Sara Noznesky, MN-AAP Lobbyist
First Committee Deadline Arrives, Focus Shifting to Budget
The first of a series of committee deadlines passed this Friday March 27. This is the Legislature’s first step in a process to begin winding down their work. For a bill to be still considered “alive” it must have passed through all non-finance or tax committees in one body or the other. The next deadline is Tuesday April 7, when bills have to be through all non-finance and tax committees in both bodies.
Following the second committee deadline the work of the Legislature shifts to longer floor sessions and work on the state budget. This is where the difficult decisions will have to be made.
The most recent budget forecast projects a $6.4 billion deficit for the next two year period. With the help of the federal stimulus that shortfall is now $4.6 billion, and the Legislature will have to pass a balanced budget through spending cuts, revenue increases, or most likely, a combination of both. With the size of the deficit, there will be plenty of pain to go around.
Governor Pawlenty has continued to promote his budget recommendations that include no new tax increases and large cuts to the health and human services programs. He no longer is recommending eligibility cuts for MA or MinnesotaCare, but he is recommending a 3% reimbursement cut, elimination of most optional benefits, and elimination of the Health Care Access Fund.
The Senate Democrats have released an outline of their recommendations to balance the budget as well. Their proposal includes a 7% across the board cut to all program areas (including K-12 education) and $2 billion in new revenues. They are arguing that this is the fairest approach so that no one program takes the brunt of the cuts.
The House Democrats most recently released their budget ideas. Their outline protects K-12 education from cuts, cuts health and human services programs between 9 and 15%, protects the Health Care Access Fund, and recommends $1.5 billion in new revenues.
These three competing plans will be now be debated and eventually melded into a final bill.
Dental Caries Prevention by Primary Care Providers
In my last update, I provided information on a bill that would require primary care providers to perform a cursory oral examination, complete a risk assessment, and apply fluoride varnish for high-risk patients over the age of one at each well child visit and episodic care visits. The bill would also require providers to give families caries prevention materials and a list of dentists who accept patients in public programs.
The House version, HF984 (Norton, DFL-Rochester), was heard March 23rd. Rep. Maria Ruud (DFL-Minnetonka) successfully offered an amendment that would require the Department of Human Services to encourage primary care providers to do the additional treatments, rather than require them to do so. The bill passed and was referred to the House Finance committee for further consideration.
The MN-AAP testified that we tremendously supportive of caries prevention and share legislators’ frustration about the availability of dentists to treat MA patients. However, we did not support placing the responsibility for certain dental services on primary care physicians.
The Senate version, SF933 (Berglin, DFL-Minneapolis) still includes the service as a mandate and remains concerning to the MN-AAP.
Child Passenger Safety One Step Closer to Law
Thursday, the full Senate passed SF99 (Carlson, DFL-Eagan) requiring children up to age eight be properly restrained while riding in vehicles. The House version, HF267 (Hortman, DFL-Brooklyn Park) is also on track. Since my last update, the bill met the policy committee deadline by passing the House Transportation and Transit Policy and Oversight Division on March 16th and the Public Safety Policy and Oversight Committee on March 26th. The bill has been referred to the House Finance committee for further consideration. Please email your representatives encouraging them to support the bill.
Let your Representative know that safety belts are not made for and do not fit kids. According 2008 Minnesota crash statistics, 386 four to seven year-olds were injured or killed in a motor vehicle crash that were not in a properly fitted booster seat. (Minnesota Department of Public Safety)
Pediatricians continue to educate parents on the use of booster seats but many parents look to our state law to determine when to graduate their child to a seatbelt. Updating the law sends parents a clear message about the importance of having their child properly restrained. Forty-four states have stronger child passenger restraint laws than Minnesota. Even our neighbors in Wisconsin, Iowa and North Dakota have enacted requirements that children be properly restrained for their age.
Newborn Screening Moves Forward
This year’s newborn screening bill also met the first deadline by successfully making it through all necessary House policy committees. HF1341 (Thissen, DFL-Minneapolis), passed the House Health and Human Services Policy Committee on March 19th then the Civil Justice Committee this passed Monday. The goal of the bill is to make sure the newborn screening program, which uses 10 different tests to screen for 54 types of diseases, is consistent with Minnesota’s Genetic Privacy Law, which went into effect in 2006.
