MMA News
Physicians Fight Provider Tax Increase
In April, approximately 500 physicians responded to an MMA Action Alert! and urged their legislators not to raise the provider tax as part of the solution to the state’s $4.2 billion budget deficit.
That effort paid off as both the House and Senate initially put forward tax bills that would increase the income, cigarette, and alcohol taxes, but not the sick tax. The Senate Tax Committee later amended the Senate bill to include a placeholder for increasing the provider tax on hospitals and surgical centers.
Thomas Bakk, DFL-Virginia, chair of the Senate Tax Committee, has said he does not want to increase the sick tax. However, he wanted to amend the bill as a procedural matter, so that if lawmakers do decide to increase the provider tax during final negotiations, the change will be codified in the tax bill instead of the budget bill.
Dave Renner, the MMA’s director of state and federal legislation, says it was disconcerting that committee members who said they didn’t want to increase the provider tax amended the bill and created an opportunity for that very thing to happen.
“Senate lawmakers were saying they don’t want to increase the sick tax and this was just a procedural thing. But this amendment shows that we need to keep on top of this issue as lawmakers try to find ways to balance the budget,” he says.
The MMA strongly opposes any increase in the provider tax and credits the work of members for making sure an increase was not part of the initial budget-balancing plan.
“We want to thank the physicians who wrote to their lawmakers and helped to persuade House and Senate members not to include a provider tax increase in the first round of tax bills,” says Noel Peterson, M.D., MMA president. “But we will have to stay vigilant until the end of the session to make sure lawmakers don’t increase this tax and further escalate health care costs.”
As of the end of April, DFL lawmakers in the House and Senate were on a collision course with Gov. Tim Pawlenty, who has pledged not to raise taxes in order to eliminate the budget deficit.
“As the governor continues to say ‘no new taxes,’ it is looking more and more likely that the final solution is going to be more cuts,” Renner says.
Prepare for New CMS Audit Process
The MMA has created a list of frequently asked questions about how physicians can prepare for and respond to a Centers for Medicare and Medicaid Services (CMS) audit.
In an attempt to identify and prevent waste, fraud, and abuse in Medicare, the CMS has hired recovery audit contractors (RACs) to examine billing trends and patterns across Medicare, specifically looking for organizations and individuals whose billings for Medicare services are at least $10 higher on average than the majority of providers and suppliers in the community.
A Virginia-based company, CGI Technologies and Solutions, will serve as the RAC for Minnesota.
Visit www.mmaonline.net and search for “RAC FAQ” to learn what you need to do to get ready.
Learn How It All Turned Out
This summer, the MMA’s lobbying team will hit the road as part of the MMA’s Advocacy Rounds program. Advocacy Rounds offer physicians a chance to get an up-close look at the 2009 Legislative session and learn how lawmakers’ actions will affect their practices.
If you would like to be notified about a meeting near you, contact our managers of physician outreach: Dennis Gerhardstein, southern Minnesota/metro area at 612/362-3745 or dgerhardstein@mnmed.org or Mandy Rubenstein, northern Minnesota at 612/362-3740 or mrubenstein@mnmed.org.
Mid-session Legislative Update
Lawmakers are scheduled to wrap up what has been a painful session dominated by a $4.2 billion deficit later this month. But with DFL lawmakers and Gov. Tim Pawlenty at odds over how to balance the state’s budget, it is unclear if they will meet the May 18 constitutional deadline for adjournment. If the two sides can’t agree, it will be up to the governor to call a special session before June 30, the end of the fiscal year.
With the session winding down, here’s a look at some of the proposals that still had a chance of passing as of mid-April and those that were dead for the session.
Still alive
Physician reimbursement cut
Lawmakers were leaning toward cutting physicians’ pay for providing care to patients in state-run health insurance programs despite already low reimbursement rates. A 3 percent cut in physician reimbursement for care provided to patients covered by Medical Assistance, Minnesota Care, and General Assistance Medical Care was included in both Gov. Pawlenty’s and the DFL lawmakers’ budget proposals, although the legislative proposal excludes cuts for primary care services. The MMA opposes this plan.
Booster seats
S.F. 99 would require children up to
8 years of age and 4 feet 9 inches tall to use proper child-restraint systems, such as booster seats. The MMA supports this bill.
Primary offense seat belt law
S.F. 47 would allow police officers to stop and ticket motorists for not wearing their seat belts (a primary offense). Existing state law requires motorists to wear seat belts, but drivers can be ticketed for not wearing a seat belt only if they are stopped for another reason. The MMA supports this measure.
Physician assistants
S.F. 230 would change the regulation of physician assistants from registration to licensure and allow physicians to supervise five instead of two physician assistants. The MMA supports this.
