NAMI Minnesota Legislative Update

April 26, 2020

Governor Walz Takes Further Action on COVID-19

This week the Governor took additional actions to respond to the COVID-19 pandemic, highlighted by the roll-out of Governor Walz's plan to dramatically increase Minnesota's COVID-19 testing capacity. While there are a lot of other steps that must be taken, increasing COVID-19 testing capacity is a crucial prerequisite for loosening requirements for Minnesotans to shelter in place.

Governor Walz has issued an executive order that will allow more businesses to get back to work. This includes manufacturing companies and certain office-spaces:

Industrial: This category includes any place of employment where goods are in the process of being created. Agriculture, forestry, fishing and hunting qualify, as do mining, construction, utilities and manufacturing. Wholesale trade and warehousing also qualify as they are preparing those goods for sale to customers and consumers.

Office Space: Any office-based employment where there is no direct contact with customers.

An eligible business must require employees to work from home whenever this is possible, maintain safe social-distancing within the workplace, allow sick employees to stay home, have a plan for employee hygiene, and ensure that the office space is safely disinfected on a regular basis. Customer facing businesses that are not considered essential are not opened under Governor Walz's executive order. You can read the full order here and review additional guidance from the Department of Employment and Economic Development (DEED).

Governor Walz also issued executive order 20-41 extending the distance learning order through the rest of the school year. Under this order, schools will be closed for in-school instruction. However, schools are still open to provide meals for children and child-care for essential workers. While it is important to prioritize the health and safety of Minnesotans, we must remember that the burden of distance learning will be hardest for communities of color, people experiencing poverty, and families that have a children with a mental illness or a disability. You can read the f ull executive order here. NAMI has reached out to the Commissioner of Education and the Governor's office to share the concerns of families who have a child with a mental

illness, particularly those children who are in a special education class more than half the day and children in a special education cooperative or Intermediate District.

School-linked mental health services are still available for Minnesota students, as well as the mental health services from an Intermediate school district. To facilitate continued access to these important supports, the Department of Human Services (DHS) has issued a waiver on school-linked mental health and intermediate mental health services:

Authorizes reimbursing school mental health providers for expanded telemedicine services through grant funds;

Increases flexibility to no longer require the first visit be in person; Waives the three-day-per-week limit on telemedicine; and Allows telephone and other non-secured electronic communications

platforms, such as Skype.

Some day treatment programs operated in schools before COVID-19 and have had trouble finding alternative locations. NAMI and Aspire have advocated that schools allow day treatement programs to continue in their buildings during this time.

NAMI Minnesota will keep you up-to-date. We are here for you to answer questions and help you or a loved one obtain the mental health supports they need.

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News from the State Level

Legislature Met This Week

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.

CMS Approves Key Waiver Requests

NAMI Minnesota is very excited to report that the Centers for Medicare and Medicaid Services (CMS) has finally approved a very important waiver request for the mental health community. Most importantly, mental health agencies can begin using telephone and video visits for the following services:

Community mental health services including Certified Community Behavioral Health Clinics (CCBHCs)

Mental health certified peer specialists and certified family peer specialists Mental health rehab workers in an Adult Rehabilitative Mental Health Services

(ARMHS) program Mental health behavioral aides in a Children's' Therapeutic Support Services

(CTSS) program Alcohol and drug counselors, alcohol and drug counselor-temps, recovery

peers, and student interns in licensed SUD programs.

This is a very positive step that will improve access to key, community-based mental health services via telemedicine. We know that ACT teams will be included and guidance from DHS will be sent out soon.

DHS also received CMS approval for a waiver to meet the requirements for a face-to-face visit for targeted case management via telephone or video contact for the following programs:

Child welfare targeted case management Children’s mental health targeted case management Adult mental health targeted case management Vulnerable adult or adult with developmental disabilities (VA/DD) targeted

case management Relocation service coordination targeted case management

Both waivers are retroactive to March 19th.

The commissioner waived the need for providers to get signatures when providing durable medical equipment (DME) and nonemergency medical transportation (NEMT) to Medical Assistance and MinnesotaCare enrollees. This change supports the need for social distancing during the pandemic. This waiver is effective April 20, 2020, and expires at the end of the COVID-19 peacetime emergency.

If you have any questions about these changes or other waivers sought by DHS, you can go to the DHS website and find additional details.

Star Tribune Highlights Work of Jin Palen and MACMHP

The Minnesota Association of Community Mental Health Programs (MACMHP) is a key NAMI partner in the mental health community. Their executive director Jin Palen was recently featured in the Star Tribune for a Q/A on Health Care Hero's. NAMI encourages everyone to read the great article and learn more about what our community mental health providers are doing to provide quality mental health treatment during the COVID-19 Pandemic.

News from Federal Level

Federal Action Needed to Support Mental Health System

COVID-19 isn’t just affecting our physical health and daily life—it's affecting our mental health. Whether it’s lack of access to mental health treatment, loneliness and depression from isolation, stress and anxiety from the danger of contagion, grief from losses, or despair from losing employment and trying to make ends meet, our country is in pain.

