Senate Counsel, Research
and Fiscal Analysis
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Tom Bottern
State of Minnesota
S.F. No. 2505 - Health and Human Services Finance and Policy Omnibus Bill (First Engrossment)
Author: Senator Michelle R. Benson
Prepared By: Senate Counsel, Research and Fiscal Analysis (651/296-4791)
Date: April 23, 2018


Article 1

Health Care

Section 1 (3.3005, subdivision 8) requires state agencies when making a request to the Legislative Advisory Commission, to spend federal funds to provide with the request a narrative description of the commitments required that includes whether continuation of any FTE positions will be a condition of receiving the federal funds.

Section 2 (62J.90) establishes the Minnesota Health Policy Commission to make recommendations to the legislature on changes in health care policy and financing.  The commission is required to: (1) compare private market health care costs and public health care program spending to that of other states; (2) compare the private health care market care costs and public health care program spending in any given year to its costs and spending in previous years; (3) identify factors that influence and contribute to Minnesota’s ranking for private market health care costs and public health care program spending; (4) monitor efforts to reform the health care delivery and payment system to understand emerging trends in the health insurance market; (5) make recommendations for health care reform; and (6) conduct any additional reviews as required by the legislature. This commission expires June 15, 2024.

Section 3 (256.01, subdivision 17a) specifies that the Commissioner of Human Services may only transfer money from the general fund to another fund for routine administrative operations and may not transfer money from the general fund to any other fund for other purposes without the approval from the Commissioner of Management and Budget.

Section 4 (256B.04, subdivision 14) prohibits the commissioner from utilizing volume purchasing through competitive bidding for incontinence products and related supplies.

Section 5 (256B.0625, subdivision 3b) adds community paramedics to the health care providers who can receive medical assistance (MA) reimbursement for telemedicine services.  This section also creates an exception to the telemedicine visit limit if the telemedicine services are for the treatment and control of tuberculosis and are consistent with the best practices specified by the CDC.

Section 6 (256B.0625, subdivision 58) Paragraph (b) specifies that a provider is not required to provide as part of an EPSDT screening any of the recommendations added on or after January 1, 2017, to the child and teen checkup program schedule in order to receive the full payment reimbursement amount for a complete EPSDT screening.  This paragraph expires January 1, 2021.  Paragraph (c) requires the commissioner to inform the legislature of any new recommendations added to an EPSDT screening after January 1, 2018, that a provider is required to perform to receive full payment.

Section 7 (256B.758) increases the MA reimbursement rate for doula services to $47 per prenatal or postpartum visit up to a total of six visits; and $488 for attending and providing doula services at a birth, beginning July 1, 2018.

Section 8 modifies the capitation payment delay passed last session by exempting from the delay the capitation payment due in May 2021 to managed care organizations for adults without dependent children.

Section 9 specifies that the Legislative Coordinating Commission shall make the first appointments to the Minnesota Health Policy Commission by January 15, 2019.

Section 10 requires the Health Services Policy Committee, established by the Commissioner of Human Services, to evaluate the integration and make recommendations based on best practices for effective treatment for musculoskeletal pain provided by certain health practitioners and covered by medical assistance.  Requires the commissioner to consult with certain health practitioners and report to the legislature due August 1, 2019, on the commissioner's recommendations. The final report to the legislature must include a pilot program to assess integrated nonpharmacologic, multidisciplinary treatments for managing musculoskeletal pain.

Section 11 repeals section 256B.0625, subdivision 31c, (preferred incontinence product program passed last session).

Article 2

Health Department

Sections 1 through 9 make modifications to the wells and borings regulations.

Section 1 (103I.005, subdivision 2) modifies the definition of "boring" to include temporary borings.

Section 2 (1031.005, subdivision 8a) specifies that an environmental well does not include an exploratory boring.

Section 3 (103I.005, subdivision 17a) adds a definition of a temporary boring.

Section 4 (103I.205, subdivision 1) changes environmental well to a temporary boring and states that notification is not required before construction of a temporary boring.

Section 5 (103I.205, subdivision 4) permits a person to construct, repair, and seal a temporary boring if the person is a professional engineer, a hydrologist or hydrogeologist, a professional geoscientist, or a geologist that meets the qualifications established by the Commissioner of Health.

