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Note: The Senate Information Office has toll-free telephone numbers to enable citizens of Greater Minnesota to obtain general information about the Minnesota Senate. The telephone numbers are: 1-888-234-1112 (voice) and 1-888-234-1216 (TTY).
Update: March 26, 2004 11:45 a.m.
S.F. 1175, carried by Sen. Ellen Anderson (DFL-St. Paul), requires retailers accepting orders for a delivery sale of tobacco products to obtain a copy of appropriate government-issued identification from the purchaser, to receive payment via check or credit card, to verify the identity and age information of the purchaser and to provide the delivery service with the age of the purchaser. The retailer is also required to mark the outside of the package as containing tobacco products, under the bill. S.F. 1175 also imposes several mandates on the delivery service, including requiring the purchaser to be the addressee, requiring the addressee to sign for the package and requiring the delivery service to check the addressee's identification. The bill requires tobacco retailers making delivery sales to report monthly to the Dept. of Revenue the names and addresses of purchasers and the brands and quantities sold. The measure provides for civil penalties of up to $10,000 for consumers who falsely identify themselves and of up to $5,000 for other violations.
Anderson said the bill is modeled after a Maine law designed to restrict youth access to tobacco via online sales. She said the measure is a step back from earlier proposals that effectively banned online tobacco sales, and other delivery of tobacco to consumers, in Minnesota. Jeremy Hanson, Minnesota Smoke-Free Coalition, said the bill is also patterned after legislation being considered in Congress to ensure that tobacco retailers and consumers do not avoid taxation by conducting business online.
Amber Backhaus, Minnesota Trucking Association, said delivery companies want to do their part to curb youth access to smoking. However, she said, S.F. 1175 treats deliverers as if they are responsible for the problem. The state and delivery companies already have methods in place for delivery of alcohol to consumers, she said. The extra requirements of the bill might force private delivery companies to stop delivering tobacco products, Backhaus said, leaving only the Postal Service to make the deliveries. She said the requirements should be pared back to require an adult signature and age verification by the delivery driver. Sen. Steve Kelley (DFL-Hopkins) offered an amendment addressing the association's concerns. The amendment removes the requirement for the retailer to provide the deliverer with the age of the purchaser, does not require the purchaser to be the addressee and permits any adult to sign for the delivery, not just the addressee. The amendment also restricts the fines of up to $5,000 to tobacco retailers or distributors. The amendment was adopted.
The bill does not provide for the data classification of the reports regarding tobacco purchasers, said Sen. Sheila Kiscaden (IP-Rochester). She said the provision may unduly expose consumers making private transactions. Kiscaden also said the $10,000 fine is excessive for youths who use an adult's ID to buy tobacco. Anderson said the reporting requirement is similar to an existing requirement in federal law. Placing the requirement in state law gives the state power to enforce it, she said. The bill was approved and advanced to the Judiciary Committee. However, Kelley later moved to reconsider the bill. He said he had consulted with the chair of the Judiciary Committee and learned that there was no need for the bill to go there. Kiscaden said it was rare for the Judiciary Committee to fail to review new civil penalties. The motion to reconsider was approved. Kiscaden then offered an amendment reducing the $10,000 fine to $1,000. She said individuals should not be exposed to a fine that is double that applied to retailers. The amendment was adopted and the bill was re-referred to the Tax Committee.
In other action, committee members, chaired by Sen. Becky Lourey (DFL-Kerrick), approved several other bills. S.F. 2844, carried by Sen. Thomas Bakk (DFL-Cook), contains the recommendations of the Workers' Compensation Advisory Council. Lourey said the bill was mistakenly sent to the committee. S.F. 2844 was sent to the full Senate without recommendation.
S.F. 2103, sponsored by Sen. Dallas Sams (DFL-Staples), modifies the nursing facilities survey process. S.F. 2639, carried by Sen. Linda Higgins (DFL-Mpls.), permits members of the Council on Disability to participate in meetings by electronic means. Both bills were sent to the floor.
S.F. 2112, also carried by Higgins, establishes criteria to demonstrate that a charitable gift was not made to establish or maintain eligibility for Medical Assistance services. The bill was forwarded to the Finance Committee.
Sen. Sheila Kiscaden (IP-Rochester) offered an amendment standardizing language in the bill, requiring three members of the board be appointed by the commissioner of commerce, and requiring the board to consider coordination with or the purchase of health plans through the Minnesota Comprehensive Health Association (MCHA). Under the amendment the MCHA board of directors may consider establishment of a separate plan to purchase coverage for those enrollees who are not high risk, including the public employees and provide that enrollee premiums include the MCHA surcharge. The amendment also set forth governance requirements for the board.
Sen. Linda Higgins (DFL-Mpls.) offered an amendment to the amendment deleting the requirement that three members of the board be appointed by the commissioner of commerce. The amendment to the amendment was adopted, the amendment was adopted and the bill was re-referred to the Finance Committee.
In other action, the committee, chaired by Sen. Becky Lourey (DFL-Kerrick), considered two additional bills. S.F. 2080, sponsored by Higgins, provides regulation for outpatient surgical centers and reporting requirements for diagnostic imaging facilities. The bill was advanced to the Senate floor. S.F. 2929, sponsored by Sen. Dave Kleis (R-St. Paul), specifies patient rights and limits civilly committed sexual psychopathic personalities and sexually dangerous persons from patients' and residents' bills of rights to ensure the safety and security of the treatment facility, staff, other patients and the public. The measure was re-referred to the Crime Prevention and Public Safety Committee.
S.F. 689, sponsored by Sen. Linda Higgins (DFL-Mpls.), establishes a registration system for massage therapists and Asian bodywork therapists. The measure provides definitions, outlines required qualifications for registration, details prohibited conduct, outlines penalties and provides for rulemaking. The measure was approved and advanced to the Finance Committee. S.F. 2839, sponsored by Sen. Steve Kelley (DFL-Hopkins), exempts newly arrived refugees and asylees as defined by federal law from participating in the diversionary work program. The bill also provides that newly arrived refugees and asylees may enroll directly into the Minnesota Family Investment program (MFIP). The bill was approved and re-referred to the Finance Committee.
