Legislative Update

MAO Legislative Update
March 23, 2018
Eric Dick, MAO Lobbyist 

First Deadline Passes, Second Looms
The first policy deadline for the Legislature passed on March 22, signaling the start of the process by which legislative leaders winnow the volume of bills that remain viable for 2018. Bills must have cleared the policy committees in either the House or Senate by March 22, and that same bill needs to clear the same mark in the other body by March 29.  A final deadline in late April applies to legislation with a tax or financial impact to the state.

While the deadlines dramatically narrow the universe of viable bills, legislators and lobbyists alike will continue to seek ways to keep their particular issues alive, often trying to amend bills that are moving through the legislative process.

Step Therapy Reforms Clear House Committees
Legislation to enhance a physician’s authority to override step therapy requirements for patients cleared two House committee in recent days, and the bill awaits action in the State Government Finance Committee.  The bill is scheduled to be heard in the Senate Health and Human Services (HHS) Finance and Policy Committees in the coming days.

Under the bill, physicians would be authorized to override a step therapy requirement in three circumstances: 1) if a step requirement required the patient to use a drug that is medically contraindicated, 2) the patient has previously tried and failed a required  drug therapy that is part of a step requirement and 3) if a patient’s condition is being successfully treated and it’s in the physician’s judgement that a change in therapy would likely be ineffective or cause the patient harm.

Rep. Kelly Fenton (R – Woodbury) and Sen. Paul Utke (Park Rapids) are the authors of the bills and are joined by numerous coauthors from both parties.

Opioid Stewardship Bills Differ Greatly in the House and Senate
Legislation to address the state’s opioid crisis received hearings in both the House and Senate last week.  Both bills provide approximately $20 million in additional funding to address opioid abuse.  The funding will be used to embed the Prescription Monitoring Program (PMP) into the electronic medical record to make it easier to use, provide grants to local communities to address opioid abuse and addiction, offer more education to prescribers and the public on the appropriate use of opioids, and assist counties in the increased costs of foster care for children of addicted parents.  Both bills passed the HHS committees in their respective bodies and were referred to the finance committees.

The bills differ greatly in how they raise the funds.  The Senate bill (SF 730) maintains the stewardship fee assessed on opioid manufacturers.  This assessment, at times called the “penny a pill” assessment, along with an increase in the licensing fees on opioid distributors raises close to $28 million.

The House bill  (HF 1440) removes the manufacturer assessments and allocated $20 million from the state’s General Fund for 2019, and an ongoing $15 million each year in the future.  It is unclear whether this will be new money to the General Fund or whether this will come out of current appropriations to other programs.

Dose Limits
Included in the opioid legislation are opioid dose limits for treating acute pain.  These limits are based on the guidelines that have been developed by the CDC and the Department of Human Services.  In the House, they propose a seven-day limit on opioids for treating acute pain, while providing an exception if in the practitioner’s professional judgment more is needed to treat the patient.  In this way, this is a treatment guideline, without telling the practitioner how a patient must be treated.

In the Senate version, the seven-day limit does not allow for professional judgment.  Instead of a guideline, it is a strict practice standard.  Regardless of what the treatment is, it is a bad precedent for the Legislature to adopt in law practice standards.

Mandatory PMP Check
Physicians have been successful in getting the message to legislators that the PMP is not an easy tool to use.  It can take up to four to five minutes to log-in to the PMP and find the patient’s prescribing history.  Both bills dedicate needed funds to embed it in the EMR.  The Senate bill goes farther, however, also mandating that prior to prescribing any opioid with more than a three-day supply, the prescriber must first check the patient’s history in the PMP.  There are no exceptions.

Tobacco Tax Inflator Considered
The House Tax Committee considered a proposal to reinstate the annual, automatic inflationary increase on the tax on tobacco products, as well as the premium cigar tax.  Both provisions had been in place in state law prior to being repealed as part of the 2017 tax cut bill.   Testifying in support of the proposal were representatives from the American Cancer Society and the Minnesotans for a Smoke-Free Generation, a tobacco control coalition that includes many health care advocates, including the MMA, the MNAAP, the MAFP, and dozens of others.  Opponents include the tobacco industry, as well as retailers like gas stations, convenience stores, and tobacco-only shops.

