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2017 Legislative Session Kicks Off

MAO Legislative Update
Eric Dick, MAO Lobbyist


Legislative Session Kicks Off
The 2017 legislative staff kicked off with the wrap of a gavel in both the Minnesota State Senate and Minnesota House of Representatives at noon on January 3, 2017.  Legislators, staff, lobbyists, and the public at large returned to a Capitol building open again for the first time in several years, as the three-year renovation project has been largely completed.  The newly refurbished building is beautiful and much brighter, and it contains significantly more space for the public.

The elections of November 2016 brought a big change to the Capitol, as the Senate flipped from DFL to Republican control.  The fall elections also saw the House remain in GOP control, and with a bigger margin.  While the two legislative bodies are now in control, passing bills into law will require the signature of DFL Governor Mark Dayton.

It will be interesting to watch the tone in which the legislative leaders and Governor Dayton interact.  Much of the summer and fall of 2016 saw on-again, off-again negotiations about scheduling a special session to address unfinished business from the ’16 session, notably relief for increased health care insurance premiums.  Efforts to reach agreement failed, and the rhetoric became quite heated.

Given that there are more than 40 new legislators and new committee chairs, the session will start slowly as most committee meeting will feature briefings on issues from state agencies and advocates.  In the next weeks legislative leaders will announce the deadlines by which legislation must pass certain waypoints to be considered viable.  The deadlines – likely in March – serve to help winnow the volume of bills under serious consideration.  The Minnesota Constitution requires that the session end no later than midnight on May 22, 2017.

Budget, Health Insurance Likely to Dominate Session
Leaders in the House and Senate, as well as Governor Dayton, have made relief for consumers facing steep increases in their health care insurance premiums a priority. Legislators have heard from constituents of enormous increases in the their premiums for 2017, and there is universal support for helping these individuals.

While few details have been announced, most proposals would offer a one-time rebate to those consumers who purchase health insurance products in the individual market and are not eligible for federal tax subsidies. Earlier proposals from House Republicans have used the Health Care Access Fund to fund the rebates, while others - Governor Dayton, notably - have insisted on using the state's reserve account or general fund dollars. Only about 5% of Minnesotans would qualify; the vast majority of Minnesotans receive their health coverage from either their employer or government payers (e.g. Medicare, Medical Assistance, MinnesotaCare).  In addition to one-time, short term relief for 2017, legislators and the Governor have committed to passing more substantial reforms to address future cost increases.

The primary task in front of legislators in 2017 is the crafting of a biennial budget that funds all operations of state government.  Minnesota, unlike the US Congress, budgets in two year increments. The state’s budget is in a strong position, with a budget surplus of more than $1 billion.  Passing a budget is the one item that must be completed.  Should the Legislature and Governor fail to reach agreement on a budget by summer, a government shutdown could occur.

Also likely to see significant attention by legislators are tax cut packages, as well as investments in transportation. Legislators had hoped to pass these measures in 2016, but agreement could not be reached. As such, these priorities remain at the top of many elected officials agendas.

Key Issues for the MAO to Watch
While it is always difficult to predict exactly which issues will garner attention at the Capitol, the MAO will be carefully monitoring action at the Legislature for a number of specific issues.

Thanks to a bipartisan agreement reached in 2011, the state’s provider tax is set for repeal on December 31, 2019.  With the GOP in control of the Legislature, an extension of the tax is unlikely.  The MAO will partner with other physician and provider groups to strongly oppose any effort to extend the provider tax.

The MAO will also continue the partnership with the Minnesota Medical Association and others to pass medication prior authorization reform.  The “Fix PA Now” coalition, of which the MAO is a member, will continue to press for passage legislation to simplify medication PA and ensure patients get the medications they need in a timely manner.  The bill passed all necessary committees in the Senate in both 2015 and 2016, but did not receive a hearing in the House of Representatives. Advocates for the bill have held multiple meetings with key legislators in the House in an effort to ensure hearings in 2017.

There have been some rumors that audiologists will be pursuing legislation in 2017, though the intent of any potential legislation remains unknown.  The MAO will carefully watch for bills that would change or broaden the scope of practice for audiologists at the risk of patient safety.

