2a392k31wksy2wkejf1y03dp-wpengine.netdna …… · Web view2020/04/04  · Allowing phone or internet visits for determining eligibility for waiver programs and the waiver case managers

NAMI Minnesota Legislative Update

April 4, 2020

Updated Information from DHS on Covid-19

The Department of Human Services (DHS) continues to act under the authority of executive order 20-12 to provide more flexibility for health care and social services. When required, DHS is also seeking approval from the federal Centers on Medicare and Medicaid (CMS) to waive certain provisions of law or rule.

One change that NAMI Minnesota to highlight is that DHS will be automatically continue health insurance coverage for Minnesotans on Medical Assistance and MinnesotaCare during the pandemic, unless an individual reaches out to DHS and requests termination of their coverage. To avoid confusion, DHS will not be sending out renewal requests, so please do not worry if you do not receive a renewal form if you or a loved one is on Medical Assistance or Minnesota Care.

Here is the most recent list of DHS waivers:Waivers under peacetime emergency authority, Executive Order 20-12

Waiving certain licensing regulatory actions and extending licenses for family child care, child and adult foster care, and community residential and treatment settings (CV02) such as suspending routine licensing and certification reviews and automatically extending licenses for three additional months.

Suspending some application requirements, interviews, and verifications that are required when applying for General Assistance, Housing Support, MN Supplemental Aid, MN Family Investment Program and SNAP (food). For example you don't need the person's signature if the worker is on the phone with the person, accept verbal confirmation of information. (CV03)

Suspending the requirement for people on Minnesota Family Investment Program and experiencing family violence to meet with an employment counselor and a family violence specialist if they can't be reached. (CV05)

Waiving certain requirements for Child Care Assistance Program payments and procedures related to absent days. (CV08, CV10)

Allowing foster care caseworker visits with children by video (CV11) Suspending new actions for child support remedies such as having drivers

licenses and occupational licenses pulled. (CV12) Allowing child care assistance payments for two child care providers when a

program temporarily closes (CV07)

Extended by three months child care assistance program redetermination due dates (CV09)

Waiving requirements for reporting, documentation and reporting for MFIP. GA, MSA and housing supports and not allowing overpayments due to agency or system errors to be collected from recipients. (CV04)

Waiving recertification process for HIV/AIDS services and drug assistance program (CV14)

Allowing telemedicine for School-Linked Mental Health services and Intermediate School District Mental Health services for children and their families and not requiring the first meeting to be in person, waiving the three day a week limit under telemedicine and allowing telephone and other platforms to be used such as Skype. (CV21)

Modifying certain background study requirements due to closure of fingerprinting sites. (CV23)

Waiving in-person requirement to allow fair hearings to take place by telephone or video (CV29)

Waivers under emergency authority, Executive Order 20-12: Approved by CMS:

Allowing phone or internet visits for determining eligibility for waiver programs and the waiver case managers can connect this way as well. (CV15)

Expanding access to telemedicine services for Children’s Health Insurance Program, Medical Assistance and MinnesotaCare enrollees by allowing telephones as well and allowing the first visit to be by phone. The three visits per week limitation is waived. Managed care must follow these polices. It appears that payment would not begin until April 1 for those providers who have a telemedicine assurance on file with DHS. (CV16)

Increasing the limits on prescriptions from 34 to 90 days for certain medications such as antidepressants, antipsychotics, and many other medications. (CV19)

Postponing provider screening and re-enrollment (CV22)

DHS is waiting for federal approval to allow payment for phone or internet use for targeted case management visits, this includes adult and children's mental health case management. (CV24)

In addition to the changes outlined above under the emergency authority, the commissioner made the changes below under the authority of existing laws,

Waiving work requirements for certain SNAP participants (CV18) Suspending sanctions for some Minnesota Family Investment Program and

Diversionary Work Program participants (CV06)

Expediting payments to nursing homes (CV01)

NAMI has also been in touch with staff at DHS to learn more about efforts to prevent the spread of COVID-19 at state operated services, particularly at Anoka Metro Regional Treatment Center and the Security Hospital. It appears that every precaution is being taken including screening all staff before they enter, making sure there is distance between patients in groups, and cleaning - a lot. If you have any concerns, please let us know.

