2013 Legislative Summary

NAMI Minnesota ConferenceSt. Paul, MN

November 16, 2013Glenace Edwall, Cynthia Godin and Sue Abderholden

2013 Children’s Mental Health Legislation: Glenace Edwall

2013 Adult Mental Health Legislation: Cynthia Godin

2014 Plans and Prospects: Sue Abderholden

Overview

1. Grant expansions and additions2. Medicaid benefit changes3. Policy and infrastructure studies, changes

Children’s Mental Health (CMH) Legislation

School-Linked Mental Health Grants increased by 50% for first year of biennium, 100% for second for total increase of $7.434 millionRFP yielded >40 applications, with requests totaling nearly twice the appropriationContract negotiations in process; target initiation of services 1/1/14

CMH Grants

Crisis Teams ExpansionWork with AMHD to establish four joint child-adult mobile crisis response teams in previously unserved regions of the state.RFP funded by $1.5 million increase for biennium issued and closed; applications in review

CMH Grants

Text Messaging Crisis Line$1.25 million was appropriated to establish a text message suicide prevention program, allowing youth and adults to connect with crisis counselors and obtain emergency information and referralsContract negotiation with vendor nearing completion; worked to develop connections with local mobile crisis response teams

CMH Grants

Youth Mental Health First Aid Training$45,000 appropriate for biennium to fund training available to teachers, human service personnel, law enforcement and others who come into contact with children with mental health symptoms or illnessesRFP in preparation

CMH Grants

Intensive Treatment in Foster CareRevision of Section 256B.0946, first enacted in 2005 and delayed several times for fiscal considerationsTargeted for children in foster care to through age 20 with ED/SED, including trauma assessment, clinical services, 24/7 phone support; may be provided by outpatient or CTSS providersState Plan Amendment (SPA) submitted

CMH Benefits in Minnesota Health Care Programs

Family Peer SpecialistsFamily Peer Specialists may serve families in wide variety of CMH service settingsSee NAMI-MN Legislative Summary for range of functions which FPS may provideStakeholders interested in multiple pathways to certification, to allow possibilities for building professional ladders as well as immediate service possibilitiesSPA to be submitted by January, 2014

CMH Benefits

Family PsychoeducationNew state plan benefit to provide help to families in understanding symptoms, impact on child’s development, roles of treatment and skill development, and ways to promote resilience and prevent co-morbidities and relapse

SPA submitted

CMH Benefits

Clinical Care ConsultationBenefit sought by both DHS and providers, to allow reimbursement for communicating with other providers and educators; necessary for integrating care across systems and settings

Spa to be submitted to coordinate with Behavioral Health Home development

CMH Benefits

Mental Health Service Plan DevelopmentChildren’s Therapeutic Services and Supports (CTSS) providers will be reimbursed for development, review and revision of individual treatment plans, including time spent meeting with parents/caregivers and completing assessment and outcome measurements

SPA submitted

CMH Benefits

In-Reach ServicesIn-reach services previously available to MHCP recipients now explicitly extended to children and adolescents, with lower usage thresholds (ED > twice in past 3 months or hospitalization > twice in past 4 months or discharge to shelter). Provides for arranging for services and supports prior to discharge

SPA submitted

CMH Benefits

Psychiatric ConsultationMHCP currently covers psychiatric consultation by a psychiatrist to a primary care providers; service was expanded to include consultation by a licensed psychologist or advanced practice nurse certified in psychiatric mental health. Applies to both children and adults, but may have particular impact for children because of acute shortage of C&A psychiatristsSPA submitted

CMH Benefits

Autism CoverageDHS directed to develop new benefit termed Autism Early Intensive Intervention, to include applied behavior analysis, developmental treatment approaches, and naturalistic and parent training models.CMHD involved in planning; intersection with current CTSS services to be determined

CMH Benefits

Mental health practitioner who is a clinical trainee may conduct diagnostic assessment under supervision

Fees under TEFRA program eliminated for families with income <275% of federal poverty line

Unused Therapeutic Preschool option under CTSS repealed

Mental health providers and other health professionals will have reimbursement increased by 5% beginning 9/1/14

Other Changes in CMH Benefits

Child and Adolescent Behavioral Health Services (CABHS)DHS, consulting with stakeholders, will develop recommendations for the CABHS facility (Willmar) to ensure that it is meeting intensive service needs, can secure appropriate staffing, and provides effective treatmentStakeholder meetings scheduled November through January, 2014

