2019 Legislative Updates

November 11, 2019

Legalization of Marijuana—What are your thoughts?

As part of the Mental Health Legislative Network (MHLN), representatives of MPA met with a legislator about the proposed effort to legalize marijuana in Minnesota. The legislator explained the desire for legalization for adult recreational use as a move toward regulation as a way to protect Minnesotans and reduce the criminalization of marijuana possession and its deleterious effects on people’s lives. The MHLN presented a three-part recommendation:

1. Mental health providers do not support the legalization of marijuana for recreational use because it sends the message to vulnerable populations that it is not a dangerous drug. In fact, negative educational outcomes have been noted for adolescent and young adult users of marijuana. Concerns have been raised about the impact of ingesting marijuana on the developing brain. Individuals with mental illness are at particular risk for incipient psychotic episodes from use. Use of marijuana has also been found to reduce responsiveness to mental health treatment. Other concerns include the impact on driver safety, and social, employment, and economic negative outcomes associated with use.
2. While mental health professionals are opposed to legalization of marijuana for recreational use by adults, we are cognizant of the growing cultural trend towards legalization. The MHLN made several recommendations if legalization occurs: that a task force be formed to guide the implementation of legalization to mitigate harm; that packaging and advertising be controlled to avoid appealing to adolescents; that edible forms not be included in the legalization due to the risk of overdose and its being mistakenly ingested by young people; that prior to legalization, significant efforts and funds must be expended to provide a public health education campaign to alert vulnerable populations to possible negative consequences; that additional funds for prevention and treatment of substance abuse must be made available, and that the legal age for purchase be 24 years of age in order to provide some protection to developing brains in young people.
3. The MHLN recommends decriminalization and expungement for offenses involving small amounts of marijuana possession immediately, as the consequences of involvement in the criminal justice system for individuals with marijuana possession charges can be significant and long lasting. The current disproportionate consequences to communities of color of criminal charges for possession of marijuana needs to be interrupted.

We would like to invite a dialogue with members. Here are some questions to spark your thoughts:

• What are your thoughts about legalization of marijuana for recreational use by adults? What are your concerns?
• Are there public health education approaches that could be utilized to protect the citizens of Minnesota?
• Are you in support of decriminalization and expungement?
• Are there other dimensions to consider as our state likely moves toward legalization?  
• Is there another way to pursue decriminalization and the negative effects of black market use short of legalization?
• What are the goals of legalization: to reduce criminalization of use?
• What are the social and health effects of decriminalization vs. legalization? Is there a third path between these two?
• What about money?
• Are efforts to disrupt the status quo aimed at reducing money in the hands of criminals?
• Is legalization really a mechanism for revenue generation?
• Will revenue generated be outstripped by costs for related substance abuse treatment?

Questions? Comments? Insights? [email protected]

June 11, 2019

2019 Legislative Session Summary

While there were few victories specifically for psychology in the bills ultimately passed in the 2019 legislative session, there were many positive outcomes for mental health services. One key victory we achieved was to get a hearing on the 23.7% increase to psychologists in the Medical Assistance program for the first time in four years.

An important advance was the inclusion of the mental health parity language. This will require payers to report on nonquantitative treatment limitations measures so that we can be more certain about issues such as the adequacy of provider networks. There was some restructuring of behavioral health financing, primarily the inclusion of substance abuse funding in the behavioral health budget so that better integrated dual diagnosis care can be supported. A very important investment was made in Certified Community Behavioral Health Centers, a demonstration project for a full range of coordinated services. Federal funding was set to expire, and Minnesota decided to fund and expand this very valuable program. There was much needed investment in children’s psychiatric residential treatment facilities and an expansion of psychiatric beds for the state. School-linked mental health services, where outside providers come into schools to provide mental health services, saw an increase in funding. This has been a very positive program as it has brought services to students who ordinarily would not have received services. Similar to school-linked, services were increased for youth in shelters, with additional supports for sexually exploited youth provided. Increases were also seen in funding for crisis services. Funding was also added to provide mental health services in community colleges. Suicide prevention services also saw a much needed increase in funding, given the increase in the suicide rate. Funds to provide care to youth with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections was also provided. Increases were given to two services provided by Minnesota as the care provider including increased funding for Minnesota State Operated Community Services that are provided to individuals with developmental disabilities. Funding was also increased for the Minnesota Sex Offender Program. Employment programming for individuals with serious mental illness also saw a small increase in funding. The competency restoration task force, of which MPA is a member, was given some minimal funding. Efforts are under way to try to establish outpatient competency restoration programs so that needed psychiatric beds are more available. Efforts to cut dental and vision services for individuals covered by Medical Assistance were unsuccessful. Funding to address excess use of solitary confinement was also included. Cash assistance to families receiving MFIP funding increased for the first time in 33 years. These are the main changes likely to be of interest to psychologists.