S.F. 2672, carried by Lourey, requires the implementation of the pharmaceutical care demonstration project. The project provides culturally specific pharmaceutical care to American Indian Medical Assistance recipients over the age of 55. The bill was approved and re-referred to the Finance Committee. A second bill, S.F. 2512, sponsored by Lourey was approved and re-referred to the State and Local Government Operations Committee. The measure makes changes to the Emergency Powers Act passed in 2002. The act sets up procedures for dealing with a public health emergency and the bill makes changes to liability protections for public health volunteers, emergency responders and provides employment protections for qualifying employees who have been in isolation or quarantine.
S.F. 2255, sponsored by Sen. Brian LeClair (R-Woodbury), phases out the nursing facility equal rates requirement. The bill allows facilities to charge private pay patient's the Medical Assistance rate plus an additional percentage. Under the bill, the rate is an additional two percent after July 1, 2004, four percent after July 1, 2005, six percent after July 1, 2006, and eight percent after July 1, 2007. After July 1, 2008, the equal rates requirement would be eliminated. The bill was opposed by the Office of Ombudsman for Older Minnesotans and Karin Allen, representing AARP. The measure was defeated on a 2-5 roll call vote.
Two measures proposing constitutional amendments were approved and advanced to the Rules and Administration Committee. S.F. 2333, sponsored by Sen. John Hottinger (DFL-St. Peter), proposes an amendment specifying every Minnesota resident has the right to basic health care and that it is the responsibility of the governor and the Legislature to implement all necessary legislation to assure affordable health care. S.F. 2305, authored by Sen. Linda Berglin (DFL-Mpls.), proposes an amendment to require the Legislature to establish a universal health care system that guarantees health care access to all citizens.
The panel also heard a bill relating to stem cell research. S.F. 2635, carried by Sen. Richard Cohen (DFL-St. Paul), sets forth a state policy on stem cell research and authorizes the University of Minnesota to spend state appropriated funds on stem cell research. Cohen said stem cell research offers great promise for new medical therapies for a wide range of chronic diseases. The bill was approved and re-referred to the Finance Committee.
A bill requiring the information provided through the Woman's Right to Know Act be medically and factually accurate was also heard. S.F. 2570, sponsored by Sen. Steve Kelley (DFL-Hopkins), defines medically and factually accurate to mean information that has been verified or supported by research conducted in compliance with accepted scientific methods. In addition, the measure requires the information to have been published in peer-reviewed journals, where applicable, or be information that leading professional organizations and agencies recognize as accurate and objective. Kelley said the bill is in response to a controversial posting on the department of health's web site linking abortion and breast cancer. The bill was approved and advanced to the Senate floor.
Members also considered a bill providing a universal health care system. S.F. 979, sponsored by Sen. John Marty (DFL-Roseville), requires the commissioner of health to establish a working group to design a universal health care system to be implemented by 2010. The measure requires a focus on preventive care and early intervention and requires the system to provide affordable access to high quality care. The bill was approved and advanced to the Finance Committee. A bill creating a children's health security program was also approved and re-referred to the Tax Committee. The bill, S.F. 2401, sponsored by Sen. Yvonne Prettner Solon (DFL-Duluth), creates a children's health security account to provide health care to all eligible children. Solon said the measure also increases the cigarette tax by $1 per pack and increases the tax on other tobacco products for 35 percent of the wholesale price to 108 percent of the wholesale price.
Several additional bills were also approved. S.F. 2504, authored by Sen. Sheila Kiscaden (IP-Rochester), specifies a health insurance purchasing alliance may define eligible employees to include seasonal employees. Under the bill, a seasonal employee is an employee who is employed on a full-time basis for at least six months during the calendar year. The measure was approved and re-referred to the Commerce Committee. S.F. 1759, sponsored by Sen. Linda Berglin (DFL-Mpls.), modifies conditions for application by health care providers for designation as essential community providers for health plan coverage purposes. The bill was approved and advanced to the Finance Committee. S.F. 1563, carried by Kiscaden, establishes the Sustainable Health Care Act and provides for reform of health care coverage and pubic programs for low-income and working Minnesotans. The bill directs the commissioner of health to prepare a report describing the feasibility of various options for assuring that all Minnesota residents have health coverage, pay for coverage according to their ability and receive appropriate health care services. The measure was approved and re-referred to the Finance Committee. S.F. 2602, sponsored by Lourey, modifies the Medical Assistance, General Assistance Medical Care and the MinnesotaCare programs by increasing income eligibility and benefits provided. The measure decreases the MinnesotaCare provider tax and increases the tax on cigarettes and tobacco products. The bill was approved and re-referred to the Tax Committee.
One measure failed to gain approval. S.F. 2468, carried by Kiscaden, increases the tax on tobacco products, reduces the MinnesotaCare tax on health care providers and eliminates the Minnesota Comprehensive Health Association assessment.
The measure directs the commissioner of human services to establish the program, to join an existing prescription drug bulk purchasing program and to consolidate drug purchasing. The measure requires the Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP) to negotiate the prices of prescription drugs purchased under the program, unless the prices are negotiated by an agent of an interstate prescription drug bulk purchasing program. The bill also requires the commissioner to direct MMCAP to negotiate with state-approved Canadian pharmacies or wholesalers the prices to be charge to Minnesotans who purchase their drugs from Canada under Minnesota's prescription drug importation program. The bill was approved and referred to the Finance Committee.
The committee, chaired by Sen. Becky Lourey (DFL-Kerrick), devoted the balance of the hearing to discussing bills dealing with licensing issues. S.F. 2351, sponsored by Sen. Sheila Kiscaden (IP-Rochester), makes technical changes to licensing requirements for speech-language pathologists, audiologists and occupational therapy practitioners. The bill was designate as the vehicle for all the licensing related bills.
S.F. 1985, sponsored by Sen. Jane Ranum (DFL-Mpls.), provides for registration of physician assistants under limited circumstances. S.F. 2089, carried by Sen. Dallas Sams (DFL-Staples), clarifies definitions and license requirements for podiatric medicine. S.F. 1924, also carried by Sams, authorizes physician assistant registration before the completion of a physician and physician assistant agreement and authorizes physician assistants to perform radiography.
