News

• Legislators returned to St. Paul to begin the 2013-2014 biennium on January 8. With calls for bipartisanship, veteran and freshmen legislators alike took the oath of office, many with their families next to them on the House or Senate floor. The good feelings quickly turned sour in the Senate, as legislators fought over staffing and budgets. It’s likely that partisan fights will only become more prominent as legislators begin to grapple with a $1.1 billion budget deficit.
• The 2012 elections brought dramatic change to St. Paul, with Democrats re-taking control over both the House and Senate following two years of GOP control. With the change in partisan control comes new leadership of both bodies, as well as new chairs for all committees.
• The MNAAP Board of Directors met this week to consider its 2013 legislative priorities and agenda. Following extensive committee work and discussion, the MNAAP will be focusing its legislative work on preserving and expanding access to care for children and adolescents, strengthening the state’s newborn screening program, preventing bullying and harassment in our schools, and investing in early brain development.
• Mark your calendars for the 2013 Peds Day at the Capitol! Set for February 2013, it’s a wonderful opportunity to visit with fellow pediatricians, hear from legislative leaders, and meet your elected officials.

Newborn Screening Changes Receive Gubernatorial Approval

After multiple false starts, legislative language to allow the Minnesota Department of Health to continue operations of the state’s newborn screening program was signed by the Governor last week. The newborn screening language was attached as an amendment to a bill related to HHS and education financing, and passed both the Senate and House unanimously. The amendment was offered by the same legislators who had earlier introduced the newborn screening bills, Sen. David Hann (R – Eden Prairie) and Rep. Mary Liz Holberg (R – Lakeville).

The state’s newborn screening program tests all newborns for over 50 genetic and congenital defects via a small blood sample. The samples, stored on cards as bloodspots, were used for quality assurance for future testing, research to develop new tests, and for calibration of testing equipment. Following a legal filing brought by a group of families who challenged the program on the grounds that the state was mishandling genetic samples under state law, the Minnesota Supreme Court ruled that the samples could not be used for anything outside of the actual testing of the infant. Known by the name of one of the plaintiffs as “the Bearder case,” the ruling also brought into question many other elements of MDH’s public health work, as it narrowly construed the definition of “genetic information.”  Physician groups, advocates for research, and groups of parents of impacted children lamented the ruling’s impact on the program and important public health efforts.

The language adopted by the Legislature are the products of negotiation and compromise between MDH and the bill authors, long viewed as critical of the newborn screening program. Under the new language, the program remains of an “opt out” nature, though blood spots would have to be destroyed after 71 days (and the test results after at two years).  Importantly, the amendment allows MDH to use the spots within 71 day window for test calibration and quality control, activities that the court had precluded in the Bearder decision.  Also of note, the bill also would allow parents to give consent for long term (up to 18 years) storage of blood spots and test results, as well as to use the spots for new test development.  Furthermore, the bill clarifies what information is to be given to expectant parents and parents of newborns. To address the decision’s impact on MDH’s larger public health work, the bill provides immunity from court challenge to the Department as it studies what further refinements to the law are necessary to continue its public health mission.  A report on proposed legislation is due to the Legislature in January 2013.

“Extra Innings” at the Capitol

Missing their “target adjournment” by well over a week, legislators finally wrapped up the 2012 legislative session last Thursday. With many different pieces still in motion as the target date of April 30th approached, legislative leaders announced that they would miss their mark. The House concluded Thursday morning following an all-night debate on the Vikings stadium proposal, and the Senate wrapped up Thursday afternoon after passing the same bill.  By the time of the final adjournment, legislators had also a bonding bill and several smaller tax bills, all of which were sent to the Governor.  The 2012 legislature bumped up on the number of dates by which the state constitution allows them to meet, having met for 119 of the allowable 120 days.

“Safe Routes to School” Included in Transportation Bill, Signed by the Governor

An omnibus transportation policy bill that includes a provision establishing the “Safe Routes to School” program has been signed by the Governor. The program is intended to assist municipalities in creating pedestrian-friendly routes to and from local schools. The language of the Safe Routes to School provision was added to the bill by Rep. Kim Norton (DFL – Rochester) with the support of the bill authors, Sen. Joe Gimse (R – Willmar) and Rep. Mike Beard (R – Shakopee).  Supporters of the effort included the Minnesota Medical Association, the MN-AAP, the American Heart Association, and dozens of others. While certainly a positive development in efforts to combat childhood obesity, the bill only establishes the program.  Funding for the program was not included in the bonding bill passed by the Legislature.

