NAMI Minnesota Legislative Update s5

NAMI Minnesota Legislative Update April 30, 2017

Action Alert: Legislature Sets Joint Targets House and Senate leadership held a press conference on Friday to reveal the shared budget targets for the Legislature This is a very important step that allows the conference committees to make final decisions about the items that will be funded in their omnibus bills. Note that this is an agreement between the House and Senate and once the omnibus bills are agreed upon, there will have to be an agreement between the Legislature and the Governor. Read more from the Session Daily and St Cloud Times.

The Legislature will increase spending on Health and Human Services by $2.05 billion dollars (splitting the difference between the house and senate targets), which is almost $500 million dollars below the budgeted forecast for this program. This is a significant cut to Health and Human Services spending that would force the department to make some very difficult decisions. It is extremely important for NAMI members to reach out to Republican leadership about the importance of funding mental health programs and services now that targets have been agreed upon. The reason that the Department of Human Services' budget is forecasted is that it includes Medicaid (Medical Assistance) and they have to forecast how much will be spent on health care.

The budget target for the Public Safety Omnibus bill is $87 million dollars above the spending from the previous year. NAMI wants to be sure that the necessary supports for individuals living with mental illness in the criminal justice system are there, including the Governor's request for increased mental health staff. Read a recent article about solitary confinement in the Wall Street Journal.

The Education budget target increases spending over base by $1.14 billion dollars, which is also below forecasted inflation for the education spending, while miscellaneous state spending including environment, jobs, and state government will face just over a $500 million dollar cut from the Governor's budget.

We are counting on you to reach out to House and Senate Leadership about funding for state government before Thursday. Without your advocacy, it is possible that programs serving individuals living with mental illness could be cut and certainly not increased in order to meet these targets. We need you to call House and Senate leadership this week (even if you don't live in their district) urging them to increase the HHS target. Your message is "I am NAMI member and I urge you increase the health and human services target so that we can continue to build our mental health system. The needs are great and we cannot improve access without funding."

Rep. Kurt Daudt - 651-296-5364 or [email protected] Rep. Joyce Peppin - 651-296-7806 or [email protected] Sen. Paul E. Gazelka - 651-296-4875 or email Sen Eric R. Pratt - 651-296-4123 or [email protected]

It also never hurts to let the Governor know that you care greatly about the target for health and human services - thank him for having a higher target, tell him you care about funding for community mental health services and urge him to stay strong on this issue. His number is 651-201-3400 or contact him by email

Also, we need you to continue to contact the leads on the conference committees letting them know what's important to the mental health community. Health and Human Services Leadership

38B Matt Dean White Bear 651- [email protected] 296- 3018 31 Michelle Ham Lake 651- [email protected] Benson 296- 3219

Here's what you have to say:

I am a NAMI member and I urge you to make investments in our mental health system. Please ensure that funding for school-linked mental health grants in the House bill is adopted by the conference committee. School-linked mental health grants co-locate mental health services where the students already are. This dramatically increases access to mental health services for students in need.

The mental health innovation grants in both omnibus bills are another crucial investment in our mental health infrastructure. Additional Intensive Residential Treatment Services (IRTS), crisis residential services, and collaboration between crisis teams and critical access hospitals will expand local options and provide alternatives to treatment in a hospital. NAMI urges you to adopt the Senate funding levels for these programs. Both bills provide funding to replace the loss of federal funds for our children's residential treatment programs and we strongly support this provision.

We are also counting on you to include the funding in the House omnibus bill for additional first episode psychosis programs. This early intervention leads to better outcomes for individuals experiencing psychosis. Another key investment made in the House omnibus bill are funds for supportive housing for people with mental illnesses, ACT teams, respite care, crisis services and Text4Life.

Thank you for your support and leadership on the Health and Human Services conference committee.

