Milestones
2006: As part of Governor Tim Pawlenty’s Mental Health Initiative, over $10 million in funding was
approved to address the shortage of psychiatrists in Minnesota including a 23.7% rate increase for
psychiatrists and other mental health professionals, improve crisis services, track service availability in
real-time, and evaluate outcomes.
Minnesota Department of Human Services: Fast Facts: 2006 Legislative Session, 2006. http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-4809-
ENG
Minnesota Department of Human Services: Governor’s mental health initiative: Comparison of proposed versus final legislation, 2006.
http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_058249.doc
2006: Medicare Part D Implemented
In 2006, national retail prescription drug spending increased as the financing of retail drug purchases
was substantially affected by the implementation of Medicare Part D., reversing a slowing trend that
began in 2000. The shift in the funding of prescription drug purchases resulted in large, one-time
impacts in spending growth rates in 2006, including the fastest increase in Medicare spending since
1981 (18.7 percent), while private health insurance spending grew at its slowest rate since 1997 (5.5
percent), and Medicaid spending declined for the first time (–0.9 percent).
Lower overall rebates from drug manufacturers contributed positively to the growth in prescription drug
spending in 2006. Several factors appear to be influencing this overall effect. First, drug coverage for
people who are dually eligible for Medicaid and Medicare was transferred from Medicaid to Medicare in
2006, as a result of Part D. Under laws enacted in each state, drug manufacturers must provide relatively
substantial rebates to state Medicaid programs. In practice, rebates negotiated by health insurance
plans are generally lower than these mandated levels. Conversely, rebates now exist for some new Part
D enrollees that did not previously have drug coverage. On balance, the reduction in rebates for the
large number of dually eligible beneficiaries appears to have outweighed the increase in rebates for
newly insured enrollees under Part D. Finally, the trend from brand-name prescriptions to generics,
which seldom have rebates; lowered aggregate rebate amounts.
National Health Spending In 2006: A Year Of Change For Prescription Drugs by Aaron Catlin, Cathy Cowan, Micah Hartman, Stephen Heffler,
and the National Health Expenditure Accounts Team [Health Affairs 27, no. 1 (2008): 14–29; 10.1377/hlthaff.27.1.14]
2006: Telemedicine is approved for reimbursement by Medicaid in Minnesota.
2006, State Operated Services’ 16-bed Community Behavorial Health Hospitals (CBHHs) began
operating throughout the state. The hospitals provide community services and also replace inpatient
adult mental health services previously provided at regional treatment centers as part of the redesign of
mental health services in Minnesota.
Minnesota Department of Human Services: Maps of Public Adult Mental Health Providers in Minnesota as of 6/15/2006,
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestRelea
sed&Redirected=true&dDocName=id_059089
2007: 2007 Minnesota Mental Health Initiative Implementation
Over $34 million in net new state funding was approved for community mental health services during
the coming biennium – by far the largest amount of new state money ever appropriated in Minnesota.
Items include:
• requiring foster care training in mental health topics;
• funding respite care;
Milestones – 2010 MN Mental Health System Rpt – Page 1
• assisting providers from cultural communities become mental health professionals;
• targeting dollars for victims of trauma and refugees;
• establishing a training and certification program for peer specialists;
• expanding eligibility for and study of mental health case management;
• clarifying voluntary placement agreements and requiring that data be collected;
• supporting funding for the ACE program;
• requiring a mental health screening in the jails;
• suspending, rather than terminating, benefits when people are in jail for a short time;
• funding that is ongoing for two specific residential programs for homeless individuals experiencing
mental illness;
• funding to expand implementation of children’s and adult evidence-based practices;
• funding voluntary opt-in suicide prevention efforts in the schools such as TeenScreen;
• increasing funding for the extended employment program for people with mental illness;
• authorizes reimbursement for new professional group, licensed professional clinical counselor;
• funding to expand of adult mental health supportive housing options;
• increasing funding for Bridges (state-funded rental subsidies) housing;
• funding for suicide prevention;
• expands funding for crisis intervention services
• continues funding for mental health tracking and outcomes measurement; and
• expands compulsive gambling services, and requires a study of social and economic costs of
compulsive gambling.
2008 Medicare Reform promises equitable co-payments for mental health services
On July 15, 2008, the U.S. House and Senate voted to override President Bush’s veto of H.R. 6331, the
Medicare Improvements for Patients and Providers Act of 2008. While the main focus of the bill was to
assure that scheduled cuts to physician payments were blocked, it also contained several important
protections for beneficiaries.
Currently, Medicare outpatient mental health services require beneficiaries to pay a 50% co-
payment under Part B. Other physician services under Part B require only a 20% co-payment. A phased
reduction in this co-payment for outpatient mental health services begins in 2010. Once the definition of
incurred costs reaches 100%, there is parity.
http://www.nchsd.org/libraryfiles/MedicarePartD/HDA_MedicareBillMultistateSummaryAug08.pdf National Consortium of Health Systems
Development, a project of Health and Disability Advocates, Chicago, IL
2009: Medicare– 21% cut for physician reimbursement, discontinue consultation code reimbursement
On November 11, 2009, The Centers for Medicare and Medicaid Services (CMS) confirmed the planned
21.2% physician payment cut for 2010 in a final rule released earlier.
