News

Peds Day at the Capitol Set for February 15

Building relationships with elected officials has never been more important.  With a state budget deficit of $6.2 billion and 60 new legislators, communicating with those who will be making the decisions at the Legislature is critical to promoting children’s health and well being. The MN-AAP’s annual “Day at the Capitol” is a terrific way to do just that.  We’ve invited key legislators and opinion makers to address the group and we’ll arrange for you to meet with your own legislators, too. This is a terrific way to add your voice to the MN-AAP chorus at the Capitol.

We’ve also invited some key leaders to address our group as a whole.  As of this writing, Representatives Jim Abeler (GOP – Anoka, Chair of the House HHS Finance Committee) and Erin Murphy (DFL – St. Paul), as well as Senator Linda Higgins (DFL – Minneapolis), have confirmed their availability.

It’s easy to be a part of Peds Day at the Capitol, too. To take advantage of the schedules of many area resident pediatricians, we’ve arranged for two sessions, the first orientated towards residents, the second geared toward community and faculty pediatricians. Both will present excellent opportunities to learn about the issues we’re following and to add your voice. Join us for either one… or both!

REGISTER today for this important event!

Budget Cutting Begins in Legislature

After a highly contentious debate on both floors, both the House and Senate passed what they are calling “phase one” in their work to craft a balanced budget.  The bills, passed on strict party lines, make permanent over $800 million in cuts originally found in former Governor Pawlenty’s unallottments of 2009 and passed by the Legislature in 2010.

The majority of the cuts contained within the bill are to local government aid programs, the university system, and various human service programming though, notably, not to physician reimbursement.  HHS programs for low-income Minnesotans such as General Assistance and Supplemental Aid Grants, as well as Child Support Enforcement Grants to counties would see cuts.

Republicans argue that beginning the work of cutting the budget now will make the next set of budget cuts more manageable, and note that the DFL legislature supported these very same cuts in 2010.  DFLers counter that the 2010 cuts were largely “backfilled”with federal stimulus dollars, so that the damage to programs and recipients was muted.  These cuts, they argue, will disproportionately hurt the neediest Minnesotans.

The House and Senate bills will now be referred to a conference committee, as the two versions of the bill differ.  Governor Dayton, while not specifically stating his intent to veto the bill, has repeatedly called for a single, comprehensive budget solution, rather than the “piecemeal” approach that the Legislature has begun.  The Governor is due to present his budget proposal to the Legislature on February 15.

“Freedom of Choice in Health Care” Bill Gets Hearing

A bill that would roll back Governor Dayton’s executive order enrolling Minnesota in the “early Medicaid” program made possible by last year’s federal health care reform package received two hearings in the Senate.  The bill, SF 33, is being carried by Senator David Hann (GOP – Eden Prairie), the chair of the Senate HHS Committee.  In addition to ending Minnesota’s enrollment in early Medicaid, the bill contains a “public policy statement” that declares that every resident of Minnesota has the “freedom of choice” in health care.   Click HERE to view the text of the bill.

The bill received its first hearing on January 26 in Senator Hann’s HHS Committee.
A number of individuals testified in opposition to the bill, including Minnesota Medical Association President Patricia Lindholm, a family physician from Fergus Falls.  Dr. Lindholm noted that passage of this legislation would serve to shift the costs of health care of those covered by public programs onto physicians, hospitals, employers who provide coverage for their employees, and all-rate payers.

Several individuals, including representatives from the Citizens Council on Health Care and the 10th Amendment Center spoke in support of the bill, arguing that the federal reforms passed last year infringed on Minnesota’s sovereign rights as a state.

