Friday, March 6, 2015
Push for Prior Authorization Reform Continues
There is growing momentum to pass legislation to reduce medication delays, disruptions, and confusion for patients at the State Capitol. The bills,HF 1060 and SF 934 were introduced on February 19 by chief authors Rep. Tony Albright (R – Prior Lake and Sen. Melisa Franzen(DFL – Edina). The MAFP recently joined the MMA-led coalition to pass the bills, a coalition that also includes the Minnesota Chapter of the American Academy of Pediatrics (MNAAP), the Minnesota Orthopaedics Society (MOS), Minnesota HealthCare Network, and Midwest Independent Practice Association and more importantly many patient-related groups. There are now more than 30 patient advocate, physician, and provider organizations supporting the bill. Three additional members of the House have also signed on as cosponsors of the bill, including Rep. Jennifer Schultz (DFL – Duluth), Rep. Leon Lillie (DFL – North St. Paul) and Rep. Mark Uglem (R – Champlin).
The bills have a number of important patient disclosures and protections, including requirements to improve patient understanding and comparisons of insurance plans’ medication coverage and out-of-pocket costs for covered drugs. The bill also limits health plans from changing formulary and coverage levels during health plan’s enrollment period and requires them to provide a medication transition period for patients who change insurance plans or policies. And finally, the most controversial part of the bill bars prior authorization for drugs that are included on a health plan’s formulary, turning PA into a retrospective, quality assurance process.
The bills have drawn significant, vocal opposition from both health plans and pharmaceutical benefit managers (PBMs). Opponents have argued that reform of prior authorization will lead to greater costs and risks to patient safety, arguing that PA serves as a check against physician error in prescribing.
To pass the bill essddwill require grassroots advocacy on the part of physicians. Legislators need to hear that the current prior authorization is hurting patient care and adding costs. The MAFP sent out an action alert to members last week asking for legislative contacts. There is also a link to an alert that can be found on the MMA’s website here. This has talking points for you to use and will help you send an email directly to your legislators.
The MMA also has started a new website – www.fixPAnow.org - that offers a complete list of coalition members and the latest news on the effort to reform prior authorization. It also includes stories from physicians and patients on the problems caused by PA.
State Forecast Shows Larger Budget Surplus
Minnesota Management and Budget (MMB) announced on February 27 the newestbudget forecast for the upcoming biennium, and the news was good. The February forecast showed a projected surplus of $478 million in the current biennium and growing to $1.87 billion in the 2016-2017 biennium. The most recent forecast shows the state’s surplus growing $832 million from the last forecast announced in December 2014. The improved forecast can be attributed to both greater than anticipated revenue, as well as lower than expected state spending, particularly in K-12 education.
The budget’s good news continued in the latest projections for the Health Care Access Fund (HCAF). Due to increased revenue from federal sources, a budget that had been anticipated to have a $62 million deficit as soon as 2017 has now improved to show surplus dollars until 2019 when the fund is projected to be in balance. The projected surplus in 2017 is expected to reach $13 million, a figure not large enough to trigger an automatic reduction in the provider tax. The provider tax remains on track to be repealed on December 31, 2019.
Physician's Interstate Compact Clears Last Senate Policy Committee
Continuing its steady march through the Senate committee process, the Interstate Medical Licensure Compact passed out of the Senate Judiciary Committee on February 24. Because the bill has some small costs to the Board of Medical Practice, the bill has now been referred to the Senate Finance Committee.
Under the bill, SF 253, sponsored by Sen. Kathy Sheran (DFL - Mankato), Minnesota would participate in a newly created interstate compact that would expedite the process by which physicians who practice in multiple states can be licensed. Completely voluntarly for physicians, the licensing would still be done by state medical boards in the state the physician chose to be licensed, but the commission established under the bill would serve as a clearinghouse that would ease the burden of seeking licensure in multiple states. The commission only becomes functional once passed by at least seven states. Identical bills have now been introduced in 15 state legislatures across the country. The bill has passed legislative bodies in other states, including the unanimous passage of the bill in Utah.
