2018 Legislative Highlights and the 2018 Elections. Speaker: Mary Krinkie Friday, July 13 2:30 3:30 p.m. Lake Osakis/Minnewaska/Miltona

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1 2018 Legislative Highlights and the 2018 Elections Speaker: Mary Krinkie Friday, July 13 2:30 3:30 p.m. Lake Osakis/Minnewaska/Miltona

2 Mary Krinkie Mary Krinkie makes politics and the formation of public policy her vocation and her avocation. For more than a decade, she has been the vice president of government relations at the Minnesota Hospital Association, directing MHA s policy and advocacy efforts. Mary is the MHA staff person our government officials see at the capitol and the one who provides us with the most up-to-date information during the session and then helps us make sense of what happened after the session is over.

3 2018 Legislative Highlights & the 2018 Elections Hidden gems within the potholes! 2018 Summer Trustee Conference Friday, July 13, 2018 What happened, What is happening and What may happen 2018 Legislative Session highlights A 2018 election update The need for advocacy A 2019 Legislative Session preview 1

4 MHA legislative priorities Continue to build mental health supports Preserve meaningful health care coverage for low-income Minnesotans Take bold action to address the opioid crisis Pass MHA-approved reform of MN s outpatient workers compensation system Modernize Minnesota s Health Records Act to improve coordination of patient care Oppose nurse staffing ratio legislation and other new burdensome mandates Building mental health supports Highlight of the 2018 Legislative Session was passage of the Capital Investment Bonding Bill. Mental health community infrastructure was a key component. $28.1 million for mental health crisis centers $1.9 million for the Scott County mental health crisis center $30 million for housing infrastructure bonds for persons with behavioral health needs. MHA sponsored legislation (HF 2945/SF 2545) to streamline the facility licensing process for both Intensive Residential Treatment Services (IRTS) and mental health crisis services. This passed as a stand-alone bill with bipartisan support. 2

5 Crisis center Potential for innovation The Behavioral Health Crisis Facilities grants to be awarded by the Department of Human Services (DHS) will support the establishment of facilities whose purpose is to provide mental health or substance use disorder services. DHS will give priority to projects that: demonstrate a need for the program in the region; provide a detailed service plan, including the services that will be provided and to whom, and staffing requirements; provide an estimated cost of operating the program; verify financial sustainability by detailing sufficient funding sources and the capacity to obtain payments for services provided, including private insurance and federal Medicaid and Medicare financial participation; demonstrate an ability to build on existing resources in the community; and agree to a comprehensive evaluation of services and financial viability by the commissioner. Grants are limited to $5 million per project. Preserve meaningful health care coverage MHA joined with other stakeholder groups to defeat legislation mandating a work requirement for able-bodied adults to be eligible for Medical Assistance coverage. MHA worked to defeat an amendment that would have thwarted our innovative Integrated Health Partnerships (IHPs). MHA worked to stop a provision allowing for the sale of short-term coverage policies. 3

6 IHPs have made a positive difference The IHP program, in its first four years, has produced positive results: $213 million in cost savings to the state, a 7% decrease in emergency room visits, A 14% decrease in hospital stays. All while improving the quality of care for 460,000 Minnesotans. Take bold action to address the opioid crisis MHA supported holding pharmaceutical companies partially responsible for their role in Minnesota s opioid crisis either through the penny-a-pill proposal or increased opioid manufacturer licensing fees. Strong bi-partisan support in Senate. House leadership refused to allow the issue to be considered on the House floor. The vetoed supplemental budget bill appropriated about $16 million over the remainder of this biennium and the next biennium and would have funded a rate increase for treatment providers and various grant programs. Included $2 million for the opioid prevention programs being shepherded by CHI St. Gabriel s Health to other communities. 4