There are still many outstanding issues such as paying ARMHS, CTSS and Waivered services providers to deliver in-home services by phone, allowing paraprofessionals and special education teachers to go into students' homes, and more. NAMI Minnesota is doing our best to keep you informed. Don't hesitate to reach out if you have any questions.

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News from the State Level

COVID-19 Update

Additional Funding for the Emergency Services programThe COVID-19 emergency package includes over $26 million in funding for homeless service programs. Funds can be used to maintain or expand shelter capacity that promotes health and safety and quarantine options, purchase hygiene and sanitation supplies so providers can comply with Centers for Disease Control and Prevention guidance, and support staffing needs for homeless programs to maintain and hire staff necessary to protect the health and wellness of participants and staff.

Funds must be expended by February 1, 2021, or until 60 days after expiration of the peacetime emergency declared by the Governor in an executive order that relates to the infectious disease known as COVID-19, whichever occurs first.

Providers applying for these funds must:1. Target homeless persons as defined by the State of MN which is: any

individual, unaccompanied youth or family that is without a permanent place to live that is fit for human habitation. Doubling-up is considered homeless; and

2. Must be either a drop-in center, overnight shelter-rotating church, congregate overnight shelter-fixed site, overnight shelter-motel voucher, congregate transitional housing, and/or street/mobile outreach program.

HIPAA Standards During COVID-19

Mental Health and Substance Use Disorders providers have had to adapt quickly in order to offer services to their clients during the COVID-19 pandemic. With the necessary shift to providing more services via telemedicine - or just over the phone - this raises questions about compliance with the Health Insurance Portability Accountability Act or HIPAA. It is very important for everyone to know that the Office for Civil Rights OCR will not be enforcing HIPPA violations for good faith efforts to provide telemedicine during the COVID-19 pandemic on any audio or video based platform, including video chats on skype, zoom, apple face-time, and other similar programs. However, this does not apply to public facing applications like FaceBook live or Twitch. To learn more, you can read the full bulletin from OCR.

The CARES Act repeals existing restrictions in 42 CFR Part 2 that prohibited records for patients with substance use disorders (SUDs) to be shared with other health care professionals, thus making it difficult for providers to coordinate integrated, whole-person care. In some cases, the dangerous restrictions led to patients with SUDs being inadvertently prescribed addictive substances in emergency rooms or other settings simply because the treating doctors weren’t aware of the SUDs.

DHS Guidance on Housing Support Rate Increase

The most recent state COVID-19 package included a temporary 15% rate increase for housing supports, formerly known as GRH. DHS is currently finalizing the details for this rate increase in the months of March, April, and May. However, here are the steps that providers should begin tracking all COVID-19 related expenses in order to maintain a safe and health environment for clients and staff. These expenses do not need to be tracked at an individual level. While details are still being finalized about reporting, the rate increase can be used to cover any expenses that are related to provision of room and board standards in response to federal or state health and safety guidance regarding COVID-19. Examples include, but are not limited to the following:

Costs for cleaning, hygiene, sanitation, or personal protection equipment for staff or residents.

Modifications for quarantine or isolation spaces in order to meet recommended guidelines from the Minnesota Department of Health.

Costs to maintain or reconfigure meal programs or meal delivery services. Costs to maintain staffing levels to ensure minimum room and board

standards are met. Costs to maintain staffing levels to ensure minimum supplemental service

standards are met.

For additional details, you can read the full bulletin from DHS.

COVID-19 and Housing

On March 23, 2020, Governor Walz signed Emergency Executive Order 20-14 suspending evictions and writs of recovery for the term of the COVID-19 peacetime emergency. This Executive Order keeps people stably housed and prevents displacement during this health emergency.

Note that evictions and terminations are allowed in cases where the tenant seriously endangers the safety of other residents or for violation of 504B.171, subd. 1 (certain unlawful activities).

