:

Victoria W. Bayless, CEO of Anne Arundel Medical, said she is “very pleased” with the outcome of the vote and grateful for the unanimous support of the commission for the project. She said mental health services represent the single largest health care need in the local community.

“We transfer out about 1,200 patients a year from our emergency department for mental health, and they end up having to go to places like Shepard Pratt,” she said. “It’s important for us to be able to provide this service closer to home.”

The facility is expected to be fully operational by summer 2020.

Read the full article for more information.

Building A Culture of Health in Garrett County

Garrett County is receiving national recognition for its health-improvement efforts. The county is one of eight 2017 winners of the Culture of Health Prize awarded by the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy.

According to the Robert Wood Johnson Foundation,

A Community Holding Hands to Bridge its Divide

Up at Deep Creek Lake, in the heart of the county, multimillion-dollar homes and fast-multiplying condos fuel a more than $300 million tourism economy. Meanwhile, many county residents work seasonal and low-wage jobs at tourist-friendly restaurants, hotels and resorts, and the county faces a child-poverty rate of 19 percent, compared with 14 percent of all Maryland children. Dependent on industries such as health care, light manufacturing and farming, in addition to tourism, Garrett County’s median household income is about two-thirds the state average.

To address the challenges and bridge economic, cultural and health divides, Garrett County has capitalized on a deep-rooted strength: Everyone seems to know everyone, and neighbors care for each other and band together. That community spirit has brought about a robust, data-driven health planning process focused on reducing disparities in housing, education, employment, income and health care so that all residents can thrive. This small town spread across farmland and country roads has found a way to enable every high school graduate to attend community college for free and has raised $4.9 million to build a cancer center in its county seat.

The county’s health planners have drawn in the most vulnerable residents — including those struggling with intergenerational poverty, chronic disease, and housing instability — county leadership, and health care and social services partners. They are encouraging participation and tracking progress using an online planning tool, The multifaceted collaborative effort has earned the county a 2017 Culture of Health Prize.

“One of the good things about being small is we communicate very effectively,” says County Commissioner Jim Hinebaugh. “A lot of sharing goes on.”

Education, Opportunity, and a ‘Community of Caring’

When Garrett County, Maryland, native Shelley Argabrite says, “This is truly a community of caring,” she’s speaking from experience. Like many, due to unfortunate circumstances she experienced poverty as a single parent. Her resilience combined with assistance from the people in service agencies in the county helped her navigate the difficult situation, providing her family with, among other things, healthy food and a homebuyer’s grant that helped them secure a more sustainable future.

Now she’s paying it forward. As the strategic health planner at Garrett County Health Department, she’s working to address the county’s most pressing health needs, in part by gathering input from those who struggle as she once did.

That “leave no one behind” attitude pervades in Garrett County and has led to creative solutions aimed at expanding opportunities available to residents. When Commissioner Jim Hinebaugh, then the county’s director of economic development, proposed starting four scholarships at Garrett College about a decade ago, the county’s Board of Commissioners rebuffed him. But not for long.

“They said, ‘That’s going to make four people happy and a lot of people mad,’” says Hinebaugh, a county commissioner since 2014. “So I did the math. If we offered free scholarships to all for two years of community college, it would be one cent on our tax rate.”

Hinebaugh’s eureka moment generated a scholarship program that enables Garrett County residents with a high school degree or GED to attend the college for free if they study full time and maintain a 2.0 grade-point average. The program will soon expand to include non-traditional age students.

“It was absolutely instrumental to me,” says John Corbin, public affairs specialist at the Garrett County Health Department, of his scholarship, which meant he spent only $15 on a parking permit during his two years at Garrett College and graduated debt-free. “[Community college] is basically unaffordable to a lot of residents without the scholarship.”

If education is at the center of opportunity building in Garrett County — 1 in 5 residents has a bachelor’s degree or higher — so too is chipping away at poverty. The county’s 2-G, or two-generation program, which aims to improve outcomes for children and economic security for families, has been lauded by many, including Maryland Gov. Larry Hogan. This year, he moved to create a commission that will study the approach as a model for the state.

