May 23, 2023
Legislative Session Nearing End - Corrections and Updates
The session ends today. We apologize for the incorrect information on the Human Services Bill. We reviewed the wrong version of the bill. We try to provide as accurate information as possible, so are sorry for the error. The correct information is below. In addition the 844 page Health and Human Services bill was released this morning and we just finished reading it, so we have added information to that section as well.

Human Services - Passed SF2934: 
  • Creates requirements for sober homes. Includes maintaining a supply of opiate antagonists, having written policies regarding evictions, returning all property and medications to a person discharged, documenting contact information for persons in case of an emergency, maintaining contact information for emergency resources in the community, have policies on staff qualifications, have a policy on medication use, have a fee schedule and refund policy, distribute the sober home bill of rights, have policies requiring abstinence, and policies that promote resident participation. There is also a sober home resident bill of rights listed in the law. Complaints can be made to the Ombudsman for Mental Health and Developmental Disabilities. Requires DHS to conduct a survey on sober homes, where they are, who they serve, etc.
  • Creates a Task Force on Priority Admissions to State-Operated Treatment Programs. NAMI Minnesota is named as a member. Also restates that someone from a jail must be moved in 48 hours when a medically appropriate bed is available.
  • Allows for remote supervision in community residential settings if it’s appropriate
  • Allows PCAs to drive the client
  • Funds supportive decision making programs
  • Requires a study on licensure for Early Intensive Developmental and Behavioral Intervention
  • Funds a pilot project to attract post-secondary students to become PCAs or direct support personnel
  • Creates a study to figure out how to expand services under the waivers to decrease the numbers of people who remain in hospitals, jails, and other acute or crisis settings
  • Requires study on presumptive eligibility for people with disabilities and older adults for programs such as Medicaid and home and community-based services
  • Creates a task force to look at the need for transitional care for people leaving acute care settings
  • Eliminates TEFRA fees for families who have children with a disability who need Medicaid services
  • Eliminates the asset limit under the Medical Assistance for Employed Persons with Disabilities program and the premiums
  • Increases rates for NEMT except for protected transport
  • Moves from a subcabinet position to an Office of Addiction and Recovery and adds a Division of Youth Substance Use and Addiction Recovery within the Department of Management and Budget. 
  • Makes numerous changes to substance use disorder laws including timing of assessments, using the American Society of Addiction Medicine criteria
  • Develops withdrawal management and family treatment start-up grants and safe-recovery sites
  • Requires DHS to evaluate the feasibility of to cover traditional healing, behavioral health services in correctional settings under Medicaid
  • Creates an opioid treatment program work group
  • Requires DHS to develop recommendations for peer recovery services and MA coverage
  • Creates culturally responsive recovery community grants and for harm reduction 
  • Requires correctional facilities to have opioid overdose emergency procedures
  • Requires community corrections to have supplies of opiate antagonists 
  • $2M for grants to Tribal Nationals and urban Indian Communities for behavioral health workforce
  • Funds Project Echo around opioids
  • Requires supportive housing to have opioid antagonists
  • Funds an awareness program for substance use disorders and an overdose surge alert system 
  • Creates a separate agency for Direct Care and Treatment
  • Eliminates the cost of care paid by counties when someone is committed as having a mental illness and is dangerous and is at Anoka Regional Treatment Center and is waiting to be discharged to another state operated facility until June 30, 2025
  • Funds $4 million for training for mental health peers
  • Funds $300,000 a year for Wellness in the Woods to provide peer support for people leaving prison

