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2007 Health, Housing and Family Security Committee updates
Update: March 31, 2008 4:45 p.m.
The Health, Housing and Family Security Committee engaged in a discussion with Minnesota Dept. of Health Commissioner Sanne Magnan, and approved her confirmation, Mon., Mar. 31. The committee then heard two brief presentations.
Committee chair Sen. John Marty (DFL-Roseville) asked the commissioner to address three concerns. The first is treatment of employees who may express concerns on issues as private citizens, not on behalf of the agency. Magnan said reprimanding or scolding is not her style, and while she expects employees to support the agency's plans, she would not interfere with employees speaking as private citizens to their legislators.
Marty asked her to speak about the agency's commitment to the original intent of data practices and open meeting laws providing more transparency in government. Magnan said many of those ideas were developed before email, and she encourages people to carefully consider what they put in email, but not to stifle "vigorous debate."
The third concern Marty asked Magnan to address is how a commissioner may express ideas that are contrary to an official administration position. Magnan said she walked a fine line between being an appointed commissioner supporting the governor and a pubic servant. She said that her role is to defer to the will of the people by supporting the recommendations of their elected executive officials. Magnan did say that she would speak against something she felt was a fundamental injustice, corruption and illegal or unethical activity.
Berglin said the state was fortunate to have the commissioner as an advocate for public health needs in the administration.
The committee then heard two presentations. Dr. Stan Shanedling of the Dept. of Health spoke on the state's heart disease and stroke prevention plan. Heart disease and stroke together are the No. 1 cause of death in Minnesota, or 28 percent of the deaths annually, said Shanedling. In addition, hospitalizations costs are $2.1 billion annually, he said.
Indicators of high blood pressure, high blood cholesterol, diabetes, overweight, or obesity are all increasing, according to a program mid-course review.
Challenges to improving heart health include a need for public education, a lack of commitment to address the issue from certain population groups and geographic demographics, and the challenge of elevating the health risk in the perception of the public eye, according to Shanedling.
Positive indicators include a decrease in cigarette smoking and physical inactivity, and an increase in consumption of five fruits and vegetable servings daily.
In the context of the health care reform debates this information is particularly important, said Rachel Callanan of the American Heart Association. The association is requesting $400,000 for the stroke and heart disease prevention unit to continue to implement the plan. Callanan also answered questions about efforts to address health disparities related to income.
The committee then heard a presentation on anticipated shortages within the health care workforce. John McLaughlin of the Hennepin-Carver Workforce Development Fund said an initiative sponsored by Sen. Linda Higgins (DFL-Mpls.) has been unsuccessful in securing funds.
Dr. Bruce Nauth of the fund said the industry may lose tens of thousands of people in upcoming years due to an aging workforce, decreased entry into the labor force, and a decrease in the working age. These factors will converge with an increase in need due to advances in medical technology and longer life spans, said Nauth.
Sen. Sharon Erickson-Ropes (DFL-Winona) said the Legislature has failed to connect the dots between education funding and health care, and different sectors need to communicate better. Testifiers explained the slow increase in the capacity of the higher education system to accommodate interest in health care careers.
The Health, Housing and Family Security Committee reconvened for an evening hearing Wed., Mar. 19. The panel, chaired by Sen. John Marty (DFL-Roseville), met to complete work on its agenda prior to the second committee deadline.
Members spent the lion's share of the hearing discussing a bill, S.F. 3429, providing for an exception to the hospital moratorium in order to allow for the construction of a new psychiatric hospital in Woodbury.
Jim Golden, Minnesota Dept. of Health Division of Health Policy, presented information about the department's review of the need for a new psychiatric hospital in Woodbury. Golden said the department is required to consider five factors in its analysis of a plan submitted for public interest review: whether the new hospital is needed to provide timely access to care or access to new or improved services; the financial impact of a new hospital on existing hospitals; how the new hospital will affect the ability of existing hospitals to maintain existing staff; the extent to which the new hospital will provide services to nonpaying or low-income patients; and the views of the affected parties.
Golden said the department received a request from Prairie St. John's, a North Dakota health care organization, for a public interest review of a proposal to build a new 144-bed specialty psychiatric hospital in Woodbury. He said the department's review concluded that it is not in the public interest that Prairie St. John's build a new psychiatric hospital in the Metro Area. Golden said, the conclusion does not mean that there aren't problems with the mental health system in Minnesota, but the scale of the proposed project is large relative to any documented need for additional mental health beds in the Twin Cities. Golden said that recent mental health initatives are expected to reduce the need for hospitalizations and research indicates that with appropriate availability of intermediate resources, a significant number of hospitalizations could be avoided. Finally, Golden said the department also concluded that the proposal would likely have a negative financial impact on existing hospitals.
However, Golden said that during the course of the study, staff heard a number of individual stories that indicate the existing system does not serve mental health patients well.
Saltzman said there are other ways to look at the report from the Dept. of Health. "We've all heard stories of care delayed and care denied and that's the wrong way to deliver services to those who need them," said Saltzman. She said we hear about a medical arms race in health care. It is not okay for thousands of patients to be shuttled around the Midwest, she said. The department's report indicates 2,600 people must travel to obtain the mental health or chemical dependency treatment they need, Saltzman said.
Dr. Shaleen Kennedy, a psychiatrist, said, "We are desperate for psychiatric beds; often people, when faced with long waits in hospital emergency rooms, simply give up and go home." Kennedy said Prairie St. John's offers high quality care and has an excellent reputation. Prairie St. John's has taken proactive steps to provide integrated care for mental health patients, she said.
John Ryan, Prairie St. John's, said, one in ten patients in the Twin Cities must travel outside the Metro Area to find care and many others just go home. Ryan said the proposed facility won't even meet one third of the need for available beds. He said alternatives to inpatient care are not appropriate for patients having acute mental health episodes. Our charity care rates rival the best in the Twin Cities, Ryan said.
Opponents said that everyone agrees there are problems with the mental health system, but we must be careful about thinking inpatient beds are the solution. In recent years, we have come to understand the need for integrated services for mental health patients that includes medical care, they said. Dr. Lisa Capell, Fairview, said the question comes down to a choice between high-cost treatment for the privileged few or spreading resources to benefit more people. Kathy Knight, Fairview, said the for-profit model does little to meet the needs of medically complex cases.
Members laid the bill on the table. Marty said the measure sparked a good discussion and that the issue will be worked on in the coming months.
In other action, the committee advanced one additional bill. Sen. Tony Lourey (DFL-Kerrick) sponsored a bill, S.F. 3780, allowing optometrists to dispense a legend drug at retail if the drug is administered to the eye through a contact lens that is intended to correct vision.
A measure permitting chiropractors to practice on animals was approved by members of the Health, Housing and Family Security Committee, Wed., Mar. 19.
S.F. 3165, authored by Sen. Gary Kubly (DFL-Granite Falls), permits licensed chiropractors to engage in animal chiropractic care after completing at least 210 hours of specialized education. Annie Seefeldt, a chiropractic student, and Jim Hulbert, a dog breeder, discussed the benefits of chiropractic care for animals and its low availability in Minnesota. Kubly said the bill is based on a similar provision from Oklahoma. He noted that Oklahoma has not had any reported problems under its system, where a veterinarian's referral is not needed before an animal can be taken to a chiropractor.
This proposal raises serious issues relating to the quality or standard of care, said Dr. Robert Washabau, a professor of veterinary medicine at the University of Minnesota. A five-week course on animals tacked on to a human-centered course of education is insufficient, he said, and does not compare to the time veterinarians spend learning about animals and animal diseases. We would never accept having veterinarians take a five-week course on humans and then practice medicine on humans, he said. It would be preferable to adopt a structure where the veterinarian makes a diagnosis and refers the animal to a chiropractor if that is the right course of treatment, Washabau said.
We need to keep in perspective the differences between animals and humans, said Sen. Betsy Wergin (R-Princeton). We treat animals well, but they do not have the same status as humans, she said. For example, animals are checked into the cargo space of airplanes, she said. If owners believe their animals would benefit from chiropractic care, they should be able to obtain that care, Wergin said. It makes more sense to me for a veterinarian, who specializes in animals, to be offering this treatment, rather than a human-oriented chiropractor, said Sen. Debbie Johnson (R-Ham Lake). It should be a proposal for additional training for veterinarians to practice chiropractic care, she said.
Wergin offered an amendment providing that a chiropractor who practices on both animals and humans must have separate adjusting rooms, with the animal adjusting room non-carpeted. Wergin said the amendment seeks to help prevent the accidental transmission of disease from animals to humans. The amendment was adopted.