Testimony on the bill was followed by contentious debate within the HHS Committee, with DFL members lamenting the lack of significant discussion on the state’s finances.  Much of the discussion focused on the U.S. Constitution, and the relative wisdom of a committee of the Minnesota Senate debating constitutional law.   A fiscal note prepared for the bill stated that the cost to Minnesota would total $45 million for the next biennium.  On Thursday, February 3, the bill received its second hearing in the Senate Judiciary Committee, where debate once again focused on issues such as the state’s rights and sovereignty.  The bill passed on a voice vote and was referred to the Finance Committee.

SF 33’s House companion, HF 199, is being carried by Rep. Steve Gottwalt (GOP – St. Cloud), chair of the House Human Services Reform Committee, though it has yet to receive a hearing.  Governor Dayton has stated his intention to veto any legislation that attempts to undo the state’s participation in early Medicaid.

MinnesotaCare Changes Move Forward

A proposal by Rep. Steve Gottwalt (GOP – Saint Cloud) to move a number of MinnesotaCare enrollees into private health insurance advanced earlier this week when it was passed by the House Commerce Committee. The bill’s next step is to be considered by the House Human Services Finance Committee.  The text of the bill, HF 8, is available HERE.  The bill’s Senate companion, SF 32, carried by Senator David Hann (GOP – Eden Prairie) also took its first step, as it was passed from the Senate HHS Committee to the Senate Commerce Committee.

The Gottwalt and Hann proposals would provide subsidies to eligible adults without children with incomes above 133% of the federal poverty level to purchase individual, private insurance in place of MinnesotaCare.  Subsidy levels are determined on a sliding scale based on age and income.  Those individuals denied care in the private market would receive a slightly higher subsidy to seek coverage from the Minnesota Comprehensive Health Association (MCHA), Minnesota’s high-risk insurance pool.  The bill’s proponents argue that the bill would save the state money while opponents raised concerns about the poor being able to navigate the private market.

Rumblings Around Newborn Screening?

In an otherwise mundane and dry House HHS Finance hearing regarding the internal finances of the Department of Health, questions arose from several freshman GOP members about the newborn screening program.  The newborn screening program is a Minnesota initiative in which all babies born in Minnesota are screened for more than 40 disorders.  Several parents brought suit against MDH, claiming that the way the department operated the program ran counter to the authorizing statute.  The MN-AAP has long been a supporter of the program.

The legislators, Reps. Mary Franson (GOP – Alexandria), Kathy Lohmer (GOP – Lake Elmo), and Carolyn McElfatrick (GOP – Deer River), asked several MDH officials about the cost of the newborn screening program, the cost of the lawsuit defending the Department and the cost of storing the samples.  While the MDH officials didn’t have ready answers, they promised to provide those details to the committee.    While these legislators didn’t directly speak to a bias against the program, it seems likely that they are critical.

After these questions, Rep. Tina Liebling (DFL – Rochester) stated that any financial assessments should also attempt to put a figure on the savings from treating newborns from the conditions that are diagnosed via the screen.  Rep. Tom Huntley (DFL — Duluth) noted that one legislator had a child whose condition was successfully treated because of the early diagnosis the screen provided.

While no legislation has yet been introduced that would repeal or modify the newborn screening program, this line of questioning in committee clearly signals continued interest in the program.  The MN-AAP continues to monitor closely both the pending Supreme Court case and the Legislature for developments.

Committees Continue Issue Overviews

The pace of committee hearings remained relatively sluggish with many committees continuing their work to bring members “up to speed” on the issues before them.  One month into the legislative session, very few bills have been heard by committees and even fewer have been considered by the full House or Senate.

On Tuesday the Health and Human Services Reform Committee heard two presentations on the federal Patient Protection and Affordable Care Act.  The first was from Dr. Stephen Parente of the U of M’s Carlson School of Management and the second was from Peter Nelson of the Center for the American Experiment.  Both presenters talked about the positives and negatives of the legislation and suggested alternatives including med mal reform, expanded high-risk pools and long-term care insurance.

