Executive Director Ed Eide has been traveling the state, talking with LAC groups about how they can be a part of improving mental health services in Minnesota.

One of the question he’s been hearing a lot is: What will happen to services in the SOS redesign? He’s taken what he’s heard from LAC meetings in Hennepin, Dakota, Watonwan and Sherburne counties and other consumers and made sure you are being heard at the Capitol.

SOS is just one part of the picture for mental health services, but it represents the challenges we face.  Cuts are being made without transparency or consumer support.  We don’t have a lot of faith that the new SOS system will function better for patients.

Listen to Ed’s testimony here: look for the meeting of the Finance Health and Human Services Budget Division on March 23rd.  He testifies first at the beginning of the meeting.

Ed will be heading to Faribault tomorrow to work with the Rice County LAC meeting.  To learn how MHAM can help your LAC group become a better place for consumers to be heard, or if you have a personal story about SOS that would help the Legislature understand what is at stake in the redesign, please call Ed at 612-331-1630.  We’ll have more updates after he appears before the Health Care and Human Services Policy and Oversight Committee in the House on Thursday.

This was the question Sen. Sheran asked yesterday at the SOS presentation on their redesign.  The Department of Human Services (DHS) released its report and presented at Tuesdays Senate hearings in regard to their redesign of State Operated Services (SOS). The following are key changes to take place over the next fifteen months:

• Level 1 psychiatric care centers in each region of the state. These centers will provide the highest level of care for individuals with the greatest acuity and complexity and will involve 24 hours of staffed psychiatric coverage such as that now provided by Hennepin County Medical Center, Regions Hospital and the University of Minnesota Medical Center-Fairview, in the metro region. Level 2 inpatient psychiatric care centers, which provide a lower level of care, and Psychiatric Extensive Recovery Treatment Services (PERTS) will also be developed.
• A new 24-hour psychiatric access service. This service will provide consultation to emergency departments, primary care clinics, mobile crisis teams, jails and other mental health providers. Comprehensive assessments, triage services and referrals to appropriate levels of care will be provided. The access service will also include a new psychiatric emergency transportation system to be developed in consultation with consumers, family members, advocates, law enforcement, providers and other stakeholders.
• A partnership process to involve service providers. Through this process, hospitals, mental health centers, primary care centers and state-operated facilities in regions of Minnesota can collaborate to respond to state requests for proposals for Level 1 and 2 psychiatric care services and PERTS appropriate to the needs of their areas.
• Permanent closure of the Community Behavioral Health Hospital-Cold Spring, which has not been operating since October 2009.
• Closure of the 10-bed Mankato Crisis Center, with those crisis services transferred to nearby Community Behavioral Health Hospital-St. Peter.
• Closure of the state-operated adult mental health residential facility in Eveleth, to be replaced by a new adult therapeutic transitional foster care facility in northeastern Minnesota.
• Replace community transition beds with a new adult therapeutic transitional foster care facility in northeastern Minnesota in order to close the state-operated adult mental health recovery facility in Eveleth.
• Transition of state-operated dental services for people with disabilities to another model of service partnered with community providers.
• Transition of one unit at Anoka-Metro Regional Treatment Center to a state-operated psychiatric nursing facility in St. Peter. A partnership process would be started for operation of the remaining units at the Anoka facility.
• Launch of the psychiatric access service to replace the current centralized admission process to State Operated Services facilities. And establish a 24 hour psychiatric access service.
• Temporary conversion of community behavioral health hospitals in Willmar and Wadena to Psychiatric Extensive Recovery Treatment Services (PERTS). Regional stakeholders would be asked to partner to respond to a request for proposals for psychiatric facilities with levels of care matching the region’s needs.
• Conversion of Minnesota Neurorehabilitation Services in Brainerd to a 16-bed neurocognitive psychiatric extensive recovery treatment facility and additional adult therapeutic transitional foster care facilities.
• Conversion of Minnesota Extended Treatment Options in Cambridge to a 16-bed neurocognitive psychiatric extensive recovery treatment facility and additional adult therapeutic transitional foster care facilities.
• Conversion of Child and Adolescent Behavioral Health Services in Willmar to two child and adolescent psychiatric extensive recovery treatment facilities in Willmar and Bemidji.

