Criminal Justice by hedongchenchen

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									                      National Alliance on Mental Illness of Minnesota
                            2010 Minnesota Legislative Session
                                     Summary of Laws
           Affecting Children and Adults with Mental Illnesses and their Families

This session will be remembered more by what did not happen than by what did happen. The
$13 million in cuts to mental health recommended by the Governor and the nearly $50 million
recommended by the House were not adopted. Instead mental health services were cut $11.3
million in the early adopted General Assistance Medical Care (GAMC) reform bill and $4.3
million in the final budget bill (excluding the unallotments). The cuts were reduced only due to
the incredible actions of the mental health community, including NAMI members, who contacted
their legislators and urged them not to vote for these cuts. Your voice, your actions, made a
difference.

The legislature did not pass the education bill which contained a provision that would have
required the Minnesota Department of Education to develop recommendations on curricula that
teaches adolescents about mental illnesses. The legislature and Governor also failed to agree to
use the early opt-in for Medicaid which would have allowed people currently on GAMC to be on
Medical Assistance. This would have ensured access to mental health services and ensured that
mental health providers would be paid for the treatment they provide. A bill that would have
sealed certain juvenile records, allowed certain juvenile convictions to be “set aside” when
applying for a job that requires a background study and required a chemical use screen for
juveniles was passed by the legislature but vetoed by the Governor. A bill that would have
required health plans to cover Applied Behavioral Analysis, set diagnostic standards and clinical
supervision for autism services also did not pass.

It was a difficult session with the state facing an over $900 million deficit and then the Supreme
Court finding that the Governor exceeded his authority when he unalloted $2.7 billion last
summer. While a bit shaken by the session and certainly experiencing millions of dollars of cuts,
the mental health system evaded even more serious cuts. Listed below are the major actions
passed into law this session.

Adult Mental Health
Adult Mental Health Grants
Adult mental health grants were reduced by $5 million for 2010 and an additional $7.704 million
for 2011. More funding had been unalloted by the Governor last summer and the legislature
ratified only a portion of the cuts. Additionally 100% of the grants to develop culturally specific
treatment was eliminated for 2011 for a total of $300,000. The funding for housing with support
services was reduced by $3.3 million for 2010 and funding of $200,000 for crisis intervention
team training for police officers was eliminated for 2010. The adult mental health specialty care
grants were reduced by $800,000. The Commissioner of Human Services is not allowed to
transfer any funding from the mental health grants to state operated services without specific
approval from the legislature. Chapter 1, Special Session and Chapter 200.

Mental Health Counseling to Farm Families
This small program was reduced by $6,000 in 2011. Chapter 215.



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State Operated Services
Last session, the legislature directed the Department of Human Services to redesign the Anoka
Regional Treatment Center in order to bring in more federal dollars. The Department did not do
this, instead embarking on a vision to change all of state operated services. Faced last fall with a
$17 million shortfall State Operated Services and Community Behavioral Health Hospitals that
had less than 75% of their beds occupied, (SOS) looked to closing and changing some of its
programs. This has been a sticking point with NAMI and the rest of the mental health
community who before and during the session called for a place at the table as these decisions
were made. It became a hot topic at the legislature as well.

SOS funding was reduced by $422,000 in 2010, $4,588,000 in 2011, $12,286,000 in fiscal year
2012 and $12,394,000 in fiscal year 2013. Plus they are to save $6,000,000 in 2011 due to
increasing the use of Medical Assistance for many of the state operated services. But they were
also given an additional $8.15 million for 2010 to delay many of the proposed closings and
changes. SOS can now only use funding to do the following:
     transfer the crisis center services in the Mankato area to a community collaborative and
        recruit former state employees of the center.
     maintain the building in Eveleth that currently houses community transition services and
        establish a psychiatric intensive therapeutic foster home as an enterprise activity. The
        commissioner shall request a waiver amendment to allow CADI funding for psychiatric
        intensive therapeutic foster care services provided in the same location and building as
        the community transition services. If the federal government does not approve the waiver
        amendment, the commissioner shall continue to pay the lease for the building out of the
        state-operated services budget until the commissioner of administration subleases the
        space or until the lease expires, and shall establish the psychiatric intensive therapeutic
        foster home at a different site.
     convert the community behavioral health hospitals in Wadena and Willmar to facilities
        that provide more suitable services based on the needs of the community, which may
        include, but are not limited to, psychiatric extensive recovery treatment services. The
        commissioner may also
        establish other community-based services in the Willmar and Wadena areas that deliver
        the appropriate level of care in response to the express needs of the communities. The
        services established under this provision must be staffed by state employees.
     continue the operation of the dental clinics in Brainerd, Cambridge, Faribault,
        Fergus Falls, and Willmar at the same level of care and staffing that was in effect on
        March 1, 2010.
     convert the Minnesota Neurorehabilitation Hospital in Brainerd to a neurocognitive
        psychiatric extensive recovery treatment service; and
     convert the Minnesota extended treatment options (METO) program to community-
        based services provided by state employees.