Health plan payment disclosure
The MMA worked with legislators to introduce a bill that would require health plans that administer state safety-net programs (Medical Assistance, MinnesotaCare, and General Assistance Medical Care) to annually report information about their managed care payments to providers. Physicians suspect that insurers have not been passing along a portion of the payment increases they receive from the state to physicians and other care providers. The MMA supports this.
Licensed birthing centers
DFL lawmakers introduced legislation that would create a licensing process for nonhospital-based birthing centers. The intent of the bill, S.F. 780, is to encourage women having “low-risk pregnancies” who are enrolled in safety-net programs to deliver their babies at those birthing centers as a cost-saving measure. The MMA succeeded in making the House version of the bill less onerous by removing a payment cap for the deliveries and making it clear that prospective mothers on public programs were not required to use the birthing centers. The MMA opposes the Senate version.
Cesarean deliveries
Another bill, S.F. 1403, aims to reduce the frequency of cesarean deliveries by establishing a blended reimbursement rate for all deliveries (cesarean and vaginal). The bill proposes a facility fee of $4,187 and a professional payment of $982 per birth. The MMA opposed the measure.
Obstetrics health care home
H.F. 1346 directs the commissioners of Health and Human Services to establish certification standards for obstetric health care homes. The goal of the bill is to create and pay for a bundled set of birth-related services for patients in state-run health programs and to promote more natural births. The MMA finds this bill problematic because the 2008 Health Care Reform Act has already created a process for exploring a similar payment concept called “baskets of care.”
Dental caries prevention
S.F. 633 would require all primary care providers to perform a cursory oral examination, complete a risk assessment for dental caries, and apply fluoride varnish during well-child and other visits for children ages 1 and older who are covered by state-run health insurance programs. The MMA was able to amend the House version so that it encourages, rather than mandates, dental exams. The MMA opposes the Senate version.
Shared decision-making requirement
The MMA raised concerns about S.F. 696, which would require patients to engage in a specific decision-making process before choosing to have surgery for abnormal uterine bleeding, benign prostate enlargement, chronic back pain, early-stage breast and prostate cancers, gastroesophageal reflux disease, hemorrhoids, spinal stenosis, temporomandibular joint dysfunction, ulcerative colitis, urinary incontinence, uterine fibroids, varicose veins, or total hip replacement or bypass surgery for coronary disease or angioplasty for stable coronary artery disease. The MMA is concerned that the bill makes shared decision-making a requirement for reimbursement (similar to prior authorization) and questions how it would be implemented.
Provider tax
Both the House and Senate have considered bills to increase the provider tax. H.F. 2315 would raise the provider tax 1 percent. Although the bill was heard in the House Tax Committee, it was not included in the House tax bill. The Senate tax bill initially did not include an increase in the tax, but an amendment was offered with placeholder language in case legislators decide to increase the tax at a later date. The MMA opposes increasing the tax.
Newborn screening
Legislation allowing Minnesota’s newborn screening program to continue albeit with changes to the storage and research part of the program (H.F. 1760) met the policy deadline. Members of the Senate expressed concern that the bill would limit the length of time samples collected through the program could be stored to only two years, and senators have worked to stall the bill. The MMA supports passing a bill to protect this important program.
Dead as of April
Advanced practice registered nurses
H.F. 1668 proposed eliminating the requirement that advanced practice registered nurses have a written prescribing agreement with a physician. The bill, which the MMA opposed, was tabled in a committee.
Appeals of death determinations
H.F. 176 would have allowed a determination of death by a physician to be challenged in court if a family member, or anyone else, disagreed with the cause of death listed on a death certificate. It was defeated in the House Civil Law Committee. The MMA opposed it.
Limit on copying costs for medical records
A bill that would limit the amount that hospitals and clinics could charge for duplicating medical records failed to meet the deadline for passing out of policy committees. S.F. 857 would have set the allowable price for copying medical records at 5 cents per page or the actual cost of the copy, whichever was less. The MMA opposed the bill.
Gift ban expansion
A Senate committee tabled S.F. 1237, which would have expanded Minnesota’s current ban on gifts to health care providers from drug companies to also include medical device companies. The bill was never heard in the House. The MMA did not take a position on it.
Vaginal birth following a cesarean section
S.F. 1468 would have prohibited hospitals from establishing policies that prohibit women from having a vaginal birth following a cesarean section (VBAC). The bill was problematic for hospitals that use the American College of Obstetrics standards for VBACs, which require a surgeon and an anesthetist to be available immediately if needed. The bill was tabled in the Senate. The MMA opposed it.