“At the heart of the two-generation approach is the idea that you work with children and families simultaneously, but you do it in a way where your services are really integrated,” says Duane Yoder, president of Garrett County Community Action, a poverty reduction nonprofit. Families work with staff to develop a “pathway plan” that includes at least one goal related to education, employment or financial management.

To leave poverty behind, families need places to live and ways to get to work. So Garrett County Community Action and its public and private partners have developed 700 affordable, low-income, mixed-income and workforce housing units. And the county’s Wheels to Work program helps families afford a used car, since Garrett, like many rural communities, lacks traditional public transit.

In every endeavor, the people of Garrett County are important partners.

“We work as a team with families,” says Barbara Miller, vice president for family economic security at Garrett County Community Action. “We listen to what they feel they need in their lives.”

To read more about Garrett County’s efforts to to ensure all residents have the opportunity to live healthier lives, visit the Robert Wood Johnson Foundation’s website.

Federal Court Strikes Down Maryland’s Generic Drug Price Protections

Baltimore Sun article (2018-04-13) reported that the 4th Circuit Court of Appeals in a 2-1 ruling has struck down a Maryland law regulating prices on generic drugs as violating the dormant commerce clause. The recently enacted law (HB 631 of 2017) was heavily supported by Maryland Attorney General Brian Frosh and was designed to protect consumers from rapidly increasing generic medicine costs. The law allowed the Office of the Attorney General to review generic drug prices and order price reductions or fines if the Office determined the prices increased too steeply without a valid reason.

The case was brought against Frosh and then-Maryland Secretary of Health Dennis Schrader by the Association for Accessible Medicines (AAM). The holding is the first of its kind and could chill the efforts of other states to address generic drug prices.

From the article:

“To be clear, we in no way mean to suggest that Maryland and other states cannot enact legislation meant to secure lower prescription drug prices for their citizens,” [majority opinion author Judge Stephanie Thacker] wrote. “Although we sympathize with the consumers affected by the prescription drug manufacturers’ conduct and with Maryland’s efforts to curtail prescription drug price gouging, we are constrained to apply the dormant commerce clause.” …

Judge James A. Wynn dissented from the majority opinion, saying the other judges had interpreted the commerce clause too broadly. Wynn wrote that their ruling would stop “Maryland from protecting its citizens against unconscionable pricing practices by out-of-state generic drug manufacturers.”

The article noted that Frosh is considering the State’s options, which include requesting an en banc review by all the 4th Circuit judges or appealing the case to the United States Supreme Court.

Useful Links

HB 631 of 2017

4th Circuit Court of Appeals Opinion – Association for Accessible Medicines v. Frosh, et al.

Maryland Congressman Proposes Comprehensive Federal Opioid Crisis Funding

Proposed CARE Act Funding: $4B to states; $2.7B for hard hit local governments; $1.8B for research; $1B for expanded services; $500M for naloxone; and $400M for CDC.

Maryland Representative Elijah Cummings in partnership with Senator Elizabeth Warren of Massachusetts is planning to introduce the Comprehensive Addiction Resources Emergency Act or CARE Act. Modeled after the 1990’s Ryan White Act, the CARE Act would provide $10 billion in annual federal funding to state and local government to tackle the opioid crisis.

As reported by The Baltimore Sun:

Cummings and Warren say the overdose epidemic must be dealt with in the same way the health crises of the past were. The Ryan White Act of 1990, they say, helped turn around the AIDS crisis and reduced deaths dramatically.

Cummings said he and Warren got the idea to fund a massive public health campaign against opioids from Baltimore Health Commissioner Dr. Leana Wen and her staff, who pitched the lawmakers on the need for increased funding.

“We have been calling for the same thing all along: Sustained funding,” Wen said. “It needs to be a proportional amount to the size of the epidemic. The funding needs to be given directly to the highest-need jurisdictions.”

Read the full article in The Baltimore Sun to learn more.

City Launches Fall Reduction Initiative for Older Adults

Fast facts: In Baltimore injuries from falls cost $60M annually; fall rates are 20% higher and hospitalization rates are 55% higher statewide average.

Baltimore City will launch an initiative to reduce falls as well as the high costs and hospitalizations that result from them. A key part of the initiative will focus on education and prevention for older adults. The goal is to reduce the rate of falls by 20% over the next 10 years.