The commissioner shall notify the chairs and ranking minority members of
the relevant legislative committees regarding the redesign, closure, or relocation of
state-operated services programs. The notification must include the advice of the Chemical
and Mental Health Services Transformation Advisory Task Force. If the closure of a state-
operated facility is proposed, and the department and respective bargaining units fail to arrive at
a mutually agreed upon solution to transfer affected state employees to other state jobs, the


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closure of the facility requires legislative approval. This does not apply to state-operated
enterprise services.

The commissioner can not move beds from the Anoka-Metro Regional Treatment Center to the
psychiatric nursing facility at St. Peter. The task force will also recommend an array of
community-based services in the metro area to transform the current services now provided
to patients at the Anoka-Metro Regional Treatment Center. The community-based services
may be established in partnership with private and public hospital organizations, community
mental health centers and other mental health community services providers, and
community partnerships, and must be staffed by state employees.

The planning for this transition must be completed by October 1, 2010, with a report
detailing the transition plan, services that will be provided, including incorporating peer
specialists where appropriate, the location of the services, and the number of patients that
will be served, to the committee chairs of health and human services by November 30, 2010.
The individuals employed by the community-based services under this section are state
employees. No layoffs shall occur as a result of restructuring under this section. Savings
generated as a result of transitioning patients from the Anoka-Metro Regional Treatment
Center to community-based services may be used to fund supportive housing staffed by
state employees.

There will also be a state-operated services account in the special revenue fund. Revenue
generated by new state-operated services such as intensive residential treatment services, foster
care services, and psychiatric extensive recovery treatment services that are not enterprise
activities must be deposited into the state-operated services account. Chapter 1, Special Session.

Children’s Mental Health
Children’s Mental Health Grants and Services
The specialty grants budget was eliminated for a total loss of $200,000 per year. These grants
were to be used for services such as eating disorder treatments, but these grants had not yet been
awarded. The Youth Assertive Community Treatment Teams (ACT) were delayed another year
until November 2011 for a loss of 2.859 million. There was also some “clean up” language that
gets rid of the requirement that counties determine the appropriate level of care for when
children are hospitalized and that clarifies that some language related to day treatment. Chapter
1, Special Session, Chapter 303 and Chapter 200.

Children’s Psychiatric Hospital in Hennepin County
A 2009 law which allowed Prairie Care to build a 20-bed in-patient psychiatric hospital for
children and adolescents in Hennepin County was changed so that it can be built in the western
2/3rds of the county. Chapter 198

Foster Care
Six months before a foster child’s 18th birthday the local agency is to inform this child (and their
parents or legal guardians if any) of the option of staying in the foster care program until age 21.
Children transitioning out of foster care at age 18 can keep their benefits up until they are 21 if
they are finishing high school, enrolled in college, participating in a vocational program,
employed for at least 80 hours a month, or have a medical condition which prevents them from


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participating in any of these activities. If the child wants to stay in the program then the county
will work to develop an independent living plan with the child and others that lays out the their
needs related to education, employment, vocational and their social or maturational needs.
Jurisdiction over a child in foster care cannot be terminated without first informing the child and
giving them an opportunity to offer their input about whether their benefits are still needed. A
child has the right to attend their own review hearing and he or she should receive a notice of any
motion to dismiss the court’s jurisdiction. This was in rule and now is in statute. A court may
continue to have jurisdiction over a child in foster care until age 21.

Court reviews of foster care placements must be held in court and a child has the right to attend
their own review hearing. This was in rule and now is in statute. A court may continue to have
jurisdiction over a child in foster care until age 21. For all other purposes the child who continues
in foster care after age 18 is treated as an adult.

Youth over age 18 in foster care can keep additional income and resources other than from
supplemental security income if it is needed to complete and carry out their independent living
plan. Foster care benefits now include payments for traditional foster care settings or payments
for a supervised independent living setting. Foster parents or the directors of transitional living
programs are able to approve driver's license applications for children in their care.

Youth who are under state guardianship will receive help from the social services agency to
develop an independent living plan and are eligible for foster care and other counseling services.
Counties must do this regardless of funding. Youth who left foster care while under state
guardianship as dependent or neglected can return to foster care anytime between the ages of 18
and 21.

Child foster care providers can serve people over the age of 18 if they are approved to continue
in foster care up to age 21. Chapter 269 and Chapter 301

Licensing of Children’s Residential Treatment Facilities
The state will not license children’s residential treatment facilities that accept children from other
states without an agreement from the other state (or other entity) to pay for educational and
medical expenses. Chapter 329

Minors Purchasing Car Insurance
An individual under the age of 18 can purchase car insurance on a car they own the same as an
adult. Under the old law, minors had to purchase car insurance through their parent’s policy
which created a barrier for foster children and others for who did not have that option. Chapter
278

Indian Children’s Mental Health
Tribal representatives must be notified of and allowed to participate in county juvenile screening
teams conducting assessments on Indian children and teenagers. In addition, when tribal money
is used to pay for a child’s mental health treatment, the Indian Health Services or tribal health
care facility is responsible for determining the appropriate level of care. The changes are
intended to give tribes more input and control over mental health services for their communities.
Chapter 303



