This was a difficult session for the mental health (MH) community. It is, perhaps, a symptom of the fragmented nature of the MH system that there were so many proposals with potential impact on services and supports for persons living with mental illness (MI). MH services are affected by all the changes to health care eligibility, co-pays and medications, as well as cuts to counties and grant programs. Everyone worked hard to minimize the pain within the difficult budget constraints.

Here is a brief review of information not covered in the previous Access Press:

Day Treatment (Corrected information)

Final legislation does not phase out or eliminate day treatment. Instead it authorizes DHS to achieve similar budget goals through a prior authorization procedure and by substituting other MH rehab services and partial hospitalization.

Child Mental Health.

Overall, mixed results. Therapeutic rehab services (home-based, day treatment, family community support and therapeutic support of foster care) funded by Medical Assistance (MA) were redefined into a more flexible benefit with major components: skills and therapy. New law defines eligible provider entities, certification, staffing, clinical supervision and accountability of providers. The Legislature adopted the governor’s proposal to fund MH screening, follow-up assessment and therapy services for children on welfare and in the juvenile justice systems. Two new metro area subacute crisis residential facilities were approved and funded as an MA service.

Child and Community Services Grant

The Legislature adopted an amended version of the governor’s proposal to consolidate the community social service act grant (CSSA) and 17 child MH grants into one new grant, with a cut of $25 million in ’05. Many provisions deal with accountability, performance targets, provider contracts, funding formulas and service priorities. Generally, counties must spend at least 40 percent of the funds for services to assure the mental health, safety and permanency of children from low-income families. Certain priorities are specified: crisis/emergency services, case management, child protection, etc. This is a very big concern for the MH community because numerous people are not MA-eligible, and many services are not covered by MA. The cuts are scheduled to be restored in ’06-’07.

Prescription Drug Coverage

No prior authorization or co-pay is required for atypical antipsychotic medications if: 1) there is no generic equivalent; and 2) the drug was prescribed prior to 7/1/03; or 3) the drug is part of recipient’s current course of Rx.

Restructuring Adult MH Residential Services

A complex package of reforms will modify some community residential (Rule 36) facilities; other community residential facilities will convert into new housing options. MA will cover intensive residential and non-residential rehabilitative services. To encourage placement in noninstitutional options, the county’s share for certain institutional placements will increase from 10 to 20 percent, effective July 1, 2004.

State Operated Services (SOS)

Policies were changed to encourage community placements and modify services in order to reduce overhead. This was not a proposal to close Regional Treatment Centers (RTCs), but rather to use current law and funding opportunities to further facilitate a natural evolution that would improve supports and care closer to home. Among the strategies is one to blend SOS staff and other resources into community-based systems to expand capacity, utilize staff expertise and strengthen linkage with the broader MH system. DHS must present a specific plan to the Legislature prior to closing an RTC and ensure that there is no overall decrease in services. DHS and unions must abide by the collective bargaining agreements and the 1989 Negotiated Agreement.

Commitment Act Amendments

A person voluntarily participating in treatment is not subject to civil commitment. However, a judge may commit a person who is voluntarily participating in treatment if clinical evidence shows that (s)he is unlikely to continue treatment without commitment. Other changes give nurses more authority to authorize 72-hour holds.

Adult Rehabilitative Mental Heath Services (ARMHS)

Changes to current MA coverage for ARMHS include redefining MH professionals to include unlicensed individuals who are certified as rehab counselors or a psychosocial rehab practitioners, if they have a master’s degree in a related field and 4,000 hours of supervised MH experience. Provider recertification is every three years versus two. Also, a diagnostic assessment completed within the past three years preceding admission is acceptable.

Corrections and Offenders with MI

Alternative placements and treatment in the community can be provided for convicted offenders with MI who are being considered for a prison sentence. Courts can decide to use this option if consistent with public safety and individual needs.

Suicide Prevention Grants

Out of a $1.1 million budget, the suicide prevention grant to community organizations was cut by $123,000/year.

Supported Housing and Managed Care Pilot Project

An additional $500,000 per year will offset other loses for projects that provide integrated, intensive and individualized case management services, employment services, health care, rent subsidies/housing assistance and supportive services to homeless families and individuals.

Commercial Health Insurance

If a state regulated health plan intends to discontinue coverage due to a child’s age, it will be obligated to inform the family that they must provide continuing family coverage for the dependent child after the child becomes an adult, if (s)he is incapable of self-sustaining employment because of a mental illness/disorder.

Chemical Dependency Grants and Rates

The Chemical Dependency Consolidated Fund, Tier III, was eliminated for persons with limited income and assets greater than the MA eligibility limits. Reimbursement rates were decreased 1 percent.

Crisis Services for Children with EBD

School districts are required to improve how they respond to crises with children with EBD (emotional behavioral disorders), increase their graduation rate and learn about warning signs for MI.

For more information, visit: www.mn.nami.org.