HEALTH CARE POLICY

Legislative Session Overview

Examining some health care bills

BY ZACHARY BRUNNERT

Much like the rest of the country, the Minnesota Legislature “returned to office” in a hybrid fashion at the end of January. With the Senate operating mostly in-person, the House’s operations continued to be split in-person and virtual, with floor sessions in-person and committee hearings being held online. As session has progressed, the House announced the further reopening of offices in late March, and in another step towards normalcy, Rathskeller Café reopened their doors in the building. With lawmakers and advocates again filling the halls of the state house, the hustle and bustle has returned to St. Paul.

The state is in the middle of the two-year budget cycle, which runs through June 30, 2023, and projections of the estimated surplus continue to grow. Initially, surplus expectations were around $7.7 billion, but the latest estimate in February forecasted a $9.25 billion surplus. In response to the updates from the Office of Management and Budget, Governor Tim Walz and Lt. Governor Peggy Flanagan released a revised budget plan. Their new proposal includes direct payment to taxpayers, $500 for single filers and $1,000 for those filing jointly, and $215 million to recruit certain frontline health care workers over a three-year period. The so-called “Walz Checks” have received a tepid response from Senate Republicans who would prefer to lower the tax burden on Minnesotans. Their proposal would lower the first tier of the state’s income tax from 5.35% to 2.8%. Additionally, there continues to be jockeying between the chambers on how to distribute payments to frontline workers.

The 2021-2022 biennium has seen over 4,500 bills filed in the House of Representatives, and over 4,200 filed in the Senate. That is a very large number of bills competing for committee time prior to deadlines. For 2022, those deadlines included March 25 for committees to act favorably on bills in their house of origin, the April 1 deadline for committee to act favorably on bills or companion bills that met the requirements of the first deadline, and then the April 8 deadline for committees to act favorably on appropriation and finance bills. If bills meet these deadlines, then it is a sprint to win approval in both chambers before session adjourns on May 23.

Given the breadth of health care bills filed, we’ve outlined some of the topics being discussed by policy makers. Reinsurance: Over five years ago, lawmakers passed the Minnesota Premium Security Plan, a program that partially reimburses health plans in the individual marketplace for high-cost claims to control these costs. This was initially funded with state dollars, but some of that cost has shifted to the federal government after the state received a State Innovation Waiver from CMS. Minnesota estimates that the costs of these individual health plans are roughly 20% less on average than they would be without this program. This session, HF 3717 sponsored by Representative Zack Stephenson and SF 3472 sponsored by Senator Dahmns, Senator Utke, Senator Benson, and Senator Rosen, are moving through the legislature to extend the sunset of this program to 2027. The Senate version of the bill is now cross chambers and in the House having superseded the House bill.

Access to Diagnostic Mammography: SF 989 sponsored by Senator Nelson and HF 447 by Representative Acomb look to expand access to health care services regarding the diagnosis of breast cancer by prohibiting cost-sharing requirements for follow-up diagnostic mammography. This legislation will allow citizens greater access to essential women’s health care at a time when it is estimated that nearly half of annual breast cancer screenings and other diagnostic studies were delayed due to the COVID-19 pandemic and resulting limitations on elective procedures. Prohibitive cost barriers can limit access to these essential follow-up services and a patient’s inability to pay should not prevent them from obtaining a potential lifesaving early diagnosis. This increased ease of access will directly impact the health outcomes of patients by requiring coverage for additional follow-up services at no cost to the patient. White Bagging: Some provider groups are pursing legislation to limit a new payer practice known as “white bagging”. Insurers, in certain cases, have been requiring clinically administered medications, like ones you would find at an infusion center, be dispensed by a pharmacy designated

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by the insurer. Proponents of the bill say this practice contributes to delays in patient care if the shipment of medication is delayed or is received in an inappropriate dosage, and increases costs to patients when billed to their pharmacy benefit versus their medical benefit. Additionally, this practice can lead to drug waste when doses sent by the specialty pharmacy cannot be used by another patient if their treatment regime is changed.

In Minnesota, SF 3265 sponsored by Senator Koran and Senator Klein had an informational hearing on March 7, and the House companion bill, HF 3280 sponsored by Representative Freiberg, had an informational hearing in the House Health Finance and Policy Committee on March 1. These bills look to establish definitions of “clinically administered drugs”, prohibit payers from requiring coverage of these medications as a pharmacy benefit instead of a medical benefit, and prohibits the practice of having to transport these medications to their provider. Nurse Licensure Compact: Efforts are again underway to allow Minnesota to join nearly 40 other states in the Nurse Licensure Compact (NLC), and the purpose of the bill is to allow nurses licensed in one state of the compact to be able to practice in another, although this measure is not without opposition. While SF 2302 sponsored by Senator Nelson is now cross-chambers and referred to the Health Finance and Policy Committee in the House, there will be an uphill climb in the chamber. The bill is opposed by the Minnesota Nurses Association as they state it would lower Minnesota’s high standards of licensure. Proponents of the measure argue that simplifying licensure will increase ease of access for patients in underserved communities. POLST Registry: Known as a Provider Order for Life-Sustaining Treatment, these mobile orders help direct EMS and end of life providers to the wishes of their patients. This differs from an advance health care directive in that a POLST is signed by a provider. The Minnesota Medical Association established the first standardized POLST form over a decade ago, and now efforts are underway to direct the Minnesota Department of Health to establish an advisory committee, consisting of members representing various licensed health care providers, to study the development of a statewide POLST registry. HF 3360 sponsored by Representative Morrison and SF 3339 sponsored by Senator Housley have been filed on this issue, and they will help ensure a patient’s medical treatment preferences are followed by all health care providers. All-Payer Claims Database: All-Payer Claims Databases (APCD) began to first be adopted and implemented over a decade ago, with roughly half of states having some form of data repository, as health care transparency efforts took hold. These databases often include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers and are directly reported to states from insurers. HF 3696 sponsored by Representative Schultz and Representative Elkins, along with SF 3689 sponsored by Senator Nelson aim to add data contractual value-based payments to the mix of data already being collected. Additionally, these bills require the Commissioner of Health to provide a report to the legislature by next February on this data, and in particular, the report must include specific health plan and third-party administrator estimates of health care

spending for claims-based payments and non-claims-based payments for the most recent available year, reported separately for Minnesotans enrolled in state health care programs, Medicare Advantage, and commercial health insurance. The report must also include recommendations on changes needed to gather better data from health plan companies and third-party administrators on the use of value-based payments that pay for value of health care services provided over The 2021-2022 biennium has seen volume of services provided, promote the health over 4,500 bills filed in the House of all Minnesotans, reduce health disparities, and of Representatives, and over support the provision of primary care services and 4,200 filed in the Senate. preventive services. The House version of the bill has been heard in committee. These issues are just some of the myriad of health care related bills being considered this legislative session before adjournment in late May. As each week goes by, the halls of the state house continue to grow fuller and fuller with lawmakers and advocates as the operations behind the legislative process return to business as usual. Zachary Brunnert is the director of state legeslative policy for RAYUS Radiology.