What s in Store for the 2016 Legislative Session Speaker: Mary Krinkie Friday, Jan. 8, 2016 3:10 4 p.m. Northland Ballroom
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.
Preview of the 2016 Legislative Session Or Fast and Furious 7.5 Place picture here Mary Krinkie Vice President Government Relations Minnesota Hospital Association 2016 Winter Trustee Conference January 8, 2016 Review of 2015 Legislative Session 2015 was a budget setting year for the 2016-2017 biennial state budget. Allocated $41.833 billion. The H&HS bill appropriates $12.469 billion in GF dollars for FY 2016 and FY 2017 spending. $301 million less than the February 2015 forecasted expenditures of $12.771 billion. Transferred $455 million from FY 2015 GF bottom line into the Health Care Access Fund by June 30, 2015 for expenditures to be made during the 2016-17 biennium. H&HS spending grew by $1.29 billion over the previous biennium. H&HS services spending represents about 29.8% of the state s budget. 1
Review of 2015 Legislative Session Included in the H&HS Budget Bill, Chapter 71 Sustaining our rural hospital infrastructure. MHA successfully advocated for an additional $5.1 million in new inpatient fee for service Medical Assistance payments, bringing CAHs up to either 85, 90 or 100% of their costs. Advancing the delivery of Telemedicine services. MHA spearheaded the effort to pass the Minnesota Telemedicine Act, ensuring parity of services and parity in payments for telemedicine services. Effective 1/1/16 for Medical Assistance and 1/1/17 for commercial plans. Improving access to mental health services. MHA worked with the National Alliance on Mental Illness (NAMI), the Mental Health Legislative Network and the Department of Human Services to successfully advocate for $48 million in much needed new funding, most of which supports community based mental health services. Demonstrating leadership on the issue of workplace violence. MHA was able to significantly amend the MNA s bill which was extremely regulatory and punitive for hospitals. Previous leadership and membership engagement on the issue of workplace violence resulted in a positive outcome. Political Landscape Governor Dayton (DFL) mid-point of second term. Not up in 2016. Has stated his intentions to not seek public office again. 2016 Election: All 201 legislative seats are on the ballot. MN House majority party status changed with 2014 election. 72 Republicans and 62 DFL There are 26 freshman legislators in total, 21 Republicans and 5 DFLers. (Of the 26 freshman, 15 from open seats and 11 from Republican candidates defeating DFL incumbents.) Of the 11 Republicans defeating DFL incumbents, 10 are from outside of the metropolitan area. (Policy implications) MN Senate: 39 DFL and 28 Rs. Running for a 4 year term in 2016. 2016 Session: All politics, all the time! Elevation of urban vs. rural political split. 2
Political Realities and Timeframe 2016 will be a short session. Starts March 8. Strong motivation to end on time. Easter is March 27 and Passover starts on April 22. House floor sessions in the Capitol? Senate Republicans in the SOB, Senate DFL in new offices. Limited appetite for health and human services reform or spending. Bonding bill, taxes and transportation likely to be the focus. Will there be any supplemental H&HS Budget appropriations? Likely to have all budget divisions in one Omnibus spending bill, with one H&HS conferee from each body. (Sen. Tony Lourey and Rep. Matt Dean) Announced committee deadlines First Committee deadline: April 1. (All policy committee action completed in 1 body.) Second Committee deadline: April 8. (All policy committee action completed in the other body on bills that met the deadline in the first body.) Third Committee (Finance) deadline: April 21. (House Ways and Means Committee and Senate Finance Committee must have completed work on appropriation/finance bills.) 3
Limited agenda in 2016 Implications: All stakeholder groups will be challenged to focus and narrow their legislative agendas. Stakeholder groups will be more successful if the advocacy ask is made early and it is specific. Pre-session work in January and February. Controversial items likely to be delayed. Exception being if one body wants to have a political vote on the record. MHA needs to speak with one voice, without internal opposition. May need to advocate with the other budget division chairs. Mental health has broader legislative support, than just a hospital funding request. November state budget forecast FY 2016-17 forecast balance of $1.871 billion. $594 million allocated to the budget reserve $71 million allocated to environmental funds $1.206 billion available balance Higher than expected Sales and Corporate Taxes offset lower than expected Income Taxes Lower Health Care forecast reduces overall spending Long term budget outlook remains strong 4
Lower Health Care Costs Drive Spending Reduction Changes in State Health Care Spending 5
HHS Growth Issue Looking Ahead Lawrence Peter Berra (1925-2015) Better known as Yogi The hard thing about predictions is that they re in the future. Violence Prevention Plans MHA s mental health legislative agenda Health Care Financing Task Force Health care reform/public program sustainability 6
Workplace Violence Prevention Each hospital must have a workplace violence prevention plan by January 15, 2016. Must be developed with input from a committee that includes non-managerial staff. Does notneed to be a new committee. Violence prevention training at time of hire and annually for all staff with direct patient contact. (MDH has set a date of 8/1/2016.) The plan and incidents of violence need to be reviewed annually by the Committee. Upon request, must provide plan to law enforcement & labor unions. No new reporting mandates, as requested by MNA. Questions: Will there be additional legislation in 2016? Does the St. Cloud hospital tragedy change the dialogue? Will there be a discussion on the use of restraints and/or tasers? Available MHA resources regarding violence prevention Preventing Violence in Healthcare gap analysis Educational videos Toolkit 7