The rule also finalized a CMS proposal to eliminate Medicare payment for consultations and use the
money from these services to increase payments for visits, including visits bundled into global surgical
services.1
On November 18, 2009, the U.S. House of Representatives passed H.R. 3961, the Medicare
Physician Payment Reform Act, to permanently fix the Sustainable Growth Rate formula causing deep
annual cuts to physician payments under Medicare. H.R. 3961 wipes away the $245 billion "debt" that
has accumulated from years of postponing scheduled cuts in Medicare payments caused by the SGR
formula. The bill blocks the 21.2% cut scheduled for January 1, 2010, and replaces it with a small positive
adjustment while transitioning to a new payment update system that more reasonably adjusts for
annual growth in Medicare costs.2
Milestones – 2010 MN Mental Health System Rpt – Page 2
1 http://www.mmaonline.net/LinkClick.aspx?fileticket=D361qurr6oM%3d&tabid=2208
2 Library of Congress, Thomas; http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h3961:
2008: Legislative Session
“The Minnesota Legislature approved a number of proposals affecting the community mental health
system, including a health reform package. In addition, reductions were made to eliminate a $968
million deficit in the current state biennium, including $219 million in reduction for human services
including Chemical and Mental Health Services administration. The Governor and Legislature
demonstrated continued commitment to the 2007 Mental Health Initiative by exempting mental health
services from some budget cuts.”
2009 Community Mental Health Services Block Grant application
2008: Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) passes extending parity to
Minnesota’s self-insured plans
On October 3, 2008, the President signed the Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA). Key changes made by MHPAEA include the following:
• If a group health plan includes medical/surgical benefits and mental health benefits, the financial
requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits
or days of coverage) that apply to mental health benefits must be no more restrictive than the
predominant financial requirements or treatment limitations that apply to substantially all
medical/surgical benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, the
financial requirements and treatment limitations that apply to substance use disorder benefits must
be no more restrictive than the predominant financial requirements or treatment limitations that
apply to substantially all medical/surgical benefits;
• Mental health benefits and substance use disorder benefits may not be subject to any separate cost
sharing requirements or treatment limitations that only apply to such benefits;
• If a group health plan includes medical/surgical benefits and mental health benefits, and the plan
provides for out of network medical/surgical benefits, it must provide for out of network mental
health benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, and
the plan provides for out of network medical/surgical benefits, it must provide for out of network
substance use disorder benefits;
• Standards for medical necessity determinations and reasons for any denial of benefits relating to
mental health benefits and substance use disorder benefits must be made available upon request to
plan participants;
• The parity requirements for the existing law (regarding annual and lifetime dollar limits) will
continue and will be extended to substance use disorder benefits.
Health Insurance Reform for Consumers, The Mental Health Parity Act,
http://www.cms.hhs.gov/healthinsreformforconsume/04_thementalhealthparityact.asp
2009: MN Legislature requires DHS to transform the MN Mental Health System
• Mental Health Crisis Teams added to 911 Responders
Beginning August 1, 2009, mental health crisis teams were added to the list of emergency 911
responders, where available.
Milestones – 2010 MN Mental Health System Rpt – Page 3
• Unallotment ends General Assistance Medical Care (GAMC). On May 14, 2009, the governor line-
item vetoed the $378,000,000 fiscal year 2011 general fund appropriation for GAMC in the health
and human services finance bill (Laws 2009, ch. 79/H.F. 1362). The fiscal note for the line-item veto
assumes that coverage for GAMC services will need to be terminated April 1, 2010, due to the lag in
provider billing for services and the need to pay program expenditures out of the fiscal year 2010
appropriation. In June 2009, the governor announced that he would reduce the fiscal year 2010
general fund appropriation for GAMC by $15,000,000 through unallotment. DHS projects that the
GAMC program, given this action, will have sufficient funding available to pay for coverage up to
March 1, 2010.1
On November 9, 2009, the Pawlenty administration announced a plan to automatically enroll
28,000 current GAMC recipients in MinnesotaCare for six months with the counties paying their
premiums. The remainder are those whose GAMC eligibility is running out or who already are
applying for MinnesotaCare. Adding these 36,000 persons to MinnesotaCare along with the 20
percent increase in MinnesotaCare enrollments attributed to the economy, is projected to have a
major effect on the health care access fund which is expected run out of funding by April of 2011 as
a result.2
1 Chun R., General Assistance Medical Care Information Brief , Minnesota House of Representatives Research Department, October 2009,
http://74.125.95.132/search?q=cache:fN3lA4vsr8oJ:www.house.leg.state.mn.us/hrd/pubs/gamcib.pdf+general+assistance+medical+care,
+mental+illness&cd=1&hl=en&ct=clnk&gl=us
2 Yee, C, State's poor being shifted to different medical plan, Star Tribune, November 10, 2009.
http://www.startribune.com/politics/state/69627047.html
Coordinated Care Delivery Systems (CCDS) On June 1, 2010 most services* for GAMC clients
began being provided through coordinated care delivery systems (CCDS) available through four Twin
Cities metro-area hospitals: Hennepin County Medical Center, North Memorial Medical Center,
Regions Hospital and University of Minnesota Medical Center-Fairview. Additional hospitals may
establish CCDSs each quarter (September, December, March, etc.). *CCDS Services: Emergency
care, Emergency medical transportation within the 7 county metro area, Inpatient services,
Outpatient services, Clinic services at primary care clinic, Mental health services.
As of August 6, 2010, North Memorial Medical Center no long accepted new patients, followed by
Fairview Health Services on August 27 and Regions Hospital on September 8, leaving Hennepin
County Medical Center as the only CCDS accepting new patients after September 8, 2010.
Milestones – 2010 MN Mental Health System Rpt – Page 4