2017 Legislative Priorities
The annual MHA Legislative Report provides a guide to all legislation from the 2016 session impacting hospitals and health care. Download the 2017 Legislative Report.
With input from the MHA Board of Directors and the Policy and Advocacy Committee, the following five issues highlighted below were identified as the priorities for the 2017 legislative session. We are pleased to report success on the first four priority issues and progress on the fifth issue.
- Preserve meaningful health care coverage for low-income Minnesotans.
- Update Minnesota’s Medical Assistance payment methodology for inpatient hospital services.
- Support mental health initiatives.
- Prevent a duplicative, complicated and proprietary new quality measurement system for hospitals.
- Modernize Minnesota’s Health Records Act to allow for better coordination of patient care.
Defeating any legislative proposal involving a government-mandated nurse-to-patient staffing ratio remains a top priority for MHA. A ratio bill (SF 2382/HF 2650) that also includes several other burdensome components was introduced but not given a hearing in 2017. MHA must remain vigilant and outspoken about our opposition to this legislation, particularly given the number of newly elected legislators who are unfamiliar with the issue and the past compromise of 2013, which established the public reporting of nurse staffing levels on all inpatient hospital units.
Priority 1: Preserve meaningful healthcare coverage for low-income Minnesotans.
Throughout the legislative session, MHA advocated for the preservation of both the Medicaid expansion program for low-income populations below 138 percent of the federal poverty limit and the MinnesotaCare program with eligibility for individuals with incomes between 138 percent and 200 percent of the federal poverty limit. Despite the federal matching dollars and the importance of coverage, many Republican legislators remain opposed to the Medicaid expansion because it was part of the ACA. This will continue to be a challenge for MHA, particularly if federal matching dollars are eliminated.
In addition, a handful of House Republicans made attempts to eliminate Minnesota’s current benefit set, if the sale of plans covering only catastrophic care were to become allowed. MHA joined with NAMI Minnesota and other stakeholder groups speaking in opposition to this legislation and highlighted the need to keep a robust mental health benefit set. This issue will likely return in future legislative sessions, particularly if federal legislation eliminates mandatory benefit sets.
The MHA Board of Directors, while very supportive of MinnesotaCare, took a position to oppose a proposal to expand MinnesotaCare eligibility to anyone regardless of income, referred to as the “public option.” MHA testified throughout the session that this proposal would further erode the remaining individual market and could threaten the small group commercial market as well. With government payers not covering the actual costs of providing care to public program enrollees, maintaining some commercial coverage is important to MHA members.
Priority 2: Update Minnesota's Medical Assistance payment methodology for inpatient hospital services.
MHA worked throughout the legislative session with the Minnesota Department of Human Services to reauthorize the department’s use of policy adjusters within the inpatient fee-for-service Medical Assistance program. This will mean additional funding for key services like mental health and obstetric services in the MA program. Commonly referred to as the hospital rebasing bill, MHA introduced legislation SF1335/HF 1559, authored by Sen. Michelle Benson and Rep. Matt Dean, that updated the base payment rate year from 2012 to 2014. This legislation was incorporated into the final health and human services bill of the special session, SF 2.
The original Senate bill cut hospital inpatient fee-for service payments by delaying the Medical Assistance rate rebasing until 2021, which would have negatively impacted all hospitals. The provision would have saved the state $15.4 million for the 2018-19 biennium and $38.9 million for the 2020-21 biennium. The impact to hospitals, however, would have been significant because these payments leverage federal matching funds, and currently expenditures for the Medicaid expansion population have a 90 percent federal match. Our success on this initiative will mean an additional $40.9 million to hospitals in the 2018-19 biennium and $100.4 million in the 2020-21 biennium, contingent on federal funds at current levels. This is the first for fee-for-service increase in the Medicaid program for PPS hospitals since 2007.
The Senate bill also included across-the-board health care provider payment cuts of 2.3 percent on July 1, 2017, and 3 percent on July 1, 2019, saving the state $28.3 million this biennium and $48.2 million in the next biennium. These cuts would have also brought a significant loss of federal funding and would have reduced payments to physicians, ambulatory surgical centers, therapists and outpatient hospital services. MHA worked with other healthcare providers to defeat this provision.
Priority 3: Support mental health initiatives.
MHA introduced and worked to pass a new Mental Health Innovation Grant program. This legislation – SF 564/HF 737, authored by Sen. Julie Rosen and Rep. Roz Peterson – provides seed money to encourage community collaborations between hospitals, counties and community mental health centers. The final HHS bill allocates $2.171 million dollars this biennium and $2.162 million in the next biennium for this grant program. Grants can be used for programs like Intensive Residential Treatment Services (IRTS) facilities or crisis residential services to provide an alternative to hospital-level care. MHA is pleased that this initiative has started and looks forward to partnering with counties and community mental health centers to expand access to mental health services.
The Legislature proposed significant cuts in DHS’s direct care and treatment (DCT) services. The Department had estimated that the proposed cuts could have necessitated the elimination of 210 positions in DCT operations. The HHS bill fully funds the requests for the Minnesota Security Hospital ($22 million), state-operated services ($10.2 million) and the department’s operations. MHA advocated for this restored funding, recognizing that if the state could not provide mental health services, community hospitals would experience greater demand to serve populations with challenging needs.
Priority 4: Prevent a duplicative, complicated and proprietary new quality measurement system for hospitals.
The HHS bill vetoed by the governor included a provision that would have required DHS to implement a new quality measurement system for hospitals. This would have been in addition to new federal CMS reporting requirements as well as the current Statewide Quality Reporting Measurement System (SQRMS) to which hospitals already report on dozens of quality measures. This legislation would likely have resulted in hospitals needing to purchase a 3M software product to be able to analyze claims data.
The legislation called for DHS to establish incentive and penalty payments for hospitals in a budget-neutral manner based on this claims data. This legislation could have also jeopardized the work of Minnesota’s nation-leading Integrated Healthcare Partnerships (IHPs) in our Medical Assistance program. MHA is pleased to report this provision was not included in the final HHS bill.
Priority 5: Modernize Minnesota's Health Records Act to allow for better coordination of patient care.
Minnesota’s Health Records Act should not be more restrictive than federal privacy laws. Minnesota’s requirements go far beyond those of the federal Health Insurance Portability and Accountability Act (HIPAA), impeding more streamlined exchange of clinical information. State policy should encourage greater care coordination across the continuum and more innovative care delivery models. This issue, identified by MHA’s Board of Directors as part of our three-year strategic plan,will require extensive work educating bipartisan legislative privacy advocates that Minnesota’s current laws harm patients and add costs to the system. MHA introduced legislation addressing this issue late in the session; SF2406/HF 2703, authored by Sen. Melissa Wiklund and Rep. Nick Zerwas, updates Minnesota’s Health Records Act to comply only to the HIPAA standard.