Monthly Archives: March 2015

Legislative Update 3/23/2015

MAO Legislative Update
March 20, 2015

Eric Dick, MAO Lobbyist

Prior Auth Reform Clears Two Committees

The bill to provide more transparency and standardization to the prior authorization process cleared another two hurdles as the Senate Commerce Committee passed the bill on a voice vote on Wednesday March 18. It also cleared the Senate State & Local Government Committee on Friday, March 20. The effort is being led by the MMA, and the MAO has joined dozens of physicians groups and patient advocacy groups in supporting the proposal.

SF 934 (Franzen – DFL, Edina) continues to move through the process with strong support from many medical and patient groups, and opposition from health plans and companies who serve as pharmacy benefit managers (PBMs). Senator Franzen has tried to address some of the concerns raised by opponents without gutting the major components of the bill. As the bill now stands health plans would be required to disclose to consumers ahead of open enrollment time what drugs are covered and what patient cost-sharing would be required. It also prohibits health plans and PBMs from adding new restrictions on their drug coverage during the enrollment year.

The bill does not prohibit the use of prior authorization for medications but it requires the use of standardized prior authorization request forms and requires health plans and PBMs to develop mechanisms to inform prescribers in real time why a drug was denied and what alternatives are recommended. It also cuts in half the timelines for utilization review organizations to make initial coverage determinations and respond to appeals.

The House companion bill, HF 1060 (Albright – R, Prior Lake) is still awaiting its first hearing in the House. For the bill to remain alive as a standalone bill it must pass one or two House committees next week before the final policy committee deadline. There is some resistance to the bill because of accusations that it will result in increased drug costs for insurers and employers.

Legislators need to continue to hear from physicians and others on the need for this bill. The fixPAnow.com website now lists 38 different physician, patient, and advocacy organizations that support the PA bill. It also lists news coverage of the effort to pass the bill, along with patient stories of problems caused by PA.

Changes to PMP Proposed

Changes to the state Prescription Monitoring Program (PMP) are included in bills making their way through both the House and Senate in recent days. The bills, HF 1652 and SF 1440, authored by Rep. Dave Baker (R - Willmar) and Sen. Julie Rosen (R - Vernon Center) adopt many of the recommendations of the PMP Task Force, a group established by the 2014 legislature on which the MMA has a seat.

The House and Senate versions of the bill differ in several ways. The Senate version of the bill strikes current law's requirement that a patient provide consent before a prescriber may access the patient's data when providing medical treatment, though that provision was removed in the House. Both bills allow the Board of Pharmacy to hold prescribing data longer for the purposes of trend analysis. Notably, the Senate version of the bill requires all prescribers with active DEA licenses to register for a PMP account, though this provision was struck from the House bill. Neither bill would require a prescriber check the PMP before issuing a prescription to a patient.

In a related bill intended to address abuse of prescription drugs, Sen. Rosen is also the author of SF 1425. Under the bill, pharmacies would have greater latitude to serve as depositories for pharmaceutical waste in the form of old, expired medication. Participating pharmacies would have to comply with all federal laws that govern the destruction of legend drugs.

Physician Compact Marches On

The effort to enroll Minnesota in a newly formed compact to ease licensure burdens for physicians who wish to practice in multiple states cleared its last two policy committee hurdles in the House in recent days. The bill had passed the needed policy committees in the Senate earlier in the session.

The Interstate Compact for Physician Licensure establishes a commission that will serve as a clearinghouse for licensure of physicians who wish to hold licenses in multiple states.

Participation in the process is entirely voluntary for physicians. The compact only becomes active once approved by at least seven states, though already two states have signed the compact into law and it's moving through legislatures in more than a dozen more.

The House bill, HF 321, authored by Rep. Tara Mack (R - Apple Valley), cleared all three necessary committee stops (HHS Reform, State Government Operations, and Civil Law) in the House in just the last week and with virtually no opposition. Both the House bill and the Senate File, carried by Sen. Kathy Sheran (DFL - Mankato) await action in each body’s HHS Finance Committee.

All Payer Claims Database Bill Moves in the Senate

A bill to allow an additional use for the state's All Payer Claims Database (APCD) was heard in the Senate HHS Policy Committee on March 18. The bill, SF 1818, authored by Sen. Melissa Wiklund (DFL - Bloomington), passed with little discussion and was referred to the Senate Judiciary Committee.

