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NAMI Minnesot a Legislati ve Update

August 2, 2015

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DHS Releases Managed Care Contracts Governor Mark Dayton and Department of Human Services (DHS) Commissioner Lucinda Jesson announced that Minnesota's first statewide competitive bidding process for managed care contracts, and other contract adjustments, saved taxpayers nearly $650 million. The savings come from both contracting reform (nearly $450 million) and a contract settle-up provision allowing DHS to recoup unspent health insurance dollars ($200 million). These public programs provide more than 800,000 Minnesotans high-quality health coverage.

The Dayton Administration launched the state's first ever competitive bidding process for managed care contracts in 2011, which, along with other managed care reforms, saved taxpayers more than $1 billion dollars. That first competitive bidding process included only the seven county metro. In 2014, the state competitively bid an additional 27 counties. In 2015, all 87 counties were competitively bid.

Competitive bidding provides incentives for MCOs to innovate and produce the lowest cost, highest quality proposals. Each MCO went through a rigorous bidding process that evaluated proposals based on network adequacy, quality measures, technical scores, and operations capabilities. Past experience has shown that MCOs with unsuccessful bids one year may return to the process with a more competitive proposal in the next round of competitive bidding.

Contracts will be awarded on a county-by-county basis, with generally two plans options for enrollees in every Minnesota county, and three plans in each county within the 7-county metro area. In most counties Medical Assistance and MinnesotaCare enrollees will have the opportunity to choose from the same set of plans. This statewide procurement will provide greater choice to enrollees by offering more plans to choose from in 23 counties. The new contracts will take effect on January 1st 2016. The winning MCOs and the number of counties awarded for each program are:

Medical Assistance MinnesotaCare Blue Plus 73 77 HealthPartners 33 33 Medica 45 55 PrimeWest 13 13 Itasca Medical Care 1 1 South Country Health Alliance 1 1 Hennepin Health 1 1

One thing to note is that UCare was not awarded contracts for ANY county. This will mean that about 360,000 people will need to find a new health plan. It's fair to say that most people were shocked at learning the news. South Country Health Alliance was only awarded one county making it very difficult for them to continue. The NAMI board will be looking at this issue more closely this next week.

To view the map showing the information by county, click here. Information from a press release from the Governor's office.

Minnesota Security Hospital in St. Peter The Minnesota Security Hospital in St Peter has again been in the news. The serious injury to a staff person at MSH by a minor who has a development disability brought renewed scrutiny. Initially the focus was on staff and their working conditions, including the union stating that the use of seclusion and restraints were banned. Then, the disability advocates became involved asking why a minor with a developmental disability was placed at MSH. Finally, the MN Disability Law Center issued a report showing that in fact seclusion and restraints are used and are used inappropriately. To read the report click here. There has been a lot of media attention on this issue. NAMI Minnesota's executive director was on MPR along with Commissioner Jesson last week discussing the issue.

The media coverage has been frustrating. First they incorrectly stated that seclusion and restraints cannot be used at MSH. Next, when the focus shifted to the teen with a developmental disability the media referred to him as a child and disability advocates used very troubling words to describe people at MSH: "They allowed a 16-year-old child with a developmental disability to go into a hostile place with a criminal population, and now you see the result - disaster." "What does this say about the state of our safety net if the best we can do for a developmentally disabled child is to put him in a state facility with adult criminals?" People committed to MSH are not criminals, they are people with the most serious mental illnesses.

NAMI's main concern is that despite funding increases and lots of training, restraints and seclusion continue to be used. NAMI's executive director has been in touch with the Commissioner and the head of MSH, Carol Olson. The key problem is lack of programming and treatment. This issue was discussed at length at a recent meeting of the Mental Health Legislative Network meeting. Look for a commentary from members of the network this week in the Mpls Star Tribune.

Read the articles here: Staff Injured ; 16 year old; Disability Law Center MPR Stories here and here and here

New Work Group on Foster Care Appointed Minnesota Human Services Commissioner Lucinda Jesson has appointed a work group to review concerns about the child foster care system and provide recommendations on how to make improvements.

"We rely on foster parents to provide the safe, nurturing environment that children need," Jesson said. "The majority of foster children return to their birth families and some may be adopted by their foster parents. Unfortunately, sometimes there are poor outcomes when we don't give children and foster parents the support they need."

In addition, there appears to be a shortage of qualified foster care providers, and a disproportionate number of African-American and American Indian children removed from their homes and placed in foster care. These combined circumstances call for a comprehensive review. "I want this team of experts to focus on keeping children safe while improving the foster care system in Minnesota," she said.

