Transcript Legislative Changes Impacting Healthcare in Minnesota

Legislative Changes Impacting
Healthcare in Minnesota
Tom Poul, Messerli & Kramer P.A.
Dave Renner, MN Medical Association
2014 Session Overview
• Convenes Tuesday, February 25 at 12:00 Noon
▫ Must adjourn Sine Die by May 19, 2014
• Capital bonding year (non-budget)
• All DFL House, Senate and Governor’s Office
• House and Governor up for election November
2014
2014 Session Overview
• House Health & Human Services Policy Cmte
▫ Rep. Tina Leibling (DFL), Rochester
• House Health & Human Service Finance Cmte
▫ Rep. Tom Huntley (DFL), Duluth
• Senate Health, Human Services & Housing Cmte
▫ Sen. Kathy Sheran (DFL), Mankato
• Senate Health & Human Service Finan. Division
▫ Sen. Tony Lourey (DFL), Kerrick
ACA Begins in 2014
• MNsure/Health Insurance Exchange
MNsure: What’s the Need?
• 490,000 uninsured Minnesotans
• In MN, only 38.5% of small employers with 1-49
employees offered health insurance (2009-10)
• On average, small businesses pay up to 18 percent
more per worker than large firms for the same
health insurance policy
• January 2014 individual mandate
Sources: Minnesota Department of Health, Health Coverage in Minnesota, Early Results from the 2011 Minnesota Health Access
Survey, March 2012; Minnesota Department of Health, Minnesota’s Small Group Market General Overview, March 2012; The White
House, Report on Small Business and Health Reform, July 2009.
Who Will Use MNsure?
450,000 individuals
(80% with tax credits)
+ 160,000 Small businesses and employees
(2-50 employees; up to 100 after 2015)
+ 690,000 Medical Assistance enrollees
= 1.3 million Minnesotans
Plan Cost-Sharing Features
% of
benefit
covered by
plan
Premium
-25 yr old
-Fam. 4
Out of
pocket
limits
PLATINUM
GOLD
SILVER
BRONZE
90%
80%
70%
60%
$151
$141
$121
$91
$634
$595
$565
$380
$6,050 for individual policies and $12,100 for
family plans (HSA levels, 2012)
Carrot: Federal Tax Credits
• Individuals
▫ < age 65
▫ Between 138%-400% of poverty
 $15,856 - $45,960 (single)
 $22,981 - $94,200 (fam.
▫ Exchange interfaces with IRS data to determine tax
credit eligibility (first year will rely on attestation)
• Small employers
▫ Fewer than 25 FTE employees
▫ Average annual wages below $50,000 and must pay at
least half of the cost of their employee’s health
insurance.
▫ 2014 and beyond: Up to 50% of the employer’s
contribution toward insurance premiums.
Why Does it Matter to Physicians?
• 1 in 5 Minnesotans expected to use Mnsure
• Expect to see more information about clinic cost
and quality published
• Are they in the networks?
Health Care Workforce
• Hospital Staffing Report
▫ Requires hospitals to submit core staffing plans to
the Minnesota Hospital Association by January 1,
2014. Plans will be posted to the MHA Hospital
Quality Report website by April 1, 2014. Direct
patient care reports will also be due to MHA on a
quarterly basis.
▫ Requires MDH to convene a study group to look at
nurse staffing levels and its relationship to patient
outcomes.
Health Care Workforce
• Nurse Licensure Compact
▫ Introduced in previous sessions, but not adopted
in final HHS Omnibus Bill agreements.
▫ Under this bill, Minnesota would join a compact
which would permit multi-state practice for
registered nurses and practical/vocational nurses
who are licensed and practice in compact states.
▫ Twenty-four states are compact members,
including North Dakota, South Dakota, Iowa and
Wisconsin.
Health Care Workforce
• Scope of Practice Issues
▫ Chiropractors
 “Update” of Chiropractic Practice Act
▫ APRN




National model legislation: independent practice
Collaboration vs. supervision
Prescribing; Schedule II narcotics?
Disclosure to patients
Drugs
• Opiate Use/Abuse
▫ Treatment guidelines for acute/chronic pain
▫ Prescription Monitoring Program
▫ Limit who can prescribe? Limit dosages?
• Medical Marijuana
▫ A bipartisan effort to legalize marijuana for
medicinal purposes.
▫ Compassion for ill vs. “war on drugs”
▫ Law enforcement strongly opposed
Public Health Issues
• E-cigarettes
▫ Lack of regulation by FDA
▫ Indoor use?
▫ Advertising bans?
