Monthly Archives: February 2017

Legislative Update – 2/17/2017

MAO Legislative Update
February 17, 2017
Eric Dick, MAO Lobbyist

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Physicians’ Day at the Capitol a Big Success
Over 160 physicians, residents, and medical residents from around the state gathered in a newly restored Capitol for the annual Physicians’ Day at the Capitol.  The turnout for this years’ event exceeded that of any Day at the Capitol event in recent memory.   The MAO was a sponsor the event.

Attendees heard keynote remarks from Senator Michelle Benson (R – Ham Lake), the chair of the Senate’s Health and Human Services Finance & Policy Committee.  Senator Benson updated the group on the status of a number of MMA priorities, while also providing insight into how to be an effective advocate when meeting with an elected official.  Also providing comment was Sen. Matt Klein, MD (DFL – Mendota Heights), a hospitalist at HCMC.  Senator Klein shared with his physician colleagues his impressions of his first weeks as a Senator.  Senator Klein continues to see patients two nights every week at HCMC.

Following an update from staff on the MMA’s legislative agenda for 2017, attendees scattered throughout the Capitol complex to meet with their legislators.  The event concluded in the evening with a reception in the Rathskaller, the Capitol’s historic dining hall.

Physician Title Protection Bill Introduced
In an effort to strengthen the Board of Medical Practice’s ability to protect the use of the word “physician” when it is improperly used by non-physician health professionals legislation was introduced in late January.  The bills, authored by Rep. Tony Albright (R – Prior Lake) and Sen. Carla Nelson (R – Rochester) essentially restate current law that prohibits the use of terms such as "doctor of medicine," "medical doctor," "doctor of osteopathic medicine," "osteopathic physician," "physician," "surgeon," "M.D.," "D.O.," by non-licensed individuals.  By moving it to a new section it makes it clear that a health care provider licensed a different board is not automatically exempt from this prohibition.

The BMP sought the statutory clarification per the guidance of the state’s Attorney General.  The BMP has been working to preclude a chiropractor who has been advertising his services as a “physician.”

Health Care Workforce Legislation Moves Forward
Four separate bills addressing health care workforce were heard and passed the House Health & Human Services Reform Committee on Thursday, February 16.  All of the bills were developed and promoted by the Legislative Health Care Workforce Commission.  This commission was established in 2014 to address health care workforce shortages.  It was set to sunset on January 1, 2017.  HF 1169 (Albright R-Prior Lake) extends the sunset to 2021 to allow the commission to continue its work.  The Commission is directed to develop a report the Legislature on the projected demand for health professionals and evaluate incentives to attract and retrain workers, especially in the areas of oral health, mental health, primary care, and long-term care workers.

A second bill that passed, HF 744 (Albright R-Prior Lake) establishes a new Minnesota Health Care Workforce Council.  Unlike the existing commission, this council would consist of 29 members representing physicians, hospitals, training institutions, and other providers to provide ongoing program monitoring and coordination to analyze workforce trends and needs and recommend public and private sector efforts to meet our needs.  They shall develop a comprehensive plan every five years, with the first plan by September 30, 2019.

In an attempt to encourage more physicians to serve as preceptors for both medical students and residents, HF 1167 (Schultz DFL-Duluth) creates a tax credit for physicians, APRNs, PAs, or mental health professionals who serve as preceptors.  To qualify for a $5,000 tax credit, a preceptor must serve for at least 12 weeks or 480 hours in a year and receive no additional compensation for that service.  This is purposed as a pilot until 2020, to see if the tax credit helps increase interest in serving as a preceptor.

Finally, the committee passed HF 743 (Albright R-Prior Lake), a bill to establish new training grants for PAs, APRNs, and mental health professional training programs.  The grants can be used for establishing or expanding clinical training programs, recruitment and retention of students and faculty, student financial support, or training site improvements.

Policy Deadlines Loom
In an effort to manage the workflow of the Legislature, legislative leaders each session set a series of deadlines by which legislation must pass to remain viable.  The 2017 deadlines were recently announced, and they will set in place a flurry of legislative activity given how closely they loom.