Some questions needing to be answered about this redesign:

• When the Mental Health Initiative passed in 2007, it was the largest investment of new dollars into Minnesota’s mental health system in our history – $34 million. How can we cut half of that money and not have a negative impact?
• What are Psychiatric Extensive Recovery Treatment Services (PERTS)? Who will be using them? How will they be different than IRTS?
• Where is $17million in cuts actually coming from? • Where is the actual substance of the plan and when will we see it?
• What are the consequences and outcomes of this plan? How will it be evaluated?
• Where is the money for the new level 1 hospitals, PERTS and transportation coming from?
• Where are details on the Anoka redesign?
• How will this benefit people with mental illness?
• Where are the five regions and who will decide?
• What are the impacts of layoffs?
• What was the timeline on the decision to close and reorganize facilities?
• How does this plan fit with the needs, priorities, and goals of the community?
• How can we make this massive transition in 15 months?
• Where is the actual transformation?
• How does this relate to the intensive needs report?
• How will the 24 hour psychiatric services function?

There were many questions from members of the committee and I’m sure more to come on Friday March 19th when the presentation continues in Sen. Berglin’s committee.

That appears to be the question asked this past week at the Legislature.  In order to provide health care to the poorest Minnesotan’s, hospitals will have to develop a Coordinated Care Organization (CCO) for their GAMC patients.  GAMC recipients will have to learn to go to clinics instead of the emergency room.  Their health care will be “coordinated” in order to improve their health.  Can this system of health care work well with the homeless population once the new program begins in June?

There will be two levels of hospitals in this bill.  Level one are those who currently serve a substantial number of GAMC patients (approximately 17).  These hospitals will receive a lump sum reimbursement determined by the hospital’s recent share of GAMC business.  Currently level one hospitals serve 80 % of the GAMC patients.

The second level serves the other 20%.  They would receive funding for serving GAMC patients through an uncompensated care pool of $20 million for six months (June to November 2010) and then could become a CCO.

There are some positives with this new plan:

• Current GAMC recipients will be automatically eligible with no transition.
• It preserves access and affordability of prescription drugs.
• It preserves the Health Care Access Fund (HCFA).

Here are some questions and concerns to be alert to:

• What are the type of services to be offered?
• Will they be different depending on the CCO?
• Will hospitals opt in or out?

Part of the funding is taken from the Adult Mental Health grants to counties.  What services at the county level will be cut or eliminated? MHAM’s view of the GAMC funding bill is that it maintains a level of health care for our poorest Minnesotans.  But what will be lost in other mental health services provided at the local level with the shifting of dollars throughout the system?

State Operated System (SOS) Redesign

DHS has released their SOS redesign.  Here are some brief highlights:

• There will be Level 1 psychiatric care centers in regions of the state.
• There will be a new 24 hour psychiatric access service
• There will be a partnership process to involve service providers.
• Closure of the Mankato Crisis Center and transfer to St. Peter.
• Closure of the adult mental health residential facility in Eveleth.
• The development of Psychiatric Extensive Recovery Treatment Services (PERTS).

As we mentioned before, there is more to information to come and many more questions.  We will provide additional information on Wed. March 17^th following a presentation at Sen. Berglin’s committee Tuesday morning.

As many of you know, State Operated Services has been up for redesign.  In our 2010 Legislative report, the Mental Health Legislative Network asked that whatever plan came out of that process be judged on how well it reflected the input of consumers and advocates.  We believe that the people who are most affected by services changes and cuts are the people who are currently using those services.

Now that the report is out, we are greatly disappointed.  We were aware that with the budget cut, SOS was going to reduce services and we had made some recommendations as to what we thought could be done.  However, the deeper issue is that we have noticed community input is going unheard.  We came to the table in good faith, participating in the community listening sessions held around the state.  But we do not see that reflected in these changes.  As it stands, it appears that the proposal leads us to more restrictive settings and services  and away from community based models.  Recovery is spoken of as a goal, but the spending looks like confinement and triage.

We will be asking tough questions about how this proposal was formed, and why it looks so different from the trajectory we have been on towards more independence and crisis management, instead of bringing back a state hospital system.