The measure was advanced to the full Senate.
Kubly also authored S.F. 2902, which provides that a supplemental health plan, purchased solely to cover hospitalization expenses in excess of the MinnesotaCare cap, does not make an enrollee ineligible for MinnesotaCare. A motion to advance the bill to the full Senate failed on a divided voice vote.
S.F. 2368, carried by Sen. Paul Koering (R-Fort Ripley), requires the Dept. of Human Services to notify the Legislature before the department relocates regional treatment centers or state-operated nursing homes. The bill was forwarded to the full Senate. S.F. 3353, authored by Chair John Marty (DFL-Roseville), provides rate increases for nursing facilities and other long-term care and community-based service providers. The bill was advanced to the Finance Committee. S.F. 3030, also carried by Marty, requires the commissioner of human services to convene a work group to study the feasibility and cost of establishing a toll-free telephone number for mental health crisis calls. The measure was re-referred to the State and Local Government Operations and Oversight Committee.
The Health, Housing and Family Security Committee met Mon., Mar. 17, to hear several bills suggested by the Dept. of Health and the Dept. of Human Services.
S.F. 2232, carried by Sen. Betsy Wergin (R-Princeton), makes changes to nursing home moratorium provisions. Wergin offered an amendment combining three technical bills into one measure. The amendment was adopted. The bill modifies the Department of Health's regulatory authority over several aspects of nursing facility operations. The measure also modifies provisions relating to the administrative process for approving exceptions to the facility and construction moratorium. The measure was approved and advanced to the full Senate.
Sen. Tony Lourey (DFL-Kerrick) sponsored a bill, S.F. 3571, exempting state-operated services clients, who work in the day training and habilitation vocational programs for therapeutic and rehabilitative purposes, from the requirement of being state employees. The bill was approved and sent to the Senate floor. S.F. 3563, authored by Sen. Sharon Erickson Ropes (DFL-Winona), makes a number of changes to provisions relating to reimbursement to independent living skills services and other listed providers through Medical Assistance waiver programs to eliminate conflict with federal law. The measure was approved and sent to the full Senate.
S.F. 3168, carried by Sen. Linda Berglin (DFL-Mpls.), makes changes to General Assistance Medical Care, Medical Assistance and MinnesotaCare. The bill also modifies provisions relating to claims, liens and the treatment of assets and establishes a statewide information exchange. The measure was approved and sent to the Senate floor.
The panel, chaired by Sen. John Marty (DFL-Roseville), also approved a bill allowing dogs to accompany persons patronizing outdoor cafes. The bill, S.F. 2232, allows municipalities to enact ordinances to authorize dogs to accompany patrons of outdoor food and beverage service establishments. Sen. Scott Dibble (DFL-Mpls.), chief author, said, because more people are moving to downtown areas with sidewalk cafes and coffee shops, a number of individuals and establishments would like to be able to have dogs accompany their owners at the cafes. The bill was re-referred to the State and Local Government Operations and Oversight Committee.
In light of the first committee deadline, the Health, Housing and Family Security Committee met Fri., Mar. 14, to clear bills from the agenda.
Members, chaired by Sen. John Marty (DFL-Roseville), began by considering a proposal to expand home and community-based long-term care services for older adults and family caregivers. S.F. 1931, sponsored by Sen. Sharon Erickson Ropes (DFL-Winona), establishes a statewide priority to enhance the mobility of older adults, establishes demonstration projects and establishes a tax credit for family caregivers of adults of all ages. Erickson Ropes said the bill strives to allow older Minnesotans to stay in their homes longer. Dawn Simonson, Minnesota Council on Aging, spoke in support of the measure.
The bill requires the Minnesota Board on Aging, in cooperation with other agencies, to establish a home modification program for low-to-moderate income adults age 60 and older who do not qualify for other publicly funded programs. In addition, the bill requires the establishment of a volunteer transportation program and a caregiver support program for family caregivers. The bill also provides for a home care tax credit for taxpayers who care for a family member who would otherwise be eligible for placement in a nursing home or other long-term care facility.
The bill was approved and advanced to the Taxes Committee.
Sen. David Tomassoni (DFL-Chisholm) sponsored a measure, S.F. 3300, directing the University of Minnesota to study workers' lung health. Tomassoni said mesothelioma, a type of cancer, was first thought to be caused by exposure to asbestos in industrial applications, but the recent disclosures of the occurance of the disease in iron miners has created an urgent need to study the health of mine workers. Under the bill, the study must include industry-specific worker mortality and morbidity studies, clinical disease studies, exposure assessments, case-control screening of current and former workers and environmental studies that assess health impacts on workers and communities. The bill was approved and advanced to the Finance Committee.
S.F. 3699, authored by Sen. John Doll (DFL-Burnsville), requires prescription information be kept confidential. Doll said the bill is aimed at preventing data mining for commercial purposes. Under the bill, commercial purpose includes, but is not limited to advertising, marketing, promotion, or any activity that could be used to influence sales or market share of a pharmaceurtical product, influence or evaluate the prescribing behavior of an individual health care professional, or evalute the effectiveness of a professional pharmaceutical detailing sales force. Members engaged in a wide ranging discussion on the practice of pharmaceutical detailing and whether physicians are influenced by gifts from pharmaceutical representatives. The bill was advanced to the Judiciary Committee, without recommendation, with the understanding that the stakeholders would come together to work on provisions relating to information about certain rare diseases.
Sen. Ann Lynch (DFL-Rochester) sponsored a bill, S.F. 3315, expanding the list of tasks class B home care aids may perform to include assisting with toileting, transfers and ambulation if the client is ambulatory and has no serious illness or infectious disease. Lynch said the bill was brought to her by a constituent who suggested the changes as another method of reducing health care costs. Tom Stinson, representing a care provider, said the bill allows for the more efficient use of nurses. The measure was approved and advanced to the Senate floor.
S.F. 3573, authored by Sen. Kathy Sheran (DFL-Mankato), provides for the University of Minnesota School of Public Health to develop a model that assesses the impact of proposed health care reforms or major health care related legislation on all sectors of the health care system. Sheran said the model is to include access to the full range of health care, public health, public and private health insurance coverage, long-term and continuing care, programs for persons with disabilties and social services. She said the model must be developed with safeguards to make sure that the model and its assumptions and formulas are based on valid and objective data, research and expert opinions. In addition, the model must be designed to identify risks of unpredictable or unintended consequences, cost-shifting between or within sectors of the health care system and opportunities to make changes in one sector that will produce a benefit to other sectors. Sheran cited the example of beneficial changes made in the public health sector having a later beneficial effect on long-term care. Michael Scandrett, Safety Net Coalition, said the proposal is one of the recommendations from a Health Care Access Commission working group.
Lynch offered an amendment to delete a section of the bill requiring the economic analysis of health care reform plans devised by the Legislative Health Care Access Commission, the governor's Transformation Task Force and a single statewide plan. She said by the time the analysis is available, the state will be already embarked on a reform process. Doll opposed the amendment and said the language is central to getting a grasp on the costs and benefits of the various proposals. The amendment failed.
The bill was approved and advanced to the full Senate.
S.F. 3673, authored by Sen. Tony Lourey (DFL-Kerrick), promotes community-based care for older adults through the establishment of community consortium demonstration projects. He said the bill is aimed at helping consumers have access to a full range of services, create an adequate supply of affordable home-based alternatives to nursing home care and help manage chronic and complex medical conditions through better service coordination. The bill was approved and re-referred to the Finance Committee.
S.F. 3701, carried by Marty, requires pharmacy benefits managers (PBM) to disclose all financial transactions related to prescription drug pricing. The measure requires PBMs to have a certificate of authority issued by the commissioner of health and requires the PBMs to include information on all rebates, discounts, or other forms of economic incentives that apply between the PBM and any prescription drug manufacturer, in the disclosures. Supporters said there needs to be more transparency in the drug pricing process. Opponents said PBMs are an excellent example of the private market adding rationality to prescription drug pricing. A representative from a PBM said disclosing pricing information destroys competitiveness in the marketplace. Members laid the bill over.
A bill proposing a statewide health insurance pool for school employees was approved by members of the Health, Housing and Family Security Committee, Wed., Mar. 12. The panel, chaired by Sen. John Marty (DFL-Roseville), advanced the bill to the Finance Committee.
