Opioid Tax: CORI’s top priority during the 2019 legislative session was securing funds to help stem the tide of opioid deaths. Legislation passed, raising $20,000,000 in future years, plus current appropriations for support of the SRHN (an anti-opioid advocacy and naloxone distribution group) and Minnesota Recovery Connection (community-based support group, including recovery coaches).
1115 Waiver: CORI continued to work on implementation of the Medical Assistance Waiver using MA funds to match at 50% level community-based treatment services.
Corrections: CORI advocated for improving treatment services for offenders entering the criminal justice and social service system. We continued to advocate for more specialty courts for persons charged with a crime or in juvenile court, as the vast percentage of those individuals have substance use disorder and should be diverted to health and community support services.
Opioid Funding: CORI’s top priority during the 2018 legislative session was securing funds to help stem the tide of opioid deaths in the State of Minnesota. It was important to CORI and its members that pharmaceutical companies be held accountable for the damage they have done. We fought to impose a “Penny a Pill” and a fee on the drug manufactures but ran into resistance by a wall of pharmaceutical lobbyist in the last
days of the legislature. Ultimately, the MN House would not hold pharmaceutical companies accountable and funded some additional resources out of the state general fund, which meant the State’s taxpayers, were on the hook and not big pharma. The 2018 legislative
session ended with vetoes of major finance and tax bills because the Governor and the Legislature could not come to agreement on major legislative package, which means we will have to gear up to fight again during the 2019 legislative session.
1115 Waiver for Substance Use Disorder: Carried forward from 2016, funding for this waiver was again CORI’s top priority for the 2017 session. The Medicaid SUD (Substance Use Disorder) Waiver Request to HHS includes changes that will draw federal Medicaid funding primarily by using existing state funds and will start treating the disease as one that needs ongoing support after treatment to improve client success. Specific issue areas include:
- Direct access/comprehensive assessments
- Withdrawal management
- Care coordination
- Direct reimbursement
- Peer support
If granted, the waiver generates federal funding to supplement existing state funding – adding an estimated $50,000,000 to SUD programs and services.
Detox Funding: $7,000,000 was included in this waiver proposal to pay for the county share of detox in 2020/21, again to be supplemented by Medicaid. This funding will allow counties to reopen detox centers and provide a stable funding source for existing centers. Due to capacity and reimbursement issues, detox centers in hospitals will discharge as soon as the medical crisis is stabilized rather than retain substance users for a day or two while locating in-patient treatment.
Recovery School Funding: Money to expand two recovery schools in Rochester and St. Cloud was in the K-12 bill. Current base funding is $500,000 per year for the existing four schools – that number has now increased to $750,000 for all six schools; transportation is also a permissible use of these funds.
UJAMAA Place: Again included in equity funding $600,000 in ’18 & ’19, allowing continued expansion of their services for young-adult minority males exiting the prison system. They will then be put in a competitive grant program in 2020/21.
Treatment Courts: The state appropriated $1.7M per year for treatment courts to stabilize the program. This is the first major commitment from the state to fund these highly effective programs diverting substance users from incarceration to accountable, structured rehabilitation.
1115 Waiver for Substance Use Disorder: This legislation was CORI’s top priority for the 2016 session. The bill directs the Commissioner of DHS to seek the federal waiver and present an update to the legislature by February 1, 2017. If the Centers for Medicare and Medicaid Services (CMS) grant Minnesota’s waiver application, it will bring a substantial amount of additional federal funding to improve our continuum of care for individuals with substance use disorder; for example, additional resources would be available for transportation, employment, and housing needs. In addition, the waiver would allow for exclusions to the IMD rule, which would continue to allow our providers that have more than 16 beds to receive Medicaid funds.
IMD: Since DHS recently began classifying chemical dependency treatment providers as Institutions of Mental Disease (IMDs) any providers with over 16 beds can no longer receive federal funding. $2 Million was appropriated one-time to reduce the county share for IMDs in anticipation of a longer term solution, in the form of an IMD exclusion, as a part of the 1115 waiver.
