HHS Committee Faces Difficult Task of Finding Compromise Between Senate, House Bills

May 12, 2022

The Health and Human Services (HHS) Conference Committee began meeting this week with the seemingly Herculean task of working out a compromise between the vastly different Senate and House HHS omnibus bills.   

Only 28 provisions in the House and Senate bills are considered the same or similar, while 167 provisions are only in the House bill and 81 are unique to the Senate bill. 

Of note, the Senate bill would establish a Nurse Licensure Compact, which would permit nurses to obtain multi-state licenses. The compact is strongly opposed by the Minnesota Nurses Association. The bill also includes: provisions to allow pharmacist and pharmacist techs to perform lab tests and administer certain vaccines under protocol; to streamline the criminal background check process for healthcare workers; and to implement a temporary 90-day license for individuals licensed in other jurisdictions, but new to practicing medicine in Minnesota. The Senate bill also invests heavily in nursing facilities, specifically in rate increases for long-term care, personal care attendants, and disability care providers.  

The House bill invests heavily in programs for childcare, specifically in grants for childcare centers, schools, and family childcare providers. The House proposal also includes the expansion of MinnesotaCare coverage and a “buy-in” option to allow more Minnesotans to purchase coverage through MinnesotaCare. There are many other provisions in the House’s 893-page bill – nearly twice the size of the Senate proposal. 

With very few similar items, and a much larger House bill, the 10 conference committee members face a difficult task. Conference committee members include: Sen. Jim Abeler (R-Anoka); Sen. Michelle Benson (R-Ham Lake); Sen. John Hoffman (DFL-Coon Rapids); Sen. Mark Koran (R-North Branch); Sen. Paul Utke (R-Park Rapids); Rep. Tony Albright (R-Prior Lake); Rep. Aisha Gomez (DFL-Minneapolis); Rep. Tina Liebling (DFL-Rochester); Rep. Dave Pinto (DFL-St. Paul); and Rep. Jen Schultz (DFL-Duluth). 

The MMA weighed in on several provisions through a letter submitted to the committee. The letter highlighted six priorities, all of which are in the House HHS bill, but only one of which is in the Senate version. 

1. The MMA supports language in both the Senate and House omnibus bills to protect patients with chronic pain who require opioids. Efforts to reduce the overuse and abuse of opioids have caused many patients with chronic pain to taper their medications, even when not clinically appropriate. The language in both bills balances the goal of reducing opioid overuse with the acknowledgement that some patients with chronic pain need ongoing access to these medications. 

2. The MMA strongly supports the development of a statewide registry for completed Provider Orders for Life Sustaining Treatment, or POLST, forms. POLST forms enable patients, in consultation with their medical team, to translate their preferences for end-of-life care into a medical order. A statewide registry is necessary to ensure reliable access to the form by EMS professionals, emergency room physicians, and other health professionals. We hope the strong bipartisan support for this effort will ensure its inclusion in the final omnibus bill. 

3. The MMA supports the proposed new primary care rural residency training grants. As both the Senate and House have acknowledged, the COVID pandemic has demonstrated the urgency of investing in the healthcare workforce. Minnesota has a great need for additional physicians and other healthcare providers to practice in rural and other underserved regions of our state. According to the Association of American Medical Colleges, an additional 14,100 to 17,600 physicians are needed across the country to address the shortage in rural areas. By locating training in rural areas, we can expose more future physicians to rural practice, and help address the workforce shortage of these professionals in Minnesota. 

4. The MMA strongly supports limiting the ability of insurers and pharmacy benefit managers to force patients to change their drug therapy in the middle of their enrollment year. The language in the House bill will protect patients, who often select their insurance plan based on the medications that are covered, from changes to formularies in the middle of a contract. A patient is bound by a contract to remain with their insurer for the enrollment year; the insurer should be held to the same standard. 

5. The MMA supports updates to the All-Payer Claims Database (APCD) to authorize the collection of non-claims-based payment information. Health plan payments associated with value-based payments arrangements, which are increasing, are largely missing from the APCD because such payments often flow outside of a traditional healthcare claim. The proposed changes will ensure that a more complete picture of healthcare payments is captured in the APCD. 

6. The MMA supports the coverage of tobacco cessation services by public programs. Tobacco and nicotine use continues to be the number one preventable cause of death and disease. 

The letter also noted that, though there are many more important provisions in the HHS bills, the six items listed in the letter are top priorities for the MMA.  

The conference committee is on a tight timeline as the Legislature will adjourn on May 23.