The bill was laid on the table for possible inclusion in the tax omnibus, though its prospects look grim given that the majority so recently repealed these taxes.

CMV Awareness Expanded Under Bill
A proposal to fund an awareness program for parents and health care practitioners about the human herpesvirus cytomegalovirus (CMV) cleared the House HHS Reform Committee on March 15.  The bill, HF 2653, was passed to the HHS Finance Committee.

Under the bill, the Minnesota Department of Health (MDH) would be tasked with making available to health care providers, women who may become pregnant, expectant parents, and parents of infants evidence-based information about congenital CMV.  The information is to include recommendations for testing when newborns fail hearing tests, incidence of CMV, means of transmission, resources for parents of children with CMV, prevention methods, and other information.

Pharmacist Seek Limited Prescribing Authority
Legislation to provide independent prescribing authority to pharmacists for a limited number of therapies passed out of the House HHS Reform Committee on March 20.   It was referred to the House HHS Finance Committee where its future in unknown.

HF 2962 (Peterson-R, Burnsville) would allow pharmacists to prescribe tobacco cessation medications, opiate antagonists, and travel medications.  Supporters argued that these medications have very little risk and generally do not require a diagnosis from a physician.

If this bill passes it would be first move into independent prescribing by pharmacists.  Currently, pharmacists can provide naloxone through a standing order and protocol, they can provide medication managements and modifications through protocol, and they can provide flu shots and adult vaccines.

The Senate bill has yet to receive a hearing.

Apprentice Program for International Medical Graduates Moving
For many years, legislators have been trying to find a way to utilize foreign-trained physicians who do not qualify for licensure.  There is an interest to put them to use to address physician shortages, especially in rural areas.

HF 2753 (Kiel-R, Crookston) would allow the Board of Medical Practice to issue a limited license to practice in rural or underserved communities to foreign-trained physicians who have not gone through an accredited residency program.  This limited license would allow them to practice primary care only in an employed setting under supervision by another physician.  Following practice under the limited license for two years, the individual would qualify for full medical license.

The bill is opposed by most physician groups, training programs, and the Board of Medical Practice.  The BMP believes that to ensure minimum standards and protect the public, all physicians must complete at least one year of an accredited residency program.

The Senate version, SF 2310 (Abeler-R, Anoka) was amended in the Senate HHS Finance and Policy Committee to remove the apprentice model and standardize the residency requirements for both US-trained physicians and foreign-trained physicians.  Under the bill, the requirement would be one year for both groups.  Current law requires foreign-trained physicians to complete two years of residency before qualifying for licensure.

Medical Assistance Work Requirement Considered
Legislation to establish a work requirement for certain Medical Assistance (MA) recipients received its first hearing in the House HHS Reform Committee on March 20.  Authored by Rep. Kelly Fenton (R – Woodbury), HF 3722 instructs the Commissioner of Human Services to apply for a waiver to implement a “work and community engagement requirement for able-bodies adults,” to receive health coverage through MA.

Nearly 100 groups representing providers, social services organizations, patient groups, and religious groups on a letter strongly opposing this bill.  The letter stated: “Medicaid work requirements are costly, complex, bureaucratic, and will have unintended consequences for state and local government, health care providers, and Minnesotans receiving coverage from Medical Assistance in all corners of the state.”

The bill tries to define “able-bodied” but that definition does not include someone who is receiving mental health treatments.  It would also create increased costs to providers to verify whether the person is meeting the requirement.

Gov. Mark Dayton has expressed his opposition to this legislation so it is unclear whether he would sign it into law if it reaches his desk.

Physician Compact Technical Fix Moving
Legislation to allow Minnesota’s full participation in the Medical Licensure Compact cleared the two required House committees in recent days and awaits action by the full of House.  The Senate bill is expected to be heard in the coming days.

Minnesota passed the original Medical Licensure Compact in 2015, though the state’s implementation has been blocked due to the FBI’s interpretation of the state law that governs how background checks are conducted.  The intent of the Compact is to ease the licensure process for physicians who practice in multiple states.  Rep. Tony Albright (R – Prior Lake) and Sen. Mark Johnson (R – East Grand Forks) are the authors of the bills.

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