Public Safety Leadership

23B Tony Cornish Vernon Center 651- [email protected] 296- 4240 34 Warren Limmer Maple Grove 651- [email protected] 296- 2159 Here's what you have to say:

I am a NAMI member and I urge you to adopt the house language that restricts the use of solitary confinement. This legislation sets basic living conditions for inmates in solitary confinement like dimming the lights during evening hours and requires yearly reports to the legislature so we can better understand how solitary confinement is used here in Minnesota. These changes are long overdue and we can't wait any longer.

We also need you to adopt the Governor's funding request for Mental Health Staff in our prisons and to include the House funding for mental health crisis training for Police officers. We ask that you not accept language that would make it a felony for assaulting any staff in a hospital, even on a psychiatric ward. Thank you for your support and for your work on the public safety conference committee.

Education Leadership

48B Jenifer Loon Eden Prairie 651-296- [email protected] 1069 26 Carla Nelson Rochester 651-296- [email protected] 4848

Here's what you have to say:

I am a NAMI member and I urge you to fund the help me grow program in the final K-12 omnibus bill. This interagency initiative is a very effective program that helps families identify early developmental programs and provide education and guidance for any next steps this family will have to take. We also encourage your support for Sober High Schools and funding to address the high mental health needs of students in Intermediate Districts. Thank you for your work in the K- 12 conference committee.

Jobs Leadership

58B Pat Garofalo Farmington 651-296- [email protected] 1069 28 Jeremy Miller Winona 651-296- [email protected] 5649

Here's what you have to say: I am a NAMI member and I urge you to adopt the Governor's funding level on Vocational Rehabilitative Services. With two new mandates from the federal government, Vocational Rehabilitative Services is not going to have enough funds to accept any new clients. That means that people with a mental illness in need of help from Vocational Rehabilitative Services will be put on a wait list. I would also like to thank you for maintaining current funding levels for Bridges Housing and IPS Employment. Thank you for your support and for thinking of people with mental illnesses during your work on the jobs conference committee.

Thank you for your support. to read the full document about what is in each bill, click here. If you have any questions, please reach out to Sam Smith

Letter From Commissioner Piper Following her presentation before the HHS conference committee, Commissioner Piper wrote another letter outlining her concerns with the HHS omnibus bills in their current form.

She focused on the lack of adequate funding to the central office and direct care and treatment due to the lack of an operating adjustment to their budget. Commissioner Piper was particularly concerned about what this would mean for the Minnesota Security Hospital (MSH), Anoka Regional Metro Treatment Center (AMRTC), and the Community Behavioral Health Hospitals (CBHHs).

Commissioner Piper estimated that they will be required to reduce 300 full time equivalent (FTE) positions to meet the budget cuts called for by the legislature, including 210 FTEs in direct care and treatment. DHS is even more concerned about the Senate omnibus bill, which goes further and makes a 7-10% cut to the DHS central office. Commissioner Piper warned that all the progress that has been made in recent years, including CBHHS, would be in jeopardy if DHS was forced to make these cuts.

DHS also released a table outlining their proposals to increase program oversight and deliver services more efficiently. Hopefully this additional scrutiny will lead to higher staffing levels at state operated facilities and a more efficient use of their funding.

Click here if you would like to read the letter in its entirety. While NAMI has been frustrated with the lack of progress in hiring staff at the CBHHs, which means they have been operating below licensed capacity, we have been told that we will see greater progress in April. We will share that data once we receive it. We do know that we cannot lose staff at this point.

Conference Committee Summaries Health and Human Services Conference Committee

The HHS conference committee met on Tuesday to address the policy only provisions in the House and Senate omnibus bills. While most of this work centered on non-controversial elements with no fiscal impact that are in both bills, the conference committee did accept an amendment to Senate language on school-linked mental health services. In addition to making technical changes, the amendment inserted policy language that allows school-linked grant dollars to be used for transportation for these services when school is not in session.

This is a positive step that NAMI has been advocating for and that that will help to ensure that students can access school-linked mental health services throughout the year. Now that the Senate language on school-linked mental health grants is aligned with language in the House omnibus bill, it is imperative for the Senate to match the funding increase in the House omnibus bill.