S.F. 1865, sponsored by Sen. Linda Higgins (DFL-Mpls.), authorizes the delegation of duties to speech-language pathology assistants and modifies provisions for speech-language pathology and audiology. S.F. 1968, authored by Lourey, modifies provisions relating to dentist licensure and dentists specialty licensure and clarifies malpractice insurance requirements. S.F. 2394, sponsored by Sen. Linda Berglin (DFL-Mpls.) modifies licensure provisions for registered nurses and advanced registered nurses.
All of the bills were amended into S.F. 2351. The bill was approved and advanced to the Finance Committee.
The committee also began discussion of a bill providing for massage and Asian bodywork therapists registration and regulation. S.F. 689, carried by Higgins, was laid over for further discussion.
S.F. 2091, sponsored by Sen. Dallas Sams (DFL-Staple), requires a pharmacist to provide to the purchaser, for each prescription dispensed where part or all of the cost of the prescription is being paid or reimbursed by a group purchaser, the person's co-pay amount and the usual and customary price of the prescription or the amount the pharmacy will be reimbursed for the drug by the person's employer-sponsored plan or health plan company. Sams said the bill provides a realistic picture of the cost prescription drugs. The bill was approved and advanced to the Senate floor.
The panel also approved a bill clarifying that a pharmaceutical manufacturer, medical supply or device manufacturer, health plan company or pharmacy benefit manger is prohibited from offering or paying any remuneration, to any individual to induce the individual to purchase or order a specific prescription drug, medical supply or medical equipment. S.F. 2150, sponsored by Sen. Sheila Kiscaden (IP-Rochester), also clarifies that nothing in state law shall be construed to prohibit an individual from receiving a discount or other reduction in price as long as the discount is provided directly to the person in connection with the purchase of a prescription drug, the person is not enrolled in any state and federal health care program and the discount is not more than the price of the prescription drug. The measure was approved and sent to the Senate floor.
Kiscaden also carried a bill, S.F. 2192, modifying the authority to dispense controlled substances. The measure clarifies that a controlled substance may be dispensed with a prescription written by a person lawfully licensed to prescribe in the state or by a practitioner licensed to prescribe controlled substances by the state in which the prescription is issued. The bill was amended to require a report from the health-related licensing boards for a competency-based education and assessment program for professionals authorized to prescribe, dispense or administer prescription drugs. The measure was also sent to the full Senate.
S.F. 1970, sponsored by Lourey, authorizes the commissioner of human services to collect interest on rebates from the drug rebate program. The bill was advanced to the Finance Committee. S.F. 1971, also carried by Lourey, requires prescription drug manufacturers to report to the commissioner of human services their marketing expenses in Minnesota. The measure also provides enforcement authority and sets a penalty. The bill was advanced to the Judiciary Committee.
S.F. 1627, authored by Sen. Linda Higgins (DFL-Mpls.), prohibits any persons from knowingly and intentionally soliciting or receiving any remuneration, including kickbacks, bribes or rebates in return for referring an individual to a person for the furnishing of health care, in return for purchasing, leasing or recommending purchasing any health care related good, facility or service or from offering or paying any kickback, bribe or rebate. The measure also sets both criminal and civil penalties. The bill was approved and re-referred to the Crime Prevention and Public Safety Committee.
S.F. 2365, sponsored by Sen. Steve Kelley (DFL-Hopkins) makes changes to the adverse health care events reporting requirements. The bill was approved and advanced to the floor. S.F. 2657, sponsored by Lourey, decreases the county share of financial responsibility for precommitment confinement costs for sexually dangerous persons and persons with sexual psychopathic personalities. The bill was forwarded to the Finance Committee. S.F. 2225, carried by Sen. Linda Berglin (DFL-Mpls.), creates an employment option for persons committed to a sexual psychopathic personality treatment center in order for patients to contribute to their cost of care in the center. The bill specifies that the earnings generated be divided between the inmate and the center. The bill was also re-referred to the Finance Committee.
The committee also approved a bill authorizing a long-term care partnership program. S.F. 2360, sponsored by Sen. Linda Berglin (DFL-Mpls.), authorizes the commissioner of human services and commissioner of commerce to establish the long-term care partnership program through a combination of private insurance and Medical Assistance. Berglin offered an amendment, which the panel adopted, authorizing a Programs for All-Inclusive Care for the Elderly (PACE), under federal laws and regulations governing that program and participating providers. Berglin said Minnesota was one of just a few states that did not have a PACE program. The bill was approved and advanced to the Senate floor.
Two measures were recommended for the Consent Calendar. S.F. 1671, sponsored by Sen. Mee Moua (DFL-St. Paul), places the term "assisted living facility" into statute as a formal means of referring to registered housing with services establishments. Many long-term care insurance policies refer to assisted living facilities, but in Minnesota such facilities are called housing with services. The change is to make the terms equivalent for purposes of long-term care insurance. S.F. 1604, sponsored by Berglin, requires a planned nursing facility closure to have no cost to the department. In addition, the measure was amended to include the contents of S.F. 1605. The bill, also carried by Berglin, requires the Dept. of Human Services to adjust nursing facility payment rates under specific circumstances.
Members also approved a bill providing for a review of hospital moratorium exceptions. S.F. 1835, authored by Sen. Michelle Fischbach (R-Paynesville), specifies that a hospital seeking to increase its number of licensed beds or an organization seeking to obtain a hospital license must submit a plan to the commissioner of health. Fischbach said the bill does not remove the responsibility of approving exceptions from the Legislature, but allows for impartial gathering of information. The bill was sent to the full Senate.
S.F. 2077, authored by Sen. Steve Kelley (DFL-Hopkins), permits the derivations and use of human embryonic stem cells, human embryonic germ cells and human adult stem cells from any source for research and experimentation. The bill requires health care providers treating patients for infertility to provide patients with timely, relevant and appropriate information to allow the patient to make an informed an voluntary decision regarding the disposition of any embryos remaining after fertility treatment. It is illegal, under the bill, to purchase or sell embryonic or cadaveric fetal tissue for research. The bill permits the donation of embryonic or cadaveric fetal tissue for research.