• Tanning beds
▫ Indoor tanning increases risk of melanoma 75%
▫ Prohibit tanning beds for minors
General Health Care Issues
• Surgical Technologists Qualifications/CE Req’s.
▫ Legislation introduced in 2013 would establish
education and certification standards.
▫ Current surgical techs would be grandfathered in,
and provides an exemption for licensed
practitioners.
General Health Care Issues
• Market Restrictions
▫ Cancer radiation: moratorium on non-hospital
radiation therapy facilities in the Twin Cities
metro area extended through the year 2020.
▫ Extends the radius of how close new facilities are
to existing ones—from seven to 15 miles.
Health Care & Tax Issues
• MnCare Funding Adequacy
▫ Study of the provider tax and its relationship to
the long-term solvency of the health care access
fund. They will then determine the amount of
state funding required after December 31, 2019.
Health Care & Taxes
• Provider Tax Phase-out
▫ 2011 start of phase-out?
▫ If determined that the HCAF balance is greater than
125% of the need, the commissioner must reduce the
provider tax rates to reduce the structural balance in
the fund.
▫ On December 31, 2019, the MnCare provider tax
ends.
▫ Likelyhood?
Health Care & Tax Issues
• Sales Tax on Cosmetic Surgery
▫ Proposed in 2013 but failed to be adopted into
final Omnibus Tax Bill.
▫ Would have extended the sales tax to cosmetic
surgery and dentistry, hair transplants, cosmetic
injections, cosmetic soft tissue fillers, and other
skin and laser treatments.
▫ Reconstructive vs. cosmetic?
Regulatory Reform
• Workers’ Compensation Changes
▫ Post-traumatic stress disorder a covered
occupational disease.
▫ Cap on legal services fees increased from $13,000
to $26,000.
▫ Increased the max weekly benefit amount from
$850 per week to 102 percent of the statewide
average weekly rate.
▫ Specified that a prevailing charge must be based
on no more than two years of billing data
immediately preceding the service.
Regulatory Reform
• Workers’ Compensation Changes (cont.)
▫ Clarified the commissioner’s rulemaking authority to
specifically address criteria for use of opioids or other
narcotic medications.
▫ The commissioner to establish a pilot “patient
advocate” program for employees with back injuries
considering back fusion surgery. Advocate services are
payable from the special compensation fund.
▫ The commissioner to study the effectiveness and costs
of potential reforms and barriers within the
reimbursement system.
Regulatory Reform
• Workers’ Compensation – Reimbursement Study
▫ DOLI studying cost drivers in the work comp system; will have
recommendations for legislation by December 31, 2013.
Sec. 13. REIMBURSEMENT COST STUDY.
The commissioner of labor and industry shall study the effectiveness and costs of
potential reforms and barriers within the workers' compensation carrier and health
care
provider reimbursement system, including, but not limited to, carrier administrative
costs, prompt payment, uniform claim components, and the effect on provider
reimbursements and injured worker co-payments of implementing the subjects
studied. The commissioner shall consult with interested stakeholders including health
care providers, workers' compensation insurance carriers, and representatives of
business and labor to provide relevant data promptly to the department to complete
the study. The commissioner shall report findings and recommendations to the
Workers' Compensation Advisory Council by December 31, 2013.
EFFECTIVE DATE. This section is effective the day following final enactment.
Regulatory Reform
• No-fault Auto
▫ Updating wage loss: hasn’t been updated since
1985 and currently calculates to less than
minimum wage. Suggested change: $500/week.
▫ Updating funeral expenses: hasn’t been
updated in over 20 years. Suggested change:
$5,000.
▫ Medical cost containment: there is nothing in
statute containing medical costs under no-fault,
making it susceptible to fraud/abuse. Suggestion:
create a schedule of benefits in the no-fault law.
Reimbursement Issues
• Blue Cross/Blue Shield
▫ Transition to EAPG system (Sept. 1 for FOSCs,
Jan. 1 for care system ASCs).
▫ Purpose: provide “equity” to outpatient
procedures by utilizing base rates reflecting costs
of similar providers and procedures.
▫ Challenges: lack of understanding/info; significant
decreases in reimbursement for some ASCs; Tom,
more details/examples?
Thank You!
Tom Poul, Chair of Govt.
Relations Division
Messerli & Kramer, P.A.
525 Park Street, Suite 130
St. Paul, MN 55103
651-228-9757
[email protected]
Dave Renner, Director of State
& Federal Legislation
Minnesota Medical Association
1300 Godward St. NE, Ste. 2500
Minneapolis, MN 55413
(612) 378-1875
[email protected]