[0:07] Good morning. Good morning. Good morning, everyone. [0:10] I am Councilwoman Felicia Porter representing the 10th district and [0:13] chairperson for the committee. Um, this is a reminder to please turn off your [0:18] cell phones. Um, today we have joining us council members Odette Ramos from the [0:24] 14th district. And we also have some wonderful interns um from John's Hopkins [0:30] University and also from Talson University today in the chambers. And [0:35] then we also have several representatives from the mayor's office [0:38] and city council president and committee staff is Margaret Kern. The committee is [0:44] reconvening the hearing for legislative oversight LO25-0024 [0:49] oversight of recovery homes and substance abuse clinics and mental [0:52] health substance abuse clinics in Baltimore City. This is an opportunity [0:57] for um council members and public to further ask questions about ensuring [1:02] that individuals in recovery have access to highquality, safe and well-regulated [1:07] recovery homes and substance abuse clinics. This is also an opportunity to [1:11] evaluate existing policies, access provider accountability, and explore [1:15] opportunities to enhance support systems for individuals in recovery. This [1:20] discussion will continue to prioritize community concerns, patient safety, and [1:24] equitable distribution of recovery resources in the city. I'm now going to [1:29] turn it over to our public testimony. Um, for all that do not know, we have [1:35] public testimony at the beginning of our hearings because agencies I want you all [1:40] to hear what some of the uh community are going through so that you can alter [1:44] your presentations um once you all have the opportunity. So, we're going to now [1:49] go into public testimony. We're going to have Kim lead us into public testimony. [1:54] You're going to have five minutes. And so, [1:58] we have a new technology in the chamber today. Okay. And so you'll see on your [2:04] deis, it's going to blink yellow when it is um 15 seconds left. And so we just [2:10] ask that you wrap up when you see the blinking yellow light. All right. [2:14] All right. Very good. [2:22] And if and if you could tap your microphone. Is it on? [2:26] » Perfect. This echo. All right. Kim Wyman. I'm president of Power Recovery [2:31] Center. Delighted to be here. Thank you, Chair Porter, for the opportunity to [2:34] testify. Lure is the foundation for protecting [2:38] client safety and treatment quality, which I'm sure you'll be discussing [2:42] today. After lure, most systems can count admissions, service delivered, [2:48] discharges, and length of stay, and other measures. Those measures matter, [2:54] but they don't move from activity to impact. They don't answer the harder [3:00] question. After treatment, are people safer, more stable, and experiencing a [3:05] better quality of life? We need a practical way to see the whole picture [3:09] across all the varied fragmented systems, not a monthly report, not a [3:15] report a month later about some static measure. [3:19] We need to intervene earlier, improve treatment, and make smarter public [3:25] investments. PRC is building a platform that connects [3:29] those scattered and fragmented systems into one usable longitudinal view of a [3:35] client's recovery. Instead of looking only at a treatment episode, [3:41] PAL can now look at uh across systems and across time. By this I mean we can [3:47] examine Crisp ED and EMS and public court involvement, the 12 months prior [3:53] to treatment and the 12 months after treatment as two key factors and two key [3:59] systems to connect with treatment to help us see whether treatment is [4:05] changing health safety, stability, and the quality of life of our clients over [4:09] time. Next, we're going to pilot primary care [4:13] connection and housing stability because we see those along the continuum as [4:19] critical factors in quality of life for our clients. A longitudinal view of all [4:25] of the fragmented systems combined with claims data and clinical data in an [4:30] electronic health record can examine outcomes in our system for an [4:35] individual, for a group that's defined, or for the larger system as a whole. [4:40] This platform isn't just a management tool for PAL. Let me be clear. We want [4:45] to change public health. It's a working model for treatment outcomes that [4:50] provides intelligence that could help communities move from struggling to [4:56] count the basics to transparency across multiple systems and services over a [5:02] defined period of time. It can tell us who may need help now, what providers [5:08] can improve next, and whether people are doing better over time. Again, we want [5:14] to change public health, and we want to ask for your partnership. Thank you. [5:19] » Thank you so much, Kim. All right. Next, we're going to have Jan Elyn. [5:30] » I'm a little shorter. Thank you. I apologize if I have to take [5:35] sips of water. The air quality is not helping my voice. [5:39] [clears throat] My name is Jan Eland. I am a resident of Brooklyn in Baltimore [5:45] City. I am here on behalf of the Brooklyn Curtis Bay community. Um we [5:51] have uh recently gotten a group of neighbors together regarding this [5:56] problem and started a task force. Um and we are looking of course at two things. [6:02] The distribution of the recovery centers and community concerns. One of our [6:08] community members has written I think uh an excellent set of comments that I [6:14] would like to read. [clears throat] [6:17] This neighbor lives across the street from Garrett Park, one of our parks, and [6:22] immediately next to our library. No one should have to feel that. Oops. [6:29] Sorry, I'm starting with page two. That's bad. In December 2023, [6:35] I purchased my very first home in Brooklyn, Maryland, Baltimore City. I [6:39] was single, had no children, and was incredibly proud and excited to become a [6:42] homeowner. It was a milestone I had worked hard to achieve. When I moved in, [6:47] I felt hopeful about the future. My block was quiet, my neighbors were [6:51] friendly and respectful. Across the street was a beautiful park right next [6:55] door to a thriving Boys and Girls Club and just steps away from the Baltimore [6:59] City Library. As an educator, seeing children, families, and community [7:03] resources so close to my home made me feel proud to become part of the [7:06] neighborhood. Unfortunately, as winter turned into spring and spring into [7:11] summer, that sense of pride and security began to disappear. I started witnessing [7:16] drug transactions directly behind my home. Some captured on my security [7:21] cameras, others with my own eyes. I watched individuals struggling with [7:25] addiction gather in the alleyways, on the sidewalks, on the steps of the Boys [7:29] and Girls Club, and outside the library. Sometimes they simply sat there. Other [7:35] times, the effects of the drugs they were using were heartbreaking to [7:38] witness. I heard moaning, screaming, crying, and watched people throw [7:42] themselves into the street, roll on the payment, and cry out for help. These are [7:47] human beings in crisis, but they are also cerating an environment where [7:51] families no longer feel safe. [clears throat] [7:56] One evening, I came home to find someone charging a phone using the electrical [8:00] outlet on the front of my house. The phone was sitting on my steps, blocking [8:05] the entrance to my home. When I arrived, the individual ran over and claimed it [8:09] was