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Update: July 15, 2003 1:45 p.m.
Sen. Becky Lourey (DFL-Kerrick), co-chair of the joint hearing, said that she did not want to politicize the issue, but that she did want to have the hearing in order to more closely scrutinize the process by which patients pass through the system. She said the hearing was designed to provide information on treatment and supervision administered under the sex offender civil commitment law.
Sen. Don Betzold (DFL-Fridley), the other co-chair, said, "It is probably overdue that we have a look at the program." It has been over a decade since the program was put in place, he said. Betzold also said, "The issue is treatment, not incarceration. There is a fine balance between treatment and the rights of patients."
The first speaker, Warren Maas, Hennepin County Commitment Defense Project, said he has represented 14 of the offenders currently in the program. Maas said, "Up to now, the courts have held that the patients are to undergo treatment with a careful stepdown toward completion and return to the community, but if a person follows the program and is not returned to the community, what is to prevent the court from finding double jeopardy?" He also said, "The morally correct thing to do is to honor the contract to make a good faith effort to rehabilitate offenders, but the current position of the executive branch guarantees litigation. In our opinion the governor's order is unconstitutional."
Betzold countered, "The order does not change the act, but it takes away the authority of the commissioner. We have the same process set up for patients committed as mentally ill and dangerous, so one argument is the order is a violation of the equal protection clause."
Maas also said there have been no releases from the program and that at some point there is a question of the good faith of the treatment system.
Members also discussed the program with Dr. Anita Schlank the former clinical director of the program. Schlank said discussion of changes in the program to provide for early release of some patients had been discussed long before the current governor took office. She said the changes that were proposed were primarily to save money and that she was told the program was growing too quickly. Schlank was asked why she left and she responded that she left because of changes to transition services that would set up the transition patients for failure. She also said that a proposed change to place patients under supervision of the Dept. of Corrections upon release, thus removing the patients from staff who knew them, was problematic. She said that she was told there were about 40 patients who would need to be released. In response to a question from Betzold about whether or not the program could be designated as a "Cadillac program," Schlank said, "It is a good quality, solid program, but not so extreme to be designated a 'Cadillac program.' What is in the program is absolutely necessary."
Sen. Wesley Skoglund (DFL-Mpls.) said, "It is a treatment program. If it stops being a treatment program and becomes an incarceration program, it will go away and the offenders will be let out into the community." Sen. Juliann Ortman (R-Chanhassen) said, "Patients do have rights to release. We have to decide if we want to lock them away because they are a threat to society or provide a path to release."
Commissioner Kevin Goodno, Dept. of Human Services, spoke next. Goodno said, "I cannot find any documentation that 40 people were scheduled for discharge." He said the administration has never directed people to look at 40 people for discharge. "Nor have we looked at changing the discharge process. Public safety is our primary concern and will be weighted most heavily in making a determination about transition," Goodno said. "This is a very difficult group of offenders to treat, but we are committed to providing treatment," he added. "There are no discussions about releasing people in the discharge process," Goodno said, "We are trying to strive for the most appropriate level of treatment, including the most effective."
Sen. Linda Berglin (DFL-Mpls.) said, "The whole discussion has been disturbing because I get the feeling that someone is not telling the whole truth. I don't care if the release is not under consideration anymore, but here we are with people saying we have never talked about it." She said she was concerned that changes in the program could mean that no one ever met the criteria and that changes could lessen the effectiveness of the program. "Both could jeopardize the program," Berglin said.
Goodno responded, "We are not going to give up in order to keep the status quo, but we do want to improve the program."
The panel also heard from Mike Tessneer, Dept. of Human Services, and Steve Huot, Dept. of Corrections. Tessneer reviewed the provisional discharge procedures for offenders under the law and Huot gave a presentation on the numbers of sex offenders and the sentencing and treatment process.
The committee, chaired by Sen. Becky Lourey (DFL-Kerrick), heard testimony on the measure from individuals who did not have an opportunity to speak at a previous hearing and then considered amendments.
The major amendment clarifies notice provisions for spraying. Under the amendment, notification of residents in the area to be treated must be provided at least 24 hours in advance, unless there is an immediate need because of a disease outbreak. In addition, the amendment was amended to provide that the mosquito control commission may only enter private property to monitor disease bearing mosquitoes, ticks or black gnats or to control mosquito species capable of carrying a human disease in the area of an outbreak. Members also heard testimony that diseases other than West Nile virus, such as LaCrosse encephalitis, must be controlled. The amendments, Lourey said, are an attempt to balance the rights of property owners and individuals opposed to spraying with the concerns of public health. The amendments were adopted.
The bill was approved and re-referred to the Tax Committee.
S.F. 712, authored by Sen. Claire Robling (R-Jordan), defines the district as the entire seven county Metropolitan Area and provides that the commission may enter private property, despite the owner's objections, to determine the need for control or to control for disease bearing mosquitoes. Robling said the measure is aimed at combating West Nile virus.
Members heard testimony on the measure, but no formal action was taken.
The appointments of Dianne Mandernach as the commissioner of health and of Kevin Goodno as the commissioner of human services were both approved.
Mandernach said she found the appointment as commissioner both humbling and gratifying. She said she hopes the administration and the Legislature will work together to improve the health of all Minnesotans. She said the department's goals are to protect, maintain and improve the health of Minnesota's citizens. Mandernach said she has identified five priority areas to focus the department's actions: eliminating racial and ethnic health disparities; preparedness; mental health issues; nursing home regulatory issues; and rural health care issues.
Goodno said the Dept. of Human Services primary goal is to provide a safety net for the most vulnerable citizens. "I know we all have the same goal-doing the best for citizens," Goodno said. He said the relationship between the department and counties is critical to insure delivery of the best services possible to clients. Goodno also stressed the importance of cooperation with other agencies and the Legislature.
Both appointments were advanced to the full Senate for confirmation.
The committee, chaired by Sen. Becky Lourey (DFL-Kerrick), devoted considerable time to consideration of the omnibus family law bill, S.F. 758. The measure, sponsored by Sen. Thomas Neuville (R-Northfield), recodifies laws relating to marriage dissolution, legal separation, custody, parenting time and visitation. The measure also makes a number of changes in child support provisions, including new tables for computing support and requiring the court to consider the income of both parents. The bill also exempts harassment restraining order actions from mandatory alternative dispute resolution requirements and modifies provisions dealing with the distribution of certain pension plan assets or benefits. The bill was approved and re-referred to the Finance Committee.
The panel also approved a bill, S.F. 343, sponsored by Sen. Dan Sparks (DFL-Austin), that requires health plan companies to report the compensation of the highest paid executives to the commissioner of commerce or the commissioner of health. The bill was advanced to the Senate floor.
Several additional bills were endorsed by the panel. S.F. 201, sponsored by Sen. Michelle Fischbach (R-St. Cloud), designates nursing facilities, located in areas designated as Metropolitan Areas by the federal Office of Management and Budget, as metropolitan for purposes of establishing reimbursement rates. The bill was approved and re-referred to the Finance Committee. S.F. 1152, also carried by Fischbach, provides for a statewide study of the need for additional hospital beds. The measure was also advanced to the Finance Committee.
Two bills authored by Lourey were also approved. S.F. 1402 modifies a number of provisions relating to child care assistance in an effort to prevent fraud and provide accountability. S.F. 267 modifies emergency medical services regulatory provisions. Both bills were re-referred to the Finance Committee.
The early part of the hearing was devoted to hearing testimony on S.F. 431. The bill limiting the use of family planning grants was not formally before the committee, thus no action was taken. However, there were several individuals who spoke in opposition to the measure.