S.F. 2747, authored by Sen. Don Betzold (DFL-Fridley), requires all school districts to participate in the pool, which will offer six plans. The pool is to be governed by a board split evenly between employer and employee representatives, under the bill. Betzold said the proposal was passed last year by both bodies of the Legislature, but vetoed by the governor. The governor's veto message flagged several issues, Betzold said, including inadequate reserves, insufficient oversight by the commerce commissioner and too much specificity about the plans. This bill addresses the concerns raised in the veto message, he said. Insurance costs are driving people out of education, said Tom Dooher, president of Education Minnesota. Insurance cost increases are canceling out salary increases and eating up resources that could be directed to the classroom, he said. Lower wage school workers are struggling, and this bill is a solution, said Kristin Beckmann, SEIU.
This bill does not address the drivers of insurance costs, said Bill Strusinski, representing the Minnesota Service Cooperatives. The proposal does not add any benefits, it just adds costs, he said. Cost increases will not be solved by a statewide pool, said Grace Schwab, Minnesota School Boards Association. It offers no incentive, motivation or accountability for districts to implement strategies that reduce costs, she said. A statewide pool does protect districts against dramatic price spikes, she said, but it also prevents districts from feeling the positive effects of implementing cost control measures.
Patrick Sexton, Dept. of Commerce, said the bill does not address all the solvency and governance concerns the department had regarding the proposal. He said the department is continuing discussions with proponents about how to structure the proposal to address the concerns.
We do not know if this will work, said Sen. Paul Koering (R-Fort Ripley), but we will never know if we do not try. What we do know is that health care has been squeezing a lot of school districts' budgets, he said. Sen. Patricia Torres Ray (DFL-Mpls.) said school districts that oppose the plan because it might increase their insurance costs in the short term should take a longer term perspective. This is meant to control health care costs for all employees and for years to come, she said. Some districts want to be part of a larger pool and some do not, said Sen. Ann Lynch (DFL-Rochester). If the pool was voluntary, I could support this proposal, she said, but a mandatory pool is not appropriate. Sen. David Hann (R-Eden Prairie) said it was inappropriate to punish school districts that have been working, sometimes for years, to control their premiums. Responsible districts will feel an immediate cost increase and no change in benefits under this proposal, he said.
A motion to refer the bill, without recommendation, to the Education Committee failed on a voice vote. Before the vote, Betzold said he opposed the motion because the bill has nothing to do with education policy, the jurisdiction of the Education Committee.
Sen. Betsy Wergin (R-Princeton) offered an amendment making the pool voluntary. She said the amendment protects against districts' frequently hopping in and out of the pool based on short-term considerations by requiring a decision to opt in or out to be effective for five years. Betzold opposed the amendment, saying the pool needs to be completely mandatory to be effective. The amendment failed, 4-5.
A motion to approve the bill and re-refer it to the Finance Committee prevailed on a voice vote.
In other action, the panel considered four additional measures. S.F. 3313, sponsored by Sen. Gary Kubly (DFL-Granite Falls), improves physician licensure standards based on reciprocity. Kubly said the bill is motivated by the desire of a hospital in Canby to attract from South Carolina a foreign-educated physician who is married to a physician already working at the Canby hospital. Robert Salmon, the hospital's CEO, noted that Canby is an underserved community that will lose one doctor this fall and potentially lose another doctor if the spouse cannot come to Minnesota. The measure was advanced to the full Senate.
Two bills requiring that employee pension costs at nursing facilities be treated as PERA costs for Medical Assistance reimbursement purposes were approved. S.F. 2884, authored by Sen. Steve Dille (R-Dassel), addresses nursing facilities in Jackson, McLeod, Meeker and Pennington Counties. S.F. 2470, carried by Sen. Kathy Sheran (DFL-Mankato), addresses a nursing facility in Sibley County. The nursing homes need the special legislation because the facilities recently transitioned from public ownership to private, nonprofit status, said Mary Ellen Wells, president of Hutchinson Area Health Care. Both bills were re-referred to the Finance Committee.
S.F. 2873 expands consumer choice in choosing adult foster care and family adult day services, said Sen. Ray Vandeveer (R-Forest Lake), chief sponsor. The bill clarifies that a separate license is not required to provide family adult day services in licensed adult foster care settings. A representative of the Dept. of Human Services raised concerns with the legislation, saying it was poorly tailored to address proponents' concerns. The bill was laid aside for further consideration.
The Health, Housing and Family Security Committee held an evening hearing Mon., Mar. 10, to hear a variety of bills. One of the measures, S.F. 3423, presented by Sen. Patricia Torres Ray (DFL-Mpls.) on behalf of Sen. Mee Moua (DFL-St. Paul), requires the commissioner of health to establish a registry of health care interpreter services. Under the bill, the commissioner of health is required to establish a statewide roster, registry and certification process for providers of high quality, spoken language health care interpreter services. The bill provides that the roster, registry and certification process is to be based on the findings and recommendations set forth by the Interpreter Services Work Group established last year. The bill also appropriates funds to establish the registry. Members adopted an amendment deleting provisions outlining a process for refunding the costs incurred by hospitals for interpreter services. The bill was approved and re-referred to the Finance Committee.
The committee, chaired by Sen. John Marty (DFL-Roseville), heard an additional eleven bills on a number of different topics. S.F. 2024, carried by Sen. David Senjem (R-Rochester), requires counties to provide a six-month notice to families with regard to a redetermination of eligibility for a federal program for disabled children living at home. Senjem said the bill allows families time to gather necessary information to determine ongoing eligibility. The bill was approved and sent to the full Senate.
S.F. 3000, sponsored by Sen. Ron Latz (DFL-St. Louis Park), eliminates a prohibition on complementary and alternative health care practitioners from engaging in sexual relationships with former clients for a period of two years. Under the bill, the two year time period is eliminated. Latz said the bill arises from a situation in which a massage therapist was investigated because she married a former client before the two year time period had elapsed. The bill was approved and sent to the Senate floor.
Sen. Jim Carlson (DFL-Eagan) sponsored a bill, S.F. 3332, allowing a person to give oral or written instructions about the type of conveyance to be used to transport that person's body to the place of final disposition. Carlson said the bill arose from a situation in which a fallen firefighter could not be transported to the cemetery by fire truck. He said the measure allows the use of a vehicle that is a dignified conveyance and was requested by the deceased or by the family of the deceased. The measure was approved and advanced to the Senate floor. Sen. Linda Scheid (DFL-Brooklyn Park) sponsored a bill, S.F. 2850, clarifying the effective date of child care absent day requirements. The measure was approved and re-referred to the Finance Committee. S.F. 3225, authored by Sen. Don Betzold (DFL-Fridley), allows the state Ombudsman for Mental Health and Developmental Disabilities to gather data about deceased clients. The measure was re-referred to the Judiciary Committee.
S.F. 3256, carried by Sen. Dan Skogen (DFL-Hewitt), provides that day training and habilitation programs do not need a separate license if part of the program is in a separate building adjacent to the central operation or if the program is a satellite of an existing program. The bill was approved and advanced to the floor.
Torres Ray carried two additional bills. S.F. 2847 establishes a Child Care Advisory Task Force to review and recommendations to the Legislature to remove barriers facing families applying for and receiving child care assistance. The bill details the membership and duties of the task force and requires a report by Jan. 15, 2009. The measure was approved and re-referred to the State and Local Government Operations and Oversight Committee. S.F. 3320 alters the shelter needy provisions for Minnesota supplemental aid to include persons moving out of corporate foster settings. In addition, the bill makes the shelter needy supplement amount the same as the current food stamp program amount. The bill was approved and advanced to the Finance Committee.
Sen. Tony Lourey (DFL-Kerrick) sponsored two bills dealing with foster care. S.F. 3145 extends foster care benefits to age 21. S.F. 3146 requires foster children for whom the Dept. of Human Services or counties have custody and financial responsibility be certified eligible for Medical Assistance. An amendment was adopted requiring the children to fill out the application for assistance. Both measures were approved and re-referred to the Finance Committee. Lourey also presented a bill, S.F. 3581, on behalf of Sen. Kathy Sheran (DFL-Mankato), relating to pharmacy practice. Under the bill, pharmacists may administer influenza vaccines to eligible individuals over 10 years of age and all other vaccines to patients 18 years and older. The bill was approved and sent to the full Senate.
A bill establishing a standard or protection for the risk of cancer from environmental carcinogens was approved at the Mon., Mar. 10, afternoon meeting of the Health, Housing and Family Security Committee.
S.F. 2944, authored by Sen. Sandy Rummel (DFL-White Bear Lake), establishes a lifetime risk level so that no more than one out of every 1 million people exposed to a substance or chemical over a lifetime would be estimated to develop cancer from known and proposal carcinogens in the air, water or soil. Rummel said that one of every two individuals will develop cancer and that it is necessary to assess the risk of individuals developing cancer. The measure was approved and advanced to the Finance Committee.
