Rural Health Advisory Committee Meeting Minutes

Thursday, December 8, 2011, 10 a.m. - 12 p.m.

Members Present: Ellen Delatorre, Rep. Steve Gottwalt, Rep. Larry Hosch, Margaret Kalina, Nancy Stratman, Tom Vanderwal

Members Absent: John Baerg, Tom Boe, Ray Christensen, Tom Crowley, Jode Freyholtz-London, Jeff Hardwig, Sen. Tony Lourey, Diane Muckenhirn, Sen. Julie Rosen

RHAC Staff: Paul Jansen, Mark Schoenbaum, Kristen Tharaldson

Guests: Virginia Baarson (Minnesota Academy of Family Physicians), Jason Gaines (Minneapolis Heart Institute/Allina), Linda Hinz (Rep. Hosch aide)

WELCOME AND INTRODUCTIONS

This was a joint meeting of the Health Education-Industry Partnership (HEIP) and the Rural Health Advisory Committee (RHAC). Laura Beeth, Partnership Council Chair, welcomed HEIP members, RHAC members and guests. Margaret Kalina, past chair of RHAC, introduced the panelists and agenda for the meeting.

LEGISLATIVE PANEL

Liz Quam, Minnesota Rural Health Association (MRHA) – An ongoing top priority of MRHA is for state jobs and contracts to go to rural areas to support economic growth and development. A related top priority is for Centers for Medicare & Medicaid Services (CMS) and other federal programs to ensure there are rural programs and pilots for developing new programs. Rural residents who have higher rates of insurance through individual coverage and small group coverage eagerly await health reform efforts around an insurance exchange. Finally, MRHA continues to support the state seat belt law as an important safety issue for rural areas.

O.J. Doyle, Minnesota Ambulance Association (MAA) – The MAA appreciates bipartisan support to maintain the state EMS infrastructure. The CALS program, which receives partial state funding, provides affordable EMS training. The seat belt law helps fund the EMS system as about 90 percent of the fines go to rural EMS services. Statewide 62 percent of all certified EMS providers are volunteers. There is also a need for specialist surgeons in rural areas. Minnesota is one of only four or five states that have the No Fault auto insurance law, which pays for a majority of EMS services. It ensures a minimum of $20,000 will be available to injured car accident victims. Auto insurance payments are processed quickly and charges are paid in full. It is a very important funding mechanism for rural EMS and hospitals.

Kari Thurlow, Aging Services of Minnesota – The recent announcement of a projected budget surplus at the state means Aging Services may tweak their legislative agenda. There have been drastic cuts in the last year that have impacted aging services across the state. First, CMS reduced Medicaid payments for nursing homes by 11 percent. Second, increasing numbers of long term care clients (more than 70 percent) do not pay their full cost of care. Third, there were additional cuts to Medicare. Fourth, state cuts to the elderly waiver program affected home and community-based services, especially assisted living and home care services. This amounts to a 20 percent reduction overall to long term care programs. Now our state is faced with questions around the stability of nursing homes and long term care services, especially where they are needed in rural areas. Level of care changes are coming. Thresholds to apply for programs will mean people need to be sicker before they can access public programs. Where will they go for services in rural areas with limited options? This was seen with elderly waiver cuts with a trend called “flipping the entitlement.” Communities need time to adjust to these new gaps in services. Rate equalization, which requires all payers to pay the same amount as Medical Assistance rates, has harmed long term care facilities. The mandatory consultation passed last year requires seniors to contact the Senior Linkage Line for a consult before being admitted to an assisted living or long term care residence. Public payers already did this and now private payers are expected to do the same. If the consult results in denial of admission, what other options do these elders or their families have in rural areas? The moratorium exception helps to address the capital needs of long term care facilities. $1M of this funding can support up to $70M in reconstruction costs.