S.F. 1078, authored by Sen. Sean Nienow (R-Cambridge), requires the Dept. of Health (MDH) to continue the educational campaign to providers and hospitals on vaccine safety. In addition, the bill requires the department to encourage providers to provide vaccine information statements at multiple visits and in anticipation of future immunizations. MDH must encourage providers to use existing screening for immunization precautions and contraindication materials and make proper use of the vaccine adverse events reporting system, under the measure. The bill also requires the department to develop and make available patient education materials on immunizations and to encourage providers to use thimerosal-free vaccines when they are available. When MDH proposes a modification to the immunization schedule, the department must consult with the Minnesota Natural Health Coalition, Vaccine Awareness Minnesota, Biological Education for Autism Treatment, the Minnesota Academy of Family Physicians, the Minnesota Chapter of the American Academy of Pediatrics and the Minnesota Nurses Association, in addition to current consultation requirements, under the bill.
Kris Ehresmann said the Dept. of Health is already taking the actions required in the bill, but wants to be clear in its commitment to vaccination issues. Members also adopted an amendment, offered by Sen. Leo Foley (DFL-Coon Rapids), requiring the department to develop materials educating providers about vaccine content. A.J. Peron-Wildes told committee members about her son, who developed autism after being immunized while sick with double ear infections. Almost 90 percent of autistic children were immunized while ill, she said, while only 5 percent of the general population was immunized while ill. Peron-Wildes and Stephanie Lee, whose daughter died last year after suffering from vaccine-related epilepsy, said parents should have access to complete, accurate information about vaccine risks. S.F. 1078 was approved and sent to the full Senate.
Committee members also advanced four other measures to the Senate floor. S.F. 396, carried by Sen. Dennis Frederickson (R-New Ulm), exempts children who are eligible for adoption assistance payments and who have a special need for medical or rehabilitative care from having to enroll in the prepaid medical assistance program. S.F. 418, authored by Sen. Scott Dibble (DFL-Mpls.), permits optometrists to prescribe legend drugs as well as topical drugs. Under the measure, the authority is limited to schedule IV and V controlled substances. S.F. 962, sponsored by Sen. Julianne Ortman (R-Chanhassen), authorizes a managed care pilot project for services provided to persons with developmental disabilities. S.F. 796, carried by Sen. Claire Robling (R-Jordan), permits experienced aides to work in child care centers without direct supervision for up to 25 percent of the center's daily hours. The bill also requires experienced aides to be trained in CPR every two years and to have 4,160 hours of experience, 120 days of which must be in the employment of the current company. The measure also permits child care centers to use one experienced aide for every four full-time classroom staff.
Three bills were re-referred to the Committee on Finance. Ortman sponsored S.F. 426, which authorizes an exception to the hospital construction moratorium to permit the addition of 20 beds for rehabilitation services at a Carver County hospital. Sen. Sheila Kiscaden (IP-Rochester) carried S.F. 1215, which extends until 2006 the time limit for the governor to enter into an agreement with the Nuclear Regulatory Commission for the discontinuation of the commission's licensing and related regulatory authority over by-product, source and special nuclear materials and the assumption of regulatory authority by the state. Committee members re-referred S.F. 824 to the Finance Committee without recommendation. Authored by Sen. Rod Skoe (DFL-Clearbrook), the measure provides an exception to the nursing home construction moratorium for a 124-bed facility in Hubbard County for the construction of a new addition, conversion of existing space into a special care unit and short-term rehabilitation unit and the expansion of dining and activity facilities.
In an evening hearing, committee members approved S.F. 613, carried by Sen. Linda Scheid (DFL-Brooklyn Park). The bill permits health maintenance organizations to impose a flat fee co-payment on outpatient office visits and outpatient prescription drugs. The panel also heard testimony on bills imposing additional informed consent requirements on abortions. Committee Chair Becky Lourey (DFL-Kerrick) explained that the committee could not take action on any of the bills, because they had been withdrawn by their respective authors.
The bill, authored by Sen. Linda Berglin (DFL-Mpls.), makes numerous changes in provisions regulating the family support grant, relocation service coordination, Medical Assistance home care and other Dept. of Human Services programs. Members adopted an amendment incorporating provisions of S.F. 1079. The measure, authored by Sen. Sheila Kiscaden (IP-Rochester), modifies fee requirements for child support services, changes requirements for the waiver of income withholding, provides for recovery of expenditures for alternative care for nonmedical assistance recipients and establishes an alternative care lien. The bill was approved and re-referred to the Finance Committee.
Members also advanced S.F. 1322 to the Finance Committee. The bill, sponsored by Lourey, provides for reporting and review of health care providers' expenditures and provides for audits of certain referrals.
S.F. 443, authored by Kiscaden, expands adult foster care license capacity. The measure was approved and advanced to the full Senate.
The fifth bill on the agenda, S.F. 1347, was also discussed. The bill, sponsored by Berglin, restricts the construction of radiation therapy facilities. The bill failed to gain the committee's approval.
One of the measures gaining committee approval, S.F. 377, prohibits the sale and commercial use of cribs that do not meet safety standards. The measure, authored by Sen. Ellen Anderson (DFL-St. Paul), requires cribs to meet safety standards established by the Consumer Safety Commission and the American Society for Testing and Materials. The bill requires second-hand cribs to meet the standards and prohibits the use of cribs that do not meet the safety standards by licensed child care providers and by hotels and motels. In addition, the bill contains an education component to make consumers more aware of crib safety requirements. The measure was approved and advanced to the Senate floor.
S.F. 1049, sponsored by Sen. Sheila Kiscaden (IP-Rochester), modifies newborn screenings. The measure changes terminology to require testing for "heritable and congenital disorders," rather than "inborn metabolic errors," and increases the fee to $61 per specimen. The measure also requires the commissioner of health to periodically revise the list of tests to be administered to reflect advances in medical science and improved testing methods. The bill also provides that an infant may be exempted from the tests if the parents object because the testing is in conflict with their religious beliefs. Finally, the measure provides for an advisory committee to make recommendations concerning tests and treatment for heritable and congenital disorders. The bill was approved and re-referred to the State and Local Government Operations Committee.
S.F. 1071, authored by Sen. David Senjem (R-Rochester), was also considered again by the committee. Members had discussed the bill at an earlier hearing, but laid the measure over to work out language to accurately reflect the author's intent. The bill defines a new process-that of a combination of heat and alkaline hydrolysis-for disposing of a dead human body. The measure was advanced to the full Senate.
S.F. 946, carried by Sen. James Metzen (DFL-South St. Paul), requires the Emergency Medical Services Regulatory Board to study the law governing the designation of ambulance primary service areas. The measure was approved and re-referred to the Finance Committee. S.F. 1119, authored by Sen. Steve Murphy (DFL-Red Wing), allows a licensing change in Goodhue County to an existing ICF/MR. The measure was re-referred to the Finance Committee. S.F. 1234, sponsored by Sen. Linda Higgins (DFL-Mpls.), modifies licensure requirements for occupational therapists whose licenses have lapsed for more than four years. Members approved the bill and sent the measure to the full Senate.
The evening portion of the hearing was dominated by the debate on a bill to prohibit tobacco use in a state regional treatment center, the Minnesota Security Hospital, the Minnesota sex offender program or the Minnesota extended treatment options program. The measure, S.F. 1329, authored by Sen. Leo Foley (DFL-Coon Rapids), sparked considerable discussion, but was approved and sent to the full Senate.
