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|2017 Legislative Summary|
2017 Minnesota Legislative Session Wrap
Special Thanks to the Minnesota Hospital Association for providing a comprehensive legislative summary. Below are highlights of interest to the nursing community taken from the comprehensive list of bills in the MHA legislative summary. To view all legislation in detail please go to https://www.leg.state.mn.us/
The 2017 Omnibus Health and Human Services Budget Bill
Special Session, SF 2 Sen. Michelle Benson (R-Ham Lake) Rep. Matt Dean (R-Dellwood)
All provisions are effective July 1, 2017, unless otherwise noted.
This legislation can be found at: https://www.revisor.mn.gov/laws/?year=2017&type=1&doctype=Chapter&id=6
Article 4: Health Care
Sections 34 & 44 Mental health targeted case management through interactive video
Amending Minnesota Statutes, Sections 256B.0625 (Sec. 34) and 256B.0924 (Sec. 44).
Provides, subject to federal approval, that Medical Assistance will pay for targeted case management services provided by interactive video to a person who resides in a hospital, nursing facility or residential setting staffed 24 hours a day, seven days a week. Use of interactive video must be approved in the case plan; must be in the best interests of the person; and must be approved by the person receiving services, the case manager and the provider operating the setting where the person resides. Provides that interactive video cannot be used for more than 50 percent of the minimum required face-to-face contacts.
Allows the person receiving services the right to consent to use of interactive video and to refuse the use of interactive video at any time.
Instructs the commissioner to establish criteria for providing targeted case management via interactive video and lists possible criteria addressing client safety, policies and protocols, and quality assurance.
Provides the documentation requirements for a targeted case management provider to receive Medical Assistance reimbursement for services provided by interactive video. Provides that the section is effective upon federal approval.
Section 53 Reimbursement for evidence-based public health nurse home visits
For services provided on or after Jan. 1, 2018, sets Medical Assistance payment rates for prenatal and post-partum follow-up home visits provided by a public health nurse or a registered nurse supervised by a public health nurse, using evidence-based models, at $140 per visit. Requires follow-up home visits to be administered by home visiting programs that meet specified criteria. Requires home visits to target mothers and their children beginning with prenatal visits through age three for the child.
Section 63 Opioid use and acupuncture study
Requires the commissioner of human services, within the limits of available appropriations, to study and compare the use of opiates for the treatment of chronic pain conditions when acupuncture services are also part of the treatment for chronic pain to opiate use by Medical Assistance recipients who are not receiving acupuncture.
Requires the commissioner to report findings to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance by Feb. 15, 2018.
Article 8: Chemical and Mental Health
Section 2 Establishes a new mental health innovation grant program
This was an MHA legislative priority and initiative. “Eligible applicant” includes a county, Indian tribe, mental health center, hospital and community partnership. The Department of Human Services is authorized to award grants to eligible applicants to plan, establish or operate programs to improve community-based outpatient mental health services. Specifies that half of grant funds will be awarded to applicants in the metropolitan area and half will be awarded to applicants outside the area. Allows the commissioner to reallocate underspending among grantees within the same grant period. References the mental health innovation account for ongoing funding. The legislation specifies application deadlines and what applications must contain. Lists guidelines for the commissioner to establish criteria and relevant factors for the commissioner to consider. Lists grant award purposes: intensive residential treatment services, mental health urgent care centers, crisis residential services, new or expanded community mental health services, supportive housing and other innovative projects. Requires the commissioner to provide a report on program outcomes to the legislature by Dec. 1, 2019. Requires grantees to provide information to the commissioner for the report.
Article 10: Health Department
Section 60 Loan forgiveness
Expands the category of nurses eligible for loan forgiveness through the health professional education loan forgiveness program to include nurses who agree to practice in a housing with services establishment or practice with a home care provider.
Sections 71 & 72 Restricts MDH’s ability to expand regulations of nurse staffing agencies to other health care professionals
This bill was an MHA initiative. Section 71 defines “nurse” for purposes of statutes regulating supplemental nursing services agencies to mean an LPN or an RN. Section 72 deletes language, “and other licensed health professionals.”
