Minnesota Academy of Family Physicians (MAFP) lobbyist Dave Renner, CAE, shares an update on the 2024 legislative session, including the status of bills on prior authorization, a “public option,” medical assistance reimbursement rates, insurance coverage, physician wellness and a proposed ban on flavored tobacco products.
Bills must pass through all non-finance committees by March 22, 2024, to be considered “alive.” Bills that don’t meet that deadline must get attached to another bill or they are “dead” for the year.
The final committee deadline is April 19, 2024, for omnibus finance bills. After that date, most legislative committee work is done and work shifts to floor sessions and conference committees. This all leads to the required adjournment date for the Minnesota Legislature of no later than May 20, 2024.
Public Option Bill Heard in Senate Committee
Senate File 4778 (Senator Wiklund, DFL – Bloomington) was heard in the Minnesota Senate Health and Human Services Committee on March 14, 2024.
The bill, referred to as the “public option,” would expand eligibility for MinnesotaCare, allowing anyone to buy coverage via a public option on MNsure (effective January 1, 2027). The proposal implements elements of a report by the Minnesota Department of Commerce, which examined possible implementation of a public option and included actuarial analysis of provider reimbursement rates (set at Medicare rates).
Supporters of the public option argue that it is needed to address the problem of underinsurance caused by patients purchasing high-deductible products that do not provide adequate coverage. Opponents argue that adding more Minnesotans to public programs that pay low reimbursement rates will increase financial pressures on clinics and hospitals.
The MAFP submitted a letter of support for the bill. MAFP President Bob Jeske, MD, wrote, “[Family physicians] see firsthand how barriers to care impact our patients who are uninsured and underinsured. Patients are delaying or foregoing care out of fear of the cost, causing conditions to worsen before care is sought. Obviously, this leads to more suffering, worse outcomes and an overall increase in the cost of care.”
The bill was laid over for possible inclusion in the Minnesota Senate Health and Human Services omnibus bill.
Medical Assistance Reimbursement Rates Discussed
The Minnesota Senate Health and Human Services Committee also heard a bill to update the Medical Assistance reimbursement rates for physician services and mental health services.
Introduced by Senator Wiklund (DFL – Bloomington), the bill will…
- Raise the Medical Assistance reimbursement rate for physician services to 100% of the Medicare payment rate.
- Implement an annual adjustment similar to the Medicare payment updates.
Committee members expressed support for the need to increase reimbursement rates for these services, and concerns were shared about providers being able to continue to participate in public programs if the rates are not increased. However, it is unclear whether there is support to find the money needed to pay for an increase, especially since this is a non-budget year.
This bill was not acted on, but will be discussed if there is a supplemental budget bill.
Prior Authorization Bill Receives Bipartisan Support in Senate Committee
Senate File 3532 (Senator Morrison, DFL – Deephaven) received strong bipartisan support in a hearing on March 13, 2024, before it was laid over for future inclusion in a committee omnibus bill.
The legislation…
- Prohibits prior authorization for services where a delay in care may lead to serious negative patient health outcomes, including 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).
- Prohibits prior authorization on preventive health services, generic drugs and biosimilars.
- Requires health plans to submit data reports to the Minnesota Commissioner of Health and maintain an automated process for prior authorization.
Proponents of the legislation, including medical societies, hospital systems, patient advocacy groups and other provider groups, testified that prior authorization causes delays in care which leads to negative health outcomes. This is supported by national data from the American Medical Association, showing that 89% of physicians report that prior authorization has had a negative effect on patient clinical outcomes and one in three physicians say that prior authorization has led to a serious adverse event for a patient.
Opponents from the Minnesota Council of Health Plans, Pharmaceutical Care Management Association and for-profit insurers continue to argue that prior authorization is a necessary tool to protect patients from unnecessary costs and potentially dangerous or unnecessary treatment.
The legislation was laid over for inclusion in a future omnibus bill while the committee awaits the official fiscal note which will show what the costs will be to state agencies to implement. The bill will have no other committee stops until the omnibus goes to the Senate Finance Committee, and then the Senate floor for a vote.
The Minnesota House companion bill, House File 3578 (Representative Bahner, DFL – Maple Grove), is in the Commerce Committee and needs to be acted on to be sent to the House Health Finance and Policy Committee. This action must be taken before the first bill deadline on March 22, 2024.
MAFP Supports MN Building Families Act
Legislation to mandate insurance coverage for treatment of infertility, including coverage for in vitro fertilization, referred to as the Minnesota Building Families Act, passed out of the Minnesota House Commerce Committee on March 3, 2024. House File 1658 (Representative Brand, DFL – St. Peter) would require every health plan that provides maternity coverage to cover infertility diagnosis and treatment.
