Legislative Update

February 29, 2008

Health Care Reform Debates Start in Earnest
The legislation resulting from the Governor’s Health Care Transformation Task Force and the Legislative Commission on Health Care Access has now been introduced.  In the Senate, SF 3099 has been introduced by Sen. Linda Berglin (DFL-Minneapolis) and in the House, HF 3391 has been introduced by Rep. Tom Huntley (DFL-Duluth).  Both of these bills are designed to bring “transformational” reform to our health care system in the areas of insurance reform, payment reform, marked transparency, and public health improvement.

Hearings on both bills began this week.  Both bills focus on chronic disease management, implementing a medical home model for care, increased payments for primary care services, and expanding eligibility for MinnesotaCare to ensure that health care is affordable for low-income Minnesotans.  All of these aspects are very positive for MAFP members.  There are many questions, however, with other parts of the bills, specifically related to some of the proposed payment reforms.

In the House, the payment reform is focused on two areas.  What is referred to as Level 1 payment, is a focus on increased payment incentives related to the provision of high quality care.  These are similar to the pay-for-performance programs that many payers are currently using in the market.  The second reform, referred to as Level 2 payment, is the medical home model (the House bill refers to this as a “Health Care Home,” but the concept is the same.)  While the direction of this proposal is consistent with the MAFP’s work, the specificity of the language may cause some problems.  The language would require the following for a clinician to be certified as a health care home:

Each patient in a health care home would have an ongoing, long-term relationship with a personal clinician to provide first contact, continuous, and comprehensive care.

• The clinician shall coordinate care across all provider types and care locations.

• The health care home must provide or arrange access to care 24-hours a day, seven days a week.

• The health care home must encourage the patient to actively participate in decision making.

• Care delivery must be facilitated by the use of health information technology.

• The health care home must meet process, outcome, and quality standards.

• The health care home must complete a comprehensive health assessment for each enrollee.

• The health care home must employ care coordinators who are nurses, social workers, or other clinicians, to manage patients with complex or chronic conditions. 

The bill would provide a care coordination fee of no more than $50 per person per month to pay for the medical home activities.

The Senate bill has similar language on both Level 1 and Level 2 payments.  In addition, it proposes a Level 3 payment.  This is one of the more controversial portions of the bill.  It would establish a system where providers submit bids to the state “for the total costs of providing care” to a set group of patients.  The bill would allow integrated systems to bid on all aspects of care, and it would allow individual providers to bid only on their portion of care and that would be combined with other clinics bids to determine the total cost of care.  The proponents of this program argue that this is the real reform of the bill and that it is designed to allow innovative payment methods that will reward providers for keeping patients healthy and out of the hospital.  Critics argue that it sounds very similar to a return to capitation and providers accepting insurance risk.  There are many unanswered questions about how this will work in the real world.

The Senate bill also includes a new Public Health Improvement Assessment that will be levied on hospitals beginning June 1, 2009.  The 0.2 percent assessment on patient revenues is being promoted as a way to recapture the savings that the bill expects to achieve.  The new tax has also become very controversial.

There is a bipartisan effort to move health care reform forward this year.  The bills will be heard in a half dozen committees over the next two weeks as they try to pass something this year.  The MAFP will be actively participating in the discussions related to medical home, care coordination, the need for more family physicians, and payment reform.

New Budget Numbers Show Larger Deficit
Last November the Minnesota Department of Finance announced its budget forecast showing a $373 million deficit for the remainder of the biennium that ends June 30, 2009.  This forecast showed that the slowing economy was having a negative impact on the state’s budget and that the Legislature would have to act to address the problem.

This Thursday, February 28, the Department of Finance announced its updated February forecast that shows the deficit is growing.  It is now projected that the state budget will have a deficit of $935 million by the end of the biennium.

This is very concerning.  Historically, whenever the state has had a deficit for which budget cuts were needed, a disproportionately high level of those cuts have come out of the human services part of the budget.  This has meant cuts to provider reimbursement levels, cuts to eligibility levels for low-income health programs, and increases in co-pay levels for patients who can’t afford them.  In addition, we are worried that funds like the Health Care Access Fund, where the provider tax revenues are deposited, will be considered as a way to balance the budget.  The HCAF is running a surplus of over $330 million.

The growing deficit also makes it much harder for the Legislature to adopt the health care reforms they want.  While the goal of the health care reform is to cut health care spending, many of the proposals, like the medical home idea, require some upfront investments to achieve long-term savings.

Naturopath Registration
Legislation is moving that would register doctors of naturopathy who have graduated from an accredited school of naturopathy.  Part of the purpose of the bill is to distinguish for consumers the difference between a trained naturopath and someone who calls themselves a “traditional naturopath.”  The other purpose of the bill would be to provide more credibility for naturopathy and to begin to define their scope of practice. 

The bill, HF 1724 (Walker-DFL, Minneapolis) would register naturopaths under the Board of Medical Practice.  It is designed to allow them to be registered without expanding their scope from what they currently are doing without registration.  In committee this week, the bill was amended to remove their ability to prescribe legend drugs, to provide natural childbirth services, and to remove their request for diagnostic authority similar to physicians.  With that amendment, it was passed out of the House Health Licensing Subcommittee.  The Senate version of the bill has not been heard yet.

Pharmacist Administration of Immunizations
Legislation promoted by the Minnesota Pharmacists Association would expand on the authority pharmacists currently have to administer influenza and pneumococcal vaccines to adults. 

The original version of the proposed bill would have allowed pharmacists to administer all approved immunizations to all patients.  The MAFP and MMA strongly objected to this broad authority, especially for children.  There is very little data that shows that expanding access points for immunizations has any impact on improving immunization rates for kids.

Based on this opposition, the proposal has been scaled back to allow pharmacists to administer all recommended vaccines to adults, and influenza vaccines to children age 10 and over.  The MAFP Legislative Committee is comfortable with this change, with the assurances that pharmacists will be submitting immunization data to the statewide immunization registry.  

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