Legislative Update

May 12, 2009

The Legislature has moved into the final days before the constitutionally-required adjournment date of Monday, May 18.  Unfortunately, the Governor and legislative leaders have not yet reached agreement on budget items.  In order to avoid a special session, a global agreement with the Governor would need to be reached by the end of this week to allow sufficient time to process bills and complete their work on time. While this seems unlikely right now, it is still entirely possible.  Stay tuned.

Child Passenger Safety Passes House
The child passenger safety (booster seat) bill (SF99) has passed its final hurdle and could become law by the end of the week.  Previously passed by the full Senate, the bill passed the full House this evening overwhelmingly 85-42.  Next, the Senate will need to either accept the changes made by the House or reconcile difference in conference committee.

The Governor has said he will sign the bill.

Newborn Screening Bill Still Stalled in the Senate
The newborn screening bill is set for a full House vote on the House floor but has stalled in the Senate waiting for one last hearing.  The Department of Health needs this bill to pass this session so they can maintain this critical program and step up parent and provider education about the program.

Please contact your legislators and Gov. Tim Pawlenty to urge them to support a bill that will protect Minnesota’s newborn screening program.  This life-saving program has been under siege once again this session by privacy zealots so legislators need to hear from you about the importance of this program for children’s wellbeing.

Please click here to send an email urging your lawmakers to protect this life saving program.

First Omnibus HHS Bill Passes
The big news this week is that the House and Senate completed work on their Health and Human Services Omnibus bill conference report early Sunday morning after a full week of work concluded with a 20-hour sprint to the finish.

This bill passed both bodies this afternoon but the Governor is expected to veto the bill immediately because the reductions are substantially less than he proposed.  Nevertheless, the contents of the bill are still important as this will become the base for the second bill.

Following is a summary of relevant provisions:

Article 4, Department of Health

Health Information Technology

• Requires the uniform standards to be updated on an ongoing basis and an annual report to the legislature.

• Requires the electronic health record to be a “qualified electronic health record”—makes other changes to conform to federal law.

Prior Authorization and Uniform Formulary

The bill requires the Commissioner of Health in consultation with the Administrative Uniformity Committee at the Department of Health to develop, by July1, 2009 or in six weeks from adoption of this section, a uniform prior authorization and formulary exception form.  All group purchasers must accept this form (including part D) or by phone.  An electronic system must be in place by January 1, 2011.  Effective January 1, 2011, the uniform drug authorization must be accessible by health care providers, and accepted and processed by group purchasers, electronically through a secure Internet site. 

Article 5, Health Care

Outreach Grants

The bill adds outreach, targeting geographic areas with high rates of families with un-enrolled children and racial and ethnic minorities with health disparities.

School District Enrollment and MA Billing 

• Requires public and charter schools to comply with state health care program outreach requirements. 
• Requires districts to have the applications available, maintains current law requirement that schools designate an enrollment specialist, and requires districts to have a link on their web site on how to obtain an application and enrollment assistance. 
• Allows the commissioner to use an interim rate and then a settle up payment.
• Establishes an open enrollment process for MinnesotaCare that is tied to the public education system.
• Establishes a “fast lane” process that would blend MinnesotaCare and Free and Reduced lunch applications.

Urgent Dental Care Services

• Establishes pilot programs to reduce the total costs to the state dental services provided to persons through emergency rooms.
• Establishes a subcommittee to the health services policy committee to advise the commissioner on criteria for critical access, coverage, delivery models, and services to be added or eliminated.
• Defines a limited number of services that will be eligible for dental coverage for non-pregnant adults

Health Services Policy Committee

The bill asks the Health Services Policy Committee within the Department of Human Services to study reimbursement based on patient-centered decision making, recommend ways to reduce variation for high cost specialty services where there is a high variation in utilization across physicians, and recommend best practice policies to minimize Cesarean births, including standards and guidelines for health care providers and health care facilities.

No Payment for High Cost/Low Quality Providers

The bill directs the Commissioner of Human Services, by January 1, 2011, to establish performance thresholds for providers included in the provider peer grouping system developed by MDH.  Effective January 1, 2012, any provider with combined cost and quality scores below the threshold shall be prohibited from enrolling as a vendor in state health care programs.  It is unclear whether this would also prohibit the provider from treating state employees.

Colorectal Screening

The bill extends MA coverage to participants who have been screened by a demonstration project related toe colorectal screening and determined to need treatment.  It allows State-only funded MA to paid for individuals screened by the demonstration project and sunsets the project December 31, 2010.

Pharmacy Rate

The bill cuts payment to pharmacies from the Average Wholesale Price minus 14% to the AWP minus 15%.  

Prior Authorization of Diagnostic Imaging

Effective January 1, 2010, the bill requires prior authorization or use of a decision-support tool for outpatient  CT, MRI, MRA, PET, cardiac imaging and ultrasound diagnosis imagining.  It exempts prior authorization for ER, inpatient hospitalization, or concurrent or on the same day as an urgent  care facility visit. 

Eligibility Increases

The bill incorporates a number of eligibility increases for children under 275% of FPG, and also allows children and families to buy MinnesotaCare without restrictions under 200%.  This is intended to allow Minnesota to maximize federal money under the Children’s Health Insurance Program Reauthorization Program (CHIPRA).

COBRA Premium State Subsidy

The bill creates a new state subsidy to help laid-off Minnesotans who would otherwise qualify for our public programs afford COBRA.  It pays 35% of the COBRA premium until December 31, 2010 for people who elect COBRA and are eligible for state government programs.  Combined with the 65% federal COBRA subsidy, it would allow COBRA coverage with no cost to qualifying individuals.

Pilot for Intensive Medication Program

The bill directs the Commissioner of Human Services to establish a pilot project for an intensive medication program for patients with chronic conditions and a high number of medications.

Managed Care Contracts

To help balance the budget, the bill attempts to recapture excess health plan reserves.  Health plans objected to these proposals but legislators were insistent on ensuring they experience their fair share of cuts like other constituencies in the health care arena.  This provision creates a new withhold for health plans and also extends the withhold to county-based purchasers.  The withhold amounts are 3.5% for calendar year 2010, 4% for calendar year 2011, and 4.5% for calendar years 2012 and 2013, and 3%for 2014.

Specialty Provider Payment Ratable Reduction

Effective July 1, 2009, physician and professional services will have a 5% cut for fee for service, and January 1, 2010 for health plans (PMAP).  Certain primary care outpatient services provided by family physicians and other primary care providers are excluded from the cut (procedure codes 99201 to 99215 and codes 99381 to 99412).  PT, OT, chiropractic and other basic care services are reduced by 3% for FFS and for October 2, 2009 for PMAP.

Legislators recognize the need to expand the list of CPT codes and have committed to ensuring all family physician, general pediatric services, geriatrics, general internal medicine, women’s preventative health and family planning are protected from cuts when a final budget bill is completed.

C-Section–Blended Rate

Effective October 1, 2009, the bill requires a single rate for the following DRG’s 371, 372, and 373, consistent in the increase of vaginal deliveries and reduction in C-Sections, such that the reduction in C Sections is less than or equal to one standard deviation below the average in the frequency of cesarean births for Minnesota health plan program clients at hospitals performing greater than 50 deliveries per year.  The bill also establishes blended rate for the professional services related to these codes. 

Article 7, Chemical and Mental Health

Autism Spectrum Disorders Task Force

The bill creates an Autism Spectrum Disorders Task Force composed of 15 members.  Two physicians, one named each by the MAFP and MN-AAP, are included as members of the task force. The Task Force is significantly scaled-back from the original proposal which included 28 members.

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