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News & Press: Legislation/Policy

March Legislative Report

Friday, March 2, 2018   (0 Comments)
Posted by: Allan Wachendorfer
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You can get national legislative updates here: https://www.socialworkers.org/advocacy/washington-update

 

 

March LSP Update

Allan Wachendorfer

Noah Smith

 

Sexual Assault Package

A series of bills have recently been introduced following the sexual assault scandal of sports doctor Larry Nassar. One particular bi-partisan bill package, moving swiftly, was introduced, heard testimony, and passed out of Senate Judiciary all on the same day. The package includes Senate Bills 871-880. NASW-Michigan will continue to follow this and all related legislation keep members updated, and weigh in where and when it is appropriate. Briefly:

       SB 871 (O’Brien) eliminates the statute of limitations for 2nd degree criminal sexual conduct (CSC) violations in which the victim was under 18 and extend the statute of limitations for 3rd degree CSC to 30 years after the offense or 30 after the victim turns 18, whichever is later. Currently the limitation is 10 years or age 21 of the victim, whichever is later 

       SB 872 (Knezek) extends the statute of limitations for CSC retroactively, and adds a grace period for minor victims

       SB 873 (O’Brien) would amend the Child Protection Law to extend reporting requirements to individuals employed in a professional capacity at a postsecondary educational institution and K-12 sports coaches and volunteers

       SB 874 and 880 (Jones) would increase the criminal penalties for failure of a mandated reporter to report from a 90-day misdemeanor to a 2-year felony

       SB 875 (O’Brien) Allows a survivor of child sexual abuse to file a Notice of Intent in a manner that protects his or her identity throughout the proceedings

       SB 876 (Horn) would amend the Revised Judicature Act to specify that periods of limitations for claims against the State would not apply to a claim of sexual misconduct committed against an individual who was less than 18 years of age.

       SB 877 (Knollenberg) ends governmental immunity for those who engage in childhood sexual abuse and those who enable childhood sexual abuse

       SB 878 (Hertel) and SB 879 (O’Brien) increases the maximum criminal penalty for aggravated possession of heinous Child Sexually Abusive Material (CSAM) and over 100 images of CSAM to 10 years in prison and $50,000 fine. Also creates a mandatory minimum sentence of 5 years for repeat offenders.

CARES Task Force Update

As previously reported in January, the Michigan House of Representatives released their House C.A.R.E.S. Task Force final report. https://house.mi.gov/PDFs/HouseCARESTaskForceReport.pdf

 

The House C.A.R.E.S. (Community, Access, Resources, Education, and Safety) Task Force was a bipartisan group of legislators from the House of Representatives who aimed to identify problems and solutions for the Michigan mental health system, specifically where it intersects with criminal justice. The new report outlines a number of possible solutions that could help enhance current services, and reduce existing barriers to mental health care.

 

Last month we reported on a number of bills that were recently introduced in response to the report. Below are bills that have either advanced since last reported or have been recently introduced:

 

HB 5439 would require the MDHHS to create and administer an electronic inpatient psychiatric bed registry for the purposes of identifying available beds in Michigan. The bill recently passed the House and now moves to the Senate Health Policy Committee for consideration – NASW supported

 

HB 5524 requires MDE and MDHHS to create a professional development course in "mental health first aid" for teachers identifying potential risk factors and warning signs, strategies for dealing with a crisis are included. The bill recently passed the House and now moves to the Senate Health Policy Committee for consideration – NASW supported

 

HB 5619 prioritizes individuals with certain mental illnesses and foster care children for CMH services. Currently, the Mental Health Code requires CMH to give priority to services for individuals with the most severe forms of serious mental illness, serious emotional disturbance, or developmental disability and for those with less severe forms who are in urgent or emergency situations. The bill would remove the term “most severe” and replace it with a list of priority populations including:

       schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive compulsive disorder, delusional disorder, psychotic disorder not attributable to general medical condition, or borderline personality disorder, including any of the preceding co-occurring with substance use disorders;

       Individuals with a serious mental illness or serious emotional disturbance whose level of functioning is determined to be severely impaired based on a DHHS-approved instrument for measuring severity of condition;

       and children who require any level of mental health treatment and who are placed by DHHS into residential foster care.