The 2012 Session: A Quick Recap

The 2011-2012 biennium saw over 5500 pieces of legislation introduced; almost 2500 in the “short” 2012 legislative session alone.  The vast majority of bills never receive a hearing, and a far smaller number ever become law.   Below is a list and brief description of some notable bills that were signed into law, vetoed, or never acted upon.

Signed Into Law

BMP, Physician Disclosure (Chapter 164)
• BMP website to include information on a physician’s criminal convictions, disciplinary or corrective actions, and malpractice judgments (effective 7/1/13)
• Studies background checks for licensees
• Modifies complaint process for both complainants and licensees

HHS Finance Supplemental (Chapter 247)
Contained dozens of provisions, including:
• Restoration of funding for dialysis and cancer care under the state’s Emergency Medical Assistance (EMA)
• An independent audit of the state’s PMAP program
• A study of autism in the Somali-American community
• Language instructing DHS to create a “pediatric care coordination” system
• A request that the University of Minnesota seek funding for rural primary care medical training

Provider Peer Grouping (Chapter 164)
• Updates timelines for data publication; requires use of most recent data
• Allows clinic and hospitals ability to review data
• Establishes advisory committee
• Streamlines and clarifies appeals process for providers

Newborn Screening Revisions (Chapter 292)
• Establishes 71-day “standard retention period” for bloodspots (2 years for test results) prior to destruction
• Authorizes use of spots for test calibration and quality control
• Allows extended storage for spots and results with parental consent
• Clarifies information that must be provided to parents

E-Prescribing Conformity (Chapter 246)
• Aligns state law with federal law regarding e-prescribing of controlled substances

Vetoed

Abortion Facility Licensure (SF 1921)
• Requires licensure of health care facilities performing more than ten abortions per month

Abortion Medication Requirements (HF 2341)
• Requires a physician to be physically present when a patient is administered mifepristone (also known as RU-486)

Fireworks Expansion (SF 1694)
• Allows sale of currently prohibited fireworks, including those that explode or become airborne

Health Care Compact (SF 1933)
• Enrolls Minnesota in a multi-state agreement that seeks to require the federal government to distribute all federal health care funds back to the state while waiving all federal rules and requirements

Did Not Move

Minnesota Insurance Exchange (SF 1872/HF 2290 and SF 2441/HF 2739)
• These two proposals would have established a Minnesota-based health insurance exchange as required by the federal Affordable Care Act

Tobacco Tax Increase (SF 1916/HF 2761)
• Raised the tax on tobacco products, with the revenues used to pay down debt owed to the state’s schools and reduce business taxes

Firearm Gag Rule (SF 1476/HF 1717)
• Prohibits physicians from asking patients about ownership and access to firearms in the patient’s home

Rule 101 Repeal (SF 1866/HF 2521)
• Repeals the requirement that health care providers participate in state public health care programs as a condition of participation in the state employee health plans.

Minor Consent Repeal (SF 1865/HF 2522)
• Repeals in part the law that allows providers to provide treatment to minors for certain conditions (mental health, reproductive health, and chemical dependency) to minors without parental consent.

Medi-Spa Regulations (SF 707/HF 1225 and SF 2617/HF 3026)
• Two competing proposals to modify how “medi-spas” are treated under state law.  The first would require that patients seeking cosmetic treatments with lasers be seen by a physician first.  The latter bill would have expanded the use of lasers by non-physicians.

Expect Many New Faces in 2013

With a constitutionally mandated redistricting process completed in February 2012, a large number of legislators were drawn into the same legislative districts as colleagues. Redistricting, in addition to the regular turnover of members both long-serving and junior, has led to almost 20 percent of legislators not running for reelection to their current office in the November 6, 2012 elections.  Below is a list of those who are not seeking reelection, as well as those running for different office this fall.

