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Legislative Updates & Alerts

During the legislative session, MNAAP members receive bi-weekly legislative updates emailed to them from the chapter’s policy chair and lobbyist.

The 2019 session runs from Jan 8 to May 20.

May 21, 2010

Frantic Week Leads to Budget Compromise

The legislature adjourned sine die after a frantic two weeks that included conference committee meetings into the early morning, multiple budget packages, vetoes, and a final all-night session.  DFL Legislature and Republican Governor Tim Pawlenty finally reached a compromise on the state budget bills that required a short special session to get it all done.  This session could be labeled a missed opportunity.

With the Constitutional midnight deadline approaching, a final agreement was announced at 11:30 p.m. on Sunday, May 16.  Because the Constitution prohibits the passage of any bill on the last day of session, there was not enough time to process the bill before midnight.  At 11:55 p.m. both the House and Senate adjourned the 2010 regular session sine die and at 12:01 a.m. Pawlenty called the Legislature back for a special session to pass the one budget bill to complete the deal.  The Legislature then immediately recessed to await the printing of the final package.  Finally, after spending a sleepless night waiting, the House and Senate passed the budget deal at 10:30 a.m. Monday morning and adjourned the 2010 special session sine die.

The final package addresses a nearly $3 billion budget deficit with no new taxes, large cuts to local governments and additional cuts to health and human services programs. It also balances the budget without relying on an estimated $408 million of federal money from the next round of stimulus money.  This money is tied up in Congress and if it comes through it will go to the state’s cash account.

The major sticking point of the budget negotiations was whether to become an early adopter and enroll single adults with incomes less than 75% of the poverty level into the Medical Assistance (MA) program.  Minnesota was one of 14 states that could enroll this population in MA beginning April 1 under the federal health reform bill and receive 50% federal matching money.  Supporters argued that MA would provide much better coverage than the scaled back GAMC program that is only a hospital-based program and is funded with 100% state money.  Critics said it was too expensive to provide the 50% match and that Minnesota shouldn’t be the first state to enact “ObamaCare.”

To fund the early adoption, the original bill implemented a number of surcharges on hospitals, nursing homes, group homes and HMOs, and implemented other cuts to providers and HMOs.  These surcharges were used to draw down more federal money that could be targeted to this program.  Governor Pawlenty, Republicans and the HMOs opposed these surcharges because they viewed them as new taxes and created winners and losers between hospitals and HMOs.

In the end, the surcharges were not a part of the final budget bill and the early adoption can only take place by executive order of the current governor or next governor, with authority expiring on January 15, 2011.  In addition to the provider cuts, $177 million in FY 2011; $141 million in FY 2012; and $286 million in FY 2013 of the Health Care Access Fund (HCAF) is transferred to the general fund.  If at any time the governor issues an executive order not to participate in early MA expansion, no funds must be transferred from the HCAF to the general fund until early MA expansion takes effect.  Pawlenty has made it clear that he will not execute the executive order so the earliest any early adoption can take place is January 2011, even though the bill allows for retroactive enrollment beginning July 1, 2010.

Children’s Mental Health Grants

Other than the reductions to children and community services grants  that were made last July by the governor and were included in the unallotment article of this bill, children’s mental health grants were only reduced $200,000 and a proposal to shift the school-based grants to the K-12 budget in FY2012-2013 was not part of the final agreement.

State Health Improvement Program (SHIP) and Medical Education (MERC)

The agreement did not cut SHIP funding, which provides grants to local governments to fight obesity, nor MERC, which provides additional funding for medical schools, hospitals and clinics to pay for residency programs.  The governor had proposed a $10 million reduction to SHIP and virtually eliminated the MERC funding, which would have put all the residency programs at risk.

An amendment providing $150,000 of the funds distributed to the Academic Health Center under this paragraph shall be used for a program to assist internationally trained physicians who are legal residents and who commit to serving underserved Minnesota communities in a health professional shortage area to successfully compete for family medicine residency programs at the University of Minnesota.  This is to address the number of new immigrants who were trained as physicians in their home country and are not able to practice here.

Provider Reimbursement Cuts

The House and Senate closed the $3 billion budget hole primarily by ratifying the $2.7 billion in unilateral unallotment cuts that the governor made in 2009. As a result, the final budget included $293 million in health and human services cuts. The cuts include significant reductions in payment rates for medical services, including a 7% cut in the fee-for-service rate for non-primary care services provided to MA enrollees. This rate reduction, which takes effect July 1, 2010, comes on top of last year’s 6.5% specialist services rate reduction.  Payments to psychiatrists and advance practice nurses in mental health are also exempt.

In addition, rates paid by the state to managed care plans will be reduced by nearly 3% for MA enrollees and nearly 15% for single adults over 75% of poverty in MinnesotaCare enrollees for the next three years. The law does not guarantee that health plans will not pass on these reductions to providers.

The final piece of the budget that will result in even further payment cuts is a provision that caps MA rates for physician services at Medicare levels. These cuts will mostly affect surgical and other procedural payment codes.  A scheduled 21% cut to Medicare reimbursement taking effect June 1 could also impact the state MA payments.  This should not impact pediatric clinic services; however, it may impact certain surgical procedures if there is a corresponding Medicare code.  Rehab therapy services to certain providers that had add-ons for these services, like Courage Center, are also affected.

Hospitals also had a ratable reduction of 1.96%, delayed rebasing until 2013, and are affected by the 3% non-administrative HMO reduction and Medicare cap.

Other Provisions in HF1 of Interest

Asthma Demonstration Project
Adds home environmental assessment and management training by a certified asthma educator or public health nurse with asthma training, limited to two visits.

Health Disparities
The commissioners of health and human services shall conduct an inventory on the health-related data collected by each respective department, including, but not limited to, health care programs and activities, vital statistics, disease surveillance registries and screenings, and health outcome measurements.  The report is due January 15, 2011.

