Minnesota Academy of Family Physicians (MAFP) legislative representative Dave Renner, CAE, shares an update on the 2024 legislative session, including:
- what to expect in the final weeks of session.
- the status of the omnibus health and human services bills.
- why prior authorization reform legislation has been scaled back.
- the passage of two firearm safety bills to the House floor and more.
Legislature Gears Up for Its Final Weeks
Minnesota lawmakers have just over three weeks before they are required to adjourn the 2024 legislative session.
Both the House and Senate are expected to pass respective omnibus bills and form a conference committee to finalize a joint bill, before sending the agreed upon package to the Governor for his signature.
Recent developments regarding Senator Nicole Mitchell (DFL – Woodbury), who was arrested and charged with first-degree burglary, raise questions on how the session will end. Currently, the DFL has a one-vote majority. If Mitchell is not allowed to vote on key issues, the Senate will not be able to pass bills without bipartisan support. Mitchell’s attorney said she intends to participate in the final weeks of the legislative session, despite Republicans calling for her resignation. An ethics complaint was filed and must be acted on within 30 days. Legislative leaders are trying to figure out how best to handle this difficult situation.
Omnibus Health & Human Services Bills Pass First Committee
Last week, the House and Senate released their omnibus health and human services bills, which are currently making their way through their respective finance committees and then to a floor vote.
While there are many differences between the two bills, there are some identical provisions which will likely be adopted when the omnibus bill goes to a conference committee.
What’s the same in both bills:
- Require public and private insurance to cover abortion services, gender-affirming care, wigs for cancer patients and orthotic and prosthetic devices.
- Expand maternity and postpartum coverage.
- Include a new surcharge on teaching hospitals to maximize federal and state funding for graduate medical education, which is intended to significantly increase funding for residency programs.
- Require Health Maintenance Organizations to be non-profit entities (as they were prior to 2017).
- Authorize pharmacists and pharmacy technicians to administer vaccinations to children over the age of 6.
Not included in either bill:
- Mandated coverage for in vitro fertilization (IVF) services.
What’s different between the bills:
- The House bill contains scaled back prior authorization reform language. It continues to focus on reducing the use of prior authorization for critical services, yet because of fiscal costs, the impact on medications has been reduced. The Senate bill does not include any new prior authorization provisions but applies current prior authorization laws to all public programs.
- The Senate bill includes language to address physician well-being: prohibiting health system credentialing applications from inquiring about an applicant’s past health conditions; providing protections for physicians who participate in the SafeHaven program; and allocating $500,000 for a statewide educational campaign to reduce stigma among the health care workforce associated with seeking and obtaining mental health services.
All omnibus bills are expected to go to the floor for a vote as soon as next week, followed by the appointment of a 10-member conference committee to develop the final package.
Prior Authorization Reform Legislation Scaled Back
While prior authorization reform continues to have bipartisan support at the Legislature, it is running into challenges with the cost of the reforms.
Every piece of legislation that has a cost to a state program receives a fiscal note from the Minnesota Management and Budget Office. The Legislature is then required to allocate the money needed to pay for those costs. Because this is a non-budget year, there is very little new money available to spend which is forcing legislative leaders to be creative in how prior authorization is addressed.
Most of the cost for prior authorization reform is to the Medical Assistance (MA) program and related to how medications are financed. Minnesota receives significant revenues from drug companies through supplement rebates paid to get their medications on the preferred drug list. By prohibiting prior authorization for certain medications, patients will no longer be required to use the drugs on the preferred drug list and the state will lose the rebate revenue from the manufacturer.
A preliminary estimate from the Minnesota Department of Human Services has the cost to the state of prohibiting prior authorization for generic drugs and biosimilars at more than $100 million (in lost rebate revenues). Even though the retail price of generic drugs is generally cheaper than brand name drugs, the net cost after rebates is not. While this may not make sense, the state is encouraging MA patients to use brand name drugs over generics to maximize rebate revenues.
Because of the cost of these rebate revenues, the authors of the prior authorization legislation are being forced to scale back some of the provisions in the bill. For example, instead of prohibiting prior authorization for needed mental health medications, the bill will require that prior authorization decisions be made within 48 hours, instead of the current five-day timeline.
The bill still contains language that says once a prior authorization is approved for a chronic condition that the approval does not expire unless the treatment standard changes. It also extends all prior authorization laws to the state’s public programs and requires health plans to annually report data on how often they use prior authorization, approve requests and deny them. This will help leaders better understand whether prior authorization remains an effective tool or a barrier to care.
Both the Senate and House omnibus health and human services bills have prior authorization language included in them, but in different forms. After these bills pass their respective floors, there will be a 10-person conference committee formed to meet and work out the differences.
House Holds Informational Hearing on Private Equity in Health Care
The House Commerce Committee held an informational hearing on legislation that would prohibit private equity companies and real estate investment trusts from acquiring or increasing control over providers of health care services.
The legislation would put a moratorium on private equity entities from purchasing or expanding direct or indirect ownership, financial or operational control of medical services in the state. MAFP member, medical student and former legislator Hunter Cantrell testified in support of the bill.
Proponents used nursing homes as an example of the negative impact private equity can have on health care, citing research from the Gerontological Society of America that found private equity ownership of nursing homes in Minnesota correlates with worse care and outcomes as well as higher administrative fees and lower occupancy rates.
Legislators echoed similar concerns with the growing presence of private equity firms in health care, but questioned whether the legislation goes too far without a better understanding of unintended consequences, such as further closures or reduced services in some facilities. Additionally, concerns were raised regarding the definition of private equity in the bill, whether it would include individual practice mergers or a group of physicians purchasing a practice from a colleague. Questions were also raised whether private equity investments may be needed to cover expensive operational costs such as medical supplies or technology.
There was no action taken on the legislation following the committee’s discussion; however, chief author Representative Jessica Hanson says she intends to pursue similar legislation in 2025.
Firearm Safety Bills Passed to the House Floor
Two bills to strengthen firearm safety laws passed the House Ways and Means Committee on Wednesday, April 24, 2024.
The first bill, HF 601 (Representative Her, DFL-St. Paul) would require an owner to report to law enforcement if their firearm has been stolen or lost “as soon as practicable but not later than within 48 hours of the time the person knew or reasonably should have known of the loss or theft.” The penalty for failure to report is a petty misdemeanor for the first offense.
The second bill, HF 4300 (Representative Becker-Finn, DFL-Roseville), would require firearms to be stored unloaded and locked or loaded in a locked firearm storage unit or locked gun room. The penalty for failing to do so is a petty misdemeanor; unless a child is present, then it is a gross misdemeanor.
Both of these bills are supported by the MAFP as another way to reduce harm and death from firearms. While there is support for both bills in both bodies, the outcome in the Senate has become less clear as a result of Senator Mitchell’s ethics charges.
Posted by: Emie Buege, MAFP social media manager