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NAMI Minnesota Legislative Update – Jan. 26, 2014
Mental Health in the Schools Act
Part of the new Federal Appropriations bill implements Senator Franken’s Mental Health
in Schools Act. NAMI has worked closely with Senator Franken on this bill. The bill
would provide:
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$40 million for competitive grants to schools to collaborate with communitybased mental health providers and other community organizations to expand
access to early intervention and mental health treatment for students.
$15 million for training for teachers and other adults who interact with youth to
detect and respond to mental illness in children and young adults, including how
to encourage adolescents and families experiencing these problems to seek
treatment.
On January 22, NAMI joined families, Westwood School staff, Bloomington school
board members & superintendent, Washburn staff and others to talk about the new bill.
Sue Abderholden, NAMI’s executive director was interviewed on WCCO radio later that
night to discuss the bill and the importance of school-linked mental health.
New Federal Appropriations Bill Signed into Law
Late last week, President Obama signed the fiscal year 2014 budget into law. Included in
the budget bill were a number of important priorities for substance use and mental
healthcare, a rare victory in a congressional session that has seen major cuts to
discretionary spending.
Overall, the Substance Abuse and Mental Health Services received $3.6 billion for 2014,
including $62 million from the health reform law’s Prevention and Public Health Fund.
Additional details about the line items in the SAMHSA budget have emerged from the
conference committee report which accompanies the budget bill. Among this year’s
successes were:
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Substance Abuse Prevention and Treatment Block Grant. $1.8 billion was
allocated to the SAPT block grant, an increase of $19 million vs. fiscal year
2012.* Importantly, the bill reverses prior HHS practice of using the block grant
as a source for the “evaluation tap” – a percentage of funding that is automatically
set aside for agency-wide evaluation activities. This results in nearly $80 million
of funding that will now go towards programmatic activities instead of to the tap.
Community Mental Health Services Block Grant. The Mental Health Block Grant
received $484 million, an increase of $24 million over fiscal year 2012.* Like the
SAPT block grant, it is exempted from the evaluation tap, resulting in additional
funding now available for programmatic activities. The 5% increase is to be used
for evidence-based programs that address the needs of individuals with early
serious mental illness, including psychotic disorders.
Mental Health First Aid. The budget provides $15 million for a new grant
program to provide MHFA training to police officers, first responders, judges,
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social workers and the staff of college and university counseling centers, among
others. This initiative was included in the President’s “Now is the Time”
recommendations in the wake of the tragic shooting in Newtown, CT.
Primary-Behavioral Health Care Integration. The PBHCI grant program received
$50 million, an increase of $19 million over FY 2013 and the highest allocation of
SAMHSA funds in the program’s five-year history (in prior years, the Prevention
Fund has also been used to support PBHCI).
The Screening, Brief Intervention, and Referral to Treatment program – which provides
support to grantees implementing SBIRT with individuals experiencing or at risk for
substance abuse disorders – received a substantial cut in 2014. The budget funds SBIRT
at $47 million, a decrease of about $6 million vs. FY 2013.
The budget includes level funding for:
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Youth Violence Prevention: $23.2 million
National Child Traumatic Stress Network: $46 million
Homelessness prevention programs: $30.8 million
American Indian/Alaska Native suicide prevention: $2.9 million
Project LAUNCH: $34.6 million
The delayed enactment of the FY 2014 budget has pushed back the date by which
President Obama will release his 2015 budget requests. Traditionally, the President’s
budget is released on the first Monday of February. Obama announced today that his FY
2015 proposals will be released March 4.
From Rebecca Farley, Director, Policy & Advocacy, National Council for Behavioral
Health
NAMI members please note that the 5% increase to be used for evidence-based
programs that address the needs of individuals with early serious mental illness,
including psychotic disorders includes the First Episode programs for which we have
been advocating!
Action Alert: Act Now to Prevent Restrictions on Psychiatric Medications in
Medicare!
The Federal Center for Medicare and Medicaid Services (CMS) has proposed a rule to
restrict access to anti-depressant and anti-psychotic medications in the Medicare Part D
program.