Birthing Centers
Independent birthing center licensure was in the final budget bill that was signed by the governor.  It creates a licensing process for birthing centers that are located outside a hospital or clinic setting.  Birthing centers can only provide care for uncomplicated pregnancies and cannot utilize surgery or anesthesia.  They can be staffed by physicians, nurse midwives, or licensed traditional midwives.  They must have an emergency backup plan developed for cases that need hospitalization.  DHS, along with providers, including a member of Minnesota American Academy of Pediatrics, will provide oversight and evaluate care.

Lead Levels
By January 1, 2011, the commissioner must revise clinical and case management guidelines to include recommendations for protective health actions and follow-up services when a child’s blood lead level exceeds five micrograms of lead per deciliter of blood. The revised guidelines must be implemented to the extent possible using available resources.  In revising the clinical and case management guidelines for blood lead levels greater than five micrograms of lead per deciliter of blood under this subdivision, the commissioner of health must consult with a statewide organization representing physicians, the public health department of Minneapolis and other public health departments, one representative of the residential construction industry, and a nonprofit organization with expertise in lead abatement.

Trauma Designation and Registry
This MDH provision deletes obsolete language and adds levels I and II to pediatric trauma hospital designations.  In addition, it clarifies that all information related to designation of trauma hospitals is private data on individuals and non-public data under Minnesota Statutes, chapter 13. It re-codifies the trauma registry statute that is repealed by requiring the commissioner of health to establish and maintain a major trauma registry.  Trauma hospitals will be required to participate in the statewide registry by electronically submitting information. As amended, it does not impact our current peer review process, which was a concern to hospitals as introduced.

Health Information Exchange
To the extent that the commissioner of health applies for additional federal funding to support the commissioner’s responsibilities of developing and maintaining state level health information exchange under section 3013 of the HITECH Act, the commissioner of health shall ensure that applications are made through an open process that provides health information exchange service providers equal opportunity to receive funding.

A Chemical and Mental Health Transformation Task Force is established to make recommendations on how to provide individuals with complex conditions, including mental illness, chemical dependency, traumatic brain injury and developmental disabilities, access to quality care and the appropriate level of care across the state to promote wellness, reduce cost, and improve efficiency

Vendor Accreditation and Simplification
The Minnesota Hospital Association must coordinate with the Minnesota Credentialing Collaborative to make recommendations by January 1, 2012 on the development of standard accreditation methods for vendor services provided within hospitals and clinics. The recommendations must be consistent with requirements of hospital credentialing organizations and applicable federal requirements.

HMO Reporting of Administrative Expenses
Every HMO must directly allocate administrative expenses to specific lines of business or products when such information is available. Remaining expenses that cannot be directly allocated must be allocated based on other methods as recommended by the Advisory Group on Administrative Expenses. Health maintenance organizations must submit this information, including administrative expenses for dental services, using the reporting template provided by the commissioner of health.  In addition, each HMO must allocate investment income based on cumulative net income over time by business line or product and must submit this information, including investment income for dental services, using the reporting template provided by the commissioner of health.  This provision was supported by providers to get some transparency in the way HMOs report expenses.  HMOs have been given increases from DHS over the years and it’s not clear that they have been passed along to providers or substantially increased access and care for the enrollees.

Food Support for Children with Severe Allergies
The commissioner of human services must seek a federal waiver from the federal Department of Agriculture, Food and Nutrition Service, for the supplemental nutrition assistance program to increase the income eligibility requirements to 375% of the federal poverty guidelines in order to cover nutritional food products required to treat or manage severe food allergies, including allergies to wheat and gluten, for infants and children who have been diagnosed with life-threatening severe food allergies.

Other Bills of Interest

Preventive Caries SF633 / HF984
The Legislature passed and the governor signed legislation that encourages physicians to provide preventive dental care as part of a child or teen checkup.  This dental care shall include a general visual exam of the mouth and application of fluoride varnish.  The MN-AAP supported this legislation after it was changed from a mandate on all physicians.  We have worked with the Minnesota Dental Association and the Minnesota Academy of Pediatrics Foundation to try to address dental access for low-income patients.

Physical Education Standards SF 2908 Chapter 396
This bill requires physical education standards for all schools by the 2012-2013 school year based on the standards developed by the National Association for Sport and Physical Education.  The bill also directs schools to post their wellness policies on its web site.  MDE will be encouraged to establish recess guidelines and include P.E. standards as well as local education graduation requirements as part of the common course catalog.  The bill also establishes a Health Kids Program to motivate kindergarten through grade 12 students to become active by rewarding them for their nutritional well-being and physical activity.

Complete Streets Provisions Stripped in Transportation Bill HF 2801
The “complete streets” mandate was stripped out of the final version of this bill sent to the governor.  MN-AAP had supported the concept of complete streets as it outlined development safe neighborhood environments, which would have encouraged physical activity  and healthy lifestyles in families. As introduced, the bill asked transportation planners and engineers to consistently design and alter the right-of-way with all users in mind.  The new mandate was controversial, especially in the House.

Mandatory Reporting –Pregnant Women  SF 2695 –Chapter 348
This chapter amends the current law that requires mandated providers to report a pregnant woman who they suspect might be abusing marijuana or alcohol.  As long as they are receiving a comprehensive set of prenatal care services, this reporting is no longer mandated.  The city of Minneapolis public health clinics experienced a “chilling” effect from women accessing prenatal services due to the reporting requirement.

Health Care Reform Task Force
The governor shall convene a health care reform task force to advise and assist the governor and the Legislature regarding state implementation of federal health care reform legislation.

Health Care Home
The commissioner shall provide medical assistance coverage of health care home services for eligible individuals with chronic conditions who select a designated provider, a team of health care professionals, or a health team as the individual’s health home. The commissioner shall implement this provision in compliance with the requirements of the state option to provide health care homes for enrollees with chronic conditions, as provided under the Patient Protection and Affordable Care Act.