Kelley said the measure is a balanced approach to a controversial issue. Minnesota has made a lot of progress with research on adult stem cells, he said, but more opportunities are available if we open up research with embryonic stem cells. The University of Minnesota has embarked on research with embryonic cells, he said, using private money. Kelley said his interpretation of current law indicates the research is legal, but others disagree. The state should clarify the law's position and clearly support all stem cell research, he said. Kelley said there are two primary reasons to support embryonic stem cell research as a matter of policy: economic and human. Future jobs depend on our success in promoting bioscience research and development, he said, and the suffering of thousands can be dramatically reduced or eliminated by new treatments. Dr. Catherine Verfaillie, University of Minnesota, said organ transplants may eventually be replaced by stem cell transplants. Because of Minnesota's sterling reputation in transplant research, she said, Minnesota is poised to be a leader in the area. She said some success has been had in using adult stem cells, but the adult cells are not useful for every medical condition. Verfaillie admitted that researchers have encountered difficulties in embryonic stem cell research, including the development of non-cancerous tumors. "As scientists," she said, "we are committed to doing the right things for our patients." By researching the behavior of embryonic stem cells, we can learn how to make adult stem cells behave similarly, said Dr. Doris Taylor. Taylor, who specializes in cardiovascular medicine, said the heart has few stem cells. Cardiac cells are the hardest cells to create from adult stem cells, she said, but embryonic stem cells easily become heart cells.
Only a few decades ago, organ transplants were treated as something out of Frankenstein's laboratory, said Judy Florine. Florine, a kidney transplant recipient and multiple sclerosis patient, said organ transplants were considered ghoulish by many 50 years ago; now, Minnesota is a global leader in organ transplants. "I see stem cell research as where we were with organ transplantation 50 years ago," she said. Florine said every step in the research envisioned in the bill is voluntary: from embryo donation to using the treatments developed. Medical innovation has been the sole source of new manufacturing jobs in recent years, said Phil Griffin, representing Medical Alley. Minnesota is now second only to California in medical device jobs, he said, and growth in the medical device industry is intimately tied to research at the University of Minnesota.
Sen. Linda Berglin (DFL-Mpls.) said the state faces huge projected costs for long-term care. The only hope we have to reduce those costs and help people may be in the results produced by stem cell research, she said, especially in treatments for Parkinson's disease. However, the scope of the bill is breathtaking, said Sen. Sean Nienow (R-Cambridge). We do not serve the public interest by allowing cloning to get stem cells, he said, or by allowing research without an explicit limit. Nienow said research is rapidly advancing using adult stem cells. One researcher has said that the use of embryonic stem cells will eventually appear old-fashioned compared to the possibility of using a patient's own adult stem cells, Nienow said.
In other action, committee members approved S.F. 2438. Carried by Sen. Linda Higgins (DFL-Mpls.), the bill provides a 2.5 percent rate increase for nursing facilities and various community-based providers. The additional money must be used to increase compensation for non-management employees or add non-administrative staff, under the bill. Higgins said the proposal essentially provides a cost of living adjustment for employees and is an attempt to resolve the staff crisis in long-term care. Sen. Brian LeClair (R-Woodbury) said he agreed that nursing homes are not getting enough money. He said members and the public should be aware that the bill raises rates for both government-paid patients and private-pay patients. The bill was approved and re-referred to the Finance Committee on a 7-0 roll call vote.
The primary cause of childhood lead poisoning is poorly maintained older housing, said Don Gifford, a professor of law at the University of Maryland. The bill does not envision a total removal of lead paint from older homes, he said, but implements a less expensive series of measures to reduce the risk of lead exposure. Maintaining records of lead screenings, as included in the bill, allows public health officials to target their efforts, Gifford said. Sue Gunderson, Sustainable Resources Center, also spoke in support of the bill.
Jack Horner, Minnesota Multi-Housing Association, argued against the bill and said, Minnesota currently has a model law, which has been crafted over 25 years, to deal with lead poisoning. He said the bill takes a dramatically different approach to dealing with the issue. "The bill is a bold attempt by large paint companies to shift liability to homeowners and landlords," Horner said.
The measure was approved and re-referred to the Judiciary Committee.
Members also took action on a variety of other bills. S.F. 2196, sponsored by Sen. John Hottinger (DFL-St. Peter), extends the expiration date of a supportive housing and managed care pilot project until 2007. The measure was approved and advanced to the Finance Committee. S.F. 2308, carried by Sen. Thomas Bakk (DFL-Cook), converts some loans made under the rural hospital capital improvement grant and loan program to grants. The bill was approved and sent to the full Senate.
S.F. 2242, authored by Sen. Sheila Kiscaden (IP-Rochester), clarifies the implementation of a birth defects information system. S.F. 1875, sponsored by Sen. Linda Berglin (DFL-Mpls.), modifies requirements for a relative search in out-of-home placement cases. The bill specifies that a relative's decision to not be a placement resource at the beginning of the process does not affect whether the relative is considered for placement of the child at a later date. The measure was approved and re-referred to the Judiciary Committee.
Two measures sponsored by Lourey were approved and re-referred to the Finance Committee. S.F. 2477 reduces the co-payment for General Assistance Medical Care inpatient hospitalization services from $1,000 to $100. S.F. 2615 repeals the family cap for Minnesota Family Investment Program recipients.
S.F. 570, carried by Sen. Sean Nienow (R-Cambridge), permits parents or guardians to access the health records of their minor children, unless the child has been living apart from the parents or is married. The bill also repeals provisions permitting minors to give consent for health care services involving treatment for pregnancy, sexually transmitted diseases and substance abuse. Teresa Collett, a professor of law at St. Thomas University, said current law allows minors of any age to give medical consent and close access to their parents. The parents, she said, may witness side effects of the treatment, but be completely unable to get information they need to help their children. Children often do not provide physicians with a complete medical history, Collett said, which could lead to dangerous consequences. There are abusive family situations, but that should not be default assumption about families under the law, she said. Sara, a 17-year-old, said her sister had an allergic reaction to birth control medication and collapsed in school. The Planned Parenthood clinic where she obtained the medication denied, to her parents, ever treating her sister, Sara said. Sara said she went to a clinic during school hours without parental consent. Hiding information about her sexual and substance abuse habits, Sara said, only kept her bad behavior going. "The clinic was my secret drug dealer," she said, "they supported my habits." Kresti Lyddon, Minnesota Family Council, said parents are involved in all the other medical decisions for their children, including long and difficult courses of treatment. Parents better understand treatment options, know the family's health history and are likely to ensure the child follows through on the prescribed treatment, Lyddon said.