Health and Human Services: This bill has not passed, and we saw the 800+ page bill this morning. Here is the additional information on the policy provisions in the bill:
  • Requires DHS to send a formal communication to hospitals and children's residential facilities informing them of the child protection screening guidelines which have been updated to address situations in which parents are actively seeking care to keep their child safe but services are not available and the child is boarding in the ER or "stuck" inpatient or in residential care. DHS must also consult with stakeholders to assess and suggest changes to those screening guidelines
  • Pays for Medicaid for youth in Foster Care from age 18 to 26
  • Adjusts rates for ACT, adult crisis stabilization, IRTS, for inflation starting January 1, 2024 using CMS' economic index.
  • Adjusts the PRTF per diem rates to the CMS inpatient facility market basket
  • Adds a 3% increase to mental health outpatient services and adds inflation every year until the new rate methodology is adopted. The critical access mental health rate add-on is reduced to 11.85% on 1/1/2025, to 5.92% on 1/1/2026 and to 0% on 1/12027.
  • Adds a psychiatrist to the Drug Formulary Committee along with physicians who specialize in rate diseases, pediatrics, and people with disabilities
  • Requires coverage of tobacco cessation products and services (including phone counseling) including those delivered by mental health professionals and practitioners, peer specialists, alcohol and drug counselors, certified tobacco treatment specialists, community health workers, physicians, PAs, APRNs. Doesn't allow limits on dosing or using multiple services. There is no cost sharing for these products and services under MA
  • Includes the network adequacy language and covering PRTFs in private insurance and this language takes precedent over the language in the commerce bill.
  • Requires coverage of biomarker testing under private insurance
  • Requires study on whether to develop a statewide provider directory within MDH
  • Creates a comprehensive Drug Overdose and Morbidity Act for prevention activities, epidemiologic investigations and surveillance, and looking at integrated strategies.
  • States that minors 16 years of age and older can consent to outpatient health and mental health services
  • Funds and defines school-based health centers
  • Includes language related to developmental and social-emotional screening of young children and ensuring follow-up services
  • Creates model jail practices for incarcerated parents and creates a grant program to carry it out
  • Creates a Help Me Connect program for parents with children ages birth to age 8 to help link them to appropriate community services
  • Provides workplace safety grants in health care settings on de-escalation and is for hospitals under 49 beds in rural areas, medical clinics, dental clinics and community health clinics
  • Creates a task force on pregnancy and substance use disorders
  • Allows DHS to establish and design a pilot program to expand mobile and stabilization services for children, youth, and families.
  • Allows a brief diagnostic assessment for children under the age of 6
  • Streamlines some of the mental health related statutes for service delivery
  • Establishes the transition to community initiative is for people not eligible for Medical Assistance and is expanded to children.
  • Requires six hours of training for crisis teams and crisis stabilization that serve children specific to working with children and families
  • Increases General Assistance to $350 per month and adds inflation
  • Creates automatic eligibility for housing supports for people with disabilities and lacks a residence when leaving prison
  • Creates the Department of Children, Youth, and Families
  • Requires DHS to distribute a survey to counties to determine how many children are sent to residential facilities in other states
  • Creates a Health Subcabinet to reform health care delivery and funding
  • Creates a Health Care Affordability Center within the MN Dept of Health
  • Moves from a Medicaid and MN Care Managed Care system to a fee for services system
  • Does not allow someone to be disenrolled from MA until DHS has reached out at least twice by phone or email or other methods.
  • Directs DHS to create a certified peer specialist and family peer specialist program to provide training.
  • Makes changes to the statute governing certified community behavioral health centers

