Friday, April 1, 2016
Frist Committee Deadline Today
Only four weeks into the 2016 legislative session and the Legislature has reached the first of three committee deadlines today, Friday April 1. This is the first step to narrow the number of bills to be acted on and shifts the work to more budget issues.
Earlier this year legislative leaders set a services of committee deadlines as a means to process bills and to winnow the volume of bills that remain viable. For a bill to remain "alive" and available for consideration by legislators a bill must have cleared all policy committees in either the Senate or the House by April 1. That same bill must pass then the all policy committees in the other body by next Friday, April 8. A third committee deadline set for April 21 for all bills with a fiscal impact to have cleared the finance or tax committees. As is customary at this time during session, the full House and full Senate bodies have met primarily to process bills from one committee to the next; few issues have received full debate on the floor.
With session now just short of the half way point before the constitutionally mandated adjournment date of midnight, May 23, the outlook for the remainder of the session remains cloudy. Most observers believe that the three big legislative items for this session - a tax cut package, a transportation package, and a bonding bill - remain closely linked, and that none of the three can move independent of the others. Early momentum towards a supplemental budget using some of the state's $900 million for new spending seems to have stalled in recent days.
Prescription Monitoring Program (PMP) Bill Moves in the House
Legislators remained very interested in finding solutions to the issue of prescription drug abuse - particularly of opioids. The House Health & Human Services Reform Committee passed HF 1652 (Rep. Dave Baker, R - Willmar) a bill to enhance the state's Prescription Monitoring program (PMP).
Under the legislation, the PMP would be allowed to use data contained within the database as a means to substantiate investigations of prescribers accused of criminal activities or impairment as a result of abuse of a controlled substance. The bill further allows the PMP staff access the database as part of a bona fide investigation of a prescriber accused of inappropriately prescribing controlled substances.
The House bill was amended to include mandatory registration of all prescribers. Importantly, the bill does not include mandatory consultation of the PMP before a prescription can be written, a step that some legislators have sought. Many physician groups have supported mandatory registration but have raised concerns with the administrative burden of a broad mandate on checking the PMP before every narcotic prescription.
The Senate bill, authored by Sen. Julie Rosen (R - Vernon Center), cleared its committee hurdles last year and awaits action on the Senate floor.
A separate bill (HF 1503) to allow pharmacies greater flexibility and authority to collect unused prescriptions has cleared the both the House and Senate committee process and await action by the full bodies. This is designed to reduce the number of leftover drugs that may be diverted to illicit use. Finally legislation to allow pharmacists independent prescribing authority for opioid antagonists like Naloxone (HF 2507) have stalled this year. Concerns were raised about prescribing authority for pharmacists and many have noted that pharmacies already have means to distribute naloxone if they enter into protocols or standing orders with physicians.
Bill to Ease Medical Record Sharing Clears Senate Committee
A bill to align Minnesota's health records law with that of the federal HIPAA law passed its first committee stop in the Senate on March 30. The bill, authored by Rep. Melissa Wiklund (DFL - Bloomington), cleared the Senate Heath, Human Services & Housing Committee and was referred to the Senate Judiciary Committee where it's set to be heard on April 1.
Minnesota is one of only two states whose medical record privacy protections differ significantly from the federal HIPAA standard. Minnesota's law adds additional barriers to the sharing of patient data by limiting certain data-sharing between clinics, hospitals, and physicians without express consent. The bill is supported by the Minnesota Medical Association, the Minnesota Hospital Association, the Minnesota Council of Health Plans, and most all hospital and health care systems, arguing that Minnesota law makes care coordination more difficult and additional, redundant testing more likely.
The House companion is authored by Rep. Nick Zerwas (R - Elk River) and has not yet been scheduled for a hearing. The bill faces an uncertain future in the House given opposition by some privacy advocates.