his. I firmly but respectfully asked him never to use my property again and [8:15] to find somewhere else to charge his phone. I recognized him as one of the [8:18] many individuals battling addiction in the neighborhood. The encounter shook [8:22] me. It made me anxious every time I leave my house wondering if someone [8:26] would be waiting on my porch when I returned. No homeowner should have to [8:30] live with that level of uncertainty. Then one morning I was leaving for work. [8:34] I discovered my car had been broken into. Personal belongings had been [8:38] stolen. The electrical panel had been removed as though someone was attempting [8:43] to hotwire the vehicle. Thankfully, I use a steering wheel lock, so they were [8:47] unsuccessful in stealing it. After reviewing my security footage, I watched [8:52] multiple individuals, people I recognized from my own neighborhood, [8:56] take turns entering and searching my car. The feeling of violation is [9:01] difficult to put into words. Knowing strangers had been inside my vehicle, [9:05] not knowing what they touched or what their intentions truly were, made me [9:09] physical sick. It also forced me to ask myself questions I never imagined asking [9:14] after purchasing my first home. Do I need a firearm to protect myself? If [9:19] someone is willing to break into my car, what is stopping them from trying to [9:23] break into my home? [9:27] No one should have to feel this way in a place they work so hard to own. Today, [9:32] there are 34 drug treatment and rehab centers located within the Brooklyn, [9:37] Brooklyn Park, and Curtis Bay communities. 34. Let that sink in. As [9:43] residents, we deserve answers. How [clears throat] are these facilities [9:47] regulated? Are they all meeting state and federal standards? Are they [9:50] providing effective treatment and long-term recovery? or are they simply [9:54] contributing to a revolving door that leaves both clients and surrounding [9:58] neighborhoods struggling? Residents regularly witness drug dealers waiting [10:02] in the alley behind Third and Horton Avenue for methanone doses to wear off [10:06] so they can sell drugs to vulnerable individuals. How is this acceptable? How [10:11] has this become normal? [clears throat] I also have to ask our [10:15] elected officials, why are there so many treatment facilities concentrated in our [10:20] communities? Why aren't these same facilities distributed more equitably [10:23] throughout surrounding areas, including places like Annapolis, Canton, or other [10:28] communities with the resources to help share the responsibility. The people who [10:32] live in Brooklyn, Brooklyn Park, and Curtis Bay, matter. We are hardworking [10:37] people. We are homeowners. We are parents, grandparents, educators, [10:41] veterans, and small business owners. We work every day to provide for our [10:45] families and invest in our community. We deserve to feel safe when we walk [10:49] outside, when our children play in the park, and when we come home after a long [10:52] day of work. This is not about lacking compassion for those battling addiction. [10:57] They deserve access to treatment, dignity, and every opportunity to [11:01] recover, but compassion for those struggling with addiction should never [11:05] come at the expense of the safety, peace, and quality of life of the [11:09] residents who call these neighborhoods home. I will continue standing alongside [11:14] my neighbors and speaking up for our community because we deserve better. So [11:18] I ask our elected leaders and decision makers, what are your solutions? Please [11:23] don't tell us nothing can be done because of laws and regulations. [11:28] Communities across the country have found ways to balance treatment [11:31] accountability and neighborhood safety. We deserve that same commitment. The [11:36] people of Brooklyn, Brooklyn Park, and Curtis Bay have waited long enough. [11:42] » [clears throat] >> That is one of my neighbors. I have [11:46] comments from another neighbor, but I see I have 56 seconds. Um, so I will [11:51] just stress uh the 34 drug treatment centers. Apparently, the state of [11:55] Maryland is not aware there are 34. Their census doesn't seem to include [11:59] them. And the last time they testified before this committee, they came up with [12:02] six. And we having eyes can see 34. Um [clears throat] the community [12:10] concerns of course are one particular center 800 patients per day coming into [12:16] our community many coming from outside and it's next to the park one block from [12:22] an elementary school and half a block from a high drug traffic intersection. [12:27] We ask that the city council and our elected officials take action with [12:32] respect to these problems. Thank you. >> Thank you Jan. All right. Is there [12:37] anyone else that would like to testify today? Vin McCormack. [12:43] » Good morning, Madam Chair, and [clears throat] fellow attending members [12:47] uh of city council. My name is Vim McCormack. Uh I'll Is it three minutes? [12:51] Three minutes. Okay. >> It's a great honor to be down here to [12:56] talk about recovery houses in Baltimore City. I'm going to make an admission uh [13:00] before the council. Uh I've been operational [13:04] since 2019. uh I took some advice, some suggestions [13:10] from some fellow providers who had a housing element attached to them. Uh so [13:15] I opened up some recovery houses and we were 2.1 [13:19] and uh OP and IOP initially. Uh I learned after a few years that I was out [13:27] of order. In fact, uh, Optum at the time had set out put out a, uh, an alert that [13:36] if you were operating in 2.1 IOP, you were not supposed to have housing [13:42] attached. Now, I can tell you that [13:47] many providers who have IOP have housing attached. Of course, I won't say their [13:53] names because they say snitches get stitches. But I'll tell you what I did [13:57] was because I sought to be in order and do what's expected of [14:03] me as a provider. I took the time, the money, and the effort to go and get 3.1 [14:09] and 3.3 residential treatment, which is what's supposed to happen. [14:13] » So, we went ahead and did that. Um, and we also took the time I was I was not [14:19] advised by some of the fellow providers uh that I took uh suggestions from that [14:23] you're supposed to go down to the permit office and get reasonable accommodations [14:27] through those wonderful folks and they come out and do a proper inspection and [14:31] then at which you can operate uh as an entity having more than four unrelated [14:37] people in your house. I didn't know that. I was taking suggestions from some [14:41] people who was doing it before me. What does that say? [14:46] That says you got to be careful where you get your resources from and your [14:49] information. So I can tell you that since that time I take great pains to [14:53] make sure that the houses we have currently recovery houses in east and [14:57] west Baltimore are residential properties meaning they're under the [15:00] residential license uh under Caroline and BHA. They also have taken we've [15:05] taken the time to go through the proper process to get reasonable accommodations [15:08] through the permit office. Now I'm I'm really glad that we're having this [15:12] conversation. We're going to have I think we're going to have to have more [15:14] than this meeting T Porter because it's it's a broad it's something that's [15:18] happening. You and I talk about it quite a bit. So I appreciate the effort uh and [15:22] just putting the