On Thursday, the committee heard from each of the Coordinated Care Delivery System (CCDS) hospitals (HCMC, Fairview/University, North Memorial)about the lessons learned from the changes made after the termination of the GAMC program. The final portion of the hearing was devoted to an overview of Minnesota’s Community Health Centers.  Witnesses from the Minnesota Association of Community Health Centers told the committee about their successes and challenges in working with low-income and uninsured patients.

Dr. Doug Wood, the Mayo Clinic’s leading health policy spokesman, testified before the Senate HHS Committee and the House HHS Reform Committee on Wednesday.  Wood outlined the challenges facing health care consumers, employers and the state in paying for health care.  His recommendations for reform included bundled payments for major acute episodes, a single statewide insurance exchange, using the federal employee benefit plan as the basic benefit set and promoting public health spending to reduce obesity and tobacco use.

“State of the State” Scheduled for Wednesday

Governor Mark Dayton will appear before a joint session of the Minnesota Legislature on Wednesday, February 9 to present his “State of the State” address.  Dayton will outline his budget and policy priorities.  During the gubernatorial campaign, Dayton identified jobs and education funding as top priorities.  To address the budget deficit, he said he would raise taxes on upper income households, which will meet strong resistance from the Republican legislature. The Governor’s budget will be released on February 15.

Federal Court Rules Federal Reform Unconstitutional

In a significant opinion, a federal court in Florida ruled that the entirety of the federal health care reform bill (aka the “Patient Protection and Affordable Care Act,” or PPACA) passed in March 2010 unconstitutional.   While noting that many elements of the bill contained no constitutional question, Federal District Judge Roger Vinson ruled the individual mandate to buy health insurance to be unconstitutional.  Because the bill lacks a “severability clause,” he ruled the entirety of the bill to be in violation of the Constitution.  Severability clauses are a way in which the author of legislation can keep the remainder of a bill intact should a particular element be ruled unconstitutional.  To date, two federal courts have ruled that PPACA passes constitutional muster, while two courts have ruled parts of the bill to be in violation of the US Constitution.  The issue is certain to ultimately end up before the U.S. Supreme Court.

Here in Minnesota, a senior DHS official stated that the administration and department will be moving forward with state-centered changes that the ACA offers or mandates, regardless of the lower court federal ruling.  Officials in other states, including Wisconsin, have stated that they will be stopping all activity around the federal bill given the ruling.

House Bills Introduced in First Month

Below is a listing of House bills related to health care that have been introduced during the first month of session.  There are a similar number of Senate bills introduced as well.  Compared to years past the total number of bills (364 in the House) is significantly lower this year than in prior sessions.  Many believe it is because of the severe budget deficit and many new legislators waiting for the Governor’s budget recommendations to be released.  Click on the HF number to link to the text of the bill’s language.

Gottwalt; Anderson, S.; Quam and Woodard introduced:
H. F. 8, A bill for an act relating to human services; establishing the healthy Minnesota contribution program; requiring plan to redesign service delivery for lower-income MinnesotaCare enrollees; amending Minnesota Statutes 2010, section 256L.05, by adding a subdivision; proposing coding for new law in Minnesota Statutes, chapter 256L.

Bills introduced:
H. F. 11, A bill for an act relating to taxation; increasing the research credit; amending Minnesota Statutes 2010, section 290.068, subdivision 1.

Hayden; Greiling; Scalze; Murphy, M.; Laine; Paymar; Ward; Hausman; Murphy, E.; Liebling; Moran and Greene introduced:
H. F. 51, A bill for an act relating to health; guaranteeing that all necessary health care is available and affordable for every Minnesotan; establishing the Minnesota Health Plan, Minnesota Health Board, Minnesota Health Fund, Office of Health Quality and Planning, ombudsman for patient advocacy, and inspector general for the Minnesota Health Plan; authorizing rulemaking; appropriating money; amending Minnesota Statutes 2010, sections 13.3806, by adding a subdivision; 14.03, subdivisions 2, 3; 15A.0815, subdivision 2; proposing coding for new law as Minnesota Statutes, chapter 62V.