S.F. 2055, carried by Chair John Marty (DFL-Roseville), authorizes the Dept. of Health to review registrations and assess the public health risks of the carcinogenic and endocrine-disrupting pesticides and high-potency nervous system toxins. Marty said the bill does not diminish the role of the Dept. of Agriculture, but rather adds the Dept. of Health to the process. The measure was approved and re-referred to the Agriculture and Veterans Committee.
Sen. Yvonne Prettner Solon (DFL-Duluth) sponsored two measures. S.F. 3262 permits hospital records to be transferred to electronic image or other state-of-the-art electronic preservation technology. In addition, the measure provides that once records are transferred to electronic images, paper records may be destroyed. Prettner Solon said allowing the paper records to be destroyed after transfer to electronic format will save thousands of dollars in staff and storage costs. S.F. 3486 prohibits the Dept. of Human Services from providing the names of potential enrollees to health plans for the purpose of marketing Medicare-approved special needs plans. Prettner Solon said the plans are designed to provide Medical Assistance basic health care services to persons with disabilities. The bill also requires health plans to cover any costs incurred by the commissioner in mailing marketing materials. The bill was approved and sent to the Senate floor.
A bill establishing a Minnesota Responds Medical Reserve Corps was also approved. S.F. 3135, sponsored by Sen. Linda Higgins (DFL-Mpls.), establishes a registry in the Dept. of Health of volunteer medical professionals who may be deployed within or outside of the state to aid in the response and recovery from public health emergencies that exceed local capacity. In addition, the measure provides that the volunteers are defined as state employees for purposes of workers compensation and tort claim defense. Members adopted an amendment providing reciprocity with other states allowing health care volunteers to come to Minnesota in response to an emergency.
The measure was approved and referred to the Judiciary Committee.
Members of the Health, Housing and Family Security Committee, chaired by Sen. John Marty (DFL-Roseville), met Fri., Mar. 7, to consider a number of bills brought forward by the Dept. of Health and the Dept. of Human Services.
S.F. 3049, sponsored by Sen. Linda Berglin (DFL-Mpls.), requires children's mental health providers to develop a plan for and comply with requirements on the use of restrictive procedures. The measure also lists the allowable procedures, which include physical escort, physical holding and seclusion. The bill was approved and advanced to the full Senate.
Sen. Linda Higgins (DFL-Mpls.) authored two bills. S.F. 3213 makes a variety of technical changes in provisions relating to health care and continuing care. The bill also extends the existence of the Traumatic Brain Injury Advisory Committee until 2012. The measure was approved and re-referred to the State and Local Government Operations and Oversight Committee. S.F. 3323 changes a provision for federally qualified health centers by specifying the most recent calendar year be used in calculating each subsidy. The bill was approved and recommended for placement on the Consent Calendar.
S.F. 3166, carried by Sen. Patricia Torres Ray (DFL-Mpls.), adopts a new Interstate Compact for the Placement of Children, and regulates child and adult adoptions. The bill also makes numerous technical changes and clarifies language. The bill was approved and re-referred to the Committee Judiciary. Torres Ray also sponsored S.F. 3170, changing Minnesota family investment program (MFIP) child care assistance provisions and making technical changes. The bill was approved and advanced to the Finance Committee.
Sen. John Doll (DFL-Burnsville) sponsored a bill, S.F. 3286, changing the information required for filing a complaint with a health plan company by deleting the Office of Health Care Consumer Assistance, Advocacy and Information telephone number. The bill was approved and recommended for placement on the Consent Calendar.
S.F. 3138, sponsored by Sen. Ann Lynch (DFL-Rochester), makes modifications in the newborn screening program by requiring specific information to be provided to parents. The measure specifies that the information explains that the samples and results may be retained by the department, the benefit of retaining the sample, the alternatives available with respect to the testing, including the ability to decline the tests, and the ways in which the samples and data collected be stored and used.
Debate on the bill centered on the information provided to parents, on the ability of parents to opt out of the testing and on the ability of the parents to request the samples be destroyed. The bill was approved and advanced to the Judiciary Committee.
Sen. David Hann (R-Eden Prairie), sponsored a bill, S.F. 3427, making housekeeping changes in provisions relating to licensing requirements for speech-hearing practitioners and occupational therapy practitioners. Hann offered, and members adopted, an amendment clarifying provisions relating to the transportation of human remains. The measure was approved and advanced to the Senate floor.
The final bill, S.F. 3245, authored by Sen. Tony Lourey (DFL-Kerrick), changes provisions for uniform billing forms and electronic claim filing. Lourey said the bill clarifies language enacted last year designed to reduce administrative costs. The bill was approved and re-referred to the Judiciary Committee.
The evening portion of the Wed., Mar. 5, meeting of the Health, Housing and Family Security Committee was devoted to a variety of topics.
Sen. Sandra Pappas (DFL-St. Paul) sponsored two bills. S.F. 3417 adds an exception to the complementary and alternative health care client bill of rights for in-patient hospital and hospice care. Pappas said complementary and alternative health care bill of rights are meant to cover outpatient care. Geoff Bartsh, representing Health Partners and Regions Hospital, said complementary and alternative health care in a hospital setting is covered under the hospital patient bill of rights. S.F. 2825 amends the patient bill of rights to include continuous doula support and information about evidence-based nonpharmacological pain relief. Members adopted an amendment clarifying a provision relating to informing patients about nonpharmacological pain relief. Both measures were approved and advanced to the Senate floor.
Two bills relating to physical therapists were also before the committee. S.F. 3394, sponsored by Sen. Kathy Saltzman (DFL-Woodbury), grants a waiver of the examination requirements to an applicant applying for licensure before July 1, 2008, who has been issued physical therapy licenses between 1980 and 1995 in at least three other states and one or more foreign countries. Saltzman said the bill arises from the experience of a constituent and that the Board of Physical Therapy suggested pursuing the bill as an exception, rather than pursuing a bill providing for reciprocity with other states. Several members said they were reluctant to make an exception for an individual. Sen. Yvonne Prettner Solon (DFL-Duluth) said that the standards are in place for a reason. Sen. Sharon Erickson Ropes (DFL-Winona) said that setting policy is appropriate, but there are always occasions that call for exceptions to be made. Sen. Linda Berglin (DFL-Mpls.) said that a review of policy might be in order, but the situation at hand deserved to be rectified. The bill was approved and sent to the Senate floor.
Prettner Solon sponsored a bill, S.F. 1018, changing provisions relating to physical therapy. Prettner Solon said the goal of the bill is to improve access to physical therapy. She said the bill extends the initial period of physical therapy treatment without an order of referral from a licensed health care provider from 30 to 90 days; permits physical therapists to continue to treat patients with an order of referral from advanced practice nurses; specifies that the 90 day limitation does not apply to prevention, wellness and exercise; and requires physical therapists, who have been licensed for less than a year, to practice for one year with an experienced physical therapist or under a physician's order before treating a patient without a referral. The bill was approved and sent to the Senate floor.
A bill requiring information on the human papillomavirus (HPV) and meningococcal disease to be provided through schools was also heard. S.F. 3005, authored by Prettner Solon, also requires distribution of information on the vaccines for the two diseases. The measure requires the information to be distributed at the beginning of the sixth grade school year. Prettner Solon said there is nothing in the bill requiring students to receive vaccinations.
The bill supports providing education to parents so that children may remain healthy and safe, said Diane Peterson, associate director, Immunization Action Coalition. Brigid Riley, executive director, Minnesota Organization on Adolescent Pregnancy Prevention and Parenting, said the HPV vaccine provides the best protection before young people become sexually active. Linda Sandvig, representing School Nurses of Minnesota, said school nurses want parents to have a number of types of information, but there is a cost for school districts, which are already experiencing difficulty because of cutbacks. Prettner Solon said the costs would not be too burdensome for districts. The measure was approved and re-referred to the Education Committee.
Prettner Solon's final bill of the evening, S.F. 2968, establishes a regulation system for technicians performing body art procedures and for body art establishments. Prettner Solon said that the tattoo industry is one of the fasting growing in the nation. Tattooing is not a passing fad, but in Minnesota there is no regulation of tattoo technicians or tattoo establishments, she said. Ryan Wells, owner of a tattoo establishment, said he welcomed regulation by the Dept. of Health to maintain the integrity of the industry. He said the bill requires licensing of both operators and establishments. The bill was approved and re-referred to the Finance Committee.
Sen. Tony Lourey (DFL-Kerrick) sponsored a bill, S.F. 3258, makes changes to optometrist licensing provisions. Lourey said the bill does not change the scope of practice for optometrists, but consolidates the licensure process from three steps to one step, deletes obsolete language and makes other administrative changes. The bill was approved and advanced to the full Senate.
