Legislative Update

February 19, 2008

The 2008 Minnesota Legislature is off and running and health care reform is front and center. 
Tuesday February 12, at 12:00 noon both the Senate and the House gaveled themselves to order to begin what most people are expecting to be a short, but busy legislative session.   2008 is the second year of the biennial session there is no requirement to pass a budget bill, however, the state is facing a projected deficit of $373 million so there will most likely be a supplemental budget bill to address that shortfall.

The two top priority issues being discussed is the passage of a bonding bill for the state’s capital improvement projects and passage of a transportation finance bill for roads and bridges. 

Health Care Reform
In addition to these two priorities, there is a significant amount of discussion of reforming our health care system.  Governor Pawlenty, in his State of the State address delivered last week, mentioned comprehensive health care reform as one of his priorities for the 2008 session. 

Over the summer months there have been two work groups meeting to discuss health care reform.  The Governor’s Health Care Transformation Task Force has developed a series of reforms to change how we fund health care.  ( Their final report can be found at http://www.health.state.mn.us/divs/hpsc/hep/transform/ttfreportfinal.pdf.) Their reforms are based on the need to change the funding incentives to better care for those with chronic disease.  They emphasize the development of the medical home and clinic-based chronic disease management.  The report highlights the need for more family physicians and other primary care physicians and then need to increase the pay for the services provided by family physicians.

The other work group is the Legislative Commission on Health Care Access.  The 10 member commission has also developed recommendations that are very similar to the Governor’s task force.  They also emphasize the need for more family physicians and a strong emphasis on chronic disease management.  (Their final report can be found at http://www.commissions.leg.state.mn.us/lchca/HCAC%20Report%20final%202-08.pdf.)

Currently, legislation is still be drafted to implement these recommendations.  The plan is for a draft bill to be ready by next week with hearings starting soon after that.  While many of the recommendations are favorable to family physicians, there are some that cause concern.  Both reports discuss providers transitioning into entities that would submit annual bids for the total cost of care for the population they serve.  This language sounds very similar to the concept of providers accepting insurance risk through capitation payments.  There are many questions on how this would work for smaller providers or those in rural areas where very little competition exist.  The MAFP is sharing these concerns with legislators as these proposals are developed.

Physical Therapy Compromise Reached
For the last three years the Minnesota Physical Therapy Association has been pursuing legislation to allow physical therapists to have unlimited direct access to patients without the need for any physician referral.  Current law allows direct access for 30 days, but if there is not improvement they must refer the patient to a physician.

The MAFP has opposed this bill because of the concern about a misdiagnosis by the physical therapist.  While physical therapists are an important part of a health care team for muscular-skeletal conditions, they are not trained to diagnose or treat other conditions that may show as muscle pain.

A compromise was reached on this bill last week.  The new version of the bill will extend the 30 days to 90 days of direct access, and it will retain language requiring a consultation with the referring physician if the physical therapist modifies a treatment plan.  The compromise does allow unlimited direct access to physical therapists for services related to prevention, wellness, education, and exercise.  This new version passed out of the House Licensing Subcommittee last week with no opposition.

Pharmacists’ Administering of Vaccines
Legislation proposed by the Minnesota Pharmacists Association would expand a pharmacist’s authority to administer all recommended vaccines for age 10 and above.  Currently pharmacists have the authority to administer adult influenza and pneumococcal vaccines.

The MAFP Legislative Committee reviewed this proposal and expressed concerns about the expansion, especially for children.   There is some data that shows that expanding the sites where adult vaccines are provided does improve vaccination rates, but there does not seem to be similar data for children.  In addition, when a child comes in for a vaccine it is a good time to provide other needed services.  Based on these facts, the MAFP Board voted to oppose this expansion for children under age 18, but not oppose the expansion for adults.

The bill is still being drafted and has not been introduced yet.

Day at the Capitol – March 6
Thursday, March 6, 1:30 to 4:30 p.m.  Participate in the legislative process, hear from key health care policy makers, meet with legislators to impact the care you provide to patients.  To register, call (612) 362-3764 or (800) 342-5662 or go to www.mmaonline.net.

Legislative Updates
The MAFP is starting a bi-weekly electronic member newsletter that will include a link to Legislative Updates on the MAFP website.  If you would like to receive Legislative Updates by mail, please contact the office at 952-542-0130 or 1-800-999-8198.

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