MMA News
Ruling Supports Newborn Screening Program
A Minnesota district court ruled in November that there is no legal conflict between the state’s newborn screening program and its genetic privacy law.
The MMA is a strong supporter of the program, which tests newborns for rare disorders. “This opinion is very good news for this life-saving program,” says Sara Noznesky, MMA manager of legislative affairs.
Nine families filed a lawsuit in March against the state of Minnesota, the Minnesota Department of Health, and the commissioner of health claiming that the newborn screening program’s practice of “collecting, storing, using, and disseminating blood and genetic information without written informed consent” violates the Minnesota Genetic Privacy Act (Minn. Stat. § 13.386). The defendants sought dismissal of the complaint in its entirety arguing that the genetic privacy act does not apply to the newborn screening program and that the Department of Health had not disseminated any of the plaintiffs’ genetic information.
Hennepin District Court Judge Marilyn Rosenbaum sided with the defendants and issued an order to dismiss the lawsuit on November 24. The order stated, “The blood samples taken pursuant to the newborn screening program are biological samples, not genetic information as defined in the genetic privacy act. Even if these blood samples are considered genetic information under the genetic privacy act, (it) states that it applies to the collection, storage, use, and dissemination of genetic information ‘unless otherwise expressly provided by law.’ The genetic privacy act does not supersede specific existing law such as the newborn screening program.”
Since 1965, the Minnesota Department of Health has coordinated with hospitals and health care providers to screen newborns shortly after birth for disorders that if left untreated can lead to illness, physical disability, developmental delays, or death. The blood specimens collected through the program are stored in order to improve the accuracy of the tests or develop new ones, unless a child’s parents request otherwise.
The genetic privacy act took effect in 2006.
MMA Supports Medicare Payment Reform Despite AMA Opposition
The MMA continues to support establishment of a value index for paying physicians who treat Medicare patients, despite the AMA’s coming out against such a change.
In November, the AMA voiced its opposition to the value-index Medicare payment modifier included in the Senate health care reform bill. The Senate bill required the development and application of a value index modifier that would base a portion of Medicare payments on the quality of care provided to enrollees compared with the cost of that care. That move put the MMA at odds with the AMA over the issue.
For months, the MMA and members of Minnesota’s Congressional delegation have been advocating for such a modifier. The MMA has strongly supported Sen. Amy Klobuchar’s and Rep. Betty McCollum’s efforts to ensure the inclusion of Medicare payment reform in the final health care reform bill.
The AMA opposed the establishment of a value index because it believes that the Centers for Medicare and Medicaid Services (CMS) lacks the ability or the resources to develop one. The AMA called for CMS to study the issue instead. Language in the bill already gives CMS several years to develop the index.
Value Index Timeline Proposed by Senate
2012 – Specific cost and quality measures published
2013 – Implementation of value-based adjustment process begins
2015 – Payment consequences begin
2017 – All physician payments subject to payment modifier |
The MMA agrees that any value-based payment system needs to be valid, accurate, and verifiable but does not believe the nation should wait for the perfect system to emerge before attempting to address the current situation, which penalizes providers in states such as Minnesota that provide high-quality, low-cost care.
“We have been saying since the federal reform debate began that if we fail to reform the flawed Medicare payment system, we will have failed,” says MMA President Benjamin Whitten, M.D. “We all agree that we need to move to a system that rewards quality, and this value-based payment language starts us on that path.”
The MMA will continue to communicate its support for a value-based payment system to Minnesota’s two U.S. senators and will encourage the AMA to get on board. “The reality is that the current bill has a lengthy timeline that will allow for CMS to develop a workable solution,” Whitten says.
DFL Leaders Announce Plan to Save GAMC
In December, DFL leaders announced their plan to partially restore funding for the General Assistance Medical Care (GAMC) program for 16 months. The program faced extinction when Gov. Tim Pawlenty unalloted funding for it last year.
Their proposal would create a short-term, lower-cost GAMC program that would run from March 1, 2010, until June 30, 2011. The program would serve as a bridge until federal assistance that is being considered as part of national health care reform becomes available.
The DFL proposal would be funded with a combination of federal and county money, a surcharge on hospitals and HMOs, drug-company rebates, and reduced reimbursements to health care providers serving GAMC patients.
Provisions in the DFL Plan to Save GAMC
• Outpatient services reimbursed at 50 percent of the current GAMC rate,
• Surcharge on hospitals and HMOs,
• More limited eligibility rules,
• Assessment of each county’s GAMC expenditures with each county contributing 10 percent of its costs to the program,
• Higher copays,
• Allows for counties to act as Accountable Care Organizations (ACO) and assume the total cost of caring for an enrollee in exchange for a lump sum payment,
• County ACOs may limit an enrollee’s choices of provider or require a designated primary care physician that is certified as a health care home, and
• Inpatient services not reimbursed if a hospital has less than $500,000 in services provided to GAMC recipients. |
Physicians would only be reimbursed 50 percent of what GAMC currently pays for outpatient services. Pregnant women, inmates, and Minnesotans with private insurance would no longer be eligible for GAMC under the DFL plan.
If the proposal becomes law, current GAMC enrollees would not be automatically enrolled in MinnesotaCare on March 1, which is what the Pawlenty Administration proposed last fall.
DFL leaders said their plan would not increase taxes; but Pawlenty commented that he was concerned about the proposed surcharge.
The MMA’s reaction to the plan was mixed. “We are glad to see the commitment by key legislators to find a way to maintain coverage for our most vulnerable citizens,” says Dave Renner, the MMA’s director of state and federal legislation. “But to expect clinics, which have all of the pressures of other small businesses, to accept a 50 percent cut to a payment that already does not cover overhead costs is not realistic.”