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NAMI Minnesota Legislative Update November 15, 2020Supreme Court Hears Challenge to Affordable Care ActWhile we work with the executive and legislative branches of the federal government, we also monitor cases heard by the judicial branch - especially ones that could complicate the health care landscape in 2021. The Supreme Court heard oral arguments in California v. Texas (also called Texas v. United States in lower court cases), this past week and the US Supreme Court will, once again, decide the fate of the Affordable Care Act (ACA).In 2012 the court agreed that the individual mandate in the ACA (Known as the “individual mandate,” this part of the ACA required that most Americans have a basic level of health insurance coverage) was constitutional because Congress had included a tax penalty if someone did not have insurance. Congress eliminated the tax penalty for the individual mandate in 2017, and a group of states, led by Texas, argued that without a penalty, the individual mandate is now unconstitutional. They further argued the entire law was unconstitutional because this mandate is so essential to the ACA that it was not “severable” from the rest of the ACA. Last year, a federal appeals court ruled that the ACA’s requirement for individuals to purchase health insurance was unconstitutional and now it's before the US Supreme Court. The Kaiser Foundation has an HYPERLINK "" \t "_blank" interesting article about the case. The Court could decide that all of the ACA — or key provisions that protect people with pre-existing conditions, like mental health conditions — is invalid, putting coverage and protections at risk, particularly for people with mental health conditions. However, the case will not be decided until the spring of 2021, meaning no one will be immediately impacted and no one will lose their health coverage or have protections stripped away at this time. Additionally, open enrollment in MNSure is now open and will not be impacted. If the Supreme Court rules that the ACA is unconstitutional, it would impact nearly every corner of the healthcare system and affect virtually every person in the U.S. Earlier this year, NAMI, along with nineteen patient groups representing millions of people with pre-existing conditions HYPERLINK "" \t "_blank" filed an amicus curiae (“friend-of-the-court”) brief urging the Supreme Court to uphold the law and preserve access to care for millions of people.The ACA’s Impact on People with Mental IllnessesToday, NAMI national released What the Affordable Care Act Has Meant for People with Mental Health Conditions – And What Could be Lost, an HYPERLINK "" \t "_blank" issue brief on the impact of the ACA on our community.As the brief discusses, the ACA has played an important role in helping people access mental health care through the expansion of comprehensive health insurance and Medicaid. Because of the ACA, 20 million people have gained insurance coverage, including 15.3 million who became eligible for Medicaid. The ACA has also significantly reduced the uninsured rate for people with mental health conditions.Below are some of the ways the ACA has helped people affected by mental health conditions – all of which are at risk if the Supreme Court overturns the ACA:The ACA expanded eligibility for Medicaid beyond low-income children, adults with disabilities, and pregnant women, helping millions of people with mental illnesses who do not have a disability determination become eligible for Medicaid, the nation’s largest payor of mental health services.The ACA made insurance more affordable by offering tax credits to reduce the premiums paid for health insurance by people who make up to 400% of the federal poverty level (about $87,000 for a family of three) and providing cost-sharing subsidies to limit deductibles and co-pays.The ACA extended coverage for young adults by allowing young adults to remain on their parent’s health plan up to the age of 26, even if they no longer live at home, which is critical given that 75% of chronic mental health conditions begin by age 24. While MN required plans to cover young adults up to age 25, it only impacted MN plans.The ACA ended discrimination against people with pre-existing conditions, including mental health conditions, by requiring that health plans in the individual marketplace offer coverage to all people, regardless of pre-existing conditions, and ensuring that people could not be charged more for coverage based on their health status.The ACA required coverage of mental health care by making mental health and substance use disorder care “Essential Health Benefits” (EHB), which requires that individual and small group plans cover these services, and by prohibiting annual or lifetime limits on these services.The ACA extended parity protections by requiring individual and small group plans be subject to the Mental Health Parity and Addiction Equity Act (MHPAEA), which means that these plans must cover mental health and substance use services at parity with other medical services. Because of this, plans cannot do things like covering fewer visits, requiring higher cost-sharing, or placing stricter medical management policies (such as prior authorization and utilization review) on mental health and substance use services than for comparable medical services.NAMI Minnesota's executive director also wrote an opinion piece on the ACA that was sent to papers in Greater Minnesota. Read it HYPERLINK "" \t "_blank" here. There was also a recent HYPERLINK "" \t "_blank" article in MinnPost. While we remain optimistic that the Affordable Care Act (ACA) will stay in place, it is important that we do everything we can to protect this life-saving legislation. Please consider sharing your story using this HYPERLINK "" \t "_blank" one-pager from NAMI National. Questions? Email HYPERLINK "mailto:ssmith@" \t "_blank" Sam Smith Find out who represents you HYPERLINK "" \t "_blank" Click hereNews from the State LevelPlease "Give to the Max" to Support NAMI Minnesota's Advocacy Work!It's that time of year again! That's right,?Give?to the?Max?Day is right around the corner, taking place on?Thursday, November 19, 2020. NAMI Minnesota needs your?Give?to the?Max?Day support this year more than ever. We believe that together,?with your help, we can meet our?