NAMI Minnesota Legislative Update

March 26, 2017

You Did It!

Thanks to everyone who called and emailed their member of the US House of Representatives. Because you shared your opinion on the impact of block granting or using a per capita cap for Medicaid the bill was withdrawn and no vote was taken. It was clear as they got close to voting on Friday, that the Republicans did not have enough votes to pass the bill that would have repealed the Affordable Care Act and drastically changed Medicaid.

The bill would have been hugely detrimental to our efforts to build our mental health system. It would have cut $880 billion in Medicaid funding to states and would have resulted in cuts to eligibility, payments to providers and services available. The Congressional Budget Office projected that by 2026, 14 million people would lose Medicaid coverage under this plan. It should be noted that under federal law ALL mental health benefits are optional - case management, ACT teams, residential treatment, etc.

Changes were made at the last minute. One would have removed the essential benefit set - which includes mental health and substance use disorder treatment - for every plan, not just Medicaid expansion. In an effort to help they included an additional $15 billion for state support of maternity and newborn care and mental health and substance use treatment. Losing a mandate was simply unacceptable and could not be replaced by a set amount of funding.

The night before the vote the American Psychiatric Association sent a letter to the house outlining their opposition. "The AHCA will remove insurance coverage from millions of Americans who will not be able to access treatment otherwise," said APA President Maria A. Oquendo, M.D., Ph.D. "Furthermore, the bill will roll back Medicaid expansion that occurred under the Affordable Care Act (ACA). That will threaten the 1.3 million Americans with serious mental illness and the 2.8 million Americans with substance use disorders who gained coverage for the first time under the expansion. We are willing to work with members of both parties in Congress so that more Americans have access to high-quality care. Unfortunately, we cannot support the AHCA bill because it is not a solution."

The MN Department of Human Services provided information that the AHCA (Republican bill) significantly reduces federal spending on Medicaid by establishing per capita caps (i.e. capping the amount of funding per enrollee). The bill ends the enhanced federal funds now available to help states cover adults who are eligible for the Medicaid expansion. And it eliminates federal funding for MinnesotaCare.

The bill was opposed by every major group in MN including AARP, ARC, MN Hospital Association, MN Rural Health Association, American Heart Association, Amherst H. Wilder Foundation, Autism Society of Minnesota, Catholic Charities of St. Paul & Minneapolis, Children's Defense Fund - Minnesota, Jewish Community Relations Council of Minnesota and the Dakotas, Minnesota AIDS Project, Minnesota Brain Injury Alliance, Minnesota Budget Project, Minnesota Coalition for the Homeless, Minnesota Consortium for Citizens with Disabilities, Minnesota Nurses Association, MN Association of Community Mental Health Programs and many others.

Since there was no vote, we do not have a solid record of how the Minnesota delegation would have voted. It should be noted that Congressmen Paulsen and Lewis made statements on the floor in support of the bill (although never mentioning the impact of the changes to Medicaid) and Congressman Emmer made no statement and issued no press releases. NAMI had been in pretty constant contact with his office in the days leading up to the vote. There are numerous news stories out there about the bill's demise including The Hill, The Washington Post, New York Times.

Again, thanks to everyone who responded to the action alert - know that your voice matters and made a difference!

Committee Hearings Deadlines The next deadline is this Friday, March 31st. All the funding bills must be passed out of committee by Friday midnight. What you will hear about now are "omnibus bills." What does this mean? "Omnibus" means including many items - which in these bills means that many of the bills that the various finance/budget committees heard this session will end up in one bill which will also include the budgets for those agencies. Each area of government will have one - K-12 Education, Health and Human Services, etc. If funding for one of our bills - such as First Episode or School-linked - are not in either the senate or house health and human services omnibus bills, the issue is 'dead" for this session.

House Committee on Ways and Means On Monday, the House Committee on Ways and Means convened to discuss the 2017 budget targets. The targets would cut the human services budget by over $624 million from the forecast. It's important to look at this figure from the forecast not the base because there are increasing costs in Medicaid due to a number of things including more people being eligible, more older adults needing home care, etc.

Peter Nelson from The Center for the American Experiment, a conservative think tank, testified in support of the tax cuts made possible by Republican targets. However, when asked about his thoughts for the actual targets, Peter Nelson responded that he could not respond because he did not know the details of the Republican cuts. Other testifies included the Chamber of Commerce and people concerned with education.

