# Health - General (GHG)

## Title 7.5. Behavioral Health Administration

### Subtitle 1. Definitions; General Provisions

#### Section 7.5-101

(a) In this title the following words have the meanings indicated.

(b)

  (1) "Addictive disorder" means a chronic disorder of the brain's reward-activation system in which  the individual pathologically pursues reward or relief by substance use or other behaviors, with diminished control, and the individual persists in the behavior despite adverse consequences.

  (2) "Addictive disorder" includes gambling, which is the only nonsubstance-related addictive disorder recognized by Maryland law.

(c) "Administration" means the Behavioral Health Administration.

(d) "Behavioral health" includes substance-related disorders, addictive disorders, and mental disorders.

(e) "Behavioral health care" includes prevention, screening, early intervention, treatment, recovery, support, wraparound, and rehabilitation services, for individuals with substance-related disorders, addictive disorders, mental disorders, or a combination of these disorders.

(f) "Behavioral health program" means a substance-related disorders program, a mental health program, or an addictive disorders program, or a program that consists of more than one of these programs.

(g) "Core service agency" means the designated county or multicounty authority that is responsible for planning, managing, and monitoring publicly funded mental health services.

(h) "Director" means the Director of the Administration.

(i) "Family support services" means a set of nonclinical activities provided by family members of individuals with mental health or substance-related disorders and addictive disorders to support individuals with mental health or substance-related disorders and addictive disorders or their families.

(j) "Local addictions authority" means the designated county or multicounty authority that is responsible for planning, managing, and monitoring publicly funded substance-related disorders and addictive disorder services.

(k) "Local behavioral health authority" means the designated county or multicounty authority that is responsible for planning, managing, and monitoring publicly funded mental health, substance-related disorder, and addictive disorder services.

(l)

  (1) "Mental disorder" means a behavioral or emotional illness that results from a psychiatric  disorder.

  (2) "Mental disorder" includes a mental illness that so substantially impairs the mental or emotional functioning of an individual as to make care or treatment necessary or advisable for the welfare of the individual or for the safety of the person or property of another.

  (3) "Mental disorder" does not include an intellectual disability.

(m) "Mental health program" means a set of services that consists of community-based treatment, care, or rehabilitation services, or any combination of these, for individuals with a mental disorder.

(n) "Peer support services" means a set of nonclinical activities provided by individuals in recovery from mental disorders, substance-related disorders, or addictive disorders who use their personal, lived experiences and training to support other individuals with mental disorders, substance-related disorders, or addictive disorders.

(o) "Recovery residence" means a service that:

  (1) Provides alcohol-free and illicit-drug-free housing to individuals with substance-related disorders or addictive disorders or co-occurring mental disorders and substance-related disorders or addictive disorders; and

  (2) Does not include clinical treatment services.

(p)

  (1) "Substance-related disorder" means:

    (i) An alcohol use disorder, alcohol abuse, alcohol dependence, alcohol misuse, alcohol intoxication, or alcohol withdrawal;

    (ii) A nonalcohol substance use disorder, drug dependence, drug misuse, nonalcohol substance induced intoxication, or nonalcohol substance withdrawal; or

    (iii) Any combination of the disorders listed in items (i) and (ii) of this paragraph.

  (2) "Substance-related disorder" includes substance use disorders and substance induced disorders.

(q) "Substance-related disorders program" means a set of services that:

  (1) Are community-based, including those services provided by the State or any of its political subdivisions; and

  (2) Consist of:

    (i) Any combination of treatment, care, or rehabilitation for individuals with a substance-related disorder; or

    (ii) Education for individuals known to be at risk of developing substance-related disorders.

### Subtitle 2. Behavioral Health Administration

#### Section 7.5-201

There is a Behavioral Health Administration in the Department. 

#### Section 7.5-202

(a) The head of the Administration is the Director and shall be appointed by the Secretary.

(b) The Director serves at the pleasure of the Secretary.

(c) The Director is entitled to the salary provided in the State budget.

#### Section 7.5-203

(a)

  (1) The Director exercises the powers, duties, and responsibilities of office subject to the authority of the Secretary.

  (2) The Director shall report to the Deputy Secretary for Behavioral Health.

(b) The Secretary may exercise any power or perform any duty of the Administration.

#### Section 7.5-204

(a) The Director is responsible for carrying out the powers, duties, and responsibilities of the Administration.

(b) In addition to the powers set forth elsewhere in this title, the Director may:

  (1) Within the amounts made available by appropriation or grant, make any agreement or joint financial arrangement to do or have done anything necessary, desirable, or proper to carry out the purposes of this title and Titles 8 and 10 of this article;

  (2) Organize and manage the Administration in a manner that will enable it best to discharge the duties of the Administration;

  (3) Appoint the number of assistant directors and staff provided for in the State budget;

  (4) Remove an assistant director for incompetence or misconduct; and

  (5) Unless expressly provided otherwise by law, assign to any subordinate unit or individual in the Administration any function that is imposed by law on the Director.

(c) In addition to the duties set forth elsewhere in this title, the Director shall do anything necessary or proper to carry out the scope of this title and Titles 8 and 10 of this article.

(d) It is the policy of the State that the Director may collaborate with other State agencies to promote coordinated care and treatment of individuals who have behavioral health disorders.

#### Section 7.5-205

(a) The Secretary shall provide facilities for the care and treatment of individuals who have mental disorders.

(b) The Administration shall:

  (1) Supervise the custody, care, and treatment of individuals in State facilities who have mental disorders;

  (2) Provide oversight of community-based services for persons with behavioral health disorders; and

  (3) Establish programs for research and development of care and treatment for individuals who have behavioral health disorders.

(c) The Administration may provide funds for a public or nonprofit organization to carry out pilot or demonstration projects relating to individuals who have behavioral health disorders.

(d) The Secretary shall adopt regulations to carry out the provisions of this title and Titles 8 and 10 of this article, including provisions for the issuance of licenses.

#### Section 7.5-205.1

(a) The Administration may establish an outpatient civil commitment pilot program to allow for the release of an individual who is involuntarily admitted for inpatient treatment under Sec. 10-632 of this article on condition of the individual's admission into the pilot program.