Federal Health Care Reform Demonstration Projects
Requires the DHS to apply for grants in the federal reform, including:

  • Evaluation of integrated care around hospitalization (Section 2704)
  • MA global payment system (Section 2705)
  • Pediatric Accountable Care Organization (ACO) (Section 2706)
  • MA emergency psychiatrist (Section 3707)
  • Grants to provide incentives for prevention of chronic diseases (section 4108).

Hospice Care/Under Age 21
Medical assistance covers hospice care services under Public Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21 or under who elects to receive hospice services does not waive coverage for services that are related to the treatment of the condition for which a diagnosis of terminal illness has been made.

Peer Grouping HF 3056, Chapter 344
The governor signed a peer-grouping bill that was an MMA initiative.  Peer grouping is a statewide initiative to compare clinics and hospitals based on the cost and quality of the care they provide. It was created through the 2008 Health Care Reform Act.

The 2010 legislation corrects some flaws in the initiative. It includes the following provisions that were endorsed by physicians:

  • a new requirement that the peer-grouping data must meet standards for reliability and validity before being released to the public;
  • a repeal of language that precludes providers who score in the bottom 10 percent on the quality and cost measures from treating patients covered by state-subsidized health insurance plans, and
  • an extension of the deadline for health plans to start using the data to January 2012.

The goal of the legislation is to create stronger assurances for the development of valid and reliable information, to remove the punitive aspects of the initiative, and to have a more realistic legislative timeline.

Electronic Medical Record HF 3279, Chapter 335
This MDH bill includes provisions that:

  • Ensure all information follows the patient across the full continuum of care.
  • Prevent fragmentation of health information that can occur when there is lack of interoperability or cooperation between health information exchange providers.
  • Ensures that organizations are adhering to nationally recognized standards.
  • Ensure patient privacy and security.
  • Ensure that MN infrastructure is in place by 2010 to allow Minnesota providers and hospitals to achieve meaningful data exchanges.
  • Provides definitions of meaningful use and meaningful use transactions.

Big Changes at the Legislature Next Session

Along with a new governor, there will be big changes at the Legislature next session as 13 members of the House and 8 members of the Senate have announced their retirements. In addition, all members of the House and Senate are up for re-election.
Six of the members are retiring because they are running for different offices. Those announcing their retirements include the following:

Representatives

    • Karla Bigham (DFL-Cottage Grove-57A)
    • Jeremy Kalin (DFL-North Branch-17B
    • Margaret Anderson Kelliher (DFL-Mpls.-60A)—candidate for Governor
    • Cy Thao (DFL-St. Paul-65A)
    • Laura Brod (R-New Prague-25A
    • Rob Eastlund (R-Isanti-17A)
    • Randy Demmer (R-Hayfield-29A)—candidate for Congress
    • Tom Emmer (R-Delano-19B)—candidate for Governor
    • Paul Kohls (R-Victoria-34A)
    • Doug Magnus (R-Slayton-22A)—candidate for State Senate
    • Mary Seifert (R-Marshall-21A)
    • Dan Severson (R-Sauk Rapids-14A)—candidate for Secretary of State
    • Larry Haws (DFL-St. Cloud-15B)
    • Mary Ellen Otremba (DFL-Long Prarie—11B)

Senators

    • Terryl Clark (DFL-St. Cloud-15)—candidate for Congress
    • Steve Murphy (DFL-Red Wing-28)
    • Jim Vickerman (DFL-Tracy-22)
    • Steve Dille ( R-Dasssel-18)
    • Pat Pariseau (R-Farmington-36)
    • Dennis Frederickson (R-New Ulm-21)
    • Debbie Johnson (R-Ham Lake-49)
    • Mee Moua (DFL-St. Paul-67)
April 30, 2010

House Moves Omnibus HHS Bill and Senate To Act on Monday

The House HHS bill that passed out of the Finance committee this week reduces spending for HHS programs by $18.4 million in FY10 and $147.9 million in FY11. Although the bill is not available, the Senate released its spreadsheet, which reduces spending by $6.69 million in FY10 and $113.4 million in FY11.  Both bills provide significant relief, compared to a $346 million reduction proposed by the Governor and the GAMC bill that passed earlier.  The House and Senate cover the GAMC population (under 75% of FPG) under Medical Assistance (MA) through the early opt-in allowed under the federal reform and also maintain coverage for single adults in MNCare.

The bills differ in how they generate revenue to fund this expansion.  The House has an HMO surcharge, 7.5% ratable reduction for hospitals and makes other reductions for providers. Originally, the surcharge was 7%, but was increased to generate revenue to exempt Children’s Hospitals and Gillette from the ratable, as well increase Gillette’s outpatient rates. The House also makes other cuts to providers.  The Senate increases the hospital surcharge to 2.63% July 1, 2010 and 2.3% January 1, 2011.  The HMO and nursing home surcharge is also increased to generate revenue along with other reductions to HMO’s and providers.  There is a 3% rate reduction for PMAP and the 10% rate reduction for MNCare adults over 75% of income that generate $42 million and $14.7 million respectively that cannot be passed on to providers.  In addition, the Senate delays hospital rebasing until 2013.  Neither bill cuts the MERC funding as proposed by the Governor.  The House bill made deep cuts in mental health services for both adults and children, while leaving the state-operated services untouched.  Minnesota NAMI lead the charge against the deep cuts, especially for children’s mental health, and it appears that there will be an amendment in Ways and Means to restore some of the funding.

The House bill will be in Way’s and Means on Monday and could be on the floor Monday or Tuesday.

