A Flurry of Legislative Activity
Friday, March 31, 2017
Posted by: Dave Renner, CAE, MAFP Legislative Representative
March has seen a flurry of legislative activity - below is a summary of what's been happening.
Funding Bills Unveiled
The legislature shifts its attention to budget issues this week. The House and Senate health & human services finance committees unveiled their budget proposals in recent days, and quickly moved them through the necessary committees. Both bills await action on the floors of each body. The bills share several items in common but there are significant differences that will need to be reconciled after action by each legislative chamber.
Both House and Senate bills include cuts in projected health and human services spending, with the House calling for cuts of $599 million and the Senate cutting $335 million over the next two years. To varying degrees, the two bills use budget shifts and unproven mechanisms to generate savings. The Senate, for instance, shifts $225 millions of spending into the next biennium. Both bills leave significant surpluses in the Health Care Access Fund.
Among the more noteworthy pieces in the Senate bill is a reimbursement rate cut for physician services. Under the Senate bill, reimbursement for services provided under Medical Assistance (MA) and MinnesotaCare will be cut by 2.3% on July 1, 2017 and by 3% on July 1, 2019. The House bill does not include the rate cuts, though their bill does include language that would cut rates to all providers $204 million should other savings mechanisms included in the bill not generate the projected savings.
The Senate bill also includes language that is intended to align state mandated quality measures. Those changes, sought by the MMA and other physician groups, were originally found in SF 1340, a bill authored by MAPF member Sen. Scott Jensen (R – Chaska). The House bill does not include this language.
Disappointingly, the Senate bill does not contain the prior authorization reforms that had been considered by the committee last month. That bill, SF 593, authored by Sen. Carla Nelson (R – Rochester), had been very well received in a bipartisan fashion. The House continues to block the bill from being heard in committee.
Recognizing the growing statewide concern over opioid abuse and overdoses, both bills include several measures intended to fight opioid addiction and deaths. The House bill includes language limiting prescribing of opioids in dental and certain eye surgeries to a four-day supply, as well as requiring pharmacists to distribute information about the risks of opioids when dispensing drugs from the opioid family. The House also includes a provision prohibiting the use of pain management as a component of patient satisfaction measurement. The Senate bill includes funding for grants to support prescriber education around the use of opioids and to fund pilot programs designed to treat opioid abuse.
Other provisions included in one or both bills include:
- The House includes $1.5 million each year in new funding for physician residency programs to train family physicians, pediatricians, general internists, surgeons, OBGYNs, and others willing to practice in rural areas.
- The House funds a new report on children’s mental health. Under the provision, the Department of Human Services (DHS) is to review the state’s continuum of intensive mental health care service for pediatric patients. DHS shall review data related to the access, efficacy, and utilization of the mental health system in the state, as well as reviewing models used in other states. The department is to report back to the Legislature by November 15, 2018.
- The Senate bill includes language that would require health plans to contract with primary care providers that are certified as health care homes in rural areas.
- Both the House and Senate include provisions related to HIV and AIDs, calling for the Department of Health to develop a strategic plan to address the state’s HIV epidemic by reducing the number of newly infected individuals.
- The House and Senate both include language creating a new Palliative Care Advisory Council to advise the Department of Health regarding the quality and delivery of patient-centered and family-focused palliative care. The 18-member group is to include several physicians, as well as other health professionals, patient advocates, social workers, legislators, and others.
- The Senate proposal includes language that instructs the Legislative Health Care Workforce to provide a report to the Legislature regarding the future demand for health care professionals, evaluate the effectiveness of incentives designed to attract and retain professionals, and identify potential solutions to barriers to growing the health care workforce.
- The House establishes a new working group related to youth concussions. The group is to study the incidence of youth concussions and brain injury, the level of training for school coaches, referees, and other staff, and policies related to “return to play” protocols and their effectiveness.
House and Senate Higher Ed Bills Include Funding for FP Residencies
The Senate and House higher education finance bills include funding for a number of family medicine residency programs around the state. The one area where there is a big difference is the amount of money they recommend for the U of M residency funding.
