Buck Mcalpin- Government Relations

Legislative Update

Buck McAlpin- Government Relations

May 18th, 2015

Dear members,

The State legislature adjourned on time last night at midnight and will return in 2016 for a short bonding year session. Also they will have to address the desire to complete a Tax bill and a Transportation bill. On the last day of session they did pass a lights on bill for transportation and left the tax bill on the table for next year. Most of our key legislative priorities were included in the Omnibus Health and Human Services (HHS) budget bill, (SF 1458/HF 1638), which has passed both legislative bodies and awaits the Governor’s signature. We are hopeful that the Governor will sign this important legislation.

The MAA was very concerned that the HHS budget target was set at $381 million below the current projected spending for the 2016-17 biennium, but we were very pleased that our highest priorities were funded. It is important to note, however, that much of HHS budget bill relied upon using $455 million from the Health Care Access Fund (HCAF). This will impact future discussions on the role of the HCAF and what uses of its resources are considered “acceptable” and “not acceptable.”

The Capitol is under a major renovation, which started the minute they adjourned last night. The rumor is the Governor may veto the transportation bill, which will lead to a special session. The Governor is pushing for more Pre-K funding to be added to the K-12 education bill. Lets see what happens looking ahead into the next week.

Highlights from the Omnibus HHS bill:

· Preservation of the MinnesotaCare program. There were some costs savings imposed ($65 million) associated with increased financial participation by enrollees.

· $5.096 million in funding for the Critical Access Hospitals. (This funding will leverage federal matching dollars.)

· $2 million for inpatient mental health services. (This funding will leverage federal matching dollars.)

· A new distribution formula for Disproportionate Share Hospital (DSH) payments.The new formula targets funding for children’s hospitals, psychiatric inpatient services, transplants and high volume Medical Assistance providers.

· Significant new investments in mental health services. (See the list below.)

· Some new funding for MERC, residency programs and other workforce investments. (See the list below.)

· MAA is pleased that the Telemedicine Act is included in the HHS bill.Health plans will be required to pay for services on the same basis and at the same rate regardless of whether they are delivered via telemedicine or on an in-person basis. The Medical Assistance program will also be required to cover an expanded list of providers who are now allowed to bill for services provided via telemedicine. Unfortunately, the provision requiring an originating site fee for health care providers was deleted from the bill.

· Importantly, the bill contains no mandated nurse staffing quota language.

· A new mandate requires hospitals to have violence prevention plans and provide violence prevention staff training. None of the proposals to mandate additional public reporting were included in the bill.

· $138 million for nursing home reform and payment increases.

Highlights of Mental Health Provisions:

· $5.3 million for behavioral health homes

· $1 million for “text for life”

· $260,000 for First Episode programs

· $8.57 million for crisis services

· $5.547 million to stabilize mental health intensive services

· $6.616 million for Psychiatric Residential Treatment Facilities (PRTFs) for adolescents

· $3.15 million for complex needs

· $1.322 million to expand ACT teams

· Increase county share at Anoka Metro Regional Treatment Facility

· 2% rate increase for chemical dependency providers

· Non-emergency medical transportation funding, including some funding for protective transportation

· $449,000 for suicide prevention

Highlights of Workforce Investments:

· $2 million added to the current MERC formula

· $5.262 million for loan forgiveness

· $2 million for international medical graduate residency slots

· $3 million for new primary care physician residency slots

· $2 million for home and community based services workforce scholarships

· Regretfully, the specific designation of $1 million for the rural primary care residency grant program was eliminated.

LEGISLATIVE ACTIVITY:

·  Transferring the MNSTAR Data Collection program from the EMSRB to MN Department of Health. SF#307 Senator Dziedzic /HF#188 Representative Newberger. Not Completed.