 

Proponents maintain that to some degree this may help provide consistency across the state, whereas now the level of subjectivity and resources available in each CMH allows for inconsistency – ultimately leading to geography-based service determination. Proponents note that priority status does not guarantee acceptance for services or particular types of services and doesn’t preclude CMH from accepting non-priority status individuals. However, Medicaid services, if deemed required, must be provided promptly and a majority of state funding must be spent on priority clients.

 

Opponents maintain that this will take away local experts’ discretion to provide services based on need. If consistency across counties is to be reached we need to look at bolstering resources in counties that currently lack them. Striking out “most severe” potentially blurs the lines between the PIHP and HMO service populations and may be interpreted as shifting the responsibility for mild to moderate mental illnesses to the CMH without the shift of funding needed to provide those services. Opponents also argue the bill would create budget constraints by prioritizing foster children who may otherwise be served by the HMO system.

 

CMH Association Publishes Special Edition Newsletter on Gun Violence and Mental Health

From the CMH Association of Michigan: With the recent school shooting in Parkland, Florida, communities across the country, policy makers, high school students, families, members of the law enforcement and mental health communities are expressing their grief, often accompanied by outrage, and their commitment to addressing the causes of gun violence in this country. In an effort to foster a fact and research based approach to addressing gun violence, this association published, earlier this week, a Special Edition of the Friday Facts, focused solely on gun violence and mental health. This edition compiled some of the best thinking on this issue. Note, that this Association is not advocating any specific approach to reducing gun violence. Our hope is that some of the myths that drive this debate can be replaced with facts and that the information and views contained in this special edition will support clear-headed thinking and concrete action to halt gun violence in America. This special edition of Friday Facts can be found at: https://www.macmhb.org/sites/default/files/attachments/files/special edition -  gun violence and mental health 022118.pdf

 

Ongoing Budget Issue: Disabled, Aged, and Blind Medicaid

Medicaid redeterminations may be unintentionally hurting providers and clients. Over the past 2 years there has been a significant shift in enrollment patterns for Medicaid clients at a time when enrollment continues to increase. Almost 12,000 people statewide have been transferred from DAB -  a Medicaid program set-up specifically for the Disabled, Aged 65+, and Blind - to the Healthy Michigan Plan (HMP). According to the Community Mental Health Association of Michigan, this costs Community Mental Health providers across the state millions of dollars.

 

How? The current capitated rate for the DAB program is $262.39, while the Healthy Michigan Plan rate is only $27.30. From fiscal year 2016 to fiscal year 2017 the average monthly DAB enrollment dropped by 10,866 individuals, which represents a potential $29 million loss for the service providers. This could be even worse if those who left the DAB program were moved to the TANF program. In that case, the yearly losses would be as much as $32 million. Lending support to the theory that enrollment shifting is occurring is that during the same time period DAB enrollment decreased, overall Medicaid enrollment increased by 87,103 people. The CMHAM believes that the DAB issue has left a nearly $100 million hole in CMH budgets across the state. They are currently asking the legislature for a budget supplemental to cover the past losses and come up with a permanent fix in the future budgets.  

 

This shift affects not only the budgets of the service providers, but also the well-being of the clients. Those who are enrolled in DAB have their benefits protected as an entitlement, which means that changes to services must be medically necessary. Those who are enrolled in the HMP are not protected by this and their costs could rise after 48 months in the program.