Section 98 Opioid grants
Requires the commissioner of health to award at least two statewide health improvement program (SHIP) grants to be used to confront the opioid addiction and overdose epidemic.
New Health Care Laws
All chapters can be found online at: https://www.revisor.mn.gov/laws/?view=session&year=2017&type=0
Chapter 2 HF 1 (Hoppe) SF 1 (Benson)
2017 Health Care Emergency Aid and Access Act Provides a temporary program to help pay for health insurance premium costs in the individual market for 2017 policies purchased in 2016. The bill uses $327 million from the state budget reserve to fund a 25 percent premium rebate for Minnesotans who do not qualify for federal tax credits and purchased coverage through the individual market, $15 million of which will be used for continuity of care services. MHA was pleased that the premium relief was funded by the budget reserve fund, not the Health Care Access Fund as originally proposed.
This legislation allows for-profit HMOs to enter the Minnesota market.
The legislation also allows providers to appeal network adequacy decisions based on current geographic distance considerations. This provision expires Dec. 31, 2018.
The legislation includes new language related to surprise billing that holds the patient harmless while requiring a health plan and nonparticipating provider to negotiate payment. If a payment agreement cannot be reached by the health plan company and the nonparticipating provider, either party may elect to refer the matter to binding arbitration. This provision is effective Apr. 26, 2017, and applies to medical services provided on or after this date. (See Chapter 13 below.) The effective date of this provision was delayed until Jan. 1, 2018.
Effective April 26, 2017 (90 days following final enactment).
Chapter 13 HF 5 (Davids) SF 720 (Dahms)
Minnesota Premium Security Plan Act Creates a state-operated reinsurance program funded with $200 million from the Health Care Access Fund and $71 million from the general fund in 2018, and another $200 million from the Health Care Access Fund and another $71 million from the general fund in 2019. The funding pays a portion of health claims between $50,000 and $250,000, with the goal that health plans will reenter the individual insurance market and offer policies that will be approximately 20 percent lower in cost.
The bill instructs the commissioner of commerce to apply for a federal waiver to hold harmless the federal funding that Minnesota receives for its Basic Health Plan (BHP) funding, which is dependent on the price of a silver plan on the individual market. The language says that without the waiver, the reinsurance program is no longer to be implemented.
This legislation delayed the effective date of the surprise billing provision found in Chapter 2 until Jan. 1, 2018.
Bill became law without Gov. Dayton’s signature on Apr. 4, 2017. Effective Apr. 5, 2017.
Chapter 32 HF 1619 (Schomacker) SF 1616 (Lourey)
Contingent, alternate Medical Assistance payment method for children’s hospitals
Addresses action by the Centers for Medicare and Medicaid Services (CMS) that may result in Children’s Minnesota and Gillette Children’s Specialty Healthcare losing their disproportionate share hospital (DSH) funding. This bill would help protect those hospitals from losses if their litigation against CMS is unsuccessful.
This legislation establishes a contingent, alternate medical assistance payment method for children’s hospitals requiring cost data associated with patients who are eligible for Medical Assistance and who also have private health insurance be included in the calculation of the hospital-specific DSH payment limit for a rate year. If deemed necessary, the bill requires the commissioner of health to reimburse the hospital for a rate year.
Effective retroactively from Jan. 1, 2015.
Chapter 50 HF 474 (Albright) SF 300 (Nelson)
Authorizes criminal background checks by the Board of Medical Practice; exempts certain physicians from criminal background checks under the Interstate Medical Licensure Compact This legislation updates the 2015 Interstate Medical Licensure Compact. This legislation gives authority to the Board of Medical Practice to require a physician who has designated Minnesota as the state of principal license to submit to a national criminal background check. Requires the board to use the criminal background check data to evaluate a physician’s eligibility for a letter of qualification. A physician seeking expedited licensure in Minnesota who has not designated Minnesota as the state of principal license is exempt from the requirements if the state of principal license has required a criminal background check for the physician within the last 12 months.
