Friday, January 23, 2015
The Minnesota Legislature has just completed its second, full week of session and things are still moving relatively slowly. Many committees are holding “overview” hearings to ensure all members understand the basic issues. This is especially true in the House where many members and every committee chair are new.
Money for Loan Forgiveness Programs a Priority of Senate Leadership
One way to determine the priority issues for the party in control is to look at the first five bills they introduce each year. This yearSF 3, introduced by Sen. Greg Clausen (DFL-Apple Valley), expands Minnesota’s loan forgiveness programs for physicians and other health care practitioners willing to practice in rural Minnesota. In a positive sign for the bill’s likelihood of passage, the House companion to the Sen. Clausen bill will be carried by Rep. Deb Kiel (R-Crookston) via HF 211. The funding level of the bills will be set later in session once the budget picture becomes clearer.
Current loan forgiveness programs are administered through the Office of Rural Health within the Minnesota Health Department. They provide up to $25,000 of loan forgiveness each year for up to four years. Department analysis shows these programs are effective in recruiting physicians to rural areas. For physicians who have participated in the programs, 88% are still in rural settings after 10 years, and nearly 75% after 20 years.
When the program was first started in 1992, it funded between eight to ten new physicians each year. Since new types of providers have been added to the program (nurses, pharmacists, dentists, long term care workers, etc.), and following cuts to the program funding in 2011, it now funds one to two physicians each year.
Sen. Clausen also serves as Co-chair of the Legislative Health Care Workforce Commission that released a report on December 31, 2014 calling for a number of short-term and long-term recommendations to address our looming workforce shortages. One of their recommendations is to expand loan forgiveness funding. In addition, the Governor’s Blue Ribbon Commission on the University of Minnesota Medical School also released a series of report this week that includes more funding for physician loan forgiveness.
Current health care worker loan forgiveness programs are funded by the Health Care Access Fund, which is funded by the 2% provider tax.
Governor Calls for Investment in UM Medical School
On Wednesday, Governor Mark Dayton laid out a small part of his biennial budget proposal that will be announced fully on Tuesday. He called for increased investment in the University of Minnesota Medical School. At an event held at the University and surrounded by medical students, Dayton unveiled a plan to increase funding to the medical school by $30 million over the next two years. The additional funds are intended to hire 50 additional research faculty members over the next eight years.
In making his announcement, Governor Dayton said that the renewed investment came about partly because of the drop in NIH funding that the school has received, a decrease that some blame on the loss of research faculty. This sets up the continued debate over whether the medical school should focus more on research or on meeting our health care workforce needs.
Interstate Medical Licensure Bill Introduced
A bill intended to expedite the licensure process for physicians who wish to practice in multiple states was introduced in both the House and Senate on January 22. HF321/SF 253, known as the Interstate Medical Licensure Compact, is authored by the chairs of the House and Senate HHS policy committees, Rep. Tara Mack (R-Apple Valley) and Sen. Kathy Sheran (DFL-Mankato).
A compact is a mechanism established under the US Constitution that allows multiple states to enter into agreements with one another. The Interstate Medical Licensure Compact, developed by the Federation of State Medical Boards (FMSB), would serve to lower the burdens associated with obtaining licensure in multiple states by expediting the process of licensure. The bill creates another pathway for licensure while not otherwise changing a state’s existing medical practice act. Under the compact, a physician in good standing with his/her own state’s medical practice board, who wishes to be licensed in more than one state, will be able to use a compact-established commission to seek licensure in another compact state. The compact maintains the state’s authority to regulate and discipline physicians in the location where the patient is treated. The process is entirely voluntary. Should a physician wish to be licensed in additional states through traditional means, they do not need to use the new commission.
So far we know of no public opposition to the proposal. The MMA is leading the effort on this bill with support from the Minnesota Hospital Association and other clinic/hospitals systems including Mayo Clinic, Sanford Health, Allina, and Gundersen Lutheran. Minnesota’s Board of Medical Practice has also voted to support the bills.
The proposed compact will not become effective until at least seven states enact the bill. Officials with the FMSB are aware of efforts underway in at least 11 states, including Minnesota, and the physician licensing boards in 23 states have expressed their support, as have a number of national specialty societies.
In addition to Sen. Sheran, Senate co-authors of the two bills include Senators Carla Nelson (R-Rochester), Jeff Hayden (DFL-Minneapolis), Tony Lourey (DFL-Kerrick), and Julie Rosen (R-Fairmont). House co-authors are Representatives Tina Liebling (DFL-Rochester), Matt Dean (R-Dellwood), Nick Zerwas (R-Elk River), and Diane Loeffler (DFL-Minneapolis).
Legislators Propose MNSure Changes
Legislators from both parties are proposing changes to MNSure, the state's health insurance exchange. Their proposed fixes, however, vary dramatically. With divided control of the legislature, neither proposal is likely to advance as introduced.
Authored by Health & Human Services Reform Committee Chair Rep. Tara Mack (R-Apple Valley), House Republicans have introduced a bill, HF 5, that would direct the state to seek a waiver from the federal government to allow consumers to use federal tax credits for all insurance products purchased, not just those purchased from within the exchange, as is currently prescribed under state and federal law. Rep. Mack’s bill also caps the salary of the MNSure director at the same level as that of the Governor’s cabinet. The bill does not have a Senate companion at this time.