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Parental Fees
Parents whose children with disabilities (including mental illness) under the Medical Assistance
TEFRA program will have their fees increased. The schedule is as follows using gross income:
For income between 100% and 175% of poverty the fee is $4 a month; Incomes between 175%
and 525% of poverty will have a sliding fee ranging from 1% to 8% of adjusted gross income;
Adjusted gross income between 525% and 675% of poverty will have fees of 9.5% of adjusted
gross income; Adjusted income between 675% and 900% will have a sliding fee ranging from
9.5% of adjusted gross income to 12%; Incomes greater than 900% will have a fee of 13.5% of
adjusted gross income but can be reduced by $2400 if the child lives at home and if the child is
in a residential facility the parent also pays the child’s personal needs allowance. So, for example
a family of four with an income of $44,000 a year would be at 200% of poverty and would pay
around $35 a month; a family of four with an income of $115,762 would be at about 525% of
poverty and their fee would be about $900 a month. Chapter 1, Special Session

Criminal Justice
Department of Corrections
The Department of Corrections budget was cut $2.236 million in 2010 and $4.388 in 2011.
However, in balancing their budget they cannot reduce the number of correctional officer
positions or eliminate the offender re-entry programs or discharge planning for offenders with
mental illnesses. They can eliminate treatment beds and make reductions to chemical
dependency programs and educational programs within the prisons. Chapter 215.

Detention of Juveniles
When a young person is under an extended jurisdiction and they violate the conditions of their
stayed sentence or have committed a new offense the court can take him or her into custody. A
new law clarifies that Extended Jurisdiction Juvenile offenders who are younger than 18 can be
held in a secure juvenile facility or if there are no juvenile facilities available they can be held in
an adult facility for a maximum of 24 hours or 6 hours in the metro area, not including weekends
or holidays, as long as they are kept separate from adult inmates. Separate means complete sight
and sound separation. These facilities must be approved by the Commissioner of Corrections.
Extended Jurisdiction Juveniles who are older than 18, can be held in adult facilities without
being separated from other offenders. Extended Jurisdiction Juvenile refers to young offenders
who receive both a juvenile sentence and a stayed adult sentence. Chapter 330

Interstate Compact on Juveniles
Minnesota adopted the Interstate Compact on Juveniles which is an agreement amongst states to
coordinate in locating and returning juveniles from other states who have runaway from home,
escaped from a juvenile detention facility or who have outstanding warrants. Chapter 378

Jail Inmates Charged for Room and Board
Counties can already require people convicted of a crime to pay for the cost of their room, board,
clothing, medical, dental or other correctional services. Now, any person who receives credit
towards their sentence for time served in a county or regional jail may be also be assessed for the
costs of the time they served. Chapter 318

Public Defenders




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The public defenders’ office funding was reduced $591,000 in 2010 and $1.3 million in 2011.
These cuts, on top of the ones made last year, will certainly have an impact on their ability to
meet the need for public defenders. Chapter 215.

Sentencing to Service
County boards can charge an offender who participates in sentencing to service and may assess a
fee to entities that directly benefit from these work crews. Chapter 215.

Early Childhood, Education and Special Education
Charter Schools Developmental Screenings
Charter schools that elect to perform developmental screenings must abide by the standards
already in law and inform parents when they apply for admission that their child might be
screened. Chapter 346

Early Childhood
The State Advisory Council on Early Childhood Education and Care will create a task force with
members from the legislature; county human services; departments of education, health and
human services; a local public health agency; a school district; and two nonprofits that support
early childhood education. The task force will develop recommendations on how to consolidate
funding streams, create a seamless transition from early childhood programs to kindergarten,
encourage family choice, provide consumer education, advance the quality, develop a seamless
delivery system, ensure collaboration between early childhood mental health programs and child
welfare and the Office of Early Learning, and be sensitive to a family’s values and cultural
heritage. Chapter 346

Mental Health Emergencies at Colleges
The new law clarified that when a student attending a college or university has a mental health
crisis - such as a psychotic episode, suicide attempt, or psychiatric hospitalization – his or her
parents can be notified just as they would if the student experienced any other type of medical
emergency. The new law is consistent with federal regulations and has no impact on access to
medical records. An educational agency or institution may disclose personally identifiable
information from an education record to appropriate parties, including parents of an eligible
student, in connection with an emergency if knowledge of the information is necessary to protect
the health or safety of the student or other individuals. It received the unanimous support of local
colleges and universities. This was a NAMI bill. Chapter 230

Mistreatment in Schools
The Commissioner of Education must inform parents within ten days if their child is the subject
of an investigation into allegations of mistreatment at school. Prior to the passage of this law,
there was no legal requirement for parents to be notified that investigations involving their
children were being conducted. Chapter 276