Many New Names in Key Positions
The work of the legislature begins with the committee process, and with the change in partisan control of the Senate many legislators will be taking on new leadership roles.  Chairing the Health and Human Services Finance and Policy committee is Sen. Michelle Benson (R – Ham Lake), while Sen. Jim Abeler (R – Anoka) will chair the Senate’s Human Services Reform Finance and Policy committee.  Abeler, a chiropractor, held the House HHS Finance Division gavel during the 2011-2012 legislative session prior to his election to the Senate in 2016.  Taking over as Senate Majority Leader is Sen. Paul Gazelka (R – Nisswa), an insurance agent, while Sen. Tom Bakk returns to lead the now-minority DFL Senate Caucus.

The House will see some leaders returning to their position.  Rep. Matt Dean (R – Dellwood) retains the gavel of the House HHS Finance division.  Rep. Dean’s spouse is Laura Dean, MD, an OB/GYN who practices in Stillwater.  With the retirement of the previous chair, the HHS Policy committee will now be helmed by Rep. Joe Schomacker (R – Luverne).   Rep. Kurt Daudt (R – Crown) returns as Speaker of the House, while the House DFLers have elected Rep. Melissa Hortman (DFL – Brooklyn Park) to lead their caucus.

Two Physicians Elected to Minnesota Senate
For the first time since 2002, there are not one, but two physicians serving in the Minnesota Legislature.  Representing Mendota Heights, Inver Grove Heights, and South St. Paul, Sen. Matt Klein (DFL) is a hospitalist who practices at HCMC.  Also elected in November was Sen. Scott Jenson, a Chaska Republican.  Sen. Jensen is a family physician.  Both were elected by wide margins to fill Senate seats left open by retirements of incumbent legislators.

The last physician to serve in the legislature was Rep. Dick Mulder, a Republican from Ivanhoe, who served from 1995 to 2002.

Physician’s 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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Legislative Update – 5/1/2015

MAO Legislative Update
May 1, 2015

Eric Dick
MAO Lobbyist

HHS Budget Conference Committee Set to Craft Single Bill
Second only to the bills to finance K12 education in their expense, the HHS omnibus funding proposals have passed both the House and Senate, though in markedly different forms. The differences will be negotiated in a conference committee of members of both the House and Senate.  And those differences are vast, with a chasm of more than $1.3 billion in spending between the House and Senate proposals, as well as dozens of provisions included in one package and not the other.

The Senate acted first when it passed SF 1458 authored by Sen. Tony Lourey (DFL - Kerrick) on April 29. Providing $13.1 billion in funding for the next biennium, the Senate bill clocked in at 454 pages and contains dozens of provisions related to health and human service programming. Among the provisions is reform of the prior authorization process, a bill authored by Sen. Melisa Franzen and strongly supported by the Minnesota Medical Association (MMA), medical specialties, and dozens of patient advocacy groups. The Senate bill also includes a small increase in primary care physician reimbursement in the MA and MinnesotaCare programs.

Also of note in the Senate bill are changes to MNsure, including repeal of the existing board of directors. Rather, MNsure would be moved to the executive branch where the director would be a political appointee of the Governor. The move, advocates argue, would provide more accountability than an unelected board. Also included in the Senate package are new uses for the All Payer Claims Database (APCD), funding for multiple mental health programs, and funding to reduce the incidence of fetal alcohol syndrome.

Carried by HHS Finance Committee Chair Rep. Matt Dean (R – Dellwood), the House proposal passed the body shortly after 1:00 AM on the morning of April 29 following a debate of more than seven hours. The centerpiece of the proposal is a repeal of MinnesotaCare, the health insurance program for low-income Minnesotans who earn too much to qualify for Medical Assistance. MinnesotaCare enrollees would instead be moved into MNsure, the state’s health insurance exchange, where they would be eligible for federal and state tax credits to assist in the purchase of silver-level plans.   The author and House Republicans argued that MinnesotaCare is too expensive and unsustainable into the future. The bill also sets MNsure on a path to repeal, ultimately moving all enrollees to the federal health insurance exchange. As part of the move away from MinnesotaCare, the House bill accelerates the repeal of the provider tax from 12/31/2019 to 12/31/2018.

