HF 1067 (Huntley, Hosch, Walker, and Anderson, B s1

NAMI Minnesota Legislative Update – July 22, 2010

Legislature is Out – But Our Work is Not Done While the 2010 Legislature has finished its work, NAMI’s work continues. This election season NAMI will continue its work to educate candidates and to encourage NAMI members to vote. As part of the Mental Health Legislative Network, questions have been sent to all the candidates running for governor to try to ascertain their views on key topics of concern to the mental health community. We are hoping to receive enough answers so that they can be posted on the website.

Everyone is encouraged to attend candidate forums in their community and to ask questions of any candidate that knocks on your door. You might ask what they would do to improve the mental health system or access to mental health services. You can ask about specific services such as employment, housing or school-based mental health services. You could ask for their position on expanding Medicaid to single adults at or below 75% of the federal poverty guidelines. The most important thing is to ASK! The 2011 legislative session will be equally as challenging and we need to have every legislator who is elected know that constituents in his or her district care and are concerned about mental health services and treatment.

August 10 Primary Election – Be Sure to Vote! The primary is the first step in determining who will be on the ballot in the general election. By voting in the primary, you help determine who will make important decisions about mental health services and the state budget. We need you to vote!

To find your polling place, as well as a sample ballot and a list of candidates who will be on your ballot on August 10, visit the Secretary of State's Website. The Secretary of State's website also includes candidate information and a sample ballot for you to review before August 10.

Visit the League of Women Voters Minnesota's 2010 Voter Guide to find out more about the candidates on your ballot, including a listing of candidate forums in your area.

State Operated Services The task force required under law to look at state operated services has met and the subcommittees have had several meetings. NAMI is closely monitoring and has representation on the task force and many of the subcommittees. If you want to read the reports go to the DHS website.

Changes to the General Assistance Medical Care Program In 2009 Governor Pawlenty vetoed the second year of funding for the GAMC program. The legislature created a new program and it passed with bipartisan support only to be vetoed by the Governor. A second bill passed and was signed into law. General Assistance Medical Care (GAMC) will essential go away on July 1, 2010 and a new program with substantially fewer dollars will replace it.

People who would have qualified for GAMC will go to a “Coordinated Care Delivery System” (CCDS) to receive all of their care, except that their outpatient prescriptions will be obtained and funded separately. A CCDS is essentially a hospital, however, only four have agreed to participate and they are all in the metro area (see list below). People can seek help from any other hospital until March 1, 2011 and those hospitals will have access to an uncompensated care pool or can become a CCDS in September 2010. However, under the federal EMTALA law, all hospitals that take federal funding (such as Medicaid and Medicare) must provide appropriate care and treatment to anyone who comes to their emergency department if he or she has an emergency medical condition.

The new GAMC program will cover doctor/clinic visits, hospital stays, outpatient hospital care, emergency room care (with a $25 co-pay for a nonemergency visit), emergency medical transportation and mental health services. All of the care must be obtained through the new CCDS which means that people will not be able to see their current doctors. The new GAMC program will not cover all the services that were covered in the past, including dental, vision care and eyeglasses, chiropractic care, medical equipment and supplies, hearing aids, most rehabilitative therapies, and medical transportation.

The GAMC prescription drug benefit includes only outpatient prescriptions dispensed by a pharmacy. Prescription drugs administered by a healthcare professional in a clinic or other outpatient setting are not included in the GAMC pharmacy benefit. The GAMC outpatient prescription drug benefit does not include medical supplies or other non-drug items. Drugs which must always be administered by a healthcare professional will be excluded from GAMC drug coverage effective June 1, 2010. Drugs which are usually administered by a healthcare professional but are occasionally self-administered by the recipient will be subject to prior authorization. Prior authorization will be approved only if the drug is being self-administered by the recipient. Injectable antipsychotics will be approved if dispensed by a pharmacy and administered in the patient’s home. There will be no change in coverage for products which are generally self-administered by the patient.

