Sara Noznesky, MN-AAP Lobbyist
Mark Your Calendar! Peds Day at the Capitol is March 3rd
There are no children in the legislature and no pediatricians elected at the state capitol. Legislators need to hear from you on issues important to you and your patients.
Date: Wednesday, March 3rd
Time: 12:30- 4:00 p.m.
Location: Minnesota State Capitol
Agenda
12:30 Registration, Capitol Room 118
1:00 MN-AAP issue overview
1:15 Advocacy 101: How to be an advocate for your patients and your practice
1:45 Discussion with key legislators
2:15 Meet with your legislator and attend a Legislative hearing
4:00 Debrief and follow up, Axel’s on Grand Ave. in Saint Paul.
For more information contact either Sara Noznesky at snoznesky*AT*mnmed.org or Melissa DeBilzan at debilzan*AT*mnaap.org.
RSVP to Melissa DeBilzan at debilzan*AT*mnaap.org so that we can set up an appointment for you. Please include your home address in your email so that we can set up a meeting the correct elected representatives.
Pawlenty Releases Budget Changes: Cuts All Around, One Small Positive for VFC Admin Fees
Gov. Tim Pawlenty presented his supplemental budget Monday that outlines how he would erase a $1.2 billion state budget deficit. Keeping with his ongoing pledge to not raise taxes, his budget recommendations rely on cuts to his familiar targets of health care and local government aid. He also relies on $387 million in federal money that has not yet been approved by Congress.
The budget proposal cuts $347 million from health and human services program. About one-third of those savings would come from reducing MinnesotaCare eligibility for single adults from 250 percent of poverty ($27,084 a year) to 75 percent of poverty ($8,124 a year). Hospitals and long-term care facilities receive significant cuts. The 1.5 percent rate cut for non-primary care physician services established through unallotment is extended two additional years under the proposal.
For details on the Governor’s budget recommendations click on the following link to the Department of Budget and Management: http://www.mmb.state.mn.us/
The proposed change would result in about 21,500 low-income adults losing their health care. MinnesotaCare is a premium-based program for working Minnesotans that provides subsidies on a sliding scale. If passed, the only adults without children who would qualify for MinnesotaCare would be those who in past years qualified for the General Assistance Medical Care program.
The proposal also undercuts Minnesota’s efforts to achieve universal coverage and health care reform. The budget proposal includes cutting $10 million from the State Health Improvement Program – a statewide effort to reduce tobacco use and obesity by making communities healthier that was passed as part of Minnesota’s 2008 Health Care Reform Act.
The only silver lining in the budget proposal is the recognition for the need to address issues surrounding the administration fee for vaccines provided under the federal Vaccines for Children program. The proposal increases the amount of reimbursement for administration of non-MNVFC vaccine supplied by the federal government but not in conjunction with an office visit from $1.50 to $8.50. The increase is paid for by suspension of the fee paid to retailers such as grocers for each food support EBT transaction (electronic card payment).
GAMC Passes the Legislature—Already Vetoed by Governor
What looked like a bipartisan effort to save the GAMC program was abruptly halted by Governor Pawlenty with his veto of a bill to continue coverage Thursday night.
Efforts to maintain coverage for recipients of General Assistance Medical Care (GAMC) coverage continues to move quickly through the Legislature. Governor Pawlenty has proposed transferring these individuals into the MinnesotaCare program beginning April 1, 2010. The DFL legislative leaders are proposing maintaining a scaled back GAMC program with a 50 percent cut to physician payments.
The Senate passed an amended proposal Thursday, February 11 to continue the GAMC program. The Senate dropped a funding source that would have assessed a hospital and HMO surcharge designed to draw down more federal Medicaid money, but kept steep reimbursement cuts. The bill passed on a party-line vote of 45 to 20, with DFL lawmakers supporting it.
Before passing the bill, the Senate dropped the surcharge on hospitals and HMOs in response to indications that Gov. Tim Pawlenty would veto a GAMC fix that included the surcharge. To pay for the bill, the bill’s author Sen. Linda Berglin, DFL-Minneapolis, proposed using $110 million that was scheduled to be transferred from the General Fund to the Health Care Access Fund in 2011. The $110 million transfer had been scheduled to cover the additional costs expected to occur as a result of the governor’s plan to transfer GAMC enrollees to MinnesotaCare.
The House version of the bill, authored by Rep. Erin Murphy, DFL-St. Paul, was passed on Thursday February 18 with a bipartisan vote of 125-9. Many looked at this vote as a sign that the Republican Governor would sign the bill. Surprisingly, Thursday night he announced that he had vetoed the bill because it “does not represent meaningful reform and does not address fundamental cost issues.” If you’re interested, read the Governor’s veto message.