The bill would require Minnesota Department of Health to make available to the public for no or minimal cost public data sets or tables. Language in the bill makes clear that the data contain no individual, payer, or provider identifiers. It is anticipated that researchers, non-profits, and academic institutions will be able to use the data to study cost and utilization trends and other purposes. The MMA testified in support of the bill, as did the Minnesota Hospital Association and MDH.

The bill's House companion, HF 1961, authored by Rep. Melissa Hortman (DFL - Brooklyn Park), has not been scheduled for a hearing.

First Deadline’s Arrival Narrows Field of Bills

Friday, March 20th brings the first policy deadline, the first in a series of self-imposed deadlines that help weed out viable bills from those with less support. It's by today that a bill has to have passed the needed policy committee stops in one body to remain viable. That same bill's companion will have to clear its policy committee stops by next week Friday, March 27. A final deadline comes April 7, the date by which bills must have passed the needed finance or tax committees.

With the deadline, a number of bills will be considered dead (or close to it) for the remainder of the year. While these bills will have not “made deadline,” it’s worth remembering that a bill is never truly dead until the end of the biennium, or “sine die.” A creative lawmaker still has many tools available to them to try to move legislation forward even after the deadline, though it becomes more difficult.

A number of interesting or notable bills have not made the first policy deadline, including:

SF 178 This bill would repeal not only the ban on smoking in public places, but would also repeal the entirety of the state’s Clean Indoor Act.

HF 1253/SF 1135 These bills would add e-cigarettes to the state’s Freedom to Breathe law, barring their use in most indoor spaces. Current law prohibits e-cigarette “vaping” in all government-owned buildings, clinics, hospitals, day care, and other spaces, though they still may be used in bars and restaurants.

HF 1141/SF 545 These bills would add chronic pain to the statutory list of conditions which give eligibility to patients who wish to participate in the medical marijuana program. Under current law the Commissioner of MDH has that authority. A separate bill still moving does accelerate the timeline by which MDH has to rule regarding chronic pain from July 2016 to January 2016.

HF 1038/SF 917 Under these bills, health plans would be required to offer coverage for tamper-resistant or “abuse deterrent” versions of uploads if the plans covers prescription drugs.

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Legislative Update – 3/6/2015

Push for Prior Authorization Reform Continues

Momentum to pass legislation to reduce medication delays, disruptions, and confusion for patients continues to build at the State Capitol.   The bills, HF 1060 and SF 934 were introduced on February 19 by chief authors Rep. Tony Albright and Sen. Melisa Franzen.   A number of new allies have recently joined the Minnesota Medical Association’s (MMA) coalition to pass the bills, including the Minnesota Chapter of the American Academy of Pediatrics (MNAAP), the Minnesota Orthopaedics Society (MOS), Minnesota HealthCare Network, and Midwest Independent Practice Association. There are now more than 30 patient advocate, physician, and provider organizations supporting the bill. Three additional members of the House have also signed on as cosponsors of the bill, including Rep. Jennifer Schultz (DFL – Duluth), Rep. Leon Lillie (DFL – North St. Paul) and Rep. Mark Uglem (R – Champlin).

The bills have a number of important patient protections, including requirements to improve patient understanding and comparisons of insurance plans’ medication coverage and out-of-pocket costs. Limits on formulary changes outside of a health plan’s enrollment period are included, as is a requirement for a medication transition period for patients who change insurance plans or policies.

And finally, the bill bars prior authorization for drugs that are included on a health plan’s formulary, turning PA into a retrospective, quality assurance process.

The bills have drawn significant, vocal opposition from both health plans and pharmaceutical benefit managers (PBMs). Opponents have argued that reform of prior authorization will lead to greater costs and risks to patient safety, arguing that PA serves as a check against physician error in prescribing.

To pass the bill this will require grassroots advocacy on the part of physicians. Legislators need to hear that the current prior authorization is hurting patient care and adding costs. An easy way to do so can be found on the MMA’s website here.   The MMA also has started a new website – www.fixPAnow.org - that offers a complete list of coalition members and the latest news on the effort to patients better by reforming prior authorization.

Budget Forecast Paints Rosy Picture

Minnesota Management and Budget (MMB) announced the budget forecast for the upcoming biennium, and the news was good. The February forecast showed a projected surplus of $478 million in the current biennium and growing to $1.87 billion in the 2016-2017 biennium. The most recent surplus grows $832 million from the last forecast announced in December 2014.   The improved forecast can be attributed to both greater than anticipated revenue, as well as lower than expected state spending, particularly in K-12 education.