S.F. 1266, authored by Kiscaden, makes several changes to provisions relating to licensed home care agencies. The bill permits a single background study for home care provider employees, excludes licensed home care agencies from the supplemental nursing services law and excludes certain home care agencies from state survey requirements. The bill was approved and advanced to the Senate floor.
S.F. 1053, carried by Sen. Yvonne Solon (DFL-Duluth), modifies wholesale drug distributor requirements. The measure requires manufacturers to report pharmaceutical pricing criteria such as average wholesale price, wholesale acquisition cost, average manufacturer price and best price as defined in federal law. The measure was approved and advanced to the full Senate.
Members also discussed but laid over two additional bills. S.F. 443, authored by Kiscaden, expands adult foster care licenses capacity. S.F. 1041, sponsored by Sen. Linda Berglin (DFL-Mpls.), makes numerous changes to continuing care provisions.
The committee, chaired by Sen. Becky Lourey (DFL-Kerrick), discussed bills ranging from the definition of cremation to the licensing of alcohol and drug counselors.
S.F. 394, the Minnesota Fair Health Plan Contracting Act, generated considerable discussion. The bill, authored by Sen. Dallas Sams (DFL-Staples), modifies prior authorization requirements for health care services, establishes requirements for provider contracting, modifies provisions for payment of claims and regulates utilization profiling. The major portion of the bill sets requirements surrounding provider contracting procedures. Gord Holton, representing the Provider Coalition, spoke in support of the measure. However, David Haugen, Dept. of Employee Relations, expressed concern that the measure could impact the collective bargaining process. Members adopted an amendment to exempt state public health programs from the bill. The measure was approved and re-referred to the Commerce and Utilities Committee.
Members also completed work on S.F. 448. The bill, sponsored by Sen. Sheila Kiscaden (IP-Rochester), had been heard previously by the committee. The panel adopted an amendment deleting provisions relating to an independent informal dispute resolution process. Another amendment was adopted relating to waiving physician involvement in determining the interval for checking incontinent residents. The bill was approved and sent to the Senate floor.
A bill expanding the definition of cremation was also considered. S.F. 394, authored by Sen. David Senjem (R-Rochester), specifies that cremation means the reduction of a body to essential elements through direct exposure to intense heat and flame or a combination of heat and alkaline hydrolysis. Senjem said the combination of heat and alkaline hydrolysis is a new technology and is environmentally sound. Members, however, said that consumers know what cremation means and expanding the definition to include another process is confusing. David Benke, Dept. of Health, said the department wanted to include the new process in statute so that regulatory and consumer protection provisions apply. The bill was laid over in order to work out language that is agreeable to all parties.
The committee approved two bills authored by Sen. Steve Kelley (DFL-Hopkins). S.F. 1019 is an attempt to get at the problem of preventable medical errors, Kelley said. "The bill establishes a reporting system for adverse health care events and lists 27 events that should never happen," Kelley said. The events range from leaving surgical devices inside a patient to death or injury caused by the administration of the wrong drug. The bill sets up a reporting system for such events and requires reporting of corrective actions. The measure was supported by representatives of the Minnesota Hospital Association and the Minnesota Nurses Association. The bill was re-referred to the Finance Committee. S.F. 913,establishes qualified eligibility clearinghouses to provide eligibility data to health care providers. Kelley said the measure is aimed at reducing health care costs through the use of information technology. However, Phil Griffin, representing Preferred One, and Phil Stahlberger, representing Blue Cross and Blue Shield, said their organizations were concerned about increased costs. Kelley said the idea is to provide one point of contact of eligibility information. The bill was re-referred to the Judiciary Committee.
S.F. 985, authored by Lourey, changes the requirements for licensure of alcohol and drug counselors. The bill creates licensure for tier I and tier II counselors, modifies education requirements and creates a Board of Alcohol and Drug Counselors. The measure was approved and re-referred to the State and Local Government Operations Committee. S.F. 1066, sponsored by Kiscaden, modifies social work license requirements and the payment of fees. The measure was approved and sent to the Finance Committee.
S.F. 1043, authored by Sen. Leo Foley (DFL-Coon Rapids), makes numerous technical changes to provisions relating to state-operated services. The measure was approved and recommended for placement on the Consent Calendar.
The final measure, S.F. 1043, sponsored by Sen. Brian LeClair (R-Woodbury), makes numerous technical changes to provisions relating to the Dept. of Human Services, the Dept. of Health, health care and long-term care programs. The measure was approved and re-referred to the Finance Committee.
S.F. 448, sponsored by Sen. Sheila Kiscaden (IP-Rochester), modifies nursing facilities regulatory requirements and standards. The measure expands the temporary rule waivers for nursing facilities, establishes a standard for checking incontinent residents, authorizes an informal dispute resolution process and allows nursing homes participating in the alternative payment system to develop their own quality improvement process. Kiscaden offered an amendment that eased concerns of several individuals who opposed the original provision relating to temporary rule waivers. Members discussed various provisions of the bill and heard testimony on the measure. The bill was laid over for further discussion.
In other action, the committee, chaired by Sen. Becky Lourey (DFL-Kerrick), approved a bill authorizing pharmacists to administer influenza and pneumococcal vaccines. S.F. 574, authored by Sen. Linda Higgins (DFL-Mpls.), expands the scope of practice for pharmacists to participate in administration of the vaccines to individuals over 18 years of age under standing orders from a licensed physician or by written protocol with a physician provided that the pharmacist is trained for the administration of immunizations or graduated from a college of pharmacy in 2001 or later and the pharmacist reports the administration of the immunization to the patient's primary physician or clinic. Julie Johnson of the Minnesota Pharmacists Association, Todd Sorenson of the College of Pharmacy and Diane Peterson of the Immunization Action Coalition spoke in support of the bill. Peterson said her organization's goal is for a 90 percent rate of immunization by 2010. However, Peterson said, the current rate of immunization is much lower and that racial and ethnic minorities have an even lower rate of immunization. Peterson said more people are likely to be immunized in a non-traditional setting such as a pharmacy. The bill was approved and sent to the Senate floor.
Members also approved two additional bills. S.F. 479, authored by Sen. Cal Larson (R-Fergus Falls), allows certified public accountants to perform annual audits for county nursing homes. The measure was recommended for placement on the Consent Calendar. S.F. 609, sponsored by Sen. David Knutson (R-Burnsville), provides for a planned closure rate adjustment for a 26-bed facility that voluntarily delicensed its beds in June 2002. The measure was re-referred to the Finance Committee.
S.F. 335, authored by Sen. Linda Berglin (DFL-Mpls.), extends the food assistance program to noncitizens who are 50 years of age or older beyond the current cut-off date of July 1, 2003. The measure also deletes current language that requires counties to count $100 of the value of public housing subsidies as unearned income for MFIP purposes. In addition, the bill alters the 60-month time limit exceptions to include certain participants. The bill also adds an extension for participants who have complied with the program, but have not obtained employment that results in a wage equal to or exceeding 120 percent of federal poverty guidelines.
Berglin said she wanted to place the eligibility extensions before the Finance Committee. "Obviously, when the bill gets to Finance, some hard choices will have to be made. The TANF budget is very challenging this year," Berglin said.
Linden Gawboy of the Welfare Rights Committee, Minh Ta of the Children's Defense Fund and Karen Kingsley of the Affirmative Options Coalition spoke in support of the bill. Gawboy said, "It's right to prevent hunger and it is right to prevent homelessness. The current $100 cut is a dramatic decrease in income for a two-person family." Kingsley said the bill strengthens those aspects of the program that are helping people move out of poverty.
