Monday, January 11, 2016

Subtitle 10.63

Request for Public Hearing

What is Subtitle 10.63?
These are NEW regulations proposed by Maryland Department of Health & Mental Hygiene (DHMH), which were intended to go into effect in December.  We wish to thank our elected officials –specifically, members of the Joint Committee on Administrative, Executive, and Legislative Review (AELR), for putting these regulations on hold while the Committee conducts further review in the public interest. 

Why We Are Requesting a Public Hearing!
These regulations greatly effect Maryland’s Substance Use Disorder (SUD) treatment – treatment capacity, quality of care, affordability, and access to treatment.  Therefore, these regulations impact the lives of consumers and their families –OUR LIVES! 

We need increased treatment capacity, heightened quality of care, greater affordability, and TREATMENT ON DEMAND.  These regulations will:  1) squeeze out small providers –reducing our state’s already strained capacity,  2) further erode state responsibility for providing oversight and accountability for our treatment system,  3) weaken the ability of consumers to hold treatment providers accountable for delivering high quality services,  4) significantly increase overhead costs for providers who will pass these costs on to consumers, and  5) fail to hold SUD programs to the same high quality of care standards that are currently in place for mental health programs.  

A public hearing will give voting constituents a chance to voice their opinions on what matters to them.  We need to INCREASE services, quality, and accountability –NOT DECREASE them! 

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Call & Email: Senate Chair Roger Manno:  (410) 841-3151
AND House Chair Samuel Rosenburg:  (410) 841-3297

Concerns Regarding Subtitle 10.63
For Further Information Contact Heroin Action Coalition at 301-525-6183
  • Accreditation is costly.  DHMH reports that the economic impact on “regulated industries” is “indeterminable”.  Conversely, small treatment providers report that the high costs will force them to shut down or sell out to “big business” providers.  DHMH must determine the economic impact on small providers and negate harmful consequences.  DHMH reports that the “direct and indirect effects on the public” will be “none”.  However, losing treatment beds will have a significant negative impact.  Subtitle 63 –Notice of Proposed Actions must accurately reflect effects on the public!

  • Regulation recognizes the Health Insurance Portability and Accountability Act (HIPAA).  However, regulations for mental health programs have long charged staff with explaining and obtaining “proper consent”, which allows family members to assist with aftercare planning and other important treatment decisions, as well as notifying “next-of-kin” when a patient is discharged.  An equivalent regulation for SUD treatment providers must be included.

  • Regulation disallows certain programs from “excluding or discriminating against” an individual who receives “opioid treatment services.”  While this sounds good, it potentially forces Abstinence-Based Residential Treatment (ABRT) programs to accept Medicated Assisted Treatment (MAT) clients (often on excessively high daily doses of methadone).  This policy fails to acknowledge that a primary component of the ABRT model is that formerly opiate-dependent patients rely on peer culture to abstain from (not use) opiates.  While the harm reduction model is certainly valid for those who choose that path of recovery, others in recovery have the right to choose a ‘peer-supported abstinence’ model.  Forcing ABRT providers to compromise their programs by mandating them to enroll individuals who are using opiates, albeit legally, threatens the foundation on which this treatment approach is based.  This policy assumes that ABRT is simply “recovery housing” –rather than a treatment model in and of itself.  Currently, financial incentives are used to force ABRT programs to accept clients who potentially undermine everyone else’s treatment, claiming that it is “discriminatory” not to.  This, in effect, promotes one form of treatment over another –thereby limiting, or perhaps ultimately eliminating CONSUMER CHOICE!  Regulations must support CONSUMER CHOICE!

  • Regulation states that “an opioid treatment service is one that …uses pharmacological interventions …as part of treatment, support, and recovery services.”  It is not clear whether evidence-based holistic, alternative treatment modalities that do not use medications will be compliant.  Regulations should not promote any single treatment modality or limit consumer choice!

  • Regulation mandates that “psychiatric rehabilitation program[s] for adults” provide “recovery services and supports”. A client’s "rehabilitation assessment" includes their need for housing and employment, mobility and transportation, social relationships and leisure activities, education and vocational training.  Include an equivalent regulation for SUD programs.

  • Regulation outlines provisions for residential level 3.1 programs (halfway houses), but fails to provide a directive for higher level 3.5-3.7 programs (detox) to refer clients assessed as needing a 3.1 level of care into them.  Instead, these clients are routinely referred to unregulated sober living houses, homeless shelters, and other non-treatment environments, with little regard for whether these placements meet the client’s ASSESSED needs.  Regulations MUST ensure that providers make a distinction between housing options and treatment options.  These regulations must address the referral process.

  • Similarly, regulation specifies that programs must “provide care and services that are adequate, appropriate, and in compliance with relevant State, local, and federal laws and regulations”, but fails to specify that what is “adequate and appropriate” is spelled out in the patient’s ASAM ASSESSMENT.  Regulations MUST authorize providers to make client referrals to programs that match a client’s assessed needs.  Only then, is there any assurance that the client will actually receive services that are “adequate and appropriate”.

  • Regulation, dealing with SUD assessment programs, fails to specify that consumers can request a copy of their own assessment from the assessing entity at no charge.  Consumers have a right to have copies of all treatment records.

  • Regulation stipulates that Residential Rehabilitation Programs (RRPs) that offer mental health services must implement a “managed intervention plan (MIP) for an individual …who may be at risk of an unplanned discharge”.  This plan is to include “individualized services and supports” (medication?), and “identification of temporary residential alternatives”. Unplanned SUD discharges place individuals at extremely high risk of fatal overdose (2 recent deaths).  Include the equivalent for SUD programs.

  • Regulation states that providers must have a grievance process –particularly regarding discharge or a change in services, but does not provide a directive for holding providers accountable for compliance, nor specifies a time frame for resolution.  In comparison, mental health regulations have historically outlined a very detailed resident grievance process with four stages, including mandatory meetings, written responses from program directors within specific time parameters, remedy and appeal guidelines, reviews by various committees, and reporting requirements.  Include an equivalent regulation for SUD programs.

  • Regulation, dealing with SUD programs in correctional facilities, is listed within a section that purportedly outlines “Descriptions and Criteria for Programs and Services”.  However, the only criteria noted is the requirement for “a license to operate”. MD taxpayers spend $836 million on incarceration and the #1 crime is possession w/ intent.  Regulations must provide robust and comprehensive guidelines to ensure that ‘treatment behind bars’ is evidenced-based with demonstrated successful outcomes.

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