The conference committee also adopted policy language on Psychiatric Residential Treatment Facilities (PRTFs), which provide residential mental health care to children and young adults up to age 21. The changes accepted by the committee clarify the eligibility requirements and care requirements for PRTFs. An amendment was also adopted that as well that set the effective date for this policy provision.

Public Safety Conference Committee

The Public Safety Conference committee met on Wednesday and heard testimony on a bill that NAMI opposes. This bill would make it a felony level offense for anyone to physically assault or throw bodily fluids on hospital staff anywhere in the hospital. This is a large expansion of previous legislation, which was only effective in emergency rooms.

NAMI representative John Stuart expressed NAMI's concerns with this language during public testimony, noting that this bill in no way accounts for the patients living with a mental illness, as well as patients with dementia and other medical conditions. Sen. Latz was receptive to this argument and had concerns that the legislature would have to "rely on the discretion" of the hospital and prosecutors to ensure that this policy change wasn't abused. Rep. Cornish was unconcerned with this potential risk and claimed that "I don't' mind charging mentally ill people if they deserve it." NAMI is hopeful that this policy language will not be adopted in the final version of the public safety omnibus bill. John also testified on the provisions to restrict the use of solitary confinement in the prisons.

News from the State and Federal Government The Legislature passed HF 919 / SF 562, which makes significant changes to the treatment of young children with autism. This bill makes changes to the Early Intensive Treatment for children with autism spectrum disorder, including requiring culturally competent care, a comprehensive multidisciplinary evaluation that must include input from the family and educators, and creates the Early Intensive Development and Behavioral Intervention (EIDBI) benefit set to provide this care.

Another important bill that passed over the week was HF 1702. This bill makes changes to Juvenile Justice law and requires every child over the age of ten in child protection be notified of their right to legal counsel, including that the counsel is confidential, will be provided free of charge, and that the child has a right to participate in all hearings related to the proceeding.

Three bills were heard in the Senate bonding committee on Monday that are of interest to NAMI. The first two were authored by Sen Senjem: S.F. 2159 which funds housing infrastructure bond particularly for supportive housing and S.F. 2161 which issues bonds and funding for regional behavioral health crisis programs in selected communities. Sen Senjem, Paul Fleissner from Olmsted County, Dr Bruce Sutor from Mayo Clinic, Courtney Lawson from NAMI SE, Erin Metzger from St Luke's Hospital and Sue Abderholden from NAMI Minnesota testified for the bill. Sen Senjem shared that his parents lived with a mental illness and felt it was time to take action. Courtney shared her personal story. Sue Abderholden explained the current system and urged adoption of an amendment to make clear that we needed programs that went beyond assessment and included crisis beds and short-term residential as well. The amendment was raised by Senator Laine and then Sen Senjem offered it and it was adopted.

S.F. 2086 authored by Sen Jensen, would provide bonding to convert a hospice program into a crisis residential facility in Carver County. NAMI supports this bill as well. All were laid over for possible inclusion in the omnibus bonding bill.

More on Repealing the ACA & Changing Medicaid Despite the push from the White House and certain members of Congress, there was not a vote on the AHCA and it's new amendment by the self-imposed Friday Deadline. This delay was primarily due to the strong stance of moderate Republicans and Democrats in Washington and the efforts of advocates like yourself to reach out to your members of Congress regarding the many dangerous changes being proposed. To read more, click here. The new amendment that was negotiated between the House Freedom Caucus and the more moderate Tuesday Group did not resolve the fundamental problems with the AHCA. The amendment still has way too many problems. Here's what it does:  Allowing states to pick and choose which of the essential benefits would have to be covered by insurance plans. Mental health and substance use disorder treatments are an essential benefit. You don't get to pick your illness and so states shouldn't get to pick which illnesses get covered by insurance.  Allowing plans to deny coverage because of pre-existing conditions  Eliminating community rating which prevents health plans from charging higher premiums to people who have medical conditions. It is certainly encouraging that the AHCA has faced another setback, but we cannot afford to rest on our laurels. NAMI has no doubt that another push will be made to pass this extremely problematic bill. We are counting on you all to continue to reach out to your congressperson and oppose the AHCA.