Sen. Sheila Kiscaden (IP-Rochester) said, "We seem to revisit some issues every year. This proposal, in particular, cannot be done with our limited resources." Berglin responded that although there are going to be difficult choices made, she wanted the bill to be before the Finance Committee in order to do as much as possible.
The bill was approved and re-referred to the Finance Committee.
Members, chaired by Sen. Becky Lourey (DFL-Kerrick), devoted the remainder of the meeting to hearing public testimony on Article I of the governor's health and human services budget bill.
John Currey of the Minnesota Center for Environmental Policy and Dr. David Wallinga of the Institute for Agriculture and Trade Policy spoke in support of the measure. Wallinga said, "Pesticides are poisonous and there is a presumption that pesticides are toxic to people. Clean groundwater is an initiative to protect children's health." Currey said, "There is scientific evidence linking pesticides and a variety of diseases, and pesticides are ubiquitous in groundwater."
Members adopted an author's amendment that altered the original bill and reinstated the Dept. of Agriculture as the agency responsible for monitoring groundwater. Greg Buzicky, Dept. of Agriculture, said the bill was improved by the adoption of the amendment. He said the department has one of the best monitoring programs in the country. Bruce Kleven, speaking on behalf of several grain growing organizations, said the organizations he represents are opposed to the bill. He said levels of detection of pesticides in groundwater have gone from parts per million to parts per trillion. Further, he said pesticides have already gone through EPA and state approval processes.
After considerable discussion about fees and the amounts raised by the bill, members approved the measure and re-referred the bill to the Judiciary Committee.
Members also approved two additional bills. S.F. 972, authored by Sen. Thomas Neuville (R-Northfield), modifies a number of child support enforcement provisions. Neuville said several of the changes were needed to comply with federal law. The measure was approved and re-referred to the Environment and Natural Resources Committee.
A bill recodifying provisions of the Dept. of Human Services Background Studies Act to improve readability and comprehension was also approved. The bill, S.F. 790, sponsored by Sen. Sheila Kiscaden (IP-Rochester), was recommended for placement on the Consent Calendar.
Kevin Goodno, commissioner of the Dept. of Human Services, said the projected increase in costs, according to forecasts, was 23 percent. Even with the cuts included in the bill, he said, spending will increase 8 percent. To achieve the cuts, Goodno said, the department examined its core mission-providing a safety net for the state's vulnerable people-and refocused its efforts on the most vulnerable Minnesotans. He said the most vulnerable include children, persons with disabilities and the frail elderly. Goodno said the department also examined funding sources and tried to focus cuts on programs that were funded only by the state. Other programs, he said, would be hit harder if state funding was reduced because matching federal money would also be lost. The department also achieved savings by reducing eligibility for programs and seeking efficiencies, he said. Current eligibility standards are the most generous of any surrounding state and will still be the most generous after eligibility is reduced, Goodno said. "We will be covering more people in FY 07 than we are today," he said.
Health Commissioner Dianne Mandernach said spending in the Dept. of Health is reduced by $36 million over the previous biennium. She said the department is also focusing on its core activities in protecting and maintaining the public's health. Mandernach said the agency is streamlining its operations and adjusting fee-based programs. The bill also includes, she said, a fundamental alteration of Minnesota's tobacco use prevention efforts. Sen. Linda Berglin (DFL-Mpls.) questioned Mandernach about the closing of Target Market and said a major shift in tobacco prevention policy requires legislative approval. She said funds appropriated for tobacco prevention in FY 02-03 were meant to achieve programmatic goals, not to cover severance costs for Target Market employees. Berglin said the governor's proposal to end Target Market is still a proposal and said authorizing the early termination of Target Market was inappropriate without legislative consultation.
Staff from both departments went through provisions in the bill for the panel, chaired by Sen. Becky Lourey (DFL-Kerrick). The bill includes changes to the state's welfare program, health programs and long-term care programs. A detailed summary of the bill, from Senate Counsel and Research, and the governor's budget documents, from the Dept. of Finance, are available.
The measure also requires hospitals to provide sexual assault victims with emergency contraception and appropriate antibiotics for STDs, if the victims request such treatment. Carla Ferrucci, Coalition Against Sexual Assault, and Dr. Lynn Hagedorn spoke in favor of the measure. Hagedorn presented new scientific information about emergency contraceptives. If a woman is already pregnant, the contraceptives do not cause an abortion or fetal abnormalities, she said. David Feinwachs, general counsel, said the Minnesota Hospital Association has worked with the bill's proponents on improving the bill, but there are still some concerns to be addressed. S.F. 270 was re-referred to the Finance Committee.
Members, chaired by Sen. Becky Lourey (DFL-Kerrick), also approved a bill requiring health plans covering prescription drugs to provide coverage for prescription contraceptives. Sen. Ellen Anderson (DFL-St. Paul) said S.F. 269 represents "a common sense approach to contraceptive equity." The panel adopted an amendment, offered by Sen. Sheila Kiscaden (IP-Rochester), clarifying that the bill does not require coverage for over-the-counter contraceptives. S.F. 269 was advanced to the Senate floor.
S.F. 432, also carried by Pappas, requires health plans that offer maternity benefits to provide coverage for doula services provided by a certified doula. The bill defines doula services as childbirth education and support services, including emotional and physical support, provided during pregnancy, labor, birth, and postpartum. President of the Childbirth Collective Susan Lane, Peg McCoy of HCMC, Jessica Atkins of the Family Centers Doula Program in St. Paul and Julie Lentz, a registered nurse who used a doula in the birth of her son, spoke to the benefits of using doulas. Carolyn Jones, Minnesota Chamber of Commerce, and Kathryn Kmit, Minnesota Council of Health Plans, spoke against the measure. Jones said the chamber opposes additional mandates on small employers, farmers and individuals. Mandates, she said, drive up the costs of health care and may only benefit a very limited number of individuals. Sen. Sean Nienow (R-Cambridge) offered an amendment removing the requirement for private health plans to cover services and instead requiring the commissioner of health to report on the impact of the mandate on private insurers. The amendment was not adopted. S.F. 432 was re-referred to the Committee on Commerce and Utilities.
The panel approved S.F. 155, sponsored by Sen. Charles Wiger (DFL-North St. Paul), clarifying that health plans must provide coverage for hearing aids for children with hearing loss due to a congenital malformation of the ears. Parent Patty Teachout spoke on the need of consistency in plans and said her health plan indicated it would cover surgery, which will not help her son, but not the hearing aids that will help him. The bill was advanced to the Finance Committee.
Members also advanced S.F. 357 to the Finance Committee. The bill, authored by Lourey, modifies the dental loan forgiveness and the donated dental services programs. Kiscaden offered an amendment, adopted by the committee, waiving the clinical examination requirement for dentist licensure if an license applicant has completed a one-year postdoctoral dental residency accredited by the American Dental Association. The panel also adopted an amendment, offered by Lourey, creating limited faculty licensure and full faculty licensure for foreign-trained dentists who teach at dental schools in the state.
Kiscaden offered an amendment to the bill to address concerns raised at a previous hearing on the issue. The amendment restricts the practice of denturism to public health settings, requires denturists to ensure that prospective patients have received a certificate of oral health within 60 days and requires the Dental Access Advisory Committee to report to the Legislature, by Feb. 1, 2006, on the quality of denturist services, the cost effectiveness of denturists and the overall effect on dental access of having licensed denturists. The panel adopted the amendment.