spotlight on it because it starts and ends with the provider. If [15:26] you're in the neighborhood, you have recovery house. [15:28] » The neighborhood and I appreciate this lady sharing. The neighborhood shouldn't [15:31] know. I think that you're you should your footprint should be liked and it [15:35] should make the you should make that neighborhood better because you're [15:39] there, not worse. Thank you for the time. Thank you so much, Vinn. [15:44] All right. Does anybody else would like to testify before we transition into [15:48] agency reports? >> Yes, ma'am. Thank you. [15:57] » Hello. My name is Tanya Richardson. >> Yes, ma'am. If you can pull the mic [16:01] down, please. >> Yes. My name is Tanya Richardson and I [16:06] um am administrative director for a behavioral health program. Um the change [16:12] came about the housing. When a change came about the housing, I have been down [16:19] to housing on Fed Street plenty of times. The application is so complicated [16:25] sometimes and it's no help. They say that they help you. They give you a [16:29] packet. They highlight some stuff. if I go through it and then the packet [16:33] doesn't even look like what's on the screen and then you wait too late for [16:37] the special accommodation and then they cancel it then you have to go back down [16:40] there. I feel like if we're going to follow the law that maybe we should get [16:47] some support. It's no one down there that's going to do the application. I'm [16:51] not familiar with the application. So, I do the best that I can and the one [16:56] application that I keep trying to do keep getting cancelled because I don't [17:00] know exactly how to fill all the information out [17:04] » and I think they give you like two days to finish the special accommodation that [17:10] they don't even tell you that you have to do. You just keep checking the email [17:13] and then all of a sudden it pops up. Oh, I have a special accommodation. I think [17:18] that it's like helping some individuals to feel [17:24] defeated in the situation when they're trying to do the right thing. [17:28] » So that's >> No, I appreciate that. I appreciate that [17:31] an aspect and and just to you know, I've been on the side of being a consultant [17:36] for for many uh clinics and so one one of the thing that I encourage is one to [17:42] get a mentor. uh getting with like-minded people um within the [17:46] industry that can help you kind of navigate, but then also um making sure [17:51] that you are um you're crossing your tees and dotting your eyes because [17:55] unfortunately uh lack of knowledge or lack of support [17:59] is by no means any type of um excuse for not following the law. And so, you know, [18:06] we we have that built in. We're going to be, you know, sharing some of that [18:09] technical assistance because I hear that quite often. um and you shouldn't have [18:14] to hire a very expensive consultant to um provide that technical assistance for [18:19] you. So, totally agree with you. Um and I look forward if you know I'll stay [18:23] after the hearing and I look forward to helping where I can. [18:26] » Okay. >> All right. Thank you so much, ma'am. [18:28] » All right. We're going to now turn it over to BHSB for your presentation. [18:35] » Great. Thanks, Councilwoman. Good morning, everyone. Uh, council, uh, [18:40] committee members, madam chair, for the record, my name is Dan Rabbit. I'm the [18:44] policy director at Behavioral Health System Baltimore. It's good to be with [18:48] you. [18:53] Um, so what I want to do today is go over just sort of the the framework and [18:58] the regulations that govern substance use disorder clinics and recovery homes [19:04] in the city uh, and in Maryland. share just some updates from some that have [19:09] occurred since the last time I came and um you answer any questions that folks [19:14] have. Um before I get into my presentation, I I do just want to um [19:19] share you might have seen a article in the Baltimore banner like last week um [19:26] news around budget cuts that were coming to Baltimore. Um and so I just wanted to [19:32] share that um that is happening. Uh it's across the state. It's not just [19:37] Baltimore. Um BHA, the behavioral health administration shared that all local [19:43] behavioral health authorities need to cut uh 13% from their grants and [19:48] operations. So that is happening. Um we are working you know ultimately BHA [19:53] makes the decision. We are working to develop recommendations on where we [19:57] think that uh those cuts can be made. Uh but no decisions have been made at this [20:02] time. We're happy to come back uh in a you know two months or something to [20:06] share where things landed if that would be of interest. [20:09] Um but that's not exactly what we're talking about today. Just wanted to put [20:12] that out there first. Um where should I point it? [20:30] Sorry. [20:37] Could Are you able to advance it? Can I just ask the Okay, just since got [20:43] technical difficulties. [20:47] Yep. Yes. The next slide, please. Um, just as a reminder, behavioral [20:51] health system Baltimore has been around since 1986. We merged uh with the [20:56] substance uh use system in 2013 and have been the local behavioral health [21:02] authority since then. We're an independent nonprofit uh that serves in [21:06] that role. Next slide, please. Um local behavioral health authorities uh fulfill [21:12] a number of functions. We manage public funds. We contract with providers to [21:16] provide mental health and substance services, provide public education on [21:20] behavioral health, um and oversee the system. and um providers to some extent. [21:26] Next slide, please. And so want to go over substance use [21:32] disorder programs and recovery residences. Those are two separate [21:36] things. Um and so it's important to keep that in mind. It's a little technical. [21:41] Members of the community, you know, may not be able to tell the difference [21:44] between one and the other, but regul from a regulatory perspective, they're [21:49] two separate types of programs. Next slide, please. [21:53] So, substance use disorder clinics must be licensed by the Maryland Department [21:59] of Health. They must uh obtain an agreement to cooperate with the local [22:03] behavioral health authority. And um they are regulated by uh COMAR 1063. [22:12] Um and they're traditionally what you think of when you think of like clinical [22:15] treatment for substance use disorder. We have outpatient programs, we have [22:18] residential programs, we have opioid treatment programs, which often called [22:23] methadone clinics. Um, and so all of those clinics, we know where all of [22:28] those clinics are. They have a license with the state if they are billing [22:32] Medicaid for any services and they have an agreement to cooperate with us. Um [22:37] and so we have a better sense of where these programs are and um you more [22:44] access to to what um to what sort of services are being provided there. Uh [22:50] next slide. um certain programs uh psych uh psych [22:57] rehabilitation programs, PRPs, um substance use partial hospitalization [23:02] programs, PHPs, and substance use intensive outpatient programs, IOPS have [23:09] had a pause on new enrollments with Medicaid for those three provider types. [23:15] That pause has been in effect since July 1st, 2024 and was recently extended [23:20] through December 31st, 2026. So that's two and a half years of a pause that the [23:26] state has uh put in effect and gotten permission