NAMI Minnesota provided a letter to the committee and testified on Wednesday night, the only one to testify regarding human services. Sue Abderholden stated that certainly every committee member had heard from their superintendents, sheriffs, police chiefs, hospitals and others about the need to continue to build our state's mental health system. She listed off some of the key issues that NAMI had hoped would be addressed this session. Having a low human services target would make it very difficult to fund anything on the list.

House Public Safety and Security Policy and Finance Rep. Tony Cornish introduced his Public Safety Omnibus bill on Thursday in a delete all amendment to HF 896. What this means is that all the language in HF 896 is deleted and replaced by this amendment. Here are the major provisions of the bill:  No new funding to increase staff for the public defenders  $100,000 each year through 2021 to support de-escalation training, especially for understanding returning veterans, thru the Dept of Public Safety  $7 million a year for the POST board . This is higher than the amount they requested. Every state and local law enforcement agency must provide in-service training in crisis intervention and mental illness crises, conflict management and mediation, and diversity/bias training. It will be 16 credits within an officer's three year licensing cycle.  $9.2 million for the deficit in the health care budget for the Dept of Corrections and an additional $1.574 for adding mental health staff (around 12) and other personnel to increase services to inmates with mental illnesses. The funding request to implement the department's reforms for restrictive housing (solitary confinement) was not included.  Makes changes to child protection laws - a child age 10 and over can be appointed an attorney and only they can waive the appointment of an attorney (not their parents or guardians)  Requires a direct appeal to the Court of Appeals for review of referee orders in probate or civil commitment proceedings  Allows probation/parole officers to identify community alternatives when a nonviolent controlled substance use offender has a technical violation. This information is provided to the court. If this isn't possible the officers should look to first place this person in a local jail. Creates a program to facilitate local options, including CD treatment.  Requires sheriffs to collect noncontrolled substances for disposal.  Makes it a felony to physically assault or intentionally throw bodily fluids on any physician, nurse or other person providing health care anywhere in a hospital (used to be just in the emergency room). NAMI is opposed to this section. Despite eliminating sections of the solitary confinement bill that cost money, the bill was not included in the Public Safety omnibus bill. We are hoping that on Tuesday, Rep. Zerwas will put forward an amendment to include language restricting the use of solitary confinement. Stay tuned!

House Health and Human Services Finance Committee NAMI's bill on PCA attendants was heard again in committee. This bill removes the word "constant" from requirements for accessing PCA services, thereby expanding access to more individuals living with a mental illness. HF 1132 moved through the committee on Health and Human Services Finance without opposition and was laid over for possible inclusion in the omnibus bill. Thanks to Anne Henry from the Disability Law Project for filling in for NAMI and testifying for the bill.

HF 1453 from Rep. Hamilton was also heard on Tuesday. This bill makes changes to the Minnesota Family Investment Program (MFIP). According to Rep. Hamilton, the need to retain MFIP benefits is keeping couples from marrying. HF 1453 provides an 18 month period where the new spouse's income is not included when determining MFIP eligibility, so long as the spouse's income does not exceed 275% of the federal poverty level. HF 1453 was laid over for possible inclusion in the omnibus bill.

The Human Services Finance committee met again on Thursday the 23rd. Rep. Albright made a presentation on HF 1804, which proposes changes to Group Residential Housing (GRH) eligibility provisions. In many cases when an individual with a mental illness is in a crisis home, this individual will often only use GRH funding for a few days.

With such a short stay, it can be very challenging to complete the necessary reimbursement paperwork before the client leaves the crisis home, leading to uncompensated care for crisis programs. This bill would give individuals on Medicaid presumptive eligibility to streamline the reimbursement process for GRH funding. HF 1804 did not face any opposition and was laid over for possible inclusion.

Rep. Cornish also presented HF 1260 on Thursday. This bill would provide MA assistance to fund post-arrest pre-booking community-based services. In many cases an arrested individual living with mental illness does not require the security of a public detention facility and would much better served getting mental health treatment in a community based setting. This bill is from Bllue Earth County. Rep. Considine strongly supported this bill based on his experience working in the Department of Corrections. This bill was laid over for possible inclusion in the omnibus bill. House Job Growth and Energy Affordability Policy and Finance Committee On Thursday March 23rd, Rep. Garofalo presented the Job Growth and Energy Affordability omnibus bill. During this initial presentation, non-partisan research staff laid out the investments and financial impacts of this bill. Most importantly for NAMI, funding for the Bridges Rental Assistance for people with mental illnesses remained steady in the omnibus bill. Grants funding employment services for people with mental illnesses were also left unchanged. While NAMI pushed for increased funding and a new package of employment supports, those increases were not included.

