Minnesota Academy of Family Physicians (MAFP) lobbyist Dave Renner, CAE, shares an update on the 2024 legislative session, including the status of the health finance and policy bill, work to create a commission for equitable health care services, efforts to maximize funding for graduate medical education, the status of legislation on scope of practice and more.
Deadline Looms for Health Finance & Policy Bill
April 19, 2024, marks the final committee deadline for this year’s legislative session—the date by which all major finance committee omnibus bills must be passed by their relative committees. After the deadline, work will shift to extended floor sessions and conference committees to work out differences between the two bodies.
The MAFP is advocating for the inclusion of several priority items, including…
- Prior authorization reform: This legislation 1) prohibits prior authorization for services where a delay poses an immediate danger to patient health, including treatment for substance use disorder, outpatient mental health care, cancer care and chronic conditions, and 2) requires health plans to submit data on prior authorization to the Minnesota Department of Health, who will then submit recommendations to the legislature to improve prior authorization, including a recommendation for an exemption process.
- Physician wellness: This legislation 1) creates a program through which physicians can confidentially seek and obtain professional help to address career fatigue and wellness, 2) prohibits health system credentialing applications from inquiring about an applicant’s past health conditions, 3) allocates funds to create a statewide wellness recognition program to publicly recognize Minnesota health care institutions that have committed to improving physician mental health and addressing burnout and 4) provides one-time funding to initiate a statewide campaign to reduce the stigma for health care workers to receive care for mental health and well-being.
- Health insurance coverage: The MAFP is also advocating for a number of provisions that require health insurance plans to provide coverage for gender-affirming care, fertility care and abortion care.
Bill status: The details of the House and Senate health finance and policy omnibus bill has yet to be released (as of April 12, 2024).
Legislation to Create Commission for Equitable Health Care Services Heard in Senate
Legislation that would establish a Commission for Equitable Health Care Services in Minnesota was heard in the Senate Health and Human Services Committee and the State and Local Government and Veterans Committee on April 9, 2024.
The commission would be comprised of members of the public from across the state, with the aim of developing a plan to provide meaningful availability of health care services to Minnesota residents by reviewing activities of health care entities that receive state funds.
Duties of the commission include…
- hold regional hearings.
- investigate “the financial and policy instruments employed by corporate health care entities.”
- look at the geographic distribution of providers.
- make recommendations on “transparency of ownership of health care facilities and systems and the role of private equity in the health care market.”
The bill would also…
- require health care entities that receive state money to certify to the state auditor that they are using state funds according to how the legislature intended.
- empower the state auditor to review the records of a health care entity if it has received an eligible state expenditure in the prior calendar year and require the state auditor to examine financial records of health care entities upon the commission’s request.
Some legislators raised concerns with the new authority of the state auditor, especially over independently owned smaller practices.
Bill status: The MAFP sent a letter to Senator Erin Murphy (DFL – St. Paul), the bill’s chief author, supporting the creation of the new commission. The bill was laid over for possible inclusion in a future omnibus bill. It has not currently moved in the House.
Legislation to Maximize Graduate Medical Education Funding Heard in House & Senate
A bill that would restructure the funding stream for the Minnesota graduate medical education (GME) system to help ensure steady funding for the state’s physicians-in-training was heard in the House Health Finance and Policy Committee on April 9, 2024.
Minnesota’s current GME funding program, Medical Education and Research Costs (MERC), receives about $59 million per year, including a portion paid through state- and federally-funded Medicaid reimbursement. However, in the 2023 legislative session, the MERC program was reformulated to change reimbursement to a Medicaid inpatient fee-for-service rate. This did not increase funding for teaching hospitals, and proponents argue it risks potential funding reductions in the future.
HF 5020 (Representative Tina Liebling, DFL – Rochester) aims to remedy this funding gap by directing the Commissioner of Human Services to determine and pay annual Medical Assistance (MA) supplemental payments to Minnesota’s teaching hospitals, for direct and indirect physician GME reimbursement. This new funding system is similar to the way Medicare pays a direct and indirect GME supplemental payment to teaching hospitals. The bill is funded through a surcharge on teaching hospitals, which is matched by federal Medicaid funds and paid back to the teaching hospitals.