This order took effect on March 24, 2020 at 5:00 p.m. and applies to households in their homes as of March 1, 2020. For more information about this order, please see Summary of Executive Order 20-14 and Frequently Asked Questions about Executive Order 20-14 (includes a referral list for property owners, renters, financial institutions, and borrowers).

What is Suspended During This Order?

Filing residential evictions Lease terminations Carrying out a Writ of Recovery: Enforcing an eviction through forcible

removal of a household by a sheriff or other officer

For Tenants:

Rent is not reduced or waived during this suspension. Once the suspension

has ended, owners can file for evictions and removals can be enforced. If you do not pay your rent, it could cause credit problems that will impact

future housing options and those payments are critical for landlords/owners to pay their bills.

Having trouble making rent? First, be in touch with your landlord right away. Reach out early to discuss potential payment plans or accommodations. Second, you may be eligible for assistance.

Local units of government (including counties and housing and redevelopment authorities) and nonprofits administer emergency assistance and short-term rental assistance programs that may be available. You may be eligible for other government programs as well depending on your circumstances.

Many programs, including emergency assistance, can be accessed through the Department of Human Services. Or you can reach out to your county through their website or by phone.

Short-term rental assistance through Minnesota Housing’s Family Homelessness Prevention program may also be available. Find your local program and contact them for assistance.

For other resources and referrals, please call: United Way 211: Free and confidential health and human services information

for people in Minnesota. Website: www.211unitedway.org Call: 211 or 651.291-0211 Toll Free: 800.543-7709 Text: Text your ZIP code to 898211 for information Text MNCOVID to 898211 for COVID Resources

*Language assistance available in Español (Spanish) and Hmong

COVID-19 and Criminal Justice

The House Public Safety and Criminal Justice Reform Finance and Policy committee will meet on Monday to discuss an Omnibus Intermediate Emergency COVID Response bill. The bill is largely in response to last week’s legislative recommendation by the Ombudsperson for the Department of Corrections that the Commissioner of Corrections be given authority to release low-risk people with less than 180 days left on their sentence from prison. NAMI has been in communication with the committee and offered these recommendations for criminal justice related COVID legislation.

NAMI additionally offered recommendations that the statute that requires release planning for people in prison with serious mental illnesses be amended to begin

planning earlier for those who may be considered for release during the pandemic. NAMI will continue to monitor this legislation.

On Friday, the Governor held a news briefing with several state leaders including Corrections Commissioner Paul Schnell. The Department of Corrections is updating testing results and information for families on their website. Commissioner Schnell said Friday that there have been seven confirmed positive cases in residents and one staff person at the Moose Lake facility, and thirteen residents and one staff person presumed positive due to symptoms. Two staff members at Red Wing have tested positive but so far, no youth have tested positive or show symptoms. In addition to implementing “stay-in-unit” measures to slow the spread of the virus in DOC facilities, Commissioner Schnell said that he is reviewing low-risk candidates with 90 days or less left on their sentences for work education and vocational training release.

Criminal Justice Issues

Department of Corrections Submits Qualitative Report on Solitary Confinement ProgrammingNAMI worked for several years and successfully passed legislation last session to restrict the use of solitary confinement in Minnesota prisons. In January, the Department of Corrections (DOC) submitted their first data report required by the law on the use of segregation in the prisons. Last week, the DOC submitted the required qualitative report on the measures, outcomes, and challenges to implementing a step-down management program.

The step-down management program is for people who are placed in restrictive housing, usually isolated for a minimum of 22 hours a day, because they have exhibited behaviors that are dangerous to the other residents or staff. The program’s goals are to provide evidence-based interventions and reintroduction of privileges to help people safely reintegrate into the general population. Before a person is eligible for the program, they must complete a mental health screen. Alternatives to the program must be provided if the program would be contrary to their mental health and well-being. You can read the DOC policy about the program here.

Though legislation was passed only last year, the report details the history of the DOC creating a step-down management program beginning in 2018. The report states an ideal period of three to five years to assess intervention program effectiveness, and notes that this report is informational in nature because there is not yet enough data to measure outcomes. The report includes data on the type and number of restricted housing beds in DOC facilities, details on the step-down program, and data on the number of days people in the program spend in restrictive housing.

