Minnesota Academy of Family Physicians (MAFP) lobbyist Dave Renner, CAE, shares an update on the 2024 legislative session, including continued movement on prior authorization reform; the release of the updated state budget forecast; and bills on safe storage, scope of practice, licensing international medical graduates and more.
Family Physicians Advocate at Physicians’ Day at the Capitol
More than 80 MAFP members were part of the nearly 200 physicians, resident physicians and medical students gathered at the Capitol in Saint Paul on February 28, 2024, as part of the Minnesota Medical Association (MMA) Physicians’ Day at the Capitol—a day where physicians and physicians-in-training from all specialties came together to advocate for their patients and profession.
Attendees had the opportunity to hear from Senators Kelly Morrison, MD (DFL – Deephaven), and Alice Mann, MD, MPH (DFL – Edina/Bloomington), also an MAFP member, and to meet with state legislators from their districts.
Prior Authorization Reform Receives Another House Hearing
The bill to limit the over-use of prior authorization, HF 3578 (Bahner, DFL – Maple Grove), had its second House committee hearing on February 28, 2024, when it was heard in the Minnesota House Commerce Committee. Because it was Physicians’ Day at the Capitol, the hearing was attended by many physicians and physicians-in-training wearing their white coats.
HF 3578 prohibits prior authorization for services where a delay in care may lead to serious negative patient health outcomes (e.g., mental health, substance-use disorder and cancer treatment); limits prior authorization to one-time only for treatment for chronic conditions, unless the standard of care changes; and prohibits prior authorization on preventive health services, generic drugs and biosimilars.
The committee heard from supporters and opponents. MMA President and MAFP member Laurel Ries, MD, testified and said, “I love being a doctor. The chance to help my patients is what keeps me going every day. But more and more interferences, like prior authorization, are making it more and more difficult to do what I love.”
What happens now/what to expect: The bill was laid over to wait for the official fiscal note, which informs legislators on how much the bill will cost the state government. The Senate Companion, SF 3532 (Morrison, DFL-Deephaven), is expected to receive its first Senate hearing on Tuesday, March 5, 2024.
Updated Minnesota Budget Forecast Released
Minnesota Management and Budget (MMB) released an updated budget forecast on February 29, 2024. This is the forecast that legislators will use to determine how much spending they will approve this session.
At a press event, MMB Commissioner Erin Campbell announced that the state budget surplus has grown to $3.7 billion ($1.3 billion larger than the forecast released in November 2023), but still warned of long-term financial challenges. While the size of the surplus is larger, Campbell cautioned that overall state spending is projected to exceed revenues by $1.5 billion in the years ahead, referencing additional long-term spending following the 2024-2025 state budget deal agreed to last session.
At the event, Governor Tim Walz and legislative leaders called the forecast good news, but indicated they still plan to heed state economists’ calls for restraint in new spending because of concerns about future shortfalls.
What to know: Any legislation that impacts the state budget must be passed by the finance committees of both bodies before the final budget deadline on April 19, 2024.
Safe Storage, Mandatory Reporting Legislation Heard in House Committee
A pair of bills, aimed at reducing firearm-related death and injury, were heard on February 29, 2024, in a joint House hearing of the Public Safety Finance and Policy Committee and Children and Families Finance and Policy Committee.
HF 4300 (Becker-Finn, DFL – Roseville), also known as the “Safe Storage” bill, requires that firearms be secured with a locking device, unloaded and kept separately from ammunition. HF 601 (Her, DFL – St. Paul) would require that a lost or stolen firearm be reported promptly to law enforcement.
The MAFP has long supported firearm safety legislation to reduce rates of death and injury by firearms.
According to the Centers for Disease Control & Prevention (CDC):
- Firearms are the leading cause of death for children in the U.S., surpassing motor vehicle deaths and those caused by other injuries in 2020.
- Suicide is the third leading cause of death among adolescents and young adults, aged 15-24 years, and second leading cause of death among younger adolescents, aged 10-14 years.
- On average, 22 children and young adults die each day from firearm injuries. Many of which are accidental and due to unsecured firearms.
In 2023, the Minnesota Legislature passed two firearm safety bills: universal background checks for firearm exchanges and the authorization of extreme risk protection orders, known as the “red flag” law. Safe storage requirements and mandatory reporting of lost or stolen firearms received committee hearings last session but failed to pass in the Minnesota Senate.
What happens now/what to expect: HF 4300 and HF 601 were passed and re-referred to the House Ways and Means Committee.
Scope of Practice Bills Heard in Senate Committee
On February 21, 2024, the Minnesota Senate Health and Human Services Committee heard a pair of bills that would expand the scope of practice for optometrists and pharmacists. Physician groups shared concerns with both proposals.
