Maryland Gets High Scores for Public Health Preparedness

State bests national average in survey ranking preparedness for public health emergencies.

Maryland scored a 7.5 — above the national average of 6.8 — on the 2017 National Health Security Preparedness Index, a nationwide report designed to “assess preparedness for ‘community health emergencies’.

As reported in The Baltimore Sun:

On a 10-point scale, Maryland rates 7.5 for its efforts to prepare for and respond to such emergencies, according to the 2017 National Health Security Preparedness Index.

The index is compiled annually by the nonprofit Robert Wood Johnson Foundation to assess preparedness for “community health emergencies.”

The foundation looks at more than 100 measures, such as monitoring food and water safety, flu vaccination rates, and numbers of paramedics and hospitals. The measures are grouped into six categories that are given a ranking on the 10-point scale.

Maryland came in better than the national average of 6.8.

Maryland also outranked most of its neighbors: West Virginia (6.7), the District of Columbia (7.0), Pennsylvania (7.0) and Delaware (7.2). Virginia also scored 7.5.

Vermont scored highest at 7.8, while Alaska ranked as least-prepared with a score of 5.9.

Maryland scored best for the ability to mobilize resources to deal with a health emergency, where the state earned a 9.3.

For more information read The Baltimore Sun and the 2017 National Health Security Preparedness Index.

Anne Arundel County Council Approves Medical Marijuana Zoning Tweak

Anne Arundel County Council members on Monday night passed legislation tweaking the county’s medical marijuana zoning rules, a change officials said will align the law with the council’s original intentions.

Council Bill 21-17 specifies that medical marijuana dispensaries located north of Route 50 or north of the northeast shore of the South River are not allowed within 1,000 feet of a house or school building. Those restrictions do not apply elsewhere in the county.

According to The Capital Gazette,

The change, which passed unanimously, represents a tightening of the previous law, which banned dispensaries within 1,000 feet of homes and schools only if the business was located both north of Route 50 and east of the South River.

Land affected by the updated restriction includes Annapolis, the Broadneck Peninsula, Crofton, Odenton and all of north county, including Glen Burnie and Pasadena.

The change will not apply to an application for a dispensary on West Street, which could become the county’s first. While the site falls within the new boundary lines, it will not be affected because the application is already in progress.

Administration officials and councilmen alike said the bill’s changes describe the law they thought they had passed when the rules for medical marijuana were first crafted in late 2015.

“We believe (this) is the intent when we discussed this bill originally,” said Bernie Marczyk, a lobbyist for County Executive Steve Schuh.

Councilman Chris Trumbauer, an Annapolis Democrat, voted in favor of the bill because, he said, it “just corrects the code to be what we thought we passed back then, so there are no additional regulations put on the industry.”

“I continue to believe that our code is too restrictive for this new industry, but I’m going to vote yes because I’m honoring the compromise we passed last year,” he said.

Councilman Jerry Walker, a Crofton Republican, said fewer regulations may be warranted if the existing rules prove too difficult for fledgling medical marijuana businesses.

“I think the majority of us would like to see them open, and if we create this system that’s too restrictive, too cumbersome, we may need to look at how we set it up,” he said.

Read the full article for more information.

Overdose Deaths Tax State Medical Examiner Resources

The State Medical Examiner’s Office is short staffed and overburdened; an issue the has been intensified by an increase in opioid overdose deaths. The office is in the precarious position of exceeding the national caseload standards for autopsies performed per pathologist which threatens the loss of its accreditation and hampers the flow of information to prosecutors, public health officials, and other agencies that rely on the office.

The Baltimore Sun reports:

State pathologists are performing about 40 percent more autopsies than in 2010 — almost 100 more apiece — and the toxicology lab now runs nearly nonstop, officials say. But the office has not significantly boosted the ranks of examiners, and is struggling to hold on to support staff.

“Maryland is currently fully accredited,” Peterson said. “But as is the case with many offices, it might be facing loss of that accreditation due to the intersection of caseload and staffing level.”

The agency is part of the state Department of Health and Mental Hygiene. Medical examiners investigate deaths caused by injury, homicide or suicide, and those that are untimely, suspicious or not attended by a physician. In Maryland, that’s about a third of all deaths. The office handled 14,385 cases in fiscal year 2016, and performed 5,439 autopsies.