from the federal government [23:30] to put in effect to try to figure out what's going on with these sorts of [23:34] programs and uh put in place new regulations to address concerns about um [23:41] you know a proliferation of these types of programs and a big increase in [23:45] spending and reimbursement for these sorts of programs. Um and some things [23:50] have been put in place and uh you know we hope that they will help kind of uh [23:57] prevent so many of these sorts of programs from opening up. Next slide [24:01] please. Recovery residences on the other hand [24:05] are not clinical treatment. They do not need to receive a license from BHA. They [24:09] do not need an agreement to cooperate with us. Um they can uh receive [24:15] certification from the state. Um but that is a a less rigorous process than [24:20] lensure and they don't have to and also like at the end of the day a recovery [24:26] residence is just a house. Um clinical treatment is not being provided. They [24:31] may market themselves as a safe and appropriate place for uh people early in [24:38] recovery. Um but it's essentially just a house. And um if they want to receive [24:44] funding from the state, they need to be certified. And certified recovery [24:49] residences do receive an inspection from the state um every year or two depending [24:55] on the circumstances. Um but they are sort of um a parallel thing to licensed [25:04] uh clinical substance use treatment. Um next slide please. [25:10] One thing just I wanted to lift up is that there is a new we have sort of [25:15] rebranded a existing program. It was called the substance use crisis [25:21] stabilization center. It is now called the substance use urgent care center to [25:26] better align sort of the nomenclature and the regulations that exist in the [25:31] state. Um this uh urgent care center uh accepts walk-ins. It's open 24/7 and [25:37] this is where someone can go who needs immediate support with a substance use [25:42] need. They can go they can uh receive, you know, meals somewhere place safe to [25:48] stay, referrals to ongoing treatment. Um and so we just want to let you all know [25:54] that that exists. That is a a licensed program um and a really important, you [26:00] know, kind of component to the continuum of services we provide. Next slide. [26:07] Um, one of the main things the state is doing to try to address some of the [26:12] concerns around PHPs, PRPs, and IOPS is updating the Comar 1063 regulations. [26:19] Next slide, please. These regulations uh govern lensure and [26:25] accountability and oversight for uh the public behavioral health system. Um, and [26:30] the revisions are putting in place a number of new expectations, [26:35] new tools for system accountability, and they also require all recovery [26:40] residences to get certified. So, we're excited about this. Um, and, um, you [26:46] know, it's been an ongoing process. It's been going on since, uh, again, July [26:49] 2024. Next slide, please. Um, you know, just looking through the [26:56] timeline, um, an official draft was issued in May of 2025. [27:02] Um, there were a lot of concerns about that draft and then the state rescended [27:07] the those draft regulations and then worked more intently with uh [27:11] stakeholders to develop sort of a new draft. A new draft was um has been [27:18] shared and updated over the last you know uh year. And um next slide please. [27:25] And at this stage we are happy to say that the the most recent draft was [27:29] shared with the committee for administrative executive and legislative [27:33] review uh at the state level at the in the state legislature. AALR. This is [27:38] sort of the first like the step that happens before draft rags are published [27:43] in the register. um they must be submitted at least 15 days before [27:49] publication. So they were submitted July 10th last [27:54] week. So maybe 2 3 weeks from then uh we might see them published in the register [28:01] at which point there is a 30-day comment period and then um the formal [28:06] promulgation. So we might see these new regs in place done and and in effect [28:12] maybe two months from now which is nice. We've been on quite a quite a journey. [28:17] So so that's some news to to share share with the committee. [28:22] Next slide please. Um, and I just want to go over once [28:26] again like the provider accountability um, functions that BHSB provides. And [28:33] um, again just really emphasize our our interest in partnering with the [28:38] community, with this committee, with the city council to make sure that any [28:43] provider in Baltimore City that is licensed and billing Medicaid and [28:47] serving our residents is providing highquality services. you we want to be [28:51] a partner and we want to you know help however we can to make sure that that's [28:55] occurring. Um next slide please. Um [29:01] the main again we um conduct regular audits and site visits to certain [29:07] provider types. Um we work with the state on corrective action plans, [29:12] performance improvement plans. Um we have to get a or providers have to get [29:18] an agreement to cooperate with us before they can seek lensure and we track and [29:24] respond to critical incidents and formal complaints. [29:28] Next slide please. Um we also have a provider relations [29:32] manager and team that you know goes beyond reactions to issues to providing [29:39] best practices and meeting with licensed providers a quarterly basis. We um [29:45] attempt to meet directly with any organizations seeking lensure. Uh we [29:51] provide trainings um and update the provider network on any any changes that [29:57] are coming. Uh next slide please. And you know the one thing we want to [30:03] emphasize with this group and with any community members is that if there is a [30:08] concern about a licensed behavioral health provider, please submit a [30:11] complaint. We have a team that responds to those complaints and investigates [30:15] them. You can scan that QR code. You can also go to our website. You can also [30:20] email any member of the BHSB team for support and we will enter that [30:25] complaint. It will be investigated and any findings will be kind of sent up the [30:30] chain to the state which is where uh any uh corrective action would occur. Um and [30:36] so so that's like the main like one of the main ways that we get information [30:40] about what's going on in the community. So we encourage uh folks to use that [30:44] that complaint portal. Next slide, please. [30:49] And so that's sort of just an overview of our role um and what's what's been [30:54] going on and some news since the last time we we came to present. Um, again, [30:58] just want to emphasize that we want to be a partner in addressing concerns [31:03] about whether providers are being good neighbors and providing high quality [31:07] services. >> Thank you so much, Dan. Um, I really [31:10] appreciate it. And and colleagues, I know that these hearings have been um [31:14] very long and and arduous process, but it seems like we're almost to the finish [31:20] line. Um, Komar63 has been something that I know I've worked on for the past [31:26] few years. Um and so it's really exciting um that we are close to the [31:30] finish line and it'll finally give us um some opportunities within our roles um [31:36] to really um have the the type of quality of life issues that we're seeing [31:40] in community actually to be seen and heard um and also being taken accounted [31:45] for. [snorts] Um so I'm going to