House HHS HF 2614

Article 2

  • Increases surcharge on HMO’s to 2.5% effective July 1, 2011 for fee for service and January 1, 2012 for PMAP.
  • Ratably reduces payments for inpatient admissions 7.5% beginning June 1, 2010. Exempts Children’s Hospitals and Gillette from ratable.
  • Increases pharmacy dispensing fee for sole-community pharmacies from $3.65 to $4.25.
  • Sets the acquisition price of drugs of Average wholesale price (AWP) minus 12.5% or wholesale acquisition costs (WAC) plus 5.0%, whichever is lower. Current law is AWP minus 15%.  Also sets the antihemophilic factor drugs at AWP minus 28.12 or WAC minus 13.76%.  Current law is AWP minus 30%.
  • Oral interpreters services are covered only if the interpreter is on the registry or roster established by the commissioner, effective July 1, 2010.
  • Allows commissioner to purchase medical supplies with competitive bidding and negotiating.
  • Sets income level for single adults to 75% of FPG retroactively to April 1, 2010 for MA.  Funds with HCAF.
  • Requires authorization for PT (80 unites of any approved CPT code: 20 modality sessions; and 3 evaluations/reevaluations) OT (120 units and 1 evaluation) and Speech Language (50 treatment and 1 evaluation) that exceeds certain units of treatment, modalities, and evaluations and re-evaluations.  Eliminates special maintenance therapy.  The Governor recommended elimination.
  • Amends current dental service coverage and partially restores funding for critical access.  The Governor recommended elimination.
  • Pays traditional licensed midwives up to 100% of the physician rate for the same services.
  • Reduces non-emergency co-payments for ER’s from $6 to $3.50 and increases the monthly maximum from  $7 to $12.
  • Establishes a payment reform demonstration project for providers serving an identified group of patients who are enrolled in a state health care program and are high utilizers or have characteristics that put them at risk of being high utilizers. The goal is to reduce hospitalizations, ER visits, high cost medications, specialty services, or nursing home or long term care. Projects serving patients with chronic medical conditions or complex medical needs that are complicated by a physical disability, serious mental illness, or serious socio-economic factors, are given priority.  Requires that project reduces total cost of care.
  • Intensive Management Care Program is established for enrollees over 18 in the top 5% of costs.  Requires the program to reduce costs by 20%.
  • Increases rates to HMOS after August 1, 2010 by 1.4%.
  • Reduces payments made to HMO’s by 1% on January 1, 2011.
  • Exempts rehab therapy services from the 5% ratable reduction in current law effective July 1, 2010.  Section 32, reduces payment by 3% and classifies them as basic care services.
  • Physicians and professional services
    • Reduces by 3% effective July 1, 2010.  Does not apply to preventive medicine visits provided by primary care providers that includes pediatricians.  Makes the payment reduction effective for HMO’s October 1, 2010.
    • Increases payments to HealthPartners clinics by15%.
    • Payments for services can’t exceed Medicare.
    • Increases fee for service payments by 7% effective January 1, 2011
  • Prohibits the Commissioner from modifiying state programs before July 1, 2014 under financial management statute.
  • Requires MnCare to offer supplemental hospital coverage to pay for costs over $10,000 and must state that adults without children in MnCare are responsible for the amount over $10,000.
  • Makes changes to critical access dental providers that limit the number of eligible providers.
  • Includes Medication therapy management as a covered service under GAMC between April 1 and May 31.
  • CCD’s clarifies that enrollees should choose a provider when there is more than one, what is within 25 miles of their home.  Changes the schedule of quarterly payments. Non CCD hospitals that transfer patients to receive a higher level of care are not reimbursed by the CCD and are only eligible for the charity care pool.  Add ambulance service to charity care pool; if transfer is more than 25 miles form the health care facility receiving the patient.  Extends charity care pool to December 31, 2010.

Article 5, Miscellaneous

Oral Cancer Chemotherapy Parity—requires HMO’s and insurance policies to have parity for the purpose of out of pocket costs for intravenous and oral chemo therapy agents. Effective August 1, 2010.

Autism Spectrum Disorder Coverage (page 76)
Creates a new mandate for specific services for autism spectrum disorder.  Specifies coverage, treatment providers, and services.  Exempts the State Employee Plan (SEGIP) and state health plans due to the fiscal note, however the new language requires that plans maintain their current level of coverage.  Some of the plans cover some of these services and some don’t.  Several families of autistic children testified in favor of the bill. The Somali community expressed concern that they were being discriminated as they won’t have coverage under MA or MnCare, or SEGIP as they are exempt—except for the plans that currently provide the coverage.  Appropriates $50,000 to monitor the gaps in level of service provided in state health programs, SEGIP, and private health plans.

HMO Reporting
Adds amounts paid to contractors, subcontractors, and other entities for the purpose of managing provider utilization or distributing provider payments to the current reporting requirement.

Coverage for Private Duty Nursing Services
Requires a health plan to pay for private duty nursing services at the same level as Medical Assistance.  Allows for cost sharing at inpatient hospital stay.  Effective July 1, 2010.

Advisory Group on State Operated Services
Establishes an advisory group to make recommendations on the transformation of state services for individuals with mental illness and developmental disabilities to access quality care across the state.  The bill does not make the SOS reductions proposed by the Governor.

Cambridge State Operated Services (SOS)
Allows Cambridge to reorganized into two 16 bed facilities, one for DD and one for MH, with the remaining beds converted to transitional intensive foster homes.

Pilot Projects for Chemical Dependency
Allows the DHS to approve and implement pilot projects that were authorized last session to provide alternatives to and enhance coordination of delivery of chemical health services. Projects must be revenue neutral.

Office of Inspector General
Creates an office to enhance anti-fraud activities.

Article 6, Department of Health

HMO Administrative and Investment Income Reporting
Establishes reporting requirements for HMO’s and establishes an advisory group to develop cost reporting recommendations.

E Health Records and Health Information Exchange (page 95)

  • Ensure all information follows the patient across the full continuum of care.
  • Prevent fragmentation of health information that can occur when there is lack of interoperability or cooperation between health information exchange providers.
  • Ensures that organizations are adhering to nationally recognized standards.
  • Ensure patient privacy and security.
  • Ensure that that MN infrastructure is in place by 2010 to allow Minnesota providers and hospitals to achieve meaningful use.
  • Establishes criteria, oversight and fees.

