COVID-19 provisions passed
Initial public health emergency funding
Early in the COVID-19 pandemic, legislators quickly realized funding was needed for public health response activities. With the scope of this crisis still uncertain, the Legislature urgently passed $21 million in funding for Minnesota’s public health response contingency account. Funds were utilized by the Minnesota Department of Health to coordinate response activities, conduct lab testing, and contract for needed services, staffing, and supplies. (SF 3813)
Health care grants and emergency funding
As the harsh realities of this pandemic set in, the Legislature worked quickly to develop a bill appropriating $200 million in funding to support our state’s healthcare system, which passed the Senate with unanimous support. These resources were added to be used for short-term emergency funding and to create a health care response grant fund for the Minnesota Department of Health (MDH).
From this bill, $50 million was quickly distributed on an emergency basis to provide cash flow relief to health care organizations to cover their highest priority needs. This money was awarded to nearly 350 provider organizations across the state for preparing for and responding to the COVID-19 pandemic.
The remaining $150 million went to make and administer a grant program for health care providers for costs related to COVID-19. Along with hospitals and clinics, providers working in ambulance services, pharmacies, nursing homes, or long-term care facilities were eligible for these grants. DFLers made sure that as a condition of accepting a grant, the provider must agree not to bill uninsured patients for the cost of COVID-19 screening, testing, or treatment. (HS 4334)
Minnesota Food Shelf Program Funding
Food shelves and food banks across the state are seeing increase demand during the pandemic and must quickly adapt to increased supply, staffing, and food delivery needs. Hunger advocates say the number of Minnesotans needing food stamps could double as Minnesotans struggle with lost income. As part of larger COVID-19 economic relief efforts, the Legislature passed $9 million in funding to support food shelf programs that have taken a hit due to the COVID-19 pandemic.
This funding will support the Minnesota Food Shelf Program, which is administered by the Department of Human Services in collaboration with Hunger Solutions Minnesota. This organization represents more than 250 food shelves in Minnesota and distributes funds to qualifying food shelfs and food banks within the state. The funds received will allow them to purchase food, diapers, toilet paper, and other necessary supplies, as well as enabling them to provide specialized responses to their communities’ needs. (SF 4531)
Homelessness and Housing Support
The Legislature passed over $32 million in funding this session to support housing and shelter options for low-income Minnesotans and Minnesotans experiencing homelessness in response to COVID-19.
A portion of this funding is dedicated to the Housing Support Program, which provides room and board costs for adults with low incomes who have a disability or are aged 65 or older and at risk of institutional placement or homelessness. More than 20,000 Minnesotans receive Housing Support annually. Many settings that receive Housing Support payments were forced to take out loans to maintain their current capacity as costs increase from COVID-19. Temporary rate increases included in this legislation will allow them to make up for additional expenses.
The remainder of the funding will be directed towards emergency services grants, which are critical for organizations who organizations who provide shelter and services to people experiencing homelessness. These grants can be used to purchase and provide additional shelter or isolation space, purchase cleaning and sanitary equipment, or add extra staff to accommodate health and safety guidelines. (SF 4531)
Emergency Child Care Grants
Childcare is a critical support for our families and communities both in daily life and in times of crisis. Childcare providers need support during this pandemic now more than ever as they face significant losses in revenue from families withdrawing their children as work from home or have been laid off from their jobs. On top of this, programs are seeing increased costs due to staffing needs and adaptations to meet new public health recommendations.
The Legislature passed funding for emergency childcare grants for programs who could stay open to prioritize space for emergency workers and were being strained by enrollment fluctuations and increased operating costs due to COVID-19. Child Care Aware, Minnesota’s childcare resource and referral agency, is tasked with distributing these funds equitably across the state and among providers based on the local need for childcare services during the peacetime emergency and whether the provider would be financially at risk without receiving a grant through this program.