Section 6 (103I.208, subdivision 1) extends the well sealing fee of $75 to each boring, except that a single $75 fee for all temporary borings recorded on the sealing notification for a single property sealed within 72 hours of start of construction and exempts temporary environmental borings less than 25 feet in depth from the notification and fee requirements of this chapter.  Also specifies that there is no fee required for construction of a temporary boring.

Section 7 (103I.235, subdivision 3) states that section 103I.235 (disclosure of location of wells at property sale) does not apply to temporary borings or unsuccessful wells that have been sealed by a licensed contractor in compliance with chapter 103I.

Section 8 (103I.301, subdivision 6) states that a person may not seal a boring until a notification of the proposed sealing is filed as prescribed by the commissioner and exempts from the notification requirements of chapter 103I temporary borings that are less than 25 feet in depth.

Section 9 (103I.601, subdivision 4) requires an explorer to submit to the Commissioner of Health ten days before beginning exploratory boring notification of the proposed boring map and a fee of $275, and submit to the Commissioners of Health and Natural Resources a county road map on a single sheet of paper that is 8 ½ by 11 inches in size showing the location of each proposed exploratory boring. (Current law requires a fee of $275 for each exploratory boring).

Section 10 (144.121, subdivision 1a) includes security screening systems that are used in correctional and detention facilities for security screenings of humans who are in custody of the facility in the list of facilities that use ionizing radiation-producing equipment and are required to be regulated by the Commissioner of Health, including the payment of a base fee of $100 and an additional fee of $100 to the commissioner.

Section 11 (144.121, subdivision 9) exempts the operators of a security screening system from having to meet the examination requirement and the facility from having to meet the inspection requirement and permits a variance in accordance with rules.   This exemption expires when permanent rules are published in the State Register by the Commissioner of Health regarding the security screening systems.

Section 12 (144.397) requires the Commissioner of Health to administer statewide tobacco cessation services to assist individuals who are seeking advice or services to help them quit using tobacco products.  The commissioner is required to establish statewide public awareness activities to inform the public of the availability of the services and encourage the public to use the services.

Section 13 requires a report on the evaluation results for the opioid abuse prevention pilot projects receiving funds in FY 2019 to be submitted to the legislature by December 15, 2021.

Section 14 requires the Commissioner of Health to conduct a low-value health services study that analyzes: (1) the alignment of health care delivery with specific best practices guidelines; and (2) health care services and procedures for the purposes of identifying, measuring and potentially eliminating those services and procedures with low- value and little benefit to patients.

Section 15 requires the Commissioner of Health to provide grants to ambulance services to reduce opioid overdoses in the state by developing and implementing projects that connect community paramedic teams with patients who have been discharged from a hospital or emergency room following an opioid overdose episode; develop personalized care plans for those patients, and provide follow up services.

Section 16 authorizes the Commissioner of Health to adopt rules to implement section 144.121, subdivision 9, (rules governing security screening systems) by December 31, 2020.

Article 3

Health Coverage

Section 1 (62A.30) provides health care coverage for preventive mammogram screening that includes digital breast tomosynthesis (3D) for enrollees who are at risk for breast cancer.  At risk for breast cancer includes having a family history; testing positive for BRCA1 or BRCA2; having dense breasts; or having a previous diagnosis of breast cancer.

Section 2 (62J.824)  Paragraph (a) requires a provider-based clinic that charges a facility fee to provide notice to a patient that states that the clinic is a part of a hospital and the patient might receive a separate charge or billing for the facility component which may result in a higher out-of-pocket expense.

Paragraph (b) requires a health care facility to prominently post a statement that the provider-based clinic is part of a hospital and the patient may receive a separate billing for the facility.

Paragraph (c) exempts laboratory services, imaging services, and other ancillary services that are provided by staff who are not employed by the health care facility or clinic.

Paragraph (d) defines facility fee and provider-based clinic.

Section 3 (62Q.184) establishes a step therapy override process for enrollees and prescribing health care providers to use if a health plan company restricts coverage of a prescription drug through the use of a step therapy protocol.

Subdivision 1 defines the following terms: clinical practice guideline; clinical review criteria; health plan company; step therapy protocol; and step therapy override. The definition of a health plan company specifies that this does not include a managed care plan or county-based purchasing plan or an integrated health partnership participating in medical assistance or MinnesotaCare.

Subdivision 2 requires the health plan company when establishing a step therapy protocol to consider available recognized evidence-based and peer-reviewed clinical practice guidelines.  Requires a health plan company to provide to an enrollee upon request, the clinical review criteria that is applicable to a specific prescription drug.