As announced by the Baltimore City Health Department:

The public health falls prevention strategy will focus on three major components: mapping where falls are occurring throughout the City using near real-time hospital data; targeting fall prevention activities in ‘hotspots’—the areas of high fall numbers and rates; and educating the general public that falls are preventable and resources are available.

In Baltimore City, nearly 5,000 older adults visited the ED last year due to a fall. Falls-related ED visits in Baltimore City are more than 20% higher than the statewide average, and the city’s rate of falls-related hospitalizations is 55% greater than the state’s. The average cost of a hospitalization due to a fall is $39,000, or $60 million annually in Baltimore City.

“Our Citywide strategy uses innovative, evidence-based methods to go to where people are, by using science to map out where falls are occurring, providing holistic services such as help with medications and housing interventions, and educating residents on how to prevent falls,” said Dr. Leana Wen. “The Baltimore City Health Department is glad to convene partners across all sectors and lead this collective impact strategy to improve health. I thank Mayor Pugh for her steadfast leadership and for being such a tremendous advocate for our seniors.”

For more information:

Baltimore City Officials Announce Citywide Falls Prevention Strategy for Older Adults (Baltimore City Health Department)


Round-up of the 2018 Session for Counties

MACo’s legislative efforts earned an 80% success rate – and as usual, the counties’ voice makes a difference in Annapolis. Bills we support are more likely to pass, and bills we oppose are more likely to fail.

2018 Legislative Results Infographic

MACo’s legislative initiatives, priorities, and positions are directed by its Legislative Committee. This body comprises elected representatives from all of MACo’s members – the 24 county jurisdictions (including Baltimore City).

The “one county, one vote” system of deciding the Association’s legislative strategies, ensures that all counties have an equal voice. All 24 jurisdictions participated regularly in the weekly meetings throughout the session – where they also engaged with policy leaders and advocates who joined the meeting to address county leadership.

Our policy staff have compiled updates and results on all of the bills the Legislative Committee decided to take action on this year.

For the 2018 End of Session Wrap-up for each subject MACo covers, click below:

2018 End of Session Wrap-Up: Assessments and Taxation

2018 End of Session Wrap-Up: Business Affairs

2018 End of Session Wrap-Up: Disparity Grants

2018 End of Session Wrap-up: Economic Development Tax Credits

2018 End of Session Wrap-Up: Education

2018 End of Session Wrap-Up: Elections

2018 End of Session Wrap-Up: Employee Benefits & Relations

2018 End of Session Wrap-Up: Environmental Legislation

2018 End of Session Wrap-Up: Finance and Procurement

2018 End of Session Wrap-Up: Government Liability & Courts

2018 End of Session Wrap-Up: Health & Human Services

2018 End of Session Wrap-Up: Housing & Community Development

2018 End of Session Wrap-Up: Intergovernmental Relations *MACo Initiative Area*

2018 End of Session Wrap-Up: Parks & Recreation

2018 End of Session Wrap-Up: Pensions

2018 End of Session Wrap-Up: Planning & Zoning

2018 End of Session Wrap-Up: Property Taxes

2018 End of Session Wrap-Up: Public Information & Ethics * MACo Initiative Area *

2018 End of Session Wrap-Up: Public Safety and Corrections

2018 End of Session Wrap-Up: Road Funding * MACo Initiative Area *

2018 End of Session Wrap-Up: School Construction * MACo Initiative Area *

2018 End of Session Wrap-Up: State Budget & Fiscal Affairs

2018 End of Session Wrap-Up: Tax Sale Bills

2018 End of Session Wrap-Up: Transportation and Public Works

2018 End of Session Wrap-up: Wynne Tax Bills

2018 End of Session Wrap-Up: County Tax Revenues

2018 End of Session Wrap-Up: Other Tax Bills

2018 End of Session Wrap-Up: Health and Human Services

MACo advocates actively for policies that continue to confront the opioid crisis and to support county social services programs. The segments below provide a brief overview of MACo’s advocacy in the area of health and human services in the 2018 General Assembly. 