It is not clear why or how this is being done. It is possible that caseworkers are making the enrollment changes thinking they are helping their clients. However, it is clear that this is not helping. NASW-Michigan is hoping to raise awareness of this issue so that social workers will ensure that this is not happening in their county offices. -Erik Fuller is an MSW Intern with NASW-Michigan. Please direct questions to policy@nasw-michigan.org

 

Changes to Healthy Michigan Plan

Beginning April 1, 2018, the State of Michigan will begin to transfer some Healthy Michigan Plan enrollees to a Michigan Marketplace insurance plan. You may recall that when Michigan passed the Medicaid expansion (Healthy Michigan Plan) under the Affordable Care Act (ACA), one stipulation was that there be incentives to participate in “healthy behaviors,” in addition to cost-sharing and other “skin in the game” incentives. In the recent past, cost-sharing was increased for individuals who were not making an initiative to improve their health through what are deemed “health behaviors.” This new change aligns with that and begins to shift those individuals into the private marketplace with some state assistance continuing to help with cost.

Beneficiaries will be required to transition to the MI Marketplace Option if they meet all of the following criteria:

       Have been enrolled in a Healthy Michigan Plan health plan for twelve (12) consecutive months or more (note: this does not apply to beneficiaries in FFS)

       Have incomes above 100% of the federal poverty level (FPL)

       Are age 21 years or older

       Are not pregnant

       Are not American Indian or Alaska Native

       Do not have cost-share exempt status

       Have not completed a “healthy behavior”, and

       Are not medically exempt.

Beneficiaries enrolled in the MI Marketplace Option will receive health care benefits through enrollment in participating MI Marketplace Option health plans. These health plans will be distinct from the current Healthy Michigan Plan health plans. Additionally, certain services not covered under MI Marketplace Option health plans may be covered through Medicaid Fee-for-Service (FFS) – as Essential Health Benefits (EHB) are still required under the ACA. Beneficiaries who are not required to enroll in the MI Marketplace Option will continue to receive their health care benefits through Healthy Michigan Plan health plans.

Providers who want to participate with MI Marketplace Option health plans will be required to enroll with each health plan. (compiled with excerpts from DHHS March 2018 policy bulletin) If you want to read more about the new policy, you can find the complete bulletin here: http://www.michigan.gov/documents/mdhhs/MSA_18-05_615825_7.pdf

Medicaid Managed Care Provider Enrollment Requirements CHAMPS

This applies to everyone who serves Medicaid clients: Recently, the Michigan Department of Health and Human Services (MDHHS) announced federal regulations under the Affordable Care Act and 21st Century Cures Act that require all providers who serve Michigan Medicaid beneficiaries, including providers participating in a Managed Care Organization’s (MCO) provider network, to be screened and enrolled in the Michigan Medicaid program. The regulations prohibit payment to providers who are not appropriately screened and enrolled.

 

Due to the overwhelming response from providers, MDHHS will be extending both the implementation dates of March 1 for denying claims for typical (licensed health professional) non-enrolled providers, and May 1 for denying pharmacy claims for non-enrolled prescribers. While compliance is still mandated, the department will continue to work with federal partners toward state implementation timelines that allow beneficiary access to care. Despite the delays, MDHHS continues to encourage providers to enroll as soon as possible using the state’s online Medicaid enrollment and billing system, Community Health Automated Medicaid Processing System (CHAMPS). MDHHS will monitor enrollment processing time and determine new enforcement dates.

 

Providers enrolling in CHAMPS are divided into two categories: typical and atypical. Typical providers are professional health care providers that provide health care services to beneficiaries (including social workers). Atypical providers provide support services for beneficiaries (such as peer supports). Atypical providers are slated to be mandated for addition to CHAMPS next fall. (compiled with experts from Feb 2018 DHHS press release)

 

For information about the Provider Enrollment process, visit: http://www.michigan.gov/MedicaidProviders and click on Provider Enrollment

 

Michigan Accepts Bids for 298 Pilots

Below are excerpts from a recent Crain’s Detroit Business article on the Section 298 pilot initiatives:

 

Michigan has received bids from community health agencies to participate in up to three regional pilot projects to test combining behavioral health and physical health services in the Medicaid system. Under what is known as Section 298, named after a budget section the Legislature approved last year, Michigan will test the pilot projects over the next several years to determine if costs can be reduced, quality improved and services expanded using a managed care approach.

