ATTACHMENT 20. Highlight/Summary

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1 ATTACHMENT 20 SAPT Director s Report for April 2016 LRE Board Meeting Highlight/Summary 1. Marijuana Update 1 All three ballot initiatives said to be falling short of required signature 2. Marijuana Update 2 Senator Arlan Meekhof blocks package of bills to allow marijuana regulation 3. Section 298 Workgroup Report

2 1. Marijuana Update 1 Ballot Initiatives: There have been three separate ballot initiative efforts to decriminalize possession and use of marijuana in Michigan. Reports in the Detroit Free Press (inserted below) provides an update on how these campaigns are going. I provide it for information only. Detroit Free Press Hopes dim for fall ballot measures to legalize pot by Bill Laitner, March 10, 2016, 10:31 p.m. EST Unless you have deep pockets and a lot of paid people to stand around with clipboards, it's not easy to collect enough signatures to get your concern on ballots in Michigan, pro-marijuana groups say. They dug deep into their middle-class pockets, held fundraisers across the state and spent months going door to door or standing at shopping centers and city halls to gather petition signatures. But hopes are dimming fast for the volunteer effort called MiLegalize, which aimed to put on ballots this November a proposal to legalize, regulate and tax recreational marijuana in Michigan. A bill rushed Thursday through the Michigan Senate was aimed at closing a loophole that might have let MiLegalize qualify for the ballot by certifying thousands more of the signatures the group gathered. "With everything happening, from Flint to the Detroit schools, this is the priority for the Legislature," said an exasperated Jeff Hank, a Lansing lawyer who is chairman of MiLegalize known in full as Michigan Comprehensive Cannabis Law Reform Committee. Yet, Hank said the fight isn't over to qualify most of about 250,000 signatures that the group has gathered and more that it still needs. The bill, expected to gain quick passage in the state House and then receive Gov. Rick Snyder's signature, won't make it easier. But Hank maintains that any new law governing the process can't apply retroactively to his group's ongoing petition campaign. And he said his group plans to use existing law to assert that signatures it gathers outside the 180-day limit can be certified. The group needs about 253,000 valid signatures from registered Michigan voters; but because such efforts typically include numerous invalid signatures, the raw total should be more than 300,000. Because MiLegalize began collecting in late June, it already has exceeded Michigan's long-time limit of 180 days in which circulators may collect signatures. Hank's contention shared by an environmental group seeking to get approval for its anti-fracking measure, which would sharply curtail petroleum drilling in Michigan is that Michigan's 180-day limit can be stretched if a group proves that signatures gathered outside the time frame are still valid. And they should be able to do so using modern technology the state's database of registered voters, developed well after the 180-day limit came into use, he said. He's encouraging MiLegalize volunteers to continue collecting signatures, hoping that they'll be able to use that state database can be used to verify a signer's qualifications. "Petitioning is a fundamental right, just like freedom of speech, and so the policy (that regulates it) has to be the least burdensome way of exercising that right," Hank said Thursday,adding: "If the state doesn't approve us for the ballot, we're going to sue that's 100% guaranteed." Medical-marijuana user Deborah Young, 58, of Ferndale, a retired florist, said she and other volunteers had gathered about 500 signatures Tuesday at two voting precincts in Ferndale. "And we had people all over the state doing the same thing this isn't over," Young said. If the proposal fails to make the ballot, it would probably spell the end of what is apparently the best-funded and best-organized effort to put a cannabis question on state ballots this year. Two other groups dropped their efforts last fall. A fourth, Midland-based Abrogate Prohibition, is seeking to amend the state constitution an even higher bar that requires collecting 315,000