Legislative leaders said they will attempt to override the Governor’s veto as early as Monday February 22. In order to be successful they will have to convince at least three House Republicans to vote for the override in order to get the two-thirds voted needed.
Amended Dental Caries Bill Moves Forward
Legislation encouraging physicians to provide basic dental screenings for children as part of their child and teen check up is moving forward. HF 984 (Norton-DFL, Rochester) was amended last year in response to MN-AAP concerns, from language that mandated that these services be provided by physicians to language that says the Commissioner of Human Services shall encourage physicians to provide these services. The services would include a general visual exam of the child’s mouth without using probes or other dental equipment, a risk assessment using the factors established by the American Academies of Pediatrics and Pediatric Dentistry, and application of fluoride varnish beginning at age 1 to those children assessed by the provider as being high risk.
The bill passed the House Finance Committee on February 16 and is awaiting final action on the House Floor.
The Senate companion bill SF 633 (Berglin-DFL, Minneapolis) is in the Senate Finance Committee. It still has the old language mandating the service, but the expectation is that Senator Berglin will adopt the House language.
Complete Streets
On February 16th the House Transportation Policy and Finance Committee held a hearing on Complete Streets policy. The bill, SF2461 (Lourey-DFL, Kerrick) and HF 2801 (Obermueller-DFL, Eagan), implements a “complete streets” policy for state-funded roads. “Complete streets” is a method for planning, scoping, design, implementation, operation, and maintenance of roads in order to reasonably address the safety and accessibility needs of users of all ages and abilities. It is also expected to support safe walking and biking, thereby one of many important policy changes to increase the overall activity level of children and adults alike.
The bill was amended and laid over for further discussion.
Mental Health Professionals Want Authority to Make ADHD Diagnosis
A number of other bills have been introduced that the MN-AAP will be reviewing. HF2995/SF2708 sponsored by Rep. Tillberry (DFL-Fridley) and Sen. Lynch (DFL-Rochester) would allow all mental health professionals to diagnose ADD and ADHD for purposes of identifying a child with a disability in a school setting.
Currently a licensed physician, an advanced practice nurse, or a licensed psychologist is qualified under law to make a diagnosis. Proponents of the bill say that allowing mental health professionals to make this diagnosis would stream line the process and make it easier for parents to bring the diagnosis to the school.
Birthing Centers Legislation Returns, No Requirements to Ensure Safe Outcomes for Newborns
SF2702/HF3046 sponsored by Sen. Linda Berglin (DFL, Minneapolis) and Rep. Maria Ruud (DFL-Minnetonka) would require licensure for birthing centers to be established in the state. Currently there are no standards for birthing centers in the state, yet a recent Pioneer Press article highlighted a new birthing center in Saint Paul.
The bill establishes licensing standards for facilities not connected to, or associated with, a hospital to perform low-risk deliveries following low-risk deliveries. Low-risk pregnancy is defined to be a “normal, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a normal uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, and neonatal health care, and generally accepted by the health care providers to whom they apply.” Birthing centers would also be precluded from abortions, general or induction anesthesia and surgical procedures except those normally accomplished during an uncomplicated birth, including episiotomy and repair.
There is no consideration for immediate newborn care currently in the legislative proposal. The MN-AAP will monitor the bill to ensure safe outcomes for newborns.
Compromise Reached on Limitations to Board of Medical Practice Authority
Legislation to limit the Board of Medical Practice’s (BMP) ability to take action against a physician solely on the basis of prescribing, administering, or dispensing long-term antibiotic therapy to a patient who has been clinically diagnosed with chronic Lyme disease was withdrawn for consideration in the House Health Care & Human Services Policy and Oversight Committee on February 17 following a compromise agreement with the BMP.
The bill SF 1631 (Marty-DFL, Roseville) and HF 2597 (Ward-DFL, Brainerd), would have put the BMP limitation in statute, creating a very bad precedent of having the Legislature tell the BMP how to regulate medical practice and how to define the standard of care. Under the compromise no legislation will move forward and the BMP will voluntarily agree to a moratorium on taking action related to Lyme disease for up to five years while more study is done on the efficacy of long-term antibiotic therapy for Lyme.
Chiropractic Practice Expansion
The Minnesota Chiropractic Association is planning to introduce legislation to rewrite portions of the chiropractic practice act. The bill would change the definition of chiropractic from “the science of adjusting any abnormal articulations of the human body…” to “the health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of prescription drugs or surgery. Chiropractic focuses on the relationship between structure, primarily the spine, and function, as coordinated by the nervous system, and how that relationship affects the preservation and restoration of health.” The bill would also authorize chiropractors to use the term “Chiropractic Physician” with patients.