Similarly, a deal for GAMC was announced last Friday.  The text of the bill was not released until Wednesday night, and many things had changed by then.  For one, Adult Mental Health grants were back in the bill as a funding source.  We strongly oppose reductions in these services as a funding mechanism for other programs, but are not optimistic.  These grants have already been reduced by unallotment and may see further reductions in the omnibus budget.

We are not pleased with many aspects of this bill.  There is significant concern that this new model of care will not be ready by June 1, and that is largely unproven for this population.

This has become the session of bad negotiation.  There appears to be a great deal of horse trading going on, but the consistent factors have been an unwillingness to consider revenue, repeated cuts to critical services, and the direction of these cuts coming from the Governor and DHS alone.

Right now, MHAM is going back out to the community, and especially to Local Advisory Councils and talking about what services are most important and how these changes may affect people.  We hope to mobilize and inform more consumers so that they can be at the table when these deals are made.  It’s critical that we start now, even against these headwinds.  Grassroots take time to grow, and we will continue working with our fellow advocates and consumers at the Capitol, trying to be heard.

Last Friday, a new proposed solution to GAMC was unveiled.  Legislators from both parties and the Governor held a joint press conference, signaling that the long standing conflict over this program may be coming to an end.

The proposed solution is a block grant to hospitals that had high GAMC patient populations.  This money would go towards what would otherwise be uncompensated care.  Details on which providers would receive funding have not been fully released.  As Sen. Berglin noted, this plan still places a high burden on the health care system, and these costs will come back to anyone who pays for medical care in the state.

There are many questions left unanswered at this point.  We are still looking at what services these hospitals will be accountable for delivering, and what the impact will be of removing the direct link between funding and individual need.  However, we are relieved to see some forward progress on this issue, and commend the legislators who worked so hard to make a solution possible.  We are also pleased to see that the funding source been shifted towards the general fund.  Previous proposals had tapped county funding that provides critical social and health services.

The Senate Health and Human Services Budget Division will hear testimony on this plan tomorrow at 9 AM.

Please check back as we get more specifics on this bill and how it will impact Minnesotans with mental illnesses.

Sadly, a vote to override the Governor’s veto of GAMC restoration has failed in the house.  While 38 Republican members joined the DFL in voting for the bill originally, none were willing to vote for override.

While we are disappointed not to see a solution for GAMC, we are hopeful that this action will send people back to the drawing board to come up with a new plan.  The important thing to remember is that while partisan issues that bogged down this particular solution, there is broad recognition that there needs to be some kind of fix.  Consumers, hospital groups, county representatives, and legislators all know that we need some mechanism to provide and pay for critical care for the poor.

In Executive Director Ed Eide’s testimony to the Health and Human Services Committee of the MN Senate, he explained how uncompensated care functions as a tax on everyone who gets medical care in the state.  Hospitals and clinics must make up the cost of uncompensated care, and will do so with patient dollars.  The question is how fairly will we distribute this cost.  There is some indication that the compromise would be a managed care proposal, not a fee-for-service model.  We believe it is important to remember that while some GAMC recipients have chronic care issues that require frequent care, many are visiting emergency rooms only when their condition has substantially deteriorated.

We know by the number of unclaimed notification of coverage letters that the state has been making payments for managed care that homeless recipients were not benefiting from.  We encourage lawmakers to carefully consider the varying needs of GAMC recipients to understand what models of care will work best to reduce costs.

Thank you to everyone who contacted their legislators on this important issue.  We will continue to watch for new proposals, and speak out for those who rely on this safety net.

The Minnesota Senate has voted to override Gov. Pawlenty’s veto of a modified GAMC program, and the bill moves again to the House. While the bill passed with votes on both sides of the aisle, some members are now withdrawing their support. A 125 to 9 vote to approve this bill now appears to be three votes shy becoming law.

Please call your representative today to make sure they are supporting the GAMC bill. We expect a vote to come very soon, so please call now. As we’ve said before, it is not a perfect solution, but it protects patients and hospitals, and allows the system to be reformed, not scrapped.