Retirements

House
Rep. Mark Buesgens (R – Savage)
Rep. Denise Dittrich (DFL – Champlin)
Rep. Marion Greene (DFL – Minneapolis); Lost in an endorsing contest
Rep. Mindy Greiling (DFL – Roseville)
Rep. Bill Hilty (DFL – Finlayson)
Rep. Larry Hosch (DFL – St. Joseph)
Rep. Kate Knuth (DFL – New Brighton)
Rep. John Kriesel (R – Cottage Grove)
Rep. Mike LeMieur (R – Little Falls)
Rep. Pat Mazorol (R – Bloomington)
Rep. Carol McFarlane (R – White Bear Lake); Lost in an endorsement contest
Rep. Mark Murdock (R – Perham)
Rep. Nora Slawik (R – Maplewood)
Rep. Ron Shimanski (R – Silver Lake); Lost in an endorsing contest
Rep. Tom Tillberry (DFL – Fridley); Lost in an endorsement contest

Senate
Sen. Al DeKruif (R – Madison Lake)
Sen. Chris Gerlach (R – Apple Valley)
Sen. Mike Jungbauer (R – East Bethel); Lost in an endorsement contest
Sen. Ken Kelash (DFL – Minneapolis); Lost in an endorsement contest
Sen. Amy Koch (R – Buffalo)
Sen. Gary Kubly (R – Granite Falls); Passed away mid-session
Sen. Keith Langseth (DFL – Glyndon)
Sen. Doug Magnus (R – Slayton)
Sen. Mary Jo McGuire (DFL – Falcon Heights); Lost in an endorsement contest
Sen. Geoff Michel (R – Edina)
Sen. Gen Olson (R – Minnetrista)
Sen. Claire Robling (R – Jordan)

Running for Different Office

House

Rep. Bruce Anderson (R – Buffalo Township); Running for Minnesota Senate
Rep. Kurt Bills (R – Rosemount); Running for US Senate
Rep. Bobby Joe Champion (DFL – Minneapolis); Running for Minnesota Senate
Rep. Connie Doepke (R – Orono); Running for Minnesota Senate
Rep. Keith Downing (R – Edina); Running for Minnesota Senate
Rep. Kent Eken (DFL – Twin Valley); Running for Minnesota Senate
Rep. Mary Kiffmeyer (R – Big Lake); Running for Minnesota Senate
Rep. Lyle Koenen (DFL – Clara City); Elected to Minnesota Senate to replace deceased Sen. Gary Kubly
Rep. Brandon Peterson (R – Andover); Running for Minnesota Senate
Rep. Bev Scalze (DFL – Little Canada); Running for Minnesota Senate
Rep. Torrey Westrom (R – Elbow Lake); Running for Minnesota Senate

Senate

Sen. Linda Higgins (DFL – Minneapolis); Running for Hennepin County Board
Sen. Gretchen Hoffman (R – Vergus); Lost endorsement contest for US Congress
Sen. Mike Parry (R – Waseca); Running for US Congress

Senate Hears, Tables Newborn Screening Bill

With testimony from two MN-AAP pediatrician members offering qualified support, a bill was heard last week to allow the state’s Newborn Screening Program to use bloodspots for quality assurance and establish a consent program for longer term storage of spots and test results. The bill was tabled in committee, and its future is uncertain.

House and Senate Unveil Supplemental Finance Bills

The House and Senate unveiled budget supplemental bills containing some new spending and dozens of new policy proposals. Of particular note, the bills contain funding for a study of autism in the Somali-American community, language about establishing a “pediatric care coordination” service for certain infants and children, and a speedier prior authorization process for OT, PT, speech language therapies, and mental health services for some patients.

Newborn Screening

A bill to codify some of the changes that the Minnesota Department of Health (MDH) enacted following a Minnesota Supreme Court ruling in November impacting the state’s newborn screening program was the subject of behind-the-scenes discussion last week. Following the Supreme Court ruling, the MN-AAP, other physician groups and parents of impacted children lamented the ruling’s impact on the program.  The bills, SF 2463 and HF 2697, are sponsored by Sen. David Hann (R – Eden Prairie) and Rep. Mary Liz Holberg (R – Lakeville).

While supportive of the bills language allowing the program to continue to run high quality tests, the MN-AAP, other physicians groups, researchers, and advocates noted that the bill doesn’t go far enough in re-establishing the nation-leading program that existed prior to the Bearder decision. Specifically, MN-AAP remains concerned that a 71-day period is inadequate for completion of full testing. MN-AAP remains opposed to any efforts that might occur to make the program “opt-in” and continues to work closely with other child advocates on this issue.

