Sara Noznesky, MN-AAP Lobbyist
A Short Break for Legislators to Gear-Up for Upcoming Deadlines
Minnesota legislators took a break for Easter and Passover before coming back to face some difficult spending decisions. Lawmakers returned Tuesday and the pace picked up quickly as they faced a Thursday deadline for all finance bills to have made their rounds through the finance divisions. Internal deadlines give legislative finance committees less than a week after that to put the finishing touches on spending bills before sending them to the House and Senate floors for votes.
Tuesday April 7 was the second committee deadline for the Legislature. With the passage of this deadline bills must be through all non-tax and finance committees in order to be considered alive. Because of this, all policy committees are now done with their work for the year. Also, we now have a better idea what bills are alive and what bills are dead.
Now Starts the Budget Work
Minnesota’s Constitution requires the Legislature to adjourn no later than May 18. It is still unclear whether or not the Democrats, who control both the House and the Senate, and Republican Governor Tim Pawlenty can reach agreement on a new state budget. If not, the Governor would have to call a special session before the state budget expires on June 30.
With deadlines for policy committees behind us, the work on passing a balanced budget will now become the main focus of the Legislature. The most recent budget forecast projects a $6.4 billion deficit for the next two year period. With the help of the federal stimulus money that shortfall has been reduced to $4.6 billion. The Legislature is required to pass a balanced budget before they adjourn. This can be done through spending cuts, revenue increases, or most likely, a combination of both.
Governor Pawlenty continues to promote a budget that includes no new tax increases and large cuts to the health and human services programs. Because of strings that are attached to the federal stimulus money, he is no longer recommending eligibility cuts for Medical Assistance (MA) or MinnesotaCare. He is still recommending a 3 percent payment cut to all providers, elimination of most of the optional benefits for adults enrolled in MA, and elimination of the Health Care Access Fund. The Governor’s recommendations total more than $1 billion in cuts to the health and human services programs over the next two years.
The Senate Democrats have released an outline of their budget recommendations that includes a 7 percent across the board cut to all program areas (including K-12 education) and $2 billion in new revenues. They argue that this is the fairest approach so that no one program takes the brunt of the cuts. The size of a 7 percent cut to the HHS area totals $719 million in cuts. When stimulus money is added the 7 percent cut is offset to a 5.9 percent cut, totaling $606 million in 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 4 and 15 percent, protects the Health Care Access Fund, shifts nearly $1 billion into the next biennium, and recommends $1.5 billion in new revenues. The targets for cuts to the HHS areas total $489 million in cuts, or just less than 5 percent.
The task immediately before legislators is to begin passing omnibus budget bills out of committee. With cuts ranging from $500 million to over $1 billion needed, the challenges that face them are great. Because the size of the cuts, discussions are floating about using an increase in the Provider Tax to help solve the problem. The 2 percent Provider Tax raises over $500 million each year. Even a ½ percent increase would raise $250 million over the two-year biennium.
Also of interest to physicians is that fact that both the House and the Senate are considering modifying the Governor’s recommendation to cut MA physician payments by 3 percent. The Governor recommends cutting payments for all outpatient providers y. Sen. Berglin and Rep. Huntley are recommending cutting every provider 3 percent except for office visits and preventive services provided by primary care providers. This is an acknowledgement that primary care physicians are under-reimbursed for their services.
Following is an update on the status of a number of policy bills.
Prior Authorization for ADHD Drugs and e-Prescribing
SF 1401 (Berglin) requires the Commissioner of Human Services to establish a utilization review program within the MA program for attention deficit/hyperactivity disorder (ADHD) and attention deficit disorder (ADD) medication and psychotropic medication prescribed to children. The program would require prior authorization for ADHD medication prescribed to children younger than five years of age and a second opinion from a commissioner-approved provider. The bill also requires a physician to receive a second opinion from a commissioner-approved provider for children ages 5 to 18 years of age for ADHD medications that exceed certain dosages.
This is being pursued because a similar program in the state of Washington saved their Medicaid program over $1 million per year in prescription costs.
The MN-AAP is working with the Minnesota Psychiatric Society to express concerns about added prior auth requirements and the impact the bill could have on access to mental health services for children.
The bill also requires the Commissioner of Human Services establish a pilot project to incorporate e-prescribing applications with a clinical information database to reduce errors, increase patient safety, duplication of therapies and reduction in waste. The commissioner shall ensure that each provider identified has the ability through e-prescribing software to receive the following:
(1) a patient’s specific medication history for the last 100 days;
(2) the preferred drug list and formulary verification;
(3) prescription details; and
(4) drug interaction alerts.
