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2013 Legislative Summary. NAMI Minnesota Conference St. Paul, MN November 16, 2013 Glenace Edwall , Cynthia Godin and Sue Abderholden. Overview. 2013 Children’s Mental Health Legislation: Glenace Edwall 2013 Adult Mental Health Legislation: Cynthia Godin

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2013 Legislative Summary

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    1. 2013 Legislative Summary NAMI Minnesota Conference St. Paul, MN November 16, 2013 GlenaceEdwall, Cynthia Godin and Sue Abderholden

    2. Overview • 2013 Children’s Mental Health Legislation: GlenaceEdwall • 2013 Adult Mental Health Legislation: Cynthia Godin • 2014 Plans and Prospects: Sue Abderholden

    3. Children’s Mental Health (CMH) Legislation • Grant expansions and additions • Medicaid benefit changes • Policy and infrastructure studies, changes

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

    5. CMH Grants Crisis Teams Expansion Work 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

    6. 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 referrals Contract negotiation with vendor nearing completion; worked to develop connections with local mobile crisis response teams

    7. 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 illnesses RFP in preparation

    8. CMH Benefits in Minnesota Health Care Programs Intensive Treatment in Foster Care Revision of Section 256B.0946, first enacted in 2005 and delayed several times for fiscal considerations Targeted 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 providers State Plan Amendment (SPA) submitted

    9. CMH Benefits Family Peer Specialists Family Peer Specialists may serve families in wide variety of CMH service settings See NAMI-MN Legislative Summary for range of functions which FPS may provide Stakeholders interested in multiple pathways to certification, to allow possibilities for building professional ladders as well as immediate service possibilities SPA to be submitted by January, 2014

    10. CMH Benefits Family Psychoeducation New 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

    11. CMH Benefits Clinical Care Consultation Benefit 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

    12. CMH Benefits Mental Health Service Plan Development Children’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

    13. CMH Benefits In-Reach Services In-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

    14. CMH Benefits Psychiatric Consultation MHCP 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 psychiatrists SPA submitted

    15. CMH Benefits Autism Coverage DHS 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

    16. Other Changes in 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

    17. CMH Infrastructure and Policy 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 treatment Stakeholder meetings scheduled November through January, 2014

    18. CMH Infrastructure and Policy Case Management for Transition-Age Youth Continued 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 developed Bulletin in preparation; incorporated into TCM training

    19. CMH Infrastructure and Policy Case Management Redesign DHS 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 report Stakeholder meetings scheduled through January

    20. CMH Infrastructure and Policy Pilot Provider Survey DHS 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

    21. CMH Infrastructure and Policy Mental Health Behavioral Aide (MHBA) II Certificate Development Legislation 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 development Meetings with MnSCU began last summer

    22. CMH Infrastructure and Policy Work Force Development Summit MnSCU 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

    23. CMH Infrastructure and Policy Social Work Licensure Social 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.

    24. CMH Infrastructure and Policy Juvenile Justice System Report Legislature 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 conditions CMHD is participating

    25. Adult Mental Health Legislation • 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.

    26. 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.

    27. 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.

    28. 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

    29. Substance Abuse 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.

    30. Integrated Treatment 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

    31. Employment related Legislation • Expansion of Individual Placement Support model • Combines employment service provider services with mental health services

    32. 2014 Legislative Session • Crisis Teams, earlier intervention • First Episode • County control • Day treatment • Corporate Foster Care • Juvenile Justice • Housing/Bonding • Criminal Justice • Seclusion and Restraint • Case Management

    33. Contact Information • 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