Minnesota Hospital Association


May 30, 2017

MHA Newsline: May 30, 2017

In this issue 

HHS bill passes during special session

After calling a special session that lasted four days, lawmakers approved the state’s $46 billion, two-year budget. The governor is expected to take final action on the budget this week.   

The $14 billion health and human services bill reduces forecasted general fund expenditures by $463 million in FY 2018 and another $273 million in FY 2019. To offset these reductions, $391 million is being used from the Health Care Access Fund (HCAF) to cover a growing portion of the state’s Medical Assistance costs.   

Highlights of the bill of interest to the hospital community include: 

  • Preserved access to mental health services: MHA had concerns with the HHS bill that was originally passed by the Legislature and subsequently vetoed by Governor Dayton, which included cuts in the Direct Care and Treatment services provided by the state. The Department of Human Services had estimated that the proposed cuts to its budget could have necessitated the elimination of as many as 210 positions in Direct Care and Treatment operations. The HHS bill fully funds the requests for the Security Hospital ($22 million), state-operated services ($10.2 million) and the department’s operations. 
    • The bill also includes $4.7 million for redesigning intensive mental health services for children. 
    • The bill also includes partial funding ($2.1 million) for MHA’s mental health innovation grant program. We are pleased that this initiative has started and we look forward to partnering with counties and community mental health centers to expand access to mental health services. 
  • Protected hospital payments: The original Senate bill cut hospital inpatient fee-for-service payments, delaying Medical Assistance rate rebasing until 2021. This would have negatively impacted all hospitals. This 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 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. MHA is pleased to report this provision was not included in the final HHS bill. 
  • Protected health care provider payments: The original Senate bill cut health care provider payments across the board, 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 meant a loss in federal funding. This would have been a cut in payments to physicians, ambulatory surgical centers, therapists and outpatient hospital services. MHA is pleased to report this provision was not included in the final HHS bill. 
  • Prevented 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 be in addition to the current SQRMS program (Statewide Quality Reporting Measurement System) that already has hospitals reporting on dozens of quality measures and new federal CMS reporting requirements. 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/penalty payments for hospitals in a budget neutral manner based on this claims data. MHA is pleased to report this provision was not included in the final HHS bill. 

The HHS bill uses $391 million from the HCAF on top of the $400 million from the HCAF previously allocated this year for the 2018-19 reinsurance program. The projected HCAF surplus has now been spent. This will create real and difficult challenges for the health care community in future legislative sessions, particularly if federal funding coming into Minnesota is lost with potential repeal and replacement of the Affordable Care Act. This federal funding supports not only our state’s Medical Assistance program, but also funding for Minnesota’s Basic Health Plan – our MinnesotaCare program.   

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 Ashley Beno, member services and communications specialist, 651-603-3545. return to top   

CBO releases House-passed AHCA cost estimate; Senate begins drafting its bill

The Congressional Budget Office (CBO) on May 24 released its cost estimate of the House-passed American Health Care Act (AHCA). CBO projected that the AHCA will increase the number of insured by 14 million in 2018, growing to 23 million by 2026; the previous bill would have raised the number of uninsured by 24 million in 2026. CBO estimates the AHCA will reduce the federal deficit by $119 billion over the next 10 years, which is lower than the $150 billion cost estimate of the previous version of the AHCA.   

According to the CBO estimate, the ACHA will significantly increase the number of uninsured among people ages 50 to 64 with income under 200 percent of the federal poverty guidelines and will lower federal Medicaid spending by $834 billion over 10 years. Additionally, the House-passed bill will reduce individual market premiums overall while sharply increasing premiums for older, low-income people and significantly increase out-of-pocket costs for people in states that waived ACA requirements on essential health benefits, particularly for maternity, mental health and substance abuse services.   

In the Senate, discussions about how to repeal and replace the Affordable Care Act (ACA) continue. Senate Republican and Democratic leadership have said the Senate will not approve the House-passed AHCA, a position that was reiterated after the release of the CBO cost and coverage estimate. It is being reported that Republican leadership staff are beginning to draft legislative language based on the discussions of the Republican work group. The draft legislative language will be shared with Republican senators when they return from the Memorial Day recess. A vote on a Senate bill could occur in late June or July.   