Historically, Medicare Part D Plans have been required to include on their preferred drug
lists all or substantially all psychiatric medications in recognition that personal choice and
clinical judgment are critically important in decisions about these medications. The
proposed rule would restrict the availability of anti-depressant medications in 2015 and
restrict the availability of anti-psychotic medications in 2016.
NAMI has long supported preserving open access to all Food and Drug Administration
(FDA) approved medications in the Medicare Part D program. Restricting access to
psychiatric medications can be extremely harmful for individuals living with serious
mental illness, including increased hospitalizations and other negative consequences. At
a time when national attention is focused on improving mental health care, a rule
restricting access to psychiatric medications does not make sense.
Final comments on the proposed rule are due to CMS by March 7, 2014. NAMI will
circulate sample comments prior to that date. Click here to send a letter to your U.S.
Representative and Senators and ask them to communicate with CMS that they oppose
implementation of this proposed rule. For more Information go here
Action Alert: Comments Needed on Proposal to Establish Community First Services
& Supports (CFSS) to Replace Personal Care Assistance (PCA) Program
The Minnesota Department of Human Services (DHS) is seeking public comments about
a proposal to replace Personal Care Assistance (PCA) services with a different service
called Community First Services and Supports (CFSS). CFSS will be available as part of
the Medical Assistance (MA) benefit set to people who are currently eligible for PCA
services.
However, in 2009 the Legislature established more restrictive eligibility criteria for PCA
services, which has made it difficult for many people with mental illnesses to access this
service. The biggest problem is the requirement that people need "constant supervision or
cueing." People with mental illnesses don't need this help "constantly" which will make
them ineligible for the program. Continuing these eligibility criteria for the new CFSS
program will prevent many people with mental illnesses from accessing needed supports.
This is not what was intended when the federal government created this service option for
states.
We need people to send comments to DHS urging them to revise the eligibility criteria so
that people with mental illnesses will be able to qualify for this new service. Comments
can be emailed to [email protected]. Here’s what to say:
To: DHS Staff Working on 1915(k) State Plan Amendment
I live with a mental illness/have a family member with a mental illness/work in the mental
health field/etc. and I am concerned that Minnesota’s proposed “1915(k)” state plan
amendment will not meet the needs of children and adults who live with mental illnesses.
I urge you to change the state’s definition of “dependency” to remove the word
“constant”. This would allow more people to access this service and help them to remain
independent in the community.
If you or someone you know has benefited from PCA services, talk about that as well.
Comments are due by 4 pm on February 12.
Work Begins on Bonding Bill
Governor Dayton released his bonding bill last Wednesday. He is proposing nearly $1
billion of investments that includes a number of projects that would benefit people living
with mental illnesses and their families. These include:
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$56 million to remodel the Minnesota Security Hospital in St. Peter in order to
improve safety for both patients and staff. The plan includes removing areas that
have blind spots or narrow corridors and generally bring the facilities up-to-date.
The proposal would also move all the units for people committed to St. Peter
because of a mental illness onto the upper part of the campus and separate those
units from the Minnesota Sex Offender Program.
$50 million for affordable housing, including supportive housing.
$32 million to remodel the intake and health services units at the state prison
in St. Cloud. The goal of this proposal is to increase safety, reduce crowding, and
ensure better privacy during intake screenings for mental illnesses and other
healthcare issues.
$3.75 million for a grant to Hennepin County to acquire and predesign, design,
construct, furnish, and equip the expansion and renovation of the St. David's
Center for Child and Family Development. The center will be used to provide
early childhood education and respite care, children's mental health services,
and other interventions for children at risk of poor developmental outcomes or
maltreatment.
$720,000 for the city of Maplewood to design, renovate, and equip Harriet
Tubman Center East, which will be used as a regional safety service center for a
domestic violence shelter, legal services, youth programs, mental and chemical
health services, and community education.
$2,000,000 for St. Louis County to pay for pre-design of a new office building
that would house, among other things, the Range Mental Health Center.
While NAMI supports all of the projects listed above, our top two priorities for the
bonding bill are the renovation of St. Peter and substantial investment in affordable and
supportive housing.
