Health and Human Services
PASSED AND SIGNED INTO LAW
Child care background studies – SF 2683
The Legislature amended background study fingerprinting and photograph requirements for children ages 13-17 living in the homes of child care providers. The human services commissioner must now have reasonable cause to collect fingerprints and photographs going forward.
Child care oversight – SF 3310
The Legislature made it easier for family child care providers and child care centers to hire staff and operate under certain caregiver-to-child ratios. The human services commissioner is now required to work closely with providers to improve the oversight process and ensure that providers have the information and support they need to be successful.
Foster care sibling bill of rights – SF 2902
The Legislature established a bill of rights for siblings who are living in foster care. The Minnesota Department of Human Services (DHS) is required to inform siblings and foster families about these rights when a child enters the foster care system. Siblings now have the right to be placed together when possible, or close to one another if placement together is not possible. Siblings also have the right to be in frequent contact with each other and be actively involved in each other’s lives.
Training to combat sex trafficking – SF 3367
The Legislature mandated annual training for individuals who work at hotels and motels to improve the hospitality industry’s ability to recognize potential victims and report crimes to law enforcement.
Step therapy patient protections – SF 2897
The Legislature established criteria for granting overrides of health insurer “step therapy” protocols and approved related consumer protections. Step therapy is a controversial practice used by health insurance companies that limits patient choice by requiring patients use less costly and sometimes less effective medications first and interferes with a physician’s ability to prescribe medications.
DID NOT PASS
Opioid Stewardship Fee – SF 730
A bipartisan coalition of lawmakers tried to address the opioid epidemic by requiring pharmaceutical companies to pay one penny for every opiate painkiller sold. A “penny-a-pill” fee would generate $20 million annually for treatment and local government costs. The Senate approved a modified version of the bill containing a registration fee on manufacturers and wholesalers by a margin of 60-6, but Republican leadership killed the bill in the House after strong opposition from the industry. As a result, taxpayers will continue to shoulder the costs of addressing the opioid epidemic.
Work requirements for Medical Assistance (MA) recipients – SF 3611
Republican lawmakers tried to require certain MA recipients to work in order to receive benefits. The proposal kicks low-income Minnesotans off their health care and puts taxpayers on the hook for nearly $300 million in new costs to accurately verify recipient eligibility. The majority of recipients who are able to work already do so. Individuals who are unable to work are often disabled, have a serious illness, or lack stable housing. House and Senate committees passed the bill despite DFL opposition; however, it did not advance after dozens of community organizations and local governments denounced the bill.
MNsure operating budget – SF 3392
Republican lawmakers tried to cut MNsure’s operating budget by $30 million, or 25%, over the next three years but abandoned the proposal during the conference committee process. Their bill would give the money to insurance companies, who last year received a one-time $542 million taxpayer bailout intended to stabilize the individual marketplace. Cutting MNsure’s budget by 25% would cripple customer service needed to help consumers navigate an already complex health care system.
Minnesota African American Family Preservation Act – SF 3779
A bill was introduced this session to address racial disparities in child protection for African American children and families. The Minnesota African American Family Preservation Act establishes minimum standards to prevent arbitrary and unnecessary removal of children from their families and requires culturally appropriate services in child welfare to prevent out-of-home placements. The bill did not receive a public hearing and did not advance in the legislative process after attempts to amend it to other legislation.
Ultrasound requirements for abortions – SF 2849
The House and Senate approved a controversial bill requiring physicians to tell a patient that she can view or decline to view her active ultrasound image if at any point prior to or during an abortion procedure an ultrasound is performed. The bill forces elected officials in the middle of the doctor-patient relationship. Patients already have the right to be fully-informed about all medical procedures and physicians already ensure that patients understand the benefits, risks, and alternatives of any procedure.
Supplemental budget – SF 3656
The budget appropriates $18 million for health and human services expenditures in FY 2018-2019, but lacks solutions to adequately address two statewide challenges lawmakers agreed needed urgent action, the opioid epidemic and elder abuse prevention. Governor Dayton asked Republican leadership to address both as single-subject, standalone bills, but lawmakers sent him half-measures tucked into their 990-page budget.
In response to media coverage of abuse and neglect at nursing homes and assisted living facilities last year, Governor Dayton convened a consumer working group led by AARP Minnesota. The working group created a list of recommendations that reflected feedback from victims, advocates, family members, direct care workers, and facility staff members. The office of the Legislative Auditor conducted an investigation into the shocking allegations and also provided recommendations for the Legislature. Consumer advocates urged lawmakers to act swiftly and pass legislation to hold providers accountable, strengthen and improve the system used to report abuse, and empower vulnerable Minnesotans and their families.