Opponents of the bill argued that the premiums and out-of-pocket expenses for these plans would be so high as to lead many families to either purchase high-deductible health plans that provide poor coverage or forgo insurance entirely. Others, including the MMA and other physicians’ groups, have been highly critical of the bill’s transfer of more than $600 million of General Fund obligations to the Health Care Access Fund.

Just as with the Senate companion, the House bill contains dozens of different provisions, including cuts to the Department of Health & Human Services and Minnesota Department of Health’s administrative budgets, competitive bidding requirements for PMAP providers, and investments in a number of new and existing mental health services and initiatives, and child protective services. Of note, the House file does not include the prior authorization reform language that is embedded in the Senate bill, and it also eliminates funding for the State Health Improvement Program (SHIP), a means of investing in local public health programming. The House version of the bill also includes expanded authority for pharmacists to administer vaccines, something not included in the Senate bill. And finally, only the House version of the bill includes funding for community groups to support promotion of advanced planning and “living wills” within families, an effort led by the Twin Cities Medical Society (TCMS).

The conference committee is expected to begin meeting early next week.

Physician Compact Receives Unanimous Vote
The effort to enroll Minnesota in a soon-to-be established compact of states intended to ease the process of licensure for physicians who wish to be licensed in multiple states took a leap forward on April 30th when it passed the Senate on a 59 to 0 margin.

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, though the identical bill has now been introduced in 13 state legislatures.

A key priority for physicians groups in 2015, the bill has seen little organized opposition. Supporters have included the Board of Medical Practice, the Minnesota Hospital Association, Mayo Clinic, Allina Health, Sanford Health, Essentia Health, Children’s Hospitals and Clinics, Gillette Specialty Healthcare, and Gundersen Health. The House bill, HF 321, is authored by Rep. Tara Mack (R - Apple Valley) and is expected to be heard on the House floor in the coming weeks.

Higher Ed Bills Invest in Medical Education & Training
The package of funding proposals for the University of Minnesota and MNSCU making way through the legislative process include a number of notable pieces that support medical education and training. The Senate's funding package, SF 5, authored by Sen. Terri Bonoff (DFL - Minnetonka), passed the Senate on April 20. The House proposal, authored by Rep. Bud Nornes (R - Fergus Falls), had cleared the full House on April 27. Given significant differences in the bills, a final package will be negotiated by a conference committee made up of members from both the House and Senate.

Both versions of the higher education bills contain funding for the residency program at United Family Medicine, though the House funds the program at a slightly higher level of $500,000 in both years of the next biennium. Both proposals also fund graduate family medical education programs at HCMC at $645,000 in both 2016 and 2017. The bills also include provisions to fund research into biotechnology and medical genomics via a joint Mayo Clinic and University of Minnesota research partnership. The Senate includes provisions not contained in the House version, including family medicine residency programs at the St. Cloud Hospital as well as funding for Alzheimer's disease and traumatic brain injury research. In a novel section of the Senate bill, the University of Minnesota is authorized to refinance the bonds for the construction of TCF Bank Stadium, with the savings earmarked for the Medical School and Academic Health Center.

The Senate bill also contains language requiring monthly reports by the University to the Higher Education Committees in the House and Senate regarding the Board of Regents progress in developing and implementing a plan to conduct human subject research at the University. The U of M came under fierce scrutiny of the handling of the suicide of a subject participating in a psychiatric drug trial in 2004. The case was the subject of a highly critical report from the Office of the Legislative Auditor who stated that the case involves “serious ethical issues and numerous conflicts of interest(s)” between the University and drug manufacturers.

Tobacco Provisions Included in Tax Bill
Unveiled in a committee hearing April 23, the House omnibus tax bill contains a number of notable provisions related to tobacco taxation totaling almost $80 million. Authored by House Tax Committee Chair Rep. Greg Davids (R - Preston), HF 848 repeals a piece of the landmark 2013 tobacco tax bill. In addition to raising the tax on a pack of cigarettes by $1.60, the 2013 bill also included an automatic annual inflationary increase, a provision repealed by this year's proposal.   Also included in the House tax bill is language to alter the way e-cigarettes are taxed. Currently law taxes e-cigarettes at 95% of the wholesale price. Under the new law, taxation would be based upon the volume of liquid nicotine. The provision is largely seen as a boon to the big tobacco companies that have come to dominate the e-cigarette market at the expense of smaller independent "vape shops." Anti-tobacco groups have opposed the provision on the grounds that the change would likely make those e-cigarette devices most accessible to minors cheaper.