Lanning, Abeler and Hayden introduced:
H. F. 77, A bill for an act relating to human services; establishing grant programs to promote healthy communities and the development of circles of support initiatives; appropriating money.

Clark, Hayden, Huntley and Champion introduced:
H. F. 167, A bill for an act relating to public health; requiring the commissioner of health to research and report on autism; requiring the Department of Human Services to train autism service providers; requiring notification of autism service options for medical assistance and MinnesotaCare recipients; proposing coding for new law in Minnesota Statutes, chapter 256.

Hackbarth; Howes; Rukavina; Anderson, B., and Buesgens introduced:
H. F. 188, A bill for an act relating to health; providing an exemption from smoking prohibition in public places; amending Minnesota Statutes 2010, section 144.414, by adding a subdivision.

Gottwalt, Abeler, Holberg, Lohmer, Dean, Shimanski, Sanders and Banaian introduced:
H. F. 199, A bill for an act relating to health; providing a statement of public policy declaring that every resident of Minnesota has the freedom of choice in health care; amending Minnesota Statutes 2010, section 8.31, subdivision 1; proposing coding for new law in Minnesota Statutes, chapter 1; repealing Minnesota Statutes 2010, sections 256B.055, subdivision 15; 256B.0756; Laws 2010, First Special Session chapter 1, article 16, sections 6; 7; 18; 46; 47.

Gottwalt, Abeler, Lohmer, Fritz, Norton, Hayden and Brynaert introduced:
H. F. 200, A bill for an act relating to health; requiring collection and reporting of certain data related to Alzheimer’s disease; proposing coding for new law in Minnesota Statutes, chapter 144.

Gottwalt, Abeler, Mack, Torkelson and Vogel introduced:
H. F. 222, A bill for an act relating to health insurance; requiring guaranteed issue in the individual market; requiring MCHA to reinsure ceded risk on certain health plans; ending additional enrollment in MCHA; amending Minnesota Statutes 2010, sections 62A.65, subdivision 2, by adding a subdivision; 62E.10, subdivision 7; 62E.11, subdivision 1; 62E.14, subdivision 1; repealing Minnesota Statutes 2010, section 62A.65, subdivision 6.

Mack, Hayden, Gruenhagen, Quam, Davids, Gottwalt, Abeler, Huntley, Eken, Kiffmeyer, Dean, Zellers, Ward, Persell, McElfatrick, Lohmer, Barrett and McDonald introduced:
H. F. 262, A bill for an act relating to human services; adding community paramedics to the list of community health workers; amending Minnesota Statutes 2010, section 256B.0625, subdivision 49.

Urdahl; Hamilton; Gruenhagen; McElfatrick; Gunther; Westrom; Murdock; Anderson, B.; Franson; Kiel; Swedzinski; Anderson, P.; Schomacker; Vogel; Koenen; Eken; Gottwalt; Lohmer; LeMieur; Scott; Dettmer and Shimanski introduced:
H. F. 264, A bill for an act relating to civil actions; prohibiting actions against certain persons for weight gain as a result of consuming certain foods; proposing coding for new law in Minnesota Statutes, chapter 604.

Hayden and Clark introduced:
H. F. 278, A bill for an act relating to health; creating medical homes for children with autism spectrum disorders.

Peds Day at the Capitol Set for February 15

Building relationships with elected officials has never been more important.  With a state budget deficit of $6.2 billion and 60 new legislators, communicating with those who will be making the decisions at the Legislature is critical to promoting children’s health and well being. The MN-AAP’s annual “Day at the Capitol” is a terrific way to do just that.  We’ve invited key legislators and opinion makers to address the group and we’ll arrange for you to meet with your own legislators, too. This is a terrific way to add your voice to the MN-AAP chorus at the Capitol.

