NAMI Minnesota Legislative Update

May 3, 2020

NAMI Legislation Moving Successfully Through Legislature

Despite a great deal of challenges, the House and Senate have been able to move forward with significant, bipartisan legislation to build our mental health system. As we all know, there were many important bills moving forward before the emergency response to COVID-19 hit. NAMI Minnesota is pleased to report that some of these priorities are moving through the process this year. Most importantly, we could not have done this without your voices!

Thank you to everyone who contacted their legislator, shared their personal story, or attended the 2020 Mental Health Day on the Hill. It has been a hard few weeks for many of us, so it is as important as ever for us to celebrate all the progress we've made.

Civil Commitment BillNAMI Minnesota is especially excited that our comprehensive re-write of the Civil Commitment Law has been included in policy omnibus bills for both the House and Senate. This is one of our top priorities for the 2020 session. Key changes include:

Changes outdated language such as “regional treatment centers.” Reflects new treatment options and increasing use of community mental

health services and residential treatment. Transitions to person-first language by referring to someone subject to this

statute as a “person posing a risk of harm due to a mental illness.” Also clarifies that not everyone with a mental illness is subject to commitment.

Clarifies that medications can be delivered under a JARVIS order in a jail if there are appropriate health care personnel.

Rewrites the sections on transport holds and emergency holds to make it easier to understand and clarifies the role of crisis teams.

Expands definition of health officer to include all mental health professionals and the entire mental health crisis team. Expands examiner to include all mental health professionals and APRNs.

Makes a distinction between an examiner and a court examiner to expedite assessments under an emergency 72-hour hold.

States that commitment does not automatically end if 30/60/90 paperwork is lost or not properly filed and provides additional time to complete and submit

this paperwork. Replaces the early intervention section with a new Engagement Service that:

Targets people with mental illnesses who are developing the symptoms of a serious mental illness or those who are likely to decompensate and require commitment unless they are engaged in treatment.

Requires 90 days of assertive outreach to encourage the individual to voluntarily engage in treatment and connect the person with resources.

We have worked on this legislation for almost three years, so it is very exciting to see this legislation move forward this session. Thank you to our chief authors Rep. Edelson and Sen. Relph, as well as everyone who worked so hard on the task force to ensure that we had a positive bill that reflects the general consensus of the mental health community.

In addition to the civil commitment bill, other important NAMI priorities are moving through the legislative process as well. Here are the key bills:

SF 3834 (Draheim) / HF 3793 (Acomb): Updates language on Youth ACT Teams, including allowing family peer specialists to be on a Youth ACT Team. Allows Youth Crisis Teams to provide services in emergency rooms and urgent care settings. Currently only Adult Crisis Teams can do this. This bill is included in the Senate policy omnibus but not the House. Please contact your legislator if they sit on the Health and Human Services Policy Committee.

SF 3759 (Nelson) / HF 4257 (Moller): Requires every teacher in Minnesota to get mental health training. Currently only Tier 3 and Tier 4 teacher licenses require mental health training. This bill is in the House omnibus policy bill but not the Senate. Please contact your legislator if they sit on the E-12 Policy and Finance Committee.

Other important mental health legislation from our partners has been included in the House and Senate omnibus bills, including policy on Psychiatric Residential Treatment Facilities (PRTFs), Certified Community Behavioral Health Centers and other key priorities.

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News from the State Level

Activity in Legislature this Week

It was another busy week at the capitol, with both the House and Senate moving forward with omnibus policy bills. Despite the importance of rapidly responding to the COVID-19 pandemic, 2020 is a policy year and there is a significant number of policy bills waiting to be heard in committees.

On Tuesday morning, the House Agriculture Finance Committee discussed their supplemental budget for 2020. This includes an additional $50,000 in funding for farmers' mental health supports including suicide prevention and to develop curriculum to target adolescents in farm communities at risk of suicide or self-harm. The committee will vote on the bill on May 5.