3 signatures by July 1, according to state election law. John Pirich, a Lansing lawyer and veteran constitutional law expert, testified last month and again Monday before the state Board of Canvassers against any move to stretch the 180- day limit, Pirich said. He also testified last week before the state Senate Elections Committee in support of the bill that would affirm the 180-day limit, he said. "When the framers of the constitution came up with this process, it was never meant to be easy. It s supposed to be a high bar," he said. Such citizen referendums prevailed when Michiganders approved the returnable bottle-and-can law in 1978 and the state's medical marijuana act in The 180-day limit is "what we've all lived with" for decades, Pirich said, adding: "It s just the petition drives that don t have enough signatures that are arguing with that." The bill s passage came on a day that two medical-marijuana dispensaries or sales outlets were raided by police, according to the Oscoda County Herald newspaper web site. The raids were reportedly in Mio and Lewiston, east of Grayling. 2. Marijuana Update 2 Senator Arlan Meekoff reported to be holding the line on a package of bills that propose to establish a regulatory structure for expanded medical marijuana use. MIRS News Meekhof: Senate A No-Go On Medical Marijuana Regulation For Now April 13, 2016 A bill package outlining new regulations on the state's medical marijuana industry is still running into roadblocks in the Senate months after passing with broad support in the House. Senate Republicans spent most of the morning discussing medical marijuana regulation in caucus, and the outlook was not positive for the time being. Senate Majority Leader Arlan MEEKHOF (R- West Olive) said he is not ready to discharge the package from the Senate Judiciary Committee to the full Senate for consideration, telling reporters that the concerns are broad within his caucus. "There are a lot more questions than there are answers from our members," Meekhof said. "What's in front of us isn't quite there, yet." Asked where there were any particular concerns with the package, Meekhof responded, "All of it." Meekhof said Senate Republicans are well aware that there is science-backed evidence in favor of medical marijuana use. What's less clear is how to regulate it in a manner where it's grown well and treated like a pharmaceutical. Although a few additional ideas were brought forward in caucus, Meekhof said it's unclear whether those concepts have been covered at the committee level already. He's tasking Sen. Rick JONES (R-Grand Ledge) with continuing to work through new ideas and additional concerns. The bills are HB 4209, HB 4210 and HB 4827, and together would implement a three-tiered system of regulated growing, distribution and selling, as well as revamp guidelines on medical marijuana and impose a 3 percent tax on the gross income of the provisioning centers that would sell the product. Under HB 4209, there would be licensing requirements for provisioning centers, secure transporters and safety compliance facilities. In addition, municipalities would have the choice of whether to authorize medical marijuana facilities within their boundaries. Under HB 4209, there would be licensing requirements for provisioning centers, secure transporters and safety compliance facilities. In addition, municipalities would have the choice of whether to authorize medical marijuana facilities within their boundaries. The bill would allow a five-member state board to implement the new regulations, and under the legislation, state-licensed activities involving medical marijuana would be protected.

4 On the financial side, the bill establishes regulatory assessments and licenses for growers, processors, provisioning centers and transporters. HB 4287 would establish a seed-to-sale tracking system for commercial marijuana. Jones is in support of the legislation, but couldn't scrounge up the votes to move the package through his committee late last year. He'd previously asked Meekhof to discharge the bill from his committee and hold a vote on the Senate floor (See "Medical Marijuana Regulation Shelved Until 2016," 12/9/15). In the House, all three bills passed with a wide margin. Longtime medical marijuana advocate Tim BECK said he's disappointed that a vote on popular legislation that's been on the legislative radar for so long is being held up by a few senators being reluctant to the idea. "The public is way, way in favor of regulation," Beck said. "It's pathetic what is going on here. The tail is wagging the dog." 3. Section 298 Workgroup Report I will not overshadow any report you may get from LRE Board Member Bonnie Gonzales about her observations from the 2 nd meeting of Lt. Governor Calley s Section 298 Workgroup. I will say, though, that her voice and the numerous voices of others who receive services from the system have left little need to add anything else to the conversation. I have concentrated on adding relevant comments on services and system needs for persons with substance use disorders and for the broader needs of our communities for effective prevention. At the risk of being perceived as completely dependent on news reports, I will insert the most recent Crain s article that summarizes the current issues fairly and accurately from my perspective, at least. Legislators halt controversial plan to reform state's mental health system April 15, :51 a.m. by Jay Greene The other shoe dropped this week in Lansing concerning the ongoing battle between Medicaid HMOs and mental health organizations over Michigan's $2.4 billion Medicaid behavioral health budget: the Michigan Legislature. On Tuesday, House and Senate leaders stepped into the fray and inserted their own suggestions for how to proceed into the state's proposed fiscal 2017 budget. Legislators essentially put a halt to Gov. Rick Snyder's effort to hand over Medicaid behavioral health funding to the health plans, at least for this year. They also rendered moot Lt. Gov. Brian Calley's self-imposed deadline of mid-may to have a workgroup create replacement language for Section 298 that would have enabled the HMOs to takeover the behavioral health funding in the proposed 2017 budget, which begins Oct. 1. Everyone, however, including Snyder, Calley, legislative leaders, Medicaid HMOs and mental health officials, wants to find a way to improve coordination between behavioral and physical health for patients with mental illnesses, intellectual and developmental disabilities and substance use disorders. How best to improve the system cut administrative costs and improve service delivery to about 200,000 patients will be first left with a 122-member Behavioral Health Section 298 Workgroup. The workgroup was suggested by Calley in February in response to intense opposition to Snyder's original plan from mental health advocates. The workgroup now will have until December, under the House proposal, to write a report on its recommendations, and until next February to report back to the Legislature and state departments under the Senate's budget language. First, before I get into details about the House and Senate proposals, a little background.