S.F. 1520, sponsored by Sen. Patricia Torres Ray (DFL-Mpls.), establishes registration for naturopathic doctors. The bill defines naturopathic physical medicine as including, but not limited to, the therapeutic use of the physical agents of air, water, heat, cold, sound, light and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, hydrotherapy massage, stretching, colon hydrotherapy, frequency specific microcurrent, electrical muscle stimulation, transcutaneous electrical nerve stimulation and therapeutic exercise. The bill outlines the scope of practice of naturopathic doctors and the requirements for registration.
Dr. Carolyn Torkelson, University of Minnesota, said she supported the registration of naturopathic doctors because many of the patients she treats have complex medical conditions and are seeking integrated treatments that involve both traditional medical treatment and naturopathic treatment. She said she wanted to be able to refer patients to qualified naturopathic doctors. Torres Ray said consumers are choosing to pursue integrated treatments and need to be able to make educated choices. She said naturopathic doctors are licensed in a number of other states.
Opponents said the bill does not improve consumer safety, but does exclude a number of well-respected practitioners of alternative health care. Sen. Linda Berglin (DFL-Mpls.) said the other practitioners could continue to practice, but they would not be listed in the registry.
Torres Ray said the language does not limit other practitioners, nor is the intent to limit other practitioners. She said it is important to move forward in order to protect consumers. The bill was approved and re-referred to the Judiciary Committee.
S.F. 2742, authored by Sen. Sharon Erickson Ropes (DFL-Rochester), requires hospitals to develop staffing levels for direct care registered nurses. Erickson Ropes said she would not ask for a vote, but that various stakeholders would continue working on the bill. She said the bill is aimed at improving patient safety through the implementation of staffing plans that establish the maximum number of patients that may be assigned to a direct care registered nurse.
The Health, Housing and Family Security Committee met Wed., Mar. 5, to consider bills relating to prescription drug sales, screening for STDs and public swimming pool requirements along with a number of other measures.
S.F. 2941, authored by Chair John Marty (DFL-Roseville), modifies the requirements for what constitutes a valid prescription by requiring that the prescription be based on a documented patient evaluation that includes an examination. Marty said the bill also describes what constitutes an examination and lists the drugs covered by the bill. Marty said the purpose of the bill is to get at the problem of obtaining a prescription and purchasing drugs through the Internet. Dan Pearson described the conditions that led to his son's death from drugs obtained through the Internet. Cody Wiborg, Minnesota Board of Pharmacy, spoke in support of the measure and explained the types of drugs listed in the bill. The bill was approved and advanced to the full Senate.
Marty also sponsored a bill, S.F. 2879, allowing a health practitioner to prescribe or dispense oral antibiotic drugs for the sexual partner or partners of a patient who has been diagnosed by the practitioner with a sexually transmitted chlamydia or gonorrhea infection. The bill also contains an appropriation for grants to local health agencies and nonprofit organizations to provide services for the detection and treatment of sexually transmitted infections.
Peter Carr, Dept. of Health, reviewed the upward trend of STDs in Minnesota over the last few years. Marty said the trends are all going in the wrong direction, but with the talk of health care reform this year, the bill's emphasis on prevention and treatment could aid in lowering costs later on. The measure was approved and re-referred to the Finance Committee.
Sen. Geoff Michel (R-Edina) sponsored a bill requiring public pools and spas to be equipped with anti-entrapment devices and systems. The bill also expands licensure requirements to pools that are currently unlicensed, requires inspections and requires existing pools to be retrofitted with drain covers that are in compliance with industry standards. Michel described the pool accident involving Abbey Taylor last summer. Michel said, "We need to beef-up safety standards for our public pools, especially kiddie pools." Scott Taylor, Abbey's father, spoke about the problem of pool safety and the incidence of accidents similar to Abbey's. He said the standards in the bill are not stringent enough because the industry set the standards, which would continue to allow the same type of drain cover. Michel said the industry has made some improvements, but has not moved as far as the Taylors would wish. In addition, the bill allows for a discussion about what we, as public policy makers, can do to improve standards and safety, Michel said. The bill was approved and advanced to the Finance Committee.
S.F. 2698, sponsored by Sen. Kathy Sheran (DFL-Mankato), provides for colorectal cancer screening for uninsured and underinsured persons. Sheran said the bill sets forth the eligibility requirements and provides for Medical Assistance for individuals who have colorectal cancer found through the screening. Sheran said it is the third most common form of cancer, but it is a preventable disease. Dr. David Perdue said up to 90 percent of colorectal cancer can be prevented through early detection and treatment. Cindy Hillger, former WCCO television anchor, spoke in support of the measure. She described her experience as a survivor of the disease. She emphasized the importance of screening and early detection in preventing colon cancer and the subsequent costs and hardships associated with cancer treatments. The bill was approved and re-referred to the Finance Committee.
A proposal to create a new, mid-level dental practitioner was approved by members of the Health, Housing and Family Security Committee at an evening meeting, Mon., Mar. 3. The panel, chaired by Sen. John Marty (DFL-Roseville), advanced the bill to the Finance Committee.
S.F. 2895, authored by Sen. Ann Lynch (DFL-Rochester), establishes a new level of practice for an advanced dental hygiene practitioner (ADHP). Lynch said the bill is not for or about any group of practitioners or any curriculum at any institution. The bill is about expanding access to dental care, she said, recounting the story of a 12-year-old Maryland boy who died after bacteria from a dental abscess traveled to his brain. Lynch briefly outlined the bill's provisions and noted that nothing in the bill mandates the use of an ADHP in any dental clinic.
Michael Scandrett, Minnesota Safety Net Coalition, said the lack of access to dental care is one of the biggest problems facing patients who use the state's safety net clinics. Patients may wait as long as eight months to see a dentist for a routine visit and two years for a complex procedure, he said. Scandrett noted that the number of dentists projected to retire in coming years greatly outstrips the projected supply of new dentists. Seven emergency rooms in the Twin Cities reported 10,000 visits relating to oral health, costing more than $4.7 million, he said. Scandrett noted that many emergency room visits could have been avoided with adequate preventive and routine care. The bill creates a practitioner who will provide only basic restorative services, supervised generally by a dentist, he said. Scandrett noted that ADHPs will be able to practice outside traditional clinic walls and that safety net clinics could employ three ADHPs for the cost of one dentist. Mid-level practitioners have been used in 20 countries for many years, including for over 30 years in Canada, he said. We do not know the depth and breadth of the access problem, said Maureen Johnson, a dental hygienist with the Salvation Army Good Samaritan Dental Clinic in Rochester. It is startling that we have faith-based organizations entering the field of dental care, she said. The ADHP would be a cost-effective, well-used member of the team at a safety net clinic like mine, Johnson said.
Several practitioners raised concerns with the proposal. Dr. Bob Brandjord, an oral surgeon, said the bill represents a rush to judgment. We need more information and study before acting, he said. The state should evaluate all potential options, he said, and require a planned curriculum and a pilot program before authorizing a new practice. An outline or a list of competencies is not enough, he said. Dentists recognize the access problem and the needs of the uninsured and underinsured, said Dr. Scott Lingle, representing the American Dental Association. We are concerned about patient safety, he said, and every medical procedure could be called simple until something goes wrong. The worst case is for something to go wrong when the practitioner lacks the education to know it has gone wrong, he said. When a procedure becomes something more complex in a split second, Lingle said, practitioners need well-trained surgical skills to finish the job. When I was a dental hygienist, I disagreed with some of the treatment options recommended or ordered by the dentists I worked for, said Patricia Stone, a dental student. She said that when she went back to school, she did not understand why she needed to retake some science courses and take other advanced science courses. Once I started treating live patients in my third year, she said, I realized how critical that education was to patient safety.
The bill was approved, 9-3.
Committee members also considered a bill, S.F. 3122, creating a dental school scholarship program and expanding a loan forgiveness program to include dentists who agree to provide services through a nonprofit organization, community clinic, or federally qualified community health center for a period of at least three years. Carried by Sen. John Doll (DFL-Burnsville), the bill also provides for community dental health coordinators, who will promote oral health through organized and coordinated community-based promotion and prevention programs. Finally, the bill creates a unified oral health system to help improve the administrative efficiency and effectiveness of the state's existing public dental health programs. Members adopted an amendment, offered by Lynch, removing the unified oral health system provisions. S.F. 3122 was approved and forwarded to the Finance Committee.