The good budget news continued in the latest projections for the Health Care Access Fund (HCAF). Due to increased revenue from federal sources, a budget that had been anticipated to fall $62 million into deficit as soon as 2017 has now improved to show surplus dollars until 2019 when the fund is projected to be in balance. The projected surplus in 2017 is expected to reach $13 million, a figure not large enough to trigger an automatic reduction in the provider tax. The provider tax remains on track to be repealed on December 31, 2019.

Physician's Interstate Compact Clears Last Senate Policy Committee

Continuing its steady march through the Senate committee process, the Interstate Medical Licensure Compact passed out of the Senate Judiciary Committee on February 24.   Because the bill has some small costs to the Board of Medical Practice, the bill has now been referred to the Senate Finance Committee.

Under the bill, SF 253, sponsored by Sen. Kathy Sheran (DFL - Mankato), Minnesota would participate in a newly created interstate compact that would expedite the process by which physicians who practice in multiple states can be licensed. Completely voluntarily for physicians, the commission established under the bill would serve as a "clearinghouse" that would ease the burden of seeking licensure in multiple states. The commission only becomes functional once passed by at least seven states. Identical bills have now been introduced in 15 state legislatures across the country. The bill has passed legislative bodies in other states, including the unanimous passage of the bill in Utah.

A key priority for the MMA in 2015, the bill has seen little organized opposition thus far and has been very well received by legislators. Supporters have thus far included the Board of Medical Practice, the Minnesota Hospital Association, Mayo Clinic, Allina Health, Sanford Health, and Gundersen Health. The House bill, HF 321, is authored by Rep. Tara Mack (R - Apple Valley). The bill is tentatively scheduled for its first hearing in the House on March 11.

MMA Day at the Capitol Set for March 11

It’s not too lake to make plans to join your physician colleagues for the annual Minnesota Medical Association’s Day at the Capitol set for March 11. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.

With most of the Capitol closed to the public due to construction, our 2015 Day at the Capitol will be a little different than years past. This year we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders (including the Senate author of the prior authorization reform bill) and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.

The “White Coats Day” at the Capitol is a key piece of the MMA’s advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.

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Legislative Update – February 2015

Prior Authorization Reform Package Unveiled—SF 934/HF1060

In an effort to reduce medication delays, disruptions and confusion for patients, a central legislative priority for the Minnesota Medical Association was introduced in the House and Senate on February 9th. Authored by Sen. Melisa Franzen (DFL – Edina) and Rep. Tony Albright (R – Prior Lake), the bills represent significant reform of the law that governs how health insurers use utilization review and impose prior authorization requirements.

The legislative package was unveiled at a St. Paul press conference with the two legislative authors and representatives of a number patient advocacy groups including the Minnesota AIDS Project, the Epilepsy Foundation, and the Arthritis Foundation. Robert Meiches, MD, MBA, the CEO of the MMA was joined by George Schoephoerster, MD, a gerontologist who practices in St. Cloud in representing the MMA. Dr. Schoephoerster led a workgroup of physicians over the course of more than nine months in the development of the legislation.

The package was the result of many months of work and effort to partner with health plans and payers. Unfortunately, there was little interest on the part of the health plans to work collaboratively to even share metrics on prior authorization. The MMA then turned to a legislative approach to reform.

The proposal has a number of key elements, including:

  • Improved patient understanding and comparisons of medication coverage. The bill standardizes the disclosure of pharmaceutical coverage, including providing information to consumers on what drugs are on the formulary or preferred drug list and what their cost-sharing arrangements are. This would be provided at least 30 days prior to open enrollment. This is similar to Medicare Part D requirements already in place.
  • Limit changes during enrollment year. Drugs could be added to a plan’s formulary at any time, though no formulary limitations or patient cost changes may occur within an enrollment year. Authorizations for non-formulary coverage remain valid for duration of a patient’s continuous enrollment.   This is also similar to the current law governing Medicare Part D. All too often, physicians who have been prescribing a given drug to a patient for years are suddenly told that the drug is no longer covered.
  • Create 60-day transition period to prevent gaps in ongoing medication needs. Patients changing to a new plan via a change or annual renewal must be provided 60 days of ongoing coverage to accommodate transition to a new covered medication if their current drug is no longer covered. Again, this is similar to Medicare Part D requirements.
  • Transform medication PA to a retrospective QI function. Drugs on a plan’s formulary could not be subject to prior authorization requirements. Health plans would still be able to work with prescribers to modify prescribing patterns after the fact for quality improvement purposes.
  • Improve state oversight and transparency. The bill creates an advisory committee within the Minnesota Department of Health to monitor changes in pharmaceutical coverage, formulary design, and benefit design. Health plans and pharmacy benefit managers would need to report certain prior authorization metrics such as the volume of approvals, denials, appeals, response time, etc to the department.
  • Simplify administrative process. When drug request claims are denied by the payer, the plan would be required to inform the prescriber of covered alternatives. The bill also shortens the time frame for plans to consider request for coverage, and deems as approved those requests that exceed the timeframes.

