With the COVID-19 pandemic, the Minnesota Legislature was forced to rethink how to complete its business. The overall agenda of what could be accomplished also changed. Bills for which an agreement could not be reached between the House and Senate authors did not have much of a chance to move this year.
Here is a high level overview on the key issues that the MAFP pursued this session:
- Tobacco 21
- Prior authorization reform
- Drug price transparency
- Insulin program (emergency and affordable insulin)
- Scope of practice provisions
- COVID-19 response legislation
DID NOT PASS
- Direct Primary Care standards
- Firearm death and injury prevention (criminal background check expansion, red flag law)
- Liability protection during peacetime emergency
PRIMARY CARE INVESTMENT
Another priority for the MAFP is increasing the state’s financial investment in primary care spending. Most of the work on this issue has been outside the legislature, including work with the Minnesota Department of Health and many stakeholder groups to build support for 2021 legislation.
Read on for a more detailed 2020 legislative session summary from our legislative rep Dave Renner, CAE.
Following action by Congress at the end of 2019 to raise the age to purchase cigarettes and other nicotine products to 21, Minnesota passed legislation to align with the federal law. This bill also provides the authority to local law enforcement to enforce the law and take action against retailers that violate the law.
The bills, authored by Representative Heather Edelson (DFL-Edina) and Senator Roger Chamberlain (R-Lino Lakes), both passed their respective bodies with strong, bipartisan votes, and Governor Walz signed Tobacco 21 [Chapter 88] into law on May 16, 2020.
Prior Authorization Reform (PASSED)
Following more than five years of trying to pass significant reforms to reduce the amount of hassles and delays caused by prior authorization requirements, the legislature passed legislation to reduce the time an insurer has to act on a prior authorization request, require more transparency in the criteria an insurer uses to make a prior authorization decision and ensure that patients can get the care they need in a timely manner. This was a high priority for the MAFP.
Chapter 114 was authored by Senator Julie Rosen (R-Vernon Center) and Representative Kelly Morrison, MD (DFL-Deephaven).
PRIOR AUTH Reforms effective January 1, 2021:
- Reduces the time insurers have to act on a standard prior authorization request to five business days if the request is made electronically and six business days if it is filed in paper form. Beginning January 1, 2022, all standard prior authorization determinations must be done within five business days.
- Reduces the time insurers have to act on an expedited request to 48 hours, as long as at least one business day is included.
- Reduces the time for insurers to act on a standard appeal to a denial to 15 days.
- Prohibits insurers from retroactively revoking a prior authorization that has been approved (unless there was misinformation provided or fraud).
- Requires that the physician who is reviewing a prior authorization request be licensed in Minnesota AND have the same or similar specialty as a provider that typically treats or manages the condition that is being reviewed.
- Requires health plans to post on their public website the prior authorization requirements, restrictions and written evidence-based criteria used to make determinations.
- Requires the insurer to notify all providers in their network of changes to the prior authorization requirements at least 45 days prior to any change taking effect.
- Requires that if a patient changes health plans that the new health plan cover any existing prior authorizations for at least 60 days.
- Prohibits insurers from changing coverage or criteria for an approved prior authorization during a patient’s enrollment year.
- Requires insurers to post on their website about the number of prior authorizations requested each year, the number approved and denied and the reasons for denial. The Department of Health will also begin reporting this data annually.
Drug Price Transparency (PASSED)
Minnesota passed new reporting requirements for drug companies that unreasonably raise their prices in any year.
Chapter 78, authored by Senator Julie Rosen and Representative Kelly Morrison, MD, requires a manufacturer to report to the Minnesota Department of Health if a price for a name-brand drug goes up more than 10% in one year or 16% over two years and if a price for a generic drug goes up more than 50% in one year.
For these drugs, some of the items the manufacturer MUST report, no later than 60 days after the price increase, include:
- Name and price of the drug.
- Factors that contributed to the price increase.
- Price when the drug was first approved and the yearly increase for the last five years.
- Cost to manufacture, distribute and market the drug.
- Total sales revenue of the drug over the last year.
Insulin Program (PASSED)
A multi-year effort to provide relief for diabetics who cannot afford insulin passed by a wide bipartisan margin and was signed into law by Governor Tim Walz on April 14, 2020. The new law is named the Alec Smith Insulin Affordability Act after a young man who died trying to ration insulin.
Chapter 73 establishes two separate programs to make insulin available to low-income individuals and those with high drug expenses. The first program establishes an emergency insulin program for individuals facing urgent needs, while a second program makes affordable insulin available for a full year. Eligible individuals must be Minnesota residents, uninsured and/or not eligible for MinnesotaCare or Medical Assistance, and those with high drug costs. The bill caps the cost of a month of emergency insulin at $35, while the monthly cost of the long-term program is capped at $50.
Notably, the law uses pharmacies or mail-order delivery to eligible patients (earlier versions of the Senate bill used physician offices as distribution points).
