Department of Health & Mental Hygiene (DHMH)
Employees at State Institutions
The budget committees are concerned that employees in the Department of Health and Mental Hygiene (DHMH) that work with forensic patients are not classified or compensated appropriately. The Forensic Services Workgroup of 2016 recommended that these employees receive reclassifications in order to better recruit and retain these individuals. The budget committees request DHMH to submit a report on the implementation of these recommendations for employees at institutions administered by the Behavioral Health Administration and the Developmental Disabilities Administration.
Office of Health Care Quality
Provided that $100,000 of the general fund appropriation in program M00A01.01 Executive Direction made for the purpose of administration may not be expended until the Department of Health and Mental Hygiene (DHMH) submits a three-year plan to the budget committees outlining how DHMH will fully staff the Office of Health Care Quality. The report should include (1) an analysis of appropriate compensation for recruitment and retention of nurse surveyors; and (2) an assessment of strategies other than salary that the federal government and other states use to retain nurse surveyors. This report shall be submitted by October 1, 2017, and the committees shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and will revert to the General Fund if the report is not submitted.
Explanation: The budget committees are concerned about the safety of the State’s health care facilities regulated by the Office of Health Care Quality with the chronic staffing shortage that plagues the agency. The agency has had large staffing deficits for over a decade that impinge its ability to meet statutory mandates. The committees request that DHMH provide the budget committees with a three-year plan to fully staff the agency to be compliant with its statutory staffing analysis study. The plan is to include an analysis of compensation levels for nurse surveyors, and an analysis of retention strategies other than salary (such as benefits or training opportunities) for nurse surveyors.
DDA
Implementation of New Waivers:
The Department of Health and Mental Hygiene (DHMH) proposes to implement two waiver programs. The community services waiver will provide funding of $25,000 a year per individual to support nonresidential services in the community. People on the waitlist in the crisis resolution and the crisis prevention priority categories would be eligible for this funding. The family support waiver would provide funding of up to $12,000 per family per year for children under the age of 21 and their families to secure supplemental, wraparound services to those provided by the Maryland State Department of Education. Both waivers are pending the approval of the Centers for Medicare and Medicaid Services (CMS). The budget committees request that DHMH submit a report on the status of implementing the two new capped waivers including an update on CMS approval, how many individuals are expected to receive funding by the end of the fiscal year, and if DHMH expects to use all funds budgeted for the program in fiscal 2018. Due Date: December 31, 2017.
Conferees adopted the following language: provided that if the funding for the proposed capped family supports waiver or community supports waivers cannot be utilized in fiscal 2018, the Developmental Disabilities Administration shall use the funding to provide services for individuals on the waitlist.
Report on Direct Support Wages:
The budget committees request that the Department of Health and Mental Hygiene (DHMH) submit a report on wages for direct support workers, including:
- The wage levels needed to ensure a quality direct support workforce in each jurisdiction, taking into account differences in local minimum wages;
- The funding needed to achieve the wage levels; and
- Recommendations to ensure that direct support wages become and remain competitive on an ongoing basis.
PACT Funding
$400,000 of this appropriation intended for the transition from Community Supported Living Arrangements to Personal Supports may not be expended for that purpose and instead may only be sued to provide funding for the PACT Helping Children program
Department of Human Resources (DHR)
Review of Services Available to Parents with Disabilities:
DHR does not remove children from their home solely due to a parent’s disabilities. Caseworkers
work with parents to assess the services needed for a child to remain in the home or to be reunified with their parents if the child has been placed in out-of-home care. DHR has funding for some types of services, such as in-home aide services. The Title IV-E Waiver presents an opportunity to support additional family preservation and post-reunification services including services specific to parents with disabilities. However the committee is concerned about whether adequate resources exist in communities to address the needs of parents with disabilities, including both physical and developmental disabilities, such as alternative styles of parenting courses that address different learning styles of needs. Therefore, the committees request DHR, in consultation with the Maryland Department of Disabilities, submit a report (1) identifying services availability in the community to address family preservation or post-reunification needs for parents with disabilities; (2) identifying gaps in services and options for addressing the gaps; and (3) reviewing best practices in providing family preservation and post-reunification services to parents with disabilities. Report due November 15, 2017.
Budget Amendment: Placement Determinations for Children with Complex Medical Needs
$100,000 of the general fund appropriation within the Department of Human Resources (DHR), $100,000 of the general fund appropriation within the Department of Health and Mental Hygiene (DHMH), and $100,000 of the general fund appropriation within the State Department of Education (MSDE) may not be expended until DHR, DHMH, and MSDE submit a report to the Senate Budget & Taxation Committee, the Senate Finance Committee, the House Appropriations Committee, and the House Health and Government Operations Committee detailing:
- The processes in place to ensure coordination between DHMH, MSDE, DHR, and the hospitals serving children in Maryland to find appropriate community placements for children and adolescents with mental illness, developmental disabilities, or complex medical needs.
- The processes in place to ensure coordination between DHMH, MSDE, DHR, and the hospitals serving children in Maryland to find out-of-home placements for children and adolescents with mental illness, developmental disabilities, or complex medical needs.
- The availability by jurisdiction of the following resources for children and adolescents with mental illness, developmental disabilities or complex medical needs:
- Dedicated child and adolescent impatient psychiatric beds in acute general and specialty hospitals;
- Therapeutic foster care;
- Residential treatment center services;
- Transportation assistance; and
- Any other community-based treatment service designed to meet the needs of children and adolescents with severe mental illness, developmental disabilities, or complex medical needs.
- Recommendations, based on an analysis of the data, to improve community placement processes for children and adolescents with severe mental illness, developmental disabilities, or complex medical needs including availability of treatment options based on the payer, that will facilitate increased community-based care and decrease inpatient lengths of stay beyond what is medically necessary. The report shall be submitted by November 15, 2017, and the budget committees shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and shall revert to the General Fund if the report is not submitted.
Out-of- State Placement Determinations and Monitoring
$100,000 of the general fund appropriation within the DHR, $100,000 of the general fund appropriation within the MSDE, and $100,000 of the general fund appropriation within the Governor’s Office for Children may not be expended until DHR, MSDE, and GOC submit a report to the budget committees detailing:
- The processes in place to determine whether to place children in out-of-state placements when in-state resources cannot meet the needs of the child;
- The processes in place to determine in which out-of-state facilities children are placed;
- The frequency of the review of the out-of-state placement to determine whether or not the needs of the child can be met through an in-state provider;
- The current process in place between DHR and MSDE to ensure that the out-of-state facilities in which children are placed are compliant with the Individuals with Disabilities Education Act;
- The current processes for monitoring children in out-of-state placements and any plans to alter these monitoring practices to ensure the safety of children in out-of-state placements; and
- The resources that would be necessary (both funding and number and type of placements) to move all children in out-of-state placements to in-state placements.
The report shall be submitted by August 15, 2017, and the budget committees shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and shall revert to the General Fund if the report is not submitted.