start colleagues we're going to have um DHCD I [31:51] know you all don't have a presentation but would you like to provide any [31:54] comment before we go into our round of questioning? [32:01] I'd like to ask a question if I could. >> Sure. [32:04] » Um, with the recovery homes being certified, [32:08] » what role will you guys provide with that? Um, is it anything similar to what [32:13] you provide now for licensed? >> No. So, um, recovery residences are [32:20] handled more centrally at the state level. They do the certification. They [32:24] maintain the list of recovery homes. They respond to complaints. They do the [32:30] inspections. I think we we hope that we will we will have an opportunity to work [32:36] with the state on getting the word out on um educating community recovery [32:43] residences providers about the changes that are occurring in Comar 1063. So, we [32:48] want to be a partner and we hope that we will be a partner with the state, but [32:51] recovery residences are just more managed more centrally. [32:55] » Yeah. So, that's what I figured was going to be the answer. And and so DHC's [33:00] comments would be that, you know, Miss Evelyn testified about um one neighbor [33:06] and and the impact that the recovery homes have on that neighbor and the [33:10] neighborhood. And uh DHCD he's hears this constantly and we're expected to [33:16] step up and do enforcement on these homes and pull their permits or stop [33:22] them from, you know, getting the zoning >> um cite them, you know, take them to [33:28] court. And really, >> most of what goes on is outside of [33:34] DHCD's control or oversight or ability to regulate. Um, and I would have hoped [33:41] that the state in in doing the regulations for um, 6310 [33:47] would have actually pushed recovery houses to that licensed status [33:52] » because I think that then gets you to the point where [33:56] » there is someone >> who can deal with these problems. And [34:01] when the complaints come into DAC and we're going out and sending inspectors [34:04] and all we can do is sight for the trash or the high grass or um you know [34:11] [clears throat] make sure they're properly permitted. [34:14] » Can't shut them down, but we can get them to to have the right permits in [34:18] place >> usually, but that there would be someone [34:21] that those referrals could go to that would then [34:24] » be able to revoke a license and shut a place down [34:27] » if they're needing to be shut down. Um, and that's the frustration we share with [34:33] the community in that we're here to try and help and serve and make better [34:38] Baltimore, make Baltimore a better place. [34:41] » Um, and a lot of times our hands are tied and it is very difficult for us to [34:47] then, >> you know, properly respond without [34:51] » being the the fall guy. >> Yeah. No, Jason, I appreciate that. And [34:55] and I want to just take that a little bit further. And um I I want to take [35:00] that a little bit further because I I I think that [35:07] outside of citation and high grass and weeds, I think that there are things [35:11] that DHCD could be doing. So we could possibly revoke their rental license. we [35:15] could possibly um you know have some sort of connectivity with BHSB to say [35:21] hey this is um a site that we haven't seen that is registered you know have we [35:27] looked into do they have any Medicaid complaints do they have any complaints [35:31] with the state like I want us to think a little bit more strategically than [35:36] exactly what is on paper because again and this kind of flows into my first [35:41] question how do you all and I suspect from your answer that there's not much [35:46] that has been done, but like how do you all handle any type of 311 complaints um [35:51] that come in related to said uh said residences? Like walk me through that [35:57] process and walk me through how you all are um again citation or fines or [36:07] anything. How how do you all walk through that process? [36:10] » Sure. So I it does depend on what kind of complaints are coming in. So, if it's [36:15] just the standard um sanitation related complaints, that usually lands with uh [36:22] um the property maintenance inspections division and they will respond like they [36:26] respond to any home. >> Um if they see trash or high grass and [36:30] weeds or other sanitation issues, they would issue a citation [36:33] » and that really is the the end of that until there's another complaint. um if [36:38] it does rise to that level where it's egregious, then it may get referred to [36:43] the legal section to do a pattern practice case or something. [36:46] » And how how many do you know like what is the threshold for the legal section? [36:51] Um because I mean for example in Brooklyn and Curtis Bay, there are key [36:56] um key sites that I know on the over the past 5 years that have been cited and [37:02] pushed through 311, but they haven't hit that legal threshold yet. [37:05] » Yeah. I mean, there's not a set number, but it's the where the complaints are [37:10] and the citations exist and then the citations aren't getting a response. So, [37:16] when we take a case like that to court, usually we're looking at multiple [37:19] citations within a three-month period. >> Um, not something that has dragged out [37:24] over, you know, like three citations in three years would not be a a place that [37:30] would rise to that level. But when you're getting um regular calls and [37:34] going out and seeing the same issue that isn't being addressed by the property [37:39] owner or the property manager, whoever may be in responsible, that's that's [37:44] when those things can be elevated. Um >> but if they're not enough inspectors or [37:48] only minimal inspectors that kind of handle a quadrant, um how are they going [37:54] to get out the repeated, you know, how how are they going to get out there to [37:57] the repeated calls if they're going to other places? And so like that three [38:01] month >> it [38:02] » yeah it is a constant challenge. Um they 311 calls are um prioritized you know so [38:11] where things fall off more is when it's reinspections and violation notices and [38:15] those things but they do go out >> um and if there is a violation we'll [38:19] issue the citation or a notice as appropriate. Um, [38:24] » what would happen if we pull a reasonable accommodation from a [38:27] residence? [38:32] » The reasonable accommodation itself, [38:38] » nothing really. >> So, they wouldn't have to shut down. So, [38:40] in order for them to >> we'd have to pull the use permit. [38:44] » The use permit. So, yeah. What would it be if we pull even even if we pulled the [38:47] use permit, what would that would that shut them down? [38:51] um they they would be operating without a use at that point, [38:55] » which would be a violation. >> Which would be a violation. And then [38:58] » um you our our revocation of a use permit is not the same as health [39:03] department shutting down a restaurant for code violation or even the fire [39:08] department like shutting down. It's it's not immediate in that sense. So if they [39:12] continue to operate, they'd be operating illegally and then we would take them to [39:16] court. We could also find them and other things, but [39:19] » And what's the uh duration um from for when we take them to court? [39:24] » Uh >> are we looking at a three month, six [39:26] month? What are we looking at? >> Yeah, the court process is usually we [39:31] would get into court within four to six weeks [39:33] » and