Dr. Tim Peterson, a licensed prosthodontist, said denturists pose a significant health and safety risk. He said dentists would rather see legislative efforts to encourage more people to become dental lab personnel than the creation of another professional tier. Marshall Schragg said the Board of Dentistry has several concerns: the lack of standardized, accredited training programs in denturism; the lack of standardized competency testing; and the lack of coordination between denturists and other dental professionals, since denturists will not be governed by the Board of Dentistry. However, Dr. Carl Ebert said Dept. of Human Services data shows that only 35 percent of Minnesota dentists provide some level of public health services. He said Legislators must take decisive steps to improve dental access for the poor and elderly. Denturism is a safe, effective and cost effective alternative, he said. He noted that denturism students take over 2.5 times as much course work in teeth replacement as dental students.
Members also considered four other bills. Sen. Michelle Fischbach (R-Paynesville) carried S.F. 229. The measure expands the authority of physician assistants to include certification of physical disabilities and the ability to authorize 72-hour holds. Under an amendment, offered by Fischbach and adopted by the panel, physician assistants designated by doctors to authorize 72-hour holds must be knowledgeable, trained and practicing in the area of mental illness. The bill was sent to the Senate floor.
S.F. 593 permits adult day care providers to seek a variance to provide respite care. Under the bill, authored by Sen. Michele Bachmann (R-Stillwater), providers may expand their capacity by only one bed to provide respite care. Bob Johnson, an adult day care provider, and Jackie Cunningham Zierdt, who cares for her elderly parents, testified in support of the bill and discussed the need for respite care. The bill was re-referred to the Finance Committee to determine if it has a fiscal impact.
Sen. Linda Higgins (DFL-Mpls.) carried S.F. 433, which provides for dementia treatment training for employees of nursing homes and home care providers. Under the bill, care providers offering services specifically for persons with Alzheimer's disease or related disorders must train staff and supervisors in dementia care. Information regarding the training must be provided to consumers, under the measure. Iris Freeman, representing the Alzheimer's Association, said staff training is the highest concern of families placing individuals with dementia in nursing homes or other care. She said the measure will provide facilities with latitude regarding the required training and will improve consumer and employee satisfaction. The bill was advanced to the Senate floor.
Committee Chair Becky Lourey (DFL-Kerrick) carried S.F. 357. The bill transfers the donated dental services program from the Board of Dentistry to the Dept. of Health, exempts retired dentists participating in the program from continuing education requirements, expands the duties of dental hygienists and dental assistants in restorative procedures, modifies the duties of the Dental Access Advisory Committee and requires a study on the feasibility of developing urgent care dental clinics. The bill was laid over for further consideration due to time constraints.
S.F. 425, sponsored by Sen. Don Betzold (DFL-Fridley), codifies the process by which persons denied social services can appeal the decision. Betzold offered two amendments that addressed concerns of the Dept. of Human Services. The amendments were adopted. Kenneth Mentz, DHS, said only one concern remained, relating to Tennessen warnings and data practices. Charles Thomas, a Legal Aid attorney, reviewed the provisions of the bill for the panel. However, the bill may increase costs to health plans, said Phil Griffin, representing UCare Minnesota. He said the bill is creating more of a legal proceeding than a hearing. Claudia Brewington said the Metropolitan Inter County Association has concerns about the burdens the bill places on counties. S.F. 425 was re-referred to the Judiciary Committee.
Sen. Sheila Kiscaden (IP-Rochester) carried S.F. 397. The bill removes a sunset from the Region 10 quality assurance project and authorizes expansion of the project outside of Southeastern Minnesota. Kiscaden said the program is a consumer-driven alternative to a regulatory approach to providing quality services to persons with developmental disabilities. John Jordan, a Houston-area farmer with a son with developmental disabilities, and Cindy Ostrowski, director of the project, discussed the successes of the project and the national attention it has received. The bill was re-referred to the Committee on State and Local Government Operations.
Members also advanced S.F. 473 to the State and Local Government Operations Committee. Sponsored by Sen. Linda Higgins (DFL-Mpls.), the bill makes the Council on Disability permanent. Current law included a sunset date of June 30, 2003, for the council, which has existed since 1973. Executive Director David Skilbred reviewed the council's recent activity and future plans. Tim Jahnke, Dept. of Finance, said the council was not included in the governor's FY 04-05 budget recommendations because of the sunset date. In speaking with the commissioner of finance, Jahnke said, he understands the administration will not oppose funding for the council.
One of the more sweeping proposals, S.F. 535, the "Fair Drug Pricing Act," provides for a drug rebate program for persons who lack prescription drug coverage. Under the proposal, participating pharmacies are required to sell prescription drugs to enrolled individuals at the pharmacy's retail price minus the amount of a rebate from the manufacturer equal to the rebate provided under Medical Assistance. Hottinger said the proposal levels the playing field and allows uninsured persons to obtain needed prescription drugs at an affordable, fair price. The bill is essentially the same as a bill passed by the Senate two years ago, Hottinger said.
The measure also sets forth the eligibility requirements for the program. The bill specifies that an applicant be a resident of Minnesota; not be enrolled in Medical Assistance, General Assistance Medical Care, MinnesotaCare or the prescription drug program; not be enrolled in prescription drug coverage under a Medicare supplemental plan; and not be enrolled in prescription drug coverage under a Medicare supplemental plan. The bill also gives the Office of the Attorney General the authority to enforce to provisions of the act.
Hottinger rebutted several of the arguments against the bill two years ago. He said opponents argued that the measure was unconstitutional. However, he said lawsuits against a similar law in Maine did not find the law unconstitutional. Hottinger said one of the arguments was that the federal government would provide a solution, but that has not happened. He also said one argument is that the bill will somehow impede research, but the reality is that 50 percent of the research is funded by taxpayers and much more is spent on advertising and marketing.
Robert Comer and Marty Gates representing the Minnesota Senior Federation spoke in support of the measure. Mike Banselow, Office of the Attorney General, said the attorney general was very supportive of the bill.
However, Marjorie Power, senior assistant general counsel, Pharmaceutical Research and Manufacturers of America, spoke in opposition. She said pharmaceutical companies participate in voluntary programs and the bill undermines that effort.
Members also discussed a bill, authored by Sen. Sheila Kiscaden (IP-Rochester), that also provides assistance for prescription drug purchases. Kiscaden said the primary difference between her bill, S.F. 398, and the Hottinger bill is that S.F. 398 requires applicants have a gross income of 250 percent of the federal poverty guidelines or less, in addition to the eligibility requirements in S.F. 535. Kiscaden said the measure has a lower cost than the Hottinger bill, but the important point is to get a program in place.
Sen. Steve Kelley moved to approve S.F. 535 and re-refer the measure to the Finance Committee. He said it is vital to get an assistance program in place. Kiscaden said she would prefer to move both bills to the Finance Committee without recommendation. She said there are proposals on the table to eliminate health insurance for 33,000 Minnesotans and it is going to be very difficult to provide funding for prescription drug assistance. Kelley responded, "I am not yet willing to concede that the governor's plan is going to be adopted by the Senate or the Legislature and that the committee should endorse the policy."
Both bills were advanced to the Finance Committee without recommendation on identical 5-4 roll call votes.
Sen. Keith Langseth (DFL-Glyndon) also carried a prescription drug measure. S.F. 444 establishes a senior citizen health benefit fund by using one percent of the medical education, the tobacco prevention and the local public health endowment accounts. The measure also expands the eligibility for the prescription drug program and establishes a task force to develop recommendations to provide financial assistance to senior citizens in obtaining prescription drugs. Kelley moved to delete the section of the bill that provides for funding from the medical education endowment account. The motion was adopted. Members also deleted a section specifying eligibility requirements. The measure was approved and re-referred to the Finance Committee.
