NAMI Minnesota Legislative ALERT – March 22, 2011
Action Alert on House Budget Proposals
As you can see below, thereis a wide-range of issues. NAMI members are encouraged to call their state representatives. If they serve on the Jobs and Economic Development Finance Committee, you might say that you are disappointed that they cut funding for this important jobs program. IF they serve on the Health and Human Services Committee, you can pick your issue – but please start off with “I am a NAMI member and I want to first thank you for preserving the children and adult mental health grants.” Then add whatever issues above concerns you such as the changes to MinnesotaCare, the Medicaid block grant, etc.
Budget Bills Released
A number of budget bills were released yesterday and today. Here is a brief summary.
House Health and Human Services Budget
The key issues here are that they maintained funding for the children’s and adult mental health infrastructure and other grants! They also maintained funding for the Children’s and Community Services Act that also funds mental health services. There are some other positive measures as well, but some that are worrisome such as major changes to MinnesotaCareand the Minnesota Comprehensive Health Association, closing all the Community Behavioral Health Hospitals, and creating a big Medicaid block grant program.The bill is over 300 pages and we wanted to get this to you quickly so we apologize if things are explained in great detail.Acronyms are spelled out just once.
EBT cards for people on General Assistance (GA) or Minnesota Supplemental Aid (MSA) cannot withdraw more than $20 cash from it. The head of household’s name will be on the card. Retailers can ask for a photo ID and someone else cannot use the card. Can’t use it outside of MN, not even neighboring states (except for food) Could cause a problem for people whose families or PCAs assist the person with groceries, etc.
· Limits GA and GAMC to people who have been in the state for 90 days. This could be a problem for families who bring a loved one home from another state and try to get them help.
· Limits GA to certain people, no longer eligible are those who are needed in the home due to a disability of another member of the household, someone who has an application or appeal pending for Social Security, those with a disability or illness that lasts less than 90 days, can’t work due to advanced age, a child under the age of 18 (affects 66 kids), people who live more than four hours round trip traveling time for a job, people who don’t speak English and are going to school part-time, people with a chemical dependency who aren’t amenable to treatment
· People on GA have to volunteer 20 hours a month or work 20 hours a month (unless you can’t). They have to provide monthly proof to the county
· Allows people to save up more money when in a treatment program - $150 instead of $50 up to $500 a month (instead of $150). Increases these amounts for a CD program from $1000 to $2000 in a savings account.
· Provides for flexibility under MN Supplemental Aid (MSA) so that someone can be in multifamily housing with more than four units, as long as no more than 50% of the units at one address are occupied by people on MSA.
· Facilities that don’t check on people meeting the residency requirement or doing their 20 hours of volunteer or paid work, get paid less
· Creates a pilot project in Anoka County for homeless adults to be in-home caretakers of foreclosed homes.
· Exempts for two years health care providers with total net revenue under $500,000 from implementing electronic health records (they also can’t get the subsidy money)
· Creates additional standards for electronic prescribing by including formulary exceptions and prior authorization requests on the form.
· Eliminates the training program for pediatricians on case management and medication management for children with mental illnesses.
· The formula for distributing health care training money is changed and includes $500,000 and $200,000 for community mental health centers.
· For the MERC funding (medical education) they have added psychiatrists along with advanced practice nurses, physician assistants, pediatrics, family medicine and internal medicine at a higher “weight” which means more money for those training programs.
· Several sections place an emphasis on training for people from diverse communities especially where there are health disparities
· Includes psychiatrists and certified clinical nurse specialists under the health professions opportunities scholarship program.
· Exempts boarding care homes who are certified under MA from state licensure requirements
· For home visiting programs through community health boards, they need to obtain permission from the family to share their information and unmet needs with other providers.
· Transfers the health facility licensing duties from the Health Department to the Department of Human Services
· Gives Licensed Professional Counselors two more years to meet the requirements of a Licensed Professional Clinical Counselor. Adds 40 hours of continuing education
· Allows a social worker to be supervised by a mental health professional for 25% of their required hours and allows for alternative supervision for even higher percentages in those counties where it’s hard to find appropriate supervisors.
· Changes the combined application form to include a question about if someone is a military veteran so that if they are, they are referred to their county veterans’ service officer.
· Requires the commissioners of health and human services to get approval from three of the four chairs and ranking minority members for any funding received from federal grants. We are wondering if this includes federal mental health block grant funding.
· Changes the fee structure for Licensed Marriage and Family Therapists
· Changes the Minnesota Comprehensive Health Association program (Minnesota’s high risk pool) by changing the premiums to be from 101% to 125% of the weighted average of rates charged by insurers and HMOs. Creates a range of deductibles and co-payments. People will pay 100% of brand name drugs (most antipsychotics). Allows people to purchase plans that exclude mental health and substance abuse coverage. NAMI is opposed to this.
· If the federal government eliminates or reduces the federal Medicaid match, the commissioner shall eliminate coverage for persons under Medical Assistance. We believe that they are referring to the early opt-in for Medical Assistance for people who used to be on GAMC, but it is so broadly written that we have some concerns.
· Defines emergency medical condition for people who are non-citizens, thus limiting their access to care.
· Acupuncture services would be covered under Medical Assistance
· Expands medication therapy management for people taking three or more medications (was four) and with one or more chronic medical condition (was two). Plus this service can be provided in a long term care setting or assisted living facilities.
· Both nonemergency and ambulance transportation rates were cut 4.5%
· Does not allow the department to authorize services under Medical Assistance if they have other insurance until the provider has made a good faith effort to receive payment or authorization from private insurance. This could delay treatment, particularly for children.
