The 2024 Legislative Session essentially ended at midnight on Sunday - which was when all voting had to end. To say it ended in chaos, is putting it mildly. There was lots of yelling in the final minutes of both bodies. We wanted to let you know what happened Sunday night so delayed this legislative update until today.

Many of the conference committee reports were not voted on separately but merged into the tax bill. This huge bill (over 1400 pages) included:

• HF 5242 (Transportation, Housing, Labor)

• HF 4247 (Scope of Practice)

• HF 4024 (Higher Education)

• HF 2609 (Straw purchase/binary trigger ban)

• SF 4942 (Agriculture/Energy)

• SF 5335 (DHS)

• SF 4699 (HHS)

• Paid family leave, HF 5363, 4th engrossment

• Tax Bill

Some conference committee reports were discussed but then placed into the tax bill so that there was time to pass all of them. The Human Services Bill was heard on the Senate floor on Sunday night. Senator Hoffman walked through the bill providing the thousand foot highlights. Senator Rasmussen had several questions about the bill, including the concerns from the Long-Term Care Imperative who was opposing the initial two hour training and one hour annual training on mental health for workers in Assisted Living. Senator Hoffman stated that they had been involved in the discussions and much of that section had been watered down. He read off the list of organizations who wrote to support that section of the bill including the AARP, Alzheimer's Association, and NAMI Minnesota. Senator Rasmussen then went on to talk about a constituent of his whose husband really needed someone to help engage him in treatment voluntarily and then spoke in favor of NAMI Minnesota's legislation on voluntary engagement. Senator Utke rose to support the bill as well. The bill garnered 5 votes from Republicans.

The good news amidst the chaos is that many of NAMI and the Mental Health Legislative Network's priorities did pass! Read below for a high level overview of what passed and is waiting to be signed by the Governor. We know there is more in the bills, but this will give you an understanding of some of the key issues that were passed. We did get more money for providers' rates and key grant programs. Some key policy changes were also adopted.

Finally, thank you so much for your advocacy this year, and be on the lookout for our much more detailed legislative summary which should be available in the next few weeks. We have a lot to be proud of in a year with few resources. When we set out this year, we said we wanted mental health to be on the priority list for the legislature and with your help and the help of our many partners around the state, we were certainly able to shine a spotlight on mental health. We're looking forward to carrying this momentum forward to keep building our mental health system.

Provisions included in the tax bill, HF 5247:

Human Services

Health and Human Services

• Clarifies that Community Support Programs includes the Clubhouse model

• Clarifies that the program to support clinics providing free supervision is also targeted to clinics in rural areas of the state

• Expands respite care to families whose children lost their in-home services or have used the ER or crisis services and to provide regular access to regularly scheduled respite care

• Makes technical and streamlining changes to allow providers to choose a valid functional assessment or level of care assessment tool, addresses medication administration in residential or day settings, eliminates a requirement that each of the two required mental health professionals specialize in different disciplines, allows exceptions to attend weekly meetings in IRTS

• Funds room and board for persons enrolled in MinnesotaCare when provided through intensive residential treatment services and residential crisis services under 240.5 section 256B.0622.

• Creates a Mental Health Provider Certification process

• Removes requirement for ACT to have a county contract

• Removes language related to ACT and has them simply have a passing score on the TMACT which looks at fidelity to the model

• Adds occupational therapists to ARMHS services

• Rebases CCBHC rates for certain providers

• Expands family psychoeducation to child and family psychoeducation under medical assistance to include individual, family, or group skills development training

• Requires that providers notify DHS when key staff positions change in children's detox and residential facilities

• Allows treatment by multiple children’s providers at the same time if one service is being delivered to the child and the other to the child’s family and the child is not present

• Allows a co-occurring disorder specialist instead of an LADC on Youth ACT

• Changes the quarter used to adjust rates for ACT, Youth ACT, and IRTS from the fourth to the third quarter

• Changes the quarter used to adjust rates for crisis teams and rehabilitative services from the fourth to the third quarter

• Requires DHS to develop a Medicaid benefit for children’s crisis residential stabilization

• Requires withdrawal management and other SUD programs to report key staffing changes to DHS

• Doesn’t require written consent for behavioral health homes services

• Requires hospitals to provide advanced notice before reducing, relocating, or eliminating services

• Sets the 988 telecommunications fee at 12 cents

• Requires the revisor to separate out IRTS and ACT in statute

• Increase access to opiate antagonists in SUD, IRTS, and crisis residential

• A health plan company must include all essential community providers that have accepted a contract in each of the company's provider networks.

• Changes the definition of clinical trainee to include people who are waiting to take or learn their scores from licensing exams

• Requires DHS to look at simplifying mental health codes to CPT codes

• Requires DHS and Management and Budget to look at moving some of the mental health grants to a formula (such as crisis, school linked)

• Requires DHS to update rules to reflect current practice in children’s residential mental health treatment.

