Omnibus health finance bill moves along in legislative process

Like many omnibus bills approved by committees this week, Friday’s vote on the omnibus health finance bill fell along party lines.

Following the 11-8 vote, HF2128, as amended, is on its way to the House Ways and Means Committee, where it is expected to be merged next week with the omnibus human services and early childhood bills.

“I’m extremely proud of this bill,” said Rep. Tina Liebling (DFL-Rochester), the bill sponsor. “… There’s a lot in this bill that’s to try to make our health system (better) and try to improve health equity in our state.”

One example she cited is additional coverage proposed under Medical Assistance to aid in health equity and improve the health of Minnesotans on public programs.

Rep. Joe Schomacker (R-Luverne) has numerous concerns, including unknown impacts on hospitals, trying to recapture savings in areas such as durable medical equipment, and some carve outs.

“At the same time that this bill raises some of the requirements and mandates for private health insurance, we exclude the state programs from doing that. So we start to hold ourselves at a lower standard overall as a state for insurance than what we do the private coverages,” he said.

In addition to a mainly technical amendment to fix errors and clarify language, four others were added to the delete-all amendment:

• Rep. Liz Reyer (DFL-Eagan) offered a plan to create a dental home demonstration project to increase the number of dental providers serving Medical Assistance and MinnesotaCare enrollees and increase capacity of existing providers;
• a second Reyer amendment would increase dental reimbursement rates by 20% for providers designated as critical access dental providers under Medical Assistance and MinnesotaCare;
• an amendment from Rep. Laurie Pryor (DFL-Minnetonka) would ensure Medical Assistance recipients eligible for a monthly public transit pass for non-emergency medical transportation are not eligible for a pass through another program; and
• Rep. Mike Freiberg (DFL-Golden Valley) offered an idea to allow a tribal medical cannabis program that meets certain Health Department criteria to have the same privileges as current state programs.

An amendment unsuccessfully offered by Rep. Lisa Demuth (R-Cold Spring) would, in part, have provided $10 million to create the Greater Minnesota Dental Residency Grant Program whose focus would include educating and training dentists to serve outside the seven-county Twin Cities metropolitan area. An amendment from Rep. Glenn Gruenhagen (R-Glencoe) to increase a reimbursement rate for independent pharmacies was also rejected.

The bill checks in at $18.95 billion in spending for the biennium that begins July 1, 2021.

A joint target between the health and human services bills is $346.51 million above current base, including $154.93 million in health spending.

[MORE: View the spreadsheet and list of bills in the omnibus bill]

“This bill has so many good things in it,” said Rep. Kelly Morrison (DFL-Deephaven). “Telehealth has been a silver lining during the pandemic and the ability to continue to practice in that way is going to be a boon for patients and providers.”

In addition to calling for $27.63 million to expand telehealth coverage, the bill would add additional requirements for coverage of telehealth by private sector insurers, and modify Medical Assistance coverage of telehealth services to be consistent with changes made in private insurance coverage.

Rep. Tina Liebling

The American Telemedicine Association supports greater use of telemedicine, but would prefer the proposed telehealth definition be more technology neutral.

“State policies should not mandate which types of technologies are more appropriate than others or under which circumstances certain technological modalities may be used in the delivery of health care services,” wrote Public Policy Director Kyle Zebley.

Nonetheless, Rochelle Westlund, director of public policy for the Minnesota Association of Community Health Centers, generally supports the bill.

“A vast majority, 80%, of our patients are either uninsured or enrolled in a public health care program. … This flexibility enables our patients, who often suffer the impacts of health disparities, to continue to access care at their Community Health Center,” she wrote in a letter. “MNACHC requests that audio-only services continue as an effective strategy to address access barriers and ultimately, healthier communities.”

Other proposed new spending includes:

• $6.34 million to expand Medical Assistance postpartum coverage from 60 to 180 days;
• $6 million to reimburse counties for a portion of the costs of treatment in children's residential facilities;
• $2.6 million to address and better understand disparities in maternal and infant morbidity and mortality;
• $2.1 million for adult periodontal non-surgical treatment;
• $1.61 million to expand grants for integrated care for high-risk pregnant women;
• $866,000 to provide Medical Assistance coverage for enhanced asthma care services;
• $725,000 to allow Medical Assistance to cover weight loss medication;
• $558,000 for an initiative to support healthy development of babies during pregnancy and postpartum; and
• $200,000 for a skin lightening products public awareness and education grant program.

Lilly Melander, state policy and advocacy director for The Medical Alley Association, supports the postpartum extension, but would like to see it go for a full year. “Every woman, regardless of their background or location, should have access to equal maternal health and care services. The language included in this bill takes a strong step toward improving access to maternal and infant health,” she wrote.

[MORE: Health committee hears good, bad about its omnibus bill]

[WATCH: Tuesday’s walk-through of the bill]

Proposed policy changes in the bill include:

• prohibiting drug manufacturers from imposing excessive price increases on generic or off-patent drugs;
• removing barriers to kinship placements that disproportionately impact people of color and bring foster home licensing standards more in line with current adoption standards and federal policy;
• requiring hospitals with obstetric care and birth centers to provide continuing; education on anti-racism and implicit bias;
• changing who may obtain a certified birth or death record; and
• providing an exception to the hospital construction moratorium for mental health or substance use disorder beds.