Monthly Archives: March 2017

MAO Legislative Update – 3/17/2017

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

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Deadlines Make for Busy Week at Capitol
Moving well into the third month of the legislative session, the first and second legislative deadlines have come and gone.  Each legislative session, legislative leaders set benchmarks by which legislation must clear to remain viable.  Recent weeks have seen committees meet often and late into the evening as they try to process bills.

The next and final deadline is March 31.  By that date bills that have financial or tax impact will have to have been heard in committee. The next weeks will see committees spending much of their time assembling budget bills.  There will also be more action shifting to the floors of the House and Senate, as policy bills make their way through the legislative process.

HPV Vaccine Bill Draws House Author
Legislation to allow minors to offer consent to receive the HPV vaccine without parental consent has drawn a House author to complement the Senate companion.  The bill, authored by Sen. Matt Klein (DFL – St. Paul) and Rep. Jennifer Schultz (DFL – Duluth), amends current law’s provision allowing minors to consent to health care related to pregnancy, STIs, and drug/alcohol abuse.   Sen. Klein is a physician who practices hospital medicine at HCMC.

Unfortunately, the bills are unlikely to receive a hearing or move during this legislative session, as they are opposed by many legislators who are skeptical of both immunizations and minor consent laws.

Prior Authorization Bill Subject of Press Conference, Senate Hearing
A key legislative goal of many physician and patient advocacy groups - reform of the medication prior authorization process (PA) – has seen several important steps forward in recent weeks. The MAO is a supporter of the effort.

The Senate bill, authored by Sen. Carla Nelson (R - Rochester), received a warm reception in the Senate Health and Human Services Finance and Policy Committee on March 9.  Testifying in support was David Agerter, MD, President of the Minnesota Medical Association, sharing with the committee the burden of PA on clinics, as well it's negative impact on patient health and outcomes. Also sharing the perspective of patients was Sue Abderholden, the executive director of the National Alliance on Mental Illness (NAMI-MN).  NAMI joins a group of dozens of other disease and patient advocacy groups in supporting the bill.  Every member of the committee who spoke did so in strong support, with one member, Senator Scott Jensen (R - Chaska) comparing the fight between physicians & patients vs. health plans & PBMs to that of David against Goliath.  The bill was held over for possible inclusion in a larger omnibus to be announced later in the legislative session.

The House author, Rep. Rod Hamilton (R - Mountain Lake) has thus far been denied a hearing for his bill. In an effort to gain some momentum and secure a hearing, Rep. Hamilton called a press conference for Tuesday, March 14.  Rep. Hamilton shared the story of his diagnosis with Multiple Sclerosis (MS), and his struggle to get the medications his physician has prescribed.  It was a powerful press conference, and received significant coverage across the state. Both Dr. Agerter and Ms. Abderholden spoke at the press conference, as well.

Under the bill, health plans would be precluded from changing a patient's formulary in the middle of a patient's enrollment year if the patient is currently taking a drug therapy. The bill has been vigorously opposed by the state's health plans, as well as pharmacy benefit managers (PBM) such as ExpressScripts and Prime Therapeutics. The MMA and its partners have sought passage of PA reform for the last three years, though these special interests have blocked passage.

Quality Measures Alignment Bill Receives Hearings
Efforts to align the quality measures required by state and federal entities was heard in the Senate Health and Human Services Finance and Policy Committee on March 14 and laid over for possible inclusion in a larger omnibus package to be unveiled at a later date.

Under the bill, SF 1340, authored by Sen. Scott Jensen (R – Chaska), the quality measures included in the Statewide Quality Reporting and Measurement System (SQRMS) must align with Medicare’s Merit-based Incentive Payment System (MIPS) measures.  The bill further limits the number of measures that clinics would be required to report to six for a single-specialty clinic and ten for a multi-specialty clinic.  The intent of the bill is to reduce the administrative burden associated with reporting to both the state and federal governments, as the measures required by both were slightly different from one another.

The House bill, HF 1517, is authored by Rep. Matt Dean, the chair of the House Health and Human Services Finance Committee, where it was heard and laid over for possible inclusion in their omnibus bill.