The final measure relating to prescription drugs, S.F. 544, authored by Sen. Linda Berglin (DFL-Mpls.), was also approved and re-referred to the Finance Committee. The bill directs the Minnesota Board on Aging to establish a program to assist individuals in accessing programs offered by drug manufacturers that provide free or discounted prescription drugs or provide coverage for prescription drugs. Berglin said the board is to use a software program to link individuals with the pharmaceutical assistance programs most appropriate for the individual.
Members also discussed three additional bills. S.F. 426, sponsored by Sen. Julianne Ortman (R-Chaska), grants an exemption from the hospital construction moratorium for a hospital in Carver County. Members laid the bill over in order to gather more information about existing hospital bed capacity in the Metro Area.
S.F. 533, authored by Hottinger, provides an exception to the nursing home construction moratorium for a facility in Nicollet County. S.F. 534, carried by Hottinger, appropriates $1 million from the TANF block grant fund to provide services to families who are participating in a supportive housing and managed care pilot project. Both bills were approved and re-referred to the Finance Committee.
She said the populations most likely to be affected by this lack of access are those who depend on public programs and those whose incomes are low, but not low enough for public subsidies. Kiscaden said many of these people lack proper preventive oral health care and lose teeth. Only 79 students are enrolled in the dentistry program at the University of Minnesota, she said, and the fitting of dentures is not emphasized in the program. The bill proposes licensing for denturists, a class of professionals who specialize in fitting full and partial dentures. Kiscaden said denturists could be required to work in public health settings, as part of a dentist's practice or only by referral from dentists. Six other states and several nations license denturists, she said, including Canada, which has done so for 40 years. Public health services could be provided at a more cost-effective rate, Kiscaden said, by adding licensed denturists to the mix of service providers. Tom Jordan, Senior Federation, and Dr. Carl Ebert, a dentist, testified in favor of the bill. Ebert said dentistry is essentially a monopoly profession and that it is time to look at the marketplace to address the increasing cost of care.
Walter Warpeha said denturists are much more limited in skills and knowledge than dentists. Warpeha is a prosthodontist, or dentist specializing in teeth replacement. He said the health and safety of patients is at stake with denturists. Dental schools, Warpeha said, are not emphasizing dentures as much as they did several years ago because the public's oral health has improved and fewer people are losing teeth. Mary Dee, representing the Board of Dentistry, said the board shares Warpeha's concerns. She said denturists are not qualified to examine patients for oral health and may place dentures over oral pathology. Dee said some patients may rely solely on a denturist and ignore their other treatment options. Deborah Jacobi of the Uptown Dental Clinic noted that many people let their dental problems go untreated by a dentist.
The committee laid S.F. 179 on the table for further consideration of the issues involved in denturist licensure.
In other action, two bills were advanced by the panel. S.F. 141 provides for the licensure, rather than registration, of dental assistants. Sen. Jim Vickerman (DFL-Tracy), sponsor of the measure, said consumers and practitioners support licensing. Terri Morin, Minnesota Dental Assistants Association, said the measure is supported by the Board of Dentistry, the Dental Hygenists Association and the Dental Education Assocation. Dee said dental assistants are a vital part of the dental team. However, Dominic Sposeto said the Minnesota Dental Association is opposed to the change because there is no reason for it other than professional recognition. He noted that licensure includes a higher level of regulation that may deter people from considering a career in dental assisting. The bill was sent to the Senate floor.
Kiscaden also carried S.F. 304. The bill provides for the licensing and regulation of master's degree level professional counselors. She said Minnesota is one of four states not offering such licensure. The panel adopted an amendment, offered by Sen. Linda Berglin (DFL-Mpls.), requiring all counselors to be licensed. S.F. 304 was re-referred to the Judiciary Committee.
Sen. Wesley Skoglund (DFL-Mpls.) carried S.F. 127, which provides clarification in the authority to impose costs and penalties as a result of disciplinary proceedings for several health-related licensing boards. Sen. Steve Kelley (DFL-Hopkins) offered an amendment that addressed issues raised at a previous hearing. The amendment was adopted and the bill advanced to the Agriculture, General Legislation and Veterans Affairs Committee.
S.F. 272, sponsored by Sen. Linda Berglin (DFL-Mpls.), increases adult foster care capacity from four beds to five beds for facilities caring for persons with HIV/AIDS. Under the bill, a facility can only increase its capacity after receiving a variance from the Dept. of Human Services. The bill was sent to the Senate floor.
Sen. Dallas Sams (DFL-Staples) carried two bills. S.F. 283 requires contracts between the emergency medical services regulatory board (EMSRB) and regional EMS systems to be for four years, contingent on adequate appropriations, allows volunteer ambulance attendants to have two sets of special license plates, expands the definition of a claimant agency under the Revenue Recapture Act to include all licensed ambulance services and allows ambulance service personnel to install police radios in their private vehicles. Berglin offered an amendment deleting the first section, relating to EMSRB contracts, because it would tie the bill up in the budget process. The amendment was adopted. Sen. Leo Foley (DFL-Coon Rapids) said he was concerned about the number of people who would be eligible to install police radios and the misuse of those radios to avoid speeding tickets. O.J. Doyle, representing the Minnesota Ambulance Association, said the reality in Greater Minnesota is that having the radios allows volunteers to respond faster. Doyle said volunteers can apply for permission to install the radios from their sheriffs, but that statutory permission streamlines the process. S.F. 283 was approved and advanced to the Finance Committee.
S.F. 333, the other Sams-sponsored bill, changes the regulation of speech-language pathologists and audiologists from registration to licensure. Sams said the bill mirrors the model licensing acts of the national professional associations. Tom Keliher, representing the Minnesota Academy of Audiology and the Minnesota Speech-Language-Hearing Association, said the bill rewords the scope of practice to use more appropriate terms of art, but does not expand the scope of practice. Members adopted an amendment, offered by Sen. Sheila Kiscaden (IP-Rochester), to raise civil penalties in the bill from $7,500 to $10,000 to conform with similar penalties for other health professions. The bill was sent to the Senate floor.
A bill allowing doctors to delegate certain duties to physician assistants was tabled. S.F. 229, carried by Sen. Michelle Fischbach (R-Paynesville), permits designated physician assistants to sign disability parking permits and permits the designee of a hospital's medical officer on duty to approve an emergency admission for mental health reasons, also known as a 72-hour hold. Berglin said she was concerned by the 72-hour hold provision, because the delegation could be made to staff lacking sufficient training.
The other bill laid on the table was sponsored by Sen. Becky Lourey (DFL-Kerrick), who chairs the committee. S.F. 267 makes various modifications to the laws regulating the EMSRB. The bill was laid aside because members said they are hearing concerns about the proper role of the board and whether it is a regulatory agency or an advocate for EMS providers.
The bill, S.F. 127, authored by Sen. Wesley Skoglund (DFL-Mpls.), provides that the health related licensing boards may collect costs and penalties from individual licensees involved in disciplinary proceedings. The measure also provides for civil penalties. Discussion on the measure centered on the question of under what circumstances a board should recover costs. Sen. Sheila Kiscaden (IP-Rochester) and Sen. Steve Kelley (DFL-St. Louis Park) questioned the due process limitations and the lack of limits. The measure was laid over in order to draft amendments to address members concerns.
In other action, the committee approved a bill authorizing the Hennepin County Community Clinic to apply for essential community provider status. S.F. 39, carried by Sen. Linda Berglin (DFL-Mpls.), allows the clinic, which serves a Native American population to apply for essential community provider status and be able to be included in other provider networks. The bill was sent to the full Senate.