The office began exceeding the national standard of 250 autopsies per examiner per year in fiscal 2013, according to the state health department. Its inability to meet that standard has led to its designation as deficient.

After the first quarter of fiscal 2017, the pathologists were on target to perform 328 autopsies — exceeding the limit of 325 for maintaining accreditation.

The article notes the increase in opioid overdose deaths is stressing already overburdened examiners and lab resources:

But there were far more deaths from overdose: 1,468 statewide in the first nine months of 2016, up from 1,259 for all of 2015, and more than twice as many as in 2010. Maryland was one of 30 states to report a large increase in overdose deaths.

More than 900 of the fatal overdoses in 2016 were related to heroin. More than 700 were related to fentanyl, a far more powerful opioid that is often mixed with heroin, unbeknownst to users.

Read The Baltimore Sun to learn more.

Hogan Reappointment of Two to Cabinet Sets Up Legal Fight With Assembly

Setting up a potential constitutional clash, Governor Larry Hogan reappointed two officials to his Cabinet on Wednesday who failed to make it through the confirmation process during the General Assembly session that ended Monday, April 10.

Hogan named Dennis R. Schrader to head the Department of Health and Mental Hygiene despite withdrawing his name after a dispute with Maryland Senate Democrats.

He also announced he would keep Wendi Peters, whose nomination was turned down by the Senate Executive Nominations Committee but withdrawn before full Senate action, as acting planning secretary.

According to The Baltimore Sun,

The governor’s office contends that Hogan, who had signaled his intention to reappoint the officials, is within his rights under the law. The Democratic leaders of the Senate contend that Hogan is violating the Maryland Constitution.

“The advice-and-consent process is a fundamental tenet of American democracy and the separation of powers,” said Sen. Bill Ferguson, chairman of the Executive Nominations Committee.

But Hogan spokesman Doug Mayer countered by saying that the Senate’s nomination process this year was “very political” and asserted the governor’s power to appoint whom he wants.

“The governor 100 percent has the power to withdraw and reappoint,” Mayer said.

The reppointments came just one day after the Republican governor and the Democratic leaders of the General Assembly praised the bipartisan accomplishments of the legislative session. Hogan’s actions raise questions about whether the Senate can block any individual from exercising the powers of a high state office if the governor is determined to appoint that person. If not resolved before January, the dispute could hang over any pending Hogan appointments that require confirmation.

Ferguson, a Baltimore Democrat, said Hogan’s actions put the state and its citizens in jeopardy.

“The validity of the acting secretaries’ power is in question as a result of the governor’s decision because the governor has willfully bypassed the constitution,” Ferguson said. In the case of the health department, he said, citizens could go to court to challenge enforcement decisions on the grounds that the secretary doesn’t hold the office legally.

Seeing a confrontation looming, the legislature adopted budget language this year to bar the use of state funds to pay the salaries of secretaries or acting secretaries who were nominated during the session but who did not win confirmation before their names were withdrawn. That provision takes effect July 1.

“We think that’s unconstitutional, and we think they know it,” Mayer said.

A letter of advice dated March 15 from the state attorney general’s office says that in Peters’ case, “nothing prevents the governor from choosing as his recess appointee the person whose nomination had been submitted but then withdrawn” because she had not been rejected by the full Senate.

However, the letter also says the legislature may use the budget bill to block the payment of the salary of someone appointed after the session whom the committee had rejected and whose name had been withdrawn — as in the case of Peters. Lawmakers are waiting for answers to a request for an opinion on issues concerning Schrader.

Mayer said Hogan is relying on the advice of his own general counsel rather than the opinion of the office headed by Democratic Attorney General Brian E. Frosh.

Read the full article for more information.

2017 End of Session Wrap-Up: Health and Human Services

MACo advocates actively for policies to help 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 2017 General Assembly. 