Big Turnout at MMA Day at the Capitol
Despite freezing rain and snow more than 100 physicians, residents, and medical students gathered for the annual MMA Day at the Capitol on March 23. Physicians from around the state gathered in St. Paul to advocate on behalf of patients and medicine. The MAFP was well represented by many members, including MAFP President Tariq Fareed, MD and President-Elect Dania Kamp, MD. Attendees heard presentations on key legislative priorities for the 2016 session, including reform of the prior authorization process, maintaining repeal of the provider tax, and strengthening of the state’s immunization laws, as well as tips on talking with legislators. They then were off to talk with their individual Senators and Representatives.
Because of continued construction at the Capitol building, the event was once again held at the downtown St. Paul DoubleTree hotel. Attendees received an update on the legislative session from MMA leadership and staff before boarding the light rail train for the short trip to the State Office Building and Minnesota Senate Building for meetings with legislators.
The lunchtime keynote speaker, Rep. Tara Mack (R - Apple Valley), the chair of the HHS Policy Committee, was forced to cancel her appearance because of activity on the House floor. Rep. Erin Murphy (DFL - St. Paul) joined the group at the post-event reception and shared remarks on hot button health care issues.
House Bill Looks to Fund Opioid Addiction, Maternal Depression Treatment for New Moms
Rep. Matt Dean (R – Dellwood), successfully passed his bill (HF 3419) to seek a federal grant for opioid addiction treatment for new mothers out of Health & Human Services Reform Committee on March 29. The bill was then referred to the Health &Human Services Finance Committee. It does not yet have a Senate companion.
The bill seeks to take advantage of new federal funding to establish pilot projects to provide treatment and services to pregnant and postpartum women with substance use disorder, including opioid addiction. Pilot projects funded under the bill are to provide treatment and services; fund family-based treatment and services; identify gaps in services along the continuum of care; and encourage new approaches to service delivery and service delivery models.
Additionally, the bill authorizes the Minnesota Department of Health to seek federal funding for programs to provide culturally competent services to screen and treat pregnant women and new mothers for maternal depression. The grant program is to provide health care providers with appropriate training and relevant resources on maternal depression screening, treatment, and follow-up support.
Senate Committee Tackles Prescription Drug Pricing
The Senate Health, Human Services & Housing Committee took up a number of bills related to the rising price of pharmaceuticals on March 24. While the four bills successfully passed out of committee, the outlook on passage is in doubt given lack of action in the House.
Sen. Melisa Franzen (DFL – Edina) is the author of three of the proposals. Under SF 2948, pharmaceutical manufacturers would be prohibited from making available to consumers discounts or coupons for name brand drugs when a generic version is available. Testifying in support of the proposal was Stephen Schondelmeyer, PharmD, PhD, a professor of Pharmaceutical Economics in the College of Pharmacy at the University of Minnesota. Schondelmeyer shared his belief that manufacturer’s couponing programs lead patients to request and physicians to prescribe higher cost drugs when far cheaper versions are available.
Also considered at the hearing was Sen. Franzen’s SF 2496, a bill to establish a program that would provide information and education on the therapeutic and cost-effective utilization of prescription drugs to prescribers. The intent is to make available to physicians and other prescribers a resource other than drug manufacturers for information on drugs. The program would be funded by a tax on drug wholesalers. The third bill authored by Sen. Franzen (SF 2942) would require all drug manufacturers who sell drugs whose cost exceeds $1,000 per month or per treatment to file regular reports with the Department of Human Services. The department would in turn issue regular reports about these drugs and their pricing to the Legislature.
The final bill was authored by Sen. Tony Lourey (DFL – Kerrick). SF 2239 would require DHS to establish a program to make available to Minnesotans discounted pharmaceutical drugs reimported from Canada. The bill drew opposition from pharmaceutical manufacturers, the Chamber of Commerce, and other business groups. The House companion is carried by Rep. Joe Atkins (DFL – Inver Grove Heights) and has not been scheduled for a hearing.
In related news, Rep. Matt Dean (R – Dellwood) presented his HF 2140 to the Health & Human Services Reform Committee on March 29. Rep. Dean’s bill would require DHS to establish an online tool for consumers to compare local pharmacy prices for the most commonly filled prescription drugs based upon "usual and customary prices for prescription drugs paid by consumers without prescription drug coverage.” The bill passed and was referred to the HHS Finance Committee; there is no Senate companion.