 

Originally, Medicaid health plans lobbied legislators in 2016 to have them manage the state's $2.6 billion Medicaid behavioral health system. The managed care organizations, some of which are for-profit companies, already manage a nearly $9 billion Medicaid physical health system.

 

But state officials only allowed the quasi-public community mental health agencies, which currently manage Medicaid behavioral health services, to submit proposals. However, several Medicaid health plans will participate in the pilots in ways the state has yet to specify. The Michigan Department of Health and Human Services plans to hear oral presentations of the proposals March 1-2; announce pilot decisions March 9; complete contracts and other details by July 1; and have the pilots fully implemented by Oct. 1.

 

Last year, the Legislature allowed for a fourth pilot to be allowed in Kent County, but the local mental health agency, Network 180 in Grand Rapids, was unable to find a Medicaid health plan to participate. In a statement, the Community Mental Health Association of Michigan said it supports the range of innovative submissions delivered by state community mental health organizations. "We commend the community mental health organizations and leaders across the entire state," CEO Robert Sheehan of CMHAM said in a statement. "The system's value lies in our ability to develop innovative integrated health care practices in communities of all types and sizes, and we must continue to work together for the state's mental health safety net, as well as serving some of Michigan's most vulnerable public citizens."

 

CMHAM said themes represented in the submitted applications included: public and private partnerships; advanced integrated models of behavioral and physical health care using traditional and nontraditional (housing and employment) services; and fostering person-centered care through collaboration.

 

While only community mental health agencies were considered "qualified applicants" by the state, the Michigan Association of Health Plans submitted its own pilot proposal for discussion purposes, said Dominick Pallone, the association's executive director. Pallone said that proposal is what the Medicaid HMOs believe should be the model for integrating behavioral and physical health care. "Our approach would allow the health plan to contract with the community mental health (agency) and also with direct care service providers to enhance the network of credentialed behavioral health providers," Pallone said in an email to Crain's. "This approach would promote individual consumer choice of provider networks and would eliminate county geographic restrictions that exist today," he said.

 

Under the proposal, care management and care coordination would be aligned between the health plan, community mental health agency, the provider, enrollee and family. The system would follow an "integrated care team" approach, which would be patient-centered, he said. Medicaid health plan involvement in pilots: When devising the pilot standards, state officials concluded that enabling regulations prevented allowing Medicaid HMOs to be lead applicants for the pilots, Pallone said. "We disagreed and suggested that the Legislature could remove any perceived statutory barrier similar to the way they acted to amend the Social Welfare Act to allow health plans to hold the contract for the purposes of the pilot," Pallone said.

 

However, state officials decided only community mental health agencies could apply for the pilots, but the "HMO would ultimately hold the contract." State officials did not release the number or whereabouts of pilot proposals. However, Pallone said he believes some of the pilot proposals have been submitted in Muskegon, Saginaw County, Ludington and Genesee County.

 

The four pilot proposals with which Pallone said he is familiar promote programs the agencies are already doing; they propose to give state mental health Medicaid funds to the health plans, which will reimburse the mental health agencies for services so they can pay providers. "All propose managing their own providers (and performing) care management," he said. "All would increase co-location or reference the co-location of clinical services they are already doing, and all would suggest that they would assume the responsibility for the mild to moderate population that is currently the responsibility of the health plan. Pallone said the Medicaid health plans have been promised by MDHHS that if the final plans for integration fail to show meaningful progress in financial, clinical and operation integration "then it's not likely the pilots actually get off the ground even if the department selects them from the RFI process. "

 

Section 298 has undergone several revisions over the past year, the last being Feb. 9 when the state updated its timeline for the request for information and amended its financing model.