The committee did release a spreadsheet on Friday night. The funding for mental health is about $98M per biennium which is less than what the Governor requested and what the Mental Health Legislative Network wanted. The Governor asked for $122.777M in FY24/25 and $141.864M in FY26/27.
Here are the mental health related issues in the spreadsheet:
  • A rate increase for community mental health providers, including adult day treatment (roughly 3%)
  • Funding 988, the Suicide and Crisis Lifeline, with a telecom fee 
  • Paying childcare for low-income parents living with a mental illness who don’t have a work requirement and thus don’t qualify for childcare subsidies but need care when in treatment
  • New funding for an online searchable program to make it easier to find mental health and SUD providers - $990,000 a year for 2 years
  • Start-up funding for Psychiatric Residential Treatment Facilities
  • Funding for the White Earth Adult Mental Health Initiative 
  • Increases in grant funding for:
  • Early childhood mental health services $2.4M
  • School-linked behavioral health services $14M FY24/25 and $9M FY25/26 and has a start date retroactive to 7/1/2023 and allows culturally specific providers to serve children across schools
  • Mobile mental health crisis teams, including tribal teams $18M but $0 for FH25/26
  • Cultural and Ethnic Minority Infrastructure $6M each biennium and putting the grants into statute and adding paying for interpreters in residential facilities, and paying for case specific consultation
  • First Episode of Psychosis programs $2.7M each biennium
  • Transition for Homelessness program $10M each biennium
  • Increases in grant funding to address workforce shortages, including:
  • Loan forgiveness for mental health professionals $2.78M
  • An additional psychiatrist residency slot $800,000 each biennium
  • Training pediatricians with child psychiatrists $2M each biennium
  • Paying for BIPOC mental health professionals to become supervisors $1M each biennium
  • Mental health agencies providing free supervision to trainees $3.2M each biennium
  • Placing Certified Community Behavioral Health Centers back in the federal demonstration project
  • Funding children’s residential treatment so that families of children with serious mental illnesses do not need to go through the child protection system
  • Funding the Mankato project for a community MH center
  • Funding of $2M for the African American Child Wellness Institute
  • Modifications to MH provider licensing
  • Modifying the adult residential health rule

Other funding items in the bill:
  • Continuous MA eligibility for children
  • GA benefit increase
  • $100M to enhance and create shelter spaces across the State. 
  • $6M each biennia for Transitional Housing: 
  • $30M each biennia for the Homeless Youth Act: $ 
  • $4.25M increase in 2024/25 and $2.5M in 2026/27 for Safe Harbor 
  • $11.4 to Hennepin County and the same to Ramsey County to address homelessness 
  • $95M of one-time funding for the Family Homeless Prevention Assistance Program
  • $15M to rehab Public Housing 
  • Study to look at foster youth and their SSI?SSDI benefits
  • Reinstate comprehensive dental benefits under MA
  • Eliminate cost-sharing under MA
  • Extending audio only telehealth under MA
  • $500,000 to study psychedelics
  • Comprehensive drug overdose and morbidity prevention act ($24M)

Concerns with the spreadsheet:
• It is not clear how the rate increase will be implemented,
• Funding was not included for voluntary engagement, where a person exhibiting symptoms of a mental illness can be engaged by a peer specialist early to agree to treatment voluntarily, thereby avoiding the ER or a police response. The ask was for this pilot project was just $250,000. If we want to address homelessness and ER visits, we must fund early intensive services. 
• Funding for the first episode mood disorder program was not included.
• Funding to add children to the Transitions to Community program, which would have dedicated resources to children boarding in the ER or “stuck” in inpatient or residential treatment, was not included.
• $13 million in the 24/25 biennium is for grants that DHS never spent in the current biennium (FY22/23) (despite the need for that funding). 
• The Housing with Supports for Adults with Serious Mental Illness Grant did not receive funding and it is an important program to help people with mental illnesses who are homeless or are trying to leave institutional settings obtain and retain housing. 
• With some grants, funding was reduced or zeroed out in the second biennium – such as school-linked and mobile crisis. This will cause major service disruption to people, especially children. 

Judiciary and Public Safety - Passed Chapter 52: Almost all of the Mental Health Legislative Network's (MHLN) proposal was included in the bill:
  • Requiring free phone calls from jail when they are to a mental health provider, case manager, insurance navigator, or the MN Warmline;
  • Requiring an updated model discharge plan for all jails;
  • Strengthening the existing requirement for discharge planning for people with serious and persistent mental illnesses who have been sentenced to jail;
  • Requiring correction orders on jail licenses to be posted publicly;
  • Establishing standards for county reentry coordination programs.