These are some of the major points from the report:·      Three of the eight adult facilities with restrictive housing units currently have a step-down management program.·      Since 2018, there have been 83 participants that have either successfully completed the step-down program or been discharged for other reasons. Participants receive an average of seven months of programming. However, the report is not clear whether those discharged without completing the program were returned to restrictive housing or the general population.·      There is no additional funding outside of general facility budgets available to provide these programs and the report cites high burn out for staff due to the intensity of the services.·       Though some participants are successful, the report notes that the step-down program is the first cognitive skills programming many residents have completed while incarcerated.

Segregation can have detrimental effects on a person’s mental health and NAMI will continue to monitor this issue and advocate for increased programming, interventions, and mental health care throughout Minnesota prisons.

Sherburne Jail Lawsuit Alleges Inadequate Care in Death by SuicideThe Star Tribune reported this week that a lawsuit is being brought against several defendants involved in the 2017 death of a man in the Sherburne County jail. The lawsuit claims that 31-year-old James Lynas was not given appropriate attention while he was experiencing withdrawal symptoms from prescribed opioids, even after a physician’s assistant made an “urgent referral” for him to be seen by a qualified mental health professional. Even though Lynas indicated suicidal ideation in a form he filled out he was never put on suicide watch in the jail. Lynas’ family attorney claims that he was never given the appropriate attention by jail medical staff or the healthcare company MEnD Correctional Care. NAMI Minnesota has been working this year with stakeholders to update the administrative rules that govern jails and their treatment of people with mental illnesses. We will continue to advocate for incarcerated people to receive adequate mental health care and to increase and expand jail diversion programs across the state.

News from Federal Level

Federal Action

The Federal Government has issued guidance to ensure authorized practitioners may

admit and treat new patients with opioid use disorder (OUD) during the public health emergency. There is also an updated FAQ on the issue.

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.These temporary changes will ensure that patients have access to physicians and other providers while remaining safely at home.

Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.

CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.For additional background information on the waivers and rule changes, go here.

Federal Support for Mental Health Agencies

With the passage of the Federal Stimulus Bill last week, there are a number of opportunities for small businesses and non-profits to apply for grants and loans to weather the COVID-19 pandemic. Here are some options put together by the National Council that may be of interest to mental health providers and other NAMI supporters:

ECONOMIC INJURY DISASTER LOAN (EIDL)

Who is eligible? Small businesses and private non-profit organizations of any size are eligible for purposes of the EIDL program.

What does this loan do? EIDL provides loans of up to $2 million, with an emergency grant of up to $10,000. The advance funds will be made available within three days of

a successful application and will not have to be repaid. Beyond the advance loan, EIDLs may offer up to $2 million in assistance and can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. Even if the applicant is denied for the larger loan, they will not have to repay the $10,000 advance.

These loans may be used to provide paid sick leave to employees unable to work due to COVID-19, maintain payroll during business disruptions, meet increased costs arising from supply chain disruption, make rent or mortgage payments, and repay obligations that cannot be met due to revenue loss.

When and where can I apply? You can apply now and the application is available here .

PAYCHECK PROTECTION PROGRAM (PPP)

Who is eligible? The PPP is available to any 501(c)(3) non-profits that employ not more than either: 500 employees; the size standard established by the SBA for their industry; or a business that has more than one physical location (with 500 or fewer employees per location). Sole proprietors, independent contractors, and self-employed individuals are eligible for PPP loans, as well.

What does the program do? PPP authorized up to $349 billion to support employers in maintaining job retention and covering certain other expenses. Eligible recipients may qualify for a loan up to $10 million determined by 8 weeks of prior average payroll plus an additional 25% of that amount. Loan payments will be deferred for six months. If an employer maintains their workforce, SBA will forgive the portion of the loan proceeds that are used to cover the first 8 weeks of payroll and certain other expenses following loan origination.

The employer can use the proceeds on the loans for things such as payroll costs, benefits, interest on mortgage obligations, rent, and utilities.