Even before this pandemic, Minnesota had been facing a shortage of available and affordable childcare, especially in Greater MN, where there has been a significant loss of providers in recent years. COVID-19 has exacerbated these challenges while emphasizing the true value of caregivers working in this field. More work will be needed to stabilize the childcare industry, and Senate DFLers will continue to prioritize investments for our youngest Minnesotans and the safety of families and workers. (SF 4531)
The need for expanded telemedicine and telehealth services was immediately apparent as Minnesotans quickly adapted to recommended health and safety guidelines. Legislators made several reforms this session to make sure health care practitioners across the state could use virtual options to connect with patients and be reimbursed by insurers.
First, the Legislature made sure that the law allowed telemedicine services to include communications with patients or clients over the telephone while they are at home. Another reform clarified that a health insurance company could not deny or reduce coverage for a service or consultation simply because it is administered via telemedicine. Through working with health insurance carriers and a vast range of providers, legislators continue to evaluate how telehealth options can be strengthened or continued beyond the peacetime emergency. (HS 4334)(SF 4556)
MDH temporary emergency authority
Governor Walz issued several Executive Orders during the peacetime emergency to give certain state agencies temporary authority to waive or modify certain requirements to ensure services can be delivered safely and without undue delay. By codifying these orders, legislators sought to remove any ambiguity about the departments’ authority to accomplish these actions.
The Legislature passed a bill to give MDH additional flexibility to prepare for, prevent, or respond to an outbreak of COVID-19 and to preserve access to programs and services provided, licensed, or regulated by the Department of Health. This will allow them to stand up alternative care spaces quickly and remove the moratorium on creating new hospital beds in hospitals across the state. Related legislation was also passed to allow MDH to enroll temporary alternative health care facilities as Medical Assistance providers. (HS 4456)
Medical Assistance coverage for COVID-19 testing
Federal changes allowed Medical Assistance (MA) to cover the cost for COVID-19 testing and related office visit for uninsured individuals. Bipartisan legislation was passed to codify this change into state statute for the duration of the federal emergency declaration. (HS 4456)
COVID-19 provisions not passed
Contact tracing is a vital infectious disease control measure that has been employed by local and state health departments for decades and is a key strategy for preventing further spread of COVID-19 and reopening the economy, according to federal and CDC guidelines.
COVID-19 is a reportable infectious disease, which means that any confirmed cases, suspected cases, or deaths must be reported to MDH. This is not unique to coronavirus – there are several dozen infectious diseases that require reporting, including measles, shingles, and chicken pox. Typically, this will be reported by a health care practitioner, or a school/child care/residential setting. State and local health departments employ contact tracers to call those who had close contact with an individual who tests positive for COVID-19; these contacts are interviewed to assess their risk, monitor their symptoms, and encouraged to self-isolate if possible. Current law protects the health data of those contacted; no one in the state would be forced to be tested or required to cooperate in case investigations, including identifying those they might have infected.
Despite claims that they support testing and are eager to re-open the economy, Senate Republicans blocked efforts that would have allowed the Legislature to have a say in how an expanded contact tracing program would operate in Minnesota. A contact tracing bill was significantly amended by Senate Republicans in committee that removed the bulk of a contact tracing program which would have established guidelines around MDH’s ability to provide contact tracing, case investigation, and follow up services. It is disappointing that Republicans in the House and Senate refused to engage on this topic amid this deadly outbreak.
Minnesota Family Investment Program payments
Despite repeated efforts by Senate DFLers, a bill to provide a one-time emergency assistance payment to approximately 27,700 families who participate in the Minnesota Family Investment Program (MFIP) failed to pass. MFIP supports some of our lowest-income families with children by offering cash and food benefits with employment services. Even though working or seeking employment is a requirement of the program, they often do not qualify for Unemployment Benefits but are still facing significant challenges during the COVID-19 pandemic. This bill was passed off the House floor but did not receive a hearing in the Senate. (HF 4582)
Uninsured insurance coverage for COVID-19 treatment
Among COVID-19 relief efforts passed this session was a provision to align state statute with recent federal changes to provide Medical Assistance (MA) coverage for any COVID testing and the related office visit for uninsured individuals. Senate DFLers knew that simply covering the cost of testing is not enough, but efforts to make sure uninsured populations have access to health coverage so they can obtain any necessary treatment or follow-up services failed in negotiations.