We were disappointed that our proposal to provide grants for reentry programs and jail social workers was not included in the final budget agreement, but we will keep advocating for this next year! Other highlights include:

  • The Minnesota Rehabilitation and Reinvestment Act will allow incarcerated people to complete individualized incentive plans to earn time off of their sentence and reinvest funds in victims services, community supervision, and the general fund;
  • $3.1 million each year to provide free phone calls to people incarcerated in prisons;
  • A $92 million increase over the biennium for public defenders;
  • $1 million over the biennium for a Juvenile Restorative Justice Office and $8 million for restorative practices grants;
  • Creation of Extreme Risk Protection Orders to assist in suicide prevention and means restriction; and
  • Delaying the enactment date of the new competency attainment law that was passed last year. The date change moves certain deadlines for the State Competency Attainment Board to October, 2023 and moves the full enactment of the policy to April 1, 2024.

Education - Passed HF2497: The education conference committee met yesterday and is expected to submit their report very soon. We know these MHLN priorities have been included:
  • Increased funding for student support personnel;
  • Creating a mental health services lead at the Department of Education; and
  • Allowing extended time revenue to cover costs for students who missed school due to residential treatment or juvenile justice involvement.
  • Providing free menstrual products and opiate antagonists
  • Creating structure around active shooter drill to not traumatize students
  • Including 988 and the county crisis lines on students IDs, planners, etc.
  • Creating a discipline complaint procedure
  • Requiring 8 hours of training for paraprofessionals and time to review the IEP
  • Providing grants to schools to reduce suspensions and expulsions
  • Requires the district oversight committee on restrictive procedures to examine disparities
  • Prohibits the use of seclusion on children from birth through grade 3 by September 1, 2024
  • Allows students in residential facilities to do online learning through their home school district
  • Allowing school social workers to bill Medicaid for the services they provide and to use an IEP instead of diagnostic assessment

Commerce - Passed SF2744: We have a lot to be proud of in this bill with many of the important provisions from the Mental Health Legislative Network included which will make a big impact in accessing care including:
  • Creating and funding the Mental Health Parity and Substance Abuse Accountability Office;
  • Mandating coverage of Psychiatric Residential Treatment Facilities (PRTFs);
  • Defining and requiring free preventive services which includes screenings for depression, suicide, alcohol and drug use, and autism;
  • Providing private insurance coverage for the psychiatric collaborative care model;
  • Changing the exclusion time line for life insurance policies or certificates from two years to one year and updating some of the language related to suicide;
  •  Adopting broader network adequacy standards than 30 miles, 30 minutes for mental health services such as wait times and diversity of providers;
  •  Allowing any wiling mental health provider for the next two years to address the mental health crises of Minnesotans;
  •  Allowing six months for providers to submit bills for Medicaid Managed Care.

Housing - Passed Chapter 37: $5.338 million each year through 2027 for the Bridges rental assistance program and that money can be used for landlord risk mitigation .

Employment: $2 million each year through 2027 for Individual Placement and Support (IPS) programs.

Veterans: $300,000 each year of the biennium for grants to make EMDR therapy available to veterans and veterans' spouses experiencing PTSD. The bill funds these grants ongoing at $200,000 beginning in FY26. The bill also includes funding for homelessness intervention and healthcare.
News from the Capitol
48 Hour Law
Last week, late in the conference committee process for the Human Services budget bill, new language was released changing a controversial law known as the 48-hour law. If a person is in jail and has been found incompetent to stand trial and then been civilly committed, the law requires DHS to admit the person to a state operated program within 48 hours. The law is well-intended so that people who need inpatient treatment do not languish in jail, but it has always been a narrow attempt to fix a much larger problem.

Recently there have been lawsuits against DHS for not admitting people within the 48-hour requirement. This is because there are not available beds, or insufficient staff to open beds at the state operated hospitals at Anoka Metro Regional Treatment Center or the Minnesota Security Hospital for people committed as mentally ill and dangerous (MI&D). The change that passed last week makes it so that the 48-hour clock does not begin until an appropriate bed is available.

