Legislative Update

MAO Legislative Update
April 5, 2018
Eric Dick, MAO Lobbyist 

Legislators Return to St. Paul on April 9
The midpoint of the 2018 legislative session arrived in late March when the Easter and Passover holidays arrived, bringing with them a week-long break from action in St. Paul.  Legislators will return for the final push to complete their work on April 9.  The Minnesota state constitution stipulates that the session must conclude no later than midnight on May 21. 

Several large items remain on the Legislature’s plate, including consideration of legislation to bring Minnesota’s tax code into compliance with that of the federal government.  Also awaiting legislators is consideration of a budget supplemental package. With the state running a surplus of more than $300 million, legislators will be fiercely debating how to use the additional dollars, with Republicans lobbying for additional tax cuts and DFLers arguing for new spending in critical programs.  And finally, as is customary in the second year of a biennium, legislators will likely consider a bonding bill to support capital-intensive projects such as university buildings, municipal convention centers, museums, and the like. 

“Gag Clauses” on Pharmacists Barred Under Bills
Pharmacy benefit managers (PBMs) and health plans would be prohibited from placing “gag clauses” that prevent pharmacists from telling patients that a medication would be cheaper if purchased with cash rather than using their insurance benefit.  These provisions are often included in the contracts that PBMs offer to pharmacists.  The House bill has cleared its policy committee hurdles and has been held over for possible inclusion in an omnibus package to be unveiled later in the session.  The Senate has also acted favorably on the issue, passing the bill to the Senate floor.

The House bill is authored by Rep. Matt Dean (R – Dellwood), while Sen. Scott Jensen (R – Chaska) is the Senate author.  Jensen also authored a similar bill with Rep. Roz Peterson (R – Lakeville). 

Legislators Seek to Add Transparency to Health Care Costs
Under legislative language discussed in recent weeks in the Senate, clinics would be required, upon request, to give patients additional information about the costs they would incur  .  Current law already requires clinics to give patients a good faith estimate of the average allowable reimbursement the provider accepts as payment from private third-party payers for the services specified by the consumer and the estimated amount the noncovered consumer will be required to pay. The new information would include the types of fees or charges that the consumer may be required to pay in conjunction with a visit to the provider, including but not limited to any applicable facility fees.  The new language also stipulates that the clinic would be required to provide the information within 10 days.

In related news, a proposal is moving forward that would require clinics to post cost information about the 25 most commonly performed services in the clinic (including the five most commonly billed evaluation and management codes that are billed for more than $25 and of the 10 most frequently billed CPT codes for preventive services).  The lists are to be updated annually and made available both on the clinic’s website and at the clinic.  For each code, the clinic is to list the following:  1) the provider's charge, 2) the reimbursement rate received for the service from the provider's highest volume health plan payer in the commercial insurance market, 3) the Medicare allowable payment rate (if applicable) and the Medical Assistance fee-for-service payment rate.  The same bill also amplifies current law’s requirement that clinics must offer patients a “good faith estimate” of costs, including if the patient does not have insurance or is out of network.  The bill also contains a provision that precludes health plans from including in their contracts with providers language that bars providers from sharing negotiated pricing information with patients.  The state’s health plans have been vigorously opposed to these provisions, arguing that they would lead to a “race to the top” as providers compared their reimbursement to that of their peers. 

Transparency in health care costs was a significant topic of consideration for members of the Senate Select Committee on Health Care Consumer Access and Affordability, a bipartisan group chaired by Sen. Scott Jensen (R – Chaska), a family physician. 

All Payer Claims Database Sunset Extended Under Bill
Bills to remove or extend the sunset on the state’s All Payer Claims Database (APCD) advanced in recent weeks through both the House and the Senate.  Housed at the Minnesota Department of Health, the APCD is a state repository of deidentified health care claims data that is derived from medical providers’ billing records sent to insurance companies, plan administrators and public payers.

Current law allows the APCD to be used for analyzing variations in health care costs, quality, utilization, and illness burden based on geographical areas or populations only up until July 1, 2019.  Under the bills authored by Rep. Nick Zerwas (R – Elk River) and Sen. Scott Jensen (R – Chaska), the use of the APCD for these purposes would be extended until 2023 (in the House bill) or indefinitely (in the Senate bill).  The bills have broad bipartisan support in both chambers. 

Opponents to the APCD have included privacy advocates, who have argued that the collection of data in this manner violates patient’s rights.  Many health plans have been skeptical of the APCD also, contending that the APCD’s use of data from different sources is inconsistent.  The MMA and other health care stakeholders have supported the APCD, arguing that the database is a rich source of information that can lead to better understanding of health care spending, trends, utilization, and efficacy of different health care interventions.

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