In other action, committee members completed their work on several county-based purchasing proposals heard during an afternoon session. S.F. 3181, sponsored by Sen. Tony Lourey (DFL-Kerrick), was advanced to the State and Local Government Operations and Oversight Committee. S.F. 3031, authored by Lynch, was forwarded to the Finance Committee. Sen. Sharon Erickson-Ropes (DFL-Winona) carried two bills, S.F. 3241 and S.F. 3299; motions to advance each bill failed. Members also considered a fifth proposal, S.F. 3322. The bill, sponsored by Sen. Yvonne Prettner Solon (DFL-Duluth), adopts recommendations from a recent legislative auditor's report on the financial management of public health care programs. The bill was approved and re-referred to the Judiciary Committee.
Bills dealing with county based purchasing for state health care programs were the focus of the afternoon portion of the Health, Housing and Family Security Committee meeting Mon., Mar. 3. The panel, chaired by Sen. John Marty (DFL-Roseville), heard four bills relating to county based purchasing and one bill incorporating the legislative auditor's recommendations for strengthening state agency administration of health care programs.
The first of the county based purchasing bills, S.F. 3181, modifies the dispute resolution process between a county and the commissioner of human services over county based purchasing of state health care programs such as General Medical Care, MinnesotaCare, the Medical Assistance prepayment program and other prepaid health care services. Under the bill, the three-person mediation panel is composed of a representative of the commissioner of human services, a representative of the president of the Association of Minnesota Counties and one representative selected jointly by the commissioner and the designee of the Association of Minnesota Counties. The measure, sponsored by Sen. Tony Lourey (DFL-Kerrick), also requires the commissioner to submit a report describing the activities undertaken by the commissioner to comply with the requirements of county based purchasing.
Sen. Ann Lynch (DFL-Rochester) carried a bill, S.F. 3031, requiring the commissioner of human services to assign eligible individuals to the county based purchasing health plan, if the individual resides in a county that has an approved plan. The bill also requires the commissioner to approve a county based purchasing health plan proposal submitted on behalf of Winona, Houston, Fillmore and Mower Counties for state health care programs, if the single-plan proposal does not limit an enrollee's provider choice or access to services.
S.F. 3241, sponsored by Sen. Sharon Erickson Ropes (DFL-Winona), makes several changes to the implementation of prepaid health care programs and to the county based purchasing health plan option. The bill also makes changes to the dispute resolution process. Erickson Ropes said the bill also requires the commissioner to approve a county based purchasing health plan proposal for any Minnesota county or counties establishing a county based purchasing entity as a single-plan contract for all counties eligible under federal law. The bill also specifies that there be no more than two plans, including the county based purchasing plan for those counties not federally eligible for single-plan status. S.F. 3299, also sponsored by Erickson Ropes, exempts counties located in rural areas from the requirement for county based purchasing proposals to ensure a reasonable choice of providers.
Representatives of a number of counties spoke in support of the measures. Supporters said the locally based provision of health care ensures more transparency and effectiveness for consumers. Opponents, including representatives of health plans, argued that the sole-source provisions of the county based purchasing programs limit choice for consumers. Julie Brunner, Minnesota Council of Health Plans, said that the bills are not consistent with proposed health care reforms, nor do the bills provide consumers with optimal services.
Members took no action on the bills at the afternoon portion of the hearing.
A major revamping of Minnesota's health care system was approved at the Fri., Feb. 29, meeting of the Health, Housing and Family Security Committee. The panel, chaired by Sen. John Marty (DFL-Roseville), advanced the bill to the Commerce and Consumer Protection Committee. S.F. 3099, authored by Sen. Linda Berglin (DFL-Mpls.), reforms payment methods, establishes a statewide public health program, establishes health care homes to provide coordinated care, provides for increased access to health care and establishes a health care insurance exchange to assist individuals in obtaining health care.
Members picked up the debate from the previous hearing. Berglin said the bill holds together and each piece supports every other piece. The provisions i the bill concerning payment reform provides incentive to providers and the other portions of the bill aid consumers, Berglin said.
Berglin offered, and members adopted, an amendment clarifying language including health care plans in the assessment on hospitals and clarifying that the assessment expires in five years. The assessment provides revenue for the public health portions of the bill. She also offered an amendment on the statewide health improvement plans. She said the Dept. of Health worked on the language and the amendment provides for a three phase plan--assessment, planning and implementation. In addition, the amendment provides for evaluating the program. The amendment was adopted.
Sen. Patricia Torres Ray (DFL-Mpls.) offered an amendment that requires linguistic services to be covered in the care coordination fee determined by the commissioner. The amendment was adopted.
Marty offered an amendment adding dental care, mental health services, chemical dependency, emergency transportation services and prescription drugs to the benefit set. Berglin said she envisioned that those services would be included in the benefit set, but that it is more a matter of timing. The amendment was adopted.
A second amendment, authored by Marty, deletes sections relating to the Health Care Transformation Commission and the level III payment reform. Berglin said, "I strongly oppose the amendment because the payment reforms in the bill will generate much of the savings in the health care system." Marty said, "We have a very complex system now, but in the bill a new bureaucracy is put in place." Berglin said the bill will move us forward, a long way forward, but the amendment does not. Sen. Paul Koering (R-Fort Ripley) said the amendment totally derails the bill and should be voted down. The amendment was not adopted.
Members of the Health, Housing and Family Security Committee devoted both an afternoon hearing and an evening meeting to consideration of a major health care reform package. The committee, chaired by Sen. John Marty (DFL-Roseville), approved the bill, S.F. 3099, and laid the bill over for further discussion.
Chief Author Linda Berglin (DFL-Mpls.) said the bill is the result of work done by the Health Care Access Commission and the governor's Transformation Task Force over the course of the interim. Berglin said the Health Care Access Commission working groups undertook a grueling schedule in order to develop the recommendations for change that are contained in the bill.
She said the bill has three major components-a major investment in public health, payment reform to allow providers more flexibility, and expansion of coverage to the uninsured.
She said every member of the Health Care Access Commission and the Transformation Task Force felt comfortable that savings will occur with the reforms in the bill and that those savings will allow expansion of eligibility.
Sen. Tony Lourey (DFL-Kerrick) outlined the provisions in the bill providing for the development of health care homes. The concept of health care homes for individuals is to provide coordinated care for individuals with complex or chronic conditions, Lourey said. He said the bill provides delivery reform to reestablish the trust link between patient and provider. Health care homes are a way to get out of the tyranny of the visit; those are the widgets we count right now, Lourey said. He said that by changing how providers deliver care and allowing them to be more flexible we can derive phenomenal costs savings and better care. "We need to tap into peoples' inherent wish to be healthy," Lourey said. We want to be a partner in moving the delivery forward by hooking the patient up with a health care team, he said.
Berglin said another goal of the bill is to increase access and continuity of care. To that end, the bill increases automation and coordination of state health care program eligibility and renewals, reduces Medical Assistance verification requirements, allows delayed verification for state health care programs, and provides an additional month of eligibility for state health program enrollees who fail to submit renewal documentation in a timely manner, Berglin said. The bill also increases the MinnesotaCare annual inpatient hospital limit, increases the program income limit and eliminates the four-month uninsured requirement. Berglin said the bill also establishes a new MinnesotaCare premium scale based on the affordability standard and exempts new households from the first month of MinnesotaCare premiums. The elimination of the income limits for parents on MinnesotaCare is contingent on meeting the cost containment goals and sufficient funding.
Sen. Paul Koering (R-Fort Ripley) outlined provisions in the bill dealing with providing health insurance to long-term care workers. Koering said the working group he chaired struggled with getting information and recommended that the commissioner of human services be required to do a study. He said the bill requires the commissioner to report recommendations for a rate increase that would be dedicated to purchase employee health care coverage in the private market. In addition, the commissioner is required to develop cost estimates for three levels of coverage, Koering said.
Berglin said the bill also addresses health insurance purchasing and affordability. The bill establishes a health insurance exchange, establishes Section 125 plans, establishes a Health Care Transformation Commission, establishes a standard health benefit and sets design and health technology assessments. She said the bill also restructures the health care payment system, establishes a savings recapture assessment, establishes cost containment goals, specifies an affordability standard for health coverage costs and provides subsidies for certain persons with employer-subsidized coverage.
Sen. Julie Rosen (R-Fairmont) explained the creation of the health insurance exchange and Section 125 plans. "There is true reform here," Rosen said, "the health insurance exchange is established to improve the insurance market and serve as a market clearing house." She said the exchange will facilitate better market functioning and will provide individuals with greater access, choice, portability, and affordability of health insurance products. Rosen explained that Section 125 plans allow individuals to purchase health plans directly through the insurance exchange or through an employer. She said Section 125 plans refer to the section of the federal tax code that allows the purchase of health insurance with pre-tax dollars. Under the bill, by Jan. 1, 2009, all employers with 11 or more employees are required to establish a Section 125 plan to allow their employees to purchase health insurance.