The first deadline is March 10.  By that date, all legislation must have cleared the relevant policy committees in one body to remain viable.  By March 17, the companion to those bills must clear the policy committees in the other legislative body. And finally, by March 31 all finance and tax bills must have completed the committee process and await action on the House or Senate floor.  April and May will be dominated by floor activity and conference committee negotiations. Session must end no later than midnight on May 22.

Opioid Abuse Continue to Draw Significant Attention
Legislators and state officials continue to press for additional tools to fight the epidemic of opioid abuse and deaths, and a number of bills intended to address the issue have been introduced in recent days.

The state’s Attorney General, Lori Swanson, recently rolled out a package of proposals, including some that are potentially problematic in that they allow law enforcement access to sensitive patient records.

Recently introduced bills include:

  • SF 750/HF 1136 (Sen. Chris Eaton, D – Brooklyn Center & Rep. Dave Baker, R – Willmar)

Under these bills, pharmacies could be disciplined for failing to dispense opioid antagonists such as Naloxone if the drug is in stock and there is a valid standing order in place.

  • SF 751/HF1135 (Sen. Chris Eaton, D – Brooklyn Center & Rep. Dave Baker, R – Willmar)

These proposals would require pharmacists to provide to patients specific information about the risks of opioids and how to dispose of unused medications when the drug is dispensed to a patient.

  • SF 752/HF 1134 (Sen. Chris Eaton, D – Brooklyn Center & Rep. Dave Baker, R – Willmar)

This set of bills would require that opioid prescriptions be filled within 30 days of the date the prescription, after which they would be invalid.

  • SF 753/ HF 1137 (Sen. Chris Eaton, D – Brooklyn Center & Rep. Dave Baker, R – Willmar)

Under these bills, prescribers would be required to check the state’s Prescription Monitoring Program (PMP) database before issuing any prescription for a controlled substance.  The bill provides for several exemptions, including when prescribing or dispensing to patients who are experiencing pain caused by a malignant condition, receiving hospice care, or during an emergency or in an ambulance.  Those who dispense controlled substances would be similarly required to check the database.

  • SF 795/ HF 897 (Sen. Chris Eaton, D – Brooklyn Center & Rep. Debra Hilstrom, D – Brooklyn Center)

These proposals would require all outpatient pharmacies licensed in the state to maintain collection boxes for disposal of legend drugs as pharmaceutical waste.  Such depositories currently exist in many law enforcement offices.

The MMA and other physician groups have joined the effort to prevent addiction and encourage safe prescribing.  Physician groups have strongly supported peer-to-peer education regarding opioid use and prescribing, and  urged caution to legislators as they consider proposals that would interfere directly in the practice of medicine.  The MMA has hosted 20 lectures on issues related to opioid use, abuse, and addiction, and more than 1,000 physicians and medical students have accessed the programming.

Tax Credits for Charity Care Bill Heard in House
Rep. Glenn Gruenhagen (R – Glencoe) has introduced legislation to provide a personal tax deduction to physicians and other health care providers who provide charity care.  HF 156 would require a physician, dentist, chiropractor, advance practice nurse or other provider to file report with the Commissioner of Revenue documenting the amount of charity provided and the value of the care would be calculated based on the Medical Assistance reimbursement rate the practitioner would have received for those services.

The bill passed the House Health & Human Services Reform Committee on Tuesday February 7, and was then heard in the House Tax Committee on Tuesday February 14.  The MMA testified in support of the concept of the bill in both committees.  In the Tax Committee the fiscal note for the bill estimated that physicians provided $91.4 million of charity care in 2016.  The total cost of lost revenue to the state for the tax deduction for all providers is $3.8 million in FY 2018 and $4 million in FY 2019.

The action of the House Tax Committee was to lay the bill over for possible inclusion in the omnibus tax bill.  With no Senate companion yet introduced, final passage of the proposal is in doubt.