Follow links for more coverage on Conduit Street and MACo’s Legislative Database

Opioid Crisis

Push Icons-WONMACo successfully supported passage of the “Start Talking Maryland Act, ” a bill to reduce overdose deaths and prevent addiction by focusing on Maryland’s public education system as a means for spreading awareness and providing necessary services. The bill also directs funding to mitigate costs associated with launching these programs. Senate Bill 1060/House Bill 1082 passed and is awaiting the Governor’s signature. Bill Information | MACo Coverage

Push Icons-IMPROVEDMACo successfully added amendments to omnibus legislation that offers a comprehensive approach for addressing the continuing opioid overdose and addiction problem confronting communities across the state. MACo’s amendments to help ensure the bill achieves its goals without overburdening local resources. The General Assembly passed Senate Bill 967/House Bill 1329, the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 with amendments, and it awaits the Governor’s signature. Bill Information | MACo Coverage

Push Icons-NOT IDEALMACo successfully supported passage of a bill to provide greater flexibility and increase resources to local governments for substance abuse treatment and related prevention, outreach, and maintenance efforts. Senate Bill 1194 passed the Senate but unfortunately did not advance out of the House committee before the General Assembly session came to an end.  Bill Information | MACo Coverage

Push Icons-WONMACo supported a bill to provide easier access to naloxone, a medication that can counter an overdose, to individuals who are most able to assist someone at risk of dying from an opioid death when emergency medical services or first responders are not readily available
. While Senate Bill 868/House Bill 791 did not advance out of committee, the essence of the bill was amended into Senate Bill 967/House Bill 1329, the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017. Bill Information | MACo Coverage

Push Icons-WONMACo supported a bill that enhances state and local tools to confront the opioid epidemic and helps improve the effectiveness of existing programs that help reduce overdose deaths and address addiction
. While House Bill 1549 did not advance out of committee, provisions of the bill were amended into Senate Bill 967/House Bill 1329, the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017.  Bill Information | MACo Coverage


Social Services

Push Icons-DEFEATEDMACo stopped a bill that would shift the critical responsibility of answering calls concerning child abuse and neglect from local departments of social services to the statewide 2-1-1 system. Senate Bill 945/House Bill 697 was well-intentioned but had practical shortcomings and was withdrawn by its sponsors. Bill Information | MACo Coverage



MACo successfully stopped a bill that would have a significant impact on Local Management Boards’ funding and decision-making authority when it comes to oversight of the Youth Services Bureaus. Senate Bill 784 did not advance out of committee and its crossfile, House Bill 1187 was withdrawn by its sponsor. Bill Information | MACo Coverage

Click here for a round up of the wrap-ups for all policy areas

Legislative Black Caucus Calls for Special Session on Medical Cannabis

The head of the Legislative Black Caucus said Tuesday her organization wants Governor Larry Hogan to recall the General Assembly to Annapolis for a one-day special session to pass a law expanding the medical marijuana industry.

That legislation failed in the waning minutes of the annual 90-day session on Monday night, ending a months-long fight to grant lucrative medical cannabis growing licenses to companies owned by minorities.

According to The Baltimore Sun,

Despite a state law requiring regulators to seek racial diversity, none of the 15 firms to win preliminary licenses last year was led by African-Americans.

Baltimore Democratic Del. Cheryl Glenn, chair of the 51-member caucus, said the last-minute failure of the group’s top priority left black lawmakers “feeling rejected, dejected and taken for granted” by the Democrats who lead the General Assembly. The caucus sought to issue another five licenses and reinvent the commission that had awarded the initial ones.

“Nothing changes, and most importantly, that means African-Americans are left out of this billion-dollar industry in Maryland, and that is not acceptable,” Glenn said Tuesday.

Hogan spokesman Doug Mayer declined to comment on the request. Senate President Thomas V. Mike Miller, a Democrat, referred the topic to House Speaker Michael E. Busch, also a Democrat. Busch said that the caucus needed to raise it with the governor.

Glenn planned a morning press conference Wednesday to continue to press the issue. She’ll be joined by African-American prospective business owners, Baltimore defense attorney Billy Murphy, and representatives from GTI Maryland, a company suing the Maryland Medical Cannabis Commission over how it awarded the initial round of licenses.

GTI and another firm, Maryland Cultivation and Processing, filed lawsuits against the commission after they were removed from the pool of winning applicants as the commission sought geographic diversity among growers. Negotiations broke down in the General Assembly over whether to write into state law that the two companies are entitled to a new license.

Miller insisted that any legislation contain that provision. Busch refused to consider it until late Monday, when it appeared no legislation would pass without the provision. The final vote on the House floor did not take place before the midnight deadline to adjourn.

Glenn said this has caused a rift between the caucus and Democratic leaders who rely on its members to help pass legislation.

“They failed us, and it stings,” she said. “And the way that we resolve it is the one-day special session. Let’s pick up where we left off.”

