MMGMA's 2009 Legislative Priorities

MMGMA's Government Affairs Committee has set the following priorities for the 2009 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 certainly monitor any legislation that emerges from the health care reform work groups and we continue to advocate for an increase in reimbursement for MA, PMAP and Minnesota Care. We realize this year, given the projected budget shortfall, that an increase is unlikely. We will communicate with members throughout the session via MMGMA e-mail blasts.

1. Oppose Using the Health Care Access Fund to Balance the State's Budget: The state's general fund is forecast to have at least a $2 to 3 billion dollar shortfall. The Health Care Access Fund currently has a surplus of approximately $400 million dollars. This fund balance will make it a tempting target for use in balancing the state's budget.

The Health Care Access Fund was created by imposing a two percent tax on providers and a one percent tax on health plan premiums. These funds should be dedicated exclusively to providing affordable health coverage to the uninsured.

During the state's record $4.1 billion deficit in 2003, the Governor proposed and the Legislature adopted a plan that transferred nearly $400 million out of the Health Care Access Fund to plug the state's budget shortfall. This fund should be used exclusively for the uninsured. Surplus funds should be used to expand eligibility for MnCare, fund a long-overdue increase in reimbursement to providers or to reduce the provider tax.

This position is supported by the Minnesota Medical Association, and the Minnesota Provider Coalition.

Opponents: While there are no known opponents of our position, budget pressures may make it tempting to again use the Health Care Access Fund to cover the projected shortfall in the General Fund.

2. 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.

The Department of Health is completing work on a language interpreter roster, which will list participating interpreters, their language(s) and training. The roster is the first step in creating a state registry for language interpreters. Interpreters 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.
  
  

3. 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 also 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.

4. Require All Payers Regulated by the State of Minnesota to Collaborate on a Single Plan to Establish a Standardized System for On-the-spot Eligibility Determination and Coverage Verification, Real-time Claims Adjudication and Electronic Funds Transfer: Many payers are now exploring the use of available technologies to assist providers in verifying eligibility and patient responsibility for some or all of the costs of care, at the point of service. In Minnesota, however, this is no requirement that payers collaborate on a common system instead of each creating their own. Without such a requirement it is likely that multiple systems, using different technologies, will emerge losing a rare opportunity to simplify and streamline, to the benefit of consumers and providers. The common system could be web-based or a "smart card".

The ability to do on-the-spot eligibility verification and calculate patient out-of-pocket costs will assist patients in better understanding the cost of their care and their portion of the cost. This will increase consumers' comfort level and result in enhanced patient and provider satisfaction.

Opponents: We do not yet know who would oppose this approach.

MMGMA Government Affairs

Geoff Sylvester, Chair

Candy Simerson, Past Chair

Jim Wilkus, Chair-elect

MMGMA Government Affairs Advisor

Phil Riveness

MMGMA Lobbyists

Dan Larson

Matthew Schafer

Roger Johnson