On Monday, the Minnesota County Attorney's Association, Minnesota Sheriff's Association, Association of Minnesota Counties, and Minnesota Association of County Social Service Administrators sent a joint letter to the Human Services conference committee and held a press conference their stating opposition to the change. We understand the problem that these stakeholders face, but NAMI Minnesota sent a response to the letter providing what we consider important context to the conversation.

In summary, the issues that lead up to someone being in jail and being committed begin long before the 48-law goes into effect, and the solutions must be comprehensive. It is important to note that people are often sitting in jail for weeks and months before the 48-law goes into effect. What kind of care are they receiving in jail before they are committed? It is also important to examine how people end up in jail in the first place and who brings them? Building our crisis response system would have direct impacts on diverting people away from arrest. Additionally, one of the biggest reasons for the change in the human services bill, is that the 48-hour law does not allow for DHS to determine the medical necessity of people committed from jail. The change allows medical professionals to be able to prioritize people, both in the community and in jail, who have the highest needs.

Over the last ten years since the law was enacted, the number of people that the 48-hour law applies to has risen substantially from 111 people in 2014 to 323 in 2021. This is why NAMI led the effort in 2019 to create the Community Competency Restoration Task Force and continued to drive the process to pass a comprehensive bill last year to address competency attainment in Minnesota. Both the interim and final reports of the task force provide in-depth analysis and recommendations to build the mental health system and partner with the legal system to address this issue. Some of those recommendations have been made into law, many which will take several years to see come to fruition like Travis' Law, improving mental health care in jails through the Hardel Sherrell Act, and the competency law itself. Many problems have been ongoing and exacerbated by the pandemic like workforce shortages and low reimbursement rates for mental health services.

The human services bill also creates a task force to look at the 48-hour law co-chaired by the Attorney General and the Commissioner of Human Services which includes NAMI among many other stakeholders. We are happy to continue this conversation in the task force, but we hope that the group is prepared to look broadly across the needs of our entire mental health system to solve the issue.
Cannabis Legalization Bill Sent to the Governor's Desk
Last week, the House and Senate passed HF100 to legalize cannabis after a conference committee agreement. The House passed the bill on a 73-57 vote with GOP Representatives Garofalo, Hudella, Mueller, Skraba, and West voting in favor and DFL Representative Pelowski voting against. The Senate passed the bill on a party-line vote. The bill contains some provisions that NAMI advocated for including:

  • Requiring education on cannabis to include risk factors up to age 25;
  • Requiring child welfare workers be included in cannabis education programs;
  • Requiring cannabis products to be stored away from food in home childcare settings like alcohol;
  • Providing grants to expand first episode psychosis programs, harm reduction programs, and culturally specific substance use and mental health treatment; and
  • Decriminalizing and expunging former cannabis crimes.

We will have a more in depth summary in our full legislative summary coming in June. Certain products can be legally in a person's possession and used starting August 1. The retail industry is set to go into effect early in 2025. We will be watching the implementation with our partners from the Mental Health Legislative Network.
News from the State Level
Digital Equity Plan
The MN Office of Broadband Development (OBD) is preparing a statewide Digital Equity Plan to strategize improvements to internet affordability, access to internet-enabled devices, and access to digital skills training.

“Digital inclusion” refers to a condition in which all people can adopt and use technology – including internet access – in ways that enhance their daily lives. This plan is important because it will determine how the state invests future funding in digital inclusion activities.

They are asking for people to participate in a survey to help OBD understand Minnesota's real digital inclusion needs and goals. Any information from this survey will be anonymous.

It would be helpful to have responses by June 5, 2023.
Survey link:
News from the Federal Level
Sen. Klobuchar Introduces Act to Support Law Enforcement
U.S. Senators Amy Klobuchar (D-MN) and Lisa Murkowski (R-AK) introduced the COPS Reauthorization Act to extend critical support for state and local law enforcement agencies across the country. This bipartisan legislation reauthorizes the Community Oriented Policing Services (COPS) program through FY 2029. The COPS program awards grants to state and local law enforcement agencies so they can hire new officers and provide training, technology, and equipment. It also enables the Justice Department to provide technical assistance to community leaders and law enforcement agencies at all levels.