Members also approved a bill making modifications in health plan company purchasing alliance stop loss fund account provisions. Kiscaden, the chief author of S.F. 224, said the modifications allow purchasing alliances to accept private foundation and federal funds. In addition, the bill clarifies administrative provisions, she said. The bill was also advanced to the Senate floor.
The third bill gaining committee approval, S.F. 134, was re-referred to the State and Local Government Operations Committee. The measure, sponsored by Kelley, extends the expiration date of the Acupuncture Advisory Council, the Respiratory Care Practitioner Advisory Council, the Licensed Traditional Midwifery Advisory Council and the Health Care Professionals Services Program Advisory Council until June 30, 2007.
The nursing bill, S.F. 233, authored by Sen. Linda Higgins (DFL-Mpls.), modifies provisions relating to temporary licensure of nurses. The bill authorizes the Board of Nursing to revoke a temporary permit if the applicant is the subject of an inquiry, a disciplinary action or disqualified. The measure also allows the board to release information relating to actions taken by the board relating to issuance or revocation of temporary permits. Finally, the bill prohibits the use of the title "nurse" unless an individual is licensed to practice practical or professional nursing. The bill was approved and advanced to the floor. Later in the hearing, the measure was reconsidered in order for the committee to consider an additional amendment. The amendment, offered by Sen. Sheila Kiscaden (IP-Rochester), specifies that a graduate of a foreign nursing school who has successfully completed an approved competency evaluation is eligible to administer medications in a nursing facility upon completion of a medication training program for unlicensed personnel. The amendment was adopted. The bill was approved and sent to the full Senate.
The four bills relating to psychology, sponsored by Sen. Yvonne Prettner Solon (DFL-Duluth), were all recommended by the Minnesota Board of Psychology. S.F. 215 clarifies the definition of the practice of psychology. S.F. 217 provides that interactive, visual electronic communication may be used in supervising a licensed psychological practitioner or an applicant for licensure as a licensed psychologist. Both measures were advanced to the full Senate.
S.F. 216 provides for psychologist emeritus registration. The bill was approved and re-referred to the Finance Committee. S.F. 328 authorizes the Board of Psychology to require an independent examination of a practitioner if the board has probable cause to believe the practitioner has demonstrated an inability to practice psychology. The measure was approved and re-referred to the Judiciary Committee.
Dr. Ed Ehlinger, director of Boynton Health Service at the University of Minnesota, told Senators that public health is a philosophy of how to think about health and how to provide health care for entire populations. Ehlinger contrasted medical care with public health, noting that the major difference is the scope. While medical care deals primarily with individuals seeking treatment for specific ailments, he said, public health focuses on a population of people and seeks to prevent the spread of disease or promote healthier living.
Members also heard from representatives of public health providers, including the University of Minnesota School of Public Health, Minnesota Council of Nonprofits, United Family Practice, American Heart Association, Lifetrack Resources, Elderberry Institute, Minnesota Association of Community Mental Health Programs, Human Development Center, American Cancer Society, Women's Cancer Resource Center, Minnesota AIDS Project and Family Tree Clinic.
Lourey began the discussion by reminding members that the department's proposed rules were developed at the direction of the Legislature. Assistant Commissioner Dick Wexler presented a history and background of the proposal to collect administrative billing data. He said administrative billing data is data that comes from the bills that doctors, clinics and hospitals send to insurance companies and HMOs for services. Under the rule, Wexler said, the department would get the billing data in two parts-demographic data and health care information. The demographic data is information such as name, birthdate and address and the health care information data is information about diagnosis and procedures. He also said most of the information is in billing codes and is not a medical record.
Wexler also said the rules have not yet been adopted. The department has delayed the final step before adoption in order to give the new administration time to review the proposal. He said that all but two states have some form of administrative billing data collection. The information gained from the data is important, Wexler said, for use in studying health care costs, comparing health care providers and for managing chronic disease.
He said the department has security measures in place to separate and protect identifying information. He also said, under the proposed rules, Social Security numbers are not collected, independent security audits must be done, a committee with consumer, industry and government representatives must review all projects, only departmental researchers may access the information and information may only be released in a form that doesn't identify patients.
Wendy Nelson, from the department, explained the process for gathering and encrypting the data. Sen. Don Betzold (DFL-Fridley) said one of the problems has been that people think the rules mean gathering data and putting it on the Internet, but that is not the intent. Sen. Warren Limmer (R-Maple Grove) said there is still a lot of concern that personal information can get out. Betzold said the Legislature had previously decided to err on the side of protecting public health by gathering the data. Wexler said the department takes security concerns very seriously and the staff has worked very hard to make sure no one could ever access identifiable information.
Sen. Sheila Kiscaden (IP-Rochester) said the gathering of the data is vital to provide information about how the health care system is operating. "We hear a lot about health care costs," she said, "but we need data to be able to judge outcomes. In my mind, this is a way to help providers, payers and patients know where there good outcomes."
Nelson said funding is not in place to fully implement the rules. However, she said the department made the decision to go forward with gathering some of the data, such as hospital discharge data, rather than redo the rules process when funding does become available.
Acting Commissioner of the Dept. of Health Aggie Leitheiser said all states have immunization rules. Minnesota's first immunization law was passed in 1967, she said, and included exemptions for medical and religious reasons. Leitheiser said Minnesota expanded the exemptions to include conscientious objectors, which only 15 states have done. Leitheiser also reviewed the process required for the department to update Minnesota's immunization rules.
Schools and childcare settings are prime places for the transmission of communicable diseases, said Kristen Ehresmann. Ehresmann, a program manager with the department, said the current success in controlling previously common diseases, such as measles, is attributable to the school immunization law. She said the department is proposing rules requiring vaccination for varicella, commonly called chicken pox, for non-immune children in childcare facilities, kindergarten and 7th grade. Ehresmann said the rules also include a pneumococcal vaccination for children in childcare. The ability of parents to withdraw their children from vaccination or object to the vaccination is not changing, she said. Dr. Harry Hull, state epidemiologist, said it is important to understand that the law is not an immunization requirement, but a documentation requirement. Regardless of whether a child is immunized or not, the law requires the parent to document that choice at certain points during the child's progression through school, he said. Committee Chair Becky Lourey (DFL-Kerrick) said it isn't always clear to parents they have the right to object or withdraw. Ehresmann said the department has revised its documents to make sure the font size of text regarding parental rights is the same as that used for other information. She said the department is also requiring schools and childcare providers to use department-provided or department-approved forms so that all parents know about their right to opt out.
Ehresmann said the vaccinations the department is proposing to add are not for benign diseases. Chicken pox, she said, causes two deaths every week among healthy individuals. Prominent health organizations are recommending adding the vaccination and 35 states have done so already, she said. Pneumococcol disease, Ehresmann said, causes other severe diseases, including meningitis, and is increasingly antibiotic resistant. She said parental concerns the department heard during a series of public meetings and through comments submitted to the department's website centered on the dangers of thimerosal, a possible link between vaccinations and autism and the increasing workload of school nurses. Ehresman said thimerosal, a mercury based additive, is no longer used in routinely recommended childhood vaccines. Studies have also refuted any link between the measles, mumps and rubella (MMR) vaccine and autism, she said. The department has met with school nurses and is running pilot projects with the Minneapolis and St. Paul school districts to reduce the workload on nurses, she said.
Hull provided committee members with a history of infectious diseases and vaccination in the United States. He said that observation of trends in pneumococcol disesase has shown that voluntary use of the vaccination has substantially decreased its incidence in the Metropolitan Area. Hull said increased use of the vaccine is important to fight the serious effects of the disease-including blood poisoning and meningitis-and because pnuemococcol disease is being increasingly resistant to antibiotics. "When I was in medical school, penicillin killed every pneumococcol germ," Hull said. Now, the disease is resistant to a whole range of antibiotics, he said.