The only tobacco related provision in the Senate's version of the tax bill is language closing the loophole on bulk tubs of moist tobacco. Some manufacturers have begun selling large tins of chewing tobacco that exploit a loophole on state tax law making the product cheaper. The Senate bill is authored by Sen. Rod Skoe (DFL - Clearbrook), the chair of the Senate’s Tax Committee.

Not included in either proposal is any change in how premium cigars are taxed. Under proposals introduced and considered in both bodies was a dramatic lowering of the rate of taxation on cigars that cost more than three dollars.

"Right to Try" Bill Handily Passes Senate
A bill that would allow terminal patients access to pharmaceutical drugs, biological products, and devices that have not completed FDA trials handily passed the Senate on April 21 by a margin of 60 to 4.

Under the bill, SF 100, patients with "a condition or illness which, to a reasonable degree of medical probability, is not considered reversible and even with the administration of current FDA-approved and available treatments and the administration of life-sustaining procedures will soon result in death."   The bill, authored by Sen. Brandon Petersen (R - Andover), does not mandate that a pharmaceutical or device manufacturer make the products available. The bill does require that the patient give written informed consent, as well as to receive a prescription or recommendation from a physician, before they’d be eligible. Though the physicians groups did not take an official position on the bill, the MMA and others did work with the author to amend the bill to provide liability protection for physicians who participate.

The House companion, carried by Rep. Nick Zerwas (R - Elk River), is scheduled to be considered on the House floor on May 1.

Provider Tax Repeal Accelerated Under GOP Tax Bill
The House of Representatives approved a package of tax cuts totaling more than $2 billion on April 29. In addition to cuts in various business taxes, agriculture-related taxes, and other elements, the bill also hastens the repeal of the provider tax from December 31, 2019 to December 31, 2018. The accelerated repeal is closely linked to the proposal to repeal MinnesotaCare, as the provider tax serves as the principle funding source for the program.

The Senate’s tax bill has not yet been considered on the floor and does not contain the accelerated repeal provision. Given the difference between the two bodies’ tax bills, a conference committee will be appointed to negotiate the differences. No proposals have been put forward during the session to extend the provider tax or rescind the repeal.

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Legislative Update 4/17/2015

MAO Legislative Update
Eric Dick, MAO Lobbyist

House Committee Unveils HHS Finance Omnibus
The House HHS Finance committee unveiled its spending package on April 16. The 354 page bill will be the subject of a number of committee hearings next week as the bill is "marked up" or amended. Authored by Rep. Matt Dean (R - Dellwood) with a total price tag of $11.6 billion, the bill contains all state spending on HHS programming.

One of the central pieces of the spending package is repeal of the MinnesotaCare program, a health insurance program that serves low income Minnesotans from 138-200% of poverty and replacing it with what is being called MinnesotaCare II.  In 2013, the DFL legislative majorities expanded the program to qualify as a Basic Health Plan (BHP), a program recognized under the ACA.  Rep. Dean and many Republicans have argued that the current program is too expensive and unsustainable.

Under Rep. Dean's bill, MinnesotaCare is replaced by MinnesotaCare II.  This proposal would shift enrollees to commercial health insurance products purchased on MNSure, the state's health insurance exchange. Importantly, the shift of enrollees to commercial insurance products would be coupled with state tax credits on a sliding scale to individuals and families to subsidize the purchase of enhanced silver-level health insurance products. It remains unclear at this point how affordable the plans would be for many low-income Minnesotans; some have suggested that a family of four would see a yearly increase of $800 in premium costs alone.  Of note, physician services provided under these plans would reimburse at a commercial level and not that of the anemic reimbursement under MinnesotaCare or Medical Assistance. Rep. Dean has stated that his bill would allow for an accelerated repeal of the provider tax.  Current law repeals the tax on 12/31/2019, and a related bill by Rep. Dean would move that repeal up by one year to 12/31/2018.

