Legislative Update

March 5, 2010

GAMC Veto Override Fails, Compromise Announced Late Friday
Legislators continued to work to find a solution to retain health care coverage for the enrollees of the General Assistance Medical Care program that does not transfer the population into MinnesotaCare.  Two weeks ago, S.F.2168 (Berglin, DFL-Minneapolis and Murphy, E., DFL-St. Paul) passed both chambers with bi-partisan support.  The bill maintained GAMC as a separate program, leveraged some additional federal funding, and significantly reduced payments to hospitals and providers. 

Less than 24 hours after the bill was passed, the Governor vetoed the bill and sent frustrated legislators back to the drawing board.  The Senate quickly voted to override the Governor’s veto, achieving the two-thirds vote needed.  On Monday, March 1^st, the House attempted and failed to override the veto with a strict party-line vote that fell three votes short.

Disenrollment notices are now being sent to enrollees, who on April 1^st will be auto-enrolled in MinnesotaCare.  The Governor and legislative leaders are still working to find a solution the Governor will sign, though they are far from finding a compromise. 

Also this week a new law suit was filed on behalf of GAMC recipients challenging the Governor’s unallotment authority.  This case is based on the same arguments that are already being reviewed by the state Supreme Court.  If that case is successful, it would just delay the elimination of GAMC by one more month when funding runs out.

Late Friday afternoon, Governor Pawlenty, Sen Linda Berglin, and Rep Erin Murphy announced they had reached an agreement on GAMC that will keep the current program going through May 1, 2010.  Then starting June 1^st, care will be required to be provided by new Coordinated Care Organizations (CCO).  These CCOs will be paid a flat rate to provide all the needed care to GAMC recipients.  The 15 hospitals that have the highest volume of GAMC revenue must establish CCOs to provide health care services to individuals who are now eligible for GAMC.  CCOs are very similar to state and federal proposals to create Accountable Care Organizations (ACOs).  An enrollee would choose or be assigned to a CCO to receive their GAMC care.  All care - inpatient, outpatient, preventative, etc – would be required to be provided at the assigned hospital or system in order to be covered. 

The compromise agreement still relies on large payment cuts to providers, but it maintains basic coverage to our lowest-income citizens and it funds most of the program out of the General Fund.  This agreement will not result in the Health Care Access Fund going broke as was the case under Governor Pawlenty's proposal. 

State Budget Forecast Slightly Improves Outlook
The state’s February economic forecast was released on March 2 and showed a $209 million improvement from the December forecast.  The current deficit legislators will have to budget for is $994 million in the red, down from $1.2 billion.  While the state may have a slightly smaller budget problem to fix this session, the deficit for the future was projected to be even greater.  The projected deficit for fiscal years 2012-2013 grew from $5 billion to $5.8 billion.

Minnesota Management and Budget Director Tom Hanson said that most of the improvement is related to an increase in federal Medicaid matching dollars for health care reimbursements.  Unfortunately, legislative leaders have been unwilling to commit to allow cuts to health and human service programs to be $209 million less as a result. Many legislators have their fingers crossed waiting for additional funds that could come as part of federal health care reform but time is running out.

Chiropractic Practice Act Changes Not Moving this Year
As reported in the last MAFP Legislative Update, the Minnesota Chiropractic Association (MCA) has introduced legislation to amend the chiropractic practice act. H.F.3167 would dramatically expand the scope of practice of chiropractors and allow use of the term “chiropractic physician,” currently prohibited by law.  The bill uses vague language to define chiropractors’ scope of practice, saying chiropractors could perform clinical, physical, laboratory, and other diagnostic measures, including all types of diagnostic imaging.  Chiropractors could also perform rehabilitative therapies, conduct health screenings, physical examinations, and counseling.

Many of you provided feedback with your concerns with this bill.  I met with the Senate author, Sen. Kathy Sheran (DFL-Mankato) and representatives of the MCA to express our concerns.  Following the meeting, it was agreed that the bill had a number of problems that needed addressing and that the bill would not be provided a hearing this year.  The MAFP may be asked to meet with the MCA over the interim to discuss whether it was possible to reach agreement on some of these issues.  Stay tuned.

2010 Birthing Center Bill Much Improved
Last session, legislators considered a bill to license birthing centers in the state and to create a presumption that women with low-risk pregnancies on public programs would deliver in an independent birthing center.  The MAFP opposed that legislation.

