Health Care Update - Minnesota Society of Anesthesiologists

MSA Health Care Update
Week of March 15-2014
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.