House Education Finance Committee The House Education Finance Committee presented their omnibus bill. Key provisions include:  Allows school districts to include instruction on child sexual abuse prevention and provide warning signs to parents. Districts are encouraged to train staff on how to respond to disclosure of abuse and how to comply with mandatory reporting requirements.  Requires schools to identify students in grade 3 and above who are having difficulty reading and use a tool identified by the department to screen for dyslexia. Requires the department to hire a dyslexia specialist to help schools meet students' needs.  Expands SW MN State University special education teacher program to teachers working with a variance and people teaching with a community expert license.  $2.450 million a year to provide mental health services in Intermediate School Districts and the SW MN Cooperative. Funds would go to the department of human services who will give grants to certain mental health providers or to one of those schools. If a mental health provider applies they must have a letter of support from one of those schools.  Defines Positive Behavior Interventions and Supports (PBIS) and allows schools to use charachter education to support implementation of PBIS  Includes cultural competency for paraprofssional and special education teacher training  Allows third party billing for evaluations and medical services when required for the IEP or IFSP or to determine eligibility  Creates a director of early education and development to coordinate and develop early childhood programs in the state They took public testimony on their omnibus bill on Thursday. Among the numerous testifiers, the needs of the mental health community came up many times. Chris Belmont, a school psychologist serving the St. Cloud area, gave a passionate testimony about the importance investing in mental health services. Belmont argued that "now more than ever we need to focus on educating from a mental health perspective.

Sandra Lewandowski, the Superintendent of Intermediate School district 287, spoke in support of the funding allocation for mental health services for intermediate school districts. Superintendent Lewandowski spoke about the need for a "transformation in how education and mental health services are provided to the very highest need and often most aggressive students in the public school system."

The Superintendent of Richfield Public Schools testified to ask for more resources for Minnesota Public Schools. Following this request, Superintendent Unowsky spoke to the innovative work being done at Richfield Public Schools, including partnerships that provide new mental health services for some Richfield students. NAMI is glad to hear that local districts are developing creative solutions to provide students with the mental health care they need, but this also speaks to the need for a more substantial investment from the state.

The Education Finance Committee met again on Friday to mark up the omnibus bill. This process allows members one last chance to propose changes to the omnibus bill. Rep. Thissen offered the A4 amendment, which would expand the intermediate school districts mental health funding to include the Harrison Education Center in Minneapolis. Rep. Loon respectfully opposed this amendment because she considers the funding for intermediate school districts to constitute a pilot project. NAMI would have supported this amendment and hopes that the Harrison Education Center gets more resources in the future to meet the high needs of its students. Rep. Thissen withdrew the A4 amendment.

Rep. Mary Murphy put forward the A27 amendment, which would increase funding by $5 million per year for full-service community schools. NAMI supports these full-service community schools and the mental health care they provide to students. Rep. Murphy noted that there was a "waiting list" for these schools and that demand was high. Unfortunately, Rep. Loonan was unable to find space in the budget target, so Rep. Murphy withdrew her amendment.

Rep. Moran sought to set aside some dollars for school-linked mental health grants with the A34 amendment. Rep. Moran made a passionate case for school-linked mental health grants, arguing that "schools can't do it alone." Rep. Loon agreed that more needs to be done, but noted that the Health and Human Services Finance Committee is likely to set aside resources for an increase in school-linked mental health grants. Rep. Davnie spoke in support of the A43 Amendment, contending that this increase would have a significant impact and serve about 1,500 students across the state. NAMI strongly supports school linked mental health grants and was disappointed that the amendment was not adopted.

Senate Human Services Reform Finance and Policy Committee On Monday the Senate Human Services Reform Finance and Policy met. SF 911 was heard and several amendments were adopted. One relates to the 48 hour rule and would not require the commissioner (through a regional treatment center) to admit a patient after 12:00 p.m. on Friday and before 8:00 a.m. on Monday. The other created a working group of people representing mental health, home and community-based, child care services, and other direct care services licensed, regulated, or funded by the Department of Human Services to make recommendations to simplify the regulations governing these services, and to reduce the administrative burden on counties and providers, increasing access to services, and consolidating audits, certifications, and assessments.