The bills have drawn a strong and bipartisan group of coauthors. Joining Sen. Franzen on the Senate bill are Sens. Kathy Sheran (DFL – Mankato), Jim Metzen (DFL – South St. Paul), Julie Rosen (R – Vernon Center), and John Marty (R – Roseville).   Rep. Albright is joined by Reps. Nick Zerwas (R – Elk River), Erin Murphy (DFL – St. Paul), Glenn Gruenhagen (R – Glencoe), Matt Dean (R – Dellwood), Rod Hamilton (R – Mountain Lake), Dan Schoen (DFL – Cottage Grove), and Tina Liebling (DFL – Rochester).

A growing coalition of physician specialties and advocates for patients have announced their support for the bill, including the American Heart Association, Midwest Affiliate; Epilepsy Foundation of Minnesota; Mental Health Association of Minnesota; Minnesota Academy of Family Physicians, Minnesota AIDS Project; Minnesota Psychiatric Society, Minnesota Rural Health Association; and National Alliance for the Mentally Ill—Minnesota (NAMI). The bills are likely to draw significant opposition from health plans and pharmacy benefit managers, and their opposition is likely to focus on PA as a necessary tool for cost containment and for correcting physician errors.

Updates on the push for prior authorization reform will be regularly posted to a new website, www.fixPAnow.com.

Physician Licensure Compact Continues to Advances in Senate

The Interstate Compact for Physician Licensure took another step towards becoming law when it was considered and passed by the Senate State and Local Government Committee. The bill, SF 253, received unanimous support and was passed to the Senate Judiciary Committee, the final policy committee with jurisdiction in the Senate, where it is set to be heard on Feb. 24.

Under the bill, sponsored by Sen. Kathy Sheran (DFL - Mankato), Minnesota would participate in a newly created interstate compact that would expedite the process by which physicians who practice in multiple states can be licensed. Completely voluntarily for physicians, the commission established under the bill would serve as a "clearinghouse" that would ease the burden of seeking licensure in multiple states. The commission only becomes functional once passed by at least seven states, though the identical bill has now been introduced in 13 state legislatures.

A key priority for the Minnesota Medical Association (MMA) and other hospital and clinic systems in 2015, the bill has seen no organized opposition thus far and has been very well received by legislators. Supporters have thus far included the Board of Medical Practice, the Minnesota Hospital Association, Mayo Clinic, Allina Health, Sanford Health, and Gundersen Health. The House bill, HF 321, is authored by Rep. Tara Mack (R - Apple Valley). It's expected to receive its first hearings in the lower body in early March.

Legislative Auditor Report Very Critical of MNsure

Key committees in both the House and Senate held hearings on the Office of Legislative Auditor’s (OLA) report on the first year of operations of MNsure, the state’s insurance exchange.  The report did not hold back any punches as it was very critical of MNsures’ website, its lack of customer service, its flaws in establishing enrollment targets, and its governance.

Legislative Auditor James Nobles and OLA staff Joel Alter presented in four separate hearings before the House Joint HHS Committees, House Commerce Committee, Senate Joint HHS Committees, and Senate Commerce Committee.  Among the findings:

  • MNsure website had serious technical problems that were not adequately tested prior to launch;
  • MNsure staff withheld information from the MNsure Board and other officials before enrollment was launched;
  • While MNsure announced it met its first enrollment target, that target was seriously flawed in how it was developed;
  • MNsure failed to provide adequate customer service through its call center causing long wait-times and customer frustration.

Joining the Legislative Auditor at the testifier table for the hearings were Scott Leitz, MNsure CEO; Brian Beutner, MNsure Board Chair; and Lucinda Jesson, DHS Commissioner.  Legislators from both parties expressed a great deal of frustration with MNsure and the challenges it continues to have.