Other notable spending and policy components in the bill include:

  • A requirement that medical services provided via telemedicine be reimbursed at the same rate as services provided in person. This piece was a major priority for the Minnesota Hospital Association and many clinic and hospital systems.
  • Many changes to MnSure, the state’s insurance exchange. The bill would require DHS to seek a waiver from the federal government to allow individuals to purchase health insurance products directly from health plans and still be eligible for tax credits currently over available on purchases made on the exchange. Other provisions in the bill serve to cap the salary of MnSure officials, make the MnSure executive director an appointee of the Governor, and begin to move the state away from MnSure towards a federal exchange.
  • A requirement that DHS establish a web-based interactive application to help consumers compare local pharmacy prices for the most commonly prescribed drugs.
  • New tools and requirements for DHS to monitor public health care programs to ensure that only eligible enrollees are receiving services. The nonpartisan Office of the Legislative Auditor (OLA) has published a number of reports in recent years pointing to a sizable number of ineligible enrollees receiving benefits.
  • Additional reporting requirements on the managed care organizations (MCOs) that manage the state’s Prepaid Medical Assistance Programs (PMAP) on behalf of the state. The new requirements include reporting on administrative expenses, funds spent on lobbying, marketing, and salaries for health plan executives.
  • Expands the authority of daycares, recreation centers, colleges and universities, and other places to stock and use epinephrine auto-injectors (“Epi-Pens”). The bill requires regular training in the use of the devices for employees while providing “Good Samaritan” liability protections for their use.
  • A requirement that patients be given certain information if a prenatal diagnostic test indicates the presence of a trisomy condition. The MMA and others opposed this provision as intrusion into the physician-patient relationship.
  • A number of provisions related to mental health, including mandated Medical Assistance coverage of pediatric resident psychiatric treatment, improved data collection around suicides, an increase in reimbursement for those who provide chemical dependency treatments, and a pilot program for the diversion of low level criminal offenders with mental illness from jail to treatment centers.
  • Enhanced authority for pharmacists to administer vaccines.   Current law allows pharmacists to administer only influenza vaccines to patients ten and older. Under this provision of the funding bill, pharmacists would be allowed to administer influenza vaccines to patients as young as six while allowing them to administer other vaccines to patients 13 and older. The language also requires pharmacists to both consult the MIIC prior to administering the vaccine and enter it following administration.

Also noteworthy are the things that are not included in the budget. The budget does not include any increases in reimbursement for primary care services. Many physicians groups sought to extend the ACA’s primary care “bump” that brought Medical Assistance reimbursement up to that of Medicare. That enhanced payment ended in December 2014. The funding proposal also eliminates the entire appropriation for the Statewide Health Improvement Program (SHIP), a program that offers grants to schools, cities, and counties to invest in public health infrastructure. First established in 2009, SHIP has been used to fund smoking cessation programs, expand farmers markets, and reduce obesity rates.

The Senate budget proposal is likely to be announced early next week, and is certain to include significantly more spending on these programs.   After passage by both bodies the differences will be negotiated in a conference committee of members from both bodies.

Compact Bill on the Floors
Following a short, unexpected detour to the House Ways & Means Committee, the Interstate Medical Licensure Compact awaits action on the floor of both the House and Senate. The financing of the bill was the subject of some discussion in the Ways & Means Committee, as the fiscal note prepared for the bill originally showed some costs to the Board of Medical Practice. Following additional discussion, the BMP determined that any additional costs could be absorbed through its current appropriations and license fees.

Little opposition has come forward on the bill thus far. The bill has a wide coalition of supporters, including the Minnesota Hospital Association, Allina Clinics, Mayo Clinic, Gundersen Health System, Essentia Health, and others.

Legislators Consider E-Cigarette Tax Cut Proposals
The tax levied on e-cigarettes would be rolled back under a bill considered in the House this week.  The House bill, HF 2182, is authored by Rep. Greg Davids (R - Preston), and was heard on April 16.  The Senate bill, SF 2025 (Sen. Lyle Koenen, DFL - Clara City), had been scheduled for a hearing but was removed.  Many expect it to be rescheduled soon.