On Wednesday, the House Health and Human Services Policy Committee voted on their omnibus human services policy bill which we wrote about last week. This includes NAMI Minnesota's civil commitment legislation. The language was amended in committee to allow any Advanced Practice Registered Nurse (APRN) working in a hospital emergency room to initiate a 72-Hour hold. The original language was limited to APRNs in the emergency room of a critical access hospital. Once consensus was reached within the civil commitment task force, we were able to expand to any hospital emergency room. This will be very beneficial in rural communities where there are fewer mental health professionals. Rep. Huot spoke in support of the amendment and was very grateful that a compromise was reached. There was an amendment added to clarify language around Certified Behavioral Health Centers. The omnibus human services policy bill was sent to general orders for a floor vote.

The House Judiciary Finance and Civil Law took up the bill that would implement the Family First Act. It did contain the agreement worked out between DHS, NAMI and Aspire.

The Senate Finance Committee heard SF 4344, which provides grants for broadband and telemedicine. Funds could be used to provide wireless or wire-line broadband access for a limited duration to students currently lacking Internet access so that the students may participate in distance learning offered by school districts and charter schools. Telemedicine grants would have supported the purchasing of equipment. NAMI had reached out hoping to include community mental health centers which

were not specifically named in the bill. During the hearing Sen. Rosen, the chair of the committee, asked Senate Counsel if CMHCs were included. While not their area of expertise, they thought it would since the language regarding community health centers includes providing mental health services. We think this is different (services versus centers) and are following up. The House companion, H. F. No. 3029, passed out of the Greater Minnesota Jobs and Economic Development Finance Division this week as well although the telemedicine grants were dedicated to providing COVID-19 related care. Later in the week the Ways and Means Committee addressed the bill.

The Senate Health and Human Services Finance and Policy Committee met on Thursday to walk-through their omnibus policy bill. Unfortunately, this policy bill includes major changes to the scope of practice for Physician Assistants (PAs). While the PAs and the Minnesota Medical Association (MMA) were able to reach a compromise, the mental health community was not involved and continue to have significant concerns about PAs providing treatment to people with serious mental illnesses. PAs simply do not have the training and expertise to support patients with complex mental health needs. NAMI Minnesota and our partners in the mental health community are working very hard to create additional protections when PAs treat people with serious mental illnesses, requiring that they have an explicit practice agreement with a psychiatrist. This language is being taken up in the House HHS Policy Committee this week.

On Friday afternoon, the House Education Policy Committee met to hear their omnibus education policy bill. They will vote on it this week. NAMI Minnesota is very pleased to report that the bill requiring all teachers to receive training on student mental health and suicide prevention was included. Other important additions to the policy bill includes requiring education records to include pupil withdrawal agreements when a student transfers to a new school and reducing "lunch shaming."

On Friday the House Ways and Means Committee passed a “COVID-19 Economic Security Act” by combining three House bills together including HF 168 that would expand who can be a PCA to relatives and increases the rates by 15%. An amendment was successfully added that included the grants for distance learning and for telemedicine. This amendment allowed grants for telemedicine during COVID-19 not just providing treatment for COVID-19. Rep Hausman's bill providing $100 million for eviction and mortgage foreclosure protection/emergency housing assistance was also added.

The House Health and Human Services Finance Committee passed a bill providing one-time grant money to address the opioid crisis. Funds would be used to distribute naloxone kits, provide training, support ECHO hubs, expand care, and address disparities. The committee also heard a bill (but did not take action) to provide a one-time $500 check to MFIP families. NAMI wrote a letter in support of the bill knowing that COVID has had a very negative impact on families living below the poverty line.

The Senate Committee on Agriculture, Rural Development, and Housing Finance heard SF 4495 which deals with evictions and rental assistance.

Important hearings next week:

Tuesday: The House Human Services Policy Committee will hold a hearing on an omnibus policy bill under the jurisdiction of Sen. Benson's committee.

Wednesday: The House Education Policy Committee will hold a final vote on their 2020 omnibus policy bill.

With just a few weeks before the end of the Legislative session, things are going to start moving quickly. There is still a lot of work to do - especially around a bonding bill - so be sure and stay tuned to NAMI's legislative updates.

Governor Walz Extends Stay at Home Order

Governor Walz chose to extend his executive order for Minnesotan's to shelter at home through May 18. Most requirements will stay in place, but Governor Walz has chosen to increase flexibility for Minnesotans. The biggest change will be allowing small retailers to re-open their businesses so long as they can offer curb-side pickup for customers. This applies to retailers, dry cleaners, pet-groomers, and also allows for hair salons to sell their products to customers. NAMI Minnesota strongly encourages our members to abide by these requirements to stay at home unless your are an essential worker.