Scope of Optometrists
The first bill, SF 659 (Maye Quade, DFL – Apple Valley), lifts existing statutory caps on the amount and type of medications an optometrist is allowed to prescribe, including the prescribing of oral antiviral drugs, steroids and oral carbonic anhydrase inhibitors, and would allow optometrists to perform injections in and around the eye. The bill is strongly opposed by the Minnesota Academy of Ophthalmology.
Senator Alice Mann, MD, MPH (DFL – Edina/Bloomington), offered an amendment to limit the scope expansion that was based on her bill, SF 3758, otherwise known as the Surgery by Surgeons bill. The amendment would limit surgery by optometrists to safeguard against the most concerning health impacts related to surgical procedures involving the eye. The amendment was discussed, but no action was taken on it or the bill.
What happens now/what to expect: SF 659 was laid over for possible inclusion in an omnibus scope of practice bill. The House companion bill has not been heard in a House committee.
Scope of Pharmacists
Another bill would expand the scope of practice for pharmacists, SF 1176 (Hoffman, DFL – Coon Rapids). Originally, the bill proposed expanding the authority of pharmacists and pharmacist technicians to initiate, order and administer vaccinations for children aged three and older. Currently, they are allowed to administer flu and COVID vaccines to age 6 and older and other childhood vaccines to age 13 and older.
While there is support for increasing childhood vaccination rates, there is concern that this legislation will result in fewer well-child visits and interfere with continuity of care. The committee amended the original bill to increase the age of children that pharmacists can administer vaccines to from age 3 and above to age 6 and above.
What happens now/what to expect: SF 1176 was laid over for possible inclusion in an omnibus scope of practice bill. The House companion bill has not been heard in a House committee.
New International Medical Graduate Licensure Legislation Introduced
Senator Alice Mann, MD, MPH (DFL – Edina/Bloomington), has introduced SF 3611 to provide a path to licensure for the hundreds of international medical graduates (IMGs) who have been unable to obtain a Minnesota medical license.
Under current Minnesota law, an IMG is required to have completed at least one year of graduate clinical medical training at an Accreditation for Graduate Medical Education (ACGME)-approved program, which is most often fulfilled through completing residency training in the U.S. Many IMGs are unable to be accepted into a U.S. residency, making it impossible to obtain a Minnesota medical license. This is regardless of how long they’ve been practicing as a physician in another country.
Mann’s legislation would create a limited license for specific IMGs who have “performed the duties of a physician” in another country for at least five years. Individuals would only be allowed to apply for a limited license if they have an employment offer from a clinic or hospital. The limited license would allow IMGs who have not completed a U.S. residency to practice in a rural or underserved urban area under a supervising physician within the context of a collaborative agreement within a hospital or clinical setting. Following the two years of supervised practice, they would qualify for a full Minnesota license.
The MAFP Legislative Committee reviewed the bill and agreed that efforts were needed to allow well-trained physicians from other countries to practice here. The committee did raise a number of practical questions about whether a physician would be able to be credentialled by a health plan or receive malpractice insurance if they were not eligible for board certification. They decided to remain neutral on the bill and continue to work with Senator Mann to address those issues.
What happens now/what to expect: The companion bill was introduced in the House by Representative Liz Reyer. Neither bill has received a committee hearing.
First Overdose Harm Reduction Bill Heard in Senate
A bill to require sober homes to allow the use of medications for opioid use disorder (MOUD) received its first hearing in the Minnesota Senate Human Services Policy Committee. The bill would also increase access to opioid antagonists for sober home residents.
SF 3973 (Mann, DFL – Edina/Bloomington) modifies current sober home requirements to require that opioid antagonists be placed in a conspicuous location, thereby increasing access to a drug that individuals with a history of substance use disorder will benefit greatly from. In addition, the legislation will permit sober residents to have access to MOUD, resulting in sober home residents reducing their withdrawal and cravings; preventing opioid overdose; decreasing use of non-prescribed opioids; decreasing infections secondary to injection drug use; and saving lives.
At the hearing, strong testimony on the importance of the use of MOUD to treat addiction was provided, and proponents argued the bill will “help ensure that Minnesota is in compliance with the Americans with Disabilities Act (ADA), and that we are affording individuals in recovery with the opportunity to seek the care necessary to address a disease that is too often ignored.”
Under the ADA, drug addiction is considered a physical or mental impairment, and the ADA prohibits discrimination against people in recovery from opioid use disorder (OUD). The protections apply to those individuals who are not engaging in illegal drug use. This includes those taking a legally prescribed medication to treat their OUD (e.g., MOUD or medication-assisted treatment).
Opposition to the bill came from sober homes that have a policy of “zero tolerance”
for all drugs inside their facilities, including MOUD, which is an opioid.
The Minnesota Harm Reduction Collaborative is the leading organization advocating for multiple harm reduction bills this legislative session.
What happens now/what to expect: The bill was laid over for future inclusion in an omnibus bill.