Birth Center Licensing (page 109)
Adds birth centers as an essential community provider. Establishes licensure for birth centers using the Commission for the Accreditation of Birth Centers (CABC) standards.  Includes other professionals in reviewing birth center outcomes including representative of the College of OB/GYM, American Academy of Pediatrics, the Minnesota Hospital Association, and the Minnesota Ambulance Association to the list of those evaluating the quality of care and outcomes for service providing in birth centers.

Lead Levels
Allows the Commissioner of Health to revise clinical and case management guidelines by January 1, 2011, to reflect new recommendations for protective action and follow-up services for child blood lead levels that exceed 5 micrograms of lead per deciliter of blood.  Requires the commissioner to consult with a statewide organization representing physicians, the public health department of Minneapolis and other public health departments, and nonprofits with expertise in lead abatement. The revised new guidelines must be implemented to the extent possible with available resources.  Appropriates $79,000 to revise the guidelines.

Article 7, Health Care Reform

Baskets of Care/Accountable Care Organizations (ACO)
Requires DHS to establish uniform definitions for the total cost of provide all necessary services to a patient through and ACO as specified in the federal reform bill.  Permits an ACO to establish package pricing for the baskets of care currently in statute (coronary artery disease and heart disease, diabetes, asthma and depression).  Beginning July 1, 2012 prohibits and ACO from varying the payment amount that the provider or organization accepts for full payment for services.  Requires quality measurements for ACO’s by June 30, 2012, and published comparative price and quality information on the total cost of care by January 1, 2013.

Coordinated Medical Homes (page 119)
Requires DHS to provide MA coverage of medical homes for eligible individuals with chronic conditions who select a designated provider, a team of health care professionals, or a health teams as the individual’s home in compliance with the federal reform bill.  To be eligible, the individual must have two chronic conditions, one chronic condition and be at risk of developing a second, or one serious and persistent mental illness.  Defines what services must be included and to the extent possible that they are consistent with the requirements and payments for health care homes under MA.  Allows the commissioner to modify the requirements to be consistent with the federal law.

Federal Health Care Reform Demonstration Project
Requires the DHS to apply for grants in the federal reform including:

  • Evaluation of integrated care around hospitalization. (section 2704)
  • MA global payment system (Section 2705)
  • Pediatric ACO (2706)
  • MA emergency psychiatrist (Section 3707) and
  • Grants to provide incentives for prevention of chronic diseases (section 4108).

Health Care Reform Task Force
Requires the Governor to establish a task force to advise and assist in the implementation of the federal health care reform bill.  Requires a report on recommendations by December 15, 2010.

Federal Health Care Exchange
Requires state to apply for one or more planning grants relating to establishing the exchange. Also requires the state to consider whether the exchange should be established before the federal deadline of January 1, 2014.

Appropriations

  • Reduces adult and children’s mental health grants by $15 million. Also reduces payments to counties for these services.  Some are done on one time basis and as mentioned earlier may be restored in Ways and Means.
  • Provides $8.5 million in FY12 and 13 for SHIP grants. These are one time additions.
  • $2.5 million for community clinics and $2.5 million for FQHC’s with priority to medical underserved areas of the state not served by a CCD.
  • Reduces CD fund payments, moves the CD Fund cash balance to the general fund and makes changes to CD fund payments based on new payment methodology, for providers with above average rates. Caps payments at 160% of average.

Senate HHS Bill Ready Monday

The Senate committee released its spread sheet this week, but no bill.  Based on the spread sheet, the Senate cuts $113 million for the FY10/11 biennium.

The following are included:

  • Expands MA to single adults under 75% of poverty ($115 million) Uses HACF
  • Hospital Surcharge of 2.63% July 1, 2010 and 2.3% January 1, 2011, by $43 million. Hospitals receive roughly $35 million back in various adjustments to their MA rates.
  • Delays hospital rebasing through January 1, 2013.  Cuts $9.2 million in FY11 and $94 million in FY12/13.
  •  Does not cut critical access to the extent proposed by the Governor.
  • Funds asthma demonstration project expansion.
  • Does not eliminate adult rehab services (PT, OT, Speech language)
  • Increases managed care withhold
  • Enacts HMO Surcharge
  • Reduces payments to HMO’s by 10% for MnCare single adults above 75% of poverty and non administration MA reduction of 3% effective 7/1/2010 that can not be passed on to providers.
  • Partially funds State Operated Service Increase
  • Increases pharmacy board budget—to fund NASPER.
  • Does not cut MERC
  • Does not eliminate coverage for single adults in MnCare
  • Does not eliminate rural DRG Add on.
  • Does not cut state operated services.
March 30, 2010

First Round of Budget Cuts Moves to Governor Before Passover/Easter Break
(HF 1671 / SF 3223)

The conference committee report for HF 1671 passed both the Senate and House floors on Monday March 29, just prior to the Legislature beginning its Passover/Easter break.  This bill is the first of three bills designed to close the state’s $994 million budget deficit. The bill includes net reductions in spending of $313 million in FYs 2010-2011 and $413 million in FYs 2012-2013.  It is on its way to the Governor for his signature.

The supplemental budget bill includes reductions in agency budgets for higher education, economic development, natural resources, agriculture, veterans, public safety, energy, transportation and the legislative, judicial, and executive branches of government.  It is round one of the House and Senate’s budget strategy. The E-12 Education bill and Health and Human Services will be considered after the Passover/Easter Break, which began Monday evening. Legislators will return for work on April 6th.

The HHS finance chairs are getting the details regarding what federal match might be available to soften the proposed cuts.  The HHS target assumes that there will be at least $408 million in extra federal matching funding for Medical Assistance (MA).  With this additional federal money they will be expected to still cut an additional $155 million.

At issue is whether the new money from the federal health care reform bill—that includes a provision for Minnesota to adopt immediate expansion of MA for adults without children earning up to 133% of federal poverty level—will and can be used to “fix” the GAMC bill that was just signed, and to what extent it can reduce other proposed reductions by the Governor.  Recall that the Governor’s budget proposed sharp reductions for physician payments, hospital payments, and Medical Education and Research (MERC) funding.  The House HHS budget bills are expected to be released to the public on Tuesday, April 6.  The Senate is moving slower and will hold a hearing on the federal reform on Tuesday April 6th.

