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 ( ) 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 PLATINUMGOLDSILVERBRONZE % of benefit covered by plan 90%80%70%60% Premium -25 yr old -Fam. 4 $151 $634 $141 $595 $121 $565 $91 $380 Out of pocket limits $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?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, Plans will be posted to the MHA Hospital Quality Report website by April 1, 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 ▫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, 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, 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 Dave Renner, Director of State & Federal Legislation Messerli & Kramer, P.A. 525 Park Street, Suite 130 St. Paul, MN Minnesota Medical Association 1300 Godward St. NE, Ste Minneapolis, MN (612)