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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