2007 MPS Legislative Summary

Legislators worked right up to the midnight deadline on Monday, May 21 for this year's legislative session, passing four major spending bills and a tax bill. The Governor and the legislature failed to reach “global agreement” on overall spending limits, so the spending bills passed Monday night were not guaranteed to avoid the governor’s veto. The Governor chose to selectively line-item veto several spending provisions in these bills instead of vetoing entire bills, thereby avoiding the need for a special session. 

Included in the health and human services appropriation bill just signed by the governor is $35 million in new money directed towards the state’s mental health system. A good portion of the money will go to the restructuring of the mental health system, specifically crisis services for children and adults. Additional money will also go to housing, school-based services and regional mental health initiatives. Since the $35 million for mental health was a governor’s initiative, it survived his veto pen. Congratulations to all of you who were involved with the Mental Health Action Group, which put together most of the governor’s restructuring proposal.  This was a big victory for psychiatry and mental health advocates.

The following is a brief description of some of the new funding and other major mental health issues followed this year by MPS.

Mental Health Restructuring: Ironically, the Governor had difficulty last year convincing his Republican colleagues in the House to support his initiative to begin restructuring our state’s mental health system. This year, with Democrats in charge of both the House and Senate, he had more success. He originally proposed $45 million in new funding for his initiative. During budget negotiations this amount was cut to $26 million, but eventually increased to $35 million and signed into law by the governor. The commissioner of human services is authorized to expend these funds with the goal of improving the availability, quality and accountability of mental health care within the state.  Some of this funding will be directed to the following:

Integrated Care Projects. The commissioner is authorized to fund up to three projects to demonstrate the integration of physical and mental health services within prepaid health plans. The projects will be based upon locally defined parameters, include at least one prepaid health plan; and require counties to retain the responsibility and authority for social services. The projects can be implemented no earlier that January 1, 2009 and shall be limited to not more than 40 percent of the statewide population. 

Children’s Mental Health Grants. Grants up to $5,913,000 in fiscal year 2008 and $6,825,000 in fiscal year 2009 will be made available to counties, mental health providers, Indian tribes or children’s collaboratives for providing services to children with emotional disturbances. The grants must be designed to help each child function and remain with the child’s family in the community consistent with the child’s treatment plan.

Standard Mental Health Benefit Set. Another important provision of the mental health initiative includes a standard mental health benefit set for state government programs, Medical Assistance, General Assistance Medical Care and MinnesotaCare. A consistent benefit set across these programs will greatly ease program administration.

Intensive Mental Health Outpatient Treatment. Medical assistance will now cover intensive mental health outpatient treatment for dialectical behavioral therapy for adults.

Provider Fee Increase. The payment rate increase that psychiatrists received two years ago will be extended to certain other mental health providers. Medication education provided by adult rehabilitative mental health services providers and mental health behavioral aide services provided by children’s therapeutic services and support providers will be increased by 23.7 percent effective January 1, 2008. Individual and family skills training after January 1, 2008 provided by children’s therapeutic services and support providers will be increased by 2.3 percent.

Payment Reductions. Payments for mental health services will not be subject to existing ratable reductions or managed care plan rate cuts after December 31, 2007.

Regional Children’s Mental Health Initiative. A two-year, 11 county regional children’s mental health initiative pilot project was authorized to plan and develop new programs and services related to children’s mental health in south central Minnesota. The counties included in the pilot project are Blue Earth, Brown, Faribault, Freeborn, le Sueur, Martin, Nicollet, Rice, Sibley, Waseca and Watonwan.

MFIP Children’s Mental Health Pilot Project. The commissioner of human services shall fund a three-year pilot project to measure how children’s mental health needs affect participants in the Minnesota Family Investment Program and their ability to obtain and retain employment. ($300,000)

Mental Health Services for Children. $2,528,000 in fiscal year 2008 and $2,850,000 in fiscal year 2009 is appropriated for statewide funding for children’s mental health crisis services. An additional $1,750,000 is appropriated for culturally specific treatment grants, services for children with special needs, i.e. victims of trauma, abuse and neglect, and for children’s mental health evidence-based and best practices.

Mental Health Services for Adults. $2,528,000 in fiscal year 2008 and $3,278,000 in fiscal year 2009 is appropriated for statewide funding of adult mental health crisis services. An additional $1,750,000 million is directed to culturally specific mental health treatment grants, adults with special treatment needs, and adult mental health evidence-based and best practices. 

Mental Health Peer Specialists. Medical Assistance will now cover the services of mental health peer specialists. The commissioner of human services will develop a training and certification process for peer specialists who must be at least 21 years of age. A candidate must have had a primary diagnosis of mental illness, be a current or former consumer of mental health services and demonstrate leadership and advocacy skills.

Supportive Housing Services for Adults with Mental Illness. $1,750,000 in fiscal year 2008 and $1,500,000 in fiscal year 2009 was appropriated for grants to support increased availability of housing options for adults with serious mental illness.

Suicide prevention program. $335,000 in fiscal year 2008 and $145,000 in fiscal year 2009 is approved for the state’s suicide prevention program.

Safe Schools. Additional funding was granted to school districts for voluntary suicide prevention programs and tools.  Funding was also appropriated for licensed school counselors, nurses, social workers, psychologists and alcohol and chemical dependency counselors to provide early responses to behavioral and other student problems.

