Legislative Update – May 2021

Buck McAlpin, Legislative Consultant

End of Session Update
The countdown to the end of session is officially on as we enter the last week before the Constitutional deadline for Session to end. Earlier this week legislative leaders were targeting May 12 to have joint budget targets between the two bodies so conference committees could begin adopting budget provisions working toward their joint targets.

Closing the session is a combination of coming to an agreement and having time to process the legislation to pass all of the budget bills before midnight, Sunday May 16th. With individual bills that are hundreds of pages long (the HHS bill is over 900 pages), there is significant processing time needed for staff to prepare legislation to be passed off the floors, which can only happen once agreements have been made. After the global targets are agreed to, individual budget bills are still far apart on policy and spending items in each area of the budget.

This week the Senate GOP offered an initial budget target to the House DFL leadership that was movement from their initial budget targets, but still contained many controversial initiatives. It is unclear to the public if or how often the legislative leaders are meeting to discuss budget targets at this point.

The three factors that are likely playing the biggest role in coming to an agreement on budget targets:

  • The Federal Stimulus. The state is expected to get over $2B in state funding from the Federal American Rescue Plan. The Department of Treasury has indicated they will provide states with guidance sometime in mid- to late-May on the mechanics of the funding. Some budget proposals currently working through the legislature have contingencies or propose methods to spend the federal money, although there is significant uncertainty whether the legislature will get to weigh in at all.
  • Police Reform. Some DFL lawmakers have continued to tie police reform proposals to the budget process, calling for the legislature to act on police reform initiatives before they work on coming to a budget agreement.
  • Emergency Powers. Similar to police reform, GOP members have tied the Governor’s emergency powers to the budget negotiations, demanding he end the peace time emergency before negotiating on the budget.

Governor’s Announcement on Emergency Powers
The Governor recently unveiled a plan to further dial back restrictions that are currently in place around COVID-19. In the executive order released yesterday (EO 21-21), some restrictions that are currently in place via executive order were removed as (May 7th) at noon, including changes to indoor and outdoor social gathering restrictions and event venues, and modified restaurant, gym and pool restrictions. Also included is a change in the state’s regulation to directly follow federal masking guidelines in health care facilities for fully vaccinated team members, visitors, and patients.

Phase 2 of the dial back happens on May 28th and includes loosening restrictions on the work from home recommendations, requiring a business to have a COVID-19 Preparedness Plan in place following requirements listed on the Stay Safe Minnesota website. Also rescinds several executive orders including but not limited to:

  • Deferred continuing education requirements
  • Allowing out-of-state mental health providers to render telehealth aid
  • Authorizing out-of-state healthcare professionals to render aid in Minnesota
  • Requiring facilities to prioritize surgeries and procedures, provide a safe environment, and risk analysis of performing procedures during the pandemic.
  • Flexibilities granted to the Board of Behavioral Health and Therapy to modify licensing

Phase 3 of the dial back is set for July 1 or when 70% of the eligible population is vaccinated and rescinds the following executive orders, among others:

  • Prohibiting employers to discriminate against workers reporting occupational safety or health hazards related to COVID-19 and allowing employees to refuse to work under conditions that present a danger to them
  • Restrictions on social gatherings and capacity restrictions at events
  • Mask mandate

Important distinction: While the Governor has released this phased approach, there is always a potential that things will change along the way – as the virus progresses, vaccine uptake changes, and how the political climate shifts. Additionally, while the Governor has been clear he will dial back restrictions, he has not been clear on his intention or timeline to end the Peace Time Emergency. Both of which have implications on waivers that were put in place due to COVID – like telehealth flexibilities, paused fingerprint background studies, health licensure flexibilities, among others. The ending or continuation of the PTE also has significant legislative impact, if Governor Walz continues the PTE, an automatic special session is called every 30 days, rather than the Governor having full control over when the legislature goes into a special session.

The HHS Conference Committee started work two weeks ago walking through different articles in the House and Senate bills, identifying provisions that were similar in the House and Senate proposals and having staff provide a high-level overview of provisions that were only included in one body. While there was discussion and debate on a few provisions, committee time this week has largely focused on overviews of the language by nonpartisan staff. The one thing for sure is that they will not finish the 2021 regular session on time and will need to go into Special Session to avoid a Government shutdown on June 30th of a State budget is not agreed to.

Some of the legislative items we have been watching on behalf of MNACEP are detailed below.

1. Carve-out the prescription drug benefit from PMAP and county-based purchasing.
This proposal triggers a federal rule that would result in Minnesota hospitals (all Critical Access Hospitals, all Children’s Hospital and hospitals with a large share of low-income patients) and other 340B entities losing a considerable amount in payments that are used to help provide health and community services that have either no reimbursement or low reimbursements

2. Mandated reporting of drug purchase expenses and drug reimbursements.
The proposed reporting requirements on 340B Covered Entities in this provision represent unnecessary state overreach on a federal program and do not deliver any benefits to patients. 340B Covered Entities are already frequently audited by the participating drug manufacturers and the Health Resources and Services Administration (HRSA). Additional oversight and administrative burden are not needed to ensure that the 340B program is working as intended by Congress and the federal government.

3. Uniform administration of non-emergency medical transportation (NEMT).
The provider and patient community have opposed this proposal on several different occasions in the past. While involving a new third-party entity in the process would add administrative simplification for the Department of Human Services, it would most likely come at the expense of moving payments from providers to this new vendor who would be awarded a DHS contract. Would dramatically impact hospital through put and flow.

4. Increase MDH oversight into hospital operations; regulating service line change notification, right of first refusal for hospital closure, and certain requirements added to exceptions in the bed moratorium process.
Would requires a minimum nine-month notice before closing a hospital or dropping certain service lines. This timeframe is too long, and a hospital may not be able to comply if there are not the health care personnel available to provide the service. In recent years, we have had a few hospitals that have made the difficult decision to drop labor and delivery services.

  • Requires a hospital with a planned closure to offer for sale the hospital facility to the local unit of government. Selling a hospital property to the city or county for them to try and run a hospital seems very unlikely to be successful .
  • Provides a permanent exception to the hospital moratorium law if it is for adding mental health beds. Unfortunately, the bill adds language that the hospital must have an emergency room and it must not be a facility that only provides mental health services or substance abuse services in order to get the moratorium exception. These two additional requirements add costs associated with emergency rooms and potentially thwarts innovation of alternative models of mental health care.
  1. Telehealth provisions found in both the House and Senate bills.
  • The Senate bill has an effective date of July 1, 2021, while the House has an effective date of January 1, 2022.
  • Sunset of Audio-Only Coverage is included in both bills. The Senate sunsets coverage for Medical Assistance and MinnesotaCare. The House sunsets coverage for public and private coverage. There should be no sunsets of any coverage. These services are part of the telehealth study and can be re-evaluated after the results of the study are analyzed.
  1. Streamlining the background check and fingerprinting process for licensed health care professionals.
    This provision eliminates the burden on providers and employers of a duplicative fingerprinting and background studies process, by exempting licensed health care professionals from the DHS NetStudy 2.0 process, IF the individual is duly licensed in good standing with their health licensing boards, like the Board of Medical Practices or the Board of Nursing – which have already conducted a background check with a fingerprint as part of licensure. This creates efficiencies for both employers and prospective employees and could potentially reduce some of the massive backlog of individuals needing to have a background check completed who were temporarily waived of this requirement during the health care emergency.