Minnesota Hospital Association


February 20, 2017

MHA Newsline: Feb. 20, 2017

In this issue:

Workforce legislation advances at the Capitol

Last week, four bills related to health care workforce advanced at the Capitol. With workforce shortages an important issue for hospitals and health systems, MHA is supportive of these bills. The House Health and Human Services Reform Committee passed:

  • HF 743 (Albright – GOP – Prior Lake) establishes a grant program to expand clinical training sites for physician assistants, advanced practice registered nurses, mental health professionals and pharmacists.
  • HF 744 (Albright – GOP – Prior Lake) establishes the Minnesota Health Care Workforce Council to submit a comprehensive plan to the Legislature by Sept. 30, 2019.
  • HF 1167 (Schultz – DFL – Duluth) establishes a preceptor tax credit.
  • HF 1169 (Albright – GOP – Prior Lake) extends the expiration date for the Health Care Workforce Commission.

This legislation was forwarded to additional committees for consideration.

On Feb. 21, the House Health and Human Service Reform Committee will hold a hearing on a package of legislation related to the opioid crisis in Minnesota:

  • HF 1134 (Baker– GOP - Willmar) creates a 30-day-from-issued time limit for filling opioid drug prescriptions.
  • HF 1135 (Baker– GOP - Willmar) requires additional information be given to patients regarding opioid prescriptions.
  • HF 1137 (Baker– GOP - Willmar) requires a prescriber or dispenser to review the patient’s history in the prescription monitoring program with limited exceptions.

With questions, contact Mary Krinkie, vice president of government relations, MHA, 651-659-1465, or Kristin Loncorich, director of state government relations, MHA, 651-603-3526.

Session bill tracker
For a complete list of 2017 legislative bills MHA is tracking, visit the MHA Member Center. For assistance accessing the Member Center, contact Emily Lowther, communications manager, MHA, 651-603-3495. return to top

MDH publishes report on impacts and costs of MHRA

The Minnesota Department of Health on Feb. 17 released “Impacts and Costs of the Minnesota Health Records Act,” a 48-page report that the Minnesota Legislature requested as part of the 2016 session. The following themes were revealed:

  • The MHRA does not adequately support the majority of patients whose preference, as reported by providers, is to share their health information with their providers.
  • Some clarifications to operationalize the current MHRA intentions are needed.
  • Providers need education, resources and legal assistance to understand MHRA requirements, especially providers in smaller practices. Patients also need education and resources.
  • Implementing MHRA often requires a manual work-around process for obtaining patient consent outside of the electronic health record system digital workflow.
  • It will be difficult for Minnesota to achieve its goals related to coordination of care for complex patients, improved quality of care and cost savings due to varied interpretations of the consent requirements in the MHRA.

This report was based on responses from patients and providers who responded to an MDH Request For Information (RFI) last fall. MHA actively sought member responses to this RFI and the report shows that 57 responses from the provider community were received. When the responses from patients are added in, there were a total of 81 respondents.

While the patient responses to the RFI reflected a wide range of opinions regarding the current privacy laws, there was consensus in the provider community on the negative impact of the MHRA on care, especially as it relates to coordination of care. There was also strong support voiced for aligning state laws with the federal Health Insurance Portability and Accountability Act.

The full report can be found online. For questions related to this report, please contact Mark Sonneborn, vice president of health information and analytics, MHA, 651-659-1423. return to top

Senate Finance Committee holds confirmation hearing for CMS administrator

On Feb. 16, the Senate Finance Committee held a confirmation hearing for health care consultant Seema Verma, President Trump’s nominee to serve as Centers for Medicare and Medicaid Services (CMS) administrator. During the hearing, Verma voiced support for helping rural and other health care providers avoid unnecessary burdens from federal regulatory requirements, including meaningful use of electronic health records.

Verma told the committee, “I think we have to be very careful with our rural providers to make sure that we’re not putting additional burdens on them that actually impact accessibility to care and quality of care.”

Among other comments, she said providers should not be required to participate in the Center for Medicare and Medicaid Innovation (CMMI) payment models, saying demonstrations should be tested on a small group and results evaluated and shared with providers and other stakeholders before being implemented on a large scale. The Department of Health and Human Services (HHS) Secretary Tom Price has also criticized CMMI for requiring provider participation in innovation models.

On questions about Medicaid reform, Verma said, “For me, the opportunity is to improve health outcomes.” She stressed that the current program is not working well, but did not express support for block grants or per capita cap. She also repeatedly stated that under the current Medicaid program, the variation in state funding does not align with providing better outcomes. She testified that states should be freer to redesign their Medicaid programs without needing the federal permission, in the form of waivers, that the program has always required. She said the waiver process is a barrier to innovation.