· Pays services provided by master’s prepared mental health professionals working at mental health centers at the same rate as others – 80% instead of 100%.
· Allows payment for multiple mental health or dental services provided on the same day.
· Reduces rates to particular providers who serve people who are on Medical Assistance and Medicare. Will most likely impact certain mental health providers. Results in cuts of $43 million for the biennium
· Increases co-payments and includes a deductible under Medical Assistance. Increases the limit on the amount you can spend on medications from $12 to $20. Creates a new way for managed care to figure out the co-payments based on average, risk adjusted total annual cost of care per medical assistance enrollee. The lower their costs (under 60%) the less your co-payment. (very confusing)
· Adds mental health professionals and mental health centers to those who can be a health care home. Does allow people to choose their health care home but also requires certain people to be in a health care home.
· Creates a tiering system for all providers in MN health care programs paying people less if they don’t provide cost-effective high quality care.
· Requires health care homes and counties to coordinate care and services to patients enrolled in a demonstration project for people who have complex medical needs and socioeconomic needs or a disability.
· Allows for a rural demonstration project, too.
· Allows for patient choice of provider in these demonstration projects
· Creates a care coordination advisory committee to look at payment reform demonstration projects.
· Creates pregnancy care homes, which may help pregnant women at risk for PPD.
· Requires people with certain medical conditions (but doesn’t say which ones) to be in a health care home.
· Requires people to exhaust their VA benefits before using Medical Assistance or MinnesotaCare
· Requires people under the age of 65 to be in a county-based purchasing program if there is one in their county.
· When people on Medical Assistance are readmitted to a hospital within 30 days the hospital will lose money, and if this is not 5% better than the previous year, the hospital could have its payments withheld.
· A demonstration project or county-based purchasing plan under MA has to take any providers into its network that takes MA
· Reduces capitation rates to HMOs but does not include any language that this cannot be passed on to providers.
· Requires all managed care and county-based purchasing plans to provide health education, wellness training, and information about the benefits of preventive care.
· Creates a global waiver meaning the state asks the federal government to waive all rules and laws governing medical assistance. The state takes the money and can be very flexible with how they carry out the programs. Requires DHS to apply for a federal waiver in order to “block grant” Medical Assistance. This means that they would not have to follow federal requirements related to statewideness and comparability of services; the amount, duration and scope of services; freedom of choice of providers; cost-sharing; and other areas. They expect to save $300 million. NAMI has grave concerns.
· Increases co-payments under the MinnesotaCare program.
· Creates the Healthy Minnesota Contribution Plan which essentially moves everyone at 133% of poverty or more off of MinnesotaCare and gives them a defined amount of money to purchase health insurance on the open market. People who purchase a plan without coverage for mental health or substance abuse receive a lesser amount. If people have a pre-existing condition they are given a little more money to purchase a plan through the Minnesota Comprehensive Health Association (high risk pool). NAMI continues to have concerns with this section.
· Families with children on MinnesotaCare above 133% of poverty will also go on this program once it is approved by the federal government since it involves the federal dollars. Families with 6 months of income above $25,000 are no longer eligible. And people above 200% of poverty are no longer eligible. Eliminates the “MA bridge” program to MinnesotaCare.
· Requires DHS to collect information on the name of people’s employers and a contact name. In addition, people have to renew their application for MinnesotaCare every 6 months instead of every year. This could easily result in more people losing MinnesotaCare.
· All applicants for MinnesotaCare who are veterans will be referred to their county veterans’ service officer to obtain help in applying for VA benefits
· People have to verify that they are a resident of Minnesota in order to obtain MinnesotaCare which includes showing that they have a verified address – which cannot be a place of public accommodation. NAMI’s concerned as to the definition of public accommodation, will this include shelters?
· Cuts the increased rate to critical access dental providers from 50% to 30%. As many know, there is already a shortage of dentists under MA.
· Adds performance standards for health plans under MinnesotaCare in order to decrease rehospitalizations in 30 days by 5% per year with the goal of reducing it by 25%.
· Creates a coordinated care plan with more intensive services for children with mental illnesses under MA or MinnesotaCare who have mental health and medical care expenses over $100,000 a year. NAMI supports this provision.
· Establishes a competitive bidding project in the metro area for managed care plans serving nondisabled nonelderly under MA and MinnesotaCare
· Requires DHS to identify health care professionals who are not trained to provide quality care and to limit payments to them.
· Requires DHS to evaluate the specialized maintenance occupational therapy provided to people with mental illnesses and whether it reduces hospitalization rates.
· Requires DHS to come back next session with an innovative plan for people under 133% of poverty who are on MinnesotaCare.
· Creates another demonstration project in the metro area where people can get basic care. It included mental health care but not necessarily the model benefit set.
· Repeals a number of sections of law related to MinnesotaCare including children seamlessly moving from MA to MinnesotaCare, children aging out of foster care being eligible, etc.
· Adds duties to the Disability Linkage Line, including providing benefits and options counseling, and serving as the center for the Minnesota Disability Benefits 101 web tool
· Changes the MA-EPD program by increasing the premiums from ½ percent to 5 percent and by including spousal assets.
· Makes changes to the self-directed supports option under MA waivers and PCA and increases the number of people who can be on it
· Adds rehabilitation services under the PCA program.
· Decreases the PCA payment rate by 20% when provided by a family member. This could particularly impact immigrant communities who hire people who can speak their language.