MAO Legislative Update
May 27, 2016
Eric Dick, MAO Lobbyist
Session Stumbles to a Close
The 2016 legislative session came to a chaotic close minutes after midnight on Sunday, May 22 with several major bills left incomplete. The House and Senate passed different versions of a nearly $1 billion bonding bill, and time ran out on before the two bills could be reconciled. One of the key items on many legislators’ wish list for 2016 – a robust package of investments in new transportation spending – also fell short as the House and Senate could not agree upon how to fund the investments and how much to invest in transit. A supplemental budget bill did pass both bodies, though many legislators and observers decried the fact that the final version of the bill – totally 599 pages – was released only hours before the House and Senate voted upon the bill.
As of this writing, the Governor was reported to still be considering whether to call a special session to call legislators back to St. Paul to consider a bonding or transportation bill. Only the Governor can call a special session, and legislators are usually only called back to St. Paul once an agreement on the scope of the session is agreed upon.
The clumsy close to the 2016 legislative session sets the stage for the November elections, when all 201 legislative seats will be on the ballot before voters. Given the relatively narrow majorities in the GOP-led House of Representatives and DFL-controlled Senate, majorities in one or both bodies may be subject to a change of partisan control.
MAO Activity at the Capitol in 2016
The MAO had a relatively quiet year at the Capitol in 2016. A long-rumored effort by the professional association of audiologists was not introduced for consideration. A bill to require state health plans to cover a broader swath of audiology services was introduced though it received no hearings in either body.
Also noteworthy is the fact that the state’s provider tax remains on track for repeal at the end of 2019. While the Senate heard a proposal to rescind the repeal, it did not receive further consideration and was not included in the final package. Depending on what occurs in the November elections next year – 2017 – may be a bigger challenge to preserve the repeal.
As noted below, there were several setbacks in relation to tobacco policy. Advocates for the big tobacco companies were successfully in repealing a piece of the state’s tax law that serves to annually impose an inflationary increase in the tax on tobacco products. That provision has allowed the tax on a pack of cigarettes to rise by 8-10 cents per pack each year since the provision was passed in 2013. The tax bill also includes language that effectively reduces the tax on the most commonly used e-cigarettes. This market is dominated by the big tobacco companies – Altria, Lorillard, and others.
Budget Supplemental Awaits Governor’s Action
For much of the short, ten week session legislators debated how to allocate the state’s $900 million surplus, and the House and Senate adopted very different approaches. House Republicans emphasized tax relief, while DFLers focused upon new spending. Given that the House earmarked no additional funding in HHS programs and the Senate called for an increase in health-related spending of more than $60 million, a conference committee of House and Senate legislators was required to negotiate a single finance supplemental. The final package was not released until mere hours before a vote was taken in the legislative bodies and the package approved.
Notable health care-related pieces included in the omnibus funding package include:
- Support for mental health infrastructure, including the “Excellence in Mental Health Act,” a provision that will allow the state to seek additional federal funding for mental health treatment. The bill also includes increases in grants to schools to provide school-based mental health support. Additionally, the bill directs state agencies to seek new federal funding intended to provide treatment to pregnant and post-partum women who have chemical dependency disorders.
- An additional $1 million was appropriated to the Medical Education and Research Cost (MERC) fund. MERC is used to support residency training program for physicians and other practitioners.
- Several health-related licensure bills were included in the package, including formal licensure for genetic counselors and orthotics, prosthetics, and pedorthic-fitters. The language expressly states that physicians who provide these services need not seek separate licensure.
- A new requirement was passed for health plans to provide notification to enrollees when there are changes to their provider networks. Health plans are required to update their website at least monthly to include changes when providers move from in-network to out-of-network.
- The Legislature directed the Commissioner of Health to seek additional federal funds for statewide planning, coordination, preparations, and response activities related to the Zika virus. These efforts are related to public health readiness, diagnostic testing of patients, surveillance activities, and mosquito surveillance activities.
- Additional funds were appropriated for certified community behavioral health clinics. These clinics shall provide coordination of care across different settings and provider types to ensure seamless transitions for patients.
Also noteworthy are the items not included in the funding package, including:
- Senate-supported effort to reform the manner in which medication prior authorization is governed. Led by the Minnesota Medical Association with the support of more than 45 disease advocacy groups and physician organizations (including the MAO), the “Fix PA Now” bill received robust support in the Senate but was blocked in the House by bill opponents, including the state’s health plans and pharmacy benefit managers (PBMs) like ExpressScripts and Prime Therapeutics.
- House-led efforts to prohibit or strictly regulate the University of Minnesota’s medical research any fetal tissue. The House version of the budget bill rejected by conferees would have severely limited the ability of the University to continue much of its research that involves fetal tissue.
- Senate-supported initiatives to increase reimbursement for primary care physician services by five percent were not included in the final package.
- Republican-sponsored language to repeal MNsure and move Minnesota to the federal insurance exchange were rebuffed, but new provisions included in the final package provide greater oversight to the legislature on how MNsure can utilize state resources.
Tax Bill Reduces Tobacco Taxes
A large, complex tax bill passed by the House and Senate on the last day contains tax breaks for tobacco interests totaling more than $35 million. The bill repeals the automatic tax “inflator” for cigarettes, a piece of tax law that has automatically raised the tax on a pack of cigarettes annually. Also included in the tax package is language that effectively reduces the tax on the most commonly used e-cigarette devices. The vast majority of the market share for these devices is controlled by the major tobacco companies, including Lorillard and Altria.
As of this writing the Governor had not yet signed the legislation. He has been highly critical of the tax breaks for tobacco.
Legislators Tackle Prescription Drug Abuse
Bills to address the abuse of prescription drugs passed both bodies of the legislature in the final days of the session. One has already been signed by the Governor, and the second is likely to receive his approval soon.
Signed into law on May 19, SF 1440 expands the authority of pharmacies to collect unused pharmaceutical drugs for destruction. Authored by Sen. Julie Rosen (GOP – Vernon Center) and Rep. Bob Barrett (GOP – Lindstrom), the aim of the bill is to safely dispose of drugs that may otherwise be diverted for illicit use. Also included in the bill is language to expand the mechanisms by which pharmacists can dispense naloxone, an opioid-antagonist. Current law allows pharmacists to dispense the drug if they have a standing order established with a physician or other prescriber. The new language allows pharmacists to enter into such agreements with the medical consultant of local public health boards or with a designee of the Commissioner of the Department of Health. Pharmacy advocates had originally sought to grant pharmacists the ability to “prescribe” naloxone, an approach that raised concerns by the Minnesota Medical Association, other prescriber groups, and a number of legislators.
A separate bill awaiting a likely signature by the Governor serves to strengthen the state’s existing prescription monitoring program (PMP). Authored by Sen. Julie Rosen (GOP – Vernon Center) and Rep. Dave Baker (GOP – Willmar), the bill requires all physicians and other prescribers authorized to prescribe controlled substances with a current DEA registration to register and maintain an account within the PMP. The effort is intended to increase participation in the database. Currently only 35 percent of physicians have active accounts with the PMP. Notably, the bill does not require a physician to consult the PMP before prescribing, that there are a number of legislators interested in pursuing that requirement in a future legislative session.
The bill also grants some new latitude for physicians who are treating a patient they suspect might potentially be abusing a controlled substance to consult the PMP. The provisions that govern how long the prescription data may be used by the Board of Pharmacy for trend analysis and research was the subject of fierce debate. The final language allows the use of the data for a period of no more than five years, though that authority shrinks to no more than one year in 2020.