Reinsurance Bill Headed to Conference Committee
With similar – though not identical – bills to subsidize health plans with a reinsurance pool for high cost patients having passed both the House and Senate a conference committee will soon be called to negotiate a single bill to act upon.  Legislators have acted to stabilize the individual market by subsidizing the costs of high risk, high cost patients in the individual market.  This is in result of premium costs in Minnesota's individual market increasing by over 50 percent last year.

The bills are similar in concept though they differ slightly in the funding source, as well as the levels of coverage they’ll provide.  The Senate bill, authored by Sen. Gary Dahms (R-Redwood Falls), funds the pool by transferring $360 million out of the Health Care Access Fund (HCAF) over the course of the next two years.  The House proposal uses less money from the HCAF - $80 million – though it also diverts some premium taxes that would have otherwise been directed to the fund.   The bills also differ in the level of subsidy they provide to insurance companies to cover expenses, with the Senate proposal more generous to the plans.

On the Senate floor, the Senate rejected by a tie vote an amendment authored by Sen. Tony Lourey (DFL – Kerrick) that would have allowed individuals, regardless of income, to purchase their health insurance from the MinnesotaCare program if they lived outside the seven county metro area.  In an effort to address concerns about the low reimbursement rate paid to providers, the amendment included language that raised the reimbursement rate for services provided under these plans from the MinnesotaCare level to that of Medicare, which is still significantly below the rates paid by private insurers.

Both the Governor and Legislature have indicated that they hope to have a reinsurance bill signed into law by the end of March, as health plans are already beginning the rate-setting process for 2018.  The Governor and many DFLers have expressed their opposition to funding the pool largely out of the Health Care Access Fund.

Restrictive Non-Compete Contracts Subject of Senate Hearing
A bill to prohibit the use of non-compete clauses in primary care physician employment contracts was considered by the Senate Health and Human Services Finance and Policy Committee on March 9 where it was passed and referred to the Judiciary Committee.  The bill would render void any contract that places restrictions on the right of a family physician to practice within a geographic area for any period of time after the termination of employment or partnership.  As introduced, the bill would have applied to all physicians, though it was amended to only apply to primary care physicians.

The bill is authored by Sen. Scott Jensen (R – Chaska), a family physician.  The House bill is authored by Rep. Jim Nash (R – Waconia).  Neither the Senate nor House bill completed the necessary committee stops prior to the second deadline, so the bill will almost certainly not advance this session.

Opioid Stewardship Bill Receives Senate Hearing
Authored by Sen. Julie Rosen (R – Vernon Center), a bill to add an assessment called a  “stewardship fee” of one cent per morphine milligram equivalent of opiates sold within the state was heard in the Senate Health and Human Services Finance and Policy Committee on March 9.  The fee, to be paid by the drug manufacturer, was expected to raise as much as $20 million per year, though it’s likely the fee faces opposition and may be altered.

Proceeds from the fee would be used to establish the Opiate Product Stewardship Advisory Council, an 18 member panel made up of physicians, other health care professionals, drug treatment experts, law enforcement, legislators, tribal leaders, and members of families impacted by opioid abuse.  The council would oversee investments in prescriber education, public education efforts, county social services for children and families impacted by opioid abuse, promotion and adoption of best practices related to opioid disposal, and other projects.

The House bill is being carried by Rep. Dave Baker (R – Willmar) though it has not yet received a hearing.  Rep. Baker lost his son to overdose and has been a leader on opioid and other drug issues in the Legislature.

“Any Willing Provider” Measure Heard in Senate Committee
At the beginning of the 2017 Legislative session there was a lot of discussion by legislators about growing concerns with health plans developing provider networks that were very limited.  Questions were being raised about whether these networks were adequate to meet the needs of patients, especially in the rural areas of the state.

One bill to attempt to address this is SF 1738, introduced by Sen. Scott Jenson (R-Chaska), a family physician.  This bill would prohibit a health plan from denying a primary care provider the right to contract with the plan as an in-network provider if the provider is certified as health care home by the Commissioner of Human Services.  The bill defines primary care provider as a physician or APRN in the specialties of family medicine, general internal medicine, general pediatrics, or obstetrics and gynecology, who utilize primary care teams to treat patients.

