MMA Hits .500 With Legislative Agenda This Session

5/21/2020
The MMA advocated successfully for two of its four legislative priorities during the recently completed session. The Legislature passed measures that decrease the burden of prior authorization (PA) on physicians while ensuring timely access to drugs, procedures, and diagnostic testing for patients, as well as legislation to reduce minors’ access to tobacco and e-cigarettes.

The other two priorities – increasing vaccination rates and preventing firearm injury and death – did not progress during the COVID-19-centric session.  Given political challenges for both these issues, the MMA work on these issues was intended to set the stage for passage in a subsequent legislative session.  

“Given all that happened this winter and spring with the pandemic, it’s impressive we were able to get two of our priorities passed,” said MMA President Keith Stelter, MD. “We were able to align with legislators who truly believed in the changes we were proposing and worked determinedly to secure passage.” 

The prior authorization legislation, passed by the House on the last day to pass bills, was authored by Rep. Kelly Morrison, MD (DFL – Deephaven) and Sen. Julie Rosen (R – Vernon Center). The legislation shortens the time health plans have to make a standard PA determination from current law’s 10 business days to five business days for PAs submitted electronically, and six business days for PAs submitted by paper or fax. It also shortens expedited PA determinations from 72 hours to 48 hours, as long as at least one business day in included. The bill also shortens the time to decide appeal from 30 days to 15 days for a standard appeal. Expedited appeals remain at 72 hours.

The law requires that the physician who makes an adverse determination of a PA be not only licensed in Minnesota, but that they have the same or similar medical specialty as a provider who typically treats or manages the condition that is being requested. It is hoped that this will reduce the number of denials and appeals, while also ensuring that those individuals who review PA appeals have expertise in the procedure or diagnostic test being requested.

Before a new or amended PA requirement or restriction is implemented by a health plan, the plan must provide notice of the change to all in-network health professionals at least 45 days prior to the change becoming affective. Also, health plans cannot retrospectively revoke or limit a PA that has been provided to a patient.

To ensure continuity of care for patients, the law requires that if a patient changes health plans, an existing PA must be allowed by the new health plans for at least 60 days to allow time for the patient to meet with his or her practitioner to determine continued treatments.

Finally, the law requires health plans to post information on its website related to the number of PAs that are authorized and denied each year, along with the number that are submitted electronically and the reasons for the denials. In addition, beginning April 1, 2021, the Department of Health will report to key legislators the total number of drug PA requests, how many are submitted electronically, the length of time it takes to approve or deny a request, and the reasons for denial.

The bill is awaiting Gov. Walz’s signature, but with no organizations opposing the final bill, and with a strong bipartisan vote of support in both bodies, he is expected to sign it into law soon.

Following strong bipartisan votes in both the House and Senate, legislation to align with federal law to increase the age to purchase tobacco to 21 was signed by Walz on May 16 Passage of T21 has long been a priority of the MMA, many medical specialty societies, tobacco control proponents, and public health advocates.  

While federal law was amended late last year to set a national age of 21 to purchase tobacco and products containing nicotine, passage of a law here in Minnesota was critical to ensure effective compliance and enforcement. Many retailers and law enforcement agencies have expressed concern about the confusion created by the intersection of state and federal law, and passage of this bill will assist in providing clarity for tobacco sellers and law enforcement alike.