Minnesota Academy of Family Physicians (MAFP) legislative representative Dave Renner, CAE, shares an update on the 2024 legislative session, including the status of legislation on prior authorization reform, a public option, firearm safety, medical debt and more.
There is just over one week left in the 2024 legislative session. Most of the major budget related bills have yet to be finalized. Over the next 10 days, there will be long floor sessions and conference committees as legislators work to complete their work.
Health Omnibus Bills Pass Senate & House Floors
On May 9, 2024, the Minnesota House of Representatives passed HF 4571 (Liebling, DFL – Rochester), the House health omnibus bill which includes a number of priority issues for the MAFP.
Priority: Reform Prior Authorization
One priority is needed reforms to the prior authorization process in Minnesota that will limit the use of prior authorization for critical services.
The final language does the following:
- Extends prior authorization laws to Medical Assistance (MA) and MinnesotaCare.
- Prohibits prior authorization for oral buprenorphine, preventative services, pediatric hospice care and pediatric neonatal abstinence programs.
- Prohibits prior authorization for non-medication treatments for cancer, outpatient mental health and substance use disorder; allows prior authorization for medications to treat these conditions but shortens the decision timeline for insurers to 48 hours (from five days).
- Requires that a prior authorization received for chronic conditions does not expire unless the standard of treatment changes.
- Requires health plans and pharmacy benefit managers to annually report to the Minnesota Department of Health how often they require, approve and deny prior authorizations.
- Requires health plans to implement an automated process that is consistent with the new federal requirements that identifies whether a prior authorization is required and what documentation is needed.
- Prohibits health plans from retrospectively denying coverage for a service for which a prior authorization was not required.
- Prohibits health plans from denying coverage for lack of a prior authorization if they would have otherwise covered the service.
The Senate companion bill, SF 4699 (Wiklund, DFL – Bloomington), does not include many of the needed reforms, but does include the language extending the current prior authorization laws to MA and MinnesotaCare.
Priority: Address Physician Well-being
The Senate bill includes language to address physician well-being. It prohibits health system credentialing applications from inquiring about an applicant’s past health conditions and protects physicians that participate in the SafeHaven program to address work-life balance. Additionally, the bill includes funding for a statewide campaign to reduce the stigma behind mental health treatment and encourage physicians to seek and obtain professional help to address career fatigue and wellness. This item is not in the House bill.
Priority: Expand Coverage for Abortion, Gender-Affirming & Maternity Care
Included in both bills is expanded coverage by public and private insurers to cover abortion services, gender-affirming care, expanded maternity and postpartum care, wigs for cancer patients and orthotic and prosthetic devices.
Support for Graduate Medical Education, Vaccine Requirements + More
Both bills also….
- 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.
- Reinstate the requirement that Health Maintenance Organizations be nonprofit entities.
- Authorize pharmacists and pharmacy technicians to administer vaccinations to children older than 6.
The Senate bill also includes language that allows a childcare program to require that enrollees be fully vaccinated to attend. This item is not in the House bill.
What’s next: A conference committee will be formed in the coming days to sort out the differences between the two bills. Once the language is finalized, the bill will go back to the House and Senate for a final vote before being sent to the Governor for his signature.
Senate Hears Public Option Legislation
The Senate Commerce and Consumer Protection Committee heard legislation on April 30, 2024, that would allow more Minnesotans to purchase health coverage through MinnesotaCare by offering a “public option.”
Last session, the Legislature passed a bill to implement a public option by 2027, following a study into the applicability of a future MinnesotaCare buy-in program. An actuarial analysis of provider reimbursement rates was part of that study and recommended that rates should be set at the Medicare level.
A group of stakeholders, including hospitals and health plans, voiced opposition to the public option legislation. In a letter to the committee, the group argued that the study “does not express the full cost of creating, administering and providing necessary technological support for this new state government program.”
The legislation, HF 4778 (Wiklund, DFL – Bloomington), is supported by organized labor and trade unions, who argue that a public option would significantly reduce underinsurance and offer an affordable option to Minnesotans who are currently forced to purchase high deductible plans to reduce premium costs.
