House Health and Human Services Policy Committee – part 2  3/15/19
23
September

By Adem Lewis / in , , , , , , , , , , /


THE GAVEL>>CHAIR MORAN: [INAUDIBLE] I WOULD LIKE TO CALL THE COMMITTEE ON HEALTH AND HUMAN SERVICES POLICY COMMITTEE TO ORDER. SO; MEMBERS WE HAVE A MOTION BEFORE THIS BODY AND WE ARE GOING TO TAKE A VOTE ON A. BEFORE WE DO THAT; I WOULD LIKE TO MAKE A STATEMENT. THEN WE WILL TAKE A VOTE. REPRESENTATIVE TRAN ROBBINS>>REPRESENTATIVE ROBBINS: THANK YOU; MME. CHAIR. I WANT TO SEE IF I COULD SPEAK TO THE MOTION?>>CHAIR MORAN:? EARLIER DISCUSSIONS EAR LIER BUT THERE’S A MOTION BEFORE THE BODY AND WE ARE GOING TO TAKE A VOTE>>REPRESENTATIVE ROBBINS: WE HAD NO DISCUSSION ON THE MOTION>>CHAIR MORAN: WELL I THINK REPRESENTATIVE ALBRIGHT SPOKE TO THE MOTION.>>REPRESENTATIVE ROBBINS: MME. CHAIR IS IT A DEBATABLE MOTION?>>CHAIR MORAN: IT IS A DEBATABLE MOTION OF>>REPRESENTATIVE ROBBINS: WE LITERALLY THERE WAS NO OPPORTUNITY FOR MEMBERS TO DISCUSS THE MOTION.>>CHAIR MORAN: OKAY. SO I THINK WHAT I WANT TO SAY ON THE LAST DAY OF THE FIRST DEADLINE;; WITH 19 BILLS BEFORE THIS COMMITTEE ; IS MY WISH WE GET THROUGH THE BILLS OF THIS BODY. THERE IS A MOTION ON THE TABLE AND ONE OF THE THINGS THAT I DON’T WANT TO GET INTO REALLY THE CRUX OF THE MOTION? WHAT I’M GONNