Friday, February 6, 2015
Governor Unveils Budget Proposal
On January 26, Governor Dayton unveiled his budget proposal for funding the state’s operations for the next two years. This is the first step in legislative action to adopt a biennial budget before adjourning in May.
His proposal calls for $42 billion in spending for the next two years. This becomes a starting point as legislators in the House and Senate begin developing their own proposals following the next spending forecast that will be announced in early March. The budget projections released in December showed the state anticipating a budget surplus of more than $1 billion. Many are hoping the March forecast will show an even larger surplus.
The Governor’s budget recommendations related to health and human service programming did not include many major changes, though many in the health care community applauded the Governor’s increased spending on mental health programs. Included in his recommendations are proposals to expand early childhood mental health consultation resources, to support programming to build capacity to address adverse childhood experiences, and new funding for an additional four residency slots focused upon providing psychiatric care in the public sector.
While the Governor invested in mental health workforce, notably absent in his budget package was funding for other health care workforce needs through loan forgiveness programs for health professionals who choose to practice in rural and underserved urban areas. Such programs have received much bipartisan, bicameral support from legislators, particularly from Senate DFL leadership who have made loan forgiveness a central priority for 2015. Also missing from his budget is funding to reinstate the increase in primary care MA payments that was mandated in the ACA for two years.
On a positive note, the bill does not contain any changes to the scheduled repeal of the provider tax on December 31, 2019. To maintain balance in the Health Care Access Fund, the budget calls for small increases in premiums and cost-sharing for some MinnesotaCare enrollees.
Other notable health care-related provisions contained in the Governor’s budget proposal include:
- A $30 million investment in the University of Minnesota, School of Medical. The extra resources are intended to fund an additional 50 researchers in a bid to improve the U’s national standing and attract more NIH funding.
- Increased focus upon opioid prescribing in the Medical Assistance program. Within the budget proposal is increased funding intended to assist DHS in crafting opioid prescribing protocols in conjunction with stakeholders such as prescribers, emergency departments, Minnesota Community Measurement, ICSI, and others.
- Earmarked funding to MDH to offset additional costs to the department in the wake of the rise of Ebola. During the height of the international epidemic of the disease last summer, MDH established a hotline to field calls from providers, established a surveillance system for those who traveled to affected areas, and developed educational materials for practitioners and the public.
Finance committees in the House and Senate spent much of the last two weeks reviewing the proposal in close detail and hearing testimony from agency heads and the public. Both the House Health & Human Services Finance Committee and the Senate Health & Human Services Finance Division reviewed the budget proposal for the Department of Human Services (DHS) and Minnesota Department of Health (MDH) over the course of multiple hearings.
Will Nicholson, MD, chair of the MAFP Legislative Committee, testified on the budget proposal on behalf of both MAFP and the MMA in the Senate committee. Dr. Nicholson spoke in support of the Governor's call for increased resources in mental health, though asked that legislators not lose focus on critical investments in the health care system, notably loan forgiveness for physicians and an extension of the Medical Assistance primary care payment increase that ended last year.
Loan Forgiveness Bill Clears First Committees
Bills to expand loan forgiveness for health professionals cleared their first committee stops in both the House and Senate last week.SF 3 , authored by Sen. Greg Clausen (DFL – Apple Valley) and HF 211, authored by Rep. Debra Kiel (R – Crookston) were heard in their respective bodies’ HHS policy committees, passed, and were re-referred to the committees with jurisdiction on higher education.
Neither bill has yet indicated the amount of additional funding at this point in the budget process, though Sen. Clausen has spoken of doubling the funding for loan forgiveness to $3 million per biennium. In additional to increased funding, the bills also expand the types of professions that would be eligible for loan forgiveness, from physicians, APRNs, pharmacists and dentists to include public health nurses, mental health professionals, and dental therapists. Other professions have been actively lobbying for inclusion, including physical therapists and acupuncturists. Many advocates have countered that the limited resources available under the program should be reserved for those professions that are most impactful on a communities’ health, particularly through additional support for primary care physicians.
Right to Try Act Passes First Committee Hurdle
A bill that would give terminal patients access to drugs, devices, or biological products that have cleared phase-one of FDA clinical trials, but have not received final FDA approval, passed its first committee stop on February 2. The bill,SF 100, authored by Sen. Brandon Petersen (R - Andover), passed the Senate HHS policy committee on a unanimous voice vote and was referred to the Senate Judiciary Committee. The House companion, carried by Rep. Nick Zerwas (R - Elk River), has not yet been scheduled for a hearing.