Subdivision 3, paragraph (a), requires that if a health plan company restricts coverage for a prescription drug for the treatment of a medical condition by requiring the use of a step therapy protocol, enrollees and prescribing providers must have access to a process to request a step therapy override.  The override process must be accessible through the health plan company’s Web site.  Specifies the conditions where a health plan company must grant an override.

Paragraph (b) states that once an override has been granted, the health plan company must authorize coverage for the prescription drug if the drug is covered under the enrollee’s health plan.

Paragraph (c) permits the enrollee or the enrollee’s prescribing health care provider if designated by the enrollee, to appeal a denial of a step therapy override using the complaint process established under sections 62Q.68 to 62Q.73.

Paragraph (d) If a health plan company denies an override request or an appeal of a denial, the health plan company’s decision must state why the override request did not meet the condition cited by the override request and must provide information on how to request an external review under section 62Q.73.

Paragraph (e) requires a health plan company to respond to an override request or an appeal within five days of receipt of a complete request, or within 72 hours if there are exigent circumstances.  If a health plan company does not respond within these time limits, the request is granted and is binding on the health plan company.

Paragraph (f) requires step therapy override requests to be accessible to health care providers and providers must be able to submit the requests electronically through secure electronic transmission.

Paragraph (g) states that nothing in this section prohibits a health plan company from requesting relevant documentation from an enrollee’s medical record in support of a step therapy override request or from requiring an enrollee to try a generic equivalent drug or a biosimilar prior to providing coverage for the equivalent branded prescription drug,

Paragraph (h) specifies that this section is not to be construed to allow the use of a drug sample for the primary purpose of meeting the requirements for a step therapy override.

Section 4 (151.214) states that no contract between a health plan company or a pharmacy benefits manager and a pharmacy may prohibit a pharmacist from informing a patient when the amount the patient may be required to pay under the patient’s health plan for a particular drug is greater than the amount the patient would be required to pay if purchased out-of-pocket at the pharmacy’s usual and customary price.

Section 5 (151.71) requires a contract between a pharmacy benefits manager and a pharmacy to permit for the synchronization of prescription drug refills for a patient on at least one occasion per year if the following conditions are met:

  1. The drugs are covered under the patient’s health plan or have been approved by a formulary exceptions process;
  2. The drugs are maintenance medications and have one or more refills available at time of synchronization;
  3. The drugs are not schedule II, III or IV controlled substances;
  4. The patient meets all utilization management criteria ;
  5. The drugs are of a formation that can be safely split into short fill periods; and
  6. The drugs do not have special handling or sourcing needs that require a single designated pharmacy to fill or refill the prescription.

Section 6 (152.105, subdivision 2) permits the sheriff of each county to implement a medicine disposal program as an alternative to the requirement that each sheriff maintains at least one collection receptacle for the disposal of prescription drugs.  Defines a medicine disposal program as providing educational information and making materials available for safely destroying unwanted prescription drugs.

Article 4

Health Licensing Boards

Sections 1 through 29 convert the allied health professionals regulated by the Board of Medical Practice (physician assistants, acupuncture practitioners, respiratory care practitioners, traditional midwives, registered naturopathic doctors and genetic counselors) to a licensure renewal cycle that is based on birth month.  These sections do the following for each occupation:

Specifies that a licensee whose license has lapsed before January 1, 2019, and is seeking to regain licensed status after January 1, 2019, shall be treated as a first-time licensee for purposes of establishing a license renewal schedule and shall not be subject to the license cycle conversion provisions.

Requires a licensee to maintain a correct mailing address with the board.  Specifies that placing the license renewal application in the mail constitutes valid service and failure to receive renewal documents does not relieve a licensee of the obligation to comply with this section.

Specifies that the name of the licensee who does not return a complete renewal application with the applicable fee within the time period required shall be removed from the list of individuals authorized to practice during the current renewal period.

Converts the license renewal cycle to an annual cycle where renewal is due on the last day of a licensee’s month of birth beginning for licensees, beginning January 1, 2019, for licensees who are licensed before December 31, 2018.  Specifies the conversion of license renewal cycle for current licenses and for noncurrent licenses.  Specifies that after the conversion renewal cycle, subsequent renewal cycles are annual and begin on the last day of the month of the licensee’s birth.

