MMA News
Session Comes to a Close
The 2010 legislative session was dominated by the need to erase a nearly $3 billion budget deficit. It was in this legislative environment that the MMA set out to achieve three major goals: limit reimbursement cuts, save the General Assistance Medical Care (GAMC) program, and improve the state’s peer-grouping initiative.
Physicians did change the state’s peer-grouping program in ways they felt were more fair to them, and a very scaled-back version of the GAMC program still exists. But it was not possible to stave off reimbursement cuts because of Gov. Tim Pawlenty’s unwillingness to increase revenues. Here’s a run-down of what happened in regard to these issues:
Peer Grouping
The governor signed a peer-grouping bill in May that the MMA worked with lawmakers to introduce and get passed. Peer grouping is a statewide initiative to compare clinics and hospitals based on the cost and quality of the care they provide. It was created through the 2008 Health Care Reform Act. The 2010 legislation corrects some flaws in the initiative. It includes the following provisions that were endorsed by physicians:
- A new requirement that the peer-grouping data must meet standards for reliability and validity before being released to the public;
- A repeal of language that precludes providers who score in the bottom 10 percent on the quality and cost measures from treating patients covered by state-subsidized health insurance plans, and
- An extension of the timeline for health plans to start using the data no earlier than January 2012 or 12 months after it is made public.
“The goal of our legislative effort has been to create stronger assurances for the development of valid and reliable information, to remove the punitive aspects of the initiative, and to have a more realistic legislative timeline,” says Janet Silversmith, the MMA’s health policy director. “Getting this law passed brings us closer to that goal.”
GAMC
Last year, the governor jeopardized the fate of the GAMC program, and the 37,000 people enrolled in it, when he line-item vetoed its funding. At the start of the session, he proposed ending the program and transferring GAMC enrollees to MinnesotaCare—a proposal the MMA opposed.
DFL lawmakers countered with a plan to pay for the program with revenue generated through Medical Assistance (MA) surcharges. The governor vetoed this proposal after it passed the House and Senate with bipartisan majorities. In March, Pawlenty and lawmakers agreed to support a GAMC program in which hospitals would be able to form care coordination organizations (CCOs) that would receive lump-sum payments to provide care to GAMC enrollees in a given geographic area. Under the proposal, all GAMC care would need to be delivered through the CCOs by December 1, 2010.
The MMA did not oppose the final plan but told lawmakers that it was neither realistic nor sustainable. The plan severely cut payments to hospitals and expected them to provide both outpatient and inpatient services to GAMC enrollees. Only a handful of metro-area hospitals signed up for the new GAMC program and none of the outstate hospitals agreed to participate.
The passage of national health care reform in March opened up the possibility of transferring people in GAMC to MA. The new legislation would have given Minnesota $1.4 billion in additional federal money over three years to cover about 100,000 people. The cost to the state would have been an additional $188 million.
The MMA supported doing this and argued that expanding MA would result in stable, comprehensive benefits for the men and women currently covered by GAMC, as well as better reimbursement rates for hospitals and physicians and a more streamlined state-supported health care system.
The MMA, the Minnesota Nurses Association, the Minnesota Hospital Association, and other groups that advocate for low-income Minnesotans called for the shift to MA at a joint news conference near the end of the session. But Pawlenty and Republican lawmakers rejected the expansion plan, saying the state could not afford it and that they were philosophically opposed to it because it was made possible by national health care reform.
As a result of last-minute negotiations, the state has funded and created the legal structure for the MA expansion, and Pawlenty or the next governor will have until January 15 to shift GAMC enrollees to MA by simply issuing an executive order.
The MMA will continue to push for the MA expansion.
Reimbursement Cuts
The House and the Senate closed the nearly $3 billion budget hole primarily by ratifying the $2.7 billion in unilateral unallotment cuts that the governor made in 2009. As a result, the final budget contained $292 million in health and human services cuts. There are significant reductions in payment rates for medical services, including a 7 percent cut in the fee-for-service reimbursement for nonprimary care services provided to MA enrollees. This change, which takes effect July 1, 2010, comes on top of last year’s 6.5 percent rate reduction for specialist services.
In addition, rates paid by the state to managed care plans will be reduced by nearly 3 percent for MA enrollees and nearly 15 percent for adult MinnesotaCare enrollees without children for the next three years. The law does not guarantee that health plans will not pass on these reductions to providers.