(b) If the Administration establishes a pilot program under subsection (a) of this section, the Administration shall:

  (1) Adopt criteria an individual must meet in order to be admitted into the pilot program;

  (2) Establish application, hearing, and notice requirements;

  (3) Specify the rights of an individual who may be or who has been admitted into the pilot program;

  (4) Allow an eligible individual to request enrollment into the pilot program; and

  (5) Allow an immediate family member of an eligible individual to request that the individual be voluntarily enrolled into the pilot program.

(c) If the Administration establishes a pilot program under subsection (a) of this section, on or before December 1 each year the pilot program is in existence, the Administration shall submit to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with Sec. 2-1257 of the State Government Article, a report that includes:

  (1) The number of individuals admitted into the pilot program during the immediately preceding 12-month period;

  (2) The number of applications for admission into the pilot program submitted during the immediately preceding 12-month period;

  (3) The cost of administering the pilot program for the immediately preceding 12-month period;

  (4) For individuals admitted into the program voluntarily and involuntarily:

    (i) The percentage of individuals admitted into the pilot program who adhered to the treatment plan established for the individual under the pilot program;

    (ii) Treatment outcomes; and

    (iii) The type, intensity, and frequency of services provided to individuals admitted into the pilot program; and

  (5) Any other information that may be useful in determining whether a permanent outpatient civil commitment program should be established.

#### Section 7.5-206

No otherwise-qualified individual with a behavioral health disorder, solely by reason of the individual's status as an individual with a behavioral health disorder, shall be denied the services of, or be subjected to discrimination by, any public or private hospital or community-based treatment program.

#### Section 7.5-207

(a) Subject to subsection (b) of this section, the Administration shall establish crisis treatment centers that provide individuals who are in a mental health or substance use disorder crisis with access to clinical staff who:

  (1) Perform assessments and level of care determinations 24 hours a day and 7 days a week; and

  (2) Connect the individuals to care immediately.

(b) At least one crisis treatment center shall be established on or before June 1, 2018.

(c) The Administration shall establish the crisis treatment centers required under subsection (a) of this section in a manner that is consistent with the strategic plan developed by the Behavioral Health Advisory Council, as required by Chapters 405 and 406 of the Acts of the General Assembly of 2016.

(d) On or before September 1, 2017, and on or before September 1 each year thereafter until the Administration establishes the crisis treatment centers required under subsection (a) of this section, the Administration shall submit, in accordance with Sec. 2-1257 of the State Government Article, a report on the status of the establishment of crisis treatment centers under this section to the Joint Committee on Behavioral Health and Opioid Use Disorders.

#### Section 7.5-208

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Mobile crisis team" has the meaning stated in Sec. 10-1401 of this article.

  (3) "Program" means the Behavioral Health Crisis Response Grant Program.

(b)

  (1) There is a Behavioral Health Crisis Response Grant Program in the Department.

  (2) The purpose of the Program is to provide funds to local jurisdictions to establish and expand community behavioral health crisis response systems.

(c) The Department shall administer the Program.

(d)

  (1) The Program shall award competitive grants to local behavioral health authorities to establish and expand behavioral health crisis response programs and services that:

    (i) Serve local behavioral health needs for children, adults, and older adults;

    (ii) Meet national standards;

    (iii) Integrate the delivery of mental health and substance use treatment; and

    (iv) Connect individuals to appropriate community-based care in a timely manner on discharge.

  (2) Funds distributed to a local behavioral health authority under the Program:

    (i) May be used to establish or expand behavioral health crisis response programs and services, such as:

      (1) Mobile crisis teams;

      (2) On-demand walk-in services;

      (3) Crisis residential beds; and

      (4) Other behavioral health crisis programs and services that the Department considers eligible for Program funds; and

    (ii) Shall be used to supplement, and not supplant, any other funding for behavioral health crisis response programs and services.

  (3) A local behavioral health authority may submit a proposal requesting Program funding to the Department.

  (4) In awarding grants under this section, the Department shall prioritize proposals that:

    (i) Make use of more than one funding source;

    (ii) Demonstrate efficiency in service delivery through regionalization, integration of the behavioral health crisis program or service with existing public safety and emergency resources, and other strategies to achieve economies of scale;

    (iii) Serve all members of the immediate community with cultural competency and appropriate language access;

    (iv) Commit to gathering feedback from the community on an ongoing basis and improving service delivery continually based on this feedback;

    (v) Demonstrate strong partnerships with community services that include family member and consumer advocacy organizations and regional stakeholders;

    (vi) Evidence a plan of linking individuals in crisis to peer support and family support services after stabilization; and

    (vii) Evidence a strong plan for integration into the existing behavioral health system of care and supports to provide seamless aftercare.

  (5) In awarding grants under this section, the Department shall require that proposals contain response standards that prioritize mobile crisis units over law enforcement when responding to individuals in crisis.

  (6) For each service or program that receives funding under the Program, a local behavioral health authority shall report to the Department and make available to the public all:

    (i) Outcome measurement data required by the Department; and

    (ii) Public feedback received from the community through a combination of surveys, public comments, town hall meetings, and other methods.

  (7) The Department shall establish:

    (i) Application procedures;

    (ii) A statewide system of outcome measurement to:

      (1) Assess the effectiveness and adequacy of behavioral health crisis response services and programs; and

      (2) Produce data that shall be:

      (A) Collected, analyzed, and publicly reported back at least annually; and

      (B) Disaggregated by race, gender, age, and zip code;

    (iii) Guidelines that require programs to bill third-party insurers and, when appropriate, the Maryland Medical Assistance Program; and

    (iv) Any other procedures or criteria necessary to carry out this section.

(e) The Governor shall include in the annual operating budget bill the following amounts for the Program:

  (1) $3,000,000 for fiscal year 2020;

  (2) $4,000,000 for fiscal year 2021;

  (3) $5,000,000 for fiscal year 2022;

  (4) $5,000,000 for fiscal year 2023;

  (5) $5,000,000 for fiscal year 2024;

  (6) $5,000,000 for fiscal year 2025; and

  (7) $5,000,000 for each of fiscal years 2027 through 2029.

(f) Beginning in fiscal year 2023, at least one-third of the appropriation required under subsection (e) of this section shall be used to award competitive grants for mobile crisis teams.