This session, legislators resume their push for regulation of independent birthing centers but with a much more reasonable approach.  H.F.3046 (Ruud, DFL-Minnetonka) and S.F.2702 (Berglin, DFL-Minneapolis) requires licensure for non-hospital based birthing centers and specifies that to be licensed, the birthing center must be accredited by the Commission for the Accreditation of Birthing Centers (CBAC) and have a process for determining risk status.  This year’s bill does not include language directing women in any particular population to deliver in the setting.  During testimony, the committee was asked to consider whether or not these practitioners would have medical malpractice insurance, what professional organizations would decide what constitutes low risk deliveries and who would do the new born exam. 

The Minnesota Chapter of the American College of Obstetrics and Gynecology (ACOG) and the MMA support this year’s bill.  The MAFP Legislative Committee has reviewed the legislation and does not oppose it.  Two birthing centers have opened in Minnesota and another is scheduled to open this spring.  It is felt that licensing is needed to assure some form of minimal patient protections for the health of the mother and baby.

ADHD Diagnosis Authority Expanded
A bill to expand the list of licensed professionals qualified to diagnose attention deficit disorder or attention deficit hyperactivity disorder for the purpose of identifying a child with a disability in a school setting has advanced.

Currently, physicians, advanced practice nurses and licensed psychologists are designated as mental health professionals who are allowed to make the diagnosis to begin the process for children within the school setting.  H.F.2995 (Tillberry, DFL- Fridley) adds psychiatric nurses, Licensed Clinical Social Workers and Marriage and Family Therapists as long as they also have 4,000 hours of post-masters supervised experience in the treatment of emotional disturbances or the delivery of clinical services in the treatment of mental illness.

The Senate version, S.F.2708 (Lynch, DFL-Rochester) is similar but the expansion does not include Marriage and Family Therapists. The bill has passed the relevant health policy committees in both bodies and will now be considered by the House and Senate education committees.

Creation of HIT Interchange on the Horizon
The Department of Health is pursuing legislation to establish statewide standards for electronic medical record information exchanges.  The bill would create an oversight board and certification process for organizations acting as health data exchanges in Minnesota.  All exchange vendors would be required to be certified.

The purpose of the bill is to facilitate the creation of the infrastructure needed to meet the Legislature’s mandate that Minnesota have a statewide system for interoperable electronic health records (EHR) by 2015.  It will also allow providers to meet the federal requirements for “meaningful use” of EHR.  The bill will require providers to use EHR systems certified by the Office of the National Coordinator pursuant to the federal  HITECH Act that passed Congress last year.  H.F.3279/S.F.2974 authored by Rep. Tom Huntley (DFL-Duluth) and Sen. Tony Loury (DFL-Kerrick) passed the respective Healthy Policy Committees but has a number of other committees to pass before the deadline.

Modifications to Mandatory Reporting Requirements for Pregnant Women Likely
Current law requires physicians to report pregnant women who use drugs and alcohol “excessively or habitually” to county social services.  This was passed two years ago to address growing concerns about fetal alcohol syndrome.  The Minneapolis Public Health Department has seen a drop in women receiving prenatal care over concerns about existing mandatory reporting.

HF3059 (Ruud, DFL-Minnetonka) amends the current mandatory reporting requirement to exempt providers from reporting a woman’s use or consumption of marijuana or alcoholic during pregnancy if the physician or other health care professional is aware that the woman is receiving prenatal care.  While the bill proposes to modify mandatory reporting, health care providers will retain the ability to make the report at their discretion if necessary.

The bill is making its way through the committee process with little opposition.

Childhood Obesity Legislation Moving with Broad Support
Legislation to increase physical activity among school students, H.F. 3115, authored by Rep. Kim Norton (DFL-Rochester) and S.F. 2753 authored by Sen. Terri Bonoff (DFL-Plymouth) encourages physical activity in schools and requires quality physical education.  The bill would establish statewide standards for quality physical education; help parents be informed of school health and wellness policies by requiring they be posted on school district web sites; require the development of quality recess guidelines by the Department of Education and asks the Department to track the amount of physical education offered; and create a Healthy Kids Awards program to encourage integration of physical activity into nonphysical education classes, recess, and other activities throughout the day to help children get the recommended 60 minutes per day of physical activity each day.

The bill passed the House Education policy committee on March 2^nd and the Senate Education Policy Committee on March 3^rd with enormous support. Next up are the respective Education Finance committees in each body.

Additionally, the Senate Transportation committee has passed the Complete Streets bill (S.F. 2461, Lourey- DFL-Kerrick). The bill intends to promote more opportunities for walking and physical activities by asking transportation planners and engineers to consistently design and alter the right-of-way with all users in mind.  When streets are safe for walking and biking, more people can choose to incorporate physical activity into their lives. 

- Dave Renner, MAFP Legislative Representative
(drenner@mnmed.org, 612-362-3750, 1-800-342-5662)