The likely difference between the Senate version and the House-passed version include modifications to the tax credits to buy insurance by linking them to income, not just age; changes to the Medicaid reform provisions to lessen their impact on expansion states; removal of provisions defunding Planned Parenthood; and removal of or changes to provisions giving states more authority over whether to cover the essential health benefits set.  

MHA maintains its position of opposing the AHCA and will continue to advocate for meaningful insurance coverage for all Minnesotans; coverage of all essential health care services; and for enhanced public health insurance program payments to providers to cover costs associated with caring for public program participants. MHA will continue to work with Sens. Klobuchar and Franken to protect the interests of Minnesota’s hospitals and the patients they serve.   

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   

President’s FY 2018 budget request significantly reduces health-related federal spending

On May 23, President Trump released his fiscal year (FY) 2018 budget request. Congress will not consider the president’s budget proposal, drafting its own budget resolution instead; however, the president’s budget request provides insight into the administration’s priorities. The budget assumes the passage of the House-passed American Health Care Act (AHCA) for a total savings of $250 billion over 10 years.   

MHA will continue to oppose federal spending cuts that negatively impact health insurance coverage, including Medical Assistance, and hospitals’ ability to provide high-quality care, whether they are part of efforts to repeal the Affordable Care Act or budget proposals.   

Below are the health care-related highlights of President Trump’s budget.   

The president’s budget proposed to cut Medicaid by $610 billion, in additional to the Medicaid cuts that are part of AHCA, which total $880 billion over 10 years. The budget request would reduce Medicaid spending by giving states a choice in how they restructure Medicaid’s financing through either a per capita cap or block grant option. Additionally, states would be allowed to advance further programmatic changes that include work requirements. Medicaid would be reduced by $399 million over 10 years as a result of medical liability reforms.   

The budget request did not propose any direct reductions to Medicare funding. It did include policy changes with indirect spending impacts. The budget request: 

  • Proposed to provide $1.3 billion over 10 years to reform the Medicare appeals process to address the backlog of pending appeals.
  • Proposed $70 million in new Health Care Fraud and Abuse Control Program funding for FY 2018. 
  • Repealed Independent Payment Advisory Board (IPAB), saving Medicare $7.6 billion over the next decade. 
  • Proposed to provide $31.4 billion in savings resulting from a medical liability reform legislative proposal. Medical liability reform would include capping non-economic damages, creating safe harbors when clinical standards are followed and federal guidance on state health tribunals, among other provisions. 

Children’s Health Insurance Program (CHIP)
The budget request would extend CHIP funding through FY 2019, while calling for $5.8 billion in additional savings from program funding over the two-year period. The budget request proposed: 

  • Eliminating the current enhanced federal match of 23 percentage points. 
  • Ending the eligibility maintenance of effort requirement. 
  • Capping the CHIP income limit at 250 percent of the federal poverty level. 

Other health-related provisions
The budget request proposed: 

  • Reducing federal support for the Children’s Hospital GME Program by $5 million, providing $295 million in discretionary funding in FY 2018. 
  • Providing $60 million in mandatory funding in both FYs 2018 and 2019 for the Health Center GME Program, which is an increase of $4 million over 2017 levels. 
  • Maintaining funding for the 340B Drug Pricing Program at $10 million in FY 2018 and calling for an update to the program’s regulatory authority to increase transparency and improve program integrity.  
  • Reducing funding for the Nursing Workforce Development Program by $146 million, while maintaining current funding for the NURSE Corps Scholarship and the Loan Repayment Program. 

Department of Health and Human Services
Funding for the National Institutes of Health (NIH) would be decreased by $5.7 billion. Funding for the National Cancer Institute would decline by $1 billion in FY 2018 and funding for the National Institute of Allergy and Infectious Diseases would decline by $838 million. The budget request also would reduce funding for the National Institute of Mental Health and National Institute on Drug Abuse by more than $500 million combined.   

The Agency for Healthcare Research and Quality (AHRQ) would become part of NIH and be provided $272 million.   Funding for the Centers for Disease Control and Prevention (CDC) would decline by $1.3 billion in FY 2018 under the budget request.   

Funding for the Food and Drug Administration (FDA) would increase by $456 million in FY 2018. Industry fees would be increased to fund 100 percent of premarket review and approval activities in the animal drug, animal generic, prescription and generic drug, biosimilar and medical device programs.   