Representatives of several health associations spoke against the measure and warned that removing minors' ability to consent will result in fewer minors seeking treatment at all. Margaret Dexheimer Pharris, Minnesota Nurses Association, said responsible health professionals encourage minors to talk to their parents. Current law, she said, allows practitioners to get the minor in the door and considering treatment, while also developing a trusting relationship with the practitioner. Dr. Edward Ehlinger, director of Boynton Health Services at the University of Minnesota, said students are not permitted to leave school grounds, in Minneapolis, for medical reasons without parental permission. There is no evidence, he said, that the confidentiality afforded to minors decreases the connectedness between parents and children. Ehlinger said the availability of confidential health care services does not increase high risk behaviors among minors.
Both sides agree we need to help parents communicate with children, Nienow said. He said current law is antithetical to the notion. Policymakers should ask themselves to what extent dangerous behavior could be tempered if children knew their parents had to be involved in resolving the consequences of that behavior, Nienow said. "To what extent does current law enable behavior that is dangerous and potentially lethal," he said. The opposition to the measure presumes that parents will react negatively and abusively toward their children, he said, though that is likely to be far from the case.
In other action, committee members approved three bills.
S.F. 1665 is an aggressive approach to the problem of unintended pregnancies, said Sen. John Marty (DFL-Roseville), chief author. The bill requires the Dept. of Education to develop a plan to ensure that all school districts provide comprehensive family life and sexuality education by the 2008-2009 school year and establishes a competitive statewide after-school enrichment grant program. At a reasonable time before or after an abortion is performed, the health care facility must provide the woman information on FDA-approved contraceptive methods, natural family planning and referral information on community resources providing family planning counseling at no or reduced cost, under the bill. S.F. 1665 requires the Dept. of Health to include on its website information on contraception and family planning. The bill also requires the Education Now and Babies Later (ENABL) program to be taught through a comprehensive sexuality education program that promotes postponing sexual activity and promotes male sexual responsibility. Marty said the measure ensures that family planning information is available across the state and will prevent more abortions than all the abortion restrictions enacted over the last 30 years. The bill was re-referred to the Education Committee.
Sen. Steve Dille (R-Dassel) carried S.F. 1990, which requires information on FDA-approved methods of contraception and family planning to be provided to women within a reasonable time before or after an abortion. Dille said data about the number of abortions performed, the likelihood that women had used contraception at the time of conception and the number of women who have more than one abortion led him to believe a greater focus is needed on preventing unintended pregnancies. S.F. 1990 was advanced to the Senate floor on a 6-2 roll call vote.
S.F. 2381 eliminates smoking in all public places, including places of employment, public transportation and public meetings. The bill, sponsored by Sen. Scott Dibble (DFL-Mpls.), defines a place of employment as any indoor area, including vehicles, where two or more persons work. The measure also expands the definition of public places to include bars, outdoor seating at restaurants and bars, youth centers and youth detention facilities. S.F. 2381 prohibits proprietors from providing smoking equipment, including matches and ashtrays, and expands the ban on smoking in schools from K-12 institutions to all public and private education institutions, including colleges and universities and their grounds. The bill does not prohibit smoking in private residences, automobiles or hotel rooms. Local units of government may adopt more stringent anti-smoking policies, under the bill. Dibble said the measure is "a long delayed update to the Clean Indoor Air Act." Eliminating smoking in public places is good for individual health, public health and business, he said. Dibble said hospitality workers, such as cocktail servers, should not be singled out for exposure to carcinogens. The public is crying out for a smoking ban, he said. Carla Blumberg, a restaurant owner in Duluth, said the city's smoking ban has not adversely affected business. The issue is not one person's right to smoke, she said, but the right of others to avoid secondhand smoke. Making money from smoking is not a sound business decision, Blumberg said.
However, Vickie Haugland said everything is not wonderful in Duluth. Haugland, who also owns a restaurant, said numerous small businesses have been forced to close because business dropped off after the city's ban went into effect. Some chain restaurants, she said, have seen business grow, but even a chain restaurant that was open around the clock decided to close at night because of a lack of business. Many smokers, Haugland said, have chosen to drive to neighboring Superior, Wis., to eat and drink. "Smoking policy is best left to individual establishments, rather than being set by a government mandate," said Tom Day of Hospitality Minnesota. "It is not fair to make restaurateurs alienate a portion of their customers," he said. "There are many choices of types of restaurants, and customers should have a choice of whether to smoke or not," Day said. He noted that many restaurants are voluntarily becoming entirely smoke-free. As demographics change and fewer diners want to smoke, the issue will become moot, he said.
S.F. 2381 was approved and advanced to the full Senate.
S.F. 1789, authored by Committee Chair Becky Lourey (DFL-Kerrick), makes employees of political subdivisions, and the parents of the spouse of a current or former public employee, eligible to enroll in the long-term care (LTC) insurance program. Lourey said more citizens, including public employees, need to be made aware of the importance of planning for their future. Offering more people the ability to enroll in the group LTC insurance program, she said, draws more people into the program and encourages others to shop around in the private market. Sen. Linda Berglin (DFL-Mpls.) offered an amendment requiring the state to solicit new bids from qualified vendors whenever new groups are made eligible for coverage. The amendment also requires the Dept. of Employee Relations to obtain information-including names and home addresses-of eligible persons so that contractors can mail enrollment materials. The amendment was adopted. This is not an education program, but a sales program administered under the auspices of the state, said Sen. Brian LeClair. It is counterproductive to the goal of bringing a third party-private insurance-into the mix of paying for long-term care costs, he said. LeClair also questioned the data privacy implications of the information sharing with program contractors.