“We are disappointed and frustrated that lawmakers continued this unsustainable approach of simply reducing reimbursement rates that already, in many cases, do not cover the cost of care,” says Dave Renner, the MMA’s director of state and federal legislation.
The final piece of the budget that will result in even further payment cuts is a provision that caps MA rates for physician services at Medicare levels. A 21 percent cut to Medicare reimbursement was scheduled to take effect June 1.
The MMA plans to redouble its efforts to increase payments. If you have a story about how the reductions in state reimbursements are affecting your practice, please contact MMA communications manager Scott Smith at ssmith@mnmed.org or 612/362-3726.
Legislative Wrap-up
The following is a summary of what happened to some of the bills the MMA was monitoring during the 2010 Legislative session.
PASSED
Contracting. Starting January 1, 2011, a new regulatory framework more favorable to clinics will govern contracts between providers and health plans. The MMA supported this proposal, which was brought forward by the Minnesota Medical Group Management Association.
Birthing Centers. The state approved licensing guidelines for nonhospital-based birthing centers. To be licensed, the centers must be accredited by the Commission for the Accreditation of Birth Centers. The MMA supported this proposal.
Interpreter Certification Requirement. The state approved a new policy, which is to pay for interpreter services provided to Medical Assistance (MA) enrollees only if those services are delivered by a registered interpreter. The MMA supported this.
Dental Caries. A new law encourages primary care physicians to include dental health as part of general well-child or teen check-ups for enrollees in MA and MinnesotaCare. The MMA supported this.
HIT Exchange. The state will establish a Health Information Exchange Oversight Board within the Department of Health by 2011. The board will oversee efforts to create a statewide system for electronically exchanging medical information by 2015. The MMA supported this proposal.
Complete Streets. The state will develop guidelines and policies for state road projects that ensure that streets are safe for and accessible to pedestrians, transit riders, bicyclists, and drivers. The MMA supported this. Physical Education Requirements. The state will create physical education standards for elementary schools. The MMA supported this.
DID NOT PASS
Lyme Disease Treatment Protection. This bill would have prohibited the Minnesota Board of Medical Practice from disciplining doctors who prescribe long-term antibiotics to treat Lyme disease. Instead, the Board of Medical Practice voluntarily agreed to implement a five-year moratorium on sanctioning physicians for the long-term use of antibiotics to treat Lyme disease. The MMA opposed this attempt to legislate a clinical protocol.
Laser Safety. The state would have established minimum training and supervision requirements for people who use laser and intense pulse light devices for skin treatments. The MMA joined with the Minnesota Dermatology Association to support this measure.
Chiropractic Practice Act. Chiropractors proposed expanding their scope of practice and wanted to allow use of the term “chiropractic physicians.” The MMA opposed this.
Registration of Prescribers. The state would have established a registration system for persons who manufacture, distribute, prescribe, or dispense controlled substances. The goal of this legislation was to raise revenues through a $75 registration fee. The MMA opposed this bill.
Pharmaceutical Company Gifts and Marketing. The Legislature failed to pass three bills designed to limit gifts and curb excessive marketing by pharmaceutical companies. The MMA supported the bills.
MERC Funding Cuts. Gov. Tim Pawlenty’s supplemental budget included a $55 million cut to the Medical Education and Research Costs (MERC) program. The cut, which the MMA opposed, did not end up in the final budget.
MMA Forms Health Care Reform Work Group
The MMA has selected 15 individuals to serve on a health care reform work group. The work group’s charge includes:
- Re-evaluating the MMA’s health care reform goals and policies for promoting public health, expanding insurance coverage, redesigning care delivery, reforming payment systems, improving quality, and controlling costs;
- Examining alternative health care reform proposals with respect to insurance coverage, care delivery redesign, payment reform, and quality improvement to determine whether they accomplish MMA goals; and
- Recommending strategies to further advance health care reform.
The work group was created by Resolution 311, which was adopted at the MMA’s 2009 Annual Meeting. It will report regularly to the MMA Board of Trustees on its progress and activities and will complete its work no later than December 31, 2010.
Webinar on National Reform Now Online
MMA members may access online a recording of a webinar the MMA hosted in April on the implications of national health care reform. On the recording, MMA staff highlight key provisions of the Patient Protection and Affordable Care Act with respect to Medicare payment, Medicaid eligibility, quality improvement, public health investment, and disclosure requirements. They also discuss how federal reform may influence state reform efforts already underway.