(g) On or before December 1 each year beginning in 2020, the Department shall submit to the Governor and, in accordance with Sec. 2-1257 of the State Government Article, to the General Assembly a report that includes, for the most recent closed fiscal year:

  (1) The number of grants distributed;

  (2) Funds distributed by county;

  (3) Information about grant recipients and programs and services provided; and

  (4) Outcome data reported under the statewide system of measurement required in subsection (d)(7)(ii) of this section.

#### Section 7.5-209

(a) In consultation with interested stakeholders, the Director shall prepare an annual report on behavioral health services for children and young adults in the State.

(b) The report shall include:

  (1) The number and the percentage of children and young adults who, during the reported year:

    (i) Were eligible for public behavioral health services;

    (ii) Used a public behavioral health service, including:

      (1) An outpatient service;

      (2) An inpatient service;

      (3) An emergency room service;

      (4) A residential treatment center service;

      (5) An intensive public behavioral health service, including targeted or mental health case management services, respite care services, services provided under Sec. 1915(i) of the Social Security Act, and psychiatric rehabilitation services; and

      (6) A substance-related disorders program service; and

    (iii) Used a public behavioral health service provided through telehealth;

  (2) The total expenditure and expenditure per child and young adult using a public behavioral health service, including:

    (i) An outpatient service;

    (ii) An inpatient service;

    (iii) An emergency room service;

    (iv) A residential treatment center service;

    (v) An intensive community service; and

    (vi) A substance-related disorders program service;

  (3) The total cost per child or young adult for all behavioral health services provided to the child or young adult;

  (4) The total expenditure and expenditure per child and young adult for:

    (i) Targeted case management services;

    (ii) Respite care services;

    (iii) Services provided through a plan under Sec. 1915(i) of the Social Security Act; and

    (iv) Psychiatric rehabilitation services;

  (5) The median length of time children and young adults spent:

    (i) In the hospital emergency room pending psychiatric inpatient hospitalization; and

    (ii) Waiting for placement in a residential treatment center from the date of the referral, as determined by the referral source, to the date of the placement;

  (6) The number of children and young adults who were readmitted within 30 days at:

    (i) The same hospital;

    (ii) The same residential treatment center; or

    (iii) Any other hospital or residential treatment center;

  (7) The median length of stay for children and young adults at:

    (i) A residential treatment center;

    (ii) A psychiatric unit at a hospital; and

    (iii) A residential substance-related disorders program; and

  (8) For residential treatment centers:

    (i) The total number of children and young adults admitted during the report year; and

    (ii) The total number of children and young adults discharged

    during the report year.

(c) The report shall group the information required under subsection (b) of this section by jurisdiction and by the following age groups:

  (1) Birth through 6 years old;

  (2) 7 through 12 years old;

  (3) 13 through 17 years old;

  (4) 18 through 21 years old; and

  (5) 22 through 25 years old.

(d) The report shall group the information required under subsection (b) of this section by the following races and ethnic groups:

  (1) Hispanic or Latino of any race; and

  (2) For individuals who are non-Hispanic or non-Latino:

    (i) American Indian or Alaskan Native;

    (ii) Asian;

    (iii) Black or African American;

    (iv) Native Hawaiian or other Pacific Islander;

    (v) White; or

    (vi) Two or more races.

(e) On or before December 1 each year, the Director shall submit the report required under this section to the Governor and, in accordance with Sec. 2-1257 of the State Government Article, the General Assembly.

#### Section 7.5-210

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Eligible individual" means:

    (i) A service member;

    (ii) A veteran;

    (iii) The spouse of a service member or veteran;

    (iv) A child of a service member or veteran; or

    (v) A stepchild of a service member or veteran.

  (3) "Program" means the Sheila E. Hixson Behavioral Health Services Matching Grant Program for Service Members and Veterans.

(b)

  (1) There is a Sheila E. Hixson Behavioral Health Services Matching Grant Program for Service Members and Veterans.

  (2) The purpose of the Program is to provide funds to local nonprofit organizations to establish and expand community behavioral health programs to serve service members, veterans, and their families.

(c) The Department shall administer the Program.

(d) The Program shall award competitive matching grants to local nonprofit organizations to establish and expand community behavioral health programs that:

  (1) Serve the behavioral health needs of eligible individuals in the locality served by the nonprofit organization;

  (2) Meet national standards;

  (3) Integrate the delivery of mental health and substance use treatment; and

  (4) Connect eligible individuals to appropriate community-based care in a timely manner on discharge from the community behavioral health program.

(e)

  (1) To be eligible for a grant from the Program, a nonprofit organization must have a mission to:

    (i) Provide behavioral health services; or

    (ii) Provide services to active service members, veterans, or their families.

  (2) An eligible nonprofit organization shall secure contributions for the proposal in an amount of money or other consideration at least equal in value to the amount of money requested from the Program.

  (3)

    (i) In awarding matching grants under the Program, the Department shall develop selection criteria for evaluating applicant proposals.

    (ii) The selection criteria developed under this paragraph shall include positive scoring for proposals that:

      (1) Demonstrate fiscal controls, including by making use of multiple sources of funding;

      (2) Evidence project effectiveness, including by showing how the grant awarded by the Program will be used to augment existing services to create seamless behavioral health treatment;

      (3) Show an applicant's previous successful experience administering grants; and

      (4) Meet any other criteria the Department considers relevant.

    (iii) In awarding matching grants under this section, the Department shall give priority to proposals that best meet the selection criteria regardless of the projected cost.

  (4) The Department shall establish application procedures that implement the requirements of this subsection.

(f)

  (1) The Department shall establish a statewide system of outcome measurement to assess the effectiveness and adequacy of services provided by each nonprofit organization receiving a matching grant under the Program.

  (2) A nonprofit organization receiving a matching grant under the Program shall submit any information that the Department determines is necessary for the statewide system of outcome measurement.

(g) The Department shall establish:

  (1) Guidelines that require nonprofit organizations that receive a matching grant under the Program to bill third-party insurers and, when appropriate, the Maryland Medical Assistance Program; and

  (2) Any other procedures necessary to carry out this section.

(h) Beginning in fiscal year 2022, and each fiscal year thereafter, the Governor may include in the annual budget bill an appropriation of $2,500,000 for the Program.