While, the state’s public and commercial health plans have agreed to waive cost-sharing charges for Minnesotans who are hospitalized due to COVID-19, uninsured residents are left with few options.
PCA rate increases
PCAs are facing increased risk during the pandemic as their work limits their options to stay at home and self-isolate. On top of being persistently underpaid, Minnesota was already facing a severe PCA shortage before the pandemic. Now, positions are even harder to fill, and options for overtime and hazard pay are limited. Direct support professionals are invaluable in their commitment to support people with disabilities and those with mental health issues, as they work on the frontlines of this pandemic. They should be compensated in a manner that reflects this challenging work.
DHS temporary emergency authority
While the legislature was successful in codifying Governor Walz’s Executive Order that granted MDH temporary emergency authority, similar legislation to codify the Department of Human Services’ temporary authority failed to pass in the House. DHS has made more than 50 needed modifications to increase the flexibility in their programs and policies. Some of these changes include preserving health care coverage for those in Minnesota Health Care Programs during the peacetime emergency, expanding telehealth, virtual, and remote service options, and streamlining enrollment for economic assistance programs. This language will likely be revisited should the Legislature reconvene for special session to make sure DHS has a short period of time after the peacetime emergency ends to revert any modifications back to normal, which is not an option under the existing Executive Orders. (SF 3322)
Non-COVID provisions passed
Alec Smith Insulin Affordability Act
After more than a year of hard work and negotiation, the Minnesota Legislature passed the Alec Smith Insulin Affordability Act this session. Alec Smith died in 2017 at the young age of 26 after being forced to ration his insulin due to the extremely high costs. His story has sparked a dialogue in Minnesota and put a spotlight on those who have lost their lives in the absence of a safety net program that this legislation provides. While this should have happened sooner, Senate DFLers were steadfast in their commitment to make sure that insulin-dependent Minnesotans had emergency access to this life-saving medication, as well as access to ongoing patient support programs to mitigate sky high drug costs.
This bill requires manufacturers to make insulin available for eligible individuals who are in urgent need of insulin by July 1, 2020. In conference committee, Senate DFLers were able to successfully negotiate the copay for this emergency insulin down to $35 from the original $70 copay that was passed by Senate Republicans. Along with emergency insulin, each manufacturer also must maintain an ongoing patient assistance program for qualifying individuals. Pharmacies may charge up to a $50 co-pay for each 90-day supply issued under that program to cover processing and dispensing costs. DFLers were also successful in raising the penalties that manufacturers who fail to comply must pay, which start at $200,000 a month and increase to $600,000 a month after one year of noncompliance.
Another success for the DFL during the bill’s conference committee was the removal of the Senate Republican’s expiration date on the emergency insulin program that would have ended in 2024. Unfortunately, a sunset provision still exists for the required ongoing support program, which is set to expire on December 31, 2024 and will require legislative action to continue. Diabetes is not a temporary illness; this sunset provision must be removed to make sure these programs are available to help insulin-dependent Minnesotans for the foreseeable future.
This is not a perfect bill with more work still to be done, but we are thankful that some much-needed changes were made through negotiations in order to save lives and provide long-awaited relief to insulin-dependent Minnesotans. Legislators are incredibly grateful for the work of advocates across the state who worked tirelessly on this issue to make sure no one dies from a lack of access to affordable insulin. (HF 3100)
Prescription Drug Pricing Transparency Act
Legislation was passed this session that will require drug manufacturers licensed by the Board of Pharmacy to report drug prices that are raised over certain thresholds to the Department of Health. While this is an important step, the bill stops short of meaningful reforms to lower drug costs. DFLers are supportive of increased transparency and see this legislation as a way to lay the groundwork for more aggressive measures to reduce the cost of prescription drugs next session.
Beginning October 2021, drug manufacturers must report information on new, existing, and newly required drugs whose prices are raised over certain thresholds outlined in the bill. The reports required by manufacturers are very detailed and must include information such as the factors that contributed to the increase, any generic versions of the drug available, and the price at time of acquisition. This information will help show state lawmakers any patterns or red flags on significant price increases.
While the bill allows for a civil penalty on manufacturers who fail to submit timely reports, it lacks reforms needed to lower the cost of prescription drugs. The DFL Senate remains committed to building upon this language in the future to ensure that drug manufacturers are held accountable for any unjustified increases so that Minnesotans can get the drugs they need at an affordable price. (SF 1098)
Prior authorization Reform
Prior authorization is a common requirement in health care where physicians obtain approval from your insurance companies before prescribing a specific medication or to perform a particular operation. This practice has been around for decades as a way to protect patient safety and reduce health care costs, but physicians say it is now required more often than it used to be and results in administrative and financial burden, as well as delays in care. National estimates show that the costs of prior authorization are over $36,000 annually per physician and that nurses are spending up to 4 hours per day interacting with health plans on prior authorization requests.
Over the past few years, legislators have been focused on introducing reforms to the prior authorization process. Legislation passed this session will offer relief to health care practitioners and patients by streamlining the determination process to reduce delays in care, establishing continuity of care standards for enrollees who switch health plan coverage to allow them to use previous prior authorizations determinations for 60 days, and increasing transparency throughout the decision making process. (SF 3204)
Congress passed the Tobacco Control Act in December 2019 to raise the minimum age required to purchase tobacco and related products from 18 to 21. Many retailers complied swiftly as the Food and Drug Administration informed them of these changes, but without action at the state level, some retailers expressed confusion as to whether they needed to follow this directive. Thanks to dedicated lawmakers and support from dozens of health and patient advocacy organizations, the Legislature was finally able to pass this as state law. (HF 331)
Increased access to Medical Assistance coverage
The Legislature passed two provisions that would expand access to Medical Assistance in the state. One of these provisions allows Medical Assistance (MA) to provide coverage for routine patient costs that are incurred during a clinical trial if MA would provide coverage for the same routine costs not incurred in a clinical trial. Unlike Medicare and commercial payers, Medicaid is not required by federal or state law to cover routine care costs for clinical trials. Routine costs may include non-experimental costs of treating a patient, such as physician visits or lab tests, and would likely have little impact on the overall cost to the Medicaid program. Advocates have cited that expanding the populations who join clinical research will make it more diverse, valid, and reflective of under-represented ethnic and minority groups.
The other proposal expands Medical Assistance for Breast of Cervical Cancer (MA-BC) coverage to persons diagnosed with breast or cervical cancer by any CDC National Breast and Cervical Cancer Early Detection Program in the state. MA-BC provides insurance coverage to uninsured or under-insured Minnesotans who are in need of treatment services for breast or cervical cancer or pre-cancer of the cervix but are not otherwise eligible for MA. Under current state law, MA-BC only covers those who have been screened by the Minnesota cancer control program called SAGE. This bill will expand access to include other CDC funded programs in Minnesota, such as the American Indian Cancer Foundation’s screening program. American Indian populations are less likely to be screened for cancer and more likely to be diagnosed at a later stage; this bill will reduce barriers to critical screening and treatment options for those who need it. (SF 13)
Opioid epidemic response grants awarded
The 2019 opioid response bill established the Opiate Epidemic Response Account and Opiate Epidemic Advisory Council. The account is funded by fees on manufacturers, and much of the money goes to grants recommended by the council. To get grant funding into the hands of community providers quickly during the pandemic, the council requested to forgo the lengthy grant process and request direct appropriations by the legislature. Grants were awarded to 17 organizations for naloxone distribution efforts, expansion and enhancement of care, Medication-Assisted Treatment services, and Extension for Community Health Outcomes (ECHO) programs. (HF 4601)
Non-COVID provisions not passed
Republicans in the Senate have once again refused to hear childcare provisions that would have leveraged anticipated federal funds to make changes that better serve families and raise rates paid to childcare providers. The coronavirus pandemic has highlighted how critical childcare is for our overall workforce and economy, yet the CCAP program remains out of federal compliance.
