MSA Health Care Update Week of March 15-2014 APRN Bill This past week we had another hearing on the Advanced Practice Nursing legislation, this time in the House Health and Human Services Policy committee chaired by Rep. Liebling. Unlike the hearing in the Senate, there were two bills before the committee dealing with regulation of APRNs. The first, authored by Rep. Dan Schoen – HF 435 – was the bill MSA had been most concerned about in the last year as it provides for complete independent practice but removing the collaborative requirement and the requirement for a written prescribing agreement. The second bill – HF 2803 – was introduced by Rep. Tina Liebling during the second week of session, and provided an alternative to Rep. Schoen’s bill – preserving some definition of collaboration, requiring a prescribing agreement for schedule II drugs, and prohibiting CRNAs from performing certain practices that constitute interventional pain management. As in the Senate hearing the week prior, both bills were heard and laid over for possible inclusion in a later omnibus health policy bill. The Nurse Anesthetists again had multiple testifiers and focused the testimony primarily on the practice of pain management, citing their current program at Hamline University and the development of a fellowship program sponsored by the AANA and the national certifying body for nurse anesthetists. The Minnesota Society of Anesthesiologists had Dr. Katie Arendt from the Mayo Clinic testify, and the Minnesota Society of Interventional Pain Specialists had Dr. David Schultz and Dr. Lou Sager testify on the issues of interventional pain management as the practice of medicine. During the follow up questioning from committee members there were a few comments related to anesthesia in which Dr. Arendt provided clarity that even in rural areas there is always a physician involved in the surgical setting with the CRNA. Although there seemed to be considerable skepticism on the part of committee members on the issue of interventional pain management, the CRNAs continue to push for changes to the language introduced by Rep. Liebling, despite their contention that they do not currently do the interventional pain techniques that were described in testimony. We are expecting to receive their proposed changes late this week. We believe the omnibus bill will be released early this coming week and the markup of the bill where the committee will consider possible amendments will happen on Friday the 21st. We will continue to keep members up to speed on any new updates throughout the week as we get them on this legislation. We will send out a broader round of action alerts to the entire MSA membership over the coming days to expand beyond our original targeted action alerts to the HHS Policy committee members in both the House and Senate. House DFL Budget Targets Late Friday the House DFL released their budget targets for dealing with the state’s $1.2 billion dollar surplus. The targets/priorities include a $550 million dollars tax cut bill which repeals the business-to-business taxes passed during last session and also includes federal conformity provisions bringing Minnesota tax code in line with the federal tax code. The House has already passed this bill off the House floor but they are expected to bring forward another smaller tax bill in the coming weeks to deal with property tax relief. The targets also include an additional $92 million dollars for K-12 education, largely for schools to address the costs of teacher evaluations; an additional $75 million for HHS funding to be directed towards a 5% increase for home and community based services providers; $50 million in additional transportation spending for road and bridge improvements, and $172 million for job development projects – including $125 million in cash for additional bonding projects. The House targets would also leave $194 million in the state’s bottom line for future budgets. The Governor released his supplemental budget targets a week earlier. The Governor’s proposal included a higher tax cut figure at $616 million, but significantly less additional spending, choosing instead to put a significant portion of the surplus into the state budget reserves. The Governor did include the increase for home and community based services provides but reduced it to 4% - which would have a net cost of $64 million. The Senate is likely to release their budget targets in the upcoming week. Similar to the Governor’s proposal, we can expect to see a significant portion of the surplus put back into the budget reserves.
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