Local Health Departments

Push Icons-WONMACo supported a bill that would establish a renewed commitment to aiding counties seeking to expand or establish behavioral health crisis services. This grant program affords local authorities the opportunity to build upon progress made both at the local and state levels to provide comprehensive behavioral crisis services that can meet their community needs on demand. The bill passed both houses and awaits the Governor’s signature. Bill Information | MACo Coverage

Push Icons-NOT IDEALMACo vigorously supported a bill that aimed to ensure that Core Funding for Local Health Departments (LHD) appropriately accounts for the growing costs of medical care these departments provide and sufficiently meets the needs of delivering vital public health services. Unfortunately, the bill did not make it past the first hearing in either the House or Senate. Bill Information | MACo Coverage

Push Icons-WONMACo pushed for a bill that expands insurance coverage and patients’ access to care from local health departments (LHD). Senate Bill 858/House Bill 1132 requires insurance carriers to offer insurance contracts to LHDs for the delivery of covered treatment services including behavioral health care services. The bill passed both houses and awaits the Governor’s signature. Bill Information | MACo Coverage

Prescription Drugs and the Opioid Epidemic

Push Icons-NOT IDEALMACo supported a bill that would have assisted in efforts to reduce opioid-related overdose deaths by closing an important loophole in the existing immunity provisions for EMS providers administering treatment to an individual experiencing or believed to be experiencing an overdose, regardless of changes in FDA medication or dosage guidelines. The bill did not make it past the first hearing in the House or the Senate as internal EMS policy changes rendered the bill no longer necessary. Bill Information | MACo Coverage

Push Icons-NOT IDEALMACo supported a bill that would have authorized paramedics to dispense life-saving kits of naloxone to individuals at risk for overdosing or in a position to help someone assumed to be overdosing. Unfortunately, the bill received an unfavorable report from the House Health and Government Operations Committee and will not become law. Bill InformationMACo Coverage

Push Icons-NOT IDEALSenate Bill 1083 and House Bill 88 would have strengthened the Prescription Drug Monitoring Program by requiring that the PDMP review data to identify and deter prescription drug abuse and diversion as the state continues to struggle with an opioid crisis. MACo supported the effort behind this bill. Unfortunately, the bill was referred to conference committee on the last day of session and failed to pass before the legislative deadline. Bill Information | MACo Coverage

Push Icons-NOT IDEALMACo supported Senate Bill 309 and House Bill 359 as they empowered law enforcement and first responders to report important overdose data that would help efforts to accurately track and effectively tackle the opioid crisis. As overdose data and information sharing are key components to solving this crisis, counties believe the information must be reported through secure platforms to the extent that it is practicable to do so. Unfortunately, the bill was referred to conference committee on the last day of session and failed to pass before the legislative deadline. Bill Information | MACo Coverage

Public Safety and Emergency Medical Services

Push Icons-WONMACo supported an effort to establish an advisory council and fund to support local public health offices in their violence prevention efforts. The dedicated, structured, and collective effort that House Bill 432 and Senate Bill 545 provides is key to finding solutions to the violence that is unfortunately plaguing some county neighborhoods. The bill passed both houses and awaits the Governor’s signature. Bill Information | MACo Coverage

MACo supported Senate Bill 682 which creates a path forward for emergency medical service (EMS) providers to be reimbursed for providing efficient and cost-effective delivery of health care services to their communities. The bill returned passed through the House and awaits the Governor’s signature. Bill Information

Human Services

Push Icons-DEFEATEDMACo opposed a bill that would have effectively carved out a portion of Local Management Board (LMB) funding for one specified program, consequently reducing their resources for all other programs and undermining their community-based decision-making authority. The bill was given an unfavorable report by the House Appropriations Committeee and was withdrawn. Bill Information | MACo Coverage

Push Icons-WONMACo supported Senate Bill 912 and House Bill 1685. Counties have a vested public health interest in reducing health disparities and improving the well-being of women and children, and SB 912 would act as a new state commitment to counties assisting vulnerable families through grant funding aimed at helping counties and municipalities provide care coordination, intervention, and services to low-income pregnant and postpartum women and children from birth to 3 years old. The bill passed both houses and awaits the Governor’s signature. Bill Information | MACo Coverage

For more on health and human services legislation tracked by MACo in the 2018 legislative session, click here.