CCAP serves approximately 15,000 families and 30,000 children each month, but reimbursement rates have not been updated since the 2011 new market survey. Proposals that did not receive a hearing in the Republican-controlled Senate would have resulted in at least 80% of families and their providers seeing an increase in their CCAP rates and ensured compliance with federal Child Care Development Block Grant guidelines. Refusing to address this issue risks millions of dollars in future federal funding and keeps costs higher for families and pay rates too low for many providers. (SF 3833)
Minnesota African American Family Preservation Act
A bill to protect the best interests of African American children and promote the stability and security of African American families was stalled yet again this session. This bill would establish minimum standards to prevent arbitrary and unnecessary removal of children from their families and require active efforts to use culturally appropriate services in child welfare to prevent out-of-home placements for African American children. (SF 730)
Conversion “Therapy” ban
Senate DFLers stood with Governor Walz and LGTBQ+ civil rights groups in their commitment to end conversion therapy this year after every Senate Republican voted against a ban on this torturous practice in 2019. Despite these efforts, the bill was not considered this session.
Prescription drug price
While prescription drug price transparency measures are a start, more meaningful efforts to reduce the price of prescription drugs through anti-price gouging legislation and were voted down by Senate Republicans on the floor. No one should go broke to get the medicine they need. As Big Pharma continues shamelessly putting profits over people, Republicans have continued to stand with them and protect them from accountability.
Medical Cannabis program
Republicans have stood in the way of many changes to the medical cannabis program out of fear it will lead to full legalization for personal use. As the state’s Medical Cannabis program grows to accommodate the additional patients who will be eligible for relief, addition legislation and future funding will be needed to maintain current service levels, provide program oversight, and protect patient safety.
Department of Human Services restructure
A series of reports and legislative hearings since the end of the 2019 session brought to light various payment and process issues within the Department of Human Services. While lawmakers remained vigilant on making sure internal controls were strengthened at the agency, these financial missteps had lawmakers again questioning whether DHS should be divided into several smaller agencies moving forward. A proposal to break off the Office of Inspector General and Direct Care and Treatment divisions was abandoned this session, facing significant opposition from DFL Senators who argued that thoughtlessly splitting up DHS in this way will likely exacerbate the issue it is claiming to address.
DFL lawmakers will continue to prioritize access to the critical programs administered by DHS, especially in this time of uncertainty. Senate DFLers are committed to partnering with the administration to address these issues to restore public confidence and strengthen the integrity of all public programs. (SF 4128)
Overpayment relief for counties and tribes
Amongst the concerns about DHS financial controls highlighted last year, two issues remain unresolved involving overpayments to counties and tribes.
First, DHS made overpayments to two tribal governments for their substance use disorder treatment programs totaling about $29 million. While the tribes assert that they were acting based on incorrect guidance from DHS, current state law requires DHS to recoup the money regardless of who is at fault. According to the most recent information available, there are several paths to resolution including scenarios in which the Legislature is not required to act. Second, errors DHS made in paying for certain mental health facilities, called IMDs, resulted in an increase in the counties’ shares of these costs, totaling about $9 million. Many counties have publicly stated they do not plan to pay when they get a bill from the state.
The governor has expressed support for holding both the counties and the tribes harmless for the errors. DHS is working on resolutions, but legislative action may be required to resolve this issue with counties.
Home and community-based services policy
Home and Community-based Services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing. Over the past few years, advocates and lawmakers have pushed to make sure these services are as person-centered as possible. The Senate passed three new statewide policies passed this session to affirm the rights of people with disabilities and waiver recipients and ensure that they are fully informed on their opportunities to have gainful employment, live independently, and use self-directed services. Unfortunately, these did not make it over the finish line but remain a priority for future sessions. (SF 3322)
Sexual violence prevention training requirement
People with intellectual disabilities are over seven times more likely to be the victim of sexual assault than people without disabilities, one of the highest rates of sexual assault in any population group. These crimes often go unreported for many reasons; oftentimes these populations have additional challenges in accessing resources to make a report or may have to rely on abusers for their care. As a step to address this issue, the Senate passed a requirement that direct support staff providing licensed Home and Community-Based services must be trained on how to minimize the risk of sexual violence. This language was included in a larger omnibus bill that failed to pass on the last night of session. (SF 3322)