A bipartisan group of lawmakers introduced legislation based on the working group’s recommendations, but it never received a public hearing. A watered down version of the bill advanced in the legislative process, improving some along the way, but Republican leadership gutted it during the conference committee process in favor of industry-friendly changes. The final version makes the placement of cameras in resident rooms more difficult, prevents seniors from enforcing their rights in civil proceedings, maintains the status quo regarding arbitrary terminations from assisted living facilities, and stacks the deck in favor of the industry by allowing Minnesota to continue to be the only state that does not license assisted living facilities.
AARP Minnesota and other stakeholders sent a scathing letter to Republican leadership expressing their anger with the lack of solutions.
The budget appropriates general fund revenue for initiatives to reduce opioid addiction. Taxpayers, not the pharmaceutical industry, would be on the hook for millions in new spending, including the following expenditures:
– $1 million for grants to help paramedics provide follow-up services to individuals recently discharged from the hospital after an overdose.
– $2 million to CHI St. Gabriel’s Health System for opioid prevention pilot projects.
– $2.4 million for a 1.74% increase in provider rates for chemical dependency services.
The budget also prohibits filling prescriptions for opiates more than 30 days after a prescription is issued by a physician; establishes requirements for when certain prescribers must check the prescription monitoring program before issuing a prescription; and limits the quantity of opiates prescribed for acute pain, with exceptions.
Governor Dayton’s MinnesotaCare Buy-In proposal attracted bipartisan support last year, but Republican lawmakers tried to prohibit the proposal from ever becoming law this year, preventing Minnesotans from accessing quality health coverage at a competitive price. The Governor’s proposal would allow all Minnesotans the choice to purchase their health insurance through MinnesotaCare – a state program that for 26 years has provided eligible working Minnesota families affordable, reliable health care.
MinnesotaCare Buy-In would reduce costs and improve access for an estimated 100,000 more Minnesotans who purchase their own health insurance on the individual market. Unlike traditional MinnesotaCare enrollees who receive subsidized coverage, individuals who choose MinnesotaCare Buy-In would pay their own way – meaning the cost of their premiums would pay for their coverage just like other commercial insurance plans. The need for MinnesotaCare Buy-In was underscored by recently released data showing that Minnesota’s uninsured rate increased by 46 percent last year alone, due in part to rising insurance costs, leaving approximately 349,000 Minnesotans without coverage in 2017.
Disability Waiver Rate System
The budget appropriates $27.6 million for the Disability Waiver Rate System (DWRS) in FY 2019 to increase the reimbursement rates paid to providers of services for people with disabilities. Lawmakers have authorized multiple rate increases in the last few years. When the federal government declined to match the state’s investments as expected, it created a hole in the budget that forces the state to cease rate increases beginning in July 2018. The $27.6 million appropriation would ensure that providers do not see a large rate decrease in the coming months.
Challenges to DHS authority
The budget requires DHS and MDH to create a plan to withdraw certain services from their agencies, which would then be under the purview of a newly-created state agency focused on investigation, compliance, and oversight. It also prohibits DHS from rulemaking on anything related to child care and creates duplicative processes by requiring DHS to hire an outside vendor to re-verify eligibility for some public programs.
340B Federal pharmacy payment modifications
The budget brings Minnesota into compliance with a federal rule governing how pharmacies are paid to dispense medications, but it results in higher costs for safety-net hospitals and pharmacies. It also appropriates $2.2 million in stop-gap funding for safety-net hospitals and pharmacies with the expectation that the issue will be revisited next year.
Tobacco cessation services
Minnesota received $6.1 billion plus ongoing annual fees as a result of the tobacco settlement in 1998. Using a portion of the settlement, the state created ClearWay Minnesota, a life-limited organization that will sunset in 2022. The organization’s QUITPLAN Services program ends in March 2020, at which point Minnesota will become the only state that does not provide smoking cessation services. The budget appropriates funding for a new cessation program but does so by taking money out of existing Statewide Health Improvement Partnership (SHIP) funding instead of tobacco settlement funding.
Mental health crisis hotline
The budget appropriates $969,000 to keep a Minnesota-based mental health crisis hotline operational. A request for new funding failed last year, but MDH used existing resources to make the hotline operational through the 2018 session. Minnesotans also have access to the National Suicide Prevention Lifeline.
Child Care Assistance Program (CCAP) federal conformity
The budget leverages forthcoming federal funds to improve services for homeless families and increase reimbursement rates paid to child care providers, at no cost to the state.
Health care price transparency
The budget requires clinics to provide notice to patients who are being charged a facility fee prior to delivering non-emergency medical services. It also prohibits contracts between pharmacy benefit managers/insurance companies and pharmacies from preventing pharmacists of informing patients when their copay is higher than the out-of-pocket cost of a medication.