The bill's language is similar to legislation passed in several other states, including Arizona, Colorado, Louisiana, Michigan and Missouri. Under the bill, patients with a terminal condition who would be eligible to receive drugs, devices, or products that have cleared phase-one FDA trials but have not yet been made available to the public. Importantly, at the urging of the MMA, the bill's author amended his bill to provide for liability protection for physicians who recommend or prescribe these pre-market drugs. The Senate author is expected to amend his bill to provide additional clarity around the definition of “terminal.”
Physical Education in Schools
Legislation to emphasize physical education in schools received its first hearing in a Senate Committee on January 29. The bill,SF 343, sponsored by Sen. Susan Kent (DFL – Woodbury), was heard in the E-12 Education Finance Division and held over for possible inclusion in an omnibus bill later in the legislative session. The House companion is authored by Rep. Bob Dettmer (R – Forest Lake).
Under Senator Kent’s bill, schools would be required to adopt new grade-specific benchmarks for physical education as defined by the most recent National Association of Sport and Physical Education beginning in the 2017-2018 school year. The bill further requires minimums of both elective and mandatory physical education credits starting in ninth grade. In an effort to assess students’ level of fitness, the bill requires school districts and charter schools to conduct annual assessments of students to determine the attainment of physical education learning objectives. The bill also prohibits a school from withholding recess time from a student as a means of discipline.
The bill’s chief proponent is the American Heart Association, and is supported by the Minnesotans for Healthy Kids Coalition. Testifying with concerns about the costs of implementing the mandates and assessments were representatives from the Minnesota School Boards Association and the Minnesota Rural Education Association.
Bill Proposes Tighter Immunization Exemption Requirements
A bill designed to reduce the number of parents who forgo required immunizations for their children was introduced on January 29.SF 380, authored by Rep. Mike Freiburg (DFL – Golden Valley) and Sen. Chris Eaton (DFL – Brooklyn Center) received significant media attention in light of the recent measles outbreak.
Under current law, school-age children are prohibited from attending school unless a parent opts out of the required immunization schedule by submitting a notarized statement certifying the parent’s “conscientiously held beliefs” against vaccines. The bill would change the exemption process and add a requirement that a parent submit “certificate of exemption” declaring the parent declines immunizations based on personal beliefs. The certificate must include a statement from a physician noting that the physician has reviewed with the parent the risks and benefits of immunizations.
The bill may face a difficult path in the Minnesota House of Representatives, where there is some skepticism of vaccine safety, as well as opposition to government mandates on parents.
Advanced Planning Bills Introduced, Heard in Committee
A move to support a statewide effort to encourage families to have conversations about advance planning for end-of-life decisions was introduced and advanced through its first committee stop in the Senate HHS Policy Committee. Two bills, both authored by Sen. Kathy Sheran (DFL - Mankato), with bipartisan coauthors, were heard on Feb. 4. The House companions are expected to be introduced soon.
SF 407 directs the Commissioner of Health to make grants to local community groups to increase awareness of advance planning among individuals, families, care-givers, and health care providers, and SF 410 provides a grant to a statewide group to help coordinate the efforts. The intent of the bills is to encourage and assist individuals to have conversations about end-of-life care and use tools such as living wills and health care directives to make their wishes known.
Though not explicitly named, one of the leading candidates to receive resources under the bill is Honoring Choices Minnesota, a pioneering effort to increase participation in advance planning discussions led by Twin Cities Medical Society (TCMS).
Testifying in support of both bills were Ken Kephart, MD, President of the Twin Cities Medical Society and past president of MAFP, and Greg Kutcher, MD, a family physician with the Mayo Health System.
Both bills passed with bipartisan support and were referred to the HHS Finance Division.
MAFP Partners with MMA for Day at the Capitol, March 11
The MAFP strongly encourages all members to make plans to join physicians from around the state for the annual MMA Day at the Capitol set for March 11, 2015. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and your patients. It is a great opportunity for you to directly engage with your personal legislators on the issues facing organized medicine. Following presentation from key legislative leaders, 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, the 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 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 MMA’s 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.