The Maryland Wholesale Medical Cannabis Trade Association, which represents companies that received initial permission to grow and process the drug, said the legislation’s failure allows it to continue to “focus on the primary goal: getting medical cannabis to Maryland patients,” hundreds of whom turned up in Annapolis to make their voices heard.

Dr. Paul Davies, chairman of the cannabis commission, said he was “very relieved” the commission would not be reconstituted and that it could continue work to issue final licenses that would put the drug in patients’ hands by summer. The commission has hired a diversity consultant, and by law will re-evaluate in 2018 whether the market for medical marijuana can support more growers, processors or dispensaries.

“The commission gets the message that racial and ethnic diversity is important,” Davies said. “We plan to aggressively pursue a policy of diversity.”

Read the full article for more information.

Stabilization Center to Open in Anne Arundel

As Anne Arundel County continues to see a rise in opioid overdoses — ranking third in the state for overdose deaths over the past couple of years — a new stabilization center offers a tool to help address the crisis.

The Capital Gazette reports on the new center and opines as to the impact it will have on the county:

But later this month the county will be able to celebrate some good news. Robert A. Pascal Youth and Family Services is about to open a new “stabilization center” at the former state psychiatric hospital in Crownsville. Many hope this will be a game-changer.

This is a joint venture between the nonprofit and Gaudenzia, which operates a drug and alcohol treatment center out of the same location.

The idea is to give police officers, often the first people on the scene of an overdose, another option besides putting those involved in jail, dropping them off at an emergency room or just walking away.

Officers will be able to take overdose victims to the center for an evaluation and guidance on the best course of action. The 5,000-square-foot, 16-bed facility will have mental health clinicians who can determine what level of treatment is needed, using emergency psychiatric assessment.

It is a similar approach to the county Crisis System, created to help police deal with people suffering severe mental health problems. That’s not a coincidence, as the executive director of Pascal Youth and Family Services is Katherine Bonincontri, a former director of the Crisis System.

The article notes that work at the center is slated to begin on April 24, 2017.

Read The Capital Gazette to learn more.

States Pursue Medicaid Waivers and Expansions for Addiction Treatment

Four states including Maryland have received a federal waiver that allows them to use Medicaid dollars for addiction treatment facilities with more than 16 beds. While seven additional states are in the process of seeking the waiver, the federal government is encouraging more to apply as part of a push to expand access to residential addiction treatment to help deal with the nation’s opioid epidemic.

As reported on Stateline:

To boost the number of beds available for low-income residents, the federal government has granted California, Maryland, Massachusetts and New York a waiver of an obscure Medicaid rule that prohibits the use of federal dollars for addiction treatment provided in facilities with more than 16 beds. Seven other states — Arizona, Indiana, Illinois, Kentucky, Michigan, Utah and Virginia — are seeking similar permission.

In March, the Trump administration’s new Health and Human Services secretary, Tom Price, told governors that the agency would continue the Obama administration’s waiver policies for residential facilities with 16 or more beds.

The federal government is encouraging all states to seek a waiver of Medicaid’s residential treatment rule, but only if the care is offered as part of a comprehensive set of addiction services for low-income people.

In addition to offering inpatient treatment to patients who need it, state Medicaid addiction programs must include all available addiction medications, intensive outpatient therapy, recovery support services such as job training and housing, substance abuse prevention programs, case management and physical health services.

States also must prove that adding more residential treatment slots to the list of Medicaid treatment options will cost no more than continuing to prohibit it.

Medicaid expansion, plus the federal health law’s requirement that all insurance carriers reimburse for addiction services, along with the Mental Health Parity and Addiction Equity Act’s requirement that addiction treatment be paid for at the same level as medical and surgical services, together hold out the potential that billions of dollars for addiction treatment will be available in the years ahead.

Lifting the 16-bed limit will free even more federal money, making it possible for addiction treatment providers to expand their capacity, Ingoglia said. But, he said, it’s not likely to result in treatment on demand overnight.

California was the first state to receive a federal Medicaid waiver, in December 2015. More than two years later, California’s counties, which operate separate Medicaid programs, are still ironing out details on reimbursement rates and quality standards.

Maryland’s waiver program, approved in December, is slated to take effect July 1. In the meantime, the state will set licensing and staffing requirements, and develop reimbursement rates and billing rules.

For more information read the full article on Stateline.