People who were on GAMC on July 1, 2010 should have received a notice from the state and been told to choose a CCDS. For new people applying for GAMC they will be given an opportunity to choose between GAMC and MinnesotaCare and if they choose GAMC, they will be given an opportunity to choose a CCDS. NAMI Minnesota recommends that people go on MinnesotaCare or apply for Medical Assistance. For more information, visit the Department of Human Services website at www.dhs.state.mn.us

GAMC is an important program for the mental health community because about 70% of the people on the program have a mental illness or chemical dependency or both and many mental health centers, crisis teams and Intensive Residential Treatment Services served people on GAMC – between 10 and 50%. GAMC paid about $10 million for adult mental health services including Adult Rehabilitation Mental Health Services, Intensive Residential Treatment Services and Assertive Community Treatment Teams.

NAMI is collecting stories of people who have had difficulty accessing their medications, mental health treatment and health care due to the changes in the GAMC program. Please contact Sue Abderholden by e-mail at mailto:[email protected] or by phone at 651-645-2948 ext. 105.

University of Minnesota Medical Center, Fairview – (612) 273-6099 Fairview Health Services 2450 Riverside Avenue Minneapolis, MN 55454 Must choose a primary care physician or clinic: • UMMC Riverside Primary Care Clinic, 2450 Riverside Avenue, Minneapolis, MN

North Memorial Medical Center – (763) 520-5210 3300 Oakdale Avenue North Robbinsdale, MN 55422 The CCDS will ask you to choose a primary care physician or clinic from the following list: • North Memorial Clinic – Brooklyn Center Physicians, 5415 Brooklyn Boulevard, Brooklyn Center, MN • North Memorial Clinic – Brooklyn Park Physicians, 8559 Edinbrook Parkway, Brooklyn Park, MN • North Memorial Clinic – Elk River Physicians, 800 Freeport Avenue North, Elk River, MN • North Memorial Clinic – Golden Valley Family Physicians, 8301 Golden Valley Road, Golden Valley, MN • North Memorial Clinic – Minnetonka Physicians, 2000 Plymouth Road, Minnetonka, MN • North Memorial Clinic – Northeast Family Physicians, 327 Central Avenue SE, Minneapolis, MN • North Memorial Clinic – Plymouth Internal Medicine, 2805 Campus Drive, Plymouth, MN

Hennepin County Medical Center (HCMC) – (612) 873-3000 701 Park Avenue Minneapolis, MN 55414 Must choose a primary care physician or clinic: • Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN

Regions Hospital – (651) 254-2200 640 Jackson Street Saint Paul, MN 55101 The CCDS will ask you to choose a primary care physician or clinic from the following list: • HealthPartners St. Paul Clinic, 205 Wabasha Street South, St. Paul, MN • • HealthPartners Midway Clinic, 451 Dunlap Street North, St. Paul, MN • • HealthPartners Adult & Seniors Clinic, 401 Phalen Boulevard, St. Paul, MN • MC

Briefs Filed in California and Illinois The Justice Department announced it has filed briefs in cases in California and Illinois as part of its continuing effort to enforce civil rights laws that require states to end discrimination against and unnecessary segregation of persons with disabilities. The briefs were filed as the department prepares to celebrate the 20th Anniversary of the enactment of the Americans with Disabilities Act (ADA) on July 26, 2010.

The briefs allege that public entities in both California and Illinois administer their health care systems for Medicaid-eligible individuals in a manner that violates the ADA and the Supreme Court’s decision in Olmstead v. L.C. The Olmstead ruling requires states to eliminate unnecessary institutionalization of individuals with disabilities and provide those individuals with services in the most integrated setting appropriate. The department’s briefs follow a series of recent filings in Florida, Illinois, New Jersey, New York, Georgia and Arkansas that demonstrate the administration’s increased enforcement efforts following President Obama’s proclamation of the “Year of Community Living.”

“Unnecessary institutionalization deprives individuals of the opportunity to live their lives as they choose. We are working tirelessly to end the unjustified institutionalization of individuals with disabilities,” said Thomas E. Perez, Assistant Attorney General for the Civil Rights Division. “The department is committed to ensuring that community-based services are provided to enable individuals with disabilities to live fully integrated lives in their communities.”

