Bill Summary – FastDemocracy

HB 689
                      Department of Legislative Services
                              Maryland General Assembly
                                    2021 Session
                           FISCAL AND POLICY NOTE
                              Third Reader - Revised
House Bill 689              (Delegate McComas)
Health and Government Operations                                                    Finance
    Mental Health - Assent to and Certificates for Admission - Licensed Certified
       Social Worker-Clinical and Licensed Clinical Professional Counselor
This bill authorizes a licensed certified social worker-clinical (LCSW-C) or a licensed
clinical professional counselor (LCPC), in conjunction with a physician, to (1) certify an
individual for involuntary admission to a facility or a Veterans’ Administration (VA)
hospital and (2) assent to the voluntary admission of a minor to the child or adolescent unit
of a State facility. The bill also makes conforming changes.
                                    Fiscal Summary
State Effect: The bill does not materially affect State finances or operations.
Local Effect: The bill does not directly affect local government finances or operations.
Small Business Effect: None.
                                         Analysis
Current Law:
Involuntary Admission Process
Under the Health-General Article, application for the involuntary admission of an
individual to a facility or VA hospital may be made by any person who has a legitimate
interest in the welfare of the individual. However, before the Division of Correction or the
Patuxent Institution makes an application regarding an inmate in its institution, the
Behavioral Health Administration (BHA) must first agree to pay the appropriate expenses.
A “facility” is defined as any public or private clinic, hospital, or other institution that
provides or purports to provide treatment or other services for individuals who have mental
disorders.
An application for the involuntary admission of an individual to a facility or VA hospital
for the treatment of a mental disorder must (1) be in writing; (2) be dated; (3) be on the
required form of BHA or the VA; (4) state the relationship of the applicant to the individual
for whom admission is sought; (5) be signed by the applicant; (6) be accompanied by the
certificates of either one physician and one psychologist, two physicians, or one physician
and one psychiatric nurse practitioner; and (7) contain any other information that BHA
requires.
A physician’s, psychologist’s, or psychiatric nurse practitioner’s certificate for the
involuntary admission of an individual must be based on the personal examination of the
physician, psychologist, or psychiatric nurse practitioner who signs the certificate. A
certificate may not be used for admission if the examination was done more than one week
before the certificate was signed or more than 30 days before the facility or the VA hospital
received the application for admission. Likewise, a certificate of admission may not be
used if the physician, psychologist, or psychiatric nurse practitioner who signed the
certificate either has a financial interest in the proprietary facility in which the individual’s
admission is sought or is related by blood or marriage to the individual or to the applicant.
The physician’s, psychologist’s, or psychiatric nurse practitioner’s certificate must contain
specified information, including (1) a diagnosis of a mental disorder of the individual;
(2) an opinion that the individual needs inpatient care or treatment; and (3) an opinion that
admission to a facility or VA hospital is needed for the protection of the individual or
another.
The Maryland Department of Health (MDH) must receive an individual who has been
certified by a physician, psychologist, or psychiatric nurse practitioner within 12 hours of
receiving notice of a certification, if four specified conditions are met: (1) the individual’s
involuntary admission is not limited by § 10-617 of the Health-General Article (see below);
(2) an application for admission has been completed; (3) a certifying physician,
psychologist, or psychiatric nurse practitioner is unable to place the individual in a facility
not operated by MDH; and (4) MDH is unable to provide for the placement of the person
other than in a facility operated by MDH.
The limitations under § 10-617 of the Health-General Article include that a facility or
VA hospital may not admit the individual unless (1) the individual has a mental disorder;
(2) the individual needs inpatient care or treatment; (3) the individual presents a danger to
the life or safety of the individual or others; (4) the individual is unable or unwilling to be
admitted voluntarily; and (5) there is no available, less restrictive form of intervention that
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is consistent with the welfare and safety of the individual. Additional restrictions apply if
the individual is 65 or older.
Voluntary Admission of a Minor for the Treatment of a Mental Disorder
A parent or guardian may apply, on behalf of a minor, for the minor’s voluntary admission
to (1) any facility that is not a State facility; (2) a regional institute for children and
adolescents; and (3) the child or adolescent unit of a State facility for the treatment of a
mental disorder. A facility may not admit an individual unless:
      the individual has a mental disorder;
      the mental disorder is susceptible to care or treatment;
      the applicant understands the nature of a request for admission; and
      specified health care professionals assent to the admission, including for a child or
       adolescent unit of a State facility (1) a physician and psychologist;
       (2) two physicians; or (3) a physician and psychiatric nurse practitioner.
Licensed Certified Social Worker-Clinical
An LCSW-C is an individual licensed by the State Board of Social Work Examiners to
“practice clinical social work,” which means to use specialized education, training, and
experience to practice social work, including the additional activities of supervising other
social workers; evaluation, diagnosis, and treatment of biopsychosocial conditions, mental
and emotional conditions and impairments, and behavioral health disorders, including
substance use disorders, addictive disorders, and mental disorders; petitioning for
emergency evaluation; and the provision of psychotherapy.
An applicant for licensure as an LCSW-C must have received a master’s degree from an
accredited program and provide documentation of having completed two years as a
licensee with supervised experience of at least 3,000 hours after receiving the master’s
degree – with at least 144 hours of periodic face-to-face supervision in the assessment,
formulation of a diagnostic impression, and treatment of mental disorders and other
conditions and the provision of psychotherapy.
Licensed Clinical Professional Counselor
An LCPC is an individual licensed by the State Board of Professional Counselors and
Therapists to “practice clinical professional counseling,” which means to engage
professionally and for compensation in counseling and appraisal activities by providing
services involving the application of counseling principles and methods in the diagnosis,
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prevention, treatment, and amelioration of psychological problems and emotional or
mental conditions of individuals or groups.
An applicant for licensure as an LCPC must have (1) received a master’s or doctoral degree
in a professional counseling field from an accredited institution approved by the board;
(2) provided documentation of completion of specified graduate course work in specific
areas of study; (3) provided documentation of completion of two years (for a doctoral-level
applicant) or three years (for a master’s-level applicant) of supervised experience;
(4) passed the National Counselors Examination of the National Board for Certified
Counselors, Inc.; and (5) passed an examination given by the board.
                               Additional Information
Prior Introductions: HB 1387 of 2020, a similar bill, received a hearing in the House
Health and Government Operations Committee, but no further action was taken.
Designated Cross File: SB 466 (Senator West) - Finance.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History:      First Reader - February 11, 2021
rh/jc                     Third Reader - March 17, 2021
                                 Revised - Amendment(s) - March 17, 2021
                                 Revised - Updated Information - March 17, 2021
Analysis by: Amber R. Gundlach                         Direct Inquiries to:
                                                       (410) 946-5510
                                                       (301) 970-5510
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Statutes affected: 
Text - First - Certificates for Involuntary Admission - Licensed Certified Social Worker-Clinical: 10-615 Health General, 10-616 Health General, 10-619 Health General
Text - Third - Mental Health - Assent to and Certificates for Admission - Licensed Certified Social Worker-Clinical and Licensed Clinical Professional Counselor: 10-610 Health General, 10-615 Health General, 10-616 Health General, 10-619 Health General