Firearm Safety Bills Pass House Floor
On April 29, 2024, the Minnesota House of Representatives passed legislation that would require a person whose firearm is lost or stolen to report it to law enforcement within 48 hours of the loss or theft. Not doing so the first time would result in a petty misdemeanor, with greater penalties for future failures.
“Lost and stolen firearms are an appealing source of firearms for people who are illegally prohibited from owning guns. This is a reasonable gun violence prevention measure,” said Representative Kaohly Vang Her on the House floor.
Opponents argued that the 48-hour reporting requirement would criminalize victims of theft, but the legislation passed on a 68-63 vote.
The House passed two other firearm safety bills this session:
- HF 4300 (Becker-Finn, DFL – Roseville) requires that firearms be secured with a locking device, unloaded and kept separately from ammunition.
- HF 2609 (Berg, DFL – Burnsville) prohibits the “ghost purchase” of a firearm, where one person purchases a firearm and then transfers it to a person who is prohibited from owning it.
What’s next: The bills received committee hearings in the Senate but have not received a floor vote yet.
Legislation Heard to Limit the Dissolution of the Hennepin Healthcare Governing Body
The House Health Finance and Policy Committee heard legislation that would establish explicit criteria and initiate a formal investigation process prior to dissolution of the Hennepin Healthcare System Board of Directors.
The legislation, HF 5441 (Liebling, DFL – Rochester), comes in the wake of the Minnesota Nurses Association (MNA) calling for the disbanding of the Hennepin Healthcare System Board of Directors and for the Hennepin County Board of Directors to take control of the system.
The Minnesota Medical Association, Minnesota Hospital Association and physicians from Hennepin Healthcare shared letters of support for the legislation. Others testified in favor of the legislation, including former Commissioners of Health Jan Malcolm and Edward Ehlinger, MD, MSPH, who cautioned that giving administrative authority over medical decision-making to elected officials who may be subject to political influences would disrupt patient care.
“The county set up the current board structure for a good reason…so there would be a group of folks with the time, ability and relevant expertise, clinical and otherwise, to help provide guidance and governance, on behalf of the county, to this critical institution,” Malcolm said.
The legislation is opposed by MNA members, who testified that Hennepin Healthcare has ignored requests of their workers. Many cited inadequate investments by the administration to address working conditions.
What’s next: HF 5442 was laid over for possible inclusion into the health omnibus bill.
Commerce Omnibus Bill to Include Agreement on Medical Debt
Legislation to protect patients from excessive medical debt for Minnesotans is included in both commerce omnibus bills. Dubbed the “Minnesota Debt Fairness Act,” as a chief priority of Governor Tim Walz, the legislation moved through the legislature as HF 1814 (Reyer, DFL – Eagen)/SF 2770 (Bolden, DFL – Rochester).
The legislation would:
- Prohibit hospitals and clinics from denying patients who need medically necessary care because they have medical debt.
- Prohibit reporting of medical debt to credit bureaus.
- Reduce interest on medical debt from the current cap of 8% to 4%.
- Abolish the current law requiring that married individuals automatically assume their spouse’s medical debt.
An agreement between stakeholders, including the bill authors, the office of the Minnesota Attorney General, health care providers and debt collection professionals was tentatively struck.
The agreed upon language will allow a provider to require a patient to enroll in a payment plan for outstanding medical debt. The payment plan must take information disclosed by the patient regarding their ability to pay into account. Before entering into the payment plan, a health care provider must notify the patient that if they are unable to make all or part of the agreed upon payments, the patient must communicate the patient’s situation to the health care provider and must pay an amount the patient can afford. Therefore, if the patient does not communicate with the provider and is not making payments, treatment can be denied.
What’s next: The agreed upon language will be amended onto SF 4097 (Klein, DFL – Mendota Heights), the commerce omnibus bill. That bill is currently being heard in a conference committee.
Posted by: Emie Buege, MAFP social media manager