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HEALTH CARE POLICY The 2020 legislative wrapup
BY TOM HANSON, JD, AND JOHN REICH
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As the 2020 Minnesota legislative session gaveled in on Feb. 11, it was largely expected to be a quiet term. A balanced, two-year budget had passed the year before, the economy was humming, and, with an anticipated $1.3 billion surplus, there was no must-pass legislation. Passage of a bonding bill for infrastructure projects across the state was expected to be the highlight of the session. The Democratic majority in the House indicated interest in spending the budget surplus on affordable housing and homelessness issues, while the Republican-controlled Senate had hoped to use some of the budget surplus for tax relief. However, with Minnesota remaining the only splitparty Legislature in the country and all 201 legislative seats up for election in the fall, many expected agreement would prove elusive on any controversial issues, as each caucus would push its own priorities and see no reason to compromise mere months prior to an important nationwide election.
Suffice it to say, the legislative session did not go as expected. By March 17, exactly five weeks into the session, a new reality set in due to extraordinary measures undertaken by the Legislature in response to the COVID-19 pandemic. The House and Senate both met briefly to pass a $20 million
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From March 17 to April 14, the Legislature met just twice, each day passing a single COVID-19 response bill. The first of these bills was more comprehensive in nature, including various funding and policy provisions, while the second established a rebuttable presumption that those who work in certain occupations and contracted COVID-19 had acquired it on the job, and were therefore eligible for workers’ compensation.
The Legislature eventually resumed relatively normal functions after moving to a virtual environment. Committee meetings via Zoom videoconferencing became the norm, and new rules were passed to allow for legislators to participate in floor sessions from various remote locations. As a result, both the House and Senate engaged in regularly scheduled committee meetings, and each met in floor session several times a week. The issues moved beyond only dealing with the COVID-19 response, and bills began advancing through the new, much slower, process. Eventually, nearly 50 bills were passed and signed into law in the last month of the regular session. The Legislature adjourned the 2020 regular session on the constitutionally required date of May 18.
Concurrently, Gov. Tim Walz declared a peacetime emergency on March 13, which afforded him broad authority under state law to address the COVID-19 pandemic through executive order. Each peacetime emergency declaration is in effect for 30 days and can be renewed as many times deemed necessary by the Governor. Subsequently, Gov. Walz has continually renewed the peacetime emergency, issuing more than 75 Executive Orders, which is an unprecedented number.
The peacetime emergency declaration added a wrinkle to the Governor’s relationship with the Legislature during the legislative interim. In a normal year, House and Senate members would all be back in their districts campaigning. However, state law requires that if the Governor issues, or in this case renews, a peacetime emergency and the Legislature is not in session, then the Governor must call a Special Session to allow the Legislature to review the Governor’s actions. Under state law, the Legislature may vote to terminate the peacetime emergency but does not have to approve it.
Legislation of interest
Outside of the efforts to address the COVID-19 pandemic, health care policy was not a big focus during the 2020 legislative session. As we discussed in Minnesota Physician after the 2019 session closed, there were major policy and funding changes included in the 2019-2020 budget. As a result, the 2020 session was largely focused on policy.
Highlights of legislation that passed this year:
H.F. 3398 (Morrison)/S.F. (Rosen): Prior authorization. The Legislature modified the utilization review and prior authorization requirements used by Minnesota’s health insurance companies to medically manage health
care benefits. Among other provisions, the revised law shortens deadlines for requiring drug makers to turn over insulin at little or no cost or face fines both standard review authorizing decisions and expedited review decisions; represents a violation of the Fifth and Fourteenth amendments to the states that utilization review organizations will not be able to revoke or Constitution. Gov. Walz stated that the law would remain in force pending change a prior authorization, absent evidence of fraud, misinformation, what is likely to be a protracted court battle. or conflicts with state or federal law; requires H.F. 3028 (Morrison)/S.F. 2939 (Nelson): the review to be done by a physician within the Criminal background check fee. This bill strikes same or similar specialty; mandates a continuity the $32 health board fee covering a criminal of care of 60 days if the individual changes health background check related to physician licensing plans; and requires annual posting on the health plans’ public website of the number of prior authorizations that were authorized or denied. Five weeks into the session, a new reality set in … the COVID-19 pandemic. fees, makes technical changes to the governing statute, and makes similar changes to other occupational boards.
H.F. 3100 (Howard)/S.F. 3164 (Jensen): S.F. 4458 (Howe)/H.F. 4537 (Wolgamott): Insulin pricing. Minnesota’s Alec Smith Worker’s compensation claims. This bill creates Emergency Insulin Act creates an emergency a rebuttable presumption that an employee who supply of insulin for 30 days for diabetics who contracts COVID-19 is presumed to have an cannot afford the medication. It also sets up a occupational disease arising out of and in the longer-term program for those under certain income limits and for those course of employment. Eligible employees include police officers; firefighters; who don’t have insurance (or have insurance with large co-pays). The nurses or health care workers; corrections officers or security counselors legislation requires manufacturers to supply the drug, either by resupplying employed by the state or a public body at a corrections facility; EMTs; health pharmacists or sending insulin directly to patients, and imposes fines on care providers, nurses, or assistive employees employed in a health care, companies that fail to participate. Those fines increase as non-participation home care, or long-term care setting with direct COVID-19 patient care or continues—$200,000 per month for six months, increasing to $400,000 ancillary work in COVID-19 patient units; and child care workers required per month for the next six months. After a year of non-participation, fines to provide child care to first responders and other health care workers. The go to $600,000 a month. The Pharmaceutical Research and Manufacturers of America (PhRMA) has filed a lawsuit in federal court charging that The 2020 legislative wrapup to page 254
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