7 Reform of MN s outpatient workers compensation system MHA supported compromise legislation to reform Minnesota s outpatient workers compensation payment methodology. Payment rates will be budget-neutral until there is documented compliance that 80 percent of the claims meet administrative simplification standards. Upon this 80 percent threshold being met, then there could be a 10 percent payment rate reduction. Does not include Critical Access Hospitals. MHA successfully advocated for a narrow definition of eligibility for presumed post-traumatic stress disorder (PTSD). Only licensed nurses who are employed in emergency medical care outside of a medical facility will be included in a presumed PTSD benefit, rather than any employed licensed nurse as was originally adopted by the House. Modernize Minnesota s Health Records Act A coalition of MHA, the MMA, the Minnesota Council of Health Plans, the Minnesota Chamber of Commerce, the Minnesota Business Partnership and numerous health advocacy organizations worked to pass our bill out of the House H&HS Reform Committee, with full HIPAA alignment. The Civil Law Committee chair refused to schedule a hearing for the bill. We narrowed our approach to only allow assumed consent for treatment, payment and operations. This is the standard that 48 other states have. We were pursuing a House floor amendment strategy, but in the closing days of the session, the privacy advocates prevailed. 5

8 Price transparency Under current law, health care providers and health insurers are required to provide consumers with a nonbinding good-faith estimate of the price for a specific health care service in response to a request. Revisions to the current law were made: Health care providers must now provide information on other fees or charges that a consumer may be required to pay in conjunction with a visit. Good-faith price estimates must now be delivered in 10 days. Price transparency (continued) Starting July 1, 2019, primary care providers and clinics must post a list of the 25 most frequently billed services over $25, including the 10 most commonly billed evaluation and management services and the 10 most frequently billed preventive services. For each listed service, the provider or clinic must disclose: Provider s charge Average commercial health plan payment rate Medicare payment rate Medical assistance fee-for-service rate The list must be updated annually and posted in the provider s or clinic s reception area and made available on their website. MHA was successful in amending the bill so that health systems can develop one list to be used by all associated primary care providers and clinics. 6

9 Elder abuse and vulnerable adult protections Multiple bills: Referred to as the House version, Senate version, AARP/Elder Justice Coalition version. MHA worked to amend these bills to ensure that provisions aimed at protecting residents would not apply to a patient in a hospital setting. MHA s focus was on amending language regarding false marketing claims and limiting expansion of a private right of action. MHA s concerns were addressed and we were okay with the final bill language. This legislation was included in the supplemental budget bill that was vetoed. Next year Finding the appropriate balance? Vetoed supplemental budget bill 989 pages in length, impacting all areas of the state s budget Allocated about $131 million in new net spending ($46 billion two year state budget) Numerous policy provisions good & bad Example of a good item lost: $5 million a year in grants for school-linked mental health via telemedicine. Example of a bad item lost: Creation of a new Health Policy Commission costing $1 million to replicate much of the work of DHS and MDH, with a sunset date of 2024, originally

10 H&HS must haves Home-and-community-based providers who care for Minnesotans with disabilities will experience a 7% rate cut through the Disability Waiver Rate System on July 1, 2018 because existing state law was not clarified to ensure federal approval. Minnesota s Medicaid program could lose up to $190 million a year in federal Medicaid matching funds for outpatient pharmacy payments because our law was not brought into compliance with a federal rule. Federal action to enforce the rule could hurt hospitals if federal Medicaid funds are withheld or retroactively recouped by the federal government due to this noncompliance. A change in the application of federal law has resulted in the loss of all federal Medicaid funds for residential treatment centers that provide critical mental health services to children with complex needs. State funds are needed to fully fund this critical service through the final months of this biennium. Any possibility of a Special Legislative Session, post election? Work for early action in the 2019 Legislative Session Election Update Place picture here 8

11 Federal Election Preview U.S. Senate U.S. Senate has 52 Republicans, 46 Democrats & 2 Independents. Republicans have to defend 8 seats, the Democrats have to defend 23 seats, plus 2 Independents who caucus with the Democrats. Minnesota has two U.S. Senate races: Senator Amy Klobuchar is up for re-election. Three-term State Representative Jim Newberger (R-Becker) is the endorsed Republican candidate. Senator Tina Smith is running for re-election to complete the last two years of the Franken term. Other candidates include: o DFL primary opponent Richard Painter, a U of M professor and White House ethics lawyer. o The endorsed Republican candidate is State Senator Karin Housley. o There is an Independent Party candidate Jerry Trooien, a St. Paul real estate developer. Federal Election Preview U.S. House All 435 Congressional races are on the ballot. U.S. House has 235 Republicans and 193 Democrats. 218 seats needed for a majority Democrats need 25 seats to flip control Minnesota likely to have four competitive races: First Congressional district (open seat) o Primary election in both the DFL & Republican Parties Second District Congressman Jason Lewis o DFL opponent is Angie Craig, who ran in 2016 as well Third District Congressman Erik Paulsen o DFL opponent is Dean Phillips Eighth Congressional district (open seat) o Republican candidate is Pete Stauber and 5-candidate DFL primary Fifth Congressional district (open seat) o Competitive DFL Primary 9