Possession of Weapons in Schools
The maximum penalty for possessing a weapon on school property has been raised from two
years in prison and/or a $5,000 fine to five years in prison and/or a $10,000 fine. Brandishing a
replica or BB gun in school is now a gross misdemeanor, while simply possessing a replica or
BB gun in school is now only a misdemeanor. Chapter 268


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Employment
Centers for Independent Living
The Centers for Independent Living had their budget cut by $71,000 in 2010 and $119,000 in
2011. Chapter 215

Extended Employment for People with a Serious Mental Illness (EE-SMI)
Minnesota’s EE-SMI Projects is a highly successful legislative funded program that provides
individualized support and ongoing assistance to individuals with serious mental illnesses so that
they can manage their illness, maintain employment and advance their careers. This program
was cut by $41,000 is cut in 2010 and $48,000 in 2011. In 2011, the program will lose one
service provider but no grants will be reduced, thanks to the availability of previously unspent
money. However, in 2012 the program will face a deficit and programs will be cut.
The regular Extended Employment program will be cut $22,000 in 2010 and $375,000 in 2011.
Chapter 215. Additional funding was cut by $11,000 each year for administrative expenses to the
program. Chapter 1, Special Session.

State Contracts with Extended Employment Programs
In the past, the Commissioner of Administration only had to ensure that a portion of janitorial
services contracts had to go to state rehabilitation programs and extended employment providers.
Under this new law, 19 percent of state contracts for janitorial, document imaging and shredding,
and mail collection services must be awarded to providers offering extended employment and
rehabilitation programs that employ people with disabilities. Chapter 266

Health Care
CADI Waivers
CADI waivers (Community Alternatives to Disabled Individuals), which are used by many
people with mental illnesses, will be harder to obtain. The number of waivers available each
month was reduced to 60. Chapter 1, Special Session.

Chemical Dependency
More detail was added to the law passed last year that allowed for Chemical Dependency Pilot
Projects developed last year. These projects are designed to provide services and supports
beyond treatment for a person’s addiction and include peer support, family engagement,
supported housing and employment, as well as independent living skills. Chapter 376. Rates will
also be reduced by 5% for CD providers who are above the statewide average and 1.8% for those
who are below the average. State operated CD services were exempted from these reductions.
Chapter 1, Special Session. CD providers that have a license from the Tribe but are not located
on the reservation can now access state and federal funding which will increase access to
culturally specific services. Chapter 303.

Co-payments
Co-payments are reduced from $6 for nonemergency visits to an emergency room to $3.50 under
Medical Assistance and MinnesotaCare effective January 1, 2011. Chapter 1, Special Session




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Community Health Workers
Last year legislation passed allowing community health workers to be supervised by some
mental health professionals. These workers provide health education and can often bridge the
divide between specific cultural communities and mental health services. These workers will
now be able to be supervised by all licensed mental health professionals, including licensed
professional clinical counselors. Chapter 303.

Drug Formulary Committee
The Drug Formulary Committee will now meet just twice a year instead of quarterly. The
committee which is made up of consumers, pharmacists, and health care professionals, is tasked
with reviewing and recommending which drugs should be included under the state’s Medical
Assistance program. Chapter 310

Federal Health Care Bill
The Department of Human Services is directed to apply for any of the new federal health
care reform demonstration projects included in the new federal health care reform bill
including one that would allow Medicaid funds to be used for “IMDs” or “institutes for
mental disease” that are not state operated. IMDs are facilities that have more than 16 beds.
Additionally the Commissioners of Commerce, Health and Human Services are directed to
apply for planning grants to look at the health benefit exchanges (which allow single
coverage and small businesses coverage to find lower cost health insurance) and determine
if it would be beneficial to create this option soon for Minnesotans. Chapter 1, Special
Session.

General Assistance Medical Care
Last year the Governor vetoed the second year of funding for the GAMC program. The
legislature created a new program and it passed with bipartisan support only to be vetoed by the
Governor. A second bill passed with only about a third of the funding. General Assistance
Medical Care (GAMC) will essential go away on July 1. Instead, people who would have
qualified for GAMC will go to a “Coordinated Care Delivery System” (CCDS) to receive their
care, except that their outpatient prescriptions will be obtained separately. These systems are
essentially hospitals, however, only four have agreed to participate and they are all in the metro
area. People can seek help from any hospital until March 1, 2011 and those hospitals will have
access to an uncompensated care pool or can become a CCDS in September. GAMC is an
important program for the mental health community because about 70% of the people on the
program have a mental illness or chemical dependency or both and many mental health centers,
crisis teams and Intensive Residential Treatment Services served people on GAMC – between 10
and 50%. GAMC paid about $10 million for adult mental health services including Adult
Rehabilitation Mental Health Services, Intensive Residential Treatment Services and Assertive
Community Treatment Teams. NAMI believes all this and more will be lost to mental health
providers. Chapter 200 and Chapter 1, Special Session.

Health Care Demonstration Projects
The Commissioner of Human Services will develop and authorize a demonstration project to test
alternative and innovative health care delivery systems, including accountable care organizations
that provide services to a specified patient population for an agreed upon total cost of care or
risk-gain sharing payment arrangement. The Commissioner can establish a specific pilot in



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Ramsey or Hennepin Counties and may cap the number of enrollees in the project. Chapter 1,
Special Session.