·  Transferring the Regional Program Grant Operations from the EMSRB to the MN Department of Health. SF# 175 Senator Hayden and HF # 189 Representative Greg David’s. This legislative proposal was pulled because of opposition from some of the Regions. The goal was to fund a full-time position at MDH that would find and secure additional grant money for EMS providers. The MAA, EMSRB and 7-8 Regions supported this proposal. On the last few nights of session some Region Grantees contacted legislators to stop the proposal. Not Completed

·  Repeal a 4.5% rate reduction to Ambulance and Non-Emergency Medical Transportation rates effective June 30th, 2015. SF# 177 Senator Hayden and HF# 213 Representative David’s. This legislative proposal was funded and passed in the final health bill. It replaces the rate cut effective 7-1-2016. Completed

·  Community EMT Certification Established. SF# 176 Senator Rosen and HF # 261 Representative Mack. This legislative proposal developed a new CEMT certification and was included in the final health bill. It also requires DHS to convene a work group to evaluate possible Medicaid reimbursement that would need to be approved next legislative session. Completed

·  Variance Process repealed for Basic Life Support Ambulance Services in the rural area. SF# 379 Senator Kent Eken and HF# 423 Representative Jeff Backer. This bill allows the permanent use of an EMR driver. Signed by the Governor. Completed

·  Rural and Urban Commuter Adjustments (RUCA) for Non-Emergency Medical Transportation. SF # 382 Senator Vicki Jensen and HF# 382 Representative Joe Schomacker was included for certain new modes in the Senate HHS Omnibus bill. This was part of the final deal and more money was added to the RUCA-NEMT formula. Completed

·  Safe Place for Newborns; SF # 796 carried by Senator Kent Eken and HF #825 by Representative Roz Peterson; This bill would provides $150,000 in the Senate and $350,000 in the House HHS Omnibus budget bills. The appropriation would go to the Department of Human services for grants. Will be an opportunity for the Regions to apply for additional funding. Completed

·  Stroke transport protocols emergency medical services (EMS) programs development requirement is SF # 495 Senator Kathy Sheran and HF # 513 Representative Nick Zerwas. The bill passed off the house and senate floor and is on its way and was signed by the Governor. Completed

·  Funding for the MN Department of Health Stroke Program; is SF # 790 Senator Kathy Sheran and HF # 818 Representative Nick Zerwas would provide $350,000 a year in both 2016 and 2017. This funding was included in the Health Omnibus budget final bill. Completed

·  Non-Emergency Medical Transportation Legislation (NEMT) Senator Kathy Sheran has SF # 1292 and Representative Kim Norton has HF #1350 which would fund the new NEMT modes like protected class. This proposal was partially included in the HHS Senate Omnibus bill. The Chair funded the new modes and eliminated the 4.5% rate cut to NEMT and Ambulance effective 2016. Completed

·  Community Paramedic and Community EMT’s role in Child Protection Services. Senator Rosen amended the CEMT bill in the Finance committee that would authorize a pilot and discussion around CEMTS helping with child protection. It was included in the HHS Final Omnibus bill and forms a work-group to look at services. Completed

·  Poison Control Center funding. HF # 346 Representative Joe Hoppe and SF # 359 Senator Melissa Franzen. This request is for an appropriation in 2016 for $800,000 for the Poison Control Center. The final HHS Omnibus bill included $750,000 in funding. Completed

·  A bill for an act relating to health care; modifying provisions related to physician assistants. SF # 454 Senator Chris Eaton and HF # 1036 Representative Dave Baker would change some of the supervisory oversight by Physicians and the PA. Also they added and will allow PA’s to provide mental health care. Completed

·  Tele-health expanded coverage; Senator Rosen is carrying SF#981 and Representative Tara Mack is carrying HF # 1246. Health Care Systems and providers seem to have a real desire to expand the usage and applicability to the Tele-health platform and payment system. The language mandating payment was included in the final HHS budget bill. Completed

·  Violence against health care workers in licensed hospitals preparedness and incident response guidelines establishment; violence prevention database development requirement; SF # 1071 Senator Wiger and HF # 1087 Rep Atkins. The MNA and MHA worked hard at the end to come to a common ground on the legislation. In the end the bill requires hospitals to provide violence training and report annually to MDH on violence issues.

·  Patient Care Safe Zone legislation. HF # 1088 Representative Marion O’Neil and SF # 1777 Senator Wiger is The MN Hospital Association has brought forward the “Safe Zone” hospital legislation after some of the recent attacks and assaults on workers. Dead for the session.

