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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