Health Care Disparities
The commissioners of health and human services shall conduct an inventory on the health -
related data collected by each respective department including, health care programs and
activities, vital statistics, disease surveillance registries and screenings, and health outcome
measurements.

The inventory must review the categories of data that are collected, describe the methods of
collecting, organizing, and reporting data relating to race, ethnicity, country of origin,
primary language, tribal enrollment status, and socioeconomic status, and specify
whether the data being collected in these categories is currently required.

Once the information is collected the commissioners shall consult with representatives of
culturally based community groups, community health boards, tribal governments,
hospitals, and health plan companies to review the compiled inventory and make
recommendations on: (1) whether the data currently being collected is sufficient to identify
and describe health disparities for particular communities or if the collection of additional
types and categories of data is necessary in order to better identify health disparities and to
facilitate efforts to reduce these disparities; (2) if additional types and categories of data
collection is determined necessary, what additional types and categories should be collected
and in what areas; (3) whether there is a need to aggregate data to make data more
accessible to community groups, researchers, and to the legislature; and (4) other ways to
improve data collection efforts in order to ensure the collection of high-quality, reliable data
that will ensure accurate research and the ability to create measurable program outcomes in
order to facilitate public policy decisions regarding the elimination of health disparities.

By January 15, 2011, the commissioners of health and human services shall submit a report
to the chairs and ranking minority members of the legislative committees and divisions with
jurisdiction over health and human services. Chapter 1, Special Session.

Health Care Homes
Health care homes will be covered under Medical Assistance and will be implemented in
Minnesota as required under the new federal health reform bill. People eligible for health
care homes must have either a) two chronic conditions; b) one chronic condition and at risk
of a second chronic condition; or c) one serious and persistent mental health condition.
Services include comprehensive care management, care coordination and health promotion,
transitional care (including follow-up from inpatient care), patient and family support,
referral to community and social support services, and use of health information techn ology.
Health care teams may include mental health professionals. Chapter 1, Special Session.

Health Care Provider Cuts
There were a number of cuts made to the reimbursement amounts for a number of health care
providers. Physician services under Medical Assistance (MA) and General Assistance Medical
Care (GAMC) were reduced and basic care services were reduced by 4.5% (excluding mental
health services). The rates were also brought down to the rates paid under Medicare. It’s
important to note the reimbursements to psychiatrists and advanced practice mental health nurses


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were not reduced nor were other mental health services. The rates paid under Medicare for
mental health services have been historically low due to discriminatory provisions under
Medicare. If mental health services had not been exempted, it would have been catastrophic to
many providers. Chapter 1, Special Session.

High-Risk Pools
Minnesota has a high risk pool called Minnesota Comprehensive Health Insurance
Association. Included in the federal health care reform bill is a high risk pool option as well.
The legislature passed language making sure that these efforts are coordinated. Chapter 1,
Special Session.

Income Eligibility
The state will be using the most updated federal poverty guidelines from the federal government,
for Medical Assistance and MinnesotaCare, however, the income standards cannot go below the
guidelines that were in effect on July 1, 2009. Chapter 310

Language Interpreters
Medical Assistance pays for face-to-face oral language interpreter services only if the interpreter
is listed under the state’s registry. Chapter 1, Special Session

Medical Assistance
The current or next governor is given the authority to apply to the federal government to expand
Medical Assistance (Medicaid) to adults without children who are between the ages of 21 and
65, are not pregnant and are not determined to be disabled. These individuals would have to have
incomes under 75% of the poverty guidelines (roughly $8000 a year) which is the current
General Assistance Medical Care guideline, and there would not have any asset limits. NAMI
was disappointed that this was not authorized right away as a way to ensure access to mental
health care for people currently on GAMC. Chapter 1 Special Session

Medical Assistance for Employed People with Disabilities
The premiums for this program did not go up nor was it extended to people who are age 65 or
older. However, people will receive a notice two years prior to turning 65, informing them of the
Medical Assistance guidelines for including a spouse’s income and assets once the individual
turns 65. Chapter 1, Special Session.

Medication Management
If there is no pharmacist qualified to provide medication management within a reasonable
geographic distance then it can be provided through two-way interactive video but the patient
must be at an approved setting and not at his or her home. Chapter 1, Special Session

Minnesota Comprehensive Health Association (MCHA)
The MCHA can now exclude coverage of mental health services in a residential treatment
program located out of Minnesota unless the treatment is medically necessary and it is
unavailable in Minnesota and the person has been referred for treatment by a licensed medical
practitioner in Minnesota. NAMI was concerned with this language, particularly how it might
impact people who receive treatment in a bordering state. NAMI worked with the MCHA and
have their word that they won’t unnecessarily restrict access. People should let NAMI know if
they have problems under this new section. Chapter 363


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Personal Care Assistance
Personal Care Attendants will not be allowed to work more than 275 hours per month. Chapter 1,
Special Session. Extended PCA services are defined to include when assistance is needed
periodically but less than daily or more services are needed than authorized by the state. Children
can get help with their activities of daily living if immediate attention is needed for health or
hygiene reasons.

