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

Kathleen Gearin, chief judge of Ramsey County, issued a temporary restraining order yesterday to restore funding to a program that provides food assistance to Minnesotans with complex medical dietary needs. The ruling specifically noted the constitutionality of unallotment as a law, but noted several issues with the way in which it was recently used by Governor Pawlenty. She interpreted that the use of this power is intended to be limited to addressing unforeseen budget shortfalls: “[unallotment] is not meant to be used as a weapon by the executive branch to break a stalemate in budget negotiations with the Legislature or to rewrite the appropriations bill.”

More coverage on this story can be found at MinnPost, the Star Tribune, and MPR News.

Judge Gearin also noted that simply reversing unallotment entirely is not within the boundaries of the judiciary, and that it will be necessary for the Legislature and the Governor to revisit the budget in a much more comprehensive way. While 2010 is scheduled to be a relatively calmer bonding session, this ruling could signal a much more active session as 2009 cuts are reconsidered. As we have said before, some compromise on the budget will continue to be necessary. However, we are greatly concerned by cuts that disproportionally affect Minnesotans with mental illnesses, such as the elimination of General Assistance Medical Care. GAMC is a much larger budget item, and is unlikely to be restored in a similar fashion. But we believe this underscores how critical it is to find a workable solution that acknowledges the necessity of these services.

There’s a long way to go before we know the final outcome. While the grant of a stay does send a signal about the judge’s assessment of the likely final outcome, the Governor has already announced his intent to respond. In addition, this suit is limited to one relatively small program of the many that were cut. But it reminds us that the budget of the state and many social services are still hanging in the balance. For anyone who cares about mental health services in Minnesota, it is critical to remain informed about the budget process and to talk to your legislators about the programs that you value.

Please check back soon, as we will continue to post here and send out email to our Public Policy Update subscribers. We expect to have more information shortly about cuts to the Personal Care Assistance program, which provides a measure of independence for many people with disabilities, including serious mental illnesses.

The 2010 Legislative Session has not formally opened, but action is already heating up. Yesterday, Sen. Linda Berglin and Reps. Erin Murphy and Tom Huntley set forth a proposal to help save General Assistance Medical Care. The event has been widely reported, including at MinnPost , the Star Tribune, and the PioneerPress.

As you may be aware, funding for GAMC was cut by Gov. Pawlenty through the un-allotment process. This program has helped Minnesotans who lack the means to pay for necessary medical care, but are not eligible for federal relief. Currently, the Governor has proposed transitioning GAMC recipients to Minnesota Care, but this falls short for several reasons. Low income patients are unlikely to be able to pay the premiums, and the Health Care Access Fund that supports MN CARE is already facing budget shortfalls.

With a mix of funding sources, the new plan for GAMC seeks to restore coverage to those who would have no other options, encourage transition to federal assistance for those who are eligible, and share the costs of this care in a fair manner. Federal funds, county contributions, and a surcharge on providers would all contribute, and the plan is currently tax neutral, an important compromise to the Govenor’s stated position on health care.

This proposal recognizes the unique health care needs of persons with mental illnesses. There are provisions for better urgently required care to avoid hospitalization, and payments for medication. This is what we’ve always known. We need better access to timely care and ongoing support. The alternative is waiting until a person is in even further crisis.

As the plan authors note, the federal proposals currently in discussion would likely solve these issues in the future by expanding federal Medical Assistance. But until then, we need to find real solutions for the populations served by GAMC. Cutting people off from necessary care and unleashing a wave of uncompensated care on hospitals and counties is the worst case scenario.

It’s likely that many proposals on this issue will emerge in this session and much will change before anything is signed into law, but at the Mental Health Association, we are pressing for stable sources of care for persons with mental illnesses, and cost cutting that focuses on preventive care, not slashing services.

Please contact your legislators today, and make sure that they know your priorities going into the 2010 legislative session. Minnesota needs GAMC. The cost of inaction is just too high.