12 MN s open gubernatorial election 2018 is an open Governor s race, with no incumbent DFL candidates include: DFL endorsed candidate is Erin Murphy, 6-term state representative Congressman Tim Walz, 6-term Congressman, CD 1 Lori Swanson, MN Attorney General, 2007 present Republican candidates include: Republican endorsed candidate is Jeff Johnson, Hennepin County Commissioner, present Gov. Tim Pawlenty, MN s governor, Jan Jan Attorney General race An unexpected open seat DFL candidates include: Matt Pelikan, DFL endorsed candidate Keith Ellison, Congressman CD-5, present Tom Foley, former Ramsey county attorney Debra Hilstrom, state representative, present Mike Rothman, former MN Commerce Commissioner Republican candidates include: Doug Wardlow, Republican endorsed candidate, MN House, Robert Lessard, former DFL state senator,

13 Minnesota Legislature The Minnesota Senate is at the mid-point of a 4 year term and will not be on the ballot until In the 2018 Session, Republicans held 34 seats and the DFL held 33 seats. State Senator Michelle Fischbach (R-Paynesville) resigned to assume duties as Lt. Governor. Special election to be held. State Senator Karin Housley (R-St Marys Point) is running for the U.S. Senate. If she wins, special election in SD 39. State Senator Carla Nelson (R-Rochester) running in the 1 st Congressional District. If she wins, special election in SD 26. All 134 Minnesota House seats will be on the ballot. The Republicans hold 77 seats, compared to the DFLs 57 seats. If 10 seats flip to the DFL there would be a tie. If 11 seats flip to the DFL they would gain the majority. House retirements Open seat races (23 seats) Rep. Susan Allen (DFL-Minneapolis) Rep. Jon Applebaum (DFL-Minnetonka) Rep. David Bly (DFL-Northfield) Rep. Karen Clark (DFL-Minneapolis) Rep. Matt Dean (R-Dellwood) Rep. Joe Hoppe (R-Chaska) Rep. Clark Johnson (DFL-North Mankato) Rep. Sheldon Johnson (DFL-St. Paul) Rep. Joyce Peppin (R-Rogers) Rep. Paul Rosenthal (DFL-Edina) Rep. Linda Slocum (DFL-Richfield) Rep. Paul Thissen (DFL-Minneapolis) Resigned 4/20/18 to serve on the MN Supreme Court Rep. Mark Uglem (R-Champlin) Rep. JoAnn Ward (DFL-Woodbury) Rep. Abigail Whelan (R-Anoka) 11

14 Retirements from State House (8 running for higher office) Rep. Peggy Flanagan (DFL-St. Louis Park), running for Lt. Governor with Walz Rep. Debra Hilstrom (DFL-Brooklyn Park), running for Attorney General Rep. Jeff Howe (R-Rockville), running for the open Senate seat in SD-13 Rep. Erin Maye Quade (DFL-Apple Valley), running for Lt. Governor with Murphy Rep. Jason Metsa (DFL-Virginia), running for U.S. House, CD-8 Rep. Erin Murphy (DFL-St. Paul), running for Governor Rep. Jim Newberger (R-Becker), running for U.S. Senate Rep. Ilhan Omar (DFL-Minneapolis), running for U.S. House, CD-5 Targeted House races DFL likely to target 12 districts carried by Hillary Clinton that have Republican state representatives. (Suburbs) 1. Sarah Anderson, Plymouth, 44A 2. Dario Anselmo, Edina, 49A (Clinton won with 59% of the vote) 3. Regina Barr, Inver Grove Heights, 52B 4. Drew Christensen, Savage, 56A 5. Kelly Fenton, Woodbury, 53B 6. Keith Franke, St. Paul Park, 54A 7. Randy Jessup, Shoreview, 42A 8. Jenifer Loon, Eden Prairie, 48B 9. Roz Peterson, Lakeville, 56B 10. Cindy Pugh, Chanhassen, 33B 11. Dennis Smith, Maple Grove, 34B 12. Anna Wills, Rosemount, 57B Republicans likely to target 3 districts carried by Donald Trump that have DFL representatives. 1. Rob Ecklund, International Falls, 3A 2. Paul Marquardt, Dilworth, 4B 3. Clark Johnson, North Mankato, 19A (open seat) 12