It’s easy, too. We’ve arranged for two sessions: the morning session orientated towards residents, the afternoon session geared toward community and faculty pediatricians. Both will present excellent opportunities to learn about the issues we’re following and to add your voice. Join us for either one… or both!

Register today for this important event!

Early Medicaid Enrollment Gets Boost

Governor Mark Dayton made news earlier this week with his announcement that the “early Medicaid” expansion would begin by March 1, rather than the October date projected by outgoing Pawlenty administration officials.  With the Governor’s authorization earlier this month, up to 95,000 individuals will be eligible for the joint state-federal program, replacing the state’s General Assistance Medical Care (GAMC) program and expanding care for others presently covered under MinnesotaCare.

The changes were made possible by the federal health care reforms passed in 2010 and were the subject of much debate during last year’s legislative session and gubernatorial campaign.  One day after taking office earlier this month, Governor Dayton signed the executive order making the expansion possible.  The governor and DFL legislators were highly critical of earlier statements by DHS officials that the expansion would take up to 10 months to complete.

Starting March 1, GAMC enrollees will automatically be enrolled and will receive MA benefits. New applicants who are eligible for MA can enroll starting March 1. MinnesotaCare enrollees will transition to MA over a period of six months but will be eligible for MA benefits beginning March 1 and coverage will be retroactive. Current GAMC and MinnesotaCare enrollees will receive information from the Department of Human Services (DHS) about the expansion and any actions they need to take. Information will also be available on the department’s website.

According to the department, the state cost of MA early expansion is equivalent to the current cost of providing coverage to GAMC and MinnesotaCare enrollees who will shift to MA.

In related action, Senator David Hann (R – Eden Prairie) introduced SF 33, a bill that would roll back the early Medicaid enrollment and declare that every resident of Minnesota has the “freedom of choice” in health care.  The bill, the text of which is available here, has been scheduled for a hearing next week, though no companion has been introduced in the House.  Governor Dayton has stated that he will veto any attempt to undo the state’s participation and, in fact, participated in a press event this week with U.S. Health and Human Services Secretary Kathleen Sebelius singing the program’s praises.

Governor Announces DHS Appointment

Gov. Dayton announced his pick of Hamline University Law Professor Lucinda Jesson to direct the largest agency in state government, the Department of Human Services.  This position has been highly anticipated as it is expected that the HHS budget will be the main target for budget cuts by the Legislature.

Jesson is a former prosecutor and a deputy attorney general under former A.G. Skip Humphrey.  She also served on the Dayton transition team. Jesson, who directed Hamline’s Health Law Institute, will have one of the toughest jobs in state government.  With health care costs growing more rapidly than other portions of state government and subsidized health programs a top target of the new majorities in the Legislature looking to erase a $6.2 billion projected budget deficit, the task at HHS is daunting.

The commissioner has since announced that Anne Barry, the DHS Chief Compliance Officer, will be the new Deputy Commissioner.

Several individuals familiar to the pediatric community were named to key positions, including Scott Leitz.  Leitz worked on health care reform for the Department of Health and served most recently as the director of public policy for Childrens Hospitals and Clinics; he will be assistant commissioner and will lead all the divisions currently under the Medicaid director and the assistant commissioner of health care.

Lauren Gilchrist, daughter of Dr. Gerald Gilchrest, a pediatrician and member of the MN-AAP Policy Committee, has been appointed the assistant commissioner for health policy and reform. A former senior health policy advisor to Sen. Al Franken and a health policy fellow to Sen. Edward Kennedy, Gilchrist will spearhead the agency’s efforts to implement health reform, coordinating across DHS with the Departments of Commerce and Health.  Additionally, Maureen O’Connell, a legal advocate, will be the new assistant commissioner for the Chemical and Mental Health Services Administration.