Dan Olson, HEIP Clinical Lab Group – The Health Resources and Services Administration (HRSA) Workforce Committee and state Governor’s Council created a lot of momentum around health care workforce planning. People are not as familiar with shortages in allied health science fields. Clinical lab students are required to do a clinical rotation, but there is a shortage of training sites. Minnesota has new clinical lab programs so the shortage of these sites will continue to be an issue. Fourteen other states license their clinical professionals while Minnesota does not. The HEIP Clinical Lab Group has worked as a part of a coalition to address this with the first bill proposed in 2007. It was reintroduced again in 2009 and 2011. The bill has a grandfathering clause so current lab science workers will continue to practice and there is a phase-in timeline for others.

Mary Krinkie, Minnesota Hospital Association (MHA) – MHA anticipates big cuts to providers as a part of HF25. Part of the reduction could be tempered if hospitals cut down on readmission rates. MHA is working to get data to help target ways to reduce readmissions. One method that has proven to be effective is to create a link between access to prescriptions and attendance at follow-up appointments. Medical Education and Research Costs (MERC) will be a target for potential reinstatement of funding. Without this, concerned hospitals will decrease their willingness to provide clinical training slots. MHA hopes for reinstatement of funding for the summer internship in medicine program that gets young people into nursing home and hospital settings. It is anticipated this program will return in 2014. With changes in the state Medicaid program, 78K enrollees have recently switched health plans. The managed care competitive bidding process and resulting programs may create additional savings or may result in further cuts to providers. Rural hospitals face 10-15 percent reductions because of changes to this program and their inability to get a competitive bid. The Minnesota Department of Human Services demo proposal has nine responses from hospital systems to move to a payment reform model. This method of “gain sharing” will be operational by April 2012. The Minnesota Department of Health plans to standardize the Hospital Community Benefit process through a required needs assessment. Hospitals fear other activities will need to be dropped if they are forced into a prescribed needs assessment and approval process. Minnesota’s no fault auto law ensured $175M in hospital payments and is a very important funding mechanism for rural facilities. They can shift these payments to cover losses for uncompensated care or entitlement programs.

Eric Dick, Minnesota Medical Association (MMA) – MMA represents 11K physicians, residents and students. The 2011 repeal of the “sick tax” means that provider taxes will go down as surpluses rise and the tax will be completely eliminated by 2020. Although its funds are used for a good purpose, MMA felt it was not a proper funding mechanism. The Freedom to Breathe Act may be challenged in the upcoming session. MMA wants to protect this legislation and will propose a tax increase on cigarettes. MMA will propose a ban on minors’ access to tanning beds. California passed a similar proposal to reduce the prevalence of skin cancer. MMA will propose simplification of prior authorization forms and processes. MMA supports the reinstatement of full MERC funding. The state health reform peer grouping data and preliminary results are concerning to MMA and further refinement is needed.

Julie Johnson, Minnesota Pharmacists Association (MPhA) – MPhA helped achieve statewide progress in the area of embedding pharmacists into a variety of health care settings. Pharmacists provide many benefits within these settings including reimbursement tied to medical devices and prescriptions as well as responsibility for patient safety. They help ensure compliance and adherence to treatment protocols, keeping patients healthy and saving systems money. Current workforce demands for pharmacists are low, but jobs are still available in many rural areas of the state. The University of Minnesota School of Pharmacy produces 150 graduates each year. The reinstatement of full MERC funding is important as it goes to metro and rural hospitals and covers some rotations for pharmacy students. The rural loan forgiveness program is important for recruitment of rural pharmacists. The MPhA legislative agenda for 2012 includes a broad mission to support and serve patients. One specific agenda item is related to pharmacy benefit managers (PBM) dispensing services. There are challenges with the current auditing process. On the federal level, MPhA is opposed to a large PBM merger, which would create a monopoly of two large PBM companies. This would result in driving up prices for prescriptions and lowering the quality or patient-centeredness of pharmacy services. Another MPhA legislative agenda item is identifying the unique parameters for e-prescribing of controlled substances. A state law passed (Justin’s bill), as a result of a tragic accident in St. Cloud, to reduce access to fake prescriptions. An outreach and awareness program called “AWARE” trains middle school health teachers on this issue. It reached 2,500 eight graders in Minnesota last year.