In other action, the committee approved three other measures. S.F. 1716, carried by Sen. Tom Saxhaug (DFL-Grand Rapids), provides an exception to the hospital construction moratorium for a project to add 14 new beds for rehabilitation services in an existing Itasca County hospital. S.F. 2179, sponsored by Sen. Sheila Kiscaden (IP-Rochester), makes numerous changes to the Human Services Licensing Act, which was enacted last year. Both bills were advanced to the Senate floor. Sen. Dan Sparks (DFL-Austin) carried S.F. 2020. The bill authorizes an exception to the nursing home construction moratorium for a new 60-bed facility in Austin. Of the new beds, 45 are transferred from a closed 45-bed facility in Austin and 15 are transferred from a 182-bed facility in Albert Lea. The bill also requires that 20 of the new beds be used for a special care unit for persons with Alzheimer's disease or related dementias. S.F. 2020 was re-referred to the Finance Committee.
"The bill has several components," Berglin said, "but a lot of what we are trying to do is keep people out of the deep-end of the health care system, which is the part of the system that is so much more expensive." The measure restricts health insurance premium growth rates, requires health plan companies to provide educational information on the increased personal health risks and costs due to obesity and smoking, extends the MinnesotaCare program to small employers, requires an electronic medical records system and provides bond appropriations for nursing and health care education.
Sen. Sheila Kiscaden (IP-Rochester) offered an amendment appropriating $500,000 to allow the University of Minnesota Dental School to continue to take MA patients as it has in the past. The amendment was adopted. Sen. Steve Kelley (DFL-Hopkins) offered an amendment clarifying language relating to the electronic medical record system implementation.
Kiscaden expressed concerns with several provisions in the bill. She said she was troubled by the expansion of MinnesotaCare to small employers and the caps on premiums. She said the changes may erode the private market. Berglin said the expansion of MinnesotaCare allows small employers to do something for their employees and that there has not been an erosion of the private market in other states. Sen. Brian LeClair (R-Woodbury) moved to delete the provisions capping the growth of premiums. The motion failed on a 4-5 roll call vote.
The bill was approved and re-referred to the Committee on Education on a 6-3 roll call vote.
In other action, the panel also advanced two additional bills. S.F. 1699, sponsored by Committee Chair Becky Lourey (DFL-Kerrick), modifies Medical Assistance (MA) estate recovery provisions and eliminates recoveries for alternative care cost. The measure was approved and advanced to the Finance Committee.
S.F. 1991, carried by Berglin, also modifies MA estate recovery provisions. Berglin said the bill also attempts to buy back some of the cuts made last year in the Minnesota Family Investment Program (MFIP) through changing corporate tax provisions. The bill modifies the parental fee schedule, extends MA estate recovery to apply to the alternative care program and extends MA liens to apply to life estates and joint tenancies, repeals MFIP provisions that count $50 of rental subsidy as unearned income and reduces the MFIP cash grant by $125 for each supplemental security income recipient living in the household. Members adopted several technical amendments. Lourey offered an amendment that made a number of changes to the MFIP program. A second amendment, offered by Lourey, adds county adoption assistance payments up to an amount equal to state adoption assistance payments to income exclusions for purposes of MFIP-S eligibility.
LeClair offered an amendment to delete portions of the bill relating to taxes. LeClair said the provisions are anti-job creation. Berglin said she strongly opposed the amendment. "The bill needs those provisions in order to pay for restoring the cuts," Berglin said. The amendment failed. The bill was approved on a 4-3 roll call vote and advanced to the Tax Committee.
The first portion of the hearing was devoted to hearing public testimony on the state's nursing shortage.
S.F. 1760, sponsored by Sen. Linda Berglin (DFL-Mpls.), requires the commissioners of commerce and health to establish premium growth limits for health plan companies, requires health plan companies to provide educational information to enrollees on the increased personal health risks and the additional cost to the health care system due to obesity and smoking, requires the implementation of electronic medical record systems and establishes an electronic medical record system loan program. The measure also requires the commissioner of human services to convene an advisory committee of providers who serve low-income patients to address their specific needs and concerns. The measure also provides that a clinical medical education program that trains pediatricians must include in its program curriculum training in medication management for children with mental illness in order to be eligible for MERC funds. Berglin said the measure also specifies that no health plan company is required to cover any health care service included in the list of services that do not work under evidenced based medicine.
The bill also extends the continuing care program for persons with mental illness to persons with mental illness who are eligible for General Assistance Medical Care. Berglin said the provision allows hospitalization when no regional treatment facility bed is available. The measure includes teaching at a post-secondary program for at least 20 hours in the nursing field for mid-level practitioners and nurses as an option for participation in the loan forgiveness programs.
Berglin said the bill abolishes the cap on Medical Assistance dental services, reinstates the dental benefits in the MinnesotaCare program, abolishes the co-payments in General Assistance Medical Care and reinstates the ability of individuals and families to remain on MinnesotaCare if their income increases over the maximum eligibility level but is still less than 10 percent of the annual premium for a policy with a $500 deductible available through the Minnesota Comprehensive Health Association.
The bill requires the implementation of disease management programs for Medical Assistance, General Assistance Medical Care and MinnesotaCare. In addition, the bill requires the implementation of a disease management program for Medical Assistance and General Assistance Medical Care recipients who are receiving services on a fee for service basis. The bill specifies that the commissioner establish a list of primary care providers who are qualified to act as case managers for the three most serious conditions to coordinate the care of the patients.
The measure establishes a MinnesotaCare option for small employers in order to allow the employers to offer health care to their employees. The bill spells out the requirements for participation and provides that the coverage provided is the MinnesotaCare covered services with all the applicable co-pays and coinsurance.
Sen. John Hottinger (DFL-St. Peter) explained the portion of the bill dealing with prescription drugs. He said most of the changes in the bill conform to recently passed federal legislation. In addition, the bill makes changes to the prescription drug discount program by eliminating the income limit on eligibility, making individuals who are enrolled in Medicare ineligible and changing the administration fee to an enrollment fee.
Berglin said the bill provides a rate increase of two-tenths of one percent to providers for employee scholarships and job-related training in English as a second language. The measure also requires a disease management initiative for public health care program recipients who have been diagnosed with hemophilia in order to maximize the discounted prescription drug prices of the federal 340B program.