Resurrection of Healthcare Reform, Three Questions About Sanctuaries

The National Association of Counties (NACo) held a conference call today on federal legislation and regulations that affect counties.

Screenshot 2017-04-04 15.46.59

NACo’s policy team began their federal policy update call by stating that, for NACo, review of federal policy is not seen as a partisan topic, but an issue of federalism and intergovernmental relations.


According to NACo’s policy team, the concern regarding many current federal proposals is a common underpinning of achieving federal budgetary savings through cuts to state and local governments.


Counties are a key part of the nation’s health system. Nationally, counties spend $84B a year on residents’ healthcare, counties spend $25B on premiums for their own employees, and counties own hospitals and other medical infrastructure, according to NACo.

Healthcare reform is still very much alive the NACo Policy Team reports. The President and leadership are working on efforts to revise the legislation that was withdrawn. What was put forth previously would have cut medicaid spending and other public health funding that states and local governments currently use to provide services. At the same time, the legislation would only have delayed, not repealed the Affordable Care Act’s Cadillac tax on counties and other entities according to NACo.

Given Congress’s schedule, NACo does not predict the next steps for healthcare reform to emerge until May 2017. For more information about the legislation that was proposed previously and its effect on county governments, see ACA repeal, replacement raises concerns for counties.

Tax Reform

Comprehensive tax reform has been a goal of Speaker Ryan’s for a while, as described by NACo’s tax policy lead. NACo cannot predict, however, whether this year will bring significant tax reform, or not.

There are two primary issues that NACo tracks in the area of tax reform:

  1. The tax exempt status of municipal bonds, and
  2. The state and local tax deduction

Municipal bonds have funded 75% of the nation’s infrastructure over the years, according to NACo. The concern is that the municipal bond interest exemption will be cut or capped through tax reform, threatening the utility of this infrastructure-building tool. For more information, see MACo’s prior coverage on municipal bonds.

The state and local deduction is worth $1.3T over ten years, according to NACo. But the issue is not just the loss of dollars to counties, but also the double-taxation of local residents. Maryland is not one of the handful of states that gains the most from this deduction, according to the Tax Foundation:

The deduction’s effect is for lower- and middle-income taxpayers to subsidize more generous spending in wealthier states like California, New York, and New Jersey, reducing the felt cost of higher taxes in those states.


Trump has stated his interested in an $1T increase in infrastructure, as recently as yesterday morning, according to NACo’s policy lead. NACo has a good relationship with the presidential advisor on infrastructure and NACo’s policy team is meeting with him in-person next week.

According to NACo, infrastructure needs are outstripping the ability to raise revenue nationwide. NACo advocates for the public sector to have a seat at the table as the executive branch explores possibilities for private sector involvement.

On May 16-17th NACo is hosting an infrastructure week fly-in. For more information, look for updates on the NACo website or contact Kevan Stone at NACo.

Screenshot 2017-04-05 09.22.52

Sanctuary Cities and Counties

NACo clarified that U.S. Immigration and Customs Enforcement (ICE) detainer requests are voluntary. If a county honors a detainer request without a court order or established probable cause, the county could be held liable.

Questions that remain:

  1. What is a sanctuary jurisdiction? There is no clear definition.
  2. What can the government do legal to encourage compliance? The question here is whether the federal government withhold grant funds.
  3. What does 8 U.S.C. 1373 require from county governments, if anything? This centers on reporting requirements.

NACo and partner organizations are hosting a webinar April 18, 1pm Eastern Standard Time on this issue. For more information, join the webinar Legal Issues Surrounding the Executive Order on Sanctuary Jurisdictions and see the NACo Analysis.


3,000 Times a Month, Marylanders SAVE With NACo Live Healthy Program

The NACo Live Healthy Program provides your county residents a tool to save on prescription drugs, medical supplies and services, and dental care.

The prescription drug discount card is completely free to the county, and free to your residents. Across 19 Maryland counties, every month more than 3,000 times that card gives residents the best discount available — helping many under-insured and uninsured residents with savings from 15% to 75%.

The additional services are available to residents for a very affordable fee:
Dental Discount Program: $6.95 month or $69 year for individuals. $8.95 month or $79 year for families
Medical Services: $6.95 month or $69 year for individuals. $8.95 month or $79 year for families

Learn more about NACo’s Live Healthy Program, an outstanding benefit to your county’s residents, and completely FREE to your county government!