Stay up to date with the issues with MHAM Public Policy Alerts. In the coming weeks, look for information on the critical issues for 2010, including more on GAMC, Personal Care Assistance, changes to State Operated Services, Maintenance of Effort Agreements, and the Acute Care Needs Report.

(This post was originally sent to our Public Policy Alerts email list. Sign up through MyMHAM to stay up to date with developments affecting persons with mental illnesses in Minnesota.)

The deadline is approaching for regulations to implement parity and friends of mental health in Congress want to make sure they are issued on time.

You can help them succeed.

For health plans to fully comply with the historic mental health parity law enacted last October (the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act), federal rules are needed. The law requires the Secretaries of the Departments of Health and Human Services, Labor and the Treasury to issue implementing rules before the date the parity law takes effect (for some plans this date is October 3, 2009, and for calendar-year plans, it is January 1, 2010).

With three agencies involved in what can be a lengthy approval process, quick action is critical. Earlier this year, the agencies issued a request for information (RFI) from the field to help inform their rulemaking, but final regulations have yet to be released. See the Bazelon Center’s May 26 Action Alert for a link to our comments on the RFI.

Before the August recess, Senators Al Franken (D-MN), Edward Kennedy (D-MA), Jack Reed (D-RI,) and Sheldon Whitehouse (D-RI) sent a letter to the three cabinet secretaries, concerned about the delay.  Thanks to everyone who helped secure endorsements from Senators for that letter.

With a need for continued pressure on the three departments to issue regulations in a timely fashion, Representative Patrick Kennedy (D-RI) is circulating a letter, seeking endorsements by other members of the House of Representatives. The letter will insist that the secretaries of the three departments act quickly and consider the comments that were filed in response to the request for information (RFI).

The deadline for Representatives to endorse the letter is close of business (5 pm, EST) on Monday, September 21.

By Kathy Kelso

The August congressional recess has brought us opportunities to talk with our Senators, Congressmen and Congresswomen to urge enactment of a strong, comprehensive health insurance reform bill.

It is important for mental health advocates to counter negative messages spread by anti-reform groups. Urge Members of Congress to improve health care coverage and protections for millions of Americans by:

• Preventing insurance companies from denying coverage or charging more because of a pre-existing condition, like a mental illness, or dropping and reducing coverage if you become seriously ill.
• Ensuring payment for evidenced-based practices that work.
• Extending Medicaid to households with incomes below at least 133% of the federal poverty level.
• Requiring that all plans include mental health and chemical dependency treatment, and that this coverage must be at full parity (i.e., equal to the coverage of physical health conditions).

The Bazelon Center for Mental Health Law provides a detailed webpage on how the legislation affects individuals with a mental illness and issue briefs on the integration of mental health services in healthcare reform.

A number of policy proposals are under consideration, and parity for mental health must be a fundamental benefit in the final congressional act. We know that our Senators support parity and reform, as do some of our Congressional representatives. Thank them for all they are doing to enact historic health care reform!  Contact elected officials.

By Kathy Kelso

The Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act enacted in 2008 requires three federal departments to implement rules to ensure full compliance by health plans and access to services. These implementing rules must be issued before the effective dates for health plans: a) with coverage year beginning after October 3, 2009, and b) with coverage calendar years beginning January 1, 2010. With three federal agencies involved in a lengthy approval process, expeditious action is critical.

Senator Al Franken joined with Senators Edward Kennedy, Jack Reed and Sheldon Whitehouse in circulating a letter which was sent to the Secretaries of the departments calling upon them to issue regulations that set out the clear Congressional intent of the law.

Earlier this year, the agencies issued a request for information (RFI), but rules have yet to released. For more information, see this link to the Bazelon Center website:

Please join us in thanking Senator Franken for his leadership in this effort. You can send an email to Sen. Franken thanking him for his dedication to Senator Paul Wellstone’s legacy – mental health for all.