Current law taxes e-cigarettes and the e-cigarette liquid used in the devices at a rate of 95% of the products wholesale value. Under the bill, the tax would be based upon the volume of liquid nicotine.  The proposal is widely seen as benefiting those large tobacco manufacturers who sell the "closed system" e-cigarette devices sold in gas stations and convenience stores.  Conversely, the bill would likely increase the tax rate on devices sold in smaller, independent e-cigarette retailers.  Anti-tobacco groups have been highly critical of the bill, as the law would cap the tax going forward, while current law allows the tax to grow as the price of the product increases.  The Raise it for Health Coalition, of which the MMA is a member, also noted that these same devices are far more likely to be used by children and adolescents due to their wide availability.

Tobacco companies such as RJ Reynolds and Altria dominate the e-cigarette market in the United States, particularly in the "closed system" e-cigarette market.

Prior Auth Bill Receives Finance Hearing
The effort to reform the prior authorization process took another step when the bill was heard in the Senate HHS Finance Committee on Friday, April 17.  As was expected, the bill was held over for possible inclusion in the Senate's HHS finance omnibus, which is expected to be unveiled early next week.  The MAO is a member of the coalition supporting the proposal.

During the last committee stop, the bill was further amended to address concerns raised by the Minnesota Council of Health Plans and the Department of Human Services. The heart of the bill remains, and would represent a significant reduction in administrative burden for prescribers while adding important patient protections. The amendment changes some of the timelines for action by health plans included in the original bill, and narrows them to only apply to prescription drugs.   The amendment further clarified that a change to a generic drug from a brand name pharmaceutical is not considered step therapy for the purposes of the bill.

The House version of the bill did not receive any hearings. Given that the language is only contained in the Senate’s version of the HHS Finance omnibus, the bill will be considered as part of the conference committee hearings on the overall HHS budget.

Senate Higher Ed Budget Funds Residency & Medical Education Programs
The Senate Higher Education & Workforce Development Budget Division announced its budget package earlier this week, and it includes significant investments in medical education, residencies, and research. Included in the budget proposal is $346,000 to support the St. Cloud Hospital’s family practice residencies. Also included is $467,000 for supporting the United Family Medicine Residency’s primary care program each of the next two years. And finally, $645,000 in each of the next two years is set aside for graduate family medical education at Hennepin County Medical Center.

Not unlike Governor Dayton’s proposal announced earlier this year, the Senate bill would provide $25 million in additional funding of the University of Minnesota Medical School’s research programming during the next biennum. The bill also provides for grants for research into spinal cord injuries and traumatic brain injuries. The University of Minnesota and the Mayo Medical Foundation also receives just under $7.5 million to fund a joint partnership in genomics research.

The bill also authorizes the University to refinance the existing bonds for the construction of TCF Bank Stadium with the savings earmarked for the predesign and design of improved health education and clinical research facilities of the University of Minnesota Medical School and the Academic Health Center.

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Legislative Update – 4/7/2015

MAO Legislative Update
April 3, 2015
Eric Dick
MAO Lobbyist

Easter/Passover Break Marks Session's Midpoint
Legislators left St. Paul on Friday, March 27th to begin a week-long break for the Easter and Passover holidays following a scramble of late nights of committee meetings. The annual break represents a mid-point in the session and marks the coming of budget hearings and negotiations. With the passage of the second policy committee deadline on March 27th, much of the work of policy committees has been completed, and the action will shift to the committees with jurisdiction on spending and taxing issues.

With the break, many legislators will be holding ‘town hall’ meetings back in their districts. It’s a terrific opportunity to visit your elected official to share with them what issues are important to you. Legislators want to hear from physicians and physicians-in-training, and these visits can be very impactful. Legislators return to St. Paul on Tuesday, April 7 for the final sprint toward a late-May adjournment.

No Scope of Practice Changes for Audiologists Introduced
With the passage of the policy deadlines in recent weeks, no legislation to expand the scope of practice for audiologists has been considered. In recent years, such bills have often been considered both in St. Paul and at the federal level in Washington, DC. These bills can put patients at risk be expanding the scope of audiologists to include procedures in which they are not adequately trained.