Verma also expressed support for reauthorizing the Children’s Health Insurance Program.

During the hearing, Verma said she does not support a proposal favored by Price to covert Medicare to a voucher program as a way of ensuring the Medicare program's financial solvency.

The Senate Finance Committee has not scheduled its vote on Verma’s nomination, but it will likely occur in early March.

With questions, contact Briana Nord Parish, policy analyst, MHA, 651-603-3498, or Ben Peltier, vice president of legal and federal affairs, MHA, 651-603-3513. return to top

House releases ACA repeal and replace proposal

House Republicans have released their plan to repeal and replace the Affordable Care Act (ACA). The plan aligns with House Speaker Paul Ryan’s (R-WI) “Better Way” and would provide tax credits – indexed to age, not income – for individuals to purchase private insurance; promote health savings accounts (HSAs) tied to high-deductible health plans; establish high-risk pools; and modify Medicaid by providing states with increased flexibility through per capita caps or block grants.

Per Ryan, the bill may be introduced the week of Feb. 27. The House Energy and Commerce Committee is expected to mark-up legislation related to Medicaid reform early that week.

Under the House Republican plan, states would have the option to transition their Medicaid program to a per capita cap or a block grant payment system. The per capita cap would be determined by each state’s average Medicaid spending in a base year that would grow with inflation and take into consideration the number of eligible enrollees. 

The plan says that “states that chose to expand their Medicaid programs under the ACA could continue to receive enhanced federal payments for currently enrolled beneficiaries for a limited period of time. However, after a date certain, if states choose to keep their Medicaid programs open to new enrollees in the expansion population, states would be reimbursed at their traditional match rates for these beneficiaries.”

Minnesota is among the 31 states and the District of Columbia that expanded Medicaid. Minnesota’s Medicaid expansion has resulted in the expansion of coverage and provided $1.6 billion annually in federal funding.

Under an initial analysis conducted by health care consulting company Avalere Health, under a block grant payment system, Minnesota’s Medicaid federal funding could be reduced by 16-30 percent. Under a per capita cap payment system, federal funding could be reduced by as much as 15 percent.

MHA is continuing to work with members and with Minnesota members of Congress to provide information on how this plan would impact Minnesota’s hospitals and the patients they serve. Read the full plan.

With questions, contact Briana Nord Parish, policy analyst, MHA, 651-603-3498, or Ben Peltier, vice president of legal and federal affairs, MHA, 651-603-3513. return to top

CMS issues proposed rule aimed at stabilizing federal exchanges in 2018

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule aimed at stabilizing the federal individual and small group insurance markets. The proposed rule would:

  • Shorten open enrollment period for 2018
  • Require individuals to submit documentation of eligibility and be subject to preapproval when seeking coverage during a special enrollment period
  • Require consumers to pay any past premium debt before they can be re-enrolled in coverage for the subsequent year
  • Permit insurers to provide lower cost, less coverage plans to consumers by allowing a plan that qualifies as a QHP at a particular metal level to vary from the set actuarial value while retaining its metal-level designation
  • Defer to states with the authority and means to assess insurer network adequacy and reduce the percentage of essential community providers with which plans would be required to contract from 30 percent to 20 percent

The proposed rule does not include underwriting ratios. It had been reported that the proposed rule would allow insurers more flexibility to set premium age ratios at 3.49 to 1. Under the Affordable Care Act (ACA), premiums for older enrollees can be only three times as high as premiums for younger enrollees. Health and Human Services officials argued that since 3.49 rounds down to three, the change would still comply with the law.

The CMS-proposed changes would not apply to Minnesota since the state operates its own insurance marketplace; however, CMS encourages states facilitating their own markets to implement similar changes.

The proposed rule is available online. CMS will accept comments on the proposed changes through March 7. return to top

Redwood Area Hospital CEO appointed to AHA Regional Policy Board Six

Bryan Lydick, chief executive officer (CEO) of Redwood Area Hospital, was appointed as a state delegate and member of the American Hospital Association’s (AHA) Regional Policy Board Six for a term through December 2018.

AHA Regional Policy Boards meet three times a year to discuss policy issues. Their recommendations and analyses are used by the AHA Board in its policy deliberations. Region Six encompasses Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota.

Lydick has served as CEO of Redwood Area Hospital since June 2013. He has nearly 20 years’ experience in health care leadership. return to top