MHA s Mental Health 2016 Legislative Initiatives (tentative) MHA will work to pass legislation to fund and position Minnesota to become one of eight states to participate in the federal pilot project to create Certified Community Behavioral Health Clinics as part of the Excellence in Mental Health Act. MHA will support legislation which expands competency restoration services for patients in amanner that increases bed availability at Anoka Metro Regional Treatment Center (AMRTC). This could be accomplished through redeploying existing state services for competency restoration patients as well as increasing availability and use of community-based competency restoration services. MHA will support increased state funding to more fully staff services at AMRTC and Community Behavioral Health Hospitals. Potential Mental & Behavioral Health Legislative Priorities Support funding for state match if MN is selected for Excellence in Mental Health Act pilot project MHA supported MN s successful application for $980,00 planning grant 24 states received planning grants; pilot project currently limited to 8 states 90% of costs in pilot states would be paid by CMS Pilots designed to provide more intensive upstream services for patients with serious mental illness and substance abuse disorders 8
Potential Mental & Behavioral Health Legislative Priorities Better leverage existing DHS capacityto place more patients in most appropriate care settings 20 competency restoration patients from AMRTC 10 competency restoration patients from St. Peter Funding for 10 more beds at AMRTC Fully staff 16 beds/cbhh Chemical dependency treatment facility serving approximately 12-16 patients Other Community Behavioral Health Hospitals with increased staffing Community Behavioral Health Hospital serving 12 patients Health Care Financing Task Force Broad Task Force language was included in 2015 HHS Bill. Task Force s Work Plan: Health care delivery system reform, especially IHPs MNsure: governance, structure, financing, oversight MinnesotaCare: coverage options for this population, long-term financing 29 Members: 11 appointed by governor, 14 appointed by legislative majority and minority leaders, and 4 commissioners. Appointees include: Penny Wheeler, M.D. (CEO Allina Health), Marilyn Peitso, M.D. (CentraCare Health) and Larry Schultz (Lake Region Healthcare). MHA monitoring Task Force meetings. Report due January 15, 2016. Question: Will any recommendation of substance be able to garner bipartisan support and move forward in 2016? 9
Big Policy Options (At the 50,000 foot level) Option 1: Stay the course. Keep MinnesotaCare as the BHP from 138% to 200% FPL. Federal subsidies for purchasing a QHP (qualified health plan) between 200% and 400% FPL. Option 2: Expand the BHP up to 275%, or beyond up to 400% of the FPL. Favored by some DFL Task Force members. Avoids cliff between current coverage programs. (Still a cliff at program s new eligibility FPL.) Option 3: Rep. Matt Dean s 2015 proposal --modified MA for less than 138% FPL, others on federal Exchange with some level of federal and state subsidy. Chamber of Commerce exploring supports private insurance market. Big Questions Future/Function of MinnesotaCare & MNsure Eliminate BHP/MinnesotaCare and move enrollees to the Exchange? (For the population above 138% FPL.) Do so with additional statesubsidies? How much of a subsidy and how are the subsidies paid for? Opposite view: Expand the BHP up to 400% of FPL? (Helps eliminate the coverage cliff and deductibles, etc.) Is the Exchange operated by the State, or should MN consider moving to the federal Exchange? Because of past enrollment problems, should the state Exchange be scaled back to only those using an APTC (advanced premium tax credit) ---and not for MA or MnCare enrollment? Should the State consider an APTC outside of MNsure? 10
Big Questions, continued Current law, the provider tax is repealed in 2019. Projected surplus in the HCAF of $438 million in FY 2016. Surplus grows to more than $1 billion by FY 2019. How much statemoney is needed to operate the MinnesotaCare program? At 200% FPL, or 275% FPL? How much money is needed moving to a possible new state subsidy program when purchasing a Qualified Health Plan? How much state money is needed to pay for the Medicaid expansion when the federal financial participation drops to 90% --by 2019. Could the provider tax drop to 1% and pay for the desired public program coverage? What happens if It could happen Potential for a Republican President, U.S. Senate and U.S. House. If there are challenges to the ACA, we may need a state funding mechanism to preserve coverage for low income Minnesotans; the Medicaid expansion population under 138% FPL and MinnesotaCare between 138% and 200% FPL. 11
External challenges Public perceives little difference between hospital providers and insurance companies. CEO salary caps (SEIU efforts nationwide). Non-profit status requirements; thresholds for charity care, community benefit, etc. Municipal taxing efforts; street maintenance, etc. Municipal workplace employee benefit issues: Minimum wage increases, family leave expanded, fair scheduling, etc. Twin Cities MNA contracts up in June, 2016. MNA s continued advocacy efforts focused on government mandated nurse to patient staffing quotas. Public concerns about rising health care costs. MHA s Strengthening Healthy Communities Campaign Telling compelling stories about hospitals impact on their community inside and outside their walls 15 Stories Completed 17,000 site visits Over 3 million impressions www.mnhealthycommunities.org 12
Key Messages: Minnesota s Health Care Costs MN Community Measurement Commercial TCOC pm/pm increased 3.2% or $14.00 from 2013-14 based on health plans data Inpatient pm/pm costs decreased $0.95 Pharmaceutical pm/pm costs increased $7.19 Key Messages: Minnesota s Health Care Quality! For the second year in a row, Minnesota ranks first in the nation for health care access, quality and outcomes in a report issued Dec. 9 by the Commonwealth Fund, a private foundation that promotes a high-performing health care system and supports independent research on health care issues. The report, Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition, ranks the health systems of every state and the District of Columbia based on 42 health care measures grouped into five dimensions of performance: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity. Minnesota was the only state that was rated in the top quartile for all five dimensions measured. 13
Key Messages Minnesota s Health Care Quality! Advocacy Palindrome AISIA Trustees uniquely positioned to encourage public policy makers to step up and become hospital advocates! Step 1: Awareness Step 2: Interest Step 3: Support Step 4: Involvement Step 5: Advocacy 14