The bill also appropriates money for a nursing education loan forgiveness program, for a nursing and health care education plan and for the electronic medical record system loan fund.
The committee heard testimony from a wide range of individuals who have experienced difficulties under the current system and as a result of cuts made last year. George Greene, owner of a small business, spoke on the difficulty of providing affordable health insurance. Individuals with hemophilia, multiple sclerosis and diabetes spoke on the hardships in coping with the $5,000 cap on drugs and medical supplies. Representatives from the Minnesota State Council on Disability, Courage Center and the National Alliance for the Mentally Ill spoke on the effect of co-pays. Bill Conley, Mental Health Association of Minnesota, and dental practitioners spoke on the limits for mental health care and dentistry imposed last year.
The panel also heard testimony in support of scholarships for nursing education and loan forgiveness. Dave Renner, Minnesota Medical Association, spoke on case management and Medical Assistance fee for service and pointed out some of the concerns of the MMA. In addition, Dr. Mary Braddoc, Minnesota Hospital Association, also pointed out concerns with the bill, including the mandate to develop electronic medical records systems and the $10,000 cap on in-patient hospital care.
Beth Hartwig, Minnesota Business Partnership, said the partnership applauds the goal of the bill, but is cautious about restraining the growth of premiums because the market place needs flexibility to properly function. She said the partnership looks forward to working to identify creative solutions to the health care crisis. Julie Brunner, Minnesota Council on Health Plans, also said her organization has concerns about the limits on health care premiums.
Members began discussing particular portions of the bill, but laid the measure over because of time constraints.
S.F. 2189, authored by Sen. Sandra Pappas (DFL-St. Paul), modifies the ban on gifts to medical practitioners from drug manufacturers. The measure lowers, from $50 to $20, the retail value of items that must be considered as gifts and narrows the list of what is not considered a gift. The bill also expands the prohibition to include practitioners' families and employees and others who could influence a practitioner's decision regarding prescription drugs and provides enforcement authority to the attorney general. Pappas said current law lacked enforcement and clear penalties. There is a high potential for fraud and abuse in the relationship between pharmaceutical manufacturers and physicians, Pappas said. Jack Geisser, Pharmaceutical Research and Manufacturers of America (PhRMA), said the bill has a chilling impact on the health care delivery system and effectively prohibits the payment of rebates and discounts to institutions. He noted the bill provides for the revocation of licenses for drug manufacturers as part of the enforcement powers. Excluding a manufacturer from Minnesota has serious impacts on patients, Geisser said, denying them access to needed drugs. Sen. Brian LeClair (R-Woodbury) offered an amendment deleting all of the bill's provisions except the enforcement language. The amendment was defeated. S.F. 2189 was advanced to the Judiciary Committee.
Sen. Linda Berglin (DFL-Mpls.) carried S.F. 1857, which eliminates requirements for county social service agencies to coordinate prescription drug programs with state agencies and reinstates coverage under the prescription drug program for drugs that may be covered under an assistance program offered by a manufacturer. The measure was re-referred to the Finance Committee.
Sen. Yvonne Prettner Solon (DFL-Duluth) sponsored two bills. S.F. 1650 requires pharmaceutical manufacturers to disclose pricing data to the Board of Pharmacy and the Dept. of Human Services as a condition of licensure. The pricing data mandated by the bill includes the average wholesale price, wholesale acquisition cost, average manufacturer price and Medicaid best price of each drug. Assistant Attorney General Michael Vanselow said many lawsuits have been brought against drug companies regarding their pricing information and attempts to defraud Medicare and consumers. In the last two and a half years, he said, the federal government and the states have recovered almost $2 billion. S.F. 1650 does not control, fix or set prices, Vanselow said. Geisser said the bill concerns confidential and proprietary data that the industry takes seriously. The information is already reported to the federal government and obtained by private data banks, he said. The provisions in the bill protecting the reported data as nonpublic information, Geisser said, are not strong enough. He urged the panel to reject the measure. Markets work more efficiently with full disclosure of information, Sen. Steve Kelley (DFL-Hopkins) said. The only reason to protect the pricing data, he said, would be to prevent drug companies from engaging in price fixing. "We should not stifle knowledge and discussion," Lourey said. S.F. 1650 was advanced to the Finance Committee.
A bill establishing four drug bulk purchasing programs was also carried by Solon. S.F. 1966 establishes an intrastate program consolidating purchasing by Medical Assistance, state hospitals and other state health care facilities, state correctional and educational facilities, the state health plan and other state and local government entities that purchase significant quantities of drugs. The bill also requires the Dept. of Human Services to establish or join an interstate purchasing program, to negotiate with Canadian pharmacies or wholesalers the prices charged to Minnesotans using the state's drug importation program and to establish a public-private intrastate bulk purchasing alliance. Paul Civello, an assistant attorney general, said the bill is a bottom-up initiative requiring the state to be a smart consumer. As a high-volume purchaser of many products, the state is expected to negotiate the best deal it can, he said.
Several representatives of business organizations expressed concerns with the bill. Liz Carpenter, representing the Minnesota Pharmacists Association, said pharmacists are not allowed to participate in any drug importation program. It is not considered a legal activity by either the federal government or insurance carriers, she said. Carpenter and Buzz Anderson, Minnesota Retailers Association, said policymakers should focus on changes that can be made to the current system and providing consumers with full information about drug costs. A bulk purchasing program forces a wide range of consumers into a one-size-fits-all system, said Julie Corcoran of PhRMA. The individual programs being consolidated into the intrastate program, she said, tailor their drug purchasing with an eye toward the populations they serve. Corcoran also raised issues with the importation provisions. "We have the safest distribution system of pharmaceuticals in the world," she said. The bill was laid on the table.
Committee members also heard testimony on recovery of Medical Assistance (MA) costs from the estates of MA recipients, on fees charged to recipients of human services programs and on Minnesota Family Investment Program grant reductions. State policies in the areas were enacted during 2003 and bills repealing or modifying the provisions-S.F. 1699, sponsored by Committee Chair Becky Lourey (DFL-Kerrick), and S.F. 1991, carried by Sen. Linda Berglin (DFL-Mpls.)-were before the committee. No action was taken on either measure.