Legislative Committees Begin to Craft Budget, Continue Overviews

Republican leaders in the Senate and House announced the start of their budget balancing work with bills that make Governor Pawlenty’s unallottment reductions permanent.  In total there would be $840 million in one-time spending cuts permanent. These include $584 million in cuts to tax aids and credits (primarily to local governments); $185 million to higher education; and $72 million to various health and human services programs.  Minnesota Management and Budget (MMB) is also to identify $200 million in savings that could be achieved by capturing unspent funds in agencies’ budgets.

Hearings on these cuts to health and human services programming were held in the House Health and Human Services Committee this week and proved to be contentious.  The HHS cuts, found in HF 128 available here, permanently extend the 2010 cuts to basic care programs (though not physician reimbursements).  Programs for low-income Minnesotans, such as General Assistance and Supplemental Aid Grants as well as Child Support Enforcement Grants to counties, would also see cuts.  Committee DFLers voiced significant opposition to the cuts, though efforts to stop the bill failed on party-line votes.  Republicans, including the Chair, stated that these cuts were identical to those ratified by the DFL controlled legislature at the end of the 2010 session.

While new bills continue to be introduced in the legislature (already totaling slightly more than 260 in both bodies), the majority of the committee actions thus far have been informational in nature.  All of the health care committees have taken testimony from various agency and department officials, non-partisan legislative staff, and a number of interest groups.  With so many new members on all committees, the chairs are using these first weeks to bring their members ‘up to speed’ on the issues before them.

Chairman Gottwalt Introduces Plan to Change MinnesotaCare

Rep. Steve Gottwalt (R – Saint Cloud), chair of the House Health and Human Services Reform Committee, introduced HF 8, a bill to shift a significant portion of MinnesotaCare enrollees to private insurance.

His bill, available here, would provide subsidies to eligible adults without children with incomes above 133% of the federal poverty level to purchase individual, private insurance in place of MinnesotaCare.  Subsidy levels are determined on a sliding scale based on age and income.  Those individuals denied care in the private market would receive a slightly higher subsidy to seek coverage from the Minnesota Comprehensive Health Association (MCHA), Minnesota’s high-risk insurance pool.

Rep. Gottwalt notes that under his proposal, physicians and hospitals would receive the significantly higher reimbursement rates of private payers, rather than the low Medicaid rates.  Fiscal notes prepared by non-partisan staff for earlier, similar proposals have suggested that the bill would save over $100 million over a biennium.  Critics have countered that the savings would largely come from individuals being unable to navigate the private market and dropping coverage.

The bill received its first hearing in the House Health and Human Services Reform Committee this week.  Committee DFLers expressed some interest in the plan, though voiced concern about whether the plan would allow some lower income individuals to lose their care entirely due to the complexities found in the private insurance market as well as the hurdles of a high-deductible burden.  Democrats were rebuffed in their efforts to amend the bill with a requirement that the private insurance products provide mental health coverage.  Also defeated were amendments that would mandate that individuals denied coverage be referred to MCHA (though that option remains for those denied), as well as limits on the cost of premiums and deductibles.  The bill passed committee on a voice vote and was referred to the House Commerce Committee.

The bill’s companion is being carried by Senator David Hann and is set to receive its first Senate hearing in his committee next week.

Federal Conformity Dependent Coverage Health Care Reform Act (SF 47/HF 79)

Employees will not have to pay state taxes on the value of health insurance for dependents and adult children up to age 26 (permitted under the Federal Health Care Reform bill) for tax year 2010 under a provision that passed in House and Senate tax committees this week.  Both private employers and public employers were hoping that the bill would have also passed this federal conformity for 2011 and beyond as it creates administrative hurdles to value and withhold the appropriate state taxes for this benefit for certain employees with dependent coverage.  The Senate tax committee chair, Senator Julianne Ortman (R – Chanhassen), hopes to take up the issue for tax year 2011 and beyond within the next 30 days.  Unfortunately, this issue has gotten tangled up in whether or not a legislator supports the “ObamaCare” bill.  There were several new members who were concerned that supporting the federal conformity act may be confused with support of the Federal reform bill.