5 In February, Snyder's fiscal 2017 budget proposal contained controversial language in Section 298 that would have allowed at least 14 Medicaid HMOs in Michigan to compete for contracts to manage the state's $2.4 billion Medicaid behavioral health budget. Under Snyder's original plan, which somewhat surprised everyone, the private HMOs the majority of which are for-profit health plans would essentially replace the 10 public regional prepaid inpatient health plans. The PIHPs, in turn, contract with about 46 community mental health agencies and an additional 83 service providers that deliver services to people with moderate to severe mental health difficulties across the state. But strong public outcry by mental health professionals, advocates and family members of patients led Calley to ask legislative leaders for a timeout and to create the workgroup. Over the past month, the workgroup has met twice to simply talk about the importance of personalized behavioral health services and set the stage for future meetings. Now, a month before Calley's deadline for a report, enter the state Legislature. Here is a key section of the state House's Section 298 replacement language that really sets the stage for the rest of the year: "(The Michigan Department of Health and Human Services) should work with a workgroup to make recommendations regarding the most effective financing model and policies for behavioral health services in order to improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities, and substance use disorders." This language leaves the door open for either having the HMOs take over the Medicaid behavioral health funding or simply finding ways to improve the current behavioral health system. But the House, under Rep. Rob VerHeulen, chairman of the House Health and Human Services Appropriations committee, went further than many people expected. "The (Section 298 Workgroup) shall consider the use of one or more pilot programs in areas with an appropriate number of consumers of behavioral health services and a range of behavioral health needs as part of that transition plan," according to the replacement language. This seems to suggest either regional pilot studies on an HMO takeover or methods to improve the current public mental health system. I have heard suggestions mentioned along these lines that what first should be done is to conduct a pilot study in a rural and urban region. VerHeulen and other House legislators want to give mental health executives the chance to prove they can do better at care coordination with physical and behavioral health services than they currently are able to do. They also appear to want HMOs to demonstrate they can fairly and efficiently deliver physical and behavioral health services. In other words, if you think you can do better, prove it in a demonstration project. Along with similar Senate language, this means that it is highly unlikely any formal plan to transfer all $2.4 billion of Medicaid behavioral funds to the state's HMOs will occur this year. The House wants the workgroup to issue a report by December. "(MDHHS) shall provide, after each workgroup meeting, a status update on the workgroup's progress and, by Dec. 1 (2016), a final report on the workgroup's recommendations to the Senate and House (appropriations subcommittees, fiscal agencies and the state budget office)." The Senate wants a report by February 2017 to the same Senate and House groups. "By Feb. 1 (2017), (MDHHS) shall submit a report to the Senate and House... detailing a proposal to enhance services provided by PIHPs... (to) reform payment processes with the result of more money going to high-value patient care." The House also said the workgroup shall consider the following goals: Core principles of person-centered planning, selfdetermination and recovery orientation. Avoiding the return to a medical and institutional model of supports and services for individuals with behavioral health and developmental disability needs. Coordination of physical health and behavioral health care and services at the point at which the consumer receives that care and those services. These points essentially mirror statements made by mental health officials about what they want in any reformed system.

6 The House also said the workgroup "shall include a detailed plan for the transition to any new financing model or policies recommended by the workgroup, including a plan to ensure continuity of care for consumers of behavioral health services in order to prevent current customers of behavioral health services from experiencing a disruption of services and supports." And if the Medicaid HMOs take over the system or if the PIHPs are deauthorized, the House said the following: "No funding that has been paid to the (PIHPs) in prior fiscal years from (Medicaid funding programs) shall be transferred or paid to any other entity without specific legislative authorization through enactment of a budget act containing appropriation line item changes or authorizing boilerplate language." The Senate also weighed in on what it expects for its report early next year. Proposals must include at least the following: Increase access to high-value community-based services and resident choice of provider. Increase access to integrated behavioral and physical health services within community-based settings. Identify and increase the utilization of high-value services and identify and decrease the utilization of lowvalue services. Integrate behavioral and physical health patient population risk stratification with opportunities for shared risk among contracted providers. Align behavioral and physical health care providers clinical and claims data sharing. After reading through the House and Senate boilerplate replacements, it is clear that advocates of the current mental health system, who staged massive lobbying campaigns to oppose Snyder's plan, clearly got the ear of legislators, many of whom were skeptical from the beginning that the mental health system was as broken as critics of the system once suggested. The next meeting of the behavioral health workgroup is April 27, where it is expected the topic will include how best to administer the state's physical and behavioral health systems. Submitted by Mark Witte April 19, 2016