Eileen Roberts, a professor at William Mitchell College of Law, said state policy regarding the recovery of MA costs from the estates of service recipients effectively constitutes a taking of private property for a public purpose and may be unconstitutional. The law is doubly troubling, she said, because it applies retroactively to estates planned before the law was enacted. However, Sen. Sheila Kiscaden (IP-Rochester) said people choose to apply for MA. The arrangement should be similar to entering into an agreement or a contract for public services, Kiscaden said, and not a taking of property. At the time a person applies for MA benefits, it is reasonable to expect the value of the applicant's estate to be available to pay for the costs of providing care, she said. Several members of families with estates that could be affected by the MA cost recovery law said it was unfair to change the law on them after estates had been planned. Marina Vork, a former county human services director, said previous experience with using liens on estates to recover costs of care shows a disincentive among the elderly to using alternative care options.
The Dept. of Human Services has never foreclosed on a property with an MA lien attached, said Joe Rubinstein. Rubinstein, a department staff attorney, said DHS has a file-and-forget policy. All decisions relating to the sale of the property are left to the owners, he said. Once the owners decide to sell, Rubinstein said, the state attempts to recover costs. If the value of the services received is greater than the value of the estate, the department writes off the balance, he said. He also noted the law provides for liens to last only 10 years, with an option for the department to renew the lien for an additional 10 years. Rubinstein said some families may be eligible for exceptions, including one for children living in the home providing care for their parents. The department is committed to ensuring a clear, accurate understanding of the cost recovery law, he said. Kiscaden said Rubinstein's statements make it clear the issue is communicating reality to families and counties, not the underlying policy. The bills overreach and throw out a good policy, she said.
S.F. 1573 also requires health plans to cover items and services needed to diagnose and treat complications arising from participation in clinical trials. The bill, sponsored by Sen. Linda Higgins (DFL-Mpls.), limits the coverage to clinical trials meeting the qualification process for Medicare coverage. Matthew Flory, American Cancer Society, said the measure simplifies the billing process and gives patients increased access to high quality trials. The fear of additional costs should not be a barrier between patients and potential treatments, he said. Dr. Dan Foley, chief medical officer at United Hospital in St. Paul, said the many nationally recognized centers located in Minnesota engaged in cutting edge treatment provide a direct benefit to Minnesotans. The bill, he said, equalizes the opportunity for patients of all ages to have access to clinical trials.
However, representatives of health plans and the business community said the proposal is too broad a mandate, unnecessarily interferes with the relationship between the medical community and health plans and exposes patients to unsafe clinical trials. Carolyn Jones, Minnesota Chamber of Commerce, said the qualification process for Medicare has not been fully developed and is not a standard. We should not be legislatively mandating coverage for experimental procedures without standards for quality and patient safeguards, she said. Kathryn Kmit, Minnesota Council of Health Plans, said the proposal only applies to the fully insured market. Patients covered by self-insured employers are not affected, she said, and the health plans have not been made aware of any problems with the current system for plan interaction with clinical trials. A voluntary agreement between health plans and the medical community is the only way to reach the entire market, said Dannette Coleman of Medica.
In other action, members advanced two bills. S.F. 1721, carried by Sen. Dallas Sams (DFL-Staples), is the Minnesota Health Plan Contracting Act. The measure creates a framework for contracts between health care providers and health plan companies. The measure was re-referred to the Finance Committee. Sen. Gary Kubly sponsored S.F. 1748, which modifies provisions relating to the Emergency Medical Services Regulatory Board, including board membership criteria, training program requirements, mandatory reporting requirements and longevity award criteria. The bill was sent to the floor.
Ann Kaner-Roth, Child Care Works, said cuts to child care last year were disastrous for some families. She highlighted some of the policy changes such as increased income limits for eligibility, increased fees and reduced payments to child care providers and the effect of those changes on families. Minh Ta, Childrens Defense Fund, spoke on two issues affecting families. He said the decreased availability of child care has pushed some families onto welfare rather than assisting families' efforts to get off assistance. In addition, he said, the waiting list for child care has increased markedly. Chad Dunkley, president, Minnesota Child Care Association, said the cuts fell heavily on child care providers. He said that in addition to cuts, many providers experience sharply higher fees.
Members also heard individual stories on the impact of the child care cuts from parents Mike Hines and Chris Cameron and child care provider Addie Clyde.
Lourey reviewed the cuts made to MinnesotaCare and then invited Bonnie Keeling, Duluth Family Practice Center, and Connie Walsh, United Family Practice, to speak on the impact of the cuts on their practices. Denise Koffman, a MinnesotaCare enrollee, also spoke on the way the cuts affected her health care.
Finally, members heard from Dr. Pat Foy, DDS, and Dr. Carl Ebert, DDS, on the effects of the cuts for dental services. Both said that the cuts, while saving money in the short term, lead to even greater costs in the long term.
Assistant Commissioner Brian Osberg, DHS, provided committee members with an overview of the major changes in Medicare, including the new prescription drug benefit. Representatives of members of the Minnesota Council of Health Plans discussed other aspects of Medicare and changes that are still to take effect. Members of the Greater Minnesota Health Care Coalition identified the problems they see in the Medicare changes and explained their continuing opposition to the law.
Professor Stephen Parente, Carlson School of Management, explained the health savings account (HSA) concept to the panel. The plan affects everyone, not just those enrolled in Medicare, he said. Consumer-driven health plans, such as HSAs, have seen significant growth in popularity since 2001, Parente said. At one major Minnesota employer, he noted, about one fifth of employees have selected a consumer-driven option. A sample plan requires a consumer to buy catastrophic coverage with a minimum deductible of $2,000 and the individual or employer can make pretax contributions to a health savings account of up to $5,000 per year, Parente said. While the deductible is higher than in traditional health plans, he said, the initial premium cost is much lower, which often results in far lower total costs to a consumer. Also, any money left in the HSA at the end of the year can be rolled forward, he said. The main problem with the current health care system is that consumers do not face the real cost of health care, Parente said. "We see only a $5 or $10 deductible, or a $100 copay, not the full cost of services," he said. Consumer-driver health plans solve the problem, he said, by exposing consumers to the true cost of their medical care.
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