Interstate Licensure Compact Fix Continues to Move
A simple bill to provide a technical fix to the Interstate Medical Licensure Compact cleared another hurdle and is being fast-tracked by the Legislature.  Authored by Rep. Tony Albright (R – Prior Lake) in the House, the bill cleared the Civil Law Committee and was sent to the House floor for consideration by the full body.  The Senate bill, authored by Sen. Carla Nelson (R – Rochester), readily passed its first committee stop on February 15th and is set for consideration by the Judiciary Committee on February 20.

The original Compact language, strongly supported by the MMA, other physician groups, and many clinic and hospital systems, passed unanimously in 2015.  The Compact is intended to ease the process of licensure for physicians who wish to practice in multiple states. As the Board of Medical Practice (BMP) started preparing to issue licenses under the Compact, they were told by the FBI that Minnesota's law needed a technical correction to allow them to complete the background check process.

Recreational Marijuana Use the Subject of Two Proposals
Legislators in recent days introduced two proposals related to recreational use of marijuana.  Under HF 927, Minnesota would join eight other states and the District of Colombia in allowing the legal purchase and use of marijuana.  The bill, authored by Rep. Jon Applebaum (DFL - Minnetonka), would allow adults over the age of 21 to legally purchase and posses marijuana.  The bill lays out the structure of a legal cannabis program, including licensure of marijuana production facilities, retail sellers, rule-making for government agencies, and other provisions.  Another proposal, authored by Rep. Jason Metsa (DFL – Virginia), would put the question of legal cannabis before voters as a constitutional amendment on the November 2018 election ballot.

The bills are unlikely to receive hearings.

 

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Legislative Update – 2/3/2017

MAO Legislative Update
February 3, 2017
Eric Dick, MAO Lobbyist

Prior Authorization Reform Bill Introduced
Legislation to reform the medication prior authorization was introduced in both the House and Senate on February 2.  The bills are chief authored by Rep. Rod Hamilton (R – Mountain Lake) and Sen. Carla Nelson (R – Rochester).

The bills have a number of key pieces.  Importantly, the bill precludes health plans from forcing a patient from changing to a different drug therapy during the middle of the patient’s enrollment year.  This provision will provide patients protection from health plans requiring patients to switch drug therapies when a drug that has shown effectiveness is working.  In addition, the bill requires that any approved prior authorization request remains valid for the duration of the enrollee’s contract term.  And finally, the bill contains a number of new disclosure requirements, forcing the health plan to make formulary and related benefit information available at least 30 days prior to annual renewal dates.  Health plans are also required to provide disclosure about changes in formulary and benefit information to patients, prescribers, and pharmacists at least 60 days prior to the change’s effective date.

A coalition of more than 40 groups have gathered to support the legislation, including the MAO and a number of other medical specialties and disease advocacy groups, including the National Alliance on Mental Illness (NAMI), the American Heart Association, the National Multiple Sclerosis Society, the Crohn’s & Colitis Foundation of America, and dozens of others.  More information on the coalition is available here.

Coauthors on the Senate bill include Senators Melisa Franzen (DFL - Edina), Julie Rosen (R - Vernon Center), Michelle Fischbach (R - Paynesville), and Michelle Benson (R - Ham Lake).  Representative Hamilton is joined on the House bill by Representatives Matt Dean (R - Dellwood), Nick Zerwas (R - Elk River), Dave Baker (R - Willmar), Tony Albright (R - Prior Lake), Erin Murphy (DFL - St. Paul), Tina Liebling (DFL - Rochester), Glenn Gruenhagen (R - Glencoe), Roz Peterson (R - Lakeville) and Bob Loonan (R - Shakopee).

Premium Relief Bill Signed into Law
Fast-tracked through the Senate and House and to the Governor's desk, a bill intended to provide relief for consumers facing steep increases in their health insurance premiums was signed into law on January 26.   The bill provides a 25% rebate on the cost of premium for those consumers who purchase health insurance in the individual market but are not eligible for federal tax credits.

