MMGMA's 2010 Legislative Priorities

MMGMA's Government Affairs Committee has adopted the following priorities for the 2010 Legislative Session. There will no doubt be other issues we will engage with, opposing or supporting the initiatives after we determine their impact on our patients and practices. Given the projected budget shortfall we will no doubt have to mount a major effort to oppose an increase in the Provider Tax and/or further cuts in public program reimbursement. We will communicate with members throughout the session via MMGMA e-mail blasts.

1. Oppose Increasing the Provider Tax

• Provider reimbursement is being squeezed by health plans and government payers as they freeze or reduce payments making it impossible to pass on most of the Provider Tax burden. The applicable tax is applied to total revenue, making it particularly unfair and burdensome.
• If the Provider Tax is increased from 2% to 3% of revenue, it's a whopping 50% tax increase on providers.
• The result will be lay-offs, hiring freezes, and cut backs in technology investments, including electronic medical records.
• Health Care funding cannot be resolved by taxing one industry. It requires a broad-based solution. We recommend the Legislature consider a 1% tax on all professional services to replace the 2% Provider Tax.

Perspective: The budget shortfall through the end of the biennium (June 30, 2011) is estimated to be. At this point, an increase in the Provider Tax is not on the table but if GAMC recipients are transferred to MinnesotaCare the Health Care Access Fund will be in deficit as early as 2011, no doubt prompting interest in increasing the Provider Tax. Last session the Minnesota Hospital Association supported a 1% increase in the Provider Tax – all other provider groups opposed any increase.

2. Oppose Further Cuts in Provider Reimbursement

• Physicians have not received an increase in fees under MA, GAMC, PMAP and MinnesotaCare since 1999. In fact, in 2009 specialist fees were cut 6 1/2 %. Providers are paid below their costs for virtually all services provided under these programs.
• Overhead is escalating because of mandated new reporting requirements, required electronic systems for claims, remittances, e-prescribing and patient satisfaction surveys.
• Health care employs about 15% of the Minnesota workforce so any further cuts in reimbursement will have a ripple effect on our overall economy.
• Providers may be forced to limit access for growing public program participants.

Perspective: The most recent budget forecast predicts a shortfall of $1.2 billion though the end of the current biennium (June 30, 2011). Two thirds of the shortfall is attributed to continuing high unemployment and the resultant loss in income tax revenue. While no one yet has proposed further cuts in the MA, PMAP or MinnesotaCare fee schedules, a proposal restoring the GAMC program could include substantial cuts in GAMC reimbursement. The biggest single unallotment by the Governor was the elimination of the entire GAMC program. He has yet to propose a plan to restore the program.

3. Support Reasonable Reimbursement for Release of Medical Records

• Minnesota law currently provides for a $16 medical record retrieval fee and $1.22 per page, for third party requests.
• Providers must protect patients' privacy, assure that the release has been appropriately authorized and is on file, search through multiple formats such as paper records, micro-fiche, electronic records, multiple departments, address guardianship issues and release only the proper information, and comply with ever changing regulatory requirements, etc.
• The work effort and risks far exceed the cost of a consumer making personal copies at a retail outlet. We propose that the initial fee be changed to $60 and the per page fee reduced to $.10 copy with these charges updated annually applying the relevant CPI-U factor.

Perspective: Support for dramatically reducing reimbursement for the costs associated with the release of medical records comes largely from attorneys. The bill they support would have reduced reimbursement from the current $16 retrieval fee and $1.22/page to just $.05/page. They cite extreme examples of charges for release of records in the thousands and argue that this should not be a "revenue" center for hospitals and clinics. Providers are united in opposing this draconian proposal and instead support a larger initial fee and a reduced per page charge.

4. Support Fairness in Health Plan Contracts

• Certain unfair contracting practices should be prohibited such as requiring a provider send a health plan a letter of termination as a prerequisite to negotiating contract terms or confiscatory practices such as withholding current payments to recover unsubstantiated prior overpayments without the opportunity to review or appeal.
• Health plans should also be required to allow providers to collect deductibles and estimated payments from patients at or prior to the time of service.
• Providers should be provided with a full proposed fee schedule 165 days before the contract year's effective date.
• The methodology of any quality reporting or tiering initiative must be clearly stated to providers before the program is launched. Data accuracy must be established before it is published and released to the public.
  
  

Perspective: In 2004, MMGMA, with the great help of the Minnesota Provider Coalition, (then called the Fair Contracting Coalition) succeeded in advocating for significant changes in state law governing contracts between providers and health plans. Our Provider Relations Committee has identified the issues outlined above as additional changes in state law that should be adopted to insure fairness in contracting. We have the strong support of the Minnesota Provider Coalition once again, and will seek support from other provider groups.

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Past Issues Update

Language Interpreter Reimbursement: We have lobbied for many years that the costs associated with providing interpretation for Limited English Proficiency (LEP) patients is a special hardship for health care providers and should be reimbursed by health plans. While we have strong support for our position in the Minnesota House and Senate, the Governor has continued to signal that he would veto any bill that includes this requirement because he considers it a "state mandate". We will pursue this issue in 2011 when we will have a new Governor.

Require All Payers to Collaborate on a Single Plan to Establish a Standardized System for On-the-Spot Eligibility Determination, Coverage Verification, etc.: We were successful in getting a bill passed in the last session that requires the Commissioner of Health, in consultation with the AUC (Administrative Uniformity Committee) to pursue the feasibility of a Single Standardized System. MMGMA representatives met with MDH staff to begin work on this process which, if successful, will simplify and streamline the verification process for the benefit of consumers and providers.

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Please let us know if you have concerns we should address or have questions about our priorities. Together we can have an impact on public policy for the benefit of patients and our practices.

MMGMA Government Affairs Committee
Geoff Sylvester, Chair
Candy Simerson, Past Chair
Dan Grosskopf, Chair-elect

MMGMA Government Affairs Advisor
Phil Riveness

MMGMA Lobbyists
Dan Larson
Matt Schafer
Nate Mussell