Nearly half of Americans report that COVID-19 has had a negative impact on their mental health.

Yet, despite trillions of dollars being spent to respond to this pandemic, little has gone to address the mental health emergency arising from this crisis.

This is unacceptable.Our Congressional leaders need to step up and act to help people with mental health conditions and every single person trying to cope with uncertainty, isolation and grief.Demand for mental health services has never been higher, but most mental health providers say they have been forced to cut back on their operations. Meanwhile, there has been an 891% jump in calls to the federal government’s crisis hotline.We need Congress to provide funds to keep mental health providers afloat. Congress also needs to invest in crisis services, peer supports and other services to meet growing community mental health needs. And we need Congress to respond to the spread of this virus in our criminal justice system, which houses far too many people with mental illness.

We need Congress to act, and act quickly. Reach out to your members of Congress and tell them that mental health is still missing from our nation’s response to COVID-19.

Congress passes Another COVID-19 Package

This week Congress was able to reach agreement on $484 billion dollars in spending for the COVID-19 response. This will provide additional and much needed funding for the programs created through the Cares Act. Here are the key investments:

Paycheck Protection Program: The package provides $321 billion to replenish the PPP, which provides forgivable loans for small businesses to maintain operations throughout the pandemic. The program ran out of money to disburse last week, and awaits passage of the 3.5 package to continue supporting small businesses and nonprofits. Two pools of $30 billion each will be designated for supporting PPP loans by institutions with (1) less than $10 billion in assets and (2) between $10 billion and $50 billion in assets.

Economic Injury Disaster Loans: The bill provides another $10 billion for EIDL loans, which provide up to $2 million of financial assistance to eligible small businesses. The bill also makes farms and other agricultural enterprises eligible for EIDL grants and loans.

Health Care: The bill provides $75 billion for reimbursement to hospitals and health care providers, in addition to the $100 billion that was provided in the CARES Act. Mental health and substance use disorder treatment providers are eligible for these funds, and eligibility criteria remains the same as in the CARES Act. The first $30 billion from these funds have been allocated to Medicare providers, and the National Council is working with federal agencies and lawmakers to ensure the next allotment of funds reach Medicaid providers.

COVID-19 Tests: The package provides $25 billion for researching, developing, and expanding capacity for COVID-19 tests. $11 billion of this amount would be distributed to states, with the rest being distributed across federal agencies.

This legislation had the support of the entire Minnesota Congressional Delegation and we are very excited to see it become law. Hopefully, Congress will move forward quickly and provide needed funding to support state and local governments and their response to COVID-19. (National Council)

CMS Interim Rule

On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released

an Interim Final Rule with comment period providing additional flexibility to entities that care for Medicare beneficiaries in light of the current crisis. The regulations set forth in the Interim Final Rule took effect immediately and apply retroactively beginning March 1, 2020. The CMS fact sheet on the Interim Final Rule is available here. Although the Interim Final Rule has already taken effect, CMS may make changes to it in response to comments. We have heard that mental health providers have been told that they will not be reimbursed for treatment by phone and NAMI and others are looking into this with our congressional delegation.

Updates from NAMI Minnesota

NAMI Minnesota Continues to Respond to COVID-19

Everyone is focused on COVID-19 - rightfully so - but it is important to remember that mental illnesses and substance use disorders are not going away during this pandemic. In many cases, symptoms will become more acute and people will need more support. In this trying time, please know that NAMI Minnesota is doing everything we can to ensure that people can still access the supports and services they need.

We are also working very hard to continue to deliver our classes and support groups online. You can find a full list of all upcoming classes here. These are presented by NAMI staff and mental health professionals and can be joined online through zoom. NAMI Minnesota is also offering online support groups, including groups for young people, the LGBTQ community, parents and family members. NAMI Minnesota also maintains a resource list if you have more questions about COVID-19.

Despite the sustained efforts of NAMI Minnesota and our partners, we know that it's still not good enough. If you or a loved one are experiencing challenges accessing mental health services, please contact NAMI Minnesota and let us know what isn't working. Whether it's challenges with in-home services or issues obtaining support via telemedicine, it is very important that we hear about gaps in our mental health system. We already know that hundreds of people not only don't have laptops to connect for telehealth, they don't even have phones.

If you are a provider, we want to hear from you as well.  We are especially interested in problems people are having with payments for telemedicine such as if telephone calls are actually getting covered and, if so are they getting reimbursed at the same rate that the corresponding in-person service would be reimbursed at, or if

reimbursements are being denied because the provider is an essential worker and therefore could have provided the service in-person instead of via telemedicine or the provider is being required to use a specific platform such as Doctor On Demand and you can’t use Zoom or FaceTime.

Thank you everyone for your support of NAMI Minnesota and people with mental illnesses during this challenging time.

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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