Both bills provide $501,000 for the United Family Medicine Residency, $346,000 for the St. Cloud Residency, and $686,000 for the Mayo Residency. The House bill fully funds the University’s request for $5.25 million in 2018 and $7.25 million in 2019 for the Department of Family Medicine Residency. The Senate bill only provides $800,000 each year.
The MAFP has strongly supported the University’s request for full funding and encouraged members to contact their legislators on this issue.
Tobacco Taxes Rolled Back in Tax Bill
The House unveiled its proposed tax bill, HF 4 on March 23. Among the many provisions in the $1.35 billion tax cut package are several related to tobacco. The bill was passed by the House of Representatives on March 30 on a largely party line vote.
Under the bill, the automatic inflationary increase in tobacco taxes is repealed. This component was originally passed as part of the landmark 2013 tobacco tax increase, and allowed the tax to rise with inflation. Repeal of the inflator was a central legislative priority for tobacco manufacturers and retailers.
Also included in the proposal is language to effectively repeal the tax on "premium cigars.” As part of the 2013 tobacco tax increase, an additional levy was placed on more expensive cigars. The House bill reduces the tax on these products from $3.50 to $.50.
The bill does include one positive tobacco-related provision. Tobacco manufacturers have increasingly been promoting so-called "man cans" of chewing tobacco, packaging that includes 10 or more smaller, conventional tins of tobacco. They've done so primarily because Minnesota law contains a loophole that allows these larger products to be taxed as a single, small tin. The House tax bill closes this loophole, and moves to tax these products by volume.
In a somewhat surprising development, the Senate’s tax bill does not contain any of the tobacco provisions. Given the differences in the House and Senate bills, a conference committee will ultimately determine the final package to be sent to the Governor. Governor Dayton has spoken of his opposition to the repeal of the tax inflator, and he has called for a much smaller tax bill.
Legislature Approves Large Subsidy to Health Plans in the Individual Market
In another attempt to provide relief for people who saw large premium increases for their individual health insurance, the legislature passed a state-based reinsurance program for insurers. The bill, HF 5 (Rep. Greg Davids—R, Preston; Sen. Gary Dahms, R—Redwood Falls), will proved a subsidy to insurers to help cover the costs of enrollees who have large medical expenses in a year.
Insurers that offer coverage in the individual market will receive the subsidy for any enrollee who has costs of over $50,000 in one year. For any costs over $50,000 the state will cover 80 percent of those costs up to $250,000. Any costs over that amount would be covered by the insurer alone. By providing these subsidies estimates are the premiums in the individual market will be reduced by 20 percent next year.
To ensure that this subsidy does not result in Minnesota losing federal money, the creation of this subsidy is contingent on Minnesota receiving a waiver from the federal government to maintain existing funding.
The new Premium Security Plan Account is funded by a combination of $71 million each year from the General Fund and $200 million each year from the Health Care Access Fund. This funding is for 2018 and 2019 only.
Supporters have argued that without this new subsidy more private insurers will pull out of offering any products in the individual market. This reinsurance subsidy is needed to protect all enrollees from the costs caused by a very few enrollees. Critics argue that this subsidy rewards insurers for unjustified premium increases and does nothing to increase access to options for those purchasing individual coverage.
One provision added to the bill to partially address patient choice and network adequacy is a requirement for insurers that have exclusive contracts with only one health system to also offer at least one option for access to providers outside that system. This is to address the concern caused when Blue Cross/Blue Shield’s BluePlus product, with its limited network product, was the only option for many Minnesotans in the rural counties.
Finally, the bill also includes a delay in the “surprise billing” language that was passed earlier this year. During the second week of session the Legislature passed SF 2 that included a prohibition on certain providers from balance billing patients for out-of-network services. The bill was scheduled to go into effect on April 27, 2017. The effective date for this provision has been delayed until January 1, 2018 to ensure that new requirement aligns with new federal requirements.