New Waivers from DHS in Response to COVID

The Commissioner of Human Services ordered adult day centers to close on March 29. While it was important to ensure that providers and clients stay safe, this cut many people off from a very important service. This week, DHS has granted a waiver that allows for adult day providers to offer similar services via telemedicine or telephone, in the clients home, as well as to offer a bath in the facility so long as there is only one client in the facility at a time. The following services can be offered:

Wellness checks and health-related services, including medication set-up and administration overseen by a nurse;

Socialization/companionship; Activities;

Meals, delivered to participants’ homes; Assistance with Activities of Daily Living (ADLs), including bathing; and Individual support to family caregivers.

This waiver will be effective following federal approval and rule-making changes internally at DHS.

The DHS Commissioner issued another waiver regarding the county financial responsibility for treatment at the Anoka Metro Regional Treatment Center (AMRTC) or a Community Behavioral Health Hospital (CBHH) when this level of care is no longer medically necessary. Under current, law the county must pay for each unnecessary day at the AMRTC or a CBHH. However, this has proven to be very challenging during the COVID-19 pandemic. The new DHS waiver allows for the review of these costs to the county when a patient's discharge is delayed due to COVID-19. This decision is retroactive to March 13.

Criminal Justice Update

A judge from the Sixth Judicial District gave the opinion last week that the Department of Corrections (DOC) has not met its duty to keep residents of prisons safe during the COVID-19 pandemic. The opinion was in response to a lawsuit filed by the ACLU Minnesota to release residents of the Moose Lake facility which was the first to experience a COVID-19 outbreak. The DOC must respond by May 11th and a remote hearing is scheduled for May 19th. As testing has increased, the number of residents with confirmed positive COVID-19 cases and DOC staff at Minnesota prisons has spiked. As of May 1st, there were 82 confirmed positive cases in residents, the majority split between the Moose Lake (34) and Willow River (47) facilities, with one positive case at the Lino Lakes facility. An additional 41 DOC staff have self-reported testing positive for COVID-19 across the Lino Lakes, Stillwater, and Shakopee facilities, with 31 of those at Moose Lake.

NAMI Minnesota has been in contact with the DOC amidst mounting pressure to release more residents. While the DOC has released 25 residents under an emergency expanded work release program and is accepting applications for conditional medical release, NAMI has learned that securing safe placements for many residents is difficult during the pandemic. The DOC is regularly updating their testing results on their website as well as providing information on COVID-19 strategies and information for each facility. The House has heard legislation to expand the Commissioner’s powers to release people during the pandemic but there have been no hearings in the Senate Public Safety committee. You can read a Star Tribune article from last week about COVID-19 in the prisons here.

House Public Safety and Gov Ops Committees ActionsThe House Public Safety and Criminal Justice Reform Policy and Finance Committee moved on a COVID-19 response bill on Thursday. The bill in its original form would give the Commissioner of Corrections emergency powers to grant early release to people in prison with less than six months left on their sentence. The original bill, which crafted was in response to recommendations made by the Ombudsperson for Corrections, also required more data on prison and jail populations and provided rapid COVID-19 testing for first responders and health professionals. Several amendments were made to the bill Thursday including repealing language that encourages double bunking residents in prisons and prohibiting the suspension of a driver’s license solely due to an inability to a traffic violation fine. An additional amendment modifies the emergency powers of the Corrections Commissioner to only release people with non-violent offenses early. The ACLU Minnesota supplied written testimony in support of the bill and Though the amendments were brought by members on both sides of the aisle, the final bill as amended did not receive bipartisan support, however it was still successfully passed to the Ways and Means Committee. You can watch the remote hearing here and view the amendments here.

On Thursday, the House Government Operations Committee heard HF 3568. The bill would bring stakeholders together to create a planning group to decriminalize mental illness. Duties for the group include reviewing barriers, best practices and strategies to address disparities in the criminal justice system for people with mental illnesses. The group would develop initial recommendations for early action by 2022, with recommendations for long term system change by 2025. NAMI Minnesota is listed in the legislation as a required member of the planning group. The bill was passed to the State Government Finance Committee, and is scheduled to be heard this Tuesday, May 5th.