Members of the group are:  Honorable Anne McKeig, Fourth Judicial District  Honorable Gerald Seibel, Eighth Judicial District  Joe Plumer, White Earth Nation  Lisa Pollak, Fond du Lac Human Services  VJ Smith and Cortland Powell, MAD DADS  Mary Regan, Minnesota Council of Child Caring Agencies  Foster youth representatives;  Arlana and Brandon Omaha, foster parents  Rena Moran and Deb Diver Leith, parent leaders  Penny Robertson, Hennepin County; Melanie Erickson, Morrison County, both Minnesota Association of County Social Services representatives  A representative to be named from law enforcement  Lisa Cain Becking and Julie Snyder, Minnesota Department of Corrections  Sue Benolken, Minnesota Department of Education DHS Inspector General Jerry Kerber and Assistant Commissioner of Children and Family Services Jim Koppel will lead the work group, which will convene for the first time on August 4. Specifically, the work group will make initial recommendations on:  Recruitment, application and licensing processes for foster care homes overseen by county, tribal, and private agencies  Policies that determine how children are removed from their homes, focusing on how to minimize and treat trauma  Quality and availability of staffing and resources, including case coordination to improve educational outcomes, medication management, screenings, referrals and monitoring, family visitation planning, and reunification and permanency planning. The work group will also address a number of other topics, including:  Northstar Care for Children  Minnesota Assessment of Parenting Children and Youth  Child maltreatment reports in foster care (screening, investigation, licensing notification)  Curricula and training resources for foster care providers  Reunification and aftercare support services  Racial disproportionality in foster care  Sex trafficked youth in foster care  Reasonable and prudent parent standards. The work group will provide initial recommendations in a report to the Minnesota Department of Human Services and the public by Nov. 1, 2015, and final recommendations by March 1, 2016. Information from DHS

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News on the National Level CMS Announces New Service Delivery Opportunities for Individuals with a Substance Use Disorder This week the Centers for Medicare & Medicaid Services (CMS) announced new opportunities for states to design service delivery systems for Medicaid beneficiaries with a substance use disorder (SUD); including a new opportunity for demonstration projects approved under section 1115 of the Social Security Act (Act) to ensure that a continuum of care is available to individuals with SUD. This initiative is part of CMS' continued commitment to support state efforts to reform systems of care for individuals with SUD, including enhanced availability of short-term acute care and recovery supports for individuals with SUD, improved care delivery, integrated behavioral and physical care, increased provider capacity and raised quality standards. Today's announcement complements the significant progress many states have made in achieving better outcomes for individuals with a SUD and the recently introduced Medicaid Innovation Accelerator Program that supports participating states in improving their SUD delivery system.

CMS is offering a new opportunity for Medicaid section 1115 demonstration projects to test Medicaid coverage of a full SUD treatment service array in the context of overall SUD service delivery system transformation, provided participating states meet specific requirements. CMS recognizes that existing statutory payment exclusions for services provided to individuals who reside in specific settings may challenge states' abilities to offer a full continuum of care and effectively treat individuals with SUD. As part of this initiative, states may receive federal financial participation (FFP) for costs not otherwise matchable, such as services delivered to targeted populations, in limited geographic areas, or in settings, such as an Institution for Mental Diseases (IMD), that are not otherwise covered under the Medicaid program.

The attached guidance to State Medicaid Directors details the new demonstration opportunity, outlines our expectations of a transformed SUD service delivery system and explains how to submit an application for such a demonstration project.

No Child Left Behind After the Senate passed a bipartisan overhaul to "No Child Left Behind" today, U.S. Sen. Al Franken (D-Minn.) said that several key provisions he wrote into the No Child Left Behind bill will help improve education in Minnesota and around the country.

The comprehensive reform to our nation's federal education policy, called the Every Child Achieves Act, was passed on Thursday with overwhelming bipartisan support.

Provisions that Sen. Franken wrote into the Every Child Achieves Act of interest to NAMI include:

* Mental Health in Schools. Sen. Franken's mental health in schools provisions enable schools to partner with community-based organizations to expand access to mental health services for students. These provisions also support training for school staff and volunteers to help them recognize the signs of behavioral health problems in students and refer them for appropriate services.

* Principal Training and Recruitment. This provision improves the preparation, placement, and retention of effective principals and other school leaders in high-need schools.

* Computer Adaptive Testing. Sen. Franken's bipartisan computer adaptive testing amendment allows states to use computer adaptive tests that include questions within, as well as above and below, grade level. Such tests give teachers and school systems the ability to more accurately measure each student's achievement level and determine student growth.

* 21st Century Community Learning Centers. This bipartisan amendment renews a current program to create community learning centers that provide academic enrichment opportunities during after school hours for children, particularly students who attend high-poverty and low- performing schools.

* School Counseling. Sen. Franken's amendment allows school-employed counseling professionals, such as school counselors, school social workers, and school psychologists, to work together to create and expand comprehensive school counseling programs. Counseling programs emphasize prevention and early intervention, engage families, and incorporate research-based approaches to promote students' academic success.

Support NAMI's Work at the Legislature NAMI Minnesota's legislative work is funded through individual donations and the NAMIWalk. If you want to support NAMI's legislative efforts or just give a "congratulatory" donation for this session we would greatly appreciate it. To give online simply click here and if you or your organization would like to become a sponsor for the NAMIWalk (for as little as $250) click here to learn more about the sponsorship levels. Creating change isn't free!

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