Scope of Practice Provisions (PASSED)
A session-long effort to amend the scope of practice for several health professionals passed the House and Senate by wide margins on the last night of session and awaits a likely signature by Governor Walz. The scope of practice changes were included in an omnibus bill [Chapter 115] containing dozens of health policy provisions.
The first provision changes the relationship between physicians and physician assistants (PAs). The agreed to language is intended to ease the administrative burden of having a supervisory role over a PA and maintaining a supervisory agreement with a physician. The legislation keeps the requirement that a PA maintain a “practice agreement” with a Minnesota-licensed physician “at the practice level that describes the practice of the PA.” But, it does not require that the PA have a supervising physician or maintain a written agreement. The bill, originally authored by Representative Jennifer Schultz (DFL – Duluth) and Senator Mary Kiffmeyer (R – Big Lake), further requires an annual review of the practice agreement by a licensed physician “within the same clinic, hospital, health system or other facility as the PA and who has knowledge of the PA’s practice to ensure that the PA’s medical practice is consistent with the practice agreement.” Newly licensed PAs must practice within a more prescriptive collaborative agreement within an integrated system for one year prior to being allowed to work under a practice agreement.
The second scope of practice change included in the bill is language granting pharmacists limited prescribing authority. Originally authored by two MAFP members, Senator Scott Jensen, MD (R – Chaska) and Representative Alice Mann, MD (DFL – Lakeville), the bill allows pharmacists to prescribe nicotine replacement drugs, oral contraceptives for the purpose of birth control and opioid antagonists for acute opioid overdose. The final language was narrowed to exclude nicotine cessation drugs, such as varenicline and bupropion, due to their potentially dangerous side effects. Prior to being eligible to prescribe these drugs, pharmacists would be required to complete a training course developed by the Board of Medical Practice and Board of Pharmacy, with the input of the professional association of physicians, pharmacists and APRNs.
The third scope of practice change in the bill grants licensed traditional midwives authority to order ultrasounds, provide point-of-care testing and order laboratory tests that conform to the standard prenatal protocol of the licensed traditional midwife’s standard of care. The language was negotiated by the Minnesota Chapter of the American College of Obstetricians and Gynecologists and the association for traditional midwives.
COVID-19 Response Legislation (PASSED)
The legislature passed a number of provisions related to the treatment and impact of the COVID-19 pandemic.
Chapter 70 creates a Health Care Response Fund to make grants available to health care providers for planning or responding to the outbreak and to fund the establishment and operations of temporary care sites. The state provided $150 million for the fund, and it will be used to deposit and allocate any federal money related to COVID-19. The chapter also broadened the coverage for telemedicine services by covering services where the patient is at home and included coverage for telephone-only visits. Existing law requires health plans to pay an equal amount whether the service is provided in-person or via telemedicine.
Chapter 71 provided additional funding to food shelves and funding for homeless shelters because of the increased use caused by COVID-19.
Direct Primary Care Standards (DID NOT PASS)
Legislation to promote Direct Primary Care (DPC) was an MAFP priority. Introduced by MAFP member Senator Scott Jensen, MD (R-Chaska), SF 277 would have clarified that DPC is NOT an insurance product and would have set minimum standards for DPC products. It passed the Senate floor with a unanimous vote in 2019, but did not receive a hearing in the House. An amendment that was adopted in the Senate Commerce Committee concerned clinics that were already doing DPC that it would be worse than the current law; therefore further action was not pursued.
Firearm Death and Injury Prevention (DID NOT PASS)
Two bills to address firearm death and injury passed the House this year, but were not given a hearing in the Senate.
HF 8 (Representative Dave Pinto, DFL-St. Paul) would have expanded criminal background check requirements to ALL sales of firearms, including private sales and gun show sales—both of which are currently exempt from a criminal background check requirement.
HF 9 (Representative Ruth Richardson, DFL-Minneapolis) would have allowed law enforcement to temporarily remove a gun from a person’s possession IF the person was thought to pose a significant danger of bodily harm to themselves or others. Known as the “red flag law,” it was designed to allow family members to petition law enforcement to remove the gun(s) for safety reasons.
Liability Protection During Peacetime Emergency (DID NOT PASS)
More than half of states have adopted some form of liability protection for physicians and other health care providers for care resulting from the COVID-19 peacetime emergency. With the shortage of equipment and supplies, patients delaying care because of the Governor’s order limiting non-essential health care services and the “standard of care” during the COVID-19 pandemic changing weekly, physicians are worried that the care provided during the emergency may be less than optimal and they should not be held to the same standard as before the emergency.
SF 4603 (Senator Michelle Benson, R-Ham Lake) would provide civil, criminal and administrative immunity for providers acting in good faith for damages caused by acts or omissions related to the state’s response to COVID-19. The bill passed the Senate Health and Human Services Finance and Policy Committee, but did not get a hearing in the House.
Efforts continue to have the bill acted on during the upcoming Special Session in June 2020.
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