Supporters of the bill argue that patients need continuous relationships with their primary care physicians to insure the best care and narrow health plan networks interfere with that.  Opponents argue that removing the ability of health plans and accountable care organizations to control the size and composition of their networks will make it harder to control health care costs.

SF 1738 passed the Senate Commerce and Consumer Protection Finance and Policy Committee and was heard in the Senate Health and Human Services Finance and Policy Committee where it was laid over for possible inclusion in an omnibus bill to be developed by the committee at a later date.  The House companion bill did not receive a hearing this year.

Tobacco Taxes Considered in Senate Committee
A series of bills supported by the tobacco industry were considered in the Senate Tax Committee in recent days.  One bill, authored by the chair of the committee, Sen. Roger Chamberlain (R – Lino Lakes) would repeal the automatic tax inflationary increase on a package of cigarettes.  The inflator was included in the landmark 2013 tax bill that increased the tax on a pack of cigarettes by $1.60.  A second bill heard in committee would alter the rate of taxation on e-cigarette devices, effectively making the most commonly available e-cigarette devices – a market dominated by Altria and other large tobacco companies – less expensive relative to other devices.  A third bill considered by the committee would repeal the tax on “premium” cigars – those that retail for more than $3.50.  Testifying in opposition were anti-tobacco advocates, including physicians.

The bills were laid over for possible inclusion in an omnibus tax package to be unveiled later in session.

Several bills sought by tobacco control advocates have also been introduced during the 2017 session, though their fate is uncertain.  One proposal, authored by Sen. Jeff Hayden (DFL – Minneapolis) and Rep. Rena Moran (DFL – St. Paul), would prohibit the use of coupons for tobacco sales.  Tobacco manufactures have increasingly used coupons as a means to negate the increase in tobacco taxes.  Bipartisan bills have also been introduced to fund statewide tobacco cessation phone lines.

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Legislative Update – 3/6/2017

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

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Prescription Monitoring Program Use Debated
Legislation from Rep. Dave Baker (R – Willmar) to mandate the use of the state’s Prescription Monitoring Program (PMP) by all prescribers and dispensers was heard by the HHS Reform Committee on Tuesday February 21, along with a number of other bills to address the continuing opioid crisis in Minnesota.  February 21 was Opioid Awareness Day at the Capitol.

The immediate past president of the Minnesota Medical Association, Dave Thorson, MD testified raising practical considerations related to the use of the PMP.  Dr. Thorson stated that the PMP is a helpful tool to assist prescribers to determine whether a patient seeking opioids may be abusing or diverting them, but he also pointed out that the PMP is not always an easy tool to use.  He stressed the ultimate goal is to embed the PMP into the electronic medical record so a physician will see the patient’s opioid history automatically, but to mandate its use prior to all opioid prescriptions is not the right step.

Partially in response to Thorson’s testimony, the bill was amended to provide a number of exceptions to the PMP mandate.  The PMP would not be required to be checked if opioids were being used to treat cancer, for patients in hospice or diagnosed with a terminal disease, or for 30 days or less for acute pain following surgery, an invasive procedure, or a delivery.

Further discussions with Rep. Baker have limited the requirement to check the PMP even more.  Baker is planning on further amending the bill to only require a check for an initial opioid prescription in the emergency room or an urgent care center.  In all other cases the requirement would only apply upon a refill or continuation of an opioid for more than 30 days.

While this bill in moving in the House, it has not received a hearing yet in the Senate and it is unclear whether it will this year.

Quality Measure Alignment Subject of House Hearing
A bill to align the quality measures required by state and federal entities was heard in the HHS Reform Committee on March 1 and passed to the HHS Finance Committee. Under the bill, authored by Rep. Matt Dean (R - Dellwood), would require the quality measures included in the Statewide Quality Reporting and Measurement System (SQRMS) align with Medicare’s Merit-based Incentive Payment System (MIPS) measures.  The bill further limits the number of measures that clinics would be required to report to six for a single-specialty clinic and ten for a multi-specialty clinic.  The intent of the bill is to reduce the administrative burden associated with reporting to both the state and federal governments, as the measures required by both were slightly different from one another.