The chief advocacy organization for this legislation was the MMA and it was among MMA’s legislative priorities.
Effective May 13, 2017
Chapter 53 HF 106 (Zerwas) SF 93 (Hayden)
Community medical response emergency medical technician services (CEMT) This technical legislation clarifies community emergency medical technicians to allow for post-discharge follow-up, billing and payment. The Department of Human Services and the Centers for Medicare and Medicaid suggested these technical corrections to the statute.
Effective Aug. 1, 2017.
Chapter 57 HF 733 (Haley) SF 527 (Kiffmeyer)
Modifies the nurse practices act by clarifying licensure requirements for advanced practice registered nurses Modifies licensure requirements requiring APRN programs completed on or after Jan. 1, 2016, to include at least one graduate-level course in each of the following areas: advanced physiology and pathophysiology; advanced health assessment; and pharmacokinetics and pharmacotherapeutics of all broad categories of agents; or to demonstrate compliance with the advanced practice nursing educational requirements that were in effect in Minnesota at the time the applicant completed the advanced practice nursing education program. MOLN supported this legislation offered by the Board of Nursing.
Effective May 18, 2017.
Chapter 59 HF 2177 (Zerwas) SF 1844 (Kiffmeyer)
Adds advanced practice registered nurses and physician assistants to certain statutes Expands the authority for advanced practice registered nurses and physician assistants to sign specific documents defined as only a health plan company notification of the enrollees’ rights to continuity of care, vital records information, student screenings and documents required for identification cards for individuals needing a special diet. MOLN supported this legislation.
Effective May 18, 2017.
Omnibus higher education appropriations bill
Chapter 89 HF 2080 (Nornes) SF 943 (Fischbach)
The higher education omnibus bill includes funding for health care training and mentoring programs, medical school, residency programs and research grants.
• $501,000 in each 2018 and 2019 for the United Family Medicine Residency Program for up to 21 physician residencies each year.
• $645,000 in each 2018 and 2019 for the Hennepin County Medical Center graduate family medical education programs.
• $210,000 in 2018 for the Addiction Medicine Graduate Fellowship Program.
• $100,00 in 2018 to Minnesota State Colleges and Universities (MnSCU) for use by Winona State University for HealthForce Minnesota to develop educational materials increasing awareness of career opportunities related to senior care.
• $2.157 million in each 2018 and 2019 for the University of Minnesota Primary Care Education Initiatives. Funding provided from the Health Care Access Fund.
• $9.204 million in each 2018 and 2019 for additional University of Minnesota Health Sciences spending. Including:
• $346,000 each year to support up to 12 resident physicians in the St. Cloud Hospital family practice residency program.
• $22.250 million in each 2018 and 2019 for the University of Minnesota Academic Health Center.
New Laws in Higher Ed
Effective July 1, 2017.
Policy provisions in the bill:
Directs the MnSCU Board to establish Workforce Development Scholarships to incentivize new students to enter high-demand occupations upon graduation. Scholarships will be awarded at the beginning of an academic term in the amount of $2,500 and be distributed evenly between two terms. Scholarships will be awarded to students eligible for resident tuition who are enrolled in programs of study or certification in health care services, advanced manufacturing, agriculture or information technology. Students must be enrolled for at least nine credits at a two-year college in the MnSCU system. The MnSCU Board must submit an annual report by Feb. 1 of each year to the chairs and ranking members of the Senate and House committees with jurisdiction over higher education finance and policy. The first report is due no later than Feb. 1, 2019.
Study and report on home care nursing workforce shortage
The chair and ranking minority member of the senate Human Services Reform Finance and Policy Committee and the chair and ranking minority member of the House of Representatives Health and Human Services Finance Committee will convene a working group to study and report on the shortage of registered nurses and licensed practical nurses available to provide low-complexity regular home care services to clients in need of such services, especially clients covered by Medical Assistance, and to provide recommendations for ways to address the workforce shortage.