Chicken pox is also deadly, he said. It can lead to pneumonia and a suppression of the immune system, making the body more susceptible to other diseases, Hull said. One in every 100,000 children with chicken pox will die, he said, and the disease kills 1 in 5,000 adults who contract it. The vaccine is not 100 percent effective against chicken pox, but it is fully effective against the most serious forms of the disease, Hull said. Children vaccinated against chicken pox might get a very mild form of the disease, he said. Research is currently being done on the effectiveness of a two-stage vaccination, similar to the MMR vaccination plan, Hull said. So many times, he said, the department hears parents and others say "This is an ordinary childhood disease, what's the big deal?" The bottom line, Hull said, is that chicken pox is a serious disease. "We are the survivors," he said, but those who have been damaged or killed by chicken pox cannot testify.
The department's comment period will continue through the end of February, Ehresmann said. An administrative law judge will hold a hearing on the proposed rules Feb. 28. Following the hearing, the judge will hold a 20-day comment period, with a 5-day rebuttal period for the department. Within 30 days, the judge will make a ruling, she said, and the governor will have 14 days to review the rules and either veto the rules or allow the rules to take effect.
Kathleen Henry, director, Health Care Eligibility, Dept. of Human Services, outlined the four major programs: Medical Assistance (MA), General Assistance Medical Care (GAMC), MinnesotaCare, and the prescription drug program. All of the programs have residency requirements, as well as income and asset limits.
Medical Assistance is supervised by the department, but administered by county social service agencies with half of the funding from the federal government. According to Henry, MA had an enrollment of 433, 294 in December 2002. General Assistance Medical Care is also supervised by the department and administered by county social service agencies, but is entirely state funded. GAMC had an enrollment of 36,423 individuals in December 2002, Henry said. She said that the enrollees are adults, aged 21 to 64, who have near disabled or chronic conditions, a medical incident and are General Assistance recipients; residents of institutions for mental diseases; persons released by the Dept. of Corrections; or undocumented/non-immigrant children, disabled and elderly. The income limit is 75 percent of the federal poverty guideline and the asset limit is $1,000 per family, Henry said.
MinnesotaCare is the subsidized health insurance program for lower-income Minnesotans without access to private insurance, Henry said. The program is funded through a 1.5 percent provider tax, a Medicaid Waiver that provides a 50 percent match for children, parents and administration, the state children's health insurance program (SCHIP) and enrollee premiums. She said the program had 153,986 enrollees in December 2002.
Deputy Legislative Auditor Roger Brooks introduced the program evaluation of MinnesotaCare. He said that according to recent census data, Minnesota has one of the lowest proportions of uninsured residents in the nation and that public insurance plays an important role. Brooks said the auditor was directed to conduct the study to determine how accurately state and county agencies determine MinnesotaCare eligibility and set premium levels and to find out how efficiently the Dept. of Human Services processes MinnesotaCare cases.
Deborah Junod, project manager, presented the results of the program evaluation. Junod said the report found that in about one-third of cases, state and county staff made errors when determining MinnesotaCare applicants' income which resulted in many enrollees paying the wrong premium or, in a small number of cases, incorrect eligibility decisions. The report also indicates that MinnesotaCare income estimates often do not match income reported on tax returns and to the unemployment system. She said one reason the income estimates is that, by law, the estimates are made from a four-week snapshot, but individuals' incomes change throughout the year. In addition, applicants self-declare whether or not they have access to private insurance, but based on a survey of employers, the self-reported information is often not reliable.
Junod said the report concluded that the process of determining eligibility for MinnesotaCare needs to be improved, but that the means of doing so will require weighing trade-offs between cost, program access and targeting. The program evaluation recommends expediting the automated eligibility project, tightening eligibility determination policies, doing more frequent compliance reviews, assessing ways to review income mid-year, changing the law to allow mid-year premium increases and considering alternatives to self-reporting insurance eligibility.
As for the second question about how efficiently the department processes MinnesotaCare cases, Junod said the department has reduced the time to begin processing applications to less than a week, but the application process is vulnerable to large backlogs. Junod said the increase in work load, staffing issues and reliance on manual procedures are weaknesses in the procedures. Junod said the department has responded to the rapid increase in work load by increasing staff, improving productivity and reassigning staff. The program evaluation recommends the department ensure that the new electronic case management system collects performance data, develop standard productivity measures and set performance goals.
Brian Osberg, assistant commissioner for healthcare, said the auditor's report is a good management tool to improve the integrity and efficiency of the department's MinnesotaCare program. Osberg also outlined the corrective actions the department is taking to resolve the issues raised in the report. Henry said that in the long term, a majority of the issues raised in the report will be resolved through a fully automated eligibility system called HealthMatch.
Commissioner Kevin Goodno said the Dept. of Human Services accounts for 25 percent of expected 2004-05 general fund spending or about $7.6 billion. The expenditures are 42 percent for continuing care grants, 44 percent for health care grants, 5 percent for state operated services, 3 percent for economic support grants, 3 percent for administration and 2 percent for children's services. If all funds are included, the department's spending amounts to $18 billion.
Information from the department indicates that DHS touches the lives of more than one in four Minnesotans with a wide variety of services. The agency works to help those on government assistance become self-sufficient as quickly as possible and to provide a limited, but strong, safety net for the most vulnerable Minnesotans.
The panel, chaired by Sen. Becky Lourey (DFL-Kerrick), also heard from Dennis Erickson, assistant commissioner, Finance and Management Operations; Maria Gomez, assistant commissioner, Economic and Community Support Strategies/Children's Services; and Brian Osberg, assistant commissioner, Healthcare.
Aggie Leitheiser, acting commissioner, began with an overview of the mission and core functions of public health. The mission of the department is to protect, maintain and improve the health of all Minnesotans, Leitheiser said. She said the core public health functions are public health assessment, promotion of sound policies and assuring the effectiveness of those policies.
Leitheiser said while Minnesota's public health system is known as one of the best in the nation, it is built upon a strong partnership between the department and local public health agencies throughout the state.
Among the services provided by the department, Leitheiser said, are evaluations of the state's overall health, birth and death certificates, monitoring for infectious diseases, effective response to disease outbreaks and public health emergencies, preparations for detecting and responding to bioterrorism, nutritional assistance for mothers and children, testing for newborns, resources for promoting healthy pregnancies, an immunization program for preventable diseases, assistance resolving complaints with HMOs or certain other providers, planning for rural access to care, funding for a statewide poison control system and assurance of clean and safe food and water.
Leitheiser said that currently there are three strategic directions for the department. The first is to protect the public from health threats. She pointed to the monitoring of the spread of West Nile virus as an example of the department monitoring a public health threat. Secondly, the department aims to eliminate disparities in health status among various segments of the population. The third strategic direction, Leitheiser said, is to build a healthy future for Minnesotans.
The committee, chaired by Sen. Becky Lourey (DFL-Kerrick), then turned to a financial overview of the department. Assistant Commissioner David Johnson presented the budget review. He said that almost two-thirds of the department's budget is passed through to local government agencies, tribal governments and nonprofits in the form of grants. In addition, Johnson said the department has a very complex funding structure with 39 percent coming from the federal government, 18 percent from the state's general fund, 17 percent from the Medical Education Research Costs fund (MERC) and 6 percent from the tobacco use prevention endowment earnings.
Johnson also said the department has taken action for many months to prepare to assume their fair share of the burden of the current budget crisis. He said most of the cuts for the '03 fiscal year will come from the department's operating budget.
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