The Legislative Auditor report also recommended changes to the governing structure to shift ultimate accountability from the Board to the Governor, to require MNsure to utilize the expertise of the Office of Minnesota IT Services, and to implement mechanisms to reward insurance brokers for enrolling consumers in MNsure.

Tobacco Tax Changes Under House Bill

A bill to roll back a piece of a landmark tobacco tax increase was considered in the House Taxes Committee on Feb. 18. Under the bill sponsored by Rep. Greg Davids (R - Preston), the automatic annual inflationary increase on tobacco products would be repealed. The automatic inflator was included in the tax bill passed in 2013 that increased the state's tobacco tax by $1.60. That language served to increase the tax on a pack of cigarettes by seven cents on Jan. 1, 2015. HF 700 would cap the state's tax at its current rate of $2.90 per pack.

Testifying in opposition to the bill were representatives from Clearway Minnesota and the "Raise it for Health Coalition,” of which the MMA is a member. Supporters of the bill include the Minnesota Chamber of Commerce, the Minnesota Grocers Association, and associations that represent gas stations and convenience stores.

As is customary in the Tax Committee, the bill was laid over for possible inclusion in a larger tax omnibus package to be unveiled later in the session. The bill's Senate companion, SF 777, is carried by Sen. Lyle Koenen (DFL - Clara City) and has yet to receive a hearing.

Medical Privacy the Subject of House Hearing

The House Civil Law Committee held a hearing to discuss a number of issues related to data privacy in health care on Feb. 17, 2015. The hearing was called by the chair, Rep. Peggy Scott (R – Andover).

Twila Brase, the president of the Citizens Council for Health Freedom (CCHF), spoke for much of the hearing. The CCHF has long been a vigorous opponent of HIPAA as not being strong enough on patient privacy, the state’s newborn screening program, MDH-led cancer surveillance efforts, and other activities that the group has considered a threat to individual privacy.   Brase and other speakers were critical of electronic health records (EHRs), and urged legislators to roll back efforts to expand their use.

The MMA and others have asked legislators to consider aligning Minnesota’s health records law with HIPAA. One of only two states that have a different standard than the federal rule, Minnesota’s health record law predates the advent of interoperable electronic health records. The MMA, the Minnesota Hospital System, the Minnesota Council of Health Plans, and many hospital/clinic systems, have argued that the different standard adds unnecessary and duplicative costs to the health care system. As a result patients are routinely subject to unnecessary tests and procedures due to the burdensome state standard for securing consent to share records.

More Than 2,100 Bills Await Consideration

With the legislative session now well into the second month and the first policy deadlines looming in late March, 2,108 bills have been introduced in the House and Senate.   The vast majority of these bills will not receive a hearing and even fewer will become law. Some of the more interesting and noteworthy health care bills introduced in the last two weeks include the following:

  • HF 777 (Rep. Rod Hamilton, R – Mountain Lake and Sen. John Hoffman, DFL – Champlin): Creates a spinal cord injury and traumatic brain research grant program. Grants would be made available to small businesses conducting research on innovative treatments and rehabilitative efforts for the functional improvement of people with spinal cord and traumatic brain injuries
  • SF 917 (Sen. Jeff Hayden DFL – Minneapolis and Rep. Dave Baker R – Willmar) Requires health plans to cover abuse-deterrent opioid drugs. Abuse-deterrent opioid analgesic drug products are defined as a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration (FDA) with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse of opioids.
  • HF 1087 (Rep. Joe Atkins, DFL – Inver Grove Heights): Requires all hospitals to establish and make available to staff a violence prevention and response plan.  The bill also instructs the Department of Health to create a database of violent acts committed in health care settings to allow better data gathering.
  • SF 981 (Sen. Julie Rosen, R -- Vernon Center): Requires health insurers to cover services provided telemedically similarly to how they cover them if provided in-person.

MMA Day at the Capitol Set for March 11

Make plans to join your physician colleagues for the annual MMA Day at the Capitol set for March 11, 2015. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.

With most of the Capitol closed to the public due to construction, our 2015 Day at the Capitol will be a little different than years past. This year we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders (including the Senate author of the prior authorization reform bill) and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.

The “White Coats Day” at the Capitol is a key piece of the MMA’s advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.

Read more →

 
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