Unfortunately, the legislature did not take up MPA’s suggested change to the financing of the Health Care Access Fund, and the sunset of the Provider Tax was overturned and a tax rate of 1.8% instituted. Considerable pressure was brought by some advocacy groups focused on retaining the Provider Tax with a reluctance to explore other available options to support the Health Care Access Fund and its support of MinnesotaCare and Medical Assistance. While it is disappointing that the Provider Tax was reinstated, we will redouble our efforts to try to get the funding re-routed so that psychologists are no longer put in the middle of this process. It is a positive that we are working with the Board of Psychology and the Minnesota Northland Association of Behavior Analysts (MNABA) on licensing through the Board of Psychology for behavior analysts. By working with MNABA and the Board of Psychology, we hope a license will be developed for behavior analysts that protects the public while ensuring that the scope of practice for psychology is not affected. The bill banning conversion therapy received two hearings in the Minnesota house and was offered as an amendment in the Senate, where it was ultimately voted down along party lines. While these may appear discouraging, it is significant progress compared with past years. Our bill requesting that the 23.7% increase in MA rates for mental health be extended to psychologists received a hearing in the Senate Health and Human Services Finance Committee. This is a major advance and we hope that more progress can be achieved next session. We are hopeful that stakeholders will come together and make some headway on changing the undergirding of rates for MA mental health services in Minnesota. Ultimately it is this systems change that will move our profession forward. Creating change is a marathon, not a sprint, and we will keep running.

May 28, 2019

APA Advocacy Updates

Click on the links below to see how APA is advocating for you!

Week of May 13 APA Advoacy Update
Week of May 20 APA Advocacy Update

May 14, 2019

HR2431

Please contact your Congressional Representative and ask that they co-sponsor HR2431 which is a bill that provides loan forgiveness for behavioral health providers. The bill will especially be of help in areas where there are shortages and in rural settings. If you are unsure of who your representative is, click here to find out. When you enter your zip code, you can click to be taken to the member’s website. On their website, click on connect and copy the email address provided. Here is an example of what you might say in an email:

Dear Representative ______________________

My Name is John Doe and I am a psychologist who is also your constituent. I am contacting you today to ask that you co-sponsor HR2431, the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2019. This bill provides funding for training and loan repayment for behavioral health providers. As you may be aware, there are serious shortages of mental health professionals in Minnesota, especially in rural parts of the state. This bill will help to defray the huge costs of graduate school and thereby encourage more people to enter the field. With more providers, we can address issues with access to care. Thank you for considering co-sponsoring HR2431.

Sincerely,

John Doe
Street address
City, State, zipcode
Email address
Telephone

April 30, 2019

Contact Your Legislators to Support Argosy Students

HF2849 will be heard in the Minnesota House Ways and Means committee on Wednesday morning, May 1, 2019. This bill provides assistance for individuals caught in the Argosy closure.

HF2849 provides assistance with state and other loans and grants. It also calls for a report to the legislature on the teach out and payments to students. You can read the text of the bill here. The companion bill in the senate is also up in the rules and administration committee tomorrow morning. Please call your legislators and urge the passage of this important bill to provide relief to students. If you do not know who represents you, you can find that information here. You can simply call or email and say, “Please support HF2849/SF2841 which provides some relief and assistance to Argosy students dealing with the school’s closure."

February 26, 2019

HF1387 Any Willing Provider. Why Should I Care? What Can I Do?

You may be interested in supporting a bill that has been introduced in the Minnesota House of Representatives. It would require payers to allow any mental health professional who wants to be in a network to join as long as they meet credentialing and are willing to accept the terms of the contract. Interested?

The bill, House File 1387, would require payers to allow into their networks “Any Willing Provider” who meets credentialing and agrees to the contract. This bill is being brought forth by the Mental Health Legislative Network and is spearheaded by the National Alliance for Mental Illness-Minnesota (NAMI-MN). They have chosen to work on this bill because, from an advocacy standpoint, they are repeatedly hearing that clients are unable to find mental health professionals who are in network with openings to provide care. MPA frequently hears from psychologists that they have difficulty being accepted into networks because they are told the payer already has plenty of providers. Clients tell us that we do not have enough providers in networks. It is wonderful that NAMI-MN is directing this work as it is more likely to have an impact on legislators. The bill has a limit of four years for this “Any Willing Provider” legislation to run before it would sunset. This provision is likely to make the bill less troublesome for payers.

This bill has an uphill climb and is likely to be strongly opposed by the insurance companies. Their rationales will likely be that there are sufficient numbers of providers and that it would be too costly to credential all mental health professionals who wished to be in network. They may also claim that there will be an increase in services. That is probably true, but isn’t that a good thing—that more people are getting the services they need?