The aim of the bill is to increase Medicaid rates for teaching hospitals and maximize matching federal funds used to train Minnesota physicians. It is being championed by the Metro Minnesota Council on Graduate Medical Education.
Bill status: The bill was laid over for possible inclusion in a future omnibus bill. The Senate companion, SF 4946 (Senator Melissa Wiklund, DFL – Bloomington), was also laid over for future inclusion in an omnibus bill.
House & Senate Scope of Practice Legislation Released
Both the House and Senate are currently creating bills that deal with a number of scope of practice issues.
HF 4247 (Representative Tina Liebling, DFL – Rochester) passed the Health Finance and Policy Committee on March 20, 2024, and was referred to the House Ways and Means Committee. This will be the last committee stop before the bill goes to the House floor.
Its Senate companion bill, SF 4570 (Senator Melissa Wiklund, DFL – Bloomington), was heard by the Health and Human Services Committee on April 3, 2024.
Scope of Practice Legislation: Items in the Senate bill that are not in the House bill:
- One controversial scope of practice expansion would lift existing statutory caps on optometric prescribing of oral antiviral drugs, steroids, and oral carbonic anhydrase inhibitors and expand optometrists’ authority to provide intravitreal injections. Medical groups have strongly opposed this section, arguing that current limits on optometric prescribing serve an important purpose in protecting the public.
- The creation of a separate pathway for international medical graduates who do not currently qualify for licensure in Minnesota. Stakeholders agree there is a need to find ways to allow well-qualified physicians to achieve licensure to address physician workforce shortages in the state, but many have raised concerns that the current language needs additional guardrails to ensure a minimum standard of expertise.
- A new certified midwife licensure by the Board of Nursing. In the legislation, the scope of certified midwifes allows them to manage, diagnose and treat women’s primary health care, including pregnancy, childbirth, the postpartum period, care of the newborn, family planning, partner care management relating to sexual health and gynecological care of women across the life span.
Scope of Practice: Item in both the Senate and House bills:
Another item that is concerning to physicians, especially psychiatrists, would allow physician assistants (PAs) to provide ongoing psychiatric treatment for children with emotional disturbances and adults with serious mental illness without coordinating with a psychiatrist when diagnosing and treating patients with mental illnesses. This item is opposed by the Minnesota Psychiatric Society and National Alliance on Mental Illness (NAMI), who have argued that PAs are not qualified to adequately monitor, prescribe and treat these patients independently.
What’s next: Once both bills pass their respective floors, a conference committee will be appointed to work out the differences in a final bill.
Anti-Retaliation Bill Heard in Committees
The Minnesota Nurses Association (MNA) supported bill, SF 4444 (Representative Lindsey Port, DFL – Burnsville), known as the Health Care Employee Anti-Retaliation and Labor (HEAL) Act, would prohibit a health care facility from retaliating or discriminating against a nurse who initiates a process outlining patient safety concerns related to inadequate staff levels.
The bill’s language is similar to a provision that was included in the Keeping Nurses at the Bedside Act, which failed to move in the 2023 legislative session, that would allow a nurse to “decline to accept an additional patient assignment.”
Proponents from the MNA and other labor groups referenced data from the Minnesota Department of Health that suggests health care worker burnout is leading to the severe workforce shortage in the state. Those who oppose the bill argue that it would empower a nurse to refuse to treat a patient, which is unethical for caregivers.
While the MAFP has not taken a position on this bill, MAFP member Senator Alice Mann, MD, MPH, is strongly opposed. Hospitals and business groups have also flagged concerns over the legislation, citing that it will inevitably lead to hospital unit closures, delays in care, additional backups in emergency departments, negative patient health outcomes and possible discriminatory practices and inequitable health care delivery.
SF 4444 and its House companion, HF 4200 (Representative Sandra Feist, DFL – New Brighton), have been heard in several committees this session.
Bill status: The language may be added as a part of a larger omnibus health and human services bill, but it is uncertain if it has enough support to pass in a floor vote.
Posted by: Emie Buege, MAFP social media manager