Establishes and adjusts license fees for the conversion license period.

Sections 30 through 36 update changes governing background checks conducted by health-related licensing boards and procedures relating to temporary suspensions for actions that present an imminent risk of serious harm.

Section 30 (214.075, subdivision 1) specifies that the following individuals must submit to a criminal background check: (1) applicants for initial licensure or licensure by endorsement; (2) applicants seeking reinstatement or relicensure if more than one year has elapsed since the applicant’s license or registration expiration date; or (3) licensees applying for eligibility to participate in an interstate licensure compact.  Specifies that an applicant’s criminal background check results are valid for one year from the date the results were received by the board.

Section 31 (214.075, subdivision 4) removes the 90-day time period for an applicant to submit fingerprints.

Section 32 (214.075, subdivision 5) modifies the reference to the results of the criminal background checks from criminal justice information checks to criminal history records check.

Section 33 (214.075, subdivision 6) permits the licensing board to require an alternative method of criminal history checks for an applicant or licensee who has submitted at least two sets of fingerprints that are unreadable by the BCA or FBI. (Currently three sets of unreadable prints must have been sent).

Section 34 (214.077) clarifies that in a contested care hearing regarding a temporary license suspension if an administrative law judge’s report and recommendation is for action, the board is required to issue a final order within 60 days of receipt of an administrative law judge’s report and recommendations, and if a final order is not issued within that time the temporary suspension shall be lifted.

Section 35 (214.10, subdivision 8) specifies that boards shall not exchange criminal history information with other states.

Section 36 (364.09) exempts from chapter 364 that governs the rehabilitation and employment of criminal offenders any license, registration, or permit that has been denied or reviked by a health-related licensing board.

Section 37, paragraph (a), repeals section 214.075, subdivision 8, (requiring a plan to develop criminal background checks for current licensures by January 1, 2017).  Paragraph (b) repeals obsolete rules associated with license renewal.

Article 5

Prescription Monitoring Program

Section 1 (151.065, subdivision 7) specifies that fees collected under this section by the Board of Pharmacy shall be deposited into the special government special revenue fund.

Section 2 (152.126, subdivision 6) requires, beginning January 1, 2020, prescribers to access the data of the prescription monitoring program (PMP) to the extent the data relates to the patient before prescribing a prescription for Schedule II or III controlled substances to the patient.  Specifies that this requirement does not apply if: (1) the patient is receiving hospice care; (2) the prescription is for a number of doses that is intended to last the patient five days or less, and is not subject to a refill; (3) the controlled substance is lawfully administered by injection, ingestion, or other means to the patient by the prescriber, pharmacist, or the patient at the direction of the prescriber and in the presence of the pharmacist or prescriber; (4) it is not possible for the prescriber to review the data due to an emergency; or (5) the prescriber is unable to access data due to operational or other technological failure of the PMP, if the failure is reported to the board.

Section 3 (152.126, subdivision 10) authorizes the Board of Pharmacy to modify its contract with its vendor for the PMP to provide a service to prescribers and pharmacies that allows them to access the PMP data from within the electronic health records system or pharmacy software used by those prescribers or pharmacies.  It also authorizes the board to collect an annual fee from each prescriber or pharmacist who accesses the PMP through the service offered by the vendor, not to exceed $50 per user.  This fee is to be deposited in the special government special revenue fund and is appropriated to the board. 

Article 6

Protection of Vulnerable Adults

Section 1 (144A.53, subdivision 2, paragraph (c)) requires the director of the Office of Health Facility Complaints (OHFC) to disclose to a vulnerable adult or an interested person acting on behalf of a vulnerable adult whether the OHFC has received a report or complaint involving the vulnerable adult and provide a redacted version of the initial report or complaint.

Section 2 (Direction to the Commissioner) requires the commissioner of health to institute a number of administrative changes at the Office of Health Facility Complaints that were recommended by the recent report issued by the Office of the Legislative Auditor.

Section 3 (Direction to the Commissioner of Health) requires the commissioner of health to submit quarterly reports to the legislature containing measures and analysis of the Office of Health Facility Complaints’ response to reports of maltreatment of vulnerable adults.

Section 4 (Direction to the Commissioners of Health and Human Services) requires the commissioner of health and of human services to collaborate on an annual report concerning each department’s response to allegations of maltreatment of vulnerable adults and other measures of the departments’ licensing functions of settings and providers serving vulnerable adults.






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