The need for help with daily living was changed to recognize that some activities don’t happen
daily but perhaps on a certain day of the week. The standardized training of personal care
attendants must be provided in a language other than English and accommodations must be made
due to a disability. A PCA agency cannot require an employee to sign a “do not compete”
agreement not to work with any particular PCA recipient or for another agency after leaving the
agency. When someone appeals changes to their PCA services, the department must continue to
provide services at the same level until the appeal process is completed. Chapter 352

Reduced Emergency Room Use
Managed care plans for Medical Assistance and MinnesotaCare will have a financial incentive to
reduce the unnecessary use of emergency rooms. Chapter 1, Special Session.

Small Group Health Insurance Market Working Group
A working group consisting of representatives from health plans, the business community, and
the state legislature will be exploring the impact of expanding Minnesota’s small group
insurance market from groups of 50 or fewer employers to groups of 100 or fewer employers.
The working group will study the effect on insurance premiums, the potential costs to providers,
insurance plans, and businesses as well as how to most efficiently implement an expansion. The
group will begin its work no later than August 1, 2010 and finish by June 30, 2011. NAMI is
always concerned that these types of groups will look to reduce mental health benefits or restrict
mental health parity laws to only large employers. Chapter 370

State Medical Review Teams
Appeals to the State Medical Review Teams (SMRT) about determination of disability must be
decided within 90 days or be immediately reviewed by the chief appeals referee. The SMRT
teams review people’s medical records to decide whether they meet the disability requirements
of the Social Security Administration (SSA) in order to quality for Medical Assistance because
applications to SSA take so long. Additionally, the SMRT must report to the legislature on a
yearly basis and include information such as the length of time between when a person requests
an appeal and a decision is made. Chapter 261

Substitution of Epilepsy Drugs
If the Federal Food and Drug Administration determines that substituting certain epilepsy and
seizure medication would be harmful to patients, the Board of Pharmacy will adopt the FDA
standard for handling these situations. If the changes would increase costs to the state the board
must report this to the ranking members of the House and Senate Health and Human Services
Finance committees. Chapter 289




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Therapies
Prior authorization will required for physical therapy, speech language pathology, audiology and
occupational therapy beyond certain thresholds. Chiropractic services are limited to 12 visits per
year and one annual evaluation. Chapter 1, Special Session

Housing
Centers for Independent Living
The Centers for Independent living had their overall budget reduced by $190,000 over the next
two years. The centers provide services for Minnesotans with disabilities including information
and referral, independent living skills training, peer counseling and advocacy. Chapter 215

Group Residential Housing
The Group Residential Housing (GRH) supplemental service rate was reduced by 5%, but this
excludes any GRH facility that is also licensed as a nursing home. Chapter 1, special session.

Legal
Civil Commitment
Minor technical changes were made to civil commitment law making it easier to get
documentation where it needs to go. Documents related to civil commitment can now be
considered “under oath” without being notarized as long as the person signing the document
provides a statement confirming its accuracy and an address and phone number where they can
be reached. Furthermore, signatures can be provided electronically as long as security and
authentication standards are met. Chapter 220

The new law clarifies that the county where a person resided when he or she was civilly
committed will be considered the “county of financial responsibility” and will be the default
venue for court proceedings, petitions, and will be the county responsible for coordinating
continuing care after release. It clarifies that the county where the proposed patient resides is
primarily responsible to do pre-petition screening and file a commitment petition, although the
county where the patient is present can do so as a last resort. The new law also clarifies that
“residence” for this purpose is determined under chapter 256G, the statute that generally applies
to determining residence and financial responsibility for social services programs. It clarifies
that, for the purpose of allowing a petition to be filed, a court should accept a county’s
determination that it is the county of residence

Under the previous law it was unclear which county was responsible for individuals committed
in a county other than the one they lived in before commitment. Any disputes will be decided
according to Chapter 256G. This bill is not intended to change existing practice, but is intended
to clarify it so that the courts and counties will be on the same page and so that patients, their
families and hospitals won’t be bounced from one county to another when they’re confronted
with a mental health crisis and are trying to negotiate the commitment process within very tight
statutory timelines. Chapter 357

Guardian Ad Litem Board
An independent board will be created by October 1, 2010 to oversee guardian ad litem services
across Minnesota which advocate for the best interests of children and incompetent adults in
court cases. The board will have the power to set policies regarding standards and training, and


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propose policy reforms. The board will consist of seven members, three appointed by the
Supreme Court and four appointed by the Governor. The members must include at least one
person with guardian ad litem experience, two practicing attorneys and one member of the
general public. Guardian ad litem services used to be under the direct jurisdiction of the courts
and this new independent board helps address concerns over conflicts of interest. Chapter 309

Health Care Agents and Guardians
A series of changes was made to the powers of health care governing agents and guardians for
wards and protected persons. Courts may now declare a person’s health care directive
unenforceable if they determine the directive was executed through fraud or coercion. Under the
old law the guardian was responsible for this, creating a serious conflict of interest.