Also included in the bill is language intended to help protect consumers who may receive "surprise bills" following hospital or surgery center visits that they believed to be entirely in-network.  In many of these cases, the hospital or surgery center is in-network, but some ancillary services such as radiology or anesthesia were provided by non-network providers.  The language of the bill holds patients harmless, and allows negotiation and arbitration between the non-network physician and the health plan. The original surprise billing language included in the House version of the bill would have capped the reimbursement for out-of-network physician services at the in-network payment level.  Such a proposal, the MMA and other physician groups argued, would unfairly empower health plans in their negotiations with physicians, and would incentivize even more narrow networks.

The bill also contains a provision that allows for-profit HMOs to operate in the state.  Senate conferees rejected a House provision that would have removed all state mandated coverage of conditions and treatments. Requirements that all health plan products cover mental health, maternity care, and cancer screenings along with dozens of other conditions and treatments would have been repealed.

Governor’s Budget Proposal Extends Provider Tax
Governor Dayton unveiled his proposed biennial budget late last month, and legislators soon thereafter began the work of more closely studying the $45.8 billion proposal.  The budget includes almost $2 billion in new spending compared with the last biennial budget.  Legislators will soon begin the work of crafting their own budget proposal in response.

Some notable health care items included in the Governor’s budget include:

  • An extension of the state’s provider tax, the 2% tax on most health care services. The tax is currently set for repeal on December 31, 2019.
  • The proposal shifts more than $700 million in spending for Medical Assistance (MA) from the General Fund to the Health Care Access Fund (HCAF). Medical Assistance has historically been funded from the General Fund, though MA is the single biggest expenditure from the HCAF now.
  • A new “public option” that would allow Minnesotans who purchase in the individual insurance market to buy unsubsidized insurance coverage from the state’s MinnesotaCare program. Governor Dayton’s  office predicted that the average monthly premium for the public option MinnesotaCare option would be $70 less than the average plan offered by private payers such as Medica or HealthPartners.  MinnesotaCare reimbursement to physicians, of course, is far less than that of private third party payers.

Technical Fix to the Interstate Medical Licensure Compact Advances
A technical statutory correction to the Interstate Medical Licensure Compact quickly cleared its first committee stop in the House on January 31.  Authored by Rep. Tony Albright (R - Prior Lake), HF 474 now heads to the House Civil Law Committee for its consideration on February 9.

The original Compact language, strongly supported by the Minnesota Medical Association, other physician groups including the MAO, and many clinic and hospital systems, passed unanimously in 2015.  The Compact is intended to ease the process of licensure for physicians who wish to practice in multiple states. As the Board of Medical Practice (BMP) started preparing to issue licenses under the Compact, they were told by the FBI that Minnesota's law needed a technical correction to allow them to complete the background check process.

The Senate bill is authored by Sen. Carla Nelson (R - Rochester) and is expected to be heard soon.

Palliative Care Council Created Under Bill
Legislation to create a state council focused upon raising awareness of palliative care cleared its first hurdle in the Senate when it passed out of the Subcommittee on Aging and Long Term Care on February 1.  Authored by Sen. Karin Housley (R – Stillwater), the bill establishes the Palliative Care Advisory Committee, a 20 member committee that is to include two physicians, of which one is certified by the American Board of Hospice and Palliative Medicine.  Other committee members include nurses, care coordinators, patient advocates, patients and caregivers with experience in chronic diseases, and legislators.  The group is tasked with advising state government on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state, as well as making annual reports to the Legislature.

The Senate bill passed the committee and was referred to the Senate State Government Finance and Policy Committee.  The House bill is authored by Rep. Nick Zerwas (R – Elk River), and has not yet been scheduled for a hearing.

Physicians Day at the Capitol Set for February 15
Make plans to join your physician colleagues for the annual Minnesota Medical Association’s Day at the Capitol set for February 15.  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 the extensive three year-long renovation of the Capitol largely finished, it’s a great time to visit the Capitol.

The “White Coats Day” at the Capitol is a key piece of the organized medicine’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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