GAMC Signed By Governor Chapter 200

The compromise bill for a stripped down GAMC bill passed both bodies and was signed by Governor Pawlenty on March 26th.  On final passage, the bills had only 12 no votes in both the House and Senate.  All of those no votes came from Democrats who believed that this bill left very little leverage for legislative leaders to negotiate a better bill with the Governor using the new federal match for this population included in the Health Care Reform Bill.

Highlights of the proposal include:

  • It preserves GAMC in its current form until June 1 with provider payments cut by 63 percent.
  • Beginning June 1 the program would operate through a “coordinated care delivery system” (CCDS).  The 17 hospitals representing about 70% GAMC caseload and providing geographic access would be eligible to be CCDS.
  • The CCDS are required to coordinate and provide all necessary care for a set fee.
  • Outpatient/physician services other than those provided by staff physicians of CCDS are not covered unless they contract with a CCDS.
  • From June 1 to November 30, 2010, hospitals that are not a CCDS will share a $20 million uncompensated care pool to pay for GAMC patients who need medical services. After November 30, 2010, services are available only through a CCDS.
  • Beginning December 1, 2010, other hospitals may join but the pool of money is limited.
  • Effective June 1, 2010, a prescription drug pool will reimburse pharmacies and other providers for prescription drugs. Prescription drug costs will continue to be covered outside of a CCDS will be required to pay in the aggregate 20% of the state’s appropriation for the prescription drug pool.  Each CCDS assessment must be in proportion to the system’s share of total funding provided by the state for CCDS.
  • It provides rapid access to psychiatric consultation for low-income populations.
  • It establishes a process to make recommendations on appropriate drugs and doses of ADD/ADHD and psychotropic medication for children and adolescents with the goal of reducing the use of medication.  The commission will track utilization and other practices and beginning July 1, 2011, may require psychiatric consultations and prior authorization if a provider prescribes an atypical dose or medication. Also provides some financial penalties.

Birth Centers HF 3046 and SF2702

This bill establishing licensure for birth centers is traveling as an independent bill and will likely be included in both HHS omnibus bills.  At the most recent hearings in both bodies, an amendment that requires the commissioner of health, in consultation with DHS and members of the birth centers to evaluate the quality of care and outcomes for services provided by licensed birth centers.  Following the hearing in the House, Rep. Ruud agreed to include a member of the American Academy of Pediatrics as part of an amendment to include providers other than representatives of birth centers to assist the commissioner in tracking outcomes for birth centers.  The bill allows medical assistance to reimburse only licensed practitioners for labor and delivery.  Lay midwives are not licensed in this state.  HMOs would be required to reimburse birth centers under this bill as well.  The Senate is carrying a fiscal savings in the Omnibus bill for the anticipated reduction in reimbursement for normal deliveries.

ADD/ADHD Diagnosis for Special Education – May Be Dead (HF 2995 / SF 2708)

It appears that a fiscal note from the Education Committee may permanently table the bill initiated by the Minnesota Social Workers Association to allow social workers, counselors and marriage and family therapists to make a diagnosis ADD and ADHD for the purposes of getting an independent medical plan for kids in school. There was discussion by the special education community that adding practitioners who could diagnose ADD/ADHD might lead to more referrals for special education services without providing the schools more money.  Special education funding is currently capped and any increase in ADD/ADHD services would result in reduced funding for other categories.  The education community argued that this was another unfunded mandate for which schools would have to pick up the costs.  Licensed psychologists who opposed allowing marriage and family therapists the authority to make this diagnosis without special training opposed the bill.

Compromise Primary Caries Bill Moves Forward SF633 / HF984

The bill that passed last year in the House that encouraged physicians to perform primary caries prevention at the time of the child and teen check up was heard again in House Finance Committee and sent back to the floor.  In addition, the Senate author adopted the House language that dropped the mandate for screening and defines that prevention services include a visual exam of the mouth without using probes or other dental equipment, risk assessment using AAP and pediatric dentistry; and a fluoride varnish beginning at age 1 to those assessed by the provider of being high risk for decay.  Physicians are already allowed to be reimbursed for these services. If a physician provides these services they must provide and document in the medical record that the family received information about preventing dental disease and the importance of finding a dental home.

Mandatory Reporting – Pregnant Women (SF 2695 / HF 3059)

The bill that amends the current law when a provider must report a pregnant women who they suspect are abusing chemicals if they are receiving a comprehensive set of prenatal services has passed the Senate floor and is awaiting final action in the House. The bill is designed to loosen the requirement that a health care worker immediately report to the local welfare agency if the person knows or has reason to believe that a pregnant woman has used a controlled substance for a nonmedical purpose or excessively used alcohol during her pregnancy. The Minneapolis Public Health Department experienced a “chilling” effect on women willing to access prenatal services due to the reporting requirement.  The new bill would exempt a professional from reporting if the professional knows or has reason to believe the woman is seeking or receiving prenatal care from a health care professional.

Lead Levels in Children (HF419 / SF 522)

Both of these bills address minimum blood lead levels.  They both have passed out of policy committees in differing forms and are moving through the process.

The House bill directs the Commissioner of Health to revise clinical and case management guidelines by January 1, 2011, to reflect new recommendations for protective action and follow-up services for child blood lead levels that exceed 5 micrograms of lead per deciliter of blood. It requires the new guidelines to be implemented to the extent possible with available resources.

The Senate bill amends the Lead Poisoning Prevention Act by also reducing the lead level to 5 micrograms of lead per deciliter of blood, but it uses the new dose in prioritizing lead abatement projects.