CMH Infrastructure and Policy

Case Management for Transition-Age YouthContinued case management services must be offered by a county or health plan to an adolescent who is receiving CMH case management and is turning 18, and whose needs can be met within the CMH system. Before discontinuing case management for youth 17-21, a transition plan must be developedBulletin in preparation; incorporated into TCM training

CMH Infrastructure and Policy

Case Management RedesignDHS required to submit report to legislature by February, 2014 with recommendations for changes to case management. CMHD and AMHD have established own process with stakeholders to submit recommendations specific to mental health case management into DHS reportStakeholder meetings scheduled through January

CMH Infrastructure and Policy

Pilot Provider SurveyDHS directed to survey CMH providers and pediatric home health providers to identify and measure issues in the management of MHCP; report to be submitted to legislature by January 15, 2014

Performance Measurement and Quality Improvement (PMQI) section of HCA is lead

CMH Infrastructure and Policy

Mental Health Behavioral Aide (MHBA) II Certificate DevelopmentLegislation added completion of a certificate program as a credentialing option for a Level II MHBA, and directed DHS to work with Minnesota State Colleges and Universities (MnSCU) to develop a certificate program. Course may dovetail with Family Peer Specialist credential developmentMeetings with MnSCU began last summer

CMH Infrastructure and Policy

Work Force Development SummitMnSCU will convene a summit to develop a comprehensive plan to increase the numbers of qualified individuals working at all levels in the child and adult mental health systems; plan to be submitted to legislature by January 15, 2015

One stakeholder meeting held; steering committee formed; summit scheduled for May 28, 2014

CMH Infrastructure and Policy

Social Work LicensureSocial workers employed by tribal agencies will be eligible for licensure under grandparenting provisions previously available to city, state or nonprofit employees. County social workers are still not required to be licensed.

CMH Infrastructure and Policy

Juvenile Justice System ReportLegislature directed NAMI-MN to convene a workgroup to report policy recommendations by February 15, 2014 to improve outcomes for children and adolescents in the juvenile justice system; c. 70% of these children have diagnosable mental health conditionsCMHD is participating

CMH Infrastructure and Policy

Adjust Adult Rehabilitative Mental Health Services payment rate, services.

Increases payment rates for ARMHS services, which help adults with serious mental illness to gain emotional stability and learn new coping skills. Expands the range of these services and adds provider reimbursement for currently unfunded but necessary services such as mental health functional assessments.

Adult Mental Health Legislation

Mental Health Specialty Residential Treatment Service

Establishes a 24/7 medically monitored mental health special treatment service as a transition service from psychiatric hospitalization for individuals with mental illness and complex treatment needs who require a longer stabilization period.

Adult Mental Health Legislation

Willmar Intensive Residential Treatment Service (IRTS) remains open

Operations at the Willmar IRTS will continue due to the Legislature's agreement to use dedicated State Operated Services resources and facility revenue.

Adult Mental Health Legislation

Transition to Community Initiative

$8.2 million to assist individuals ready to discharge from AMRTC or Minnesota Security Hospital

Strengthens community mental health options

Adult Mental Health Legislation

Substance Abuse Screening, Brief Intervention and Referral to Treatment

Expands the number of primary care clinicians trained to use the Screening Brief Intervention and Referral to Treatment process to identify people at risk of drug or alcohol abuse so treatment can be offered.

Substance Abuse Legislation

Zumbro Valley Mental Health Center legislative appropriation

Provides funding for a two-year pilot to develop integrated treatment, adding primary care (nursing) services to the mental health center

Integrated Treatment Legislation

Expansion of Individual Placement Support model

Combines employment service provider services with mental health services

Employment related Legislation

Crisis Teams, earlier intervention First Episode County control Day treatment Corporate Foster Care Juvenile Justice Housing/Bonding Criminal Justice Seclusion and Restraint Case Management

2014 Legislative Session

Glenace Edwall Director, Children’s Mental Health Division, DHS glenace.edwall@state.mn.us

Cynthia Godin Director, Adult Mental Health Division, DHS cynthia.godin@state.mn.us

Sue Abderholden Executive Director, NAMI Minnesota sabderholden@namimn.org

Contact Information