President Trump’s budget proposal would balance the budget over a decade while increasing defense discretionary spending by $54 billion and reducing nondefense spending by the same amount in FY 2018. Over the 10-year budget window, nondefense discretionary spending would be lowered by almost $1.5 trillion and defense spending would be increased by $489 billion. return to top   

BMP expands window for renewal of credentials, issues reminder about PMP registration

The Minnesota Board of Medical Practice (BMP) has expanded the window for renewal of credentials from two months in advance of the expiration date to three months in advance, allowing professionals whose credentials expire on or by July 31 to complete the renewal process early. Providers are encouraged to complete the online renewal process as soon as they are eligible to do so.   

In addition, effective July 1, licensees with DEA registration may be required to register for a Minnesota Prescription Monitoring Program (PMP) account. Details about the statutory PMP registration requirement are posted on the BMP website. A link to the PMP registration site is embedded in the board’s online renewal process.   

To learn more, visit the BMP websitereturn to top   

Medicaid community conversations to be held May 31

Community conversations on Medicaid will take place on May 31 from 6-7:30 p.m. in St. Cloud, Bloomington and Northfield. Each event will include an overview of Medicaid in Minnesota and a panel discussion with local experts about how federal proposals will affect Medicaid.   

The events are sponsored by a coalition of organizations called “This is Medicaid.” Organizations include AARP Minnesota, Allina Health, American Cancer Society Cancer Action Network, Amherst H. Wilder Foundation, Care Providers, Catholic Charities of St. Paul and Minneapolis, Catholic Health Association of Minnesota, Children's Minnesota, Gillette Children’s Specialty Healthcare, LeadingAge Minnesota, Lutheran Social Service of Minnesota, Minnesota Association of Community Health Centers, Minnesota Association of Community Mental Health Programs, Minnesota Budget Project, Minnesota Council of Nonprofits, Minnesota Hospital Association, NAMI Minnesota, Portico Healthnet, Safety Net Coalition and The Arc Minnesota. To learn more and register for a conversation, view the event flierreturn to top  

MHA to provide class action settlement assistance

MHA has entered into a strategic agreement with Managed Care Advisory Group, LLC (MCAG), to offer MHA members a class action settlement recovery service. MCAG will assist interested MHA members in identifying and recovering significant funds from current and future class action settlements.   

MCAG has worked closely with thousands of physician practices and hundreds of hospitals to assist in the management of class action opportunities. Health care organizations are frequently eligible for participating in class action settlements and MCAG has distributed over $300 million to thousands of customers as a result of this service.   

Through this agreement, MCAG will track relevant settlements on behalf of MHA members, identify opportunities that are meaningful and assist in filing claims for payment. MCAG is also available to help you review settlement notices that are sent directly to your organizations. The service is provided on a contingency fee basis. MHA members will not receive any invoices or bills and MCAG only receives payment when an organization recovers settlement funds.   

A webinar providing additional information about the service, as well as upcoming settlements applicable to Minnesota hospitals and health systems, will be offered on June 7 at 10 a.m. To sign up for the webinar, click here.  

Learn more on MCAG’s website for MHA members. With questions, contact Ben Peltier, vice president of legal and federal affairs, MHA, 651-603-3513. return to top   

Administrative professionals program to be held July 27

Early-bird pricing available until June 6  
MHA’s annual program for health care administrative professionals, taking place on July 27 at the Crowne Plaza Minneapolis West in Plymouth, will offer sessions on topics such as timesaving tips for using Word and Outlook, recognizing and avoiding burnout and thriving in the era of patient- and family engaged care.  

Melissa Esquibel, a Microsoft Certified Trainer, returns with sessions on Word and Outlook. She will share tips to navigate at light speed, reduce repetitive typing and use styles in Word. She will also explore timesaving tips in Outlook using email, calendars and tasks.   

Rahul Koranne, M.D., senior vice president of clinical affairs and chief medical officer, MHA, will share ideas and suggestions on how to develop a plan to lessen the risk of burnout and increase workplace satisfaction.   

Joy Benn, quality and process improvement specialist, MHA, will share learnings from patients and families serving on committees and Patient and Family Advisory Councils and how to survive and thrive in the new era of patient- and family-engaged care.   

A special early-bird rate of $159 is available to members who registration is received in our office by June 6. The regular fee is $199 for members and $299 for nonmembers. For more information, view the full brochure or visit MHA’s website, log in, click “Calendar of Events” and select the program title to register. return to top