The Justice Department’s brief in Napper v. County of Sacramento asserts that Sacramento County’s redesign of its outpatient mental health service system puts thousands of Medi-Cal, California’s Medicaid program, recipients with mental illness at substantial risk of institutionalization in violation of Olmstead’s community integration mandate. According to the brief, the plan proposed by the county will decrease the availability of necessary mental health outpatient services, putting plaintiffs at risk of entry into institutional settings. The brief also alleges that the time frame for the new system roll-out puts some persons at risk of institutionalization.

In Illinois, the Justice Department filed a brief in Hampe v. Hamos, supporting the plaintiffs’ motion for class certification of a group of young adults with severe disabilities who have “aged out” of a Medicaid program which provides home and community-based services. Under the state regulatory scheme, Illinois restricts eligibility for this program to individuals under the age of 21. Because the adult program to which most of these individuals transfer has significant funding caps and does not provide community services at the same level, plaintiffs may be forced to enter institutions in order to receive the medical services they need to survive or to remain in their homes without adequate medical care. In its brief, the Justice Department states that certification of the proposed class is proper because class actions are an effective means of achieving the systemic reform that is necessary to address community integration claims.

The full and fair enforcement of the ADA and its community integration mandate is a major priority of the Civil Rights Division. During the past year, the department has filed briefs or filed suit in federal court in 18 different cases raising Olmstead issues.

People interested in finding out more about the ADA can call the Justice Department’s toll-free ADA Information Line at 1-800-514-0301 or 1-800-514-0383 (TTY), or access its ADA website where all relevant case filings can be found.

New Federal Health Care Bill The Patient Protection and Affordable Care Act (health care reform) has many elements--from patient protections to Medicaid expansion--that offer meaningful benefits to individuals and families who live with mental illness.

To help inform members and to assist leaders, NAMI has created two new health care reform fact sheets. NAMI's "basic" fact sheet explains key provisions in a user-friendly format, while NAMI's "enhanced" fact sheet includes additional information on Medicaid options, federal grants and other significant provisions for policy leaders. For more resources on health care reform, please visit our Web site.

In addition, the U.S. Department of Health and Human Services (HHS) unveiled an innovative new online tool on July 1, 2010, which will help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. Called for by the Affordable Care Act, this first Web site is to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool. This site has a central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans.

"HealthCare.gov helps consumers take control of their health care and make the choices that are right for them, by putting the power of information at their fingertips," said HHS Secretary Kathleen Sebelius. "For too long, the insurance market has been confusing and hard to navigate. HealthCare.gov makes it easy for consumers and small businesses to compare health insurance plans in both the public and the private sector and find other important health care information."

As the health care market transforms, so will HealthCare.gov. In October 2010, price estimates for health insurance plans will be available online and, moving forward, new information on preventing disease and illness and improving the quality of health care for all Americans also will be posted.

"People need to see what choices are offered, what options cost, and how coverage works in practice," said Karen Pollitz, Deputy Director for Consumer Support, Office of Consumer Information and Insurance Oversight. "Today, HealthCare.gov takes an important first step in that direction. In the coming months and years, we will add pricing and plan performance information so that consumers can see and understand and make meaningful choices about their health coverage." Visit www.healthcare.gov.

Online service helps estimate parental fee for health care coverage A new online service on the DHS website helps parents estimate their parental fee. Minnesota law says all parents with an adjusted gross income over 100 percent of the Federal Poverty Guidelines have to pay an annual fee if their child has been approved for Medical Assistance (MA) under TEFRA, Community Alternative Care (CAC), Community Alternatives for Disabled Individuals (CADI), Traumatic Brain Injury (TBI) and Developmental Disabilities (DD) waivers or an out-of-home placement. The fee is only an estimate and parents will still need to complete a form and provide tax information. The Parental Fee Estimator is available online.

NAMIWalk! It's time to start gearing up for the NAMIWalk - a great opportunity to fight stigma and raise awareness. If you don't have a team, you can join Sue Abderholden's team - SueNAMI - creating a wave against stigma. Simply go the NAMI Minnesota website and click on the walk.