(i) On or before December 1 each year, beginning in 2023, the Department shall submit to the Governor and, in accordance with Sec. 2-1257 of the State Government Article, the General Assembly a report that includes, for the most recently closed fiscal year:

  (1) The number of grants distributed;

  (2) Funds distributed by county;

  (3) Information about grant recipients and the services provided through grant funding; and

  (4) Outcome data reported under the statewide system of measurement required under subsection (f) of this section.

### Subtitle 3. Behavioral Health Programs

#### Section 7.5-301

In this subtitle, "Council" means the Behavioral Health Advisory Council.

#### Section 7.5-302

There is a Behavioral Health Advisory Council in the Office of the Governor.

#### Section 7.5-303

(a)

  (1) The Council consists of the following members:

    (i) One member of the Senate of Maryland, appointed by the President of the Senate;

    (ii) One member of the House of Delegates, appointed by the Speaker of the House;

    (iii) Five representatives of the Department, including:

      (1) The Secretary, or the Secretary's designee;

      (2) The Deputy Secretary for Behavioral Health, or the Deputy Secretary's designee;

      (3) The Deputy Secretary for Developmental Disabilities, or the Deputy Secretary's designee;

      (4) The Executive Director of the Maryland Health Benefit Exchange, or the Executive Director's designee; and

      (5) The Deputy Secretary for Health Care Financing, or the Deputy Secretary's designee;

    (iv) The Secretary of Aging, or the Secretary's designee;

    (v) The Secretary of Budget and Management, or the Secretary's designee;

    (vi) The Secretary of Disabilities, or the Secretary's designee;

    (vii) The Secretary of Housing and Community Development, or the Secretary's designee;

    (viii) The Secretary of Human Services, or the Secretary's designee;

    (ix) The Secretary of Juvenile Services, or the Secretary's designee;

    (x) The Secretary of Public Safety and Correctional Services, or the Secretary's designee;

    (xi) The Secretary of Labor, or the Secretary's designee;

    (xii) The Executive Director of the Governor's Office of Crime Prevention and Policy, or the Executive Director's designee;

    (xiii) The Director of the Governor's Office of the Deaf, Deafblind, and Hard of Hearing, or the Director's designee;

    (xiv) The Public Defender of Maryland, or the Public Defender's designee;

    (xv) Two representatives of the State Superintendent of Schools, or the Superintendent's designee, and the Assistant State Superintendent of the Division of Rehabilitation Services, or the Assistant State Superintendent's designee;

    (xvi) Two representatives of the Maryland Judiciary, a District Court judge, and a circuit court judge, appointed by the Chief Justice of the Supreme Court of Maryland;

    (xvii) The Executive Director of the Maryland Association of Behavioral Health Authorities, or the Executive Director's designee;

    (xviii) The President of the Maryland Association of County Health Officers, or the President's designee;

    (xix) Four representatives from county behavioral health advisory councils, one from each region of the State;

    (xx) One representative, appointed by the Secretary of Health, from each of the following organizations:

      (1) Community Behavioral Health Association;

      (2) Maryland Center of Excellence on Problem Gambling;

      (3) Maryland Addictions Director's Council;

      (4) Maryland Association for the Treatment of Opioid Dependence;

      (5) Maryland Black Mental Health Alliance;

      (6) Maryland Coalition of Families;

      (7) Disability Rights Maryland;

      (8) Maryland Recovery Organization Connecting Communities;

      (9) Mental Health Association of Maryland;

      (10) National Alliance on Mental Illness of Maryland;

      (11) National Council on Alcoholism and Drug Dependence of Maryland;

      (12) On Our Own of Maryland; and

      (13) Maryland Association of Boards of Education; and

    (xxi) Two individuals representing the mental health and substance use disorder treatment community, appointed by the Governor from each of the following:

      (1) Academic or research professionals who are not State employees;

      (2) Medical professionals;

      (3) Individuals formerly or currently in receipt of behavioral health services;

      (4) Family members of individuals with mental health or substance use disorders;

      (5) A parent of a young child with behavioral health disorders;

      (6) A youth with a behavioral health disorder who is between the ages of 16 and 25 years; and

      (7) Individuals active in behavioral health issues within their community.

  (2) Additional representatives or individuals designated by the Council shall be appointed by the Secretary.

(b) Members appointed by the Governor under subsection (a)(1)(xxi) of this section shall be representative, to the extent practicable, of:

  (1) Geographic regions of the State;

  (2) At-risk populations;

  (3) Ethnic, gender, across-the-lifespan, and cultural diversity; and

  (4) Balanced representation from areas of mental health and substance use disorders.

(c) The Council shall appoint a chair from among the membership of the Council.

(d)

  (1) Members appointed by the Governor under subsection (a)(1)(xxi) of this section:

    (i) Serve a 4-year term;

    (ii) May serve for a maximum of two consecutive terms;

    (iii) After at least 6 years have passed since serving, may be reappointed for terms that comply with items (i) and (ii) of this paragraph;

    (iv) At the end of a term, continue to serve until a successor is appointed and qualifies; and

    (v) If appointed after a term has begun, serve only for the rest of the term and until a successor is appointed and qualifies.

  (2) Ex officio members serve as long as the member holds the specified office or designation.

  (3) Notwithstanding any other provisions of this subsection, all members serve at the pleasure of the Governor.

(e) With the consent of the Council, the chair may designate additional individuals with relevant expertise to serve on a committee or task force.

#### Section 7.5-304

(a)

  (1) The Council may adopt procedures necessary to do business, including the creation of committees or task forces.

  (2) The Council may consult with State agencies to carry out the duties of the Council.

  (3) The Council shall meet at least six times a year.

  (4) A majority of the voting members of the Council is a quorum.

(b) A member of the Council:

  (1) May not receive compensation as a member of the Council; but

  (2) Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.

(c) The Behavioral Health Administration shall provide one full-time project manager for administrative coordination, and other staff as necessary to support the functions of the Council.

#### Section 7.5-305

The Council shall:

(1) Promote and advocate for:

  (i) Planning, policy, workforce development, and services to ensure a coordinated, quality system of care that is outcome-guided and that integrates prevention, recovery, evidence-based practices, and cost-effective strategies that enhance behavioral health services across the State; and

  (ii) A culturally competent and comprehensive approach to publicly funded prevention, early intervention, treatment and recovery services that support and foster wellness, recovery, resiliency, and health for individuals who have behavioral health disorders and their family members; and

(2) Submit, in coordination with the Commission on Behavioral Health Care Treatment and Access, an annual report to the Governor and, in accordance with Sec. 2-1257 of the State Government Article, the General Assembly on or before December 31 of each year.