Minneapolis Survey Seeks Lived Experiences of Mental Health CrisesLast year, the city of Minneapolis created a Minneapolis Police Department (MPD)/911 Workgroup to determine alternatives to calling police when possible. NAMI corresponded with the workgroup and the Minneapolis City Council several times last year to discuss crisis response systems. In November the group released some recommendations to the City Council including expanding the use of crisis teams instead of police responses where appropriate. To further this work and improve the response to people in a mental health crisis, the city of Minneapolis is conducting a survey to gather lived experiences and information. If have the time, please take a moment to complete the survey here. NAMI has been in continued conversation with the city of Minneapolis this year and will keep advocating for a robust crisis response system.

Funding Changes Coming for Minnesota IPS Providers

Due to a decision from the Federal Rehabilitation Services Administration, Vocational Rehabilitation program funds can no longer be used to support grants for Individual Placement and Supports (IPS). IPS programs are one of the most effective services we have to support adults with serious and persistent mental illnesses find and keep a job. In order to avoid cuts to existing programs, the Department of Employment and Economic Development (DEED) is taking the one-time IPS appropriation that NAMI secured last session to make existing providers whole. While it is disappointing that we will not be able to expand access to such an effective program, it is most important to avoid cuts to the IPS programs that are already working. Because this is only one-time funding, NAMI Minnesota will have to work very hard to ensure that we can secure additional long-term funding in the next budget year.

News from Federal Level

CMS Allows for Use of Telephone to Provide Mental Health Treatment

NAMI is pleased to report that the Centers for Medicare and Medicaid (CMS) has finally taken action and expanded the mental health services that can be offered through a telephone. In addition to this important change, the National Council has also identified these other changes as being especially important:

Increase in reimbursement for audio-only E/M codes: Previous guidance permitted billing for audio-only telehealth visits for certain CPT codes, including virtual check-ins and some evaluation and management codes. CMS is now increasing payments for specified E/M telephone encounters to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

Expansion of audio-only billing for Opioid Treatment Programs (OTPs): Previous guidance permitted therapy and counseling to take place via audio-only telehealth in OTPs. OTPs will now be able to do periodic assessments via audio-only calls.

Expansion of telehealth for partial hospitalization programs: In the context of hospital and outpatient partial hospitalization programs, individual psychotherapy, patient education, and group psychotherapy can now be billed as telehealth visits, including via audio-only encounters when audio/video technology is not available. All other PHP requirements remain unchanged,

including that all services furnished under the PHP still require an order by a physician, must be supervised by a physician, and others. These encounters may take place with the patient in their own home.

While we wish that these changes could have happened more quickly, it is reassuring that CMS was able to get across the finish line and allow for Medical Assistance to cover more services telephonically. (National Council)

Updates from NAMI Minnesota

May is Mental Health MonthMay is mental health month. A time to raise awareness of the importance of good mental health, especially during these times. Each day in May we are challenging you to take action to improve your mental health. Follow us on social media and download our challenge calendar. We are creating a community as people share why they care.

You can support NAMI Minnesota’s work to improve the mental health of Minnesotans by participating in Give MN's #GiveAtHomeMN campaign, a week-long giving celebration to respond to the unprecedented need caused by COVID-19, from today, May 1 to Friday, May 8. This is a great time to support NAMI Minnesota, the mission you care deeply about, and our work to provide education, support and advocacy.

Our goal is to raise $10,000 through the #GiveAtHomeMN Give MN challenge week! NAMI Minnesota’s Board of Directors has led the way toward meeting this goal with 100% of them donating to the effort. We believe that we can make this happen with your help!

Giving is quick and easy: just visit our Give MN #GiveAtHomeMN page to donate and join this timely giving celebration!

Throughout the month of May, NAMI Minnesota’s community educators and other professionals will be offering free classes to the public. For detailed descriptions and registration information, visit our website and Facebook page. New classes will be added through the month of May!