 

National Budget Update

From the National Office of NASW: In the early morning hours of Friday, February 9, by a vote in the Senate of 71-28 and 240-186 in the House, Congress passed, and the President signed a bipartisan budget deal. The Bipartisan Budget Act of 2018:

  • Increases federal spending by about $400 billion over the next two-years;
  • Outlines two-year spending cap levels, which raise nondefense by $63 billion in Fiscal Year (FY) 2018 and $68 billion in FY19 and raise defense spending by $80 billion in FY18 and $85 billion in FY19;
  • Creates another six-week continuing resolution (CR) - funding the government until March 23 - so Congress can rally around a FY18 Omnibus spending package;
  • Raises the Debt Limit through March 1, 2019;
  • Adds $89.3 billion in disaster aid; and
  • Extends and addresses a number of outstanding Medicare provisions and other legislative priorities.

 

Coming in at just over 600 pages, the budget package contains many provisions that impact the social work profession and our clients.  Below are key highlights of this budget compromise:

 

Extends Children Health Insurance Program (CHIP):

The Congressional Budget Office (CBO) found that the longer Congress funded CHIP, the more money it saved.  CBO's findings prompted Congress to act and pass another four-year extension to CHIP in this budget bill.  The four-year addition, along with the six-year extension passed in January's CR, means CHIP is reauthorized for another 10 years!  This is a major win for more than nine million children and families.

 

Prioritizes Mental Health and Addiction Treatment:

NASW members know firsthand the importance of mental health and have seen the direct impact the opioid epidemic has had on our communities and clients.  In the Bipartisan Budget Act of 2018, Congress authorized $6 billion over two years for mental health programs and to combat the opioid crisis.  While there is more work to be done, Congress' actions are a step in the right direction and these resources are vital to our efforts.

 

Supports Public Health Programs:

Community Health Centers (CHCs): After being passed over in January's CR, CHCs received an extension and a mandatory funding increase in the Bipartisan Budget Act of 2018.  Originally funded at $3.6 billion per year, CHCs will now receive $3.8 billion for FY18 and $4 billion for FY19.  Supplemental grants are also authorized for centers that implement "evidence-based models that increase access to high-quality primary care."  This is a top priority for NASW, and we are happy to see this increase and extension of the CHCs.

 

National Health Service Corps: Supported by both Democrats and Republicans the National Health Service Corps received a two-year extension of current funding, $310 million per year, for both FY18 and FY19.  These funds ensure that clients in areas of national need continue to receive the health care services they rely upon.

 

Includes Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program:

After concerns last month that MIECHV programs could face an enrollment freeze adversely impacting children and families, Congress finally acted!  Under the Bipartisan Budget Act of 2018, MIECHV will receive level funding of $400 million per year for FY18 through FY22.  NASW has been an ardent supporter of MIECHV and is pleased to see a four-year extension to this valuable program.

 

Focuses on Family Services:

The spending bill also included the Family First Prevention Services Act (FFPA), a longstanding priority for many focused-on child welfare reform efforts.

 

States will also have access to federal funds available under IV-B and IV-E programs that focus on:

  • Partial federal reimbursements for states to provide "services that enable children to remain safely at home, or with a kin care provider, instead of entering foster care."  These services range from mental health and substance abuse prevention and treatment services to parenting skills training.
  • Continued funding for Child Welfare Services program and the Promoting Safe and Stable Families program through FY2021.
  • An additional $8 million in FY18 for grants to support the recruitment and retention of high-quality foster families.
  • Reauthorizing adoption and legal guardianship incentive programs at the same level, $43 million, per year through FY2022.
  • Providing $5.8 billion for Child Care Development Block Grants.

 

Included in the FFPA is also a provision from the bipartisan Child Welfare Oversight and Accountability Act, requiring States to compile an annual child maltreatment death data and provide information on what States are doing to develop and implement statewide multidisciplinary fatality prevention plans.


Other Key Provisions:

The budget deal also includes various Medicare extenders, one-year extension to a number of tax breaks, the closing the Medicare Part D prescription drug benefit "donut hole" in 2019 - a year earlier than anticipated, and a permanent repeal to the Medicare therapy cap.  In addition to other funding efforts, $4 billion was allocated to rebuild veterans' hospitals and clinics and $20 billion was included for infrastructure projects, such as, surface transportation and clean drinking water.