Lawmakers in the house have begun to shape their priorities for bonding as well and bills
have been proposed for these two projects. Representative Clark Johnson is authoring HF
2067, which would fund the renovation of the Minnesota Security Hospital in St. Peter
(just like the Governor’s bill).
House Capital Investment Committee Chair, Representative Alice Hausman, introduced
HF 2031 which would invest $100 million in affordable housing, including supportive
housing. The latter proposal is being championed by Homes 4 All (which NAMI is a part
of) and the group will be working hard to ensure the full $100 million for housing is
included in the final bill.
MinnesotaCare
NAMI Minnesota, the Mental Health Association and 81 other organizations from the
state of Minnesota, signed a letter submitting comments to the Centers for Medicare and
Medicaid Services, Department of Health and Human Services, in response to the
proposed payment methodology for the Basic Health Program (BHP), which was
published in the Federal Register on December 23, 2013. The BHP is part of the health
insurance exchange.
The letter pointed out the history of MinnesotaCare, our state’s precursor to the BHP,
which provides affordable, meaningful health care and mental health services to low- and
moderate-income families. In 2013, the Minnesota Legislature reaffirmed its strong
commitment to this affordable health care option by passing legislation implementing a
BHP to fund MinnesotaCare beginning in 2015.
The letter points out that “Minnesota is the only state in the nation well poised to
implement the BHP in 2015. Our BHP embodies the goals of this opportunity: providing
reduced premiums and out-of-pocket costs for financially strapped households,
improving enrollment rates, reducing barriers to needed care, and supporting continuity
of care.
We are extremely concerned, however, that the proposed payment methodology threatens
the sustainability of MinnesotaCare. The proposed methodology ignores unique market
conditions created by decades of health care innovation in our state and results in federal
funding that inadequately reflects the cost to provide services for this population. This
endangers Minnesota’s ability to implement a BHP and jeopardizes our ability to
continue health care coverage that fits the needs of working Minnesotans after 2014…
Therefore, we urge CMS to allow for greater flexibility in the payment methodology,
including using more state-level data to make calculations, appropriately accounting for
the health status of the BHP population, and retrospectively adjusting federal funding to
reflect actual costs.”
NAMI appreciates the MN Council of Nonprofits taking the lead on this issue. NAMI is a
strong supporter of MinnesotaCare since it has the same mental health benefits as under
Medical Assistance.
Report Released on People Committed as Mentally Ill & Dangerous
The Office of the Legislative Auditor’s Evaluation Report on State-Operated Human
Services, February 2013, reviewed, among other things, aspects of the treatment of
persons committed as mentally ill and dangerous and issues in moving them to less
restrictive placements. In response to that report, the Department of Human Services was
directed to convene a stakeholder group to make recommendations to the 2014
Legislature.
The stakeholder group, comprised of a wide variety of persons representing diverse
viewpoints, reviewed many aspects of the history, commitment procedures, treatment,
and release options of persons committed as mentally ill and dangerous. NAMI
Minnesota was a member of the group.
The group identified the following problems:
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insufficient time, in some cases, of the Minnesota Security Hospital to make
complete recommendations to the District Court before it makes its final
determination;
the need for full administrative hearings by the Special Review Board even when
the petition for relief (transfer, provisional discharge or discharge) is uncontested;
the lack of periodic review of persons civilly committed as mentally ill and
dangerous;
lack of qualified and ongoing legal defense counsel for the person civilly
committed as mentally ill and dangerous;
the limited experience of some judges who infrequently handle mentally ill and
dangerous civil commitment cases;
some patients’ inability to meet standardized criteria to be considered for less
restrictive settings;
the failure of the state and counties to develop and implement a range of
appropriate community placement and service options;
timeliness of reviews of Special Review Board decisions by the three judge
panel;
the lack of alternatives to the mentally ill and dangerous commitment; and
differences between mentally ill and mentally ill and dangerous commitments in
transfer and discharge options and continuing court jurisdiction.
The report contains information on the discussions that took place. The final
recommendations are:
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Authorize the Department of Human Services, through the Minnesota Security
Hospital, to submit an addendum to the 60 day report if the court directs. Amend
Minnesota Statute 253B.18, subd. 2(b) to allow the District Court to have the
discretion to continue the final determination hearing beyond 60 days absent
agreement by both parties.