BMP Adopts Lyme Position; Legislation Pulled (SF 1631 / HF 2597)

Legislation to limit the Board of Medical Practice (BMP) authority to discipline physicians related to the treatment of Lyme disease has been pulled from consideration by the authors because of action taken by the BMP at its March 13 Board meeting.  At that meeting the BMP agreed to a voluntary moratorium on action related to the treatment of chronic Lyme disease, for a period of no more than 5 years.  While this is not an ideal situation, this is a much better outcome than the passage of legislation that would have created a very bad precedent for the Legislature telling the BMP how to act.

The resolution adopted by the BMP follows:

1. Whereas: The science regarding the presumptive diagnosis “chronic Lyme disease” and the long term prescription and administration of antibiotic therapy for its treatment is unsettled.
2. Whereas: The Minnesota Board of Medical Practice has never investigated, disciplined, or taken any other action against any practitioner solely on that basis.
3. Whereas: The Minnesota Board of Medical Practice has never received any complaints solely on that basis.
4. Whereas: Patients, some physicians, and the public are seeking guidance on this issue.

Therefore, in the interest of allowing time for science to resolve this issue:

1. The Minnesota Board of Medical Practice voluntarily will engage in a moratorium for a time period not to exceed five years, or the time at which double-blind, peer reviewed studies have resolved the issues, whichever is first, on the investigation, disciplining, or issuance of Corrective Action Agreements based solely on long term prescription or administration of antibiotic therapy for “chronic Lyme disease,” except in the event of a complaint lodged by a patient or by a conservator, parent or guardian on the patient’s behalf for this specific use of antibiotic therapy.
2. Will publicize this voluntary action on its website.
3. Will educate its staff, medical coordinators, and members regarding this voluntary action.
4. Will diligently seek the results of double-blind, peer reviewed scientific studies that address this issue.
5. At the end of the five year period, in the absence of such scientific studies which bring a conclusion to the issue of the legitimacy of this diagnosis and treatment, the Board will re-examine this issue based on evidence available at the time.

March 19, 2010

GAMC Agreement Moving Fast

Governor Tim Pawlenty and DFL legislative leaders finally reached a deal to maintain the GAMC program. The “deal” fell apart several times during the week but a final legislative language was released to the public on Wednesday March 10, and the bill was heard and passed in both the House and Senate health finance committees on Thursday March 11.  Both bills are expected to be acted on by the full House and Senate by the week of March 15.

Most testifiers, including representatives of hospitals and the Minnesota Medical Association, supported the proposal under the rationale that some kind of program was better than no program.  MMA told committee members that this bill should not be billed as “reform” but as a cut to providers.  In addition, several testifiers told legislators that they must consider these cuts in balancing the budget.

The good news is that the deal continues the GAMC program beyond the scheduled elimination date of April 1, 2010.  The bad news is that it is significantly scaled back.  What has been an approximately $500 million per year program is now funded at $164 million. What had been a program that provided all services through inpatient and outpatient providers is now a program where services will only be reimbursed through hospital-based Coordinated Care Organizations (CCOs).

Effective, June 1, 2010 the Commissioner of Human Services may contract with the 17 hospitals that provide the most GAMC care.  Any hospital who becomes a CCO will be required to provide all services for GAMC patients, both inpatient and outpatient.  They will be paid a capitation fee to provide those services and they will be expected to accept all risk for the patient’s care.

Highlights of the proposal include:

  • Preserves GAMC in its current form until June 1 with provider payments cut by 63 percent.
  • Beginning June 1 the program would operate through a “coordinated care organization” (CCO).  The 17 hospitals representing about 70% GAMC caseload and providing geographic access would be eligible to be CCOs.
  • The CCOs are required to coordinate and provide all necessary care for a set fee.
  • Outpatient/physician services other than those provided by staff physicians of CCOs are not covered unless they contract with a CCO.
  • From June 1 to November 30, 2010, hospitals that are not CCOs will share a $20 million uncompensated care pool to pay for GAMC patients who need medical services. After November 30, 2010, services are available only through a CCO.
  • Beginning December 1, 2010, other hospitals may join but the pool of money is limited.
  • Effective June 1, 2010, a prescription drug pool will reimburse pharmacies and other providers for prescription drugs. Prescription drug costs will continue to be covered outside of a CCO.  CCOs will be required to pay in the aggregate 20% of the state’s appropriation for the prescription drug pool.  Each CCO assessment must be in proportion to the system’s share of total funding provided by the state for CCDs.

The exact hospitals included in the 17 is not completely clear but they include Hennepin County Medical Center, Regions Hospital, University of Minnesota Medical Center-Fairview, Immanuel St. Josephs, North Memorial, Abbott Northwestern, St. Cloud Hospital, Mercy Hospital, Fairview Ridges, United Hospital, St. Mary’s Duluth Clinic, Mayo Psychiatric  Hospital, St, Mary’s Region Health Center-Detroit Lakes, Mercy Hospital-Carlton, North County-Bemidji, Mahnomen Hospital, and Rice Memorial-Willmar.

Also added back to the bill is the section that requires the commissioner, in consultation with the Drug Review Board and Pediatric mental health providers, to identify recommended dose ranges for atypical antipsychotic drugs and drugs used for ADD/ADHD based on available medical, clinical and safety data research.  The Commissioner is required to periodically review the list of medications and pediatric dose ranges and update the medications and does listed as needed after consulting the Drug Utilization Review Board.

In addition, situations where a collaborative psychiatric consultation and prior authorization should be required before the initiation or continuation of drug therapy in pediatric patients, including, but not limited to high-does regimen, off-label use of  prescription medication, a patient’s young age, and lack of coordination among multiple prescribing providers must be identified.

DHS will also track prescriptive practices and uses of psychotropic medications in children with the goal of reducing the use of medications, where appropriate.  Effective July 1, 2011, the commissioner must require prior authorization and a collaborative psychiatric consultation before an atypical antipsychotic or ADD/ADHD drug meeting the criteria established under this provision is eligible for payment.  The collaborative psychiatric consultation must be completed before the identified medications are eligible for payment, unless: the patient has already been stabilized on the medication regimen; or the prescriber indicates the child is in crisis.  In this case the consultative evaluation must be completed within 90 days.