Upcoming Classes:·   Making COVID Daily Life Less Challenging for Children and Teens with Mental Health Challenges — With Help from Their Families (with speaker Dr. Anne Gearity): Tuesday, May 5, 9:30-11:00 AM·   Wellness Series: Keep In Touch: Friday, May 1, 2:00 – 3:00 PM·   Good Mental Health in the Workplace: Monday, May 4, 11:30-1:00 PM and Tuesday, May 12, 1:00-2:30 PM·   Wellness Series: Physical Activity: Monday, May 4, 2:00-3:00 PM·   Creating Caring Communities – Five Things You Can Do: Tuesday, May 5, 11:00-12:00 PM·   Get To Know NAMI: Tuesday, May 5, 1:00-2:00 PM and Thursday, May 14, 11:30-12:30 PM·   Together, We Can Make it OK: Wednesday, May 6, 3:00-4:30 PM, Friday, May 8, 3:00-4:00 PM, and Tuesday, May 12, 10:30-11:30 AM·   Mental Illnesses and Crisis Communication Strategies: Wednesday, May 6, 12:00-2:00 PM·   Gray Matters: Anxiety in Older Adults: Thursday, May 7, 3:00-4:30 PM·   Importance of Family Psycho-Education and Support: Friday, May 8, 11:30-1:00 PM and Monday, May 11, 2:00-3:30 PM·   In Our Own Voice: Friday, May 8, 12:00-1:00 PM and Monday, May 11, 6:00-7:00 PM·   Discipline Tips for Stressed Parents: Monday, May 11, 1:00-2:00 PM·   QPR – Question, Persuade, Refer: Monday, May 11th, 11:30-1:00 PM

Last Week's Coverage

Due to a technology glitch, many of you did not receive our weekly legislative update last week. This was due to an issue with our server that has now been resolved. We are including some of the highlights from last week's edition for those who are interested.

The Legislature held multiple, important hearings this past week on rental assistance and the House version of the Health and Human Services omnibus policy bill and a Senate human services bill.

The first hearing was Tuesday morning when the the House Housing Committee heard their bill to offer $100 million in rental assistance in response to the COVID-19 pandemic. Governor Walz has issued an executive order banning most evictions - including for unpaid rent - for the duration of the public health emergency. However, tenants will still have to pay their rent, which will place many families in a very challenging situation once that order is lifted.

NAMI Minnesota is pleased to report that both the House and Senate have recognized the urgent need for rental assistance and both bodies heard legislation this week to appropriate funding for Family Homelessness Prevention and Assistance (FHPAP) grants to offer additional rental assistance, with the Senate offering $30 million and the House coming in at $100 million. There is a broad base of support for this investment from advocates like NAMI Minnesota and the Homes for All Coalition, landlords, and other key agencies. Commissioner Ho of the Minnesota Housing Finance Agency testified before both bodies and spoke to the urgent need for this funding to stabilize Minnesota families during this public health and economic crisis. Attorney General Ellison also testified in support of this legislation in the House, describing the work his office is doing and noting that late rent has doubled according to the Minnesota Multi-Family Housing Association.

The House Human Services Policy Committee also held a hearing on their omnibus Human Services Policy bill. Rep. Moran introduced her bill and noted that she is working with Sen. Benson to develop a second policy bill that addresses the areas that are under the jurisdiction of Sen. Benson's committee. The committee walked through the bill this week and will take a formal vote on Wednesday. NAMI Minnesota is pleased to report that the bill includes NAMI Minnesota's Civil Commitment legislation. Other key parts include:

A student placed in foster care must remain enrolled in the student's prior school unless it is determined that remaining enrolled in the prior school is not in the student's best interests. If the student does not remain enrolled in the prior school, the student must be enrolled in a new school within seven school days

Requires an initial phone call between foster care providers and parents of children in foster care, to share any information regarding the child that would facilitate the child’s adjustment to the foster care setting and improve outcomes for the child. Requires that the call be coordinated as soon as is practicable, or within 48 hours of the child’s placement in foster care

Coordinate a prenatal alcohol exposure screening for any child who enters foster care. Requires the screening as soon as is practicable, or within 45 days of the child’s removal from their home

Remove reporting requirements for physicians providing prenatal care to a patient struggling with substance abuse;

Sets the MA spenddown standard that will take effect July 1, 2022, for persons who are age 65 or older, blind, or have disabilities at the current MA income limit for those groups, rather than at a specific percentage of the federal poverty guidelines.

