Minnesota Academy of Family Physicians (MAFP) legislative representative Dave Renner, CAE, reports on the end of the 2024 legislative session and shares updates (below) on legislation on prior authorization reform, physician well-being, insurance coverage, graduate medical education funding and more.
Looking for a more in-depth look at this legislative session?
Join MAFP members, leaders and staff for the 2024 Legislative Session Wrap-Up Conversation (Tuesday, June 25, 2024, 7 – 8 pm, online). Hear a review of what happened around health care and MAFP legislative priorities during the 2024 legislative session. Get your questions answered and help us begin to consider what will be prioritized for next year.
Minnesota Legislature Adjourns Amid Chaos
The 2024 Minnesota Legislative Session adjourned sine die on May 20, amid chaos.
According to the State Constitution, the deadline for passing bills was Sunday, May 19, 2024, at midnight. As that deadline approached, there was much work to be done, and Democrats accused Republicans of intentionally stalling (to run out the clock). With less than one hour before the deadline, both the House and Senate decided the only way to finish their work was to combine the many remaining budget bills into one large, 1,400-page, bill.
When this bill was taken up and pushed through, it was met with shouts of protest and anger by Republican members in both bodies. As the Speaker of the House attempted to pass the bill, Republicans claimed the DFL majority had bypassed their opportunity to adequately debate the contents of the bill, called to be recognized by the Speaker and shouted accusations of tyranny.
Despite strong, loud and prolonged protests from the minority party, the omnibus bill passed the House and was sent to the Senate. Similar action and protest took place there. In the end, the omnibus bill was passed by both bodies and sent to Governor Walz.
Included in this massive bill was the language of the Health and Human Services (HHS) bill; highlights follows.
Prior Authorization Reform Passed into Law
The HHS language that passed in the final hour of the session included language to limit the use of prior authorization for services where it has become a barrier to care.
This was a top priority for the MAFP. While the final bill was scaled back from what was introduced, it is a strong bill that will help patients get the care they need in a timely manner.
Final prior authorization reforms (effective in 2026) will…
- Apply all prior authorization laws to the Medical Assistance (MA) and MinnesotaCare programs. Previous law excluded state public programs.
- Require that a prior authorization received for a chronic condition does not expire unless the standard of treatment changes.
- Prohibit all prior authorizations for preventive services, pediatric hospice care and pediatric neonatal abstinence programs.
- Prohibit prior authorization for non-medication treatments for cancer, outpatient mental health and substance use disorder. While the law continues to allow prior authorization for medications to treat these conditions, it now requires a decision from the insurer within 48 hours, instead of five days.
- Require health plans to submit an annual report to the Minnesota Department of Health on how often they use prior authorization and approve or deny services.
- Require health plans to implement an automated process that is consistent with the new federal requirements to identify whether a prior authorization is required and what documentation is needed.
- Prohibit a health plan from retrospectively denying coverage of a service for which prior authorization was not required.
- Prohibit a health plan from denying coverage solely on the basis of lack of a prior authorization if they would have otherwise covered the service.
Physician Well-being + Change to Credentialing Applications
The final HHS language also includes legislation aimed to improve physician well-being.
Physician well-being reforms will…
- Prohibit a health plan or hospital from using a credentialing application that asks about past medical conditions that don’t have an impact on one’s ability to practice medicine. Physicians and physicians-in-training have reported being hesitant to seek care for fear of having that used against them when applying for privileges.
- Provide protections for a person who participates in the SafeHaven Program, which helps physicians address workplace fatigue. Participation is protected from discovery, subpoena or a reporting requirement to the licensing board, unless the participant voluntarily provides a written release of the information.
Insurance Coverage Expanded
The HHS bill includes a number of new mandated coverages for insurers, including the coverage of abortion services, gender-affirming care, expanded maternity and postpartum care, wigs for cancer patients, and orthotic and prosthetic devices. Many of these services were already covered by Medical Assistance, MinnesotaCare and most private insurers; however, the legislature wanted to ensure that these services/treatments will be covered in the future.
New Funding for Residency Programs
Minnesota has long had the Medical Education and Research Costs (MERC) program that provides funding to physician residencies and other health professional training programs. The HHS bill changes how we fund residency programs at teaching hospitals to maximize federal funding and greatly increase funding for graduate medical education (GME).
MERC will continue to fund non-physician training programs, but physician residency programs will now be funded through a new surcharge on teaching hospitals. This surcharge will be matched by an equal amount of federal money and then paid back to the teaching hospitals, allowing the state to maximize federal funding and provide more support for GME programs.
HMOs Required to Be Non-Profits
The legislation returns Minnesota to being the only state in the nation that requires Health Maintenance Organizations (HMOs) to be nonprofit organizations. Since 2017, the law allowed for-profit entities to have HMOs in Minnesota. This has resulted in companies like United Healthcare being able to run an HMO and be chosen as one of the HMOs offering coverage through Medical Assistance. Beginning in 2025, Minnesota will once again require all HMOs to be nonprofit entities.
Scope of Practice & Licensing Changes
This year, the Legislature considered many bills to license new providers, expand the scope of practice for existing providers or adopt licensing interstate compacts to make it easier to get licenses in multiple states.
The final HHS bill included many of the proposed scope of practice and licensing changes but did not include two that were deem too controversial: one provision not included would have created a new licensed practitioner, a certified midwife, and the second provision not included would have lifted existing statutory caps on optometric prescribing of oral antiviral drugs, steroids and oral carbonic anhydrase inhibitors and expanded their authority to provide intravitreal injections.
Both of these scope of practice proposals may be up for reconsideration in the next legislative session.
Firearm Safety Bills Pass
Two bills aimed to reduce rates of death and injury due to firearms passed the legislature:
- The first increases the penalties for the “ghost purchase” or “straw purchase” of a firearm, where one person purchases a firearm and then transfers it to a person who is prohibited from owning it.
- A second bans binary triggers on firearms, allowing firearms to fire one round when the trigger is pulled and another when it is released.
Other bills—one requiring that firearms be secured with a locking device, unloaded and kept separately from ammunition and one mandating that lost or stolen firearms be reported within 48 hours—did not pass this session.
The next legislature is expected to convene in January 2025. In the meantime, all 134 seats in the Minnesota House are up for election on November 5, 2024. The Senate and Governor are not up until 2026; however, there may be a handful of special elections in the Senate because of retirements.