Even if you've already reached out to your U.S. Representative, they need to hear from you again that we can't afford to lose mandated essential health benefits and we can't afford to block-grant or use per capita payments under Medicaid. These policy provisions will damage our mental health system. The proposed restructure of Medicaid will put a hole in states' budgets, leaving states with no other choice but to cut services for the people who need help the most. Losing Medicaid funding and not requiring private insurance to cover mental health benefits means there will be little funding to continue to build our mental health system. If you are willing to share your story with the press or for NAMI to use in lobbying against this bill, please email your story to [email protected]

Here's all you have to say: My name is ____ and I am a NAMI member and live in your district. Please vote NO on the American HealthCare Act. Please reject provisions that convert Medicaid to a per capita cap or block grant and reject provisions that allow states to choose which of the essential benefits to require. Our mental health system is still being built and we can't afford to lose funding.

Add a little about yourself, such as you live with a mental illness, have a family member, etc.

Thank you for your advocacy!

Here is the contact information: First District Timothy J. Walz (202) 225-2472 Walz Email

Second District Jason Lewis (202) 225-2271 Lewis Email

Third District Erik Paulsen (202) 225-2871 Paulsen Email

Fourth District Betty McCollum (202) 225-6631 McCollum Email

Fifth District Keith Ellison (202) 225-4755 Ellison Email

Sixth District Tom Emmer (202) 225-2331 Emmer Email

Seventh District Collin C. Peterson (202) 225-2165 Peterson Email

Eighth District Rick Nolan (202) 225-6211 Nolan Email

Not sure which district you are in? Click here for a map.

Vocational Rehabilitative Services Vocational Rehabilitation Services (VRS) provide vital support for individuals living with a mental illness who are seeking employment. VRS gives the tools people with a mental illness need to find and maintain stable employment. Unfortunately, at the funding levels currently proposed by both omnibus bills, VRS will be unable to accept any new clients including those with a mental illness.

VRS is currently facing financial pressure due to two new mandates from the Federal government. These new requirements order VRS to provide pre-employment transition services to youth with disabilities and one-on-one meetings with individuals currently receiving sub- minimum wage to determine if they would like to seek competitive wages.

Without additional state funding, these two new requirements will prevent any new Minnesotans from receiving VRS services. This program is already facing very high demand levels. Currently, VRS is only accepting Category 1 applicants, which are the highest need individuals with severe disabilities. Of the almost 12,000 Minnesotans that receive VRS services, 22% live with a serious mental illness.

Here's a table of who is currently served by VRS

Row Labels Category Category Category Category Grand 1 2 3 4 Total All Other Impairments 2114 137 130 2381 Autism 1614 58 14 1686 Chemical Dependency 57 4 3 64 Deaf/Hearing Loss 252 48 29 2 331 Developmental Disabilities 1059 19 5 1083 Learning Disabilities 1635 215 54 3 1907 Orthopedic/Neurological 531 70 25 626 Disorders Other Mental Impairments 191 10 3 1 205 Other Physical Impairments 365 72 54 491 Serious Mental Illness 2499 97 33 1 2630 Traumatic Brain 252 20 3 275 Injury/Stroke Grand Total 10569 750 353 7 11679

Individuals living with a mental illness have the highest unemployment rate, yet access to stable employment is an evidence-based practice that is proven to help people recover. We need you to reach out to your legislator if he or she is on the jobs conference committee and call on them to match the Governor's funding request for VRS.

Find your legislator here and make your voice heard.

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]

NAMI Spring Gala Come celebrate NAMI Minnesota's 40th Anniversary on May 6th at the Minneapolis Hilton. It's a fun time to celebrate NAMI's work and to raise funds for its important mission. There is a silent and live auction, dinner and dancing. Click here for more information and to reserve your tickets! There is an after party if you cannot afford the dinner - only $15 and includes dancing!

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