$35,000 fundraising goal. We are excited to share that our #GTMD 2020 donations will be used to fund our advocacy work!Please visit HYPERLINK "" \t "_blank" NAMI Minnesota's?Give?MN page to read more about how your donation will help move our advocacy work forward. All gifts made to our?Give?MN page in support of NAMI Minnesota between now and Give to the Max Day on November 19 will count toward our total - and also help put us in the running for bonus?prizes called "Golden Tickets."There is so much more work to be done, and?we need YOUR support this?Give?to the?Max?Day?to help us continue working to build our mental health system. Thank you for considering a #GTMD donation to NAMI Minnesota!Legislature Briefly Meets for Uneventful Special SessionWith COVID-19 cases surging in Minnesota and the election in the rear-view mirror, the House and Senate met for an uneventful special session. After months of criticizing Governor Walz and his management of the COVID-19 pandemic, the Senate Republican Majority chose not to contest his emergency powers. The only consequential change was temporarily electing Senator Tomassoni as the Senate President. This was a procedural move in the event that Senator Klobuchar is chosen to serve in President-Elect Biden's cabinet, and then Governor Walz chooses Lt. Governor Flanagan to be on the U.S. Senate and then the Senate President becomes the Lt Governor. That would decrease the number of Republican senators by one. Beyond a new Senate President, the DFL and GOP caucuses chose to retain their leadership heading into the 2021 session. As we get closer to the 2021 session, the caucuses will choose what members will be on each committees, so be on the lookout to see where your State Senator and State Representative will end up.DHS Publishes RFP for Children's Mental Health ProvidersThe Behavioral Health Division has published a mini-grant that will award approximately $3 million to support children's mental health and school-linked mental health providers with unmet costs that have occurred or are occurring due to the COVID-19 pandemic. Individual requests may be for any amount up to $25,000 and are intended to maintain the continuity of care during the pandemic. These resources may be used to cover increased staffing costs, training on public health guidance, and other costs associated with the COVID-19 response. To learn more, you can review the HYPERLINK "" \t "_blank" grant application and a HYPERLINK "" \t "_blank" Q & A released by DHS on Friday. Information is due by November 16th. THis was an issue that NAMI Minnesota, AspireMN and MACMHP worked on with the Governor's office.MH Fairview Should Not Close Its ERNAMI Minnesota and other advocacy and provider organizations remain concerned about the plans from M Health Fairview to close inpatient psychiatric beds and to close the ER at St Joe's. In talking with other metro hospitals, they simply cannot meet the emergency needs of people who had been served by the St Joe's ER - there have been times in the past months when St Paul ERs have been put on divert - meaning that they could no longer take new people in their ERs. We are in the midst of a pandemic - with increasing numbers of people with COVID-19 - and we are seeing more people experiencing a mental health crisis due to the pandemic. Now is not the time to close an ER. Read a recent article HYPERLINK "" \t "_blank" here. Criminal Justice UpdateCivil Rights Listening Sessions on Minneapolis Police DepartmentThe Minnesota Council on Disability will be hosting the Minnesota Department of Human Rights (MDHR) for listening sessions and a presentation on the MDHR’s investigation into the Minneapolis Police Department. Two sessions will take place this Wednesday, November 18th at 12:00pm and 6:00pm. Participants are encouraged to learn more about the investigation opened after the killing of George Floyd and how they can share their experience – positive, negative, or neutral – with neutral investigators from the department. Registration is not required HYPERLINK "" \t "_blank" click here to access the links to the Zoom meetings.NAMI Continues to Work on Crisis Response and Police ReformNAMI Minnesota is continuing to advocate for the best responses for people in a mental health crisis. As 2021 budget decisions are being made, NAMI has been working with the Minneapolis City Council to discuss crisis response and HYPERLINK "" \t "_blank" sent a letter to the Hennepin County Board of Commissioners in advance of an October 29th Health and Human Services Budget hearing. Last week we met with the policy staff of Commissioner Conley who is the chair of the Hennepin Health and Human Service Committee to discuss funding and integrating mobile crisis into 911.NAMI also HYPERLINK "" \t "_blank" joined with family in remembering Travis Jordan who was killed by police while in crisis on November 9th, 2018, and issued this press release: “NAMI Minnesota joins the loved ones of Travis Jordan in seeking increased funding and structure to ensure a mental health response to a mental health crisis. Sadly, the entire state budget for 2021 for mental health crisis services was $13.169 million compared to police department budgets of $193.3 million in Minneapolis and $125.9 million in St. Paul. Too many people struggling with their mental health, particularly from communities of color, have been injured, killed, or brought