The Senate Democrats have introduced a competing proposal. Under SF 139, authored by Sen. Tony Lourey (DFL-Kerrick), MNSure would be made a cabinet level position under the appointment authority of the Governor, rather than its current structure as an independent entity. The change, Senator Lourey argues, would serve to make MNSure more accountable to the public by placing the position under the direct purview of an elected official. Like the proposal put forward by House Republicans, Sen. Lourey’s bill also caps the salary of the MNSure director at the level of other cabinet positions.
Other proposals related to MNSure include SF 187, introduced by Sen. Paul Gazelka, (R-Nisswa), a bill to add representatives of the insurance industry to the MNSure Board of Directors. The current law disallows those affiliated with insurance carriers from serving on the governing board of the insurance exchange. Sen. Julie Rosen (R-Fairmont) has also introduced a bill that would bar the use of any funds from the Health Care Access Fund for any MNSure purposes except administrative work regarding the MinnesotaCare program. Senator Rosen’s legislation also changes the advisory board to include health care practitioners and health plan representatives, as well as requiring greater disclosure of the premium rates of health plans participating in the exchange.
Mental Health Workforce Plan Announced
An esteemed panel of mental health professionals and advocates unveiled a package of important investments and changes in the state’s programming for mental health services. The 36-member group, which included officials from the National Alliance on Mental Illness (NAMI), the Minnesota Department of Health, physicians, nurses, social workers, psychologists, child psychiatrists, and researchers was formed following the passage of legislation authored by Sen. Greg Clausen (DFL-Apple Valley) in 2013. The Minnesota State Colleges and Universities system was tasked with crafting the report.
The group’s report focused on five key categories: 1) recruitment of individuals to fill the need for a strong mental health workforce, 2) education and training of existing mental health professionals, 3) placement of professionals after program completion, including more robust loan forgiveness programs for those who choose to practice in underserved areas, 4) retention of professionals in the workforce, including a recommendation of an increase in reimbursement rates and 5) ongoing assessment of the mental health workforce. The report includes a number of recommendations to ensure that the state’s mental health system is culturally diverse and appropriate. Minnesota, the report noted, is below the US average for the number for both psychiatrists and child and adolescent psychiatrists.
In a related action, the Senate Judiciary Committee heard testimony on a bill sponsored by Sen. Barb Goodwin (DFL-Columbia Heights). The bill, SF 141, establishes a grant program for counties to develop and implement programs that would defer to mental health resources individuals charged with misdemeanor-level crimes such as trespassing. A number of law enforcement representatives testified in support of the program, though it’s not without controversy. Some mental health advocates have suggested that the program diverts scarce resources away from proven programs, and that law enforcement officers don’t have the training to adequately evaluate the right candidates for diversion.
The House companion, authored by Rep. Nick Zerwas (R-Elk River), has not yet been scheduled for a hearing.
Legislative Leaders Announce Deadlines
A key piece of the legislative picture became clearer this week as Senate and House leaders announced the committee deadlines for the 2015 legislative session. These deadlines serve to help manage the flow of legislative action by providing dates by which bills must meet certain benchmarks. With thousands of bills introduced each session, deadlines play a big role in weeding out viable proposals from those that lack the support needed to become law.
This year, the first committee deadline is March 20. By that date, to remain viable a bill must have passed out of all policy committees at least one body. The second committee deadline is March 27, when bills must have passed out of all policy committees in both bodies. And finally, all bills, including tax and spending bills will have to clear all the finance and tax committees by April 24.
Other Bills of Note
With the session yet only three weeks old, over 600 bills have been introduced in the House and Senate. While the majority of these proposals will not receive a single hearing, let alone become law, monitoring bill introductions for those that would affect physicians, patients, or the public health remains important. A few more interesting bills that have been introduced in the first weeks include:
- SF 100/HF 236 (Sen. B. Peterson, R-Andover/Rep. Nick Zerwas, R- Elk River). Known as the “Right to Try Act,” this proposal would allow physicians to prescribe or recommend to patients with terminal illnesses drugs or devices that have passed phase one of a FDA clinical trial but has not yet been approved for general use. The bill further allows, but does not require drug manufacturers to make such drugs available to patients, and physicians are not required to participate. The bill has bipartisan coauthors, though its future remains unclear. Similar bills have become law in a small number of other states, though many have questioned their efficacy or legitimacy.
- SF 178 (Sen. B. Peterson, R-Andover). Under this bill, the state’s Freedom to Breathe Act would be repealed, allowing smoking in Minnesota’s bars and restaurants. The bill has not yet drawn a House companion and is unlikely to receive any hearings.
- SF 101 (Sen. B. Peterson, R-Andover). This bill would make violation of the state’s mandatory seatbelt requirement a secondary offense. Current law allows law enforcement to pull over and stop offenders solely for not wearing a seatbelt. Under the bill’s language, seat belt violations could only be cited if a driver was pulled over for some other offense such as speeding, failure to stop, and other similar violations.
- HF 261/SF 176 (Rep. Mack, R-Apple Valley/Sen. Rosen, R-Fairmont) This bill creates a new type of provider called Community EMTs. This is based on what the Legislature did a few years ago when they created Community Paramedics. Under the law, Community EMTs would provide “interventions intended to prevent avoidable ambulance transportation or hospital emergency department use, care coordination, diagnosis-related patient education, and population-based preventive education” in rural areas.