The working group report on the findings and recommendations is due by Jan. 15, 2018, to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance. The working group’s report will include draft legislation.
Below is a list of legislation of interest to nurses that did not make it through the legislative process this year. Because Minnesota has a two-year biennium, these bills are still alive until the end of the 2018 legislative session. These bills or similar ones often return in future legislative sessions.
MinnesotaCare buy-in option
HF 92 Johnson, C. / SF 58 Lourey This legislation would have required the commissioner of human services to seek a federal waiver to allow Minnesotans, regardless of income, to purchase health insurance coverage through MinnesotaCare. This legislation did not receive a separate hearing in the House or Senate, but did receive an informational hearing in the Senate as part of the governor’s budget hearing process. The MHA Board of Directors opposed this legislation and MHA provided testimony reflecting that position.
Uniform employment mandates
HF 600 Garofalo / SF 580 Miller As introduced, this legislation preempted local units of government from adopting stricter employment rules relating to wages; leave time; scheduling; or benefits, terms of employment or working conditions. This legislation received many hearings in the House and Senate. A priority bill for the Minnesota Chamber of Commerce, this bill was supported by the Republican majorities and generally opposed by DFL legislators. A version of this legislation was vetoed by the governor during the special session.
HF 744 Albright / SF 160 Clausen This legislation would have created a 29-member health care workforce council staffed by the Minnesota Department of Health. The council would have created an annual workforce plan. While this legislation received a hearing in the House, it did not advance in the Senate and was not included in the omnibus health and human services budget bill.
HF 1169 Albright / SF 925 Clausen This legislation sought to extend the Jan. 1, 2017, expiration of the Legislative Health Care Workforce Commission until Jan. 1, 2021. A sum of $130,000 was appropriated to the Department of Health to conduct this work. While this legislation received several hearings, it was ultimately not included in the omnibus health and human services budget bill.
Penalties for assaulting medical personnel increased
HF 1481 Grossell / SF 1871 Housley This legislation would have made it a gross misdemeanor to physically assault a physician, nurse or other person providing health care services in a hospital. Current law extends only to the emergency department personally. The proposal went on to make it a felony if the assault inflicted demonstrable bodily harm or the transfer of bodily fluids or feces was intentionally thrown on a health care worker in the hospital. This legislation was included in the omnibus public safety bill, vetoed by the governor, but did not advance.
Direct-care registered nurse patient assignment requirements
HF 2505 Murphy, E. / No Senate companion
This legislation sought to establish requirements for the assignment of direct-care registered nurses. Under the legislation, if any direct-care registered nurse determines that staffing levels are inadequate and notifies the unit’s charge nurse and a manager or administrative supervisor, the manager or supervisor shall review options to address the staffing level inadequacies. If the staffing inadequacies cannot be resolved and resources cannot be reallocated after considering the options and factors, the hospital shall call in extra staff to ensure adequate staffing to meet safe patient standards. Until extra staff arrive and begin to receive patient assignments the hospital must suspend nonemergency admissions and elective surgeries that routinely lead to inpatient hospitalization; the charge nurse for the unit with inadequate staffing levels is authorized to close the unit to new patient admissions and in-hospital transfers; and a direct-care registered nurse is authorized to refuse an assignment that is unsafe, in the nurse’s professional judgment. This legislation did not receive a hearing in the House, but it was offered as an amendment to another bill on the House floor. That amendment was defeated.
Nurse staffing quotas
HF2650 Davids / SF2382 Simonson
This legislation would have required hospitals to provide direct care registered nurse staffing at levels consistent with nationally accepted standards and report shift-level nurse staffing numbers by hospitals on the MHA nurse staffing website and to the commissioner of health. It also would have required the staffing plan to have consent of union representatives, required new patient safety committees in hospitals, prohibited retaliation and imposed civil penalties. This legislation was introduced too late in the 2017 legislative process to be considered by a committee.