County Targeted Case Management and Social Services. A major ongoing issue of discussion not entirely addressed this year relates to county case management services and clarifying the responsibility of counties for the delivery of social services within an integrated physical/mental health system. The commissioner of human services was directed to bring to the State Legislature and State Advisory Council on Mental Health recommendations for updating the role of counties, and to clarify the case management roles and decision making authority of counties and health plans. These recommendations must be submitted by January 15, 2008. In the interim, $32 million was appropriated from the state’s general revenues to counties to offset any reductions in federal funding of targeted case management services as a result of the federal Deficit Reduction Act of 2005. This is in addition to the $35 million previously mentioned.

Health Care Reform: The considerable debate on universal health care coverage for children and health care reform that was prominent at the beginning of the legislative session faded away with the reality that no significant new revenues would be devoted to this issue. A proposal to cover all kids was not adopted, although changes were made to MinnesotaCare eligibility that could affect 30,000 uninsured state children. A proposal for a constitutional amendment to declare health care a right in our state passed several committees but was not enacted. Increased insurance coverage and other health care system changes will have to wait until next year.

The legislature instead decided to further study the issue of health care reform. It created a health care transformation task force to develop a statewide action plan to improve affordability, quality, and access to health care in Minnesota. The task force has 15 members appointed by the legislature and governor, reminiscent of the Health Care Access Commission created in 1994. At the request of the governor, $500,000 was directed to a study of a “Health Insurance Exchange” to increase access to private, tax-exempt health insurance for individuals. The Exchange is based upon the Massachusetts Health Connector signed into law by Governor Mitt Romney. The legislature also created a health plan purchasing pool study group to make recommendations regarding the creation of a statewide health plan purchasing pool that would contract directly with providers to provide affordable health care. The membership of the study group is made up of mostly single payer advocates. All three of these task force/studies will report to the state legislature by February, 2008.

Commitment – Pregnant Drug Users: A new law was enacted which authorizes the civil commitment of women who during pregnancy engage in excessive use of controlled substances, alcohol or inhalants that pose a substantial risk of damage to the brain or physical development of the fetus. The court may order early intervention treatment if it finds by clear and convincing evidence that a pregnant woman is chemically dependent. Physicians and others mandated to report under state law must report to the local welfare agency if the person knows or has reason to believe that a pregnant woman has used controlled substances including tetrahydrocannabinol or has consumed alcoholic beverages in any way that is harmful or excessive. Effective August 1, 2007.

Statewide Smoking Ban: Effective October 1, 2007, Minnesota restaurants and bars will be smoke free. This hard fought legislation completes the ground-breaking Clean Indoor Act passed in the mid-70s. Several exemptions were added to the total smoking ban in order for it to gain passage including one that relates to smoking in locked in-patient psychiatric units. Smoking in an inpatient unit may be allowed only if the administrator of the hospital or program adopts a policy allowing smoking in a well-ventilated area in the unit and if the treating physician believes the benefits to be gained by patient cooperation with treatment outweigh the negative impacts of smoking. Even with this new authority, it is doubtful that either the state or private hospital systems will alter their current smoke free policies.

Electronic Prescription Reporting System: Minnesota joined several states in authorizing an electronic reporting system for information relating to all Schedule II and III controlled substances dispensed in the state. The Board of Pharmacy shall establish the electronic system by January 1, 2009 after receiving recommendations from an advisory committee created in the new law. This program was quite controversial but several protections were added to the legislation at the request of the medical community to help alleviate their concerns. These include no access to the database for the sole purpose of identifying unusual or excessive physician prescribing practices without a valid search warrant or court order. No information in the database may be used to initiate or substantiate a disciplinary action against a prescriber. All data reported under the system will be removed from the database 12 months from the date it was received.

MinnesotaCare changes: Several changes were made to the MinnesotaCare program to provide access to health care coverage for more Minnesotans. Income criteria for single adults were increased, enrollment was made easier for children and many of the cuts to the program benefits made two years were eliminated. Many of these changes will not take effect until July 1, 2009. Yet, several changes discussed throughout the session were not enacted.  These include an expansion of the MinnesotaCare program to small employers and a provision that would have authorized Medical Assistance coverage of Medicare Part D co-payments. The bill also does not increase the MinnesotaCare in-patient hospital benefit for adults. The coverage remains capped at $10,000 instead of the $20,000 proposed by the legislature. These provisions were taken out of the bill at the Governor’s request to meet his spending target.

Medical Interpreters. A proposal to require health plans to pay providers for the services of medical interpreters was included in the early drafts of the HHS funding bill. However, this language was not included in the final bill. It was taken out after considerable lobbying from the Minnesota Chamber of Commerce which opposed this new mandated insurance benefit. A study of this issue was included in the bill and this issue will likely be at the forefront next session.

Medical Marijuana. A bill that would have allowed the legal physician prescription of marijuana for debilitating medical conditions was passed by the Senate on a 35-29 vote. However, it never made it to the House floor for final vote. It can be acted upon in the House next year. 

It was clearly a groundbreaking year for mental health legislation and improving how mental health services are delivered in this state.  It is a good down payment.  Hopefully, the state legislature and the governor will continue to prioritize funding for mental health as the new and improved system moves forward. 

Dominic J. Sposeto
MPS Lobbyist
 
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