Berglin said the Health Care Transformation Commission established under the bill is charged with developing a design and implementing a plan for a health care payment restructuring system. Under the bill, the commission must develop a uniform definition for "baskets of care," establish a mechanism for soliciting and accepting bids from health care providers and health care systems, and develop a method for monitoring and evaluating the effectiveness of the payment restructuring systems.
Sen. Ann Lynch (DFL-Rochester) outlined portions of the bill establishing the Health Care Value Reporting Organization. "This is the quality piece of the reform package," Lynch said, "the benefit set will be more transparent and value oriented." The bill requires the development of a cost-effective, evidence-based benefit set.
Payment reform based on incentive payments for high quality and efficient care is a major part of the reform package, Berglin said. She said the Health Care Transformation Commission is required to develop a payment system that links the level of payments to providers to the quality and efficiency of care. Berglin said there will be three levels under the reformed payment system, which will encourage innovation to improve costs and quality.
The bill also establishes a health improvement program. Sen. Patricia Torres Ray (DFL-Mpls.) explained the public health component of the bill. She said under the bill, grants are provided to local community health boards for local programs targeted at reducing the number of Minnesotans who are obese, reducing tobacco smoking and reducing the abusive use of alcohol and drugs. Torres Ray said the public health portions of the program will be funded by a small percentage of hospital and health plan company net patient revenue.
Committee members heard extensive testimony, both for and against the measure.
Dick Pettingill, president and CEO, Allina Hospitals and Clinics, said, "The old tools and methods for providing health care need to be revamped and realigned." He said Allina and the state share a common mission to deliver exceptional care all along the health care continuum. Pettingill said, "I am expressing Allina's strong support for the health care reforms in the bill." He said Allina's care model involves caring for the acutely ill, promoting wellness and managing the chronically ill. "Our new care model calls for payment reform and evidence based practices to become more efficient and more effective," Pettingill
Ann Robinow, independent healthcare consultant, said her expertise lies in incentive alignment for providers and consumers. She said without payment reform costs will continue to increase at unsustainable levels. Sustainable costs savings cannot be realized until providers use resources most effectively, Robinow said.
Dr. Jerry Potts, chief, Dept. of Family Medicine, Hennepin County Medical Center, said he applauded efforts to look a payment systems that force us to be less than optimal in our care for our patients. The concepts of medical home and payment reform will help in providing care, Potts said.
Pete Benner, former director of AFSCME Council 6 and a member of the working groups and the task force, said the proposal for reform need to be looked at as a package. Proposals for public health are essential to control costs, Benner said.
Tom Forsythe, vice president, General Mills, said he has worked on health care reform for a long time. "The point I would make is that payment reform and delivery reform is absolutely essential in health care reform," Forsythe said.
Mary Jo George, Minnesota Nurses Association, said the current method of payment and fragmentation of health care delivery needs to be replaced with a more holistic delivery system and payment reform
Phil Griffin, representing the Minnesota Council of Health Plans, said the council supports expanding eligibility and supports the efforts to improve public health, but has concerns about the financing mechanism. Griffin said the council also supports moving away from payment based on volume.
Heidi Michaels, insurance agent, said she was opposed to the health insurers exchange. The exchange will have a negative effect on access, because the information, promotion and assistance envisioned for the exchange is already happening in the marketplace; it is my job description, Michaels said. She said the creation of the exchange does not increase choice or provide portability or reduce costs, but has the opposite effect. "There is a problem in health care, but not a problem with insurance," Michaels said. Berglin countered that one of the objectives of the exchange is to provide assistance in obtaining the Section 125 plans. The second purpose is to make insurance more understandable, Berglin said.
Don Gerhardt, CEO, Lifescience Alley, said the bill will make it difficult for small and mid size med tech companies to thrive because of a section in the bill requiring a Technology Advisory Committee to review new technologies for the benefit set.
Bruce Ruebin, Minnesota Hospital Association, said there is much to be enthusiastic about, but the association is concerned about the community benefit tax. It is an additional cost that has to be borne and will fall heaviest on those with lowest income, Ruebin said. He said some types of care, such as trauma care, don't lend themselves to bundled payment. The association strongly opposes a new tax on hospitals, he said.
Beth Hartwig, Minnesota Business Partnership, said the partnership supports a majority of the proposals, because they are market based. However, she said the partnership opposes mandating that employers provide Section 125 plans. Erin Sexton, Minnesota Chamber of Commerce, echoed Hartwig. Sexton added, the savings recapture mechanism adds fees and taxes on what we already have. The chamber is supportive of the concept of the health insurance exchange, but we want people to have choice and we urge that you not limit products, Sexton said.
Dr. Robert Meiches, Minnesota Medical Association, said the MMA recognizes the system is broken. He said the MMA strongly supports the public health and medical home provisions. Meiches said the MMA is concerned some of the language is too restrictive and will hamper the medical home concept. Most of the concerns are about the payment reform provisions, he said. No one sees payment reform the same way, so there needs to be much more clarity, Meiches said.
Committee members adopted several amendments providing clarification to provisions relating to weight trends. In addition, the panel adopted an amendment including health plans in the public health improvement assessment. Sen. Yvonne Prettner Solon (DFL-Duluth) offered, and members adopted, an amendment adding the Duluth residency program to the entities receiving funds for primary care education initiatives.
The Committee on Health, Housing and Family Security reviewed two bills Mon., Feb. 25. Chaired by Sen. John Marty (DFL-Roseville), the panel focused on regulating chemicals found in consumer products.
S.F. 1858, sponsored by Sen. Sandy Rummel (DFL-White Bear Lake), bans bisphenol-A and phthalates in children's toys and products. Phthalates are used to soften plastics used in products such as teethers, and bisphenol-A is used to harden plastics such as sippy cups and as a liner for food containers, said Rummel. Both chemicals disrupt hormones and are linked to developmental problems, particularly of the reproductive system, according to Dr. David Wallinga, food and public health program director for the Institute for Agriculture and Trade Policy.
Sen. David Hann (R-Eden Prairie) questioned the science of the claims, and asked why the panel should ban a product that the Environmental Protection Agency has not targeted as dangerous. The committee adopted a Hann amendment to delete subdivisions claiming the effects of the chemicals as legislative findings.
The bill requires a phase-out of the chemicals in toys for ages three and under in line with those passed in California, explained Lindsay Dahl of Healthy Legacy. Many manufacturers already produce phthalate-free products, and they are banned entirely in Europe according to Dahl.
Julie Goodman, senior toxicologist for Gradient Corp. testified on behalf of the American Chemistry Council. She presented studies that have concluded that bisphenol-A has no effect at low doses.
Harry Fisch, director of the Male Reproductive Center and professor of clinical urology at Columbia University presented his own university-funded research on behalf of the chemical industry, finding no rise in a reproductive defect blamed on phthalates. The March of Dimes has accepted his findings, said Fisch.
The bill was recommended to pass 8-4 and sent to the Commerce and Consumer Protection Committee.
S.F. 2999, authored by Sen. Ellen Anderson (DFL-St. Paul), requires manufacturers of cosmetics to disclose on the label if dibutyl phthalate is an ingredient in the fragrance. The remainder of the fragrance ingredients must be listed on the manufacturer's website.
Anderson said that the Food and Drug Administration does not have the authority to regulate the cosmetics industry, with the exception of a few prohibited products, while the European Union has banned 110 chemicals in personal care products.
Students Katie Gasper of Bethel College and Madeline Kovacs of Macalester College presented the products they use and the chemical components that could have harmful effects according to the Skin Deep online database. Both noted products that may have hormonal and reproductive effects, in addition to listings for fragrance, which they said does not actually specify which ingredients are included.
Phil Griffin and Sharon D'Agostino of Johnson & Johnson said that they had worked with Anderson and largely support disclosure of ingredients, however, they do not support the disclosure of fragrance ingredients. D'Agostino said that fragrances are protected trade secrets of fragrance manufacturers that supplies to personal care product manufacturers.
A roll call vote advanced the bill to the Commerce and Consumer Protection Committee, 7-2.
The Health, Housing and Family Security Committee, chaired by Sen. John Marty (DFL-Roseville), met Wed., Feb. 20, to take action on three bills.
Members granted approval to all three measures and advanced them to the Senate floor.