15 Political Timeline Early voting began on Friday, June MN Primary Election: August General Election: November 6 Don t just sit there Do something! 13

16 MHA s Political Dilemma Also an opportunity On one hand.. the Democrats have traditionally been better for maintaining health care coverage and benefits. On the other hand.. the Republicans have traditionally been better on labor and nurse staffing ratio issues. The need for MHA to maintain a bi-partisan approach Other stakeholder groups do not have as much of a need to support both political party candidates as MHA does. The MNA will always be more DFL because of their union perspective. The Chamber of Commerce will always have a lean Republican perspective. Give generously to the MN Hospital PAC! Campaign/candidate requests for donations will be 14

17 Legislative outreach MHA member advocacy needed this summer Much better to build a relationship with your local legislators now than during the legislative session. Candidates want the opportunity to attend community meetings and greet constituents. Call and schedule your legislative/candidate meetings: Tell your hospital s story. Showcase your services, not just buildings and equipment. Possibly include some members of the hospital management team o Nurse leaders to talk about nurse staffing ratio issue o Social workers to discuss coverage challenges o Finance team members to discuss health care cost initiatives and community benefits o Board chair and trustee members shows community involvement and support Offer to take photos for either print or social media Offer to be a health care resource. o If they are incumbents, thank them for their public service Selecting your favorite state candidate Minnesota s Political Contribution Refund Program Under MN law, once a year, MN residents can donate up to $50 per person/$100 per married couple to a qualified political organization and receive a full refund through the state s Political Contribution Refund (PCR) program. Steps: Give the money Campaign sends you a receipt and a one page form Mail to the MN Department of Revenue 4 to 6 weeks, get your refund in the mail Legislative candidates need the money 15

18 2019 Legislative Preview Much depends on the outcome of the election, both state and federal Much depends on the November & February budget forecasts Many of the issues that were vetoed or left unresolved in 2018 will be front and center in 2019 Both political parties have shown a willingness to cut hospital Medical Assistance payment rates, as well as a willingness to increase them. Both political parties have been willing to cut mental health payments, as well as invest dollars in mental health. Issues of importance to MHA for the 2019 Session Maintaining coverage for low income Minnesotans: Efforts to pass a work requirement for able-bodied MA enrollees Preserving MN s benefit set Concerns about the MnCare Buy-In Proposal Sunset of the MnCare Provider tax on December 31, 2019 o What choices would be made without $660 million in annual provider tax revenue? o Funding $400 million of the Medicaid program o Funded $400 million of the 2-year reinsurance program Advancing health care payment reforms Working with DHS on next generation IHPs, direct contracting pilots Trying to update MN s Health Records Act Aligning with HIPAA for Treatment, Payment and Operations Defeating state mandated nurse staffing ratio legislation and other burdensome regulations which add costs and no value 16

19 Potential for big change What will for-profit health insurance companies mean for Minnesota? Aetna + CVS UnitedHealth Group + Walgreens Humana + Walmart Centene Amazon, Berkshire, JPMorgan name Atul Gawande CEO of healthcare venture Closing advice Whatsoever a man soweth, that shall he also reap. Galatians VI, The Bible, King James Version As you sow, so shall you reap. If you sow unity, you will get more unity; if you sow division, you will get more division. Congressman Tim Walz MHA Board of Directors June 22,