The “Bill of Rights for Wards and Protected Persons” was expanded to allow wards and
protected persons to execute health care directives if that power has not been delegated to a
guardian or health care agent. If someone had a health care agent’s and then the court grants a
guardian the power to make medical decisions, then the agent’s power to make health care
decisions is suspended, unless there is a court order.

Health care agents charged with managing a ward’s medical care are responsible for handling
what happens with the ward’s remains after they die, including issues around organ donation.
Individuals applying to be a guardian must include information about whether they have ever
been removed for cause as a guardian and if so provide the relevant court documents. If the
applicant is a professional guardian they must also provide a summary of their educational
background, work history and other experience. Chapter 254

Mental Health Care
Case Management
The Department of Human Services will be updating their report on case management from 2007
for people with disabilities. They need to come back next session with recommendations on how
to define the administrative and service functions of case management including how to improve
funding of the administrative functioning; how to standardize and simplify processes, standards
and timelines; how to increase opportunities for consumer choice. Chapter 352.

CCSA Funding
The Children and Community Services Block grant, which funds mental health services for both
children and adults (22% of the funding is used for mental health care) was cut by $16.9 million
in 2010, $18.2 million in 2011 and $6.4 million in the next biennium. Chapter 1, Special Session

Chemical and Mental Health Services Transformation Advisory Task Force
The Department of Human Services has to form the Chemical and Mental Health Services
Transformation Advisory Task Force which will make recommendations on the continuum of
services needed to provide individuals with complex conditions including mental illness,
chemical dependency, traumatic brain injury, and developmental disabilities access to quality
care and appropriate levels of care across the state to promote wellness, reduce cost, and
improve efficiency. Their recommendations to the commissioner and the legislature are due
no later than December 15, 2010, on the following:




                                                13
(1) transformation needed to improve service delivery and provide a continuum of
care, such as transition of current facilities, closure of current facilities, or the development
of new models of care, including the redesign of the Anoka-Metro Regional Treatment
Center;
(2) gaps and barriers to accessing quality care, system inefficiencies, and cost
pressures;
(3) services that are best provided by the state and those that are best provided
in the community;
(4) an implementation plan to achieve integrated service delivery across the public,
private, and nonprofit sectors;
(5) an implementation plan to ensure that individuals with complex chemical and
mental health needs receive the appropriate level of care to achieve recovery and wellness;
and
(6) financing mechanisms that include all possible revenue sources to maximize
federal funding and promote cost efficiencies and sustainability.

Membership on the advisory task force includes the following:
   the commissioner of human services or the commissioner's designee, and two
     additional representatives from the department;
   two legislators appointed by the speaker of the house, one from each party;
   two legislators appointed by the senate rules committee, one from each party;
   one representative appointed by AFSCME Council 5;
   one representative appointed by the ombudsman for mental health and developmental
     disabilities;
   one representative appointed by the Minnesota Association of Professional Employees;
   one representative appointed by the Minnesota Hospital Association; (8) one
     representative appointed by the Minnesota Nurses Association;
   one representative appointed by NAMI-MN;
   one representative appointed by the Mental Health Association of Minnesota;
   one representative appointed by the Minnesota Association of Community Mental Health
     Programs;
   one representative appointed by the Minnesota Dental Association;
   three clients or client family members representing different populations receiving
     services from state-operated services, who are appointed by the commissioner;
   one representative appointed by the chair of the state-operated services governing board;
   one representative appointed by the Minnesota Disability Law Center;
   one representative appointed by the Consumer Survivor Network;
   one representative appointed by the Association of Residential Resources in Minnesota;
   one representative appointed by the Minnesota Council of Child Caring Agencies;
   one representative appointed by the Association of Minnesota Counties; and
   one representative appointed by the Minnesota Pharmacists Association.

The commissioner may appoint additional members to reflect stakeholders who are not
represented above. Chapter 1, Special Session




                                                  14
Continuing Education Exemptions for Licensed Professionals
Minor changes were made to licensure requirements for professional clinical counselors.
Licensed professional clinical counselors who are applying for relicensure and who have
successfully completed at least 12 hours of post-graduate education are no longer required to
take an additional 40 hours professional continuing education to have their license reapproved.
Those who have had their licenses cancelled will still need to meet these requirements. Chapter
248

Diagnostic Assessment Payment Rates
The Commissioner of Human Services will be establishing three-levels of reimbursement rates to
providers for conducting mental health diagnostic assessments based on the complexity of the
individual beginning January 2011. Chapter 303

Mental Health Urgent Care
As a way to save money in the GAMC reform bill, the legislature added mental health urgent
care and psychiatric consultation as part of the redesign of the six community-based behavioral
hospitals and the Anoka Regional Treatment Center. This new service was not to duplicate what
already existed in the different regions of the state.