·  Mandated Nurse Staffing Ratio bill. HF # 1654 Representative Joe Atkins would require hospitals to provide staffing at levels consistent with nationally accepted standards, reporting of staffing levels required, and civil penalties imposed. It has no Senate companion. This bill was heard in the house at an informational hearing. Dead for this session

·  Medical Cannabis Expanded to allow for Chronic and Intractable Pain; Is SF # 545 Senator Branden Petersen was introduced in the Senate. This would allow the expansion of medical cannabis as a qualifying condition for Chronic and intractable pain patients. No hearings have been scheduled. Dead for Session

·  Grant to the Leech Lake Ambulance to Upgrade to ALS; Senator Tom Saxhaug has SF # 672 and HF # 699 Representative John Persell to provide $250,000 for training and equipment to the ambulance service. The house included $200,000 and the senate did not include any funding in their HHS Omnibus bill. Did not get funded

·  Interstate medical licensure compact project provided is SF # 253 Senator Kathy Sheran and HF # 321 Representative Tara Mack would allow border reciprocity and the ease of Physician licensure between states. This proposal is on the floor in both bodies and is awaiting final passage. Completed

·  Nursing Licensure Compact legislation is HF # 220 Representative Kim Norton was again introduced this year. This would allow Nurses to cross state lines and be able to practice with more ease. No hearings have been scheduled for this bill. Dead for year

·  Suicide Prevention and Training funds for Providers is offered; by Senator Kathy Sheran SF # 703. This bill has no house author as of yet. This bill would allow funding for a texting program for mental health. Also it provides $100,000 dollars for training of EMS, Police and Fire to help understand and better respond to patients. The language was included in the final HHS budget bill. Completed

·  Legend drug collection and disposal as pharmaceutical waste changes made; Representative Bob Barret carries Hf # 1503 and Senator Julie Rosen carries SF # 1425. This would allow Pharmacies to collect and dispose of legend drug waste. It has been heard in the Senate and is on the floor for final passage. .

·  No-Fault Auto Work Group Formed; is SF # 957 Senator Vicki Jensen would establish a work group to exam all aspects of the system. We amended the MAA, MNACEP and MHA onto the work group. Completed

·  Narcan grant money for training and purchasing of Narcan provided; Sf # 1410 Senator Chris Eaton and HF# 1651 Representative Dave Baker would direct $270,000 of funding to the MN Department of Health. The money would be divided e amongst the 8-Regional EMS programs to coordinate training and Narcan purchases. The HHS Omnibus bill funded $270,000 for the program. Completed

·  Opioid Prescribing Improvement Program; The HHS Omnibus Budget bill contained a provision that established a work- group around the Opioid issue and describes some best practices around prescribing.

·  Workers Compensation Payment Reform for Hospitals; This has been an issue that we have been involved with for at least 10 years. Finally late this year hospitals and insurance providers agreed to a piece of legislation. Basically it reduces cost to insurance companies in exchange for prompt pay and the elimination of scrubbers in the claims process. Completed

·  Allowing Expanded Usage of Epinephrine; SF # 1580 Senator Carlson and HF # 1604 Rep Zerwas. This bill would allow expanded civilian usage of Epi-Pens. It also would allow some liability coverage under prudent layperson for end users of the product. This legislative proposal was included in the final HHS bill. Completed

·  Funding for Ebola; the Governor signed the State deficiency bill last week, which included $2 million dollars for Ebola preparedness funding. The bill included $148,000 for ambulance services in MN and the remaining will be divided up between the 4-Ebola designated hospitals. The money will be administered through the EMSRB. Completed

·  Expanded $500 volunteer Stipend; Representative Backer introduced HF # 1324 and SF # 1982 Senator Dan Sparks, which would expand the $500 stipend program from last year to the entire state for volunteer Fire and EMS. The bill was not included in the tax bill. Dead for this session.

·  First Responders Allowed meal Expense Deduction; Representative Jim Newberger introduced HF # 1463 which would allow a $15 meal expense deduction per day. This language was included in the House tax bill at half the amounts as proposed. Had no tax bill this session

·  Medical Resource Control Centers: Both the House and Senate Public Safety Omnibus bills include the full $683,000 of funding to the MRCC’s. Completed

·  Comprehensive Advanced Life Support, $408,000 was included in the MDH base funding. Completed

·  Cooper-Sam’s Volunteer Longevity Awards, Was fully funded again for $700,000 a year to the EMSRB to administer. Completed