The Minnesota Legislature was unable to complete its work to pass the major budget bills by the end of the regular session, which meant a Special Session was held last week.
Here is an update on the key issues that the MAFP pursued this session:
- Provider tax extended at a reduced rate (stable funding continues)
- Pharmacy benefit manager regulation bill signed by the Governor
- Opioid stewardship bill signed by the Governor
- Rare Disease Advisory Council created
- Interstate Medical Licensure process fixed
- Firearm safety—no action taken
- Tobacco cessation helpline funding will continue
- E-cigarettes and other vaping devices added to Minnesota Clean Indoor Air Act
Read on for a more detailed legislative session summary from our legislative rep Dave Renner, CAE.
Provider Tax Extended at Reduced Rate
Governor Walz and the House Democrats pushed hard to continue the provider tax at 2%. Senate Republicans pushed to have the tax sunset without providing needed replacement funds. The MAFP supported alternative funds, as long as the needed access programs received the necessary funding.
In the end, Senate Republicans agreed to reinstate the provider tax at a slightly lower rate. While the tax has been extended, the rate has been reduced from 2% to 1.8%.
The MAFP is pleased that ongoing, stable funding for the MinnesotaCare and Medical Assistance programs, along with funding for rural health, primary care and public health initiatives, will continue into the future.
PBM Regulation Bill Signed by Governor
Legislation passed to more closely regulate how pharmacy benefit managers (PBMs) conduct business in Minnesota. This was a priority issue for the MAFP. The final action by the House and Senate was by a near-unanimous vote and was signed into law on May 20, 2019.
The law was authored by two MAFP members, Representative Alice Mann (DFL – Lakeville) and Senator Scott Jensen (R – Chaska).
Under the new law, PBMs operating in Minnesota will be required to be licensed and annually report data on drug costs, rebates received from drug manufacturers, prior authorization requirements, patient cost-sharing and other data to the Department of Commerce. The bill also prohibits PBMs from imposing gag clauses on pharmacies and ensures that patients are provided the least expensive drugs available to them, even if that drug is not on the PBM’s formulary. The bill also requires PBMs to maintain an adequate network of pharmacies.
Opioid Stewardship Bill Signed by Governor
A multi-year legislative effort to secure resources to battle the opioid epidemic has been signed into law. The law increases licensing fees on opioid manufacturers and wholesalers, raising $20 million per year to be used to fund treatment services, patient and prescriber education and offset increasing county expenditures related to child protection stemming from opioid abuse.
The current licensing fee for manufacturers, a mere $235 per year, is increased to $55,000. In addition, the largest manufacturers of opioids will be subject to a $250,000 “opioid product registration fee.” This additional fee will sunset once the state collects a total of $250 million in increased licensing fees or via lawsuit settlements from opioid manufacturers.
A 19-member advisory council was created and charged with developing and implementing a comprehensive and effective statewide effort to address the opioid addiction and overdose epidemic. The members include physicians and other healthcare providers, those in recovery, drug and alcohol treatment providers, tribal leaders, law enforcement and policy makers.
Several notable pieces for prescribers are included in the law:
- Physicians who prescribe controlled substances will be required to obtain at least two hours of CME regarding best practices in prescribing opioids and/or non-pharmacologic treatments for pain. This provision is effective on January 1, 2020, and sunsets in 2023.
- The new law sets dose limits of seven days (five days for patients under the age of 18) for the treatment of acute pain. Importantly, the law allows prescribers to deviate from the limits if it is in their professional clinical judgement to do so.
- The law also includes a requirement that prescribers consult the state’s Prescription Monitoring Program before prescribing opioids. Of note: This provision includes a number of exceptions, including post-surgical, hospice, inpatient, emergencies, if the PMP is not functioning and if the prescriber has a current or ongoing relationship to the patient of more than one year.
Rare Disease Advisory Council Created
A Rare Disease Advisory Council was created by legislation that was unanimously passed by the House and Senate in the last days of session. The bill was authored by MAFP member and Representative Alice Mann (DFL – Lakeville) and Senator Jeremy Miller (R – Winona).
Under the bill, the University of Minnesota is tasked with convening a group of physicians, individuals with rare diseases, parents of children with rare diseases, researchers, other healthcare providers, health plan representatives, policy makers and others to “provide advice on research, diagnosis, treatment and education related to rare diseases.”
The 24-member panel is to include at least three physicians with experience researching, diagnosing or treating rare diseases, one of which must be a pediatrician.
Technical Bill Clears Way to Enter Interstate Medical Licensure Compact
Legislation to allow Minnesota to fully participate in the Interstate Medical Licensure Compact cleared the Senate and has been signed by the Governor. The bill provides a technical fix to the statutes that govern background checks conducted as part of the licensure process for physicians who practice in multiple states.
No Action on Firearm Safety
The Legislature did not take action, this session, on bills to address firearm safety. While the House passed two provisions and included them in their Omnibus Public Safety Budget bill, they were not included in the final budget negotiations.
The first bill would have expanded the criminal background check requirement to purchase a firearm to ALL sales, including gun shows and personal sales. The second bill would have authorized law enforcement to temporarily remove a firearm from a person thought to be a danger to themselves or others. Both of these provisions have passed in other states, and public opinion polls show they are supported by a majority of Minnesotans.
The MAFP supports efforts to reduce firearm violence and death and to treat this issue like other public health issues that impact the health status of Minnesotans.
Final HHS Budget Bill Pushed to Overtime
The budget bill for Health and Human Services (HHS) was pushed into Special Session. It includes several key provisions that the MAFP supported and others that we were following.
HHS budget provisions include:
- There was no movement to find an alternative to the provider tax. We are pleased, however, that the final bill does provide ongoing funds for the many access-related programs funded by the Health Care Access Fund.
- The bill provides $4.3 million for 2020-21 to continue the tobacco cessation QUITPLAN Helpline.
- The bill adds the use of all nicotine products, like e-cigarettes and other vaping devices, to the Minnesota Clean Indoor Air Act. This will prohibit vaping indoors wherever smoking is prohibited.
- The bill provides money to increase prescription drug price transparency. These funds will be used to require the disclosure of drug prices that rise excessively during a year.
- The bill creates a new Blue Ribbon Commission on Health to develop recommendations to reduce state healthcare spending by $50 million in 2024 and $50 million in 2023.