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Amend Minnesota Statute 253B.18, subd. 5 to allow for an expedited process in
uncontested cases and authorize/direct the Department of Human Services to
develop and implement an expedited process in uncontested cases for petitions to
the Special Review Board for transfer, provisional discharge or discharge. This
would be a paper review.
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Amend Minnesota Statute 253B.18, subd. 5 to require that each person civilly
committed as mentally ill and dangerous have a review by the Special Review
Board at least once every three years.
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Amend Minnesota Statute 253B.18, subd. 4c to allow the Special Review Board
to have the additional responsibility of reviewing the barriers or obstacles to a
patient progressing in treatment.
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Amend Minnesota Statute 253B.18, subd. 4c to require that the Special Review
Board submit an annual report to the Department of Human Services which
includes trends in barriers or obstacles in cases that have come before them for
review.
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Recommend that the Department of Human Services offer increased resources to
State Operated Forensic Services to further expand person-center
planning/treatment to reflect individual treatment needs.
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Recommend that the Department of Human Services, in consultation with the
Court Administrator, develop a training module of continuing education
requirements particular to the courts and attorneys who practice in the area of
civil commitment.
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Request the Court Administrator take whatever means necessary to enforce the
Special Rules of Procedure Governing Proceedings under the Minnesota
Commitment and Treatment Act, Rule 9, to ensure representation throughout the
duration of the civil commitment.
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Direct the Department of Human Services to devote considerable resources and
efforts towards the establishment of community placement options for persons
civilly committed as mentally ill and dangerous. These options should optimize
both the person’s recovery and community safety.
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Direct the Department of Human Services to develop and implement an education
campaign, with input from counties, advocacy organizations, and other
stakeholders to promote best practices for provisional discharge documents and
educate stakeholders on the roles and responsibilities of parties regarding,
including but not limited to, the development, implementation and amendment to
the provisional discharge documents and practices.
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Special Review Board decisions should continue to be reviewed by the three
judge panel. Additional panels and judges should be appointed so that the panels
can process the reviews in a more timely manner.
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Direct the Department of Human Services to change State Operated Services
Policy 10020 to allow the Commissioner to reject an unfavorable
recommendation from the Special Review Board.
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Establish a stakeholder group to review the mentally ill and dangerous definition,
discharge criteria, and the constitutionality of the mentally ill and dangerous
commitment being of indeterminate length.
NAMI will follow the implementation of these recommendations.
New Publication
A new brief by the Council of State Governments provides an overview of opportunities
to expand health care coverage, as well as access to and continuity of care; improve
public health and safety outcomes for individuals involved with the criminal justice
system; and reduce state and local expenditures on corrections and health care. To
download a PDF of this publication, click here.
Olmstead Office
There is now an Olmstead Implementation Office (OIO) tasked with overseeing the
implementation of the plan across agencies and reporting back to the sub-cabinet as well
as the court and court monitor. The office will address numerous areas such as quality of
life indicators, design of a dispute resolution process and more.
Interim staff have been appointed until a director is hired. David Sherwood-Gabrielson is
the Interim Executive Director and has broad experience in disability policy, advocacy
and rehabilitation. Before he began work on the employment section of Minnesota’s
Olmstead Plan in July of 2013, he was Director of Community Partnerships for
DEED/Vocational Rehabilitation Services and served as agency lead to programs
providing rehabilitation, employment and independent living services. David Thompson
is the Interim Deputy Director and has been a Minnesota and national leader in efforts to
reform child protection practices by focusing on respectful engagement of families in
strength-based safety focused partnerships. Kristin Jorenby will be in charge of Dispute
Resolution and has been working with on the Olmstead Plan since the sub-cabinet was
formed in January, 2013.
A committee has been formed to select the permanent director. Sue Abderholden,
NAMI’s executive director is the co-chair of this committee along with Mary Tingerthal,
the Commissioner of Minnesota Housing.
