A Summary of What Did and Didn’t Happen
Charles Sawyer, DC
MCA Professional Officer for Legislative Affairs
The final work-product of our divided 2019 Minnesota Legislature is now a matter of record following the outcome of a special session that ended on May 25. But the process culminated in a much publicized series of closed-door meetings between the Governor, Speaker of the House Mellissa Hortman, and Senate Majority Leader Paul Gazelka. This was a budget-setting session that followed the 2018 election that resulted in a sizable DFL majority in the House, the Senate that remained in GOP control and a new governor whose legislative priorities were clearly articulated during his campaign.
Because increased funding for education and protecting the Health Care Access Fund (combined with future aspirations for expanding MinnesotaCare as a public option) were high priorities for Governor Tim Walz, the scene was set for what came next. The session started rather slowly with bipartisan promises do things differently, but then the complexity of eventually agreeing on a two-year, $48.3 billion, state budget colored by a progressive DFL “wish-list” became predictably apparent.
No Provider Tax Sunset
The 2019 session was not particularly helpful to the chiropractic profession (and other provider groups) largely due to the negotiated agreement between the GOP and DFL leadership – and Governor Tim Walz – to reduce but also extend the provider tax. Despite an alternative funding mechanism proposed by the Minnesota Medical Association through legislation introduced by Senator Jim Abeler (SF 2616), a substantial number of advocates – including the Minnesota Hospital Association – came out strong in support of extending the tax.
In contrast to most medical physicians who work for large health systems, the new rate of 1.8% obviously offers little relief for chiropractic doctors, dentists, acupuncturists and other providers who have small independent practices. However, the disappointing outcome will continue to present an opportunity for the MCA to carry its message forward regarding the inability for many younger DCs to get into health plan networks and restricted reimbursement in the Medical Assistance and MinnesotaCare programs.
Our efforts to eliminate the provider tax and advocate for alternative MinnesotaCare funding were aligned with other provider organizations and a future edition of the MCA newsletter will include a more comprehensive article by Mr. Kevin Goodno on this important topic.
The much publicized “Opiate Epidemic Response” legislation (HF 400) passed at the end of the regular session. And, although the major provisions in the bill deal with capturing funding from substantial increases in annual licensure and registration fees paid by drug manufacturers and distributors, a 19 member “Opiate Epidemic Response Advisory Council” will be formed that includes “… one member representing professionals providing alternative pain management therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy.” A second provision requires at least two-hours of continuing education for physicians and other healthcare professionals on best practices for prescribing opioids and “… nonpharmacological and implantable device alternatives for the treatment of pain …”
Both provisions in this timely, high profile legislation create opportunities for the MCA to provide information about the chiropractic profession in Minnesota and the value of non-pharmacological management of acute and chronic musculoskeletal pain.
No-Fault Auto – Nothing in 2019
There was no legislation introduced during the session related to no-fault auto insurance. The absence of any proposal to change current Minnesota law and, especially, advance a bill limiting patient access to chiropractic services provided an opportunity for the MCA to continue working on clarifying our community standard of care within the no-fault insurance system.
Toward that end, Mr. Kevin Goodno joined Drs. Doug Broman, Craig Couillard and Scott Mooring in a meeting early in the legislative session with the executive director of the Minnesota Board of Chiropractic Examiners, Ms. Michelle Becker, to learn more about and discuss the role of the Board in enforcing ethical standards in the area of personal injury treatment. Dr. Broman also updated her on his experience serving on the no-fault task force and Ms. King expressed support for our efforts, including tentative plans to co-host a one-day no-fault auto insurance symposium in the spring of 2020.
Chiropractic Reimbursement in the Medical Assistance and MinnesotaCare Programs
In a previous newsletter article, we reported that it would not be possible to secure hearings for the MCA’s legislation to expand Medical Assistance and MinnesotaCare reimbursement for the full scope of chiropractic services in the 2019 session. Identical bills were introduced in both the House (HF 1394) and Senate (SF 2341) laying a foundation for the 2020 session. However, the Legislative Committee will be exploring potential strategies for addressing the well-reasoned concerns expressed by many of our members regarding low public program reimbursement rates.
Since the federal government prevents states from mandating specific reimbursement rates in Medicaid programs that are managed by HMOs – in other words, in Minnesota’s Prepaid Medical Assistance Program – one option is to revise our bill by adding a PMAP “carve out” provision similar to legislation that was pursued this session by the Minnesota Dental Association in their efforts to seek a substantial rate increase for dental services.
What Comes Next?
On balance, the 2019 session ended in draw with the leadership of both political parties — and Governor Tim Walz – compromising in order to avoid a budget impasse and the prospect of a state government shut-down.
In the area of healthcare, some major public policy issues were left unresolved including the exclusion, from the Health and Human Services funding bill, of the much publicized Alec Smith Emergency Insulin Act and a 2018 campaign priority on the Governor’s wish-list – the ONECare comprehensive public insurance buy-in option for Minnesotans purchasing coverage through MNSure.
For the Minnesota Chiropractic Association, the Legislative Committee will continue to sharpen our message regarding the Provider Tax, revise our MA/MinnesotaCare legislation introduced this session and continue to inform members of the Legislature about issues of importance to the chiropractic profession and the patients we serve.