### Subtitle 4

#### Section 7.5-401

(a) Except as otherwise provided in this section, a behavioral health program shall be licensed by the Secretary before program services may be provided in this State.

(b) The Secretary may exempt the following persons from the licensure requirements of this section:

  (1) A health professional, in either solo or group practice, who is licensed under the Health Occupations Article and who is providing mental health or substance-related disorder services according to the requirements of the appropriate professional board;

  (2) Alcoholics Anonymous, Narcotics Anonymous, recovery residences, peer support services, family support services, or other similar organizations, if the organization holds meetings or provides support services but does not provide any type of treatment;

  (3) An employees' assistance program of a business entity;

  (4) Outpatient behavioral health treatment and rehabilitation services provided in a regulated space in a hospital, as defined in Sec. 19-301 of this article, if the services are accredited by an approved accreditation organization under its behavioral health standards; or

  (5) A private therapeutic group home as defined in Sec. 10-920 of this article.

#### Section 7.5-402

(a) Regulations adopted under this subtitle shall include:

  (1) The requirements for licensure of a behavioral health program, including a requirement that the behavioral health program:

    (i)

      (1) Establish and implement a safety plan for the safety of the individuals served by the behavioral health program; or

      (2) Implement a safety or emergency plan established for the program for another purpose; and

    (ii) Revise the safety plan not less than every 5 years;

  (2) The process for a behavioral health program to apply for a license;

  (3) A description of the behavioral health programs that are required to be licensed;

  (4) Any requirements for the governance of a behavioral health program, including:

    (i) A provision prohibiting a conflict of interest between the interests of the provider and those of the individual receiving services;

    (ii) A provision authorizing a behavioral health program licensed as an outpatient mental health center to satisfy any regulatory requirement that the medical director be on site through the use of telehealth by the director; and

    (iii) A provision authorizing a psychiatric nurse practitioner to serve as a medical director of an outpatient mental health center accredited in accordance with COMAR 10.63.03.05, including through telehealth;

  (5) Provisions for inspections of a behavioral health program, including inspection and copying of the records of a behavioral health program in accordance with State and federal law; and

  (6) Provisions for denials, sanctions, suspensions, and revocations of licenses, including imposition of civil monetary penalties, and notice and an opportunity to be heard.

(b)

  (1) The Secretary may require a behavioral health program to be granted accreditation by an accreditation organization approved by the Secretary under Title 19, Subtitle 23 of this article as a condition of licensure under regulations adopted under this subtitle.

  (2) By becoming licensed in accordance with paragraph (1) of this subsection, a program agrees to comply with all applicable standards of the accreditation organization.

  (3) If a behavioral health program is required to be granted accreditation as a condition of licensure under paragraph (1) of this subsection and the accreditation organization requires the behavioral health program to adopt a community relations plan, the behavioral health program shall submit the community relations plan to the Administration.

(c) Regulations adopted under this subtitle may include provisions setting reasonable fees for applying for a license and for the issuance and renewal of licenses.

(d) The Administration may authorize a behavioral health program to satisfy the safety plan requirement under subsection (a)(1) of this section by implementing a safety plan established for the behavioral health program for another purpose.

(e) The Department shall adopt regulations under this subtitle that establish food service facility standards that are appropriate to residential programs that have fewer than 17 residents and are licensed under:

  (1) COMAR 10.63.03.11;

  (2) COMAR 10.63.03.12;

  (3) COMAR 10.63.03.13; or

  (4) COMAR 10.63.03.14.

#### Section 7.5-403

Each individual served by a behavioral health program is entitled to the rights that are:

(1) Identified in the behavioral health program's accreditation standards; or

(2) Established for nonaccredited behavioral health programs by the Department in regulations.

#### Section 7.5-404

(a) An individual or organization may not operate a behavioral health program in violation of this subtitle.

(b) An individual or organization that operates a behavioral health program without the license required by this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $10,000 for each violation.

(c) The Department may file for and pursue an injunction to prevent an individual or organization from operating a behavioral health program without the license required by this subtitle.

### Subtitle 5. Referrals to Recovery Residences

#### Section 7.5-501

(a) The Department shall establish and operate a toll-free Health Crisis Hotline 24 hours a day and 7 days a week.

(b) The Health Crisis Hotline shall assist callers by:

  (1) Conducting a comprehensive evidence-based screening for mental health and substance use needs, cognitive or intellectual functioning, infectious disease, and acute somatic conditions;

  (2) Conducting a risk assessment for callers experiencing an overdose or potentially committing suicide or a homicide;

  (3) Connecting callers to an emergency response system when indicated;

  (4) Referring callers for ongoing care; and

  (5) Following up with callers to determine if the needs of callers were met.

(c) The Department shall collect and maintain the following information to provide to callers on the Health Crisis Hotline:

  (1) The names, telephone numbers, and addresses of:

    (i) Residential, inpatient, and outpatient substance use disorder and mental health programs, including information on private programs and programs administered by local health departments and other public entities; and

    (ii) Hospitals, including hospital emergency rooms, and other facilities that provide detoxification services;

  (2) The levels of care provided by the programs, hospitals, and facilities identified under item (1) of this subsection; and

  (3) Whether the programs, hospitals, and facilities identified under item (1) of this subsection:

    (i) Accept payment for services from a third-party payor, including Medicare, Medicaid, and private insurance; and

    (ii) Provide services:

      (1) That are specific to pregnant women;

      (2) That are gender specific;

      (3) For individuals with co-occurring disorders;

      (4) To support parents of children with substance use and mental health disorders; and

      (5) For grief support.

(d)

  (1) The Department shall provide training for Health Crisis Hotline staff who assist callers on the Health Crisis Hotline to ensure that staff are able to provide sufficient information and respond appropriately to callers who may be in a crisis.

  (2) To the extent practicable, the Department shall ensure that information provided to callers on the Health Crisis Hotline is up to date and accurate.

(e) The Department shall disseminate information about the Health Crisis Hotline to the public, both directly and through public and private organizations that serve the public.