• Takes money from mental health grants that had not been processed to fund other mental health services such as respite care, school linked, and rates

• Requires community health needs assessments to be submitted to the commissioner of health to increase transparency and accountability

• Allows a First Episode Program to determine eligibility for an Assertive Community Treatment Team

• Creates rate inflation adjustment for adult day treatment services

• Requires DHS to develop a MA benefit for First Episode of Psychosis care referred to as Coordinated Specialty Care

• Requires DHS to develop a MA benefit for First Episode of Psychosis care referred to as Coordinated Specialty Care

• Requires notice and financial record keeping when the county is the SSI/RSDI payee for children in foster care

• Requires the commissioner (DCYF) to designate a department leader to be responsible for coordination of services and outcomes around children's mental health and for children with or at risk for disabilities within and between the Department of Children, Youth, and Families; the Department of Human Services; and related agencies

• Hospitals don’t need to be JCAHO accredited to operate a day treatment program

•Managed MA plans are required to be nonprofit

•No prior authorization for outpatient MH or SUD (different for medications)

•Applies utilization review requirements to MA and MNCare

•Doesn’t count tax credits, rebates or refunds toward MA asset limits until one year later

Human Services Policy - Chapter 108/SF 4399

Education Policy - Chapter 109/SF 3567

Education Budget - Chapter 115/HF 5237

Commerce Policy - Chapter 114/SF 4097

The final version of the Tenants’ Rights Bill (S.F. 3492)passed the House and Senate and awaits the Governor’s signature. It included NAMI Minnesota’s Right to Emergency Calls provision, which clarified that residential tenants can call 911 in a mental health crisis without being threatened with eviction or other punishments from their landlord. Unfortunately, it did not include source of income protection, a policy that NAMI Minnesota supported. The policy would make it illegal for landlords to reject an applicant because they would pay part or all of their rent with public assistance.

The Minnesota Department of Commerce announced this past week a settlement in the form of a Consent Order with UnitedHealthcare that stemmed from the Department’s examination of UnitedHealthcare Insurance Company. The settlement requires UnitedHealthcare to revamp its policies and procedures to ensure parity in its coverage of mental health care. These changes aim to help remove obstacles and expand access to mental health and substance use disorder care for Minnesotans.

The Consent Order alleges UnitedHealthcare violated Minnesota’s mental health parity laws by evaluating mental health and substance abuse claims more stringently than claims for other types of medical care.

As part of the Consent Order, Commerce imposed a $450,000 fine. A portion of this fine must be paid now, but a portion of it will only be imposed if UnitedHealthcare does not complete the items listed in its corrective action plan. Commerce will continue to monitor UnitedHealthcare for compliance with the Consent Order and the corrective action plan.

“Consumers have the right to access mental health care covered by insurance on par with coverage for other medical care,” Commerce Commissioner Grace Arnold said. “Commerce is committed to protecting consumers, ensuring Minnesotans can access mental health care when they need it, and that every insurance company follows the law.”

State and federal parity laws prohibit health insurers from making it more difficult to obtain care for mental and substance use disorders than for medical and surgical services. The specific allegations against UnitedHealthcare include that the company:

• Did not demonstrate comparability in reimbursement rates between medical/surgical and mental health and substance abuse disorder providers for certain billing codes;

• Did not maintain accurate and complete provider directories;

• Engaged in utilization review practices and procedures that did not document the number of requested and denied days or units or properly document utilization review-related data;

• Did not advise insureds and enrollees in certain situations of their appeal rights for denied days or units;

• Posted prior authorization data on its public website that was untimely or inaccurate; and

• Applied some formulary design restrictions more stringently for mental health prescription drugs.

This is the third, and largest, civil penalty Commerce has assessed against an insurance carrier in the past 12 months related to mental health parity.

“This examination allowed Commerce to assess UnitedHealthcare’s systemic operations and policies for covering mental health and substance use care. I am happy the company has agreed to take steps to address Commerce’s allegations and hope these changes will improve mental health care coverage for its members,” said Commerce Assistant Commissioner of Enforcement Jacqueline Olson.

More information: Commerce’s Consent Order with UnitedHealthcare

Here's an interesting article about funding for the community mental health system.

On Tuesday, the U.S. Department of Health and Human Services (HHS) announced the release of a national strategy with recommendations to address maternal mental health and substance use issues. Published by the Task Force on Maternal Mental Health, a subcommittee of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Advisory Committee for Women’s Services, the strategy focuses on building a national infrastructure that prioritizes perinatal mental health, making services affordable and equitable, using data and research to improve outcomes, and promoting prevention by partnering with communities. The strategy also features several policy recommendations, including enhancing and increasing funding for federal programs serving perinatal populations, such as CCBHCs and Healthy Start. Read the full strategy report here.

Earlier this week, federal prosecutors announced that the State of Rhode Island violated the civil rights of hundreds of children with mental health or developmental disabilities by needlessly holding them inside of Bradley Hospital, an acute-care psychiatric facility, rather than releasing them to their families to receive community-based services.

The investigation spanned January 1, 2017, to September 30, 2022, reports the Associated Press, and found that 527 children under the care of the Department of Children, Youth, and Families (DCYF) were admitted to Bradley, staying far longer than intended. Specifically, prosecutors say the hospital disregarded its legal obligation to provide children mental health services in the most integrated setting appropriate to their needs, detaining them in Bradly for months in many cases, and for more than one year in others. Such stays are far beyond the one to two weeks patients are intended to receive in-patient treatment at Bradley Hospital.

“It is nothing short of appalling that the state has chosen to warehouse children in a psychiatric institution, rather than stepping up to provide the community care, support, and services that these kids need, and that the law requires,” Cunha said, adding that he hopes the investigation will move state to meet its obligations to youth under the law.

In response, Olivia DaRocha, an aide to Rhode Island Gov. Dan McKee, stated, “This troubling report identifies long-standing issues where improvements are clearly needed—issues that are exacerbated by the national shortage of home and community-based behavioral health services.” She says the department will work with federal regulators to find appropriate services for children.

Since November 2022, the state has taken action to fast-track discharges, in collaboration with Bradley and Hasbro Children’s Hospitals. In addition, it launched a Mobile Response and Stabilization Services program that offers on-site, on-demand crisis services to youth right where they are. To date, 90 percent of youth served by the mobile unit did not require hospitalization.