The MAO Advocacy team continues to watch for other legislation that would be detrimental to otolaryngologists and patients. Unlike in years past, there have also been no efforts to extend the state’s sales tax to “cosmetic” surgical procedures.   Proposals such as these often contain inaccurate or ill-defined definitions of what constitutes a “cosmetic” procedure, and compliance with the law would lead to intrusion in a patient’s medical records. And finally, all physician services are subject to the provider tax.   (Note: The provider tax is set for repeal at the end of 2019 and no proposals to rescind the repeal have been introduced.)

Prior Auth Reform Misses Deadline
The MMA-led effort to reform the laws governing prior authorization took a blow recently when the House HHS Reform declined to hear the bill before the Legislature’s second deadline for acting upon bills. While the bill had passed the necessary policy committee in the Senate with little opposition from legislators, opponents – particularly the health plans and pharmacy benefit managers (PBMs) successfully blocked the bill’s consideration in the lower body.

While certainly a setback, the door has not yet closed on moving the bill in its entirety or in smaller pieces. The authors of the legislation, Sen. Melisa Franzen (DFL – Edina) and Rep. Tony Albright (R – Prior Lake), have expressed interest in pursuing other mechanisms to enact some elements of the bill. It’s possible that the bill could be included in a larger omnibus package of HHS finance-related provisions, and it’s possible that pieces could be amended into other bills. This remains a priority issue for the more than 40 organizations that support its passage, a coalition that includes the MAO. The full list of supporters and additional information can be found on the fixPAnow.com website.

Budget Targets Announced by House, Senate Leaders
The work of setting a state budget for the state began in earnest last week when both the House Republicans and Senate Democrats announced their budget targets. These numbers set overall spending for both the entire state government and individual areas within state government (e.g. K-12 education, HHS, transportation, etc.). While the Senate targets are largely in line with the figures proposed by Governor Dayton in mid-March, the House Republican targets are very different.

Presented in a press conference by GOP House Speaker Kurt Daudt (R – Crown) and Rep. Jim Knoblach (R – St. Cloud), the chair of the budget-writing Ways & Means Committee, the Republicans propose overall state spending of just under $40 billion for the 2016-2017 biennium, with an additional $2 billion in unspecified tax cuts. Included in their spending numbers is $11.6 billion in the HHS budget. Republican leaders argued that the HHS number represents an increase of more than $400 million over 2014-2015 levels, while their DFL opponents noted that the figure is more than $1.1 billion less than the projected HHS spending for 2016-2017 that is included in current law.

Later in the week Senate Democrats then put forward their budget targets on March 27, and their budget more closely matches that put forward by Governor Dayton earlier in the year. Their budget provides for biennial spending of $42.7 billion, including an additional $341 million in HHS funding above current projections. Senate Majority Leader Tom Bakk (DFL – Cook) noted in his budget announcement that increased funding for loan forgiveness for rural physicians remains a high priority.

One of the central questions in the HHS funding debate will be the future of MinnesotaCare. During the last legislative session, the Legislature amended MinnesotaCare to qualify as a “Basic Health Plan” (BHP) as allowed under the ACA. The only BHP in the country, the plan provides robust health coverage to enrollees with very limited out-of-pocket expenses. Critics have suggested that the program as constructed is too expensive and not sustainable. One of those critics, Rep. Matt Dean (R – Dellwood), the chair of the House HHS Finance Committee, has proposed an alternative. Under Rep. Dean’s bill (HF 1665), the current MinnesotaCare program would be repealed and replaced by a new system dubbed “MinnesotaCare II.” Enrollees would be given state subsidies and required to purchase silver-level health plans through MnSure, the state’s health insurance exchange. The advantages of MinnesotaCare II would be that payments to physicians and other providers would be at commercial rates instead of the extremely low MA rate, and it would reduce pressure on the state’s 2% provider tax, scheduled to be repealed in 2019.It’s not yet clear what these health plans would look like in terms of out-of-pocket expenses, copays, or deductibles and whether the projected higher cost-sharing requirements will be too burdensome for low-income Minnesotans to afford. Senate leaders and Governor Dayton’s office have indicated that they are strongly opposed to any proposal that dismantles MinnesotaCare in its current form.

