Friday, March 18, 2016
Governor Announces Supplemental Budget Proposal
With session getting off to a rocky start related to process and committee structure, one of the first significant items was Governor Dayton releasing his recommendations for supplemental budget on how to manage the state’s $900 million budget surplus. He released his recommendations on Monday, March 14. While there are many pieces that will find favor among physicians and health care interests, the budget plan also includes a significant shift of provider tax dollars out of the Health Care Access Fund (HCAF).
Under his recommendations, Medical Assistance and MinnesotaCare reimbursement rates for primary care services would be increased by 5 percent. His proposed budget would also add additional investments in mental health services, including additional staffing for the state’s Anoka Metro Regional Treatment Center and support for certified community behavioral health centers. These increases are critical to ensure ongoing services to low-income Minnesotans.
Governor Dayton’s proposal also includes funding to upgrade the cannabis registry to allow non-certifying providers and emergency personnel access to limited data about cannabis use. This is an attempt to allow practitioners to access data on their patients; use of medical cannabis in a way other than embedding it in the Prescription Monitoring Program (PMP).
Concerning to the MAFP is Gov. Dayton’s recommendations for dramatic shifts of dollars out of the Health Care Access Fund to support programming that has traditionally been funded by the General Fund. The Health Care Access Fund is where revenue from the provider tax is deposited. The Governor’s recommendation is to shift amounts $56 million in 2017 and $241 million in 2018-19. He also recommends shifting the cost for MA coverage for all adults without children to the HCAF. Certain to cause consternation among Republicans (and some DFLers) is a provision that funds a $500,000 study of single payer out of the HCAF.
Physician-Aid in Dying Proposal Heard, Tabled
A Senate hearing on March 16 on a proposal to allow physicians to aid in the dying of terminally ill patients elicited passionate testimony on both sides of the bill, but resulted in no committee vote. The bill, authored by Sen. Chris Eaton (DFL – Brooklyn Center), was withdrawn by the author before a vote was taken when she realized she did not have the votes needed to pass the bill.
The proposal is built on similar laws in Oregon and several other states. Under the bill, patients who have been given less than six months to live would be eligible to receive medications to aid in their dying. Patients would need to submit two requests for aid in dying to both their attending physician and a consulting physician, and witnesses would be required. Physicians would be tasked with certifying the terminal condition, confirming that the patient was voluntarily seeking the aid, was competent, and was not suffering from a psychiatric or psychological condition or depression. Patients would be allowed to withdraw their request at any time. The bill contains explicit language that provides criminal liability protections for physicians who lawfully participate in the process.
Testifying in support of the bill were a number of relatives of people who had died painful, agonizing deaths, who had wished Minnesota had a law similar to Oregon’s. The main supporter of the bill was Dan Diaz, the husband of Brittany Maynard, the native Californian who moved to Oregon in 2015 to take advantage of that state’s physician aid-in-dying law as she battled a terminal brain tumor. Also testifying in support was David Plimpton, MD, a Minneapolis gastroenterologist. Opponents to the bill included a young woman also suffering from a brain tumor, church leaders from different faiths, and physicians.
Following testimony, members of the committee debated the proposal. With successful passage out of committee in doubt, the author withdrew her bill to avoid a negative vote. The bill will not be back for consideration this year. The House bill is being carried by Rep. Mike Freiburg (DFL – Golden Valley) but it is unlikely to receive a hearing.
Provider Tax Extension Bill Receives Hearing
A Senate bill to repeal the 2019 sunset of the provider tax received a hearing in the Senate Health, Human Services & Housing Committee on March 14. In a bipartisan agreement in 2011, the 2 percent provider tax is set to be repealed on December 31, 2019. Some legislators and interest groups have begun calling for a permanent extension of the tax. SF 2552is being carried by Sen. Kathy Sheran (DFL – Mankato) and the House bill is authored by Rep. Jennifer Schultz (DFL – Mankato).
Testifying in opposition was the Minnesota Medical Association, the Minnesota Chamber of Commerce, the Minnesota Chiropractic Association, and the Minnesota Psychologist Association. Surprisingly, the Minnesota Hospital Association testified in support for the bill, suggesting that the tax should be reinstated but lowered to better fit the current financing need.
The bill passed the committee and was referred to the Senate HHS Finance Committee. Sen. John Hoffman (DFL – Champlin) joined Republican Senators Carla Nelson (Rochester), Julie Rosen (Vernon Center), and Michelle Benson (Ham Lake) in voting against the bill. The Republican leadership in the House has stated unequivocally that the bill will not move in their body.
Bill to Extend APCD Usage Clears Committee Hurdle
The state's All Payer Claims Database (APCD) would continue to be used for analysis of health care costs, quality, utilization, and disease burden under a bill that cleared the Senate's Health, Human Services & Housing Policy Committee on March 14. The bill, SF 2340also successfully passed the Senate Judiciary Committee on March 18th and was referred to the Senate floor.
The APCD is a repository of de-identified patient claims data that was established as part of the landmark 2008 Minnesota state health care reforms. Current law sunsets on July 1, 2016 the authority of the Minnesota Department of Health to use the APCD for the study of health care costs and quality within a geographic area or population. The original language of the bill called for a permanent extension of the use of the database for these purposes, though the author, Sen. Melissa Halvorson Wiklund (DFL - Bloomington), amended the bill to allow its use until July 2019.
The House bill, authored by Rep. Nick Zerwas (GOP - Elk River), has not yet been scheduled for a hearing.
University Takes Heat for Research Practices
The House Higher Education Finance and Policy Committee took aim at the University of Minnesota and its research practices during a March 15 hearing. The wide ranging hearing looked at not only research practices, but also tuition, campus safety issues, and the athletic department.
Much of the hearing focused upon the use of aborted fetal tissue in University research. The controversy around the use and sale of fetal tissue in medical research that erupted in the summer of 2015 led to many questions from legislators here in Minnesota. Some legislators active in the "pro-life” movement believed that the University had not been forthcoming with adequate or complete answers to whether such tissue is used here in Minnesota. University President Eric Kaler and Brian Herman, PhD, the university’s Vice President for Research, and Brooks Jackson, MD, the Dean of the University of Minnesota's Medical School presented a strong defense of the University’s use of the tissue in research into spinal injuries, Alzheimer’s disease, and many other conditions.
Legislators also received an update on University policies regarding human research protocols. A participant in a psychiatric drug clinical trial, Dan Markingson, committed suicide while under the care of a University of Minnesota Department of Psychiatry researcher. The Star Tribune and the Office of the Legislative Auditor (OLA) have been highly critical of the University's handling of the case, citing serious ethical issues and conflicts of interest during the study and in response to inquiries following the suicide. The widely respected, nonpartisan OLA found in a 2015 review that the University's human research protections were inadequate and that the Department of Psychiatry "lacks a culture of excellence, compliance, and accountability." The House committee reviewed the 2015 report and heard from University officials about steps that have been taken to improve research practices.
MMA’s Day at the Capitol Set for March 23
This is the last call to join your physician colleagues for the annual MMA Day at the Capitol set for March 23, 2016. MAFP is a partner in the event. 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 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 ongoing construction, our 2016 Day at the Capitol will begin away from the Capitol building. Like last 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.