At MHAM, we are saddened to see representatives who have publicly expressed how necessary this bill is to their communities turn around and drop their support at the very moment that it matters.

Ask your representative how they voted on HF 2680 and if they plan to support the override. If they are unwilling to support an override, ask that they work with the Governor to find a workable solution.

A few points to remember:

• This fix is cheaper per person than using MinnesotaCare.
• Uncompensated care acts as tax on everyone with health insurance in the form of higher rates.
• In any given year, 70,000 to 80,000 Minnesotans will rely on GAMC.
• Hospitals and advocates agree that MinnesotaCare is not likely to work for GAMC patients who require infrequent but emergency care.
• GAMC is a necessary part of our State’s safety net. This bill will let us improve on it in coming years.

Thank you for your support! We expect this to come to a vote early next week, possibly on Monday.

Both the House and Senate voted to restore GAMC cuts yesterday. This was a bi-partisan vote and passed overwhelmingly. For that we are happy!

However there is bad news. The Governor vetoed it. The next step is an override attempt. This will happen soon.

The state will save money with this new temporary GAMC program, because it will reduce the amount of emergency care that will be needed if it is gone. If you care about the health of poor people, please contact you elected representative and ask them to support the override.

This cannot happen without you.

Find your legislator’s contact information and call, email or send a letter today.

Thank you!

By Brett Dumke, Education Coordinator

In a recent article in the journal of Preventing Chronic Disease, published by the Centers for Disease Control and Prevention (CDC), the authors stressed the critical role of primary care providers (PCPs) in “bridging mental health and public health.”   With the shift of care from mental health specialists to primary care, mental health delivery within these settings can provide a central focus on prevention from early detection, and effective continuation of care. But as the article suggests, time constraints and financial disincentives to treat mental disorders limit the ability for PCPs to provide high-quality care for these types of health conditions.  Implementing an integrated or collaborative approach for PCPs can help ensure that high standards of care can be achieved.

One such approach has been implemented right here in Minnesota and is receiving national recognition. Leading the way for improving depression care in the primary care setting is the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) program. Based upon the “IMPACT” study, the program was developed by the Institute for Clinical Systems Improvement (ICSI) and supported by members representing area heath plans, medical groups, patients, employer groups, and purchasers. The program involves a collaborative effort involving the primary care physician, consulting psychiatrist, care manager, and other mental health specialists.  The care manager plays a pivotal role in managing the essential components of the program for each patient, while the patient has an active part in determining his or her care.

So far, the success of the program is encouraging. According to the ICSI website, of the participants that have been active in the program for six months, “43% are in remission, and an additional 17% have seen at least a 50% reduction in the severity of their depression. These results are 5-10 times better than for patients with depression treated under  ‘usual’ primary care.”  Along with effective treatment results, the initial cost of treatment under programs like this can expect to be offset by substantial long-term cost savings. To track the effectiveness of this program the National Institute of Mental Health (NIMH) has provided a five-year grant to HealthPartners Research Foundation.

For more information on who is eligible for this program and what clinics are participating in this program, visit the ICSI website.

By Ed Eide

While many mental health services are delivered through county or private providers, State Operated Services (SOS) forms an important part of the mental health system in Minnesota. Recent legislation and unallotments from the Governor have created uncertainty around the future of SOS. What started out as a partial reorganization has turned into a far-reaching redesign intended to cut around $15 million from the budget.

While we agree that these services could be provided differently, we strongly believe that such significant changes must be vetted through dialogue and shared decision making with those affected by the decisions, including consumers, family members, community providers, counties, hospitals, and other stakeholders.

We’ve pressed hard to make sure that consumer voices are heard when these changes are considered. In response, SOS has agreed to hold a series of meetings around the state to gather information and hear feedback. We hope that many of you will take the opportunity to attend these meetings.

Dates and locations have been set to receive community feedback, although some details are still pending.  To find out more, please visit our calendar of events or call us at 612-331-6840 or 1-800-862-1799.

We’re attending as many meetings as possible, but we also need feedback from consumers and family members so that we can work to ensure you’re being heard. If you go to a meeting, and have comments or information on how it went, please contact me. I can be reached at the phone numbers above or by email: [email protected].

-Ed