The commissioner shall evaluate the project in terms of the number of prescriptions written by the providers participating in the demonstration project and report to the Legislature by March 15, 2011.
Health Care Homes Required for Chronic Disease
To ensure the use of health care homes, legislation is moving in the Senate that would require MA patients with chronic or complex disease to select a primary care clinic with clinicians who have been certified as health care homes. SF 1474 (Berglin) would implement this requirement only if there are two or more primary care clinics with clinicians who have been certified as health care homes available to the enrollee.
This bill is awaiting action in the Senate Finance Committee and could be included in the omnibus HHS budget bill.
Newborn Screening Changes Now in Omnibus Policy Bill
Legislation designed to allow Minnesota’s newborn screening program to continue is moving forward in a compromise version that still has many opponents. Last year Governor Pawlenty vetoed needed legislation because of concerns with privacy advocates over the ongoing use of the gathered blood spots without parent’s consent. The compromise language (found in HF1341, Thissen) requires that all bloodspots be destroyed within 25 months unless the Department of Health has parental consent to keep the specimens longer.
The Senate companion bill to HF 1341 did not make the committee deadline because key Senators did not support the compromise that the Governor proposed. They believe that it will severely threaten our role as a pro-medical research state. To keep the bill alive the House language has been amended into a separate bill, HF 1760. This bill has met deadline in both bodies.
Booster Seats and Primary Seatbelt Penalty
Two bills to strengthen our traffic safety laws to protect vehicle passengers are still moving through the legislative process. Child passenger safety bill has passed the Senate floor and met the policy committee deadline in the House. The bill, SF 99 (Carlson), would require children up to 8 years old and 4 feet 9 inches tall to use proper child restraint systems, such as booster seats. The bill is scheduled for a hearing Monday morning in the full House Finance Committee.
The seatbelt bill SF 42 (Murphy) would make not wearing a seat belt a primary offense, which would allow officers to stop and ticket motorists for not wearing their seat belts. Currently, drivers can be ticketed for not wearing a seat belt only if they are stopped for another violation. This bill is also still alive in both the House and the Senate. It is awaiting action is the finance committees of both bodies.
Dental Caries Prevention
A bill related to primary care physicians performing fluoride varnish and dental exams during Child and Teen Check Ups met the policy deadline. The Senate version of the bill (SF633, Berglin) requires that primary care providers do an inspection of the oral cavity and apply a fluoride varnish as part of any child and teen checkup. Pediatricians and family practice doctors raised concerns about this being a mandate. If the preventive check is done, the primary provider must inform the patient of the etiology of dental caries, and the importance of a dental home, and advise the parent that they contact the HMO or DHS in order to secure an appointment. The Senate passed the bill with the mandate in place to the floor—although it was referred back to the finance committee for an anticipated fiscal note. It is unclear whether the bill will be included in the Senate budget package due to an anticipated fiscal note. The House language (HF984, Norton) is permissive and has no fiscal note therefore it passed out of the House policy and finance committees.
Prior Authorization and Uniform Formulary
This bill, initiated by St. Mary’s Duluth Clinic, requires the commissioner of health, in consultation with the Minnesota Administrative Uniformity Committee, to develop a uniform prior authorization and formulary exception form that allows health care providers to request exceptions from group purchaser formularies, including Part D plans, using a uniform form, within six weeks from the enactment date or July 1, 2009, which ever is later. Effective January 1, 2011, the uniform prior authorization and formulary exception form must be accessible by health care providers, and accepted and processed by group purchasers, electronically through a secure Internet site. Electronic transmissions from providers would be required by January 1, 2011.
The House also passed a similar version of this bill and is working with the Council on Health Plans to come up with a form that can be implemented this spring.
MA Coverage Elimination for Ineffective Preventive Services
SF 1442 /HF 1783 eliminates benefit coverage under state health care programs for those clinical preventive services that the U.S. Preventive Services Task Force has recommended against providing to an asymptomatic patient, or has been graded by the task force as a “D.” Lead level testing for pregnant and women is specifically excluded and would remain a covered benefit. This bill is yet another attempt to gain fiscal savings. The bill has met policy deadlines.
Health Care Homes Outreach Requirement
SF 1474 requires the state health plan enrollees who have complex medical conditions to select a primary clinic with clinicians as certified health care homes, if there are two or more primary care clinics with clinicians who have been certified as health care homes available to the enrollee. The MN-AAP is reviewing the bill to ensure that access would not be restricted for children based on the availability of health care homes. It remains unclear whether this will result in any savings to the state, but it has met deadline and is being considered for inclusion in the Omnibus HHS Finance bills.
Committee Schedules for Next Week
Check http://www.leg.state.mn.us/leg/sched.asp for the most up-to-date information.