UJAMAA Place: Ujamaa Place serves young African American men, many of whom lack a GED or are currently testing at a grade school level educationally, and/or are homeless, unemployed, have mental health issues, chemical health issues, etc. CORI secured a $600,000 appropriation in ongoing funding each year to greatly expand the number of individuals they are able to serve.
Peer Support Services: Only 10% of adults who need treatment for addiction actually get services, Peer Recovery Support Services offer individualized guidance and help before, during, and long after treatment. CORI secured grant funding for Recovery Community Organizations to provide these services across the state. Peer recovery support services are non-clinical, peer-run services that rebuild lives, reduce costs, and empower individuals in recovery to stay sober and improve their lives. CORI secured an appropriation in the amount of $34,000 in 2017, $725,000 in 2018, and $725,000 in 2019
Drug Sentencing Reform: CORI supported the effort to pass significant reforms to Minnesota’s drug sentencing guidelines. The bill that was passed met 3 of CORI’s priorities for this legislative session: funding for specialty courts, eliminating the need for an additional state prison, and additional CD treatment beds in the Department of Corrections. Each provision is outlined below.
- Specialty Courts
- The drug sentencing reform bill creates a Community Justice Reinvestment Account – in short, the account will fund CD and mental health treatment as well as drug courts. Based on substantial reforms included in the bill, there is an anticipated savings that has been estimated at $10 million over the next biennium that will be put into this account. Funding drug courts is a spending priority for these resources. In addition, by eliminating some of the low-level minimum sentences, more offenders will have access to programs like drug courts, in lieu of incarceration.
- Eliminating the need for an additional state prison
- Currently, approximately 500 inmates are being housed in county jails for their prison sentence because all of the DOC facilities are at capacity. The reforms included in this bill will have a bed savings of approximately 700 beds, eliminating the need for the Department of Corrections to build another prison or lease the facility in Appleton.
- Additional Treatment Beds in the DOC
- The bill provides funding for 70 new chemical dependency/mental health treatment beds. Additionally, $250,000 is appropriated to fund CD release planners for the prisons in Stillwater and Shakopee.
Prescription Monitoring Program: The House and Senate were able to come to an agreement to several reforms to the PMP bill. Perhaps the most important to CORI is required registration of all prescribers to the program.
Expanded Access to Naloxone: Varied stakeholders were able to come to an agreement in expanding the ability of pharmacists to dispense naloxone.
Pharmacy Takeback: Allows pharmacies to accept unused or unwanted drugs from individuals or long term care facilities on behalf of the user for disposal.
Fetal Alcohol Spectrum Disorder: Requires training on Fetal Alcohol Spectrum Disorders for foster care providers. Minnesota is the first state to make this requirement. Researchers have found that rates of FASD children in foster care are as much as 10 times higher than the general population.
U of M Rochester Collegiate Recovery: Provides funding to design and implement a collegiate recovery program at the Rochester campus of the University of Minnesota. $100,000 one-time appropriation in 2017.
Student Support Services: Provides funding for additional student support services personnel, which includes individuals licensed to serve as school counselors, school psychologists, school social workers, school nurses or chemical dependency counselors. $12.13 million one-time funding in 2017.
Full Service Community Schools: Provides funding for full-service community schools, which allow schools to assess and provide for the needs of low-income students by partnering with community-based organizations. The schools are designed to become hubs for academic, social and health services. $1 million one-time funding in 2017.
Addiction Medicine Fellowship at HCMC: Trains physicians in treatment for opioid dependence, alcohol dependence treatment, medication assisted therapy, mental health intervention, pregnant women’s care coordination, and psychiatric services. $210,000 in 2017 to support up to four physicians in the program.