Sue Abderholden, National Alliance on Mental Illness (NAMI) Minnesota Chapter – NAMI-MN is a statewide grassroots organization that reached 10K people touched by mental health last year. The 2011 legislative session was a tough one for mental health services providers. The adult mental health grant to pay for important community programs was reduced by 10 percent ($10.5M). Children’s mental health screening grants were cut, greatly reducing access to screening, follow up and treatment. Evidence-based practice grants were cut, which especially affected mental health trauma care. Cuts to personal care assistance programs resulted in the amount of hours reduced to 30 minutes a day. NAMI-MN hopes to reinstate funding for these programs that keep people out of costlier care settings. Rates for family members who provide care were cut 20 percent, which especially affects children with autism and their families. Changes to the Community Alternatives for Disabled Individuals (CADI) waiver are problematic because assessments for these services do not measure people’s ability to function in communities. The Substance Abuse and Mental Health Services Administration (SAMHSA) supports an integrated dual diagnosis program and NAMI did trainings in this area. NAMI-MN will propose the state prioritize this issue and identify providers for further training. Ohio saved $1M in the first year with integrated care and effective use of resources. Programs in the Community Behavioral Health Hospitals are only half full. NAMI-MN wants to identify what can be done to use these programs to meet community needs. Foster care settings are required to meet new standards for mental health providers and services. The role of schools and day treatment for children is important, especially in rural areas where schools may provide the only mental health services for children. Issues include schools unwillingness to transport to community-based programs and maintenance of school-linked funding so clinicians can provide treatment in the school settings. The demand for children’s mental health services is growing. Regarding the health insurance exchange, mental health wants to be a part of the plan to ensure user-friendly access to mental health services.

LEGISLATIVE PANEL DISCUSSION

The legislative panelists were asked to identify their top rural health priority:

Association

Budget priority

Policy priority

MHA

MERC

Utilization data

Aging Services

Elderly Waiver

Effective transitions

MPhA

MERC

 

Clinical lab/HEIP

 

Licensure effort

MRHA

Health insurance exchange

 

MMA

MERC

Peer grouping

NAMI-MN

No more cuts to MH programs

 

The legislative panelists were asked to identify their top workforce issue:

MHA

Public program reimbursement

Aging Services

Budget and cost of hiring adjustments

MPhA

MERC and getting information to students about  rural careers

Clinical lab/HEIP

Need for clinical sites

MRHA

Public program reimbursement

MMA

MERC and primary care workforce

NAMI-MN

More collaborative care models including remote psychiatric consults and telemedicine

The legislative panelists were asked about the importance of getting young people in rural areas connected to health care careers. There are great needs in rural areas, especially for long term care and adult services staff. Legislators are asking the Minnesota State Colleges and Universities system to put money and training into programs where there are careers. One in six jobs is currently in the health care field. The new chancellor at Minnesota State Colleges and Universities is aware of this issue and is developing a strategic framework to address this concern. Community meetings will be held this spring to reassess and reprioritize Minnesota State Colleges and Universities programs. More dynamic engagement and educational opportunities are needed along with realistic pipeline requirements for college readiness. Science, Technology, Engineering and Math (STEM) K-12 programs for urban underserved students are projected to help fill the gap between a high school education and the skills needed to enter health care careers.

ADJOURN

The meeting adjourned at 12 p.m. The Partnership Council provided updates from 12:45-1:30 p.m. and RHAC members and guests were welcome to attend this portion of the meeting.

Ellen Delatorre has filled the remaining consumer slot for RHAC open appointments in 2011. Six open slots for 2012-2016 are currently posted through the Secretary of State website.

 

Updated Wednesday, 04-Apr-2012 10:58:23 CDT