Urgent care can include screening, mobile crisis and assessment, rapid access to psychiatry,
crisis beds, and health care navigator services. Psychiatric consultation includes consultation to
primary care practitioners and the state can develop collaborative psychiatric consultation where
a team of mental health professionals can be used to help emergency rooms and other
community providers, technology can be used, triage level assessments can be done and
evidence-based treatments are promoted. Rapid access would only be for those individuals who
are at risk of being hospitalized or otherwise unable to receive timely services and may be
provided by interactive video. This would be phased in beginning with adults in Hennepin and
Ramsey Counties and children statewide.

Additionally, the state will appoint an interdisciplinary work group to establish appropriate
medication and psychotherapy protocols to guide the consultative process and to provide advice
to the Drug Utilization Review Board on the use of antipsychotic and ADHD medications for
children and when a collaborative psychiatric consultation should be required. Effective July 1,
2011 prior authorization will be required along with consultations when these prescriptions fall
outside of the recommended dosages. If a child has already been stabilized on the medications or
the precriber indicates that the child is in crisis then the medication can be paid for. Chapter 200

Psychologist Licensure
Retired psychologists who are or were licensed to practice in Minnesota may apply to become
volunteer providers. They must still meet all the same professional and educational requirements
as they did when they were licensed and must work pro-bono. They will only have to pay fifty
percent of the normal fees to be licensed.

Psychologists licensed in another state, who have at least five years of experience, have a Ph.D.,
and successfully complete a professional responsibility examination, can be licensed to practice
in Minnesota. Psychologists, who are licensed to practice in another state, can also apply for
guest licensure to practice in Minnesota while their application is being processed. The guest



                                                 15
license is valid for one year or until the board of psychology makes a decision about their
Minnesota license, whichever comes first.

A doctoral level psychologist can conduct a peer review when there has been a denial for mental
health or substance abuse services, however, they cannot review any request or final
determination if the treating provider is a psychiatrist. Chapter 199

Veterans
Homelessness
$100,000 was appropriated to the Minnesota Assistance Council for Veterans to provide help to
veterans and their families who are homeless or who are in danger of becoming homeless. The
funds can pay for housing, utilities, employment and legal assistance. Chapter 215.

Support our Troops
The funds from the Support our Troops account can now also be used for providing services to
veterans and their families. Chapter 215

Other
Runaways
Under the Child Protection laws, a police officer who takes a runaway child into custody is
allowed to take the child to his or her home, a relative’s home or another safe place, including a
shelter care facility. Chapter 281

Commissioner of Human Services Customer Satisfaction
The Commissioner of Human Services must provide an annual report to the Governor and
legislative committee chairs about complaints made to the department and how successful they
have been in addressing complaints. This will help track how well the Department of Human
Services has been at providing services and provide a clearer picture of where improvements
might be needed. Chapter 329

Food Stamps
Food stamp eligibility will be based on income only, not other assets that a person may have
such as a car. Chapter 1, Special Session.

Government Collaboration
The legislature established a collaborative governance council that includes major statewide
governmental entities and nongovernmental statewide organizations representing cities,
counties, school districts, unions and the Chamber of Commerce. The council is to develop
recommendations on changes needed in law or rule that prevent collab oration, how
collaboration can be used to improve the delivery of services, how technology can be better
used, how to modernize financial transactions and model joint powers agreements. Chapter
319.

Harming Service Animals
Anyone who harms a service animal or hurts it enough for it to be unable to perform its duties is
required to pay restitution covering the cost of the animal’s care, lost wages by the animal’s user,
transportation, any temporary replacement services and any permanent replacement or retraining


                                                16
costs. Services animals provide invaluable assistance to individuals with disabilities and the loss
of such an animal can have a devastating impact. Chapter 292

Ladder Out of Poverty Task Force
A task force comprised of representatives from the legislature, the department of commerce, the
attorney general’s office, financial institutions, religious, community and social service
organizations and members of the public will explore the issue of poverty in Minnesota. The task
force will specifically address how to offer low-income Minnesotans an opportunity to acquire
assets and build wealth, eliminate predatory financial practices, expand culturally specific
development programs, and increase literacy and community engagement. The task force will
provide its recommendations to the legislature by June 1, 2012. Chapter 374

Maintenance of Effort
Since local government aid was reduced, this will have an impact on the Maintenance of Effort
(MOE) provisions. MOE requires counties to continue or maintain their funding of mental health
services at certain levels. These levels can be reduced when their state funding is reduced.
Chapter 1, Special Session.

Property Tax Refunds
The property tax refund amount was decreased by over $50 million. The refund is a way to pick
up the amount of property taxes that are passed on through increased rents so that rents are still
affordable for low income people. This means that many low income people who receive a
refund will see a smaller refund this year. The percentage that is used to calculate it went from
19% to 15%. Chapter 1, Special Session.

May 26, 2010


                                         NAMI Minnesota
                                    800 Transfer Road, Suite 31
                                        St. Paul, MN 55114
                                        www.namihelps.org
                               1-888-NAMI-HELPS or 651-645-2948




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