The Senate companion is authored by Sen. Scott Jensen (R – Chaska), a family physician.  It’s likely to be scheduled in the coming weeks.

Budget Forecast Paints Somewhat Rosier Picture
The annual February forecast released on February 28 by Minnesota Management and Budget (MMB), the state's fiscal agency, showed an improved budget picture. A balance of $743 million is projected for the current biennium, and a robust $1.65 billion balance is projected in the upcoming 2018-2019 biennial budget. The budget picture even looks positive into the FY 2020-2021 biennium, though MMB notes that the forecast is subject to change, particularly given the significant uncertainty emanating from Washington, DC.

The good budget news should make agreement on a final budget package somewhat easier, as there are more dollars available for both spending and tax cuts.  With the Governor having unveiled his budget proposal in late January, legislators will now use the new forecast to begin the work of assembling their own budget package.  The two sides will have to reach agreement by the constitutionally mandated close of session, set for midnight on May 22 or risk having to return for a special session.

Capitol Pace Quickens as Deadlines Loom
With the first deadline of March 10 fast approaching, many House and Senate committees have been meeting late into the evening.  The HHS Reform Committee, for example, heard 21 different bills over the course of more than five hours of hearings on February 28.  The pace will remain very quick for the next few weeks as legislators rush to move bills through the committee process to “make deadline.”  In an effort to winnow down the number of proposals considered viable, legislative leaders set deadlines by which legislation must pass certain committees.  By March 10, bills must pass through the required policy committees in one body, and the companion bill must clear the committees in the other body by March 17.  A third deadline of March 31 sets the benchmark for finance bills to clear.

House and Senate Consider High Risk Pool Proposals
In an effort to stabilize the individual market by subsidizing the costs of high risk, high cost patients in the individual market pool, both the House and Senate have taken up bills to establish a reinsurance mechanism, though the approach on how to fund it differs between the two bodies.  With premium costs in Minnesota's individual market increasing by over 50 percent last year, legislators are seeking ways to provide some stability in the market.

Both bills provide a state subsidized reinsurance pool that would cover up to 80 percent of the costs of those patients whose annual health care costs are between $45,000 and $250,000 each year.  As currently drafted both bills also uses a portion of the Health Care Access Fund to pay for the reinsurance.  The Senate proposal, offered by Sen. Gary Dahms (R - Redwood Falls) uses a direct appropriation from the Health Care Access Fund (HCAF) of $180 million in each of the next two years. Many provider groups, including the MMA and the Minnesota Hospital Association spoke in opposition, noting that drawing funds from the HCAF would weaken the state's ability to provide coverage to low-income Minnesotans in the coming years.  The proposal does not alter the sunset of the provider tax, currently set for December 31, 2019.  The Senate bill will next be considered by the full Senate Finance Committee.

The House proposal, carried by Rep. Greg Davids (R - Preston), transfers the 1 percent premium tax on health plans that currently goes to the HCAF to the new reinsurance pool. It also takes a direct appropriation of $80 million from the HCAF to provide startup funding for the program.  The bill passed the Commerce Committee on February 28 and was referred to the HHS Policy and Finance Committee.

MinnesotaCare "Public Option" Plan Considered in Committee
The Republican-led Senate considered one of Governor Dayton's central health care proposals for 2017 on March 1.  Under the proposal, carried in the Senate by Sen. Tony Lourey (DFL - Kerrick), all Minnesotans would be eligible to purchase an unsubsidized MinnesotaCare health insurance product regardless of their income. Supporters of the plan argued that it is necessary to ensure that all Minnesotans - particularly those in rural Minnesota where there are fewer choices of health plans - have access to a high quality, affordable health product.  Opponents, including the MMA and the Minnesota Hospital Association (MHA), noted that the public option is cheaper largely because the reimbursement under MinnesotaCare is very low relative to commercial payers; some procedures, they noted, reimburse for as low as 26 percent of commercial insurance.  Many argued that the proposal would lead to even more instability in the individual market as the risk pool shrunk as individuals enrolled in the public option.

No vote was taken on the proposal and it will not be included in any final budget omnibus packages.

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