MMGMA's 2007 Legislative Priorities

MMGMA's Government Affairs Committee has set the following priorities for the 2007 Legislative Session. There will no doubt be other issues we will engage with, opposing or supporting the initiatives as we determine their impact on our patients and practices. We will communicate with members through MMGMA e-mail blasts.

1. Interpreter Reimbursement: The costs associated with providing interpretation for Limited English Proficiency (LEP) patients is increasing and it is a special hardship for health care providers in communities with a large influx of immigrants. Similarly, the cost of interpretation for the deaf and hard of hearing commonly exceeds the reimbursement for the services rendered.

Health plans should be required to reimburse providers for interpreter services whether provided by staff, contract or telecommunications. In addition, MinnesotaCare and Medical Assistance currently are only required to pay for interpreter services during face-to-face time with providers. The law should be expanded to cover all time associated with the visit requiring interpretation, such as registration, forms completion, prescriptions, etc.

Finally, the Department of Health should create a state registry for language interpreters, who would have to demonstrate competency in language, interpreting ethics and medical terminology to be listed in the registry.

The Minnesota Medical Association, Minnesota Hospital Association, Minnesota Provider Coalition, Minnesota Commission Serving Deaf and Hard of Hearing People, and the Minnesota Rural Health Association support our legislation.

Opponents: Health plans and the Minnesota Chamber of Commerce are the only known opponents of our bill. They argue:

• Interpreter costs are just a "cost of doing business". (response: the cost of interpreter services often exceeds the cost of the patient exam itself and is a significant "variable" cost, which is reimbursed by many other payers like no-fault, workers' compensation, MinnesotaCare and Medical Assistance.)
• Our proposal does not address self-insured employers who account for a substantial portion of the market. (response: most self-insured plans are administered by the health plans and employers often buy the basic benefit set that would include coverage for interpreter services).
• Our bill constitutes a "mandate" and will cause employers' premiums to increase. (response: Our bill phases reimbursement in over three years giving health plans the opportunity to "experience rate" employers whose employees have required interpreter services, before the health plans are required to pay 100% of the charges, giving the health plans time to measure the cost and plan for the transition.)

2. HSA Direct Assignment and Collecting Estimated Payments From Patients With High Deductible Plans: The number of Minnesotans with HSA's is growing and may reach 500,000 to 600,000 in five years. While this pretax savings concept will assist many with health care coverage, it is important that the managers of these funds, usually health plans be required to pay providers directly for heath care services provided to the account holder. Additionally, many employers are changing their employee insurance plan to high deductible plans which require employees to pay thousands of dollars out-of-pocket before their insurance coverage kicks-in.

MMGMA supports legislation that would require direct payments by HSAs to providers for services rendered and permit providers to collect an estimated payment, at the time of service, from consumers with a high deductible insurance plan.

The Minnesota Provider Coalition strongly supports this legislation.

Opponents: It is not yet known who would oppose this legislation. Health Plans have acknowledged that HSAs and high deductible insurance plans pose a special problem for providers that if not addressed will result in higher accounts receivables and higher collection costs.

3. Transparency Requirements: Current law requires that providers disclose to consumers the average allowable payment from private third-party payers for their top 50 services and procedures. These and many additional "disclosure requirements" in Chapter 62J, though well intended, do not provide consumers useful information with which to compare providers.

MMGMA supports legislation which would require health care providers to give consumers a good faith estimate of the allowable payment the provider has agreed to accept from the consumer's health plan company for the service(s) requested by the consumer, indicating the amount of the allowable payment due from the consumer, if known. The legislation would also require that health care providers give uninsured consumers a good faith estimate of the average allowable reimbursement the provider accepts as payment from private third-party payers for the requested services and the estimated amount the uninsured consumer will be required to pay.

The Minnesota Provider Coalition strongly supports this legislation.

Opponents: We do not know of opponents to this clarification of current law and hope to convince legislators that these changes represent an improvement for consumers.

4. MinnesotaCare/M.A. Fee Schedule: Provider reimbursement under the MinnesotaCare and Medical Assistance fee schedule is the lowest of all public and private payers. The last fee schedule adjustment occurred in 1999. Since then the CPI-U has increased by more than 21%, eroding appreciably the value of payments under these plans. While MMGMA supports an expansion of eligibility under MinnesotaCare, we ask that it be coupled with an adjustment to the fee schedule. This adjustment would especially help providers in Greater Minnesota and in the inner-city areas whose patient census usually includes a higher percentage of MinnesotaCare and Medical Assistance patients.

Opponents: We are unaware of opposition to an adjustment to the fee schedule although we are aware that there would be a fiscal impact on the Health Care Access Fund and the General Fund.

5. Contingent Reduction in Provider Tax: Hundreds of millions of dollars have been transferred from the Health Care Access Fund to the General Fund, in recent years, to balance the state budget deficits. These dollars were intended to assist the uninsured in accessing health care, and should be dedicated to that use. To avoid building surpluses that exceed funds needed to pay for Minnesota Care, MMGMA supports a change in law that would require the Commissioner of Finance to determine the projected needs of the program biannually and if a surplus is forecast, reduce the provider tax accordingly.

MMGMA strongly supports H.F. 275, introduced by Representative Maria Ruud, which provides for a contingent reduction in the provider tax rate when surpluses are forecast.

Opponents: We are unaware of any organized opposition to this proposal. It had bi-partisan support in the last legislative session.

MMGMA Government Affairs Co-chairs

Candy Simerson, Jim Wilkus, Paul Louiselle

MMGMA Government Affairs Advisor

Phil Riveness

MMGMA Lobbyists

Doug Stang, Dave Kunz