Because of the large potential benefit and the likely challenge this bill will face, we need your help to advocate with your legislators. Please call your house member (it has not been introduced in the Senate as yet). You can find out who represents you here: https://www.gis.leg.mn/iMaps/districts/

Here’s some suggested language you might use in a call or email to your Representative:

Dear Representative ____________:

I am contacting you to ask that you support HF1387. My name is __________ and I am a psychologist and your constituent. This bill would require that any licensed mental health professional could be a part of any insurance network, if they meet credentialing criteria and are willing to accept the terms of the contract with the insurance company. Minnesota has critical access issues to mental health services and this bill would mean that more providers would be available to care for individuals.

As providers, we are frequently shut out of networks and then are unable to provide desperately needed services to the individuals who contact us. It is imperative that Minnesota make use of all of its professional mental health workforce. The bill sunsets after four years, with the hope that by then provider panels will be adequate. Please take a step to support the increased availability of mental health services for the citizens of Minnesota. Thank you for your attention to this important issue.

February 14, 2019

MPA Testifies in Support of Bill, HF12, Restricting the use of Conversion Therapy

On February 13, 2019, Dr. Margaret Charmoli testified on behalf of the Minnesota Psychological Association (MPA), to the Minnesota House Health and Human Services Policy Committee in support of a bill, HF12, that would restrict the use of conversion therapy. 
Click here to read the full press release. Watch Dr. Margaret Charmoli's testimony in the video below. This is MPA at work for you!

3/13/19 Update: The House of Representatives Commerce Committee passed the conversion therapy ban bill on to the next level. Thank you to Dr. Charmoli for her testimony at the recent hearing.

Dr. Charmoli's testimony	Dr. Charmoli's Q&A segment

February 4, 2019

Provider Tax

Please watch this video about the Provider Tax. We need you to contact legislators to get our message out. Find your legislator here. Thanks in advance.

January 22, 2019

Add Your Name to the List!

MPA is supporting the Mental Health Protections Act. If you would like to sign on to a letter to legislators, you can do so by sending your name to Cat at [email protected]. The bill (HF12/SF83) protects the mental health of LGBTQ adolescents and adults from therapies aimed at sexual orientation change. Such therapies have been found to be ineffective at changing sexual orientation or gender identity. Not only are they ineffective, they have been shown to be damaging to the mental health of the individuals who are often coerced into participation. You can also support the bill by contacting your legislator to let them know you support the bill. To find out who represents you, click here.

Sample language to your legislators might include:

I am a psychologist and your constituent. I am contacting you to ask you to support the Mental Health Protections Act (HF12/SF83). This bill protects LGBTQ adolescents and adults from sexual orientation change therapies. Research has demonstrated that these therapies are not effective and can be damaging to individuals’ mental health. Please support this important bill.

Call your legislators! Change the Provider Tax!

MPA needs your help in communicating to your legislators about what is to become of the provider tax. It’s important to know a few things about the provider tax. While providers send in the money, it is actually a tax on claims expenditures that the insurance companies pay. It is passed through to providers. It is not our money, even though we make the payments. It was arranged this way in order to capture funds from self-insured plans. You should know that 49 states have a provider tax.

The provider tax is supposed to sunset at the end of this year. The tax brings in $1.5 billion dollars per biennium. It supports key safety net programs such as MinnesotaCare, Medical Assistance, SHIP, and some specific mental health funding.

There are basically three options: continue the provider tax as is, make some changes to reduce the administrative burden on providers, or do nothing and have these important safety net programs go away. Many legislators intend on just repealing the sunset of the provider tax. This leaves psychologists holding the bag for bookkeeping, making quarterly payments and being at risk of a costly audit.

A different strategy is in the works that we would like you to inform your state legislators about. It is a plan called the “claims expenditure assessment.” What it would do is have insurance companies simply pay the funds directly to the state, avoiding psychologists having to do the onerous book keeping, payments, and risking an audit. If it truly is paid by the insurance companies, let them pay it directly. It would reduce the administrative burden for both providers and the state. The claims expenditure assessment approach would take providers out of the middle, and reduce our headaches. Either way our payment will be the same—if we send the tax, or if insurers pay it directly. The reason that the state has done this complicated pass through system is to capture additional money from ERISA or self-insured plans. At least one other state, Michigan, is using this approach of getting the funds directly from the insurers, and they have been able to collect the funds from self-insured programs. It was tested in court in Michigan, even going to the Appeals Court, and it was found not to infringe on these ERISA plans. This was appealed to the Supreme Court, and it was turned down, so it is settled law.

We ask that you call or email your legislator with the following message:

To find out who represents you, click here.

Dear Representative/Senator:

I am a psychologist and one of your constituents. I’m contacting you to ask that you support the claims expenditure assessment approach to dealing with the provider tax. Please take providers out of the middle of this cumbersome process. Another state (Michigan) has taken this approach and been successful in obtaining the assessment from all commercial payers, including the ERISA self-insured plans. It may be tempting to simply repeal the sunset of the provider tax, but that leaves providers stuck with an administrative burden. If you have questions about this, feel free to contact our state association, the Minnesota Psychological Association, at [email protected]. Thanks for all of your efforts on behalf of your community.