S.F. 2377, authored by Sen. Tony Lourey (DFL-Kerrick), requires that an advanced life support ambulance with a primary service area outside the Metro Area be staffed by a first responder driver and a paramedic. The bill then allows each subsequent emergency ambulance response to be staffed by one registered first responder driver and an emergency medical technical or a paramedic. Lourey said the bill will be of particular help in Greater Minnesota where there is a problem in recruitment and retention of ambulance personnel. "The bill will help staff ambulances in a safe and responsible manner," he said. Buck McAlpin, president, Minnesota Ambulance Association, and James Rieber, chair of the Emergency Medical Services Regulatory Board, spoke in support of the measure.
A second bill also concerned emergency medical services. The bill, S.F. 2418, sponsored by Sen. Paul Koering (R-Fort Ripley), lifts the limitation on terms of service for members of the EMS Regulatory Board. Current law limits members to one four-year term, Koering said. Members also adopted an amendment delaying for one year, until 2010, the requirement for ambulance licensees to have trauma triage and transport guidelines consistent with the criteria issued by the Trauma Advisory Council.
The final bill, S.F. 2667, authored by Sen. Linda Berglin (DFL-Mpls.), makes permanent the moratorium on radiation therapy facilities in a 14 county area. Berglin said a two year moratorium was enacted last year in order to allow time for study to evaluate the need for additional radiation therapy centers in the 14 counties. The study showed that the existing radiation treatment capacity is sufficient until at least until 2015 and that there is enough radiation capacity in the specified counties. In addition, Berglin said that technological advancements will further increase capacity and efficiency in existing facilties. The counties, Berglin said, are Hennepin, Ramsey, Dakota, Washington, Anoka, Carver, Scott, St. Louis, Sherburne, Benton, Stearns, Chisago, Isanti and Wright. Berglin said adding more radiation facilities in those counties, which already have excess capacity, would drive up health care costs.
Sen. Kathy Saltzman (DFL-Woodbury) said by making the moratorium permanent, hospitals will be forced to come together to develop joint facilities in the future. She said the bill is a reasonable, balanced way to contain costs.
However, Sen. David Hann (R-Eden Prairie) said the bill interferes with the workings of the marketplace. He said competition drives prices down and the bill limits competition. Dr. Tom Flynn, Minnesota Oncology Hematology, P.A., said the bill interferes with patient choice, access and convenience.
A bill creating a new Minnesota Health Plan to cover all Minnesotans, funded through premiums based on ability to pay and other revenue sources, was the primary focus of the Mon., Feb. 18, meeting of the Health, Housing and Family Security Committee. The bill, S.F. 2234, sponsored by Committee Chair John Marty (DFL-Roseville), provides for a single-payer plan to provide high quality health care to all citizens. "We need to make sure that all Minnesotans are covered and that all Minnesotans have access to health care," Marty said. He said health care costs are rising rapidly, with more than 1.1 million Minnesotans spending more than 10 percent of their income on health care. Over all, more than half of all bankruptcies are because of medical expenses, Marty said. "There has also been a significant fall-off of employers offering health insurance, from 70 percent eight years ago to 60 percent today," he said. Marty said, "We are currently spending about $6,500 for every man, woman and child in Minnesota each year, yet we still have many people without access to health care."
Marty said the bill lists nine principles that the new health plan must meet. Under the bill the health plan must ensure all Minnesotans receive high quality health care, the plan must not restrict, delay or deny care or reduce the quality of care to hold down costs, the plan must cover all necessary care, including mental health services, chemical dependency treatment, dental care, prescription drugs and home care and the plan must allow patients to choose their own providers. In addition, the new plan must be funded through premiums based on ability to pay, must focus on preventive care and early intervention, must ensure an adequate number of qualified health care professionals and facilities, must continue Minnesota's leadership in medical education, training, research and technology and must provide adequate and timely payments to providers.
Marty outlined the provisions of the bill, including eligibility, benefits, funding, payments, governance and implementation. Committee members had numerous questions relating to the funding of the plan, the availability of care and the governing structure.
Dr. Ann Settgast, spoke in support of the measure. She said she has supported single-payer health care coverage for many years. She said the current system has many inequities and complexities. "It is unclear to me why we do not consider health care a basic human right," Settgast said. She said a single-payer system will dramatically cut administrative costs and is the only sustainable option.
Mary Cowan, a citizen advocate, also spoke in support of the measure. "Our system is broken," she said, "And if other countries can provide health care to all their citizens, why can't we?"
Other supporters spoke of their experiences with the current health care system and advantages of the plan outlined in the bill. Dr. Morrie Hodges, former chief of cardiology, Hennepin County Medical Center, compared the provision of health care to the provision of police and fire services, as a right rather than a privilege.
Julie Brunner, Minnesota Council of Health Plans, said the council supports the goal of universal coverage for all Minnesotans. However, she said the current system does some things very well. She said technology in the United States is the envy of many other developed nations. She said no country has a perfect system and in every case governments are challenged to keep up with rising costs. Throwing out the entire system is not the way to provide health care for all Minnesotans, Brunner said. The rising cost of health care makes it nearly impossible to provide a universal system, she said. Utilization and technology, not administration, are driving costs upward, Brunner said. "We have very low administrative costs in Minnesota's nonprofit health care systems," Brunner said. "Countries with entirely tax supported systems are turning to the private sector to address rising costs," Brunner said. A single-payer system in Minnesota is not the answer, she said, and although our system in Minnesota is not perfect, it is one of the best in the nation.
The panel recessed and resumed in the early evening. Members continued hearing testimony on the Minnesota Health Care plan before taking action on the bill. Marty concluded by saying the bill would provide affordable coverage to all Minnesotans. The measure was approved and re-referred to the Commerce and Consumer Protection Committee.
In other action, the committee heard a bill, S.F. 1830, establishing licensure requirements for medical laboratory science professionals. The bill, sponsored by Sen. Gary Kubly (DFL-Granite Falls), also creates a Medical Laboratory Science Professional Licensing Advisory Council. The bill establishes licensing requirements for medical laboratory scientists; categorical medical laboratory technicians; medical laboratory technicians; medical laboratory specialists in molecular biology; medical laboratory specialists in cytogenetics; histocompatibility technologists; other specialists and categoricals; cytotechnologists; histotechnologists; and histotechnicals.
Supporters of the bill said the licensing requirements will ensure greater accuracy and safety in medical testing. Opponents argued that licensing is not needed and that medical laboratory science professionals are extremely competent. No action was taken on the bill.
The Health, Housing and Family Security Committee chaired by Sen. John Marty (DFL-Roseville) heard three bills on Wed., Feb. 13. Two passed directly on to general orders and the third was recommended to pass and sent on to the Finance Committee.
S.F. 2471, authored by Sen. Kathy Sheran (DFL-Mankato), allows 16-year-olds to volunteer for blood donation with written permission from a parent or guardian. Currently, anyone 17 years old and older may volunteer to donate blood without parental consent. Joe Gibson, a 16-year-old high school student from Blooming Prairie, Minn., was inspired by his grandfather's battle with leukemia to contact his legislators after discovering he was too young to donate blood. The Mayo Clinic, Memorial Blood Centers and the American Red Cross submitted testimony in favor of the change. The bill was recommended to pass and was sent to the general register.
Sen. Linda Scheid (DFL-Brooklyn Park) presented S.F. 1326, which would transition a Brooklyn Park Homeward Bound intermediate care facility for persons with severe developmental disabilities into four, smaller facilities throughout Hennepin County. Payment rate adjustments through a general fund request are also proposed to address the costs of transition and the higher costs of operating smaller facilities. Scheid explained that the intention is to move residents away from an institutional setting to smaller environments. The bill was recommended to pass and sent to the Finance Committee.
Sen. Linda Berglin (DFL-Mpls.) presented S.F. 1965. The bill allows rehabilitated convicts to retain their state issued licenses in the field of corrections. According to statute, individuals with state licenses in the fields of chemical dependency and corrections permanently lose their licenses for committing certain crimes. Before 2005, some individuals could receive set-asides from the commissioner of human services based on rehabilitation, said Dan Cain, former chair of the Sentencing Guidelines Commission. Since then, workers in chemical dependency have been able to renew those set-asides when changing jobs, explained Berglin. The bill allows workers in corrections that received a set-aside before 2005 to also renew that qualification when changing jobs within the field.
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Agency bills heard
Licensing bills heard
Pharmacy bill gains
Advanced dental hygienist bill okayed
County based purchasing debated
Health care reform bill gains
Health care reform bill heard
Safety of chemicals in products considered
First responders bill advanced
Health plan reviewed
Bood donation bill gains
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