“As a former prosecutor, I know the difference that the COPS program can make in combating crime and keeping our communities safe,” said Klobuchar. “Our bipartisan legislation will make sure this critical program is supported and that state and local police departments will be able to rely on it to continue hiring and providing needed tools and training to our law enforcement officers.”

“Reauthorizing the community-oriented policing services (COPS) program will help recruit and retain officers and strengthen local law enforcement across Alaska, from our rural communities to cities like Fairbanks and Anchorage,” said Murkowski. “As Alaska continues to grapple with the challenges of public safety, I’m proud to join Senator Klobuchar in this bipartisan effort that will make our communities more secure. We owe it to our local law enforcement to provide them with the training, tools, and information they need to keep themselves and Alaskans safe.” 

The COPS Reauthorization Act is cosponsored by Senators Chris Coons (D-DE), Lindsey Graham (R-SC), Dianne Feinstein (D-CA), and Thom Tillis (R-NC). The bill has been endorsed by the Fraternal Order of Police and the National Police Officers Association.
Klobuchar has long worked to provide law enforcement with the resources they need. 
Klobuchar helped secure significant funding for the COPS program in the 2022 end of year budget bill, including funding for the COPS Hiring Program which helps provide law enforcement agencies with the resources they need to hire additional officers. She has also successfully fought for the Byrne Justice Assistance Grant (JAG) program, which has provided state and local law enforcement with needed support to hire, train, and equip public safety officers.

In 2022, Klobuchar and Senator John Cornyn’s (R-TX) bipartisan Justice and Mental Health Collaboration Reauthorization Act was signed into law. This legislation supports state and local law enforcement agencies by funding mental health courts, crisis intervention teams, and other programs that help law enforcement assist people experiencing mental health challenges.
(Office of Senator Amy Klobuchar)
Senate HELP Committee Holds Hearing
On Wednesday, May 17, the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Retirement Security held a hearing titled, “A Crisis in Mental Health and Substance Use Disorder Care: Closing Gaps in Access by Bringing Care and Prevention to Communities.” Senators and witnesses discussed the need to promote integrated care within various health care settings in an effort to address the mental health and substance use disorder crises. In particular, there was wide ranging bipartisan support for bolstering and expanding Certified Community Behavioral Health Clinics (CCBHC), mobile crisis services, and Community Health Centers (CHC).
From the National Council
Debt Ceiling Debate
One of the issues of concern as Congress and the President work to resolve this issue is that the Republicans want a work requirement for public programs, including Medicaid. NAMI Minnesota strongly opposes work requirements for SNAP and Medicaid. Food and health care are essentials. Work requirements have shown to be largely unworkable because counties don't have the infrastructure to actually follow and process all the paperwork, and large percentages of people on these programs are employed, but are very poor.

From the Kaiser Family Foundation:
Experience in Arkansas and earlier estimates of implementing work requirements nationally suggest that many could lose coverage due primarily with barriers in meeting work reporting requirements. An analysis from the Congressional Budget Office (CBO) found that a national Medicaid work requirement would result in 2.2 million adults losing Medicaid coverage per year (and subsequently experiencing increases in medical expenses), and lead to only a very small increase in employment. CBO estimates that this policy would decrease federal spending by $15 billion annually due to the reduction in enrollment. New attention on work and reporting requirements come as millions are at risk of losing coverage due to administrative barriers as states resume routine renewals and disenrollments with the unwinding of the Medicaid continuous enrollment provision that was included in the Families First Coronavirus Response Act (FFCRA) enacted at the start of the COVID-19 pandemic.
Read more here and here
Updates from NAMI Minnesota
NAMI Legislative Committee
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