Excellence in Mental Health Act: This bill allows the state to compete for federal dollars to do a pilot program to improve access and coordination for mental health and addiction treatment. The clinics would provide treatment, as well as connect patients with resources to help them find housing, jobs and other services. Fully funded with $188,000 in 2017, $5.1 million in 2018, and $3.3 million in 2019.
Specialty Courts: CORI secured $700,000 to fund Minnesota’s specialty courts, which include drug, DWI, veteran, and mental health courts. These courts are cost-effective and smart on crime, but more importantly, they’re the right thing to do. Specialty courts emphasize rehabilitation over retribution in the criminal justice system.
Steve’s Law: CORI secured $290,000 to fund the implementation of Steve’s Law, which is already saving lives in Minnesota by preventing overdose deaths.
Poison Control Center: CORI secured $1.5 million in funding for Minnesota’s Poison Control Center, which provides poison information on medicine to thousands of callers annually while consulting on tens of thousands of exposures.
Fetal Alcohol Syndrome: CORI secured $500,000 in funding to support initiatives that eliminate alcohol consumption during pregnancy and improve the lives of those living with Fetal Alcohol Spectrum Disorders.
Child Protection Oversight: CORI secured $52 million for greater funding in this area in recognition of addiction’s impact on child welfare in Minnesota, particularly in light of the ballooning opioid problem in the state.
Integrated Care for High Risk Pregnant Women: CORI secured $271,000 for a program that provides targeted, integrated services for pregnant mothers who are at high risk of poor birth outcomes due to drug use or low birth weight in areas of high need.
Behavioral Health Homes: CORI secured $6.9 million for behavioral health homes. The Chemical and Mental Health Services and Health Care Administrations of the Department of Human Services are working together to design a behavioral health home model which will ensure access to and coordinated delivery of primary care and behavioral health services for adults and children with serious mental illness.
School-Based diversion for students with co-occurring disorders: CORI secured $65,000 in funding to implement a decision-making protocol for responding to behavioral incidents involving students. The model is designed to ensure timely referrals to mental health and substance use disorder screening, assessment, and treatment for youth at risk of involvement with the juvenile justice system, provide stronger connections between schools, and support more involvement from families.
Building community capacity to address adverse childhood experiences: CORI secured $796,000 in funding to support programming that targets adverse childhood experiences. The initiative consists of making grants to support an array of mutually reinforcing activities (awareness raising, cross-sector collaboration, capacity building, data analysis and learning) among Children’s Mental Health and Family Services Collaboratives around a common agenda of preventing, reducing and mitigating ACEs. By increasing collaborative leadership, development and community capacity, communities will decrease the incidence of ACEs in children’s lives. The resulting improvements in child resilience will decrease mental, behavioral, and physical disorders.
Opioid prescribing improvement and monitoring program: CORI secured $33,000 for the program, which works to reduce inappropriate opioid analgesia prescribing by monitoring the prescription of painkillers and developing protocols for their appropriate distribution.
Expanding the Minnesota Restricted Recipient Program (MRRP): CORI achieved net savings for MRRP, which identifies public recipients who have abused services and manages the cases throughout the restriction period. The MRRP intervenes and works to prevent the abuse of medical services but also ensures that the recipient’s medical care is appropriate and coordinated by a primary care clinician.
Recovery Schools: The House, Senate, and Governor all agreed that funding recovery schools was a priority in this years budget and as a result $500,000 was dedicated to funding the four remaining recovery schools in Minnesota in 2015 as well as $1 million in 2016/17.
Detox Centers: CORI worked with the Department of Human Services to overhaul state detox policy which will allow Minnesota to become eligible to receive Medicare funds from the federal government.
Steve’s Law: CORI worked with advocates of the Naloxone bill to help pass it through the Minnesota Legislature.
MN Nurse’s Association: CORI supported the MN Nurses Association to provide reporting and treatment options for professionals with chemical dependency issues.
ACA Implementation: Because CORI was instrumental in passing funding for detox, the department has committed to having a broader discussion about funding mechanisms around the ACA and local partners responsibilities where matching funds are concerned.