### Subtitle 5A. 9-8-8 Trust Fund

#### Section 7.5-5A-01

(a) In this subtitle the following words have the meanings indicated.

(b) "Commercial mobile radio service" or "CMRS" means mobile telecommunications service that is:

  (1) Provided for profit with the intent of receiving compensation or monetary gain;

  (2) An interconnected, two-way voice service; and

  (3) Available to the public.

(c) "Commercial mobile radio service provider" or "CMRS provider" means a person authorized by the Federal Communications Commission to provide CMRS in the State.

(d) "Consumer" means a person that purchases prepaid wireless telecommunications service in a retail transaction.

(e) "Fund" means the 9-8-8 Trust Fund.

(f) "Lifeline program" means the federal Lifeline program established by the Federal Communications Commission.

(g) "Prepaid wireless telecommunications service" means a commercial mobile radio service that:

  (1) Allows a consumer to dial 9-8-8 to access the 9-8-8 system;

  (2) Must be paid for in advance; and

  (3) Is sold in predetermined units that decline with use in a known amount.

(h) "Retail transaction" means the purchase of prepaid wireless telecommunications service from a seller for any purpose other than resale.

(i) "Telephone company" has the meaning stated in Sec. 1-101 of the Public Utilities Article.

#### Section 7.5-5A-02

(a) There is a 9-8-8 Trust Fund.

(b) The purpose of the Fund is to provide reimbursement for costs associated with:

  (1) Designating and maintaining 9-8-8 as the universal telephone number for a national suicide prevention and mental health crisis hotline in accordance with the federal National Suicide Hotline Designation Act of 2020; and

  (2) Developing and implementing a statewide initiative for the coordination and delivery of the continuum of behavioral health crisis response services in the State, including:

    (i) Crisis call centers;

    (ii) Mobile crisis team services;

    (iii) Crisis stabilization centers; and

    (iv) Other acute behavioral health care services.

(c) The Department shall administer the Fund.

(d)

  (1) The Fund is a special, nonlapsing fund that is not subject to Sec. 7-302 of the State Finance and Procurement Article.

  (2) The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.

(e) The Fund consists of:

  (1) Money from the 9-8-8 fee collected and remitted to the Comptroller under Sec. 7.5-5A-03.1 of this subtitle;

  (2) Money appropriated in the State budget to the Fund;

  (3) Interest earnings of the Fund; and

  (4) Any other money from any other source accepted for the benefit of the Fund.

(f) The Fund may be used only for:

  (1) Carrying out the purpose of the Fund; and

  (2) Any related administrative expenses of the Comptroller.

(g)

  (1) The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.

  (2) Any interest earnings of the Fund shall be credited to the Fund.

(h) Expenditures from the Fund may be made only in accordance with the State budget.

(i) Money expended from the Fund for carrying out the purpose of the Fund is supplemental to and is not intended to take the place of funding that otherwise would be appropriated for carrying out the purpose of the Fund.

(j) No part of the Fund may revert or be credited to:

  (1) The General Fund of the State; or

  (2) Any other special fund of the State.

(k) The Fund is subject to audit by the Office of Legislative Audits as provided in Sec. 2-1220 of the State Government Article.

(l)

  (1) Subject to paragraph (2) of this subsection, the Comptroller shall distribute to an administrative cost account the amount necessary to administer the fees and to cover the expenses of conducting audits under this section from the 9-8-8 fee revenue collected and remitted to the Comptroller under Sec. 7.5-5A-03.1 of this subtitle.

  (2) The amount distributed to the administrative cost account may not exceed:

    (i) For each of fiscal years 2025, 2026, and 2027, 6% of the fees collected by the Comptroller; and

    (ii) For fiscal year 2028 and each fiscal year thereafter, 3% of the fees collected by the Comptroller.

(m) After making the distribution required by subsection (l) of this section, the Comptroller shall deposit the 9-8-8 fee revenue in the Fund.

#### Section 7.5-5A-03

The Department, in collaboration with the federal Substance Abuse and Mental Health Services Administration, the National Suicide Prevention Lifeline, the National Veterans Crisis Line, and other appropriate entities, shall work to promote the public messaging of 9-8-8 services in a consistent manner.

#### Section 7.5-5A-03.1

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "9-8-8-accessible service" means telephone service or another communications service that connects an individual dialing the digits 9-8-8 to the 988 Suicide and Crisis Lifeline.

  (3) "9-8-8 fee" means the fee imposed in accordance with this section.

  (4)

    (i) "9-8-8 service carrier" means a provider of CMRS or other 9-8-8-accessible service.

    (ii) "9-8-8 service carrier" does not include a telephone company.

(b) This section does not apply to prepaid wireless telecommunications service.

(c)

  (1) Except as provided in paragraph (2) of this subsection, each subscriber to switched local exchange access service, CMRS, or other 9-8-8-accessible service shall pay a 9-8-8 fee.

  (2) A subscriber who is enrolled in the Lifeline program may not be required to pay a 9-8-8 fee.

(d)

  (1) Subject to paragraphs (2) through (4) of this subsection, the 9-8-8 fee is 25 cents per month payable when the bill for the switched local exchange access service, CMRS, or other 9-8-8-accessible service is due.

  (2) Except as provided in paragraphs (3) and (4) of this subsection, if a person is able to make more than one simultaneous outbound call using a 9-8-8-accessible service, each separate outbound call voice channel capacity, regardless of the technology, shall be considered a separate 9-8-8-accessible service for the purpose of determining the 9-8-8 fee due under paragraph (1) of this subsection.

  (3) CMRS provided to multiple devices that share the same telephone number shall be considered a single 9-8-8-accessible service for the purpose of determining the 9-8-8 fee due under paragraph (1) of this subsection.

  (4) A broadband connection that is not used as a telephone service may not be considered a separate voice channel capacity for the purpose of determining the 9-8-8 fee due under paragraph (1) of this subsection.

(e)

  (1) The Public Service Commission shall direct each telephone company to add the 9-8-8 fee to all current bills rendered for switched local exchange access service in the State.

  (2) Each telephone company:

    (i) Shall act as a collection agent for the Fund with respect to the 9-8-8 fees; and

    (ii) Shall remit all money collected to the Comptroller on a monthly basis.