The finance committees in both bodies will begin to craft their budgets upon their return from the Easter/Passover break. Given the expected differences between the two approaches, Senate and House leaders – likely in conjunction with the Governor and his top officials – final action will require conference committees and behind-the-scenes negotiations.

Tax on Premium Cigars Rolled Back Via Bill
The state's enhanced tax on "premium" cigars would be dramatically reduced under a bill heard in the House Tax Committee on March 25. The bill is authored by Rep. Jim Nash (R - Waconia). The House file was held over for possible inclusion in an omnibus tax bill that will be unveiled later in the session. The Senate bill, carried by Sen. Dave Senjem (R - Rochester) is set for a hearing shortly after legislators return from the Easter/Passover break.

Under current law, hand-rolled cigars that have a wholesale cost of more than $2.00 and whose wrapper is entirely made of tobacco are defined as a "premium cigar." These items are taxed at 95% of the wholesale value, though is capped at $3.50. This bill would lower that cap to $.50.

A number of individuals testified in opposition, including Twin Cities physician Lisa Mattson, MD, arguing that making tobacco less expensive serves no public good. The bill is being sought by tobacco retailers and the Cigar Association of America.

Physician Assisted Suicide Bill Receives Informational Hearing
A bill to allow physician-assisted was introduced in both the House and Senate, though the authors quickly acknowledge their intent to not pursue them this year but use the bills to start a broader, statewide conversation about the issues of patient decision-making and autonomy at the end of life.

The Senate took up SF 1880, authored by Chris Eaton (DFL - Brooklyn Center) in an informational hearing on March 23. Senator Eaton was joined by David Grube, MD, an Oregon family physician and the National Medical Director for Compassion & Choices. Also speaking in support was a woman whose parents had extended, difficult deaths who had stated their interest in assisted suicide.   No official action was taken at the hearing, and no hearings are anticipated for the House bill, authored by Rep. Mike Freiberg (DFL - Golden Valley).

Under the bill, terminally ill patients would be allowed to request from their physician medication intended to aid in hastening death. The bill lays out a number of requirements that must be included in the request, including the number and type of witnesses to a patient's request, as well as multiple statements of intent made by the patient over the course of at least 15 days. The bill further specifies the role of attending physicians, including a requirement that they inform the patient of the prognosis, make a determination of competency, provide extensive documentation in the patient's medical record regarding the patient's wishes, and other requirements. The bill requires patients to "self-administer" the lethal medications. The bill is modeled after Oregon's assisted suicide legislation, in place since 1998.




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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 →


Legislative Update – 5/23/2014

Session Comes to an Orderly – and Early – Close

The 2014 session wrapped up in a neat and orderly fashion late in the evening of Friday, May 16, three days earlier than the constitutionally mandated adjournment date of May 19. In the final hours of session, both the House and Senate acted on the remaining pieces of work, including significant legislation regarding tax policy, a supplemental finance bill, a nearly billion dollar bonding bill, and narrowly tailored legislation to authorize medical cannabis.   The conclusion of the session was considerably more staid than the hectic, hurried occasions in recent years.

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Legislative Update – 5/9/2014

Provider Peer Group Suspension Now Law

An MMA-supported bill to permanently suspend the state’s Provider Peer Grouping (PPG) was signed into the law on April 29. The bill, authored by Rep. Tom Huntley (DFL – Duluth) and Sen. Tony Lourey (DFL – Kerrick) passed both bodies with bipartisan support during the last weeks of April.

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Legislative Update – 4/25/2014

Legislators Begin Final Push

After a week back in their districts for the Easter/Passover break, legislators returned to St. Paul on Tuesday, April 22 for the final weeks of the 2014 session. Under the Minnesota Constitution, the legislature must adjourn no later than May 19 (and no bill may be passed on the final legislative day). As is often the case in the days following the spring break, there is growing speculation about whether the House and Senate can complete its work prior to that day, though it remains to be seen whether that remains feasible.

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