The MAFP submitted a letter of support for the bill: “House File 1658 ensures the opportunity for families to preserve their fertility without having to forego lifesaving medical care like cancer treatments. [Family physicians] also recognize the Minnesota Building Families Act provides us with an opportunity to challenge racial disparities in medical care by reducing the financial impact of fertility treatment for BIPOC families, who are disproportionately affected by infertility as well as the largest percentage of Medicaid recipients. All Minnesotans should have access to reproductive health care” (MAFP President Bob Jeske, MD).
Senate Committee Heard Bills on Insurance Coverage of Post-Partum and Gender-Affirming Care
The Minnesota Senate Commerce Committee heard several bills on March 7, 2024, on additional insurance coverage.
Senate File 3511 (Senator Mann, DFL – Edina) mandates that all insurers:
- Provide coverage for services for prenatal, delivery and postpartum periods for a mother and infant and extends the duration of postpartum care to a year, plus prohibits cost sharing for all required services associated with this care.
- Cover the transfer of a mother, newborn or newborn siblings to a different medical facility when one of them requires a medically necessary transfer.
Senate File 2209 (Senator Dibble, DFL – Minneapolis) requires coverage by insurers of gender-affirming care. The MAFP and Minnesota Chapter of the American Academy of Pediatrics support this initiative. In 2023, Minnesota became one of the few states in the region offering legal protections to patients and health care providers engaged with gender-affirming care.
Both bills were referred to the Senate Health and Human Services Committee.
Physician Wellness Legislation Moves
A bill to improve physician wellness received its first committee hearing on March 7, 2024. Senate File 3531 (Senator Morrison, DFL – Deephaven) was heard in the Minnesota Senate Health and Human Services Committee where it received overwhelming support and passed with a unanimous vote.
The legislation has four portions:
- Prohibits health system credentialing applications from inquiring about an applicant’s past health conditions.
- Creates a program through which physicians can seek and obtain confidential care for career fatigue and wellness.
- Develops a statewide wellness recognition program to publicly recognize Minnesota health care institutions that have committed to creating and sustaining positive work environments that prevent burnout, foster professional well-being and support quality care.
- Includes a one-time investment in a statewide campaign to educate the health care workforce about the importance of clinician well-being, encourage physicians to get care when needed and reduce the stigma of mental health treatment.
The bill’s chief author Senator Kelly Morrison, MD, said, “Our physicians are in trouble. Burnout for health care professionals is a real problem that is getting worse.” Morrison went on to cite that 6 in 10 physicians have felt inappropriate levels of anger, tearfulness or anxiety—symptoms of burnout; 1 in 3 have felt hopelessness or that they have no purpose; and more than half know a physician who has considered, attempted or died by suicide.
Family physician Michelle Chestovich, MD, also testified, “Burnout has many causes, such as lack of staffing, interference from insurers and pharmacy benefit managers on practice decisions, the growing lack of trust in science—there is no one solution to the problem, but we must start to address it. My younger sister, Dr. Gretchen Butler, died by suicide. Burnout and sleep deprivation contributed to her death.”
The bill passed and was referred to the Minnesota Senate Judiciary Committee. It has yet to receive a hearing in the House.
Proposed Ban on Flavored Tobacco Products
Legislation to ban the sale of flavored tobacco and nicotine products was heard in the Minnesota House Health Finance and Policy Committee on March 5, 2024. The bill, House File 2177, is authored by Representative Ethan Cha (DFL – St. Paul).
Minnesota has seen the sale of flavored tobacco products grow in recent years, and tobacco companies have increased their marketing of flavored products, such as electronic cigarettes, cigars, smokeless tobacco and hookahs. Colorful packaging and sweet flavors have enticed new users, particularly kids, and this new market for flavored tobacco and nicotine products is hindering efforts to reduce youth tobacco use. According to Minnesotans for a Smoke-Free Generation, two-thirds of current high-school tobacco users in Minnesota reported using a flavored product.
According to the American Lung Association, 75% of youth choose flavored tobacco (35% smoke menthol and 40% smoke other flavors). Recent reports issued by five leading public health organizations also found that flavoring increases experimentation among youth, and young people who initiate using are more likely to become addicted and long-term daily smokers.
Commercial tobacco remains the leading cause of preventable death and disability in Minnesota with significant disparities for individuals with mental health and/or substance use disorders. For decades the tobacco industry has targeted this population—now 40% of all cigarettes sold in the U.S. are purchased by people with a mental health or substance use disorder.
Additionally, national data from the Centers for Disease Control and Prevention recently reported that e-cigarette use has increased by 46% in just two years (2020-2022), driven by increased sales of kid-friendly flavors. Young adults with serious mental health conditions use menthol tobacco products at disproportionately high rates.
The bill was referred to the Minnesota House Commerce Finance and Policy Committee.