(f)

  (1) Each 9-8-8 service carrier shall add the 9-8-8 fee to all current bills rendered for CMRS or other 9-8-8-accessible service in the State.

  (2) Each 9-8-8 service carrier:

    (i) Shall act as a collection agent for the Fund with respect to the 9-8-8 fees;

    (ii) Shall remit all money collected to the Comptroller on a monthly basis;

    (iii) Shall keep records of 9-8-8 fees collected and remitted under this paragraph for at least 4 years after the fee is remitted; and

    (iv) Is entitled to credit, against the money from the 9-8-8 fee to be remitted to the Comptroller, an amount equal to 0.5% of the 9-8-8 fee to cover the expenses of billing, collecting, remitting, and keeping records of the 9-8-8 fees.

(g) The Comptroller shall adopt procedures for auditing fee collection and remittance by telephone companies and CMRS providers.

(h) A CMRS provider that pays or collects 9-8-8 fees under this section has the same immunity from liability for transmission failures as that approved by the Public Service Commission for local exchange telephone companies that are subject to regulation by the Commission under the Public Utilities Article.

(i) The Comptroller shall adopt regulations to carry out this section.

#### Section 7.5-5A-03.2

#### Section 7.5-5A-04

On or before December 1 each year, the Department shall submit a report to the Legislative Policy Committee, the Senate Budget and Taxation Committee, and the House Appropriations Committee, in accordance with Sec. 2-1257 of the State Government Article, that includes for the immediately preceding fiscal year a detailed description of:

(1) The amount of funds transferred and distributed from the Fund in accordance with Sec. 7.5-5A-02(b) of this subtitle;

(2) The amount of funds collected and remitted to the Comptroller under Sec. 7.5-5A-03.1 of this subtitle;

(3) The additional services provided by the funding in each local jurisdiction;

(4) The amount of any unspent funds in the Fund; and

(5) The reasons funds identified under item (4) of this section were not spent.

### Subtitle 6

#### Section 7.5-601

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "ASAM Level 3.1 services" means the level of clinically managed, low-intensity residential services for the treatment of addictive, substance-related, and co-occurring conditions described by the American Society of Addiction Medicine.

  (3) "Health professional" means a person who:

    (i) Is licensed under the Health Occupations Article; and

    (ii) Is providing mental health or substance-related disorder services according to the requirements of the appropriate professional board.

(b) Beginning November 1, 2017, a behavioral health program or health professional, when referring an individual to receive services at a recovery residence, shall:

  (1) Provide the individual with a list of certified recovery residences operating in the State that is published by the Department under Sec. 19-2503(b) of this article; and

  (2) Provide to an individual who has been assessed as in need of ASAM Level 3.1 services information on where the individual may receive those services.

### Subtitle 8

#### Section 7.5-801

(a) In this subtitle the following words have the meanings indicated.

(b) "Advisory Committee" means the Maryland Mental Health and Substance Use Disorder Registry and Referral System Advisory Committee.

(c) "Registry and Referral System" means the Maryland Mental Health and Substance Use Disorder Registry and Referral System.

(d) "State-designated health information exchange" means the health information exchange designated by the Maryland Health Care Commission under Sec. 19-143 of this article.

#### Section 7.5-802

(a)

  (1) There is a Maryland Mental Health and Substance Use Disorder Registry and Referral System in the Department.

  (2) The purpose of the Registry and Referral System is to provide a statewide system through which health care providers can identify and access available private and State inpatient and outpatient mental health and substance use services for patients in a seamless manner.

  (3) Subject to the availability of funds, the Department shall develop and implement the Registry and Referral System, in collaboration with the State-designated Health Information Exchange.

  (4) The Registry and Referral System shall include:

    (i) A searchable inventory of any private or State provider of mental health and substance use disorder services, including inpatient, crisis, and outpatient services;

    (ii) The capability to allow a provider of mental health and substance use disorder services to update registry information including the real-time availability of services; and

    (iii) An electronic referral system that is available to any health care provider in the State to facilitate electronic referrals to mental health and substance use disorder providers.

(b) The Department shall:

  (1) Determine the appropriate technology to support the operation of the Registry and Referral System; and

  (2) To the extent practicable, consider existing technology operated by the State-designated health information exchange, workflow of providers, and practices of providers when determining the appropriate technology for the Registry and Referral System.

(c)

  (1) There is a Maryland Mental Health and Substance Use Disorder Registry and Referral System Advisory Committee.

  (2) The Advisory Committee shall advise the Department on the development and implementation of the Registry and Referral System.

  (3) The Advisory Committee shall include:

    (i) The Deputy Secretary of Behavioral Health, or the Deputy Secretary's designee;

    (ii) The Deputy Secretary for Public Health Services, or the Deputy Secretary's designee;

    (iii) The Executive Director of the Health Services Cost Review Commission, or the Executive Director's designee;

    (iv) One representative with expertise in health information technology, designated by the Maryland chapter of the Healthcare Information and Management Systems Society;

    (v) Providers of mental health and substance use services; and

    (vi) Any other representatives considered necessary by the Department to assist in the development and implementation of the Registry and Referral System.

  (4) The Advisory Committee shall make recommendations to the Department relating to the design, development, implementation, and funding of the Registry and Referral System on:

    (i) Necessary regulations;

    (ii) The status of the resource directory and pilot program developed by the Department; and

    (iii) Sources of funding, including grant funds and other sources of federal, private, or State funds.

(d) Each private and State hospital shall ensure the availability of staff to identify appropriate and available services for patients in the hospital who are in need of mental health or substance use disorder services and to assist the patient in accessing the services.

(e) The Department shall adopt regulations to carry out this subtitle.

### Subtitle 9. Opioid Restitution Fund Advisory Council

#### Section 7.5-901

(a) In this subtitle the following words have the meanings indicated.

(b) "Council" means the Opioid Restitution Fund Advisory Council.

(c) "Fund" means the Opioid Restitution Fund established under Sec. 7-331 of the State Finance and Procurement Article.

#### Section 7.5-902

There is an Opioid Restitution Fund Advisory Council in the Department.