When can I apply? Starting April 3, small businesses and sole proprietorships can apply for and receive loans to cover their payroll and other certain expenses through existing SBA lenders. Independent contractors and self-employed individuals can apply beginning April 10.

You can apply through any existing SBA lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Visit www.sba.gov for a list of SBA lenders. The application form can be found here.

FYI: An organization can apply for both a PPP and an EIDL, but cannot use them

towards the same expenses. For additional guidance, please see How does this program interact with SBA’s Economic Injury Disaster Loans (EIDL) found here .

EXCHANGE STABILIZATION FUND

The Department of the Treasury will establish an Exchange Stabilization Fund. $454 billion will be available as loans, loan guarantees, and investments for eligible states, municipalities and businesses. Legislation states that the Secretary of the Treasury should, to the extent possible, make loans and investments available to mid-size and non-profit organizations between 500 and 10,000 employees. The CARES Act requires the Treasury Secretary to publish procedures for application and minimum requirements by April 6, 2020.

PANDEMIC UNEMPLOYMENT ASSISTANCEA temporary Pandemic Unemployment Assistance program was created and will operate through December 31, 2020. This will provide payment to those not traditionally eligible for unemployment benefits (self-employed, independent contractors, those with limited work history, and others) who are unable to work as a direct result of the coronavirus public health emergency. The CARES Act provides payment to states to reimburse non-profits, government agencies, and Indian tribes for half of the costs they incur through December 31, 2020 to pay unemployment benefits.

In addition to these financial relief provisions, the CARES Act includes employee retention tax credits and a delay of payroll taxes through the end of the year. The National Council is working with outside counsel to provide comprehensive resources regarding these tax implications. Stay tuned for further guidance. (National Council)

Federal Commission on Law Enforcement Looks at Mental Illness and HomelessnessNAMI Minnesota submitted comments to the President’s Commission on Law Enforcement and the Administration of Justice. The Commission was created by a November 2019 Executive Order with the mandate to examine several topics relating to law enforcement including “How do certain social ills such as mental illness, substance abuse, and homelessness affect the ability of law enforcement to police?” Our letter addressed the disproportionate use of deadly force against people in a mental health crisis, the need to build the mental health system, especially crisis response systems, homelessness, and promoting mental health and wellness in law enforcement officers.

Updates from NAMI Minnesota

NAMI Minnesota Continues to Respond to COVID-19

Everyone is focused on COVID-19 - rightfully so - but it is important to remember that mental illnesses and substance use disorders are not going away during this pandemic. In many cases, symptoms will become more acute and people will need more support. In this trying time, please know that NAMI Minnesota is doing everything we can to ensure that people can still access the supports and services they need.

We are also working very hard to continue to deliver our classes and support groups online. You can find a full list of all upcoming classes here. These are presented by NAMI staff and mental health professionals and can be joined online through zoom. NAMI Minnesota is also offering online support groups, including groups for young people, the LGBTQ community, parents and family members. NAMI Minnesota also maintains a resource list if you have more questions about COVID-19.

Despite the sustained efforts of NAMI Minnesota and our partners, we know that it's still not good enough. If you or a loved one are experiencing challenges accessing mental health services, please contact NAMI Minnesota and let us know what isn't working. Whether it's challenges with in-home services or issues obtaining support via telemedicine, it is very important that we hear about gaps in our mental health system. We already know that hundreds of people not only don't have laptops to connect for telehealth, they don't even have phones.

If you are a provider, we want to hear from you as well.  We are especially interested in problems people are having with payments for telemedicine such as if telephone calls are actually getting covered and, if so are they getting reimbursed at the same rate that the corresponding in-person service would be reimbursed at, or if reimbursements are being denied because the provider is an essential worker and therefore could have provided the service in-person instead of via telemedicine or the provider is being required to use a specific platform such as Doctor On Demand and you can’t use Zoom or FaceTime.

Thank you everyone for your support of NAMI Minnesota and people with mental illnesses during this challenging time.

NAMI Legislative Committee

Meetings are held on the second Tuesday of every month at 6 PM and in April will be by phone or zoom. To be added to the email list, contact Sam Smith.

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