Federal Government Issues Guidance on School Discipline
The Federal Department of Justice and Department of Education jointly released
guidance for schools earlier this month to help schools improve the way they handle
disciplinary issues. The guidelines provide strategies for improving school climate and
safety while keeping more students in class and avoiding unnecessarily involving
students in the criminal and juvenile justice systems. Among other things, the guidelines
encourage schools to ensure that all school personnel have proper training, including deescalation skills. NAMI applauds this effort as children with mental illnesses are
disproportionately impacted by “zero-tolerance” and other policies and are more likely to
be suspended, expelled, and/or end up in the juvenile and criminal justice systems. You
can read more about the guidelines, here
Bill Introductions
Each week during the Legislative Session, NAMI Minnesota will provide a summary of
any legislation that is introduced which could impact people living with mental illnesses
or their families. We’ll also provide updates about these bills if and when they move
forward.
Nearly 300 bills were “pre-filed” in the Minnesota House last week, many of which could
impact our community. No action can be taken on these bills until the Legislature
convenes on February 25 but some will be heard during interim hearings in the coming
weeks. We will have summaries of all relevant pre-filed bills in our next Legislative
Update and we will feature coverage of any relevant interim hearings during subsequent
updates. Stay tuned!
2014 Mental Health Day on the Hill –Thursday, March 6
The 2014 Legislative Session is approaching fast and it’s time to start getting ready for
this year’s Mental Health Day on the Hill! Legislators will be making important decisions
this session that will impact the lives of people living with mental illnesses and their
families and they need to hear from you. We need to you to join us to show your support
for people living with mental illnesses and their families and make your voice heard! Be
sure and make your appointments with your legislators now!
This year’s Day on the Hill will be on Thursday, March 6. Here’s the schedule for the
day:
Informational Briefing: 10 a.m. – 11:30 a.m.
Christ Lutheran Church – 105 University Avenue West (Across the street from the
Capitol)
Visit with your State Legislators: 12 p.m. – 1 p.m.
Call your legislators’ offices to make an appointment ahead of time. You can find your
legislators contact information here
Rally at State Capitol: 1:30 p.m. – 2:30 p.m.
State Capitol Rotunda (NOTE NEW TIME)
Buses for Day on the Hill
The Mental Health Legislative Network (MHLN) has chartered five buses to make it
easier for people outside the Twin Cities metro to attend. Buses are free to ride but preregistration is required since space is limited. To reserve a seat, contact the person
listed for the route. All buses will arrive in St. Paul by 10 a.m. and depart from the
Capitol at 3 p.m.
Baxter/Little Falls/St. Cloud
RSVP to Matt Burdick @ 651-645-2948 x107 or [email protected]
Baxter: 6:30 a.m.
Wal-Mart (7295 Glory Road)
Little Falls: 7:15 a.m.
Wal-Mart (1800 1st Ave NE)
St. Cloud: 8:00 a.m.
Wal-Mart (3601 Second Street South)
Duluth/Cloquet/Pine City/North Branch/Wyoming
RSVP to Matt Burdick @ 651-645-2948 x107 or [email protected]
Duluth: 6:30 a.m.
Holy Family Catholic Church (2430 West 3rd Street)
Cloquet: 7:05 a.m.
Scanlon Park-N-Ride (Exit 239 off I-35)
Pine City: 8:20 a.m.
Pine City Court House (635 Northridge Drive Northwest)
North Branch: 8:50 a.m.
Tanger Outlet Mall (38500 Tanger Drive Northwest)
Wyoming: 9:15 a.m.
Village Inn (4848 East Viking Blvd)
Kerkhoven/Willmar/Atwater/Litchfield/Cokato
Contact Teresa Emmen @ (320) 894-7336 for details or to reserve a seat.
Moorhead/Fergus Falls
Moorhead: 5:15 a.m.
The Social Connextion (2419 12th Avenue South)
RSVP to Dina Geiszler @ (218) 284-6069 or [email protected]
Fergus Falls: 6:15 a.m.
A Place to Belong (109 N. Court Street)
RSVP to Sue Wilkin @ (218) 739-0797.or [email protected]
Winona/Rochester
RSVP to Matt Burdick @ 651-645-2948 x107 or [email protected]
Winona: 7:00 a.m.
Central Elementary School (317 Market Street)
Rochester: 8:00 a.m.
NAMI Southeast MN Office (1700 Broadway Ave N)