The bill, sponsored by the Minnesota Department of Health, would require providers to inform parents that they can object to the genetic test or to the storage of their child’s blood sample and allow the department to store specimens for two years before destroying them. Key components of the bill provide parents with additional options related to testing and storage of specimens and explicitly defines allowable research on specimens to be limited to quality control, quality assurance, and new test development. The bill would allow the department to store specimens longer than two years if parents provided written consent.
Over the last three years, there has been much wrangling on the topics of screening and sample storage at the Legislature. The debate at the Legislature has hinged on whether the law should require parents to opt into the program or opt out of the program and whether the state should keep the samples and make them available for research. In 2007, the Department of Health agreed to do a better job of informing parents about screening and about the retention of samples in response to privacy concerns among a small but vocal minority.
The MN-AAP has supported recent bills that would protect the newborn screening program and keep the tests as “opt-out” options that are completed unless parents explicitly choose not to have them done.
The Senate version, SF1478 (Schied, DFL-Brooklyn Park) was heard in the Senate Health, Housing and Family Security Committee late in the evening on March 16. MN-AAP President Anne Edwards, M.D., MAFP, testified that while the MN-AAP preferred last year’s version of the bill, the program was so important and members were encouraged to pass the bill. Unfortunately, the motion to pass the bill failed as a result of concerns from committee members that in order to satisfy the concerns of the governor, the bill was too great a sacrifice to the program.
We have until April 7th to pass the bill out of the necessary Senate policy committees and will be working hard to find ways to keep the bill moving forward.
Health Plan PMAP Disclosure
All of MinnesotaCare and most of Medical Assistance and General Assistance Medical Care is now provided through contracts with the state’s managed care plans. The state provides payments to the health plans and the health plans agree to provide care to the public program enrollees. Every year the Department of Human Services enters into negotiations with the health plans to determine what the capitation rate the state will pay to the health plans. Federal law requires that the capitation rate be “actuarially sound” so the health plans receive an increase rate every year.
Legislators are expressing frustration when they try to find out how the health plans are spending that state money because the health plans argue that the payments they make to providers, and the methods they use to determine provider payment rates are proprietary information. Because of this growing frustration Rep Erin Murphy introduced HF 1988. This would require health plans to annually provide to the Commissioner of Human Services information on payments provided to providers, reimbursement increases provided to providers, and the methodology the health plan uses to determine provider reimbursement. Legislators have authority to allocate funding to the managed care plans and health plans have an obligation to show that the money is being used to address access to needed care.
HF 1988 passed the House Health Care and Human Services Policy and Oversight Committee on March 26. The Senate companion bill, SF 1924 (Berglin) will hopefully be heard this week.
PA Changes Moving Forward, APN Bill Appears Dead
Legislation modifying the regulation of physician assistants (PA) is continuing to move forward. SF230 (Higgins) would change the regulation of PAs from registration to licensure. It would also increase the number of PAs a physician can supervise from 2 to 5. SF 320 passed the full Senate by a vote of 55-4 on March 2. The House version (HF 240, Norton) has been included in an omnibus licensing bill that passed the House Health Care and Human Services Policy and Oversight Committee last week. At this point there has been no opposition to this bill.
Legislation proposing changes to advance practice nurse (APN) laws does not seem to be moving forward this year. This issue, arising from the Healthcare Work Force Shortage Task Force, would have eliminated the requirement for a written delegated prescribing protocol for APNs and instead implemented a written collaborative plan. The bill, HF 1668 (Murphy), was drafted by the Minnesota Nurses Association but physicians felt it did not fully represent the recommendations of the task force. The bill was heard in the House Licensing Subcommittee Tuesday March 17. As drafted the bill did not require a written collaboration plan for all APNs, only for those that were not credentialed by a hospital or health plan. The bill also applied to certified registered nurse anesthetists, even though the task force recommendations were not intended for them. Following lengthy discussion, and conflicting amendments, the bill was laid on the table and the committee adjourned.
The Senate companion bill, SF 1532, has not received a hearing so the bill did not meet deadline
Committee Schedules for Next Week
Check www.leg.state.mn.us/leg/sched.asp for the most up-to-date information.