The bill has seen little organized opposition thus far and has been very well received by legislators. Supporters have thus far included the Board of Medical Practice, the Minnesota Hospital Association, Mayo Clinic, Allina Health, Sanford Health, and Gundersen Health. The House bill, HF 321, is authored by Rep. Tara Mack (R - Apple Valley). The bill is tentatively scheduled for its first hearing in the House on March 11.
Advance Planning Promotion Bill Heard in Finance Committee
Two related bills to fund promotion of advanced planning directives were heard in the Senate Health & Human Services Finance Division on February 25. The bills,SF 407 and SF 410, were held over by the committee for possible inclusion in the Omnibus HHS Finance Bill, a package that will be crafted in the coming weeks.
The Twin Cities Medical Society (TCMS) has been the chief proponents of the legislation. Testifying in support of the bills were two physicians, Ken Kephart, MD, MAFP Past-President, and Chris Johnson, MD, and emergency physician. Dr. Kephart spoke of his interactions with elderly patients who are released from hospitals and who struggle to have conversations with their care givers and their family about the next health care decisions. Dr. Johnson recounted tales of both heartbreak and careful planning that he has witnessed with the patients he has treated. The MAFP supports these bills.
SF 410 establishes a grant system to local nonprofit organizations and public health boards to promote awareness of advance care planning, encourage and assist families to have discussions about end-of-life matters, and promote availability and awareness of resources. The bill states that such efforts must be based upon best practices, address cultural differences and racial disparities, and based upon community input, needs, and values. Administered by the Minnesota Department of Health (MDH), the grants would be distributed by October 1, 2015. SF 407 provides a grant to a statewide organization to help coordinate the efforts of the local organizations and provide technical assistance.
The House bills, HF 970 and HF 971, are authored by Rep. Joe Schomacker (R - Luverne), and are awaiting their first hearings.
Reproductive Health the Focus of Several Bills
A series of bills related to reproductive health choices and abortion were heard in the House Health & Human Service Reform Committee on March 4, 2015. The first bill,HF 606 (Rep. Kiel - R, Crookston), would require all clinics that performed ten or more abortions per month would be subject to the same regulatory framework as ambulatory surgery centers (ASCs). The primary proponent of the bill is Minnesota Citizens Concerned for Life (MCCL). They have argued that abortion is a dangerous procedure and that the additional measures required for ASCs are necessary.
Opponents responded that abortion procedures are statistically very safe when done in physician clinics, and that the real goal of the bill is to close abortion facilities. Under current law, medical clinics are not licensed, regardless of the type of care they provide. The MMA submitted a letter to the committee stating that the bill singles out a single procedure for additional regulation and noting that the physicians and nurses who practice in these facilities are licensed and regulated by the BMP and other health licensing boards. The bill was passed and referred to the Government Operations and Election Policy Committee.
A similar bill was also vetoed by Governor Dayton in 2012.
Two other abortion-related bills were also considered and passed— HF 607, a bill that would bar all state funding for abortion procedures, and HF 1047, a bill that created new civil and disciplinary actions for death or injury to a live infant born as a result of an abortion. HF 734, a bill that would require a physician to be physically present when a patient was given abortion-inducing drugs, was set to be heard but was removed from the agenda at the last minute.
It’s highly unlikely that any of the bills will be heard in the Senate.
Also moving in the House is HF 437, a bill to establish a legislative commission on surrogacy and gestational carriers. The commission would study the issues surrounding surrogacy and gestational carriers. The bill was brought forward by the Minnesota Catholic Conference and the Minnesota Family Council. At the urging of the MMA and others, the original bill was modified significantly by removing language that was seen as heavily biased against surrogacy. The bill was passed and referred to the Government Operations Committee. The Senate companion bill was heard last month but was tabled before final action.
Still Time to Come to Day at the Capitol March 11
It’s not too late to make plans to join your physician colleagues for the annual MMA Day at the Capitol set for March 11. The MAFP is a partner with this day. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from Sen. Melisa Franzen (DFL – Edina), and review of legislative talking points, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.
With most of the Capitol closed to the public due to construction, our 2015 Day at the Capitol will be a little different than years past. This year we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders (including the Senate author of the prior authorization reform bill) and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.
The “White Coats Day” at the Capitol is a key piece of the advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.