SF 911 from Sen. Abeler was heard again on Wednesday with a few more amendments. The most relevant changes were made to home and community based services including provisions related to housing supports for individuals experiencing homelessness.

However, another amendment to SF 911 raised a few more concerns. The A7 amendment requires the Department of Human services to reimburse a municipality for the public safety costs related to state operated single-client group homes. This bill was made in response to the specific challenges regarding one such group home in Coon Rapids. NAMI is concerned that the precedent this amendment sets will lead to a new set of problems and that the circumstances at the group home in Coon Rapids does not require a legislative response.

Senate Health and Human Services Finance and Policy Committee The committee met on Tuesday the 21st. The most significant bill for NAMI MN was SF 1335 authored by Sen. Benson. This bill modifies the Hospital rate and reimbursements. Julie Marquardt from the Department of Human Services spoke to the long gestation process for this bill which began in 2014. Kathryn Kmit of the MN Council of Health plans also spoke in support of this bill, which was drawn from the Governor's budget, because it creates a mechanism to increase payment for important services that the current system undervalues.

Mental health was highlighted as one such undervalued service because this treatment does not require a lot of technical or expensive resources like an MRI. Despite this fact, mental health care can be very expensive to treat. Sen. Lourey spoke in support of this bill, which he had carried in the past, because it allows the Department of Human Services and the industry to work together to adjust reimbursement rates to better reflect the costs of care. SF 1335 was laid over for possible inclusion in the omnibus bill. Senate Judiciary and Public Safety Committee The Senate Judiciary and Public Safety Committee released its omnibus bill this week. Major provisions include:  No additional funding for the public defenders  $360,000 per year for police officer training - does not specify type of training  $9.2 million for the deficiency in health care costs in prisons They convened on Wednesday March 22nd to take public testimony on their omnibus bill. The State Court Administrator Jeff Shorba testified about the need for additional funding to support for mental health assessments for criminal and civil commitment cases. With the increase of individuals entering the criminal justice system with mental health issues, Shorba called on the legislature to provide additional funding to support mental health assessments as required udner law.

The Executive Director of the POST Board, Nathan Grove, testified before the committee. Nathan Grove argued that if the state will mandate specialized training, including de- escalation training, then the state must also provide the funding to support this mandate. Without this support, the POST board will be unable to provide the adequate training necessary to productively respond to an individual experiencing a mental health crisis.

Commissioner Tom Roy of the Department of Corrections testified about the need for more mental health services in Minnesota prisons. Commissioner Roy acknowledged the scrutiny his department has gotten from the press, which has led the Department of Corrections to request substantial increases to their mental health services. NAMI supports the commitment of Commissioner Roy to provide better mental health care to inmates.

NAMI delivered a letter to the Senate Judiciary and Public Safety Committee expressing our disappointment with certain aspects of their omnibus bill. These concerns included the lack of any legislation on the reform of solitary confinement, the lack of funding for crisis intervention training for police officers, and no additional funding for the public defense board.

What's Happening Next Week The Senate and House will be revealing their omnibus health and human services bills on Monday and Tuesday respectively. On Monday we will see the Senate education bill. On Tuesday the House Public Safety bill will be voted on in committee. It will be a long week! Stay tuned.

Bill Introductions House Bill Summaries HF2470 (Kunesh-Podein, Metsa, Flanagan, Maye Quade, Lee) Referred to Education Finance Committee. Appropriates $200,000 in FY 2018-19 to the For Jakes Sake Foundation. This bill will support collaboration between this organization and school districts to integrate evidence- based drug prevention instruction. Grantee must provide detailed report on expenditures and outcomes by February 2018.

HF 2500 (Halverson) Referred to Committee on Commerce and Regulatory Reform. Modifies minimum solvency requirements for health insurers to conform with accreditation standards of the National Association of Insurance Commissioners.

Updates from NAMI Minnesota NAMI Legislative Committee Meetings are generally held the second Tuesday of every month. To be added to the email list contact [email protected] Thursdays on the Hill NAMI will meet at the capitol every Thursday to lobby MN legislators on our legislation. If you would like to join us, contact [email protected] We typically meet around 3:15 pm.

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