 

Overall Non-Defense Analysis

According to the Center for Budget and Policies Priorities (CBPP), the bipartisan Congressional  budget deal would substantially boost overall non-defense appropriations - these appropriations fund programs including education, job training, and infrastructure.  The problem with the deal is that are funded at levels that are below the rate of inflation covering the past eight years.  Therefore, these programs will essentially remain under funded during the two-year period of the budget agreement.

 

The budget agreement did raise the limits on both defense and non-defense spending for 2018 and 2019. However, because the 2011 Budget Control Act and sequestration process kept those appropriations so low, any increase only moves the budgets to a level to meet realistic budget needs. For example, the new agreement would raise the non-defense cap by $63 billion in 2018 and $68 billion in 2019, as compared to where they were at the sequestration levels. This will help mitigate some of the harm done in the past, and help meet the needs of vulnerable households.

 

Department of Justice

The Justice Roundtable and other criminal justice coalition are concerned that the two-year Congressional budget deal will leave crucial programs in jeopardy- a number of key programs are slated for cuts.  The concerns of the advocacy community are that DOJ programs have to be funded at levels that meet the growing needs. We are focusing on funding of DOJ's Office of Justice Programs (OJP). Of particular concern are;

  • Office of Violence Against Women, and
  • COPS Office in the final FY18 and FY19

The problem is that federal funding to support of these programs has declined steeply in recent years. Since FY10, the state and local justice assistance grant programs have been cut by up to 40 percent.  The coalitions are fighting against any further reductions in these programs.

 

What's next?

While the passage of the Bipartisan Budget Act of 2018 averted another government shutdown, there are still many legislative items on the "to-do" list.  Outstanding priorities impacting NASW members and clients in the coming weeks, include:

 

Deferred Action for Childhood Arrivals (DACA)/Dreamers Bill:

One item that did not make it into this budget agreement was a DACA solution.  With the March 5, 2018 deadline fast approaching, Congress has only a few short weeks to reverse Trump's decision to rescind DACA and protect 800,000 young people and their families.  As Congress works to find a compromise, NASW continues to express the need to protect this program and is working diligently to hold Congress accountable to find a solution before the March deadline. The Supreme Court declined to take up a key case dealing with the DACA program. The result is DACA will stay in place until, or if, the Supreme Court takes it up.

 

Stabilization of Health Insurance Markets:

While a bipartisan priority, this effort has taken a backseat in recent weeks.  Congress, however, will need to get back on track and focus on health care marketplace stabilization efforts.  This includes passing bipartisan solutions to avoid drastic premium hikes in 2019 and to stunt the exodus of insurers from the marketplace. NASW is committed to the stabilization of the health care marketplace so all citizens have access to high-quality, affordable health care.

 

President's Budget:

The President's FY19 budget is expected to be unveiled this week.  The President's budget is offered to Congress as a blueprint of the Administration's federal priorities and informally kicks off the Congressional appropriation season.  While the President's budget is unlikely to comport with the spending deal reached last week, Congress will ultimately work through its own process to set programmatic funding for FY19. As always, the President's budget will serve more as a signal to Congress of policy priorities for the year ahead rather than a strict spending plan.

 

FY18 and FY19 Funding of the Federal Government:

The six-week long CR, agreed upon in the Bipartisan Budget Act of 2018, gives Congress until March 23, 2018 to coalesce around an Omnibus FY18 budget plan.  Should an Omnibus deal go through, it would fund the federal government through the end of FY18 - September 30, 2018.

 

While Congress continues to finalize the FY18 budget, they will also kick off the FY19 appropriation season.  We are hopeful that with the two-year budget deal and set spending caps, the FY19 process will run smoother than the FY18's budgetary rollercoaster. Time will tell.

 

Throughout these conversations, NASW will continue to voice our support for funding federal programs imperative to social workers, the broader profession, and our clients.  As we look ahead to FY19, we will keep you updated on areas where you can weigh in and voice your support for these vital federal initiatives.

 

Washington Update

https://www.socialworkers.org/advocacy/washington-update

 

 


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