Dr. Schiff has indicated that Minnesota has a good track record in this area—and the medical community has not been identified as a state that over subscribes medication for
children.  This provision has been strongly supported by NAMI.

ADD/ADHD Diagnosis for Special Education

The ADD/ADHD (H.F. 2995/S.F. 2708) bill was considered in the Education policy Committees and there were several amendments considered.  This bill is being pursued by the Minnesota Social Workers Association to allow social workers to make a diagnosis of ADD and ADHD for the purposes of getting an independent medical plan for kids in school. There was discussion by the special education community that adding practitioners who could diagnose ADD/ADHD might lead to more referrals for special education services without providing the schools more money for this.  Senator Solon wanted to pursue her amendment to add educational requirements for the social workers.

The bill passed out of the House Education Committee limiting the new authority to diagnose ADD/ADHD to social workers and counselors.  One version of the bill also allowed Marriage and Family Therapists to do this but they were deleted from the proposal.  An amendment that would have required these two groups to be allowed to diagnose ADD/ADHD only if  the practitioner “successfully completed course work and supervised clinical experience in administering, interpreting, and integrating psychometric testing for the purpose of differential diagnosis,” failed after testimony from the school social workers opposed it as well as the bill author.  As the bill now stands in the house, social workers and counselors will be added as practitioners who can make the diagnosis.

Primary Caries SF633/HF984

The bill that passed last year in the House that encouraged physicians to perform primary caries prevention at the time of the child and teen check up was acted on in the Senate.  The Senate author adopted last year’s House language which dropped the mandate for screening and defines prevention services to include a visual exam of the mouth without using probes or other dental equipment, risk assessment using an AAP and Pediatric Dentistry tool, and a fluoride varnish beginning at age 1 to those assessed by the provider of being high risk for decay.  Pediatricians are already reimbursed for these services. If a pediatrician provides these services they must provide and document in the medical record that the family received information about preventing dental disease and the importance of finding a dental home.

Governor Recommends Drastic Cuts to Medical Education

The Governor’s proposed supplemental budget contains a $55 million reduction to the Medical Education and Research Cost (MERC) fund.  This is the main state funding program that supports a portion of the costs of the required clinical training for health
professional students and residents.  This 83% reduction will affect the University as well as our partner sites – hospitals, clinics, and pharmacies throughout Minnesota — where clinical training occurs.

MERC covers clinical training of medical students and residents, dental students and residents, pharmacy students and residents, advanced practice nursing students, physician assistant students, and chiropractic students.   The purpose of the fund is to compensate hospitals, clinics, and other health care providers for a portion of the costs of clinical training.  MERC is administered by the Department of Health.  MERC funds can only go to organizations that provide clinical training to students and residents from one of the state’s Sponsoring Institutions (e.g. U of M, Mayo, Hennepin, St. Scholastica, state colleges).  In essence, the money follows the students and goes to hospitals, clinics, and pharmacies.

MERC funds go both to medical schools and to residency training sites.  The Governor recommends cutting the dedicated payments to the University of Minnesota (Academic Health Center and Dental School) and University of Minnesota Medical Center, Fairview    ( 32.5 percent cut to $5.35 million in 2009).  He also recommends cutting the general distribution to eligible hospitals, clinics, pharmacies, and other providers based on their proportion of medical assistance and general assistance medical care (87.5 percent cut to $60.7 million in 2009).

Biggest impact of the residency cuts are (estimated in millions):

Abbott Northwestern $  2.1
Children’s Minneapolis $  3.6
Children’s St Paul $  1.5
UMMC, Fairview $  5.4
Other Fairview units $  2.1
Gillette Children’s $    .9
Health East $  2.8
HCMC $  7.5
Hennepin Faculty Assoc $    .9
St. Joseph’s $    .8
Mayo, St. Mary’s & Methodist $  3.2
Mercy Hospital $  1.1
North Country Regional $    .8
North Memorial $  2.4
Park Nicollet Memorial $  1.0
Regions Hospital $  3.7
St Cloud Hospital $  1.8
St Luke’s Duluth $    .6
St Mary’s Duluth $  1.1
United $  1.9
Unity $    .8

 

Committee Deadlines and Budget Resolution

As the second committee deadlines approaches, legislators are rushing to get policy bills passed by, Friday, March 19th.   Bills must be through all policy committees by Friday to remain alive for the year, unless a special vote is taken in the rules committee.   March 29th is the third deadline, where finance bills are to have cleared their finance divisions.  Leadership indicated that they may waive the committee deadline for health and human services and K-12 until there is action by the federal government on the FMAP extension and health care reform.  Legislators will be taking most of the Passover/Easter week off.
The House Budget Resolution was announced and cuts of $155 million out of HHS assuming $408 for FMAP and $147 for GAMC.  If FMAP does not come through and GAMC does not pass, the HHS target is down $710 million. This does not include any assumptions for additional funding if federal health reform is adopted.

No Smoking in Cars with Kids?

The House Health and Human Services Policy and Oversight Committee on Wednesday heard H.F. 379 (Slawik, DFL-Maplewood).  The bill would allow law enforcement officers to issue citations to drivers of cars in which smoking was occurring and a child under 18 was present.  Tickets could be issued only if the driver was stopped for another offense.  After hearing testimony from public health officials, the bill was laid on the table.  Rep. Slawik said that she remains committed to passing the bill, but that the issue is not yet ready to move forward.

Alcohol Prices to Go Up?

The House Health Care and Human Services Finance Division on Tuesday heard two bills that would increase taxes on alcohol to fund CD treatment and law enforcement costs of treating substance abuse.  H.F. 1896 and H.F. 2125 (Clark, DFL-Minneapolis), would increase excise and gross receipts taxes on alcohol, proposals opposed by alcohol retailers and manufacturers.  The bills were laid over for possible inclusion in the omnibus HHS finance bill.  Last year an alcohol tax increase was in the tax bill vetoed by the Governor.

February 19, 2010

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.

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