House HHS Finance Work Groups Formed

House HHS Finance Committee Chairman Jim Abeler (R – Anoka) and House HHS Reform Committee Chairman Steve Gottwalt this week announced the formation of 8 study groups intended to review issues and develop reform proposals.  It’s unclear what role the public will have with these work groups and whether their meetings will be open to the public.  The groups and their members are:

• Welfare (Reps. Lanning & Hayden)
• Child Care (Reps. Franson, Peterson & Slawik)
• Hospitals (Reps. Kiffmeyer, Murphy, Norton & Benson)
• Health Care and Dental (Reps. McDonald, McElfatrick and Gruenhagen, Huntley & Laine)
• Mental Health and CD (Reps. Barrett & Diane Anderson)
• Waivers (Reps. Lohmer, Mack, Hosch & Loeffler)
• Long Term Care (Reps. Hamilton & Schomacker)
• MDH, Rural Health & Public Health (Reps. Quam & Huntley)

Talk of a Government Shutdown?

The House Health and Human Services Finance Committee on Thursday received testimony from senior Minnesota Management and Budget staff about the process for shutting down state agencies.  The staff described the steps taken in 2001 to prepare for a shutdown, which was averted, and in 2005, when some state agencies were closed for 8 days.  In both cases, “critical life, health, safety and life functions” were ordered to be maintained.  Partisan tempers flared when DFLers questioned whether the hearing was a signal the Republican majority wasn’t serious about completing its work on time, while Republicans, including Committee Chairman Jim Abeler, noted that the value of the briefing was to prod legislators to complete their work to avoid the trauma and disruption of a shutdown.

Health Insurance Exchange Federal Funding Sought

In a reversal from former Governor Pawlenty, the Dayton administration has announced that it will seek a $1 million federal grant to begin the work of developing a state health insurance exchange.  Under Governor Pawlenty, Minnesota had previously declined the opportunity to seek the grant.  The move was announced after Governor Dayton held discussions with U.S. Health and Human Services Secretary Kathleen Sebelius.  Federal officials have indicated that the state will receive the funding by March 1.

State of the State and Budget Plan Dates

Governor Dayton will deliver his “State of the State” address February 9. He also announced that his budget will be released on February 15th. State law requires the governor to present his budget plan by the 15th and Dayton announced that he is using the entire time to put his budget together.   With the delay in the election results, the announcement did not come as a surprise.

And they’re off…

On Monday January 3, former U.S. Senator Mark Dayton was sworn in as Minnesota’s 40th governor.  Governor Dayton is the first DFLer to hold the office since Rudy Perpich’s term ended in 1991.  Gov. Dayton was sworn in along with the state’s other Constitutional officers, Attorney General Lori Swanson, Secretary of State Mark Riche, and State Auditor Rebecca Otto.

The 2011 Minnesota Legislative Session kicked off on Tuesday, January 4, 2011, ushering in historic changes.  For the first time since Senate candidates began running under partisan labels, the Minnesota Senate will now be controlled by the Republicans.  The Minnesota House of Representatives also returned to GOP control for the first time since 2006.  The incoming Senate Majority Leader is Senator Amy Koch (R; Buffalo) and the new Speaker of the House is Representative Kurt Zellers (R; Maple Grove).  Of the 201 legislators, 60 are newly elected, a remarkably high percentage.

For the first time in Minnesota’s history, we have a new Speaker of the House, a new Majority Leader of the Senate, and a new Governor, all in the same year.

With the change in partisan control of both the House and Senate, much has changed with both the structure and composition of House and Senate committees.  Both bodies saw the number of committees shrink dramatically, most notably in the Senate.  The Senate Health and Human Services Committee is to be chaired by Senator David Hann (R; Eden Prairie), while health care jurisdiction in the House will be shared by Rep. Jim Abeler (R; Anoka) who will handle HHS Finance, and Rep. Steve Gottwalt (R; St. Cloud), the new chairman of the HHS Reform Committee.