then they could ask for postponements. [39:36] » So it could be three months, six months, you know, just [39:40] » depends on the case and then to an appeal. [39:43] » Yeah. And so Trey, I I had asked the last hearing, I asked for a tiger team [39:47] related to to this. Have you all developed this tiger team? And do you [39:50] all have any outputs for today's hearing? [39:54] » Uh, thank you for the question, Councilwoman Porter. Uh, I'm not 100% [39:57] sure. Um, however, I can take it back uh um to Tylure and uh and also ask Isaiah [40:03] if he has any insight on that. >> Yeah. And so I would just love to know [40:07] the status of that Tiger team and any type of report out if we can get a um a [40:12] formal response within a week. Um that would be great to the committee. [40:17] » Colleague Billy, >> thank you colleagues. I'm going to um [40:20] turn it over to you all um for your line of question. I'm going to start with [40:23] Councilman uh Conway. [clears throat] [40:26] » Thank you, Madam Chair, and I appreciate you continuing to focus on this issue. [40:30] Um, as everyone knows here, this is a pretty nuanced issue in our communities [40:35] and we're trying to make sure that we address it appropriately and so I [40:39] appreciate uh all the leadership from BHSB um and the work you guys are doing. [40:44] Uh, I I had a question um uh very recently there was a a treatment [40:51] center that opened up in my district and I did not know about it [clears throat] [40:55] and it sort of sparked a question for myself. [40:58] um about how that could happen. Are there instances in which folks may not [41:05] necessarily have to go through certain procedures in order to open a treatment [41:08] center? Um, for instance, if they're not um is there are there instances in which [41:16] they don't necessarily need a license in order to open or [41:20] » uh if they want to be a licensed behavioral health provider in the public [41:25] behavioral health system and bill Medicaid, they have to then no, they [41:29] they need a license. Okay. if they are not providing clinical behavioral health [41:33] services. If they're you know providing mentorship or [41:38] » um [clears throat] you know after school care like there's a variety of different [41:41] you know kind of social services or health and human services that an entity [41:45] might provide um in which case like that that that's not going through the [41:50] Maryland Department of Health behavioral health license process. Um, but if they [41:55] are billing Medicaid for behavioral health services, then no, they need to [41:58] get a license from us and then we we email y'all um every other month with [42:04] with new um licensed providers that open up in your uh district. [42:09] » And if they weren't billing Medicaid, >> then then no. But but at that point, [42:17] like what are they doing? You know, like how are they serving people? I guess [42:21] they could they might if they're just billing private insurance, maybe if if [42:27] they have a grant to do something outside of the public behavioral health [42:30] system, then maybe. But um but if they're providing mental health or [42:35] substance use services, then they essentially need to be licensed. Would [42:40] you guys be notified in those instances or [42:44] » No, we're, you know, there's there's a wide range of different sorts of, you [42:49] know, social services that could be provided and so we we're only involved [42:53] with uh licensed behavioral health providers and um and other and and the [42:59] folks that we directly contract with. >> Got it. Um, and then I guess there's a a [43:05] broader question um for the um for the services that we end up [43:11] having these issues that the folks have testified earlier today about um [43:18] are these folks that only are receiving Medicaid or are the ones that are maybe [43:22] only relying on private insurance or out of pocket um do they don't they have the [43:28] same issues? Um, and in light of those issues, should we also be making sure [43:34] that we know when they open up in order that we can make sure we better support [43:40] our communities in those instances as well? I don't have the answers to those [43:43] questions, but that's one of the things that came to mind for myself. Um, so I [43:48] don't know if you want to add anything to that. [43:51] Um, yeah. I think [43:57] it's just hard for me to like it's hard for me to [44:01] envision like what these entities are doing if they didn't get a license like [44:06] um you know like a someone can call [44:11] themselves whatever they they want. Um but [44:14] » and I I think we we did respond like we worked with your office on on this one [44:18] particular uh program that you had concerns about that the the um community [44:24] had concerns about and they just weren't providing mental health and substance [44:28] use treatment. They were doing other things. Um, and so, um, I think we're [44:34] we're happy to to to to get involved and to to help help [44:39] figure out what's going on in any instance, but but it's just hard to know [44:42] like how we would how we would get informed in the first place if they're [44:45] not like applying for lensure or something. [44:48] » I appreciate I I'll follow up with you guys about the one that I have in mind. [44:52] Um I I don't know how they're being paid if they apply for a license or otherwise [44:59] and but I I'll follow up with you guys on that and figure out if this is one of [45:02] those instances. But I was curious like how it kind of slipped through the [45:06] cracks and we didn't get that notification. [45:09] » But thank you Madam Chair. >> Sure. [45:11] » Thank you so much. Any other questions, colleagues? [45:14] » Councilman Bullock. >> Madam Chair. Um, not so much a question, [45:17] but just um, thank you um, Chair Porter for holding this hearing again and just [45:21] thank you for everyone here today. Um, one of the things that's not lost on me [45:24] and it's also driven by your line of questioning as as well as that of uh, [45:28] Councilman Conway. Uh, the reality is that's a difficult situation for us to [45:32] navigate and on one side we're trying to make sure that folks are getting the [45:35] help and the care they need at the same time trying to balance that with some of [45:39] the quality of life concerns that you mentioned within our neighborhoods. So [45:42] again, appreciate housing, but also appreciate uh BHSB and uh Council Member [45:46] Porter again, just as we emphasize trying to balance these issues and what [45:50] we could do in terms of the state regulations as well. So it is much more [45:53] complicated than folks realize and all of our districts are impacted by it. Um [45:57] it's evidenced by some of the questions and comments, too. So thank you for [46:00] doing this. >> Thank you so much, Councilman. All [46:02] right, Councilwoman Ramos. >> Uh thank you, Madam Chair. Uh and thank [46:08] you again for your attention to this issue in the committee. Um I had a [46:13] couple of questions. One is uh the last hearing we asked for specific lists from [46:18] DHCD about um the uh I guess they're called recovery homes um that uh have [46:27] reasonable accommodation. Uh the answer was we don't have that list. Uh the [46:32] other uh request was how many um of these uh homes are uh classified under [46:41] the bill that we uh passed several years ago around the supportive housing. Um [46:48] and uh the answer was we don't have that list. And so uh I think there's two [46:54] things