2018 Federal Foster Care Law and Its Effect on County Services

The National Association of Counties is hosting a webinar on the Family First Prevention Services Act and how it may impact your county.

As described by the Annie E Casey Foundation, legislation with bipartisan support included in the federal budget bill may have a major positive effect on the lives of children.

The National Association of Counties will host a webinar in the coming week regarding the effect of the law on county governments. NACo describes:

During the webinar, we will be joined by majority and minority staff from the U.S. House Ways and Means Committee and the U.S. Senate Finance Committee who will discuss the recently passed legislation and what counties can expect in the coming months. The webinar is on Friday, April 13 from 2:00pm – 3:30pm ET.

Guest Speakers:

  • Anne DeCesaro, Majority Staff Director, Subcommittee on Human Resources, U.S. House Committee on Ways and Means
  • Ryan Martin, Senior Human Services Advisor, Majority, U.S. Senate Committee on Finance
  • Morna Miller, Minority Staff Director,  Subcommittee on Human Resources, U.S. House Committee on Ways and Means
  • Laura Berntsen, Chief Human Services Advisor, Minority, U.S. Senate Committee on Finance

For more information and to register for the webinar, please click here

General Assembly Passes Bill to Expedite Inmate Mental Illness Placements

The General Assembly has passed a bill that provides an accelerated process for placing defendants unable to stand trial because of serious mental illness into treatment instead of being held in jail.

MACo supported HB 111, sponsored by Delegate Erek Barron, as it addressed the crucial issue of lack of treatment beds and prompt placement of defendants court-ordered into treatment due to serious mental illness. These defendants are often held in county jails awaiting a treatment bed — an unfortunate and unacceptable situation that is bad for the defendants in need of treatment and problematic for the jails.

As passed by the General Assembly, the bill expands the types of facilities the Maryland Department of Health (MDH) may place an individual for treatment, recognizing the efforts the MDH has made to contract with hospitals and other private facilities for beds. Additionally instead of the court specifying a placement date, it sets an “as soon as possible, but no later than 10 days” time frame for placement. Finally, sanctions are limited to any that are reasonably designed to compel compliance, including reimbursement to the jails for holding a defendant beyond 10 days.

From The Baltimore Sun :

The 10-day requirement represents a compromise between proponents of the bill and the department. Barron’s original bill called for immediate admission once ordered by a judge.

Barron, a Prince George’s County Democrat, called the bill’s passage “a significant step toward relieving a longstanding issue of healthcare treatment, due process and public safety.”

“I’m hopeful Maryland is now trending towards being a national model for the decriminalization of mental illness,” he said.

For more on this and other legislation, follow MACo’s advocacy efforts during the 2018 legislative session here.

For more information:

Maryland legislature OKs deadline for state-run psychiatric hospitals to admit patients from jails (The Baltimore Sun)

Bill Fast-Tracking Inmate Psych Bed Placements on the Move (Conduit Street)

Accelerate Placement of Defendants With Mental Illness (Conduit Street)

Insurance Expansion to Local Health Departments Gives Options to Community

Senate Bill 858 expands health care insurance coverage to care from local health departments.

SB 858 would require insurance carriers to offer insurance contracts to LHDs for the delivery of covered treatment services including behavioral health care services. Currently, only some insurance carriers either contract or have agreements with LHDs and only for a limited selection of services.

This would greatly expand access to community members to the array of direct services and resources that local health departments provide. Many rural areas of the state rely on local health departments to provide a significant amount of services, particularly focusing on mental and behavioral health.

LHDs can choose to be added to carriers’ networks, which would significantly expand access to care and health services for those in each community.

From MACo Testimony:

Expanding insurance coverage to LHDs would significantly improve the ability for patients around the state to receive cost-effective and quality treatment within their communities. This is especially important for behavioral health care access. In Maryland, 19 jurisdictions are federally designated mental health provider shortage areas, and a number of those are also deficient in substance use providers. In many rural areas of the state, LHDs are the sole providers of behavioral health services. This bill saves patients from traveling significant distances to receive services from other providers at greater costs.

SB 858 supports LHDs’ efforts to deliver vital public health services and increases patients’ access to that care.”

For more on this and other legislation, follow MACo’s advocacy efforts during the 2018 legislative session here.