#### Section 7.5-903

(a) The Council consists of the following members:

  (1) One member of the Senate of Maryland, appointed by the President of the Senate;

  (2) One member of the House of Delegates, appointed by the Speaker of the House;

  (3) The Deputy Secretary for Behavioral Health, or the Deputy Secretary's designee;

  (4) The Deputy Secretary for Health Care Financing, or the Deputy Secretary's designee;

  (5) The Attorney General, or the Attorney General's designee;

  (6) The Special Secretary of Overdose Response, or the Special Secretary's designee;

  (7) Three individuals appointed by the Governor:

    (i) One of whom represents a community-based opioid treatment program;

    (ii) One of whom represents a community-based substance use disorder and mental health treatment program; and

    (iii) One of whom is a public health expert engaged in harm reduction services;

  (8) Three individuals appointed by the Secretary:

    (i) One of whom is an individual in recovery from a substance use disorder;

    (ii) One of whom is a family member of an individual who has experienced an overdose; and

    (iii) One of whom is an individual disproportionately impacted by substance use disorders and disparities in access to care;

  (9) One individual designated by the Executive Director of the Maryland Association of Counties; and

  (10) One individual designated by the Executive Director of the Maryland Municipal League.

(b) Members appointed by the Governor and by the Secretary under subsection (a) of this section shall, to the extent practicable:

  (1) Reflect the geographic regions of the State;

  (2) Be representative of at-risk populations; and

  (3) Reflect the ethnic, gender, and cultural diversity of the State.

(c) The Council shall designate a chair from among the membership of the Council.

(d)

  (1)

    (i) The term of a member appointed by the Governor or the Secretary under subsection (a) of this section is 2 years.

    (ii) The terms of the members appointed by the Governor and the Secretary under subsection (a) of this section are staggered as required by the terms provided for members of the Council on October 1, 2022.

    (iii) At the end of a term, a member continues to serve until a successor is appointed and qualifies.

    (iv) A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

  (2) A member appointed by the Governor or the Secretary under subsection (a) of this section may serve for a maximum of two consecutive terms.

  (3) Notwithstanding any other provisions of this subsection, all members serve at the pleasure of the Governor.

(e) A member of the Council:

  (1) May not receive compensation as a member of the Council; but

  (2) Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.

(f) Subject to Sec. 7.5-904(c) of this subtitle, with the consent of the Council, the chair may designate additional individuals with relevant expertise to serve on a committee of the Council in an advisory capacity.

#### Section 7.5-904

(a)

  (1) Subject to subsection (c) of this section, the Council may adopt procedures necessary to do business, including the creation of committees.

  (2) The Council may consult with State agencies to carry out the duties of the Council.

  (3) The Council shall meet at least four times a year.

  (4) A majority of the voting members of the Council is a quorum.

(b) Maryland's Office of Overdose Response shall provide appropriate staff necessary to support the functions of the Council.

(c)

  (1) If required by a court or administrative order or a settlement agreement entered into by the Attorney General, the Attorney General may direct that a Council committee be formed in accordance with the requirements of the court or administrative order or settlement agreement.

  (2) The Attorney General shall establish procedures for a committee formed under paragraph (1) of this subsection in order to ensure compliance with the requirements of the court or administrative order or settlement agreement.

  (3)

    (i) Subject to subparagraph (ii) of this paragraph, a committee formed under paragraph (1) of this subsection shall conduct only business related to the purpose of the court or administrative order or settlement agreement that required the formation of the subcommittee.

    (ii) A committee may conduct business related to multiple court or administrative orders or settlement agreements if the court or administrative orders or settlement agreements contain identical requirements.

  (4) A committee formed under paragraph (1) of this subsection may consist only of members of the Council.

  (5) Unless otherwise provided in a court or administrative order or settlement agreement, the chair of the Council, or the chair's designee, shall be chair of a committee formed under paragraph (1) of this subsection.

#### Section 7.5-905

(a) On or before November 1 each year, the Council shall provide specific findings and recommendations in writing to the Governor and the Secretary regarding the allocations of money from the Fund for expenditures consistent with uses of the Fund and considering the following criteria:

  (1) The number of people per capita with a substance use disorder in a jurisdiction;

  (2) Disparities in access to care in a jurisdiction that may preclude persons;

  (3) The number of overdose deaths per capita in a jurisdiction;

  (4) The programs, services, supports, or other resources currently available to individuals with substance use disorders in a jurisdiction; and

  (5) Disparities in access to care and health outcomes in a jurisdiction.

(b)

  (1) Within 6 months after receiving the findings and recommendations submitted under subsection (a) of this section, the Secretary shall present to the Council the decisions for the allocations of money from the Fund.

  (2) The Department shall post on the Department's website the findings and recommendations of the Council and the decisions for the allocations of money from the Fund.

### Subtitle 10

#### Section 7.5-1001

(a) The Maryland Office of Overdose Response, in collaboration with the Department, shall develop and maintain an interactive dashboard on Opioid Restitution Fund spending for the purpose of sharing prescription opioid-related settlement information with the public.

(b) The dashboard developed and maintained under subsection (a) of this section shall include, disaggregated by State, county, and municipality:

  (1) Payment schedule information on estimated payments to the State, county, or municipality from opioid settlements;

  (2) Past spending of settlement funds;

  (3) Spending plans and priorities; and

  (4) A detailed description of any initiative funded with settlement funds, including performance measures if applicable.

(c) If there is a State, county, or municipal website that provides access to additional information on the use of opioid-related settlement funds by the State, county, or municipality, the dashboard shall include a link to the State, county, or municipal website.

(d)

  (1) This subsection does not apply to a county or municipality that:

    (i) Complies with reporting requirements established in an opioid-related settlement; and

    (ii) Shares the data in the reports required under an opioid-related settlement with the appropriate State entity.

  (2) A county or municipality receiving settlement funds shall provide to the Department the necessary financial information related to settlement funding to include as information on the dashboard.

  (3) Information required to be provided under paragraph (2) of this subsection shall be in compliance with the terms of any opioid-related settlement agreement.

  (4) The Department shall upload opioid-related settlement information submitted to the Department by a county or municipality in compliance with the terms of an opioid-related settlement.

  (5) The Department shall establish an online portal with instructions for a county or municipality to report or upload required information to the Department for use in the dashboard.

(e) To the extent practicable, the dashboard shall use existing platforms that provide data on opioid use and overdoses in the State.

(f) The dashboard shall be developed and maintained using funds from the Opioid Restitution Fund as appropriated through the State budget.

---

Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)