Removes the prior authorization requirement for Psychiatric Residential Treatment Facilities (PRTFs) and instead requires department oversight and utilization reviews of PRTF referrals and admissions, and to coordinate a statewide list of children who meet PRTF medical necessity criteria and are

awaiting admission. Modifies the PRTF per diem rate to be per provider rather than a statewide

average rate. Allows for billing by either the facility or the licensed professional who provided the services

Not reequire case management in order to receive respite care Permit any minor living apart from their parent or legal guardian to consent to

receive homeless youth and sexually exploited youth services;

Unfortunately, NAMI bills on children's mental health crisis services and Youth ACT teams were not included.

During the discussion, Rep. Edelson asked if PRTFs were a residential service and if private health plans should be covering them, or are they an MA only service. Matt Burdick, from DHS, replied that PRTFs are considered by CMS to be a hospital and that mental health parity is under the jurisdiction of Commerce and the Department of Health.

The omnibus policy bill also includes DHS policy around the implementation of the Federal Family First Legislation. Lisa Bailey from DHS testified in support of the bill and noted that her department has worked closely with NAMI Minnesota and Aspire to address the concerns of the mental health community. Sue Abderholden also testified on this part of the bill and noted that following negotiations NAMI Minnesota no longer opposes the bill. However, Ms. Abderholden noted that NAMI still has grave concerns about its impact and that the only way our concerns can truly be addresses is for Minnesota to no longer seek federal Title IV-E funds to pay for room and board and to have state dollars pay for room and board. This will ensure that Minnesota Families can access voluntary residential mental health treatment without an intrusive and humiliating relative search and screening committees.

The House Education Committee met to review a policy bill. Of interest to NAMI is that student absences from March 1 through the end of the distance learning period do not count towards truancy referrals, the savings in school lunches would be extended to provide lunches for students this summer. An amendment to the bill states that if teachers and staff return to school buildings safety protocols must be in place. They also met to discuss funding including appropriating an additional $15 million for full service community schools. A full-service community school incorporates aspects of: early childhood services; academic support and enrichment activities including an extended school calendar; career counseling and internship opportunities; parent involvement and leadership; mental and physical health support; community involvement; and service learning.

The House Public Safety and Criminal Justice Reform Finance and Policy Division heard HF 717 which would divert veterans with service-connected trauma, substance

abuse, or mental health conditions, who are accused of committing all but the most serious crimes, to receive probation and social services instead of serving jail time.

A bill passed the Veterans Committee with language authorizing the Department of Veterans Affairs to establish a veterans’ stable housing initiative to help homeless or nearly homeless veterans.

On the Senate side, several bills were heard. The Senate Finance Committee heard SF4494 which has a section called “Distance Learning Broadband Access Grant Program.” This section would provide up to $8,000,000 to reimburse Minnesota school districts and charter schools for costs incurred in providing equitable access to distance learning for students during this worldwide pandemic.

SF 3694 was heard and passed in the Senate Human Services Reform and Policy Committee. This bill would do a number of things including not require TEFRA parental fees during the COVID crisis; provide a temporary rate increase for Nonemergency Medical Transportation and allowing them to deliver food and medications; Requiring the commissioner of human services to pay providers a daily retainer payment equal to 50 percent of the daily average medical assistance revenue the provider received for eligible services during January 2020 and this includes CTSS providers; and provide a 15% increase to PCA providers and residential waiver providers.

The legislature continues to hold limited hearings but are being held remotely. The public can observe remotely but can not attend in person. Key hearings include another hearing on the Senate rental assistance bill, a hearing on bonding in the Senate, a vote on the House Human Services omnibus policy bill, and other bills to be announced.

NAMI Minnesota, Aspire Minnesota and the MN Association of Community Mental Health Programs sent a letter to Rep Liebling, Chair of the Health and Human Services Finance Committee providing information on the incredible work being done by mental health providers to meet people's needs and the funding that is needed to ensure that they remain viable.

NAMI Legislative CommitteeMeetings are held on the second Tuesday of every month at 6 PM and in April will be by phone or zoom. To be added to the email list, contact Sam Smith.

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