Peds Day at the Capitol Set for February 15

Building relationships with elected officials has never been more important.  With a state budget deficit of $6.2 billion and 60 new legislators, communicating with those who will be making the decisions at the Legislature is critical to promoting children’s health and well being.  MN-AAP’s annual “Day at the Capitol” is a terrific way to do just that.  We’ve invited key legislators and opinion makers to address the group and we’ll arrange for you to meet with your own legislators, too.  This is a terrific way to add your voice to the MN-AAP chorus at the Capitol.

Mark your calendars for February 15 and plan to join us for this important event.  Stay tuned for additional details very soon!

Early Medicaid Enrollment

The biggest health care news of the week was Governor Dayton’s signature on an executive order that will usher in significant changes in the number of low income Minnesotans eligible for the state’s Medicaid program, known as Medical Assistance (MA).   With the Governor’s authorization, up to 95,000 individuals will be eligible for the joint state-federal program, replacing the state’s General Assistance Medical Care (GAMC) program and expanding care for others presently covered under MinnesotaCare.

The changes were made possible by the federal health care reforms passed in 2010, and were the subject of much debate during both last year’s legislative session and gubernatorial campaign.  Former Governor Pawlenty opposed the expansion, arguing that it was too expensive to the state and that the future of the program is in doubt due to growing federal debt.  Governor Dayton was committed to the expansion, noting that it would add significant federal investment into health care presently being paid for with state dollars only, while also expanding health care coverage.  It is unclear when the new program will be operational, and some officials at the Department of Human Services have suggested it could take up to nine months to begin enrollment.  Governor Dayton and some legislative leaders have responded that such a lengthy delay is unacceptable.

The Governor’s announcement of the expansion made for fascinating political theater at the Capitol as the Governor’s office was packed with both supporters and opponents of the move.  Saying that the Governor’s reception room was “the people’s room,” Governor Dayton invited both proponents and opponents to speak to the crowd and media before signing the order to both cheers and jeers.

New Physician Commissioner at MN Department of Health

Ed Ehlinger, MD, MSPH, a pediatrician and internist, has been appointed commissioner of the Minnesota Department of Health (MDH) by Gov. Mark Dayton.  Ehlinger has been the director and chief medical officer of the University of Minnesota’s Boyton Health Service since 1995 and spent 15 years working for MDH prior to his time at the University of Minnesota.  Additionally, he is the immediate past president of the Twin Cities Medical Society and has served as chair of the MMA’s public health committee.  With the Commissioner of Health serving as the state’s chief public health officer, it is good to see a physician in that role.  Ehlinger replaces Sanne Magnan, MD.

Joint HHS Finance and HHS Reform Meeting

The committees got to work quickly with a joint meeting of the two House health care committees holding a four-hour informational hearing on Wednesday January 5.  This hearing was the first of many for the many new members of the House.  Representatives from the Department of Human Services provided an overview of the DHS budget, highlighting where most of the money is spent.  The challenge before the legislature is that nearly 30 percent of the state’s budget is spent in the HHS area and most of that is spent on nursing homes and the disabled.

Upcoming weeks

Given the 60 new members of the Legislature, many predict a slow start to the session as new committee chairs craft their agendas and become acclimated to their new roles.  Many committees will continue to meet to offer informational hearings to new members and staff prior to beginning hearings on bills.  That said, a number of significant proposals are likely to come forward soon, including education reform and new budgeting proposals.

Legislative Contacts

For those of you that want to more closely follow the actions of the Minnesota Legislature please find below links to the Legislature’s website.  There are committee schedules, weekly newsletters, contact information for legislators, and a “Legislative Finder” to help you find out who your legislator is.

Minnesota Senate

Minnesota House

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)

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.