First Policy Deadline Passes

One of the key dates in the legislative calendar passed on March 16.  Under guidelines established by the majority party in the House and Senate shortly after the start of the session, all legislation related to policy must have passed all policy committees in either the House or the Senate.  Bills that have not met the deadline are considered “dead” for the remainder of the session (though creative lawmakers will be searching for other vehicles to move their proposals forward, including the newborn screening bill).  This deadline has made for a busy two weeks as legislators worked to clear the first legislative hurdles.  Note that bills pertaining to spending, constitutional amendments, taxes, and bonding are not subject to the deadline rule, and exceptions can always be made if a legislator has the votes to waive deadlines. The next deadline – March 23 – looms.  By that date, policy bills will have to have cleared policy committees in both bodies.

Changes to the BMP, Physician Reporting Move Forward

Proposed changes to the information that the Board of Medical Practice (BMP) is required to make public on its website continue to move forward in the Legislature.  The House bill, HF 2555, has moved through several policy committees and awaits action in the House State Government Finance Committee.

Under the bill, the BMP would be required to publish on its web site all malpractice judgments brought against a physician.  Under earlier iterations of the House bill, malpractice settlements would also be posted on the web site, though that provision was removed by the author.  In addition, the bill would require all licensees to submit a full set of fingerprints and be subject to a criminal background check.  The MMA and other physician groups have been expressing concern with the fingerprint requirement, arguing that it is needlessly burdensome given the thorough vetting physicians are subject to thought the credentialing process.

The Senate companion, SF 2304 is being authored by Sen. Terri Bonoff (D – Minnetonka).  It has not yet been scheduled for a hearing.

Pediatrician’s Day at the Capitol Tuesday!
Make plans to join the MN-AAP for the annual “Pediatricians’ Day at the Capitol,” set for Tuesday, February 21. The event brings together pediatricians from around the state to talk about issues facing patients and our profession. With the state’s Commissioner of the Department of Health set to join us at noon, and legislators from both parties dropping by to visit with the group, it’s a terrific opportunity to lend your voice to our shared efforts. If you would like to join, please call MN-AAP at 651-402-2056 or stop by the Capitol (Room 316) at noon. More details

Volume of Legislation Picks Up
With less than a month of the 2012 Legislation completed and over 1,000 bills already introduced, the pace of the session has clearly picked up. The MN-AAP has been closely following a number of new proposals, including threats to vaccine usage and repeal of minor consent, as well as opportunities around tobacco use and bullying prevention. While the Capitol has seen lots of activity, the health care committees have yet to hear a substantial number of individual bills. Watch for that to change in the coming weeks.

MN-AAP policy priorities this year include advocating for access to and coverage of optimal healthcare for all children, for bullying prevention, and for initiatives which promote early brain development. The following are several noteworthy bills that the MN-AAP has been following in recent days:

• A proposal by Rep. Mary Franson (R – Alexandria) that would make it easier for parents to opt-out of the state’s mandatory vaccination program for their school-age children.
• A bill by Sen. Gretchen Hoffman (R – Vergas), SF 1865, would repeal the state’s minor consent provisions. Minnesota’s minor consent law allows minors to seek treatment from physicians for reasons related to drug and alcohol abuse, mental health, and sexual health without first receiving consent from a parent or guardian. A similar bill was introduced last year; however, it did not move out of committee following testimony by MN-AAP members.
• HF 2230, a bill by Rep. Jim Abeler (R – Anoka), would require that MDH develop and implement a pediatric care coordination program for children with high-cost medical or high-cost psychiatric conditions who are at risk of recurrent hospitalization or emergency room use for acute, chronic, or psychiatric illness. This same bill would mandate that the health plans under contract with the state implement strategies to reduce the incidence of low-birth weight newborns. As a leading advocate for health care homes, MN-AAP will continue to monitor and advocate for ongoing improvements to support the pediatric health care home.
• As noted in an earlier legislative update, Rep. Jim Abeler is the author of anti-bullying bill, HF 1953. A different approach than earlier bullying prevention efforts, this bill does not specifically name characteristics (such as race, gender, sexual orientation) in its definition of “bullying.”
• In an effort to “streamline” government, a proposal by Senator Mike Parry, SF 1639, would abolish the Department of Health, as well as a number of other state agencies.