to jail. In addition to better police training, we simply must fund a mental health crisis response system.”We are also active in many efforts to reform and improve police education, training, and oversight including the HYPERLINK "" \t "_blank" Advisory Committee for the POST Board Rules Overhaul, the HYPERLINK "" \t "_blank" Minnesota State College System Law Enforcement Education Reform Task Force, and the HYPERLINK "" \t "_blank" Ensuring?Police?Excellence?and I HYPERLINK "" \t "_blank" mproving?Community?Relations HYPERLINK "" \t "_blank" ?Advisory HYPERLINK "" \t "_blank" ?Council. You can view upcoming meetings through the links above and HYPERLINK "" \t "_blank" watch a special POST Board meeting this Thursday at 10am on a recent audit of the board.News from Federal LevelSenate Begins FY21 Appropriations ProcessThe Senate Appropriations Committee released its spending bills this week, marking the beginning of the FY 2121 appropriations process. Much will change before any deal is reached and these bills are best understood as the opening of negotiations with the House. Federal spending is only set through December 11th, so it is important that both the House and Senate work together to avoid a costly government shutdown.The Senate’s FY 2021 draft Labor, Health and Human Services, Education, and Related Agencies HYPERLINK "" \t "_blank" bill text allocates $5.9 billion for the Substance Abuse and Mental Health Services Administration, a $117 million increase from the previous year, with $250 million of that funding earmarked for Certified Community Behavioral Health Clinic (CCBHC) grants through September 2023. In its HYPERLINK "" \t "_blank" explanatory statement on the Commerce, Justice, Science, and Related Agencies appropriations bill, the Committee directed the Drug Enforcement Agency (DEA) to finalize a HYPERLINK "" \t "_blank" special registration process allowing providers to prescribe medication-assisted treatment via telemedicine. (National Council)NAMI National Signs Letter on COVID-19 Vaccine DistributionAs we get closer to distributing a COVID-19 vaccine, it is very important to ensure that people with mental illnesses and other disabilities have equal access to the vaccine. That's why NAMI National joined the Consortium for Citizens with Disabilities in HYPERLINK "" \t "_blank" publishing a letter outlining COVID-19 vaccine allocation principles. Specifically the distribution of the vaccine must:Ensure compliance with Federal civil rights laws and guidanceUse non-discriminatory value assessments in vaccine allocation prioritizationPrioritize residents and staff in all Long Term Services and Supports (LTSS) settingsAddress health disparitiesEnsure any information on the vaccine is accessible to people with disabilities and non-English speakersEnsure accessibility of vaccination sitesEnsure all people can receive the vaccineThere is still much that needs to be done before a safe and effective COVID-19 vaccine can be widely distributed to the public. However, once it is available people with mental illnesses and other disabilities must have equal access. NAMI Minnesota has also reached out to the Governor's Office advocating for people with mental illnesses in residential or corporate foster care settings to be places on the same priority list as people in nursing homes. CMS Updates Rules on Medicaid Managed Care ProgramsThe Centers for Medicare and Medicaid (CMS) announced new rules on Managed Care programs for Medicaid and the Children's Health Insurance Program (CHIP). Under managed care, states contract with a private provider (like Medica, BCBS, HealthPartners) to administer the state's Medicaid benefits. Most states have chosen to use managed care including Minnesota. In 2016 the Trump Administration issued new regulations on managed care programs. However, feedback on these rules argued that these new rules were too prescriptive. CMS responded by making updates to the rate setting process for Medicaid, network adequacy standards for both Medicaid and CHIP, requirements for beneficiary information, and in other areas.The most significant change is to requirements for network adequacy. Under the new rule states will no longer be required to develop time and distance standards to determine network adequacy. The new standard for network adequacy must be quantitative in nature, but could include a number of standards such as provider to enrollee ratios, maximum travel time or distance, minimum percentage of contracted providers that are accepting new patients, maximum wait times for appointments, among other options. NAMI Minnesota has supported efforts to consider network adequacy in new ways - such as the number of providers accepting new patients - and welcome this proposed change. To learn more about these changes, you can read the HYPERLINK "" \t "_blank" summary here or the HYPERLINK "" \t "_blank" full CMS rule.Updates from NAMI MinnesotaNAMI Legislative CommitteeMeetings are held on the second Tuesday of every month at 6 PM. To be added to the email list, contact HYPERLINK "mailto:ssmith@" \t "_blank" Sam Smith. If you missed the complete summary of the 2020 Legislative Session, click HYPERLINK "" \t "_blank" here HYPERLINK "" \t "_blank" . Did you know Sue has a blog? Read the latest post HYPERLINK "" \t "_blank" here. NAMI Minnesota | 1919 University Ave. W., Ste. 400 | St. Paul, MN 55104 HYPERLINK "mailto:namihelps@" \t "_blank" namihelps@ | HYPERLINK "" \t "_blank" htttp:// 651-645-2948 | 1-888-NAMI-HELPS HYPERLINK "" \t "_blank" ? HYPERLINK "" \t "_blank" ? HYPERLINK "" \t "_blank" ? HYPERLINK "" \t "_blank" ABOUT NAMI HYPERLINK "" \t "_blank" GET INVOLVED HYPERLINK "" \t "_blank" EDUCATION HYPERLINK "" \t "_blank" SUPPORT HYPERLINK "" \t "_blank" CONTACT USCopyright ? 2020. All Rights Reserved. ................
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