happening here. One is there may be a confidentiality HIPPA issue I [46:59] guess. Um and if that is the case, that should have been the answer. Uh but the [47:05] other answer may be that um for some reason we're not collecting the data [47:10] after we're approving these reasonable accommodations, which does not make any [47:15] sense to me. Um I I think it should be done in a way that is uh similar to what [47:21] we do with rental licensing uh but maybe not as public because there could be [47:25] some HIPPA issues. Um but more around like you know we we need to know where [47:32] where some of these are so that we can h have conversations with BHSB [47:37] uh and the state uh as to the challenges that we're seeing and um so I just want [47:44] to hear a little bit more from DHCD about this issue. Uh again I I'm trying [47:50] to approach this as a client- centered approach. I mean, yes, we care about our [47:54] neighborhoods, but I don't think we'll be able to legislate anything unless [47:57] we're really concentrating on making sure that the clients are getting the [48:01] care that they need. Um, so we don't have these lists, even though we're [48:06] asking people to certify themselves or apply for these um these these issues. [48:16] » So, the the reasonable accommodation process, I don't remember the exact time [48:22] frame, but when it was created, it was created post litigation when the city [48:28] had been um denying permits for more than four individuals in a property, use [48:35] permits for more than four individuals in a property. And that was deemed [48:41] discriminatory. And um one of the resolutions was to create the reasonable [48:47] accommodation process so that we could grant an exception to the no more than [48:54] four unrelated people in a property based off of a legitimate need um to to [49:01] have that reasonable accommodation. Um so they [49:06] at the time it was never um thought of as a tracking method. it was just a [49:12] check and balance to issuing a use permit. Um, so we're we did pull and [49:19] we're able to pull um from the use permit data any use permits where it [49:26] mentions reasonable accommodation or um residential treatment or substance abuse [49:32] treatment. So that all by word search for you know lack of a better term [49:37] » that can be done but >> to the best of my knowledge no list was [49:43] ever generated because also um the reasonable accommodations come in um but [49:50] they may not actually go through with it and get the actual use permit to do [49:55] that. So sometimes they fall off or they they go through they open up and then [49:59] they close down. And so there's they just never created a list, [50:05] » right? >> Simple. [50:06] » And so I think we we I think we're going to need that in the new format relative [50:11] to, you know, especially if we're going to have these certified. Um and again, [50:16] we can talk about whether or not they're private or public in terms of who has [50:20] access. Uh but because also there's ADA and fair housing concerns. Um, but I [50:27] also know that um, you know, we want to figure out um, how to how to do that. [50:33] And I did see the the outline on the spreadsheet where you did have, you [50:36] know, based on whatever the permit was uh, but it was, you know, it's not [50:40] necessarily a consolidated list as well as uh, sometimes in the an early list [50:46] that I saw at the beginning of my uh, being a council person, these were like [50:50] historic. I mean, they they may not be, you know, reasonable accommodation [50:55] anymore. I just think we don't we don't we haven't built that kind of [50:58] infrastructure yet. And so, um, I think we're going to have to, and that might [51:02] be part of the tiger team that Madam Chair is suggesting is sort of a soup to [51:07] nuts approach, um, to figuring out how we're, um, having a better [51:13] accountability for making sure that the care that people are getting is the high [51:17] quality care that they're supposed to get. Um, so I will follow up um I guess [51:22] with you on that because I think that we do need to have you know something like [51:25] that. And then the the um and that's probably the same for the other piece [51:31] around a bill that we passed um in terms of figuring out the um supportive [51:36] housing um bill uh and making sure that we're actually figuring out what [51:42] properties are under that bill um and go from there. So, um, be happy to to work [51:49] with you on that because that's going to be critical information for resident for [51:52] us, um, as well. And we do I I understand the the confidentiality [51:57] concerns. Uh, but I do think that we've got to have some way of talking about [52:01] it. And then um I'd like to add and maybe this is a committee request um for [52:08] uh the um person who came in to talk about all the information that she did [52:14] not have uh to try to address this. I mean that's information not just for [52:18] providers but for the public to know so that we know what to expect um and what [52:23] certifications are needed for certain things if people are seeing things in [52:27] the neighborhood. And so we may want to develop uh that kind of public [52:32] information. Uh and madam chair, I don't know if you want to add that to the [52:35] tiger team work or if that's something to add as a committee request. [52:40] » Yeah. So I'm going to help her navigate because BHSB actually does that and so [52:44] I'm going to help her navigate through that process. Yep. Thank you. [52:47] » Sure. Sure. Um well I was also thinking that there could be you know um some of [52:51] this as well. And then the last thing I'll say is that you know my um you can [52:57] anticipate that um one of my neighborhoods does have a concentration [53:01] of uh these places and we hear from them a lot and uh I'd like to try to get some [53:08] folks together to really look at each one because sometimes it may not be that [53:13] and sometimes it is and we want to make sure that folks are are really taken [53:17] care of. So, I'll bring be pulling people together to to take a look at I [53:22] mean, they may not let us in, but at least we can knock um and and see see [53:27] what happens. Um so, thank you. And Madam Chair, I'm sorry I have to excuse [53:30] myself. I have to represent us uh at Mako um this morning. [53:34] » That's fine. Thank you so much. All right, Councilman Blanchard. [53:42] » Thank you, Madam Chair. Uh thank you, everyone. I before my question, I'll [53:45] just briefly say to uh the chair's point about the mentor program. Um recently I [53:52] had a um uh inpatient recovery facility in the district that had had some some [53:59] constituents were reaching out about it. Um you know, I'm not sure if that was [54:02] accurate or if it was stereotyping or whatever, but reached out, had a meeting [54:06] with the owners. They they were definitely reluctant to talk, but once [54:09] we talked and we had a you know decent conversation and then they had I think [54:13] it was a paid consultant but it is someone else who does this work and so [54:18] like well let me put you in touch with him and like talked to him and like 2 [54:22] days later they had a here's our good neighbor policy here's our like here's [54:27] the line of contact here's like a program description like do you want us [54:30] to come talk at like a neighborhood assessment and I was like why why can't [54:35] it always be this Um, and and so I think I think there was like one slight change [54:39] that they made. And obviously some of these entities are bad actors that are [54:44] being predatory and negligent of their neighbors, but I think a lot of times [54:48] it's not the case. And so I was that was just really interesting to me because [54:51] that is not often my experience in in a situation like this. So that was really [54:56] interesting. Um, my question is for I believe it's Mr. T, so it might be for [55:01] the deputy commissioner Hler. Um so under Baltimore zoning code res recovery [55:05] residences fall under the residential care facility use uh which covers not [55:09] just addiction rehab but also other residential facilities where supervision [55:12] is required. In 2017 under transform Baltimore and to my understanding under [55:18] the guidance of a lawsuit settlement exits the city. Our zoning code was [55:22] changed to allow these facilities in every residential area with effectively [55:26] no restrictions. This is in a very significant contrast with other major [55:31] jurisdictions in the state like PG County which has bed caps in Montgomery [55:35] County which has a lot size requirement for bed. Um, I think this lack of [55:39] regulation becomes a particular problem in neighborhoods where the property [55:45] values are lower because then it ends up being the highest and best use where [55:49] you're seeing this and I think this has to do with the the overconentration that [55:53] we're hearing about and this concern that we're hearing about in so many of [55:56] our communities. Um, had these regulations been reviewed and changes [56:00] proposed over the last I guess it's 9 years since um, you know, transform [56:07] Baltimore has come into place and as as the effects have become clearer. [56:14] » Uh, good morning madam chair, members of the committee, Eric Tiso for the [56:16] department of planning. Um there has not been changes recently and uh if other [56:21] jurisdictions have found a way to uh add additional requirements that we are not [56:26] doing. I would want to defer that to the law department to see if we can apply [56:30] that here. Um so that would be the the first thing that we would want to check [56:34] with. Um, yeah, we share similar concerns where some of our middle market [56:38] uh neighborhoods have homes that are just big enough uh to meet the needs for [56:43] residential care facilities uh but are also just affordable enough uh to meet [56:46] their needs and that is a competition factor that we are aware of. So, I'm [56:51] happy to to look into that as well. U we're also aware of um what could [56:56] potentially be uses that try to fit into other land use categories. Right. I was [57:02] a few minutes late to this hearing because I was actually answering a [57:05] question for someone else about a use that may fit that filed for a permit for [57:09] one thing but may fit under another but that use is not available so they're [57:14] applying under the use that they may fit through. Um, so this happens with some [57:21] degree of frequency and so we'd be happy to to help with that. And I think the [57:25] concerns that we have more are not licensed facilities because there's an [57:30] avenue of getting at those, right? Zoning is more like a hammer than a [57:33] scalpel. Um, it's the supportive housing that is not licensed, that is not [57:38] medical, that is, you know, something to that effect that is difficult to address [57:43] in any meaningful way in zoning. um without another more specific tool that [57:50] does not then get at protected classes. >> Sure. And and thank you, Mr. Chie. So, a [57:54] specific followup uh regarding the um the zoning as it compares to to other [58:01] counties. Um and I know there's an important, you know, set of legal [58:05] questions based off the lawsuit and concerns around that and whatnot. Um, [58:11] have you ever seen an example where like Baltimore City couldn't do something in [58:17] the zoning code that other counties were doing in the zoning code? Like in the [58:21] state of Maryland? >> Uh, I've not looked at that specific [58:25] angle before. Um, Maryland is an interesting state where it has three [58:29] different categories of county that have different rights and privileges to them [58:34] and land use specifically is delegated in different ways. Baltimore City is in [58:38] its own subcategory of the land use article under the state. Um so in some [58:43] ways this is apples and orangutangs in comparison. U but again I would need to [58:48] get some help from the law department to see if there's a tool that someone else [58:51] has that we have not looked at. >> Okay. Yeah. because I've had this [58:56] conversation with law before and I I just [58:59] I personally struggle to sort of imagine a situation where other large counties [59:03] are doing something with their zoning code that we can't just also do in our [59:08] zoning code. Um, thank you, Madam Chair. >> Thank you so much, Councilman Parker. [59:13] » No. All right. Any other questions? All right. I'm going to go back um to DHCD. [59:19] Just want to um ask one final question related to um inter agency coordination [59:24] with the health department um the environmental control board and how you [59:28] all handle some of these issues. So like if you see a recovery home um in the [59:34] district it has various citations. Are you all sharing that data uh with other [59:41] agencies so that they can also add on their particular realm or scope of [59:46] practice from a citation perspective? >> Um [59:54] not particular to recovery homes but in but in general. Yes. Um and actually [1:00:03] we DHD pushed um the mayor's office uh to create the multi- agency task force. [1:00:10] Um that was something that um we felt like a lot of times we were calling the [1:00:15] other agencies for support. And so we felt it was better that it be led by the [1:00:20] mayor's office. And so um that's a group that meets every Thursday and tackles [1:00:26] some problems that are really cross agency. Mhm. [1:00:30] » Um so we'll work with department transportation, uh fire department, [1:00:35] health department, uh liquor board. >> So the reason Yeah. The reason why I [1:00:40] asked this because I have a um specific list of SRS um that I would love to see [1:00:45] um I would love to see if they've been discussed within the MAFE. Um because [1:00:50] there hasn't been really there hasn't been much um movement on those SRs. They [1:00:55] were just closed. If you want to send I don't need the SRS but the addresses. [1:00:59] » The addresses. Okay. Perfect. >> Send those over to us and we can take a [1:01:02] look at them. >> Okay. Perfect. And I mean even some that [1:01:04] were mentioned today within Brooklyn and Curtis Bay. I would love to see I mean [1:01:07] those are just addresses right off the top of my head without going to the [1:01:10] office. >> Having the addresses would be [1:01:12] » okay. Perfect. >> Any other questions colleagues? [1:01:15] » All right. Hearing and seeing none. Thank you all so much for joining us [1:01:18] today. Um I really appreciate it. Um I believe we have just one second. I [1:01:22] believe we have one more person. Um, Janet Allen that wanted to provide [1:01:27] testimony. I'll allow uh two minutes. Miss Janet. [1:01:40] Miss Janet. [1:01:45] Miss Janet. [1:01:49] All right. If you are on mute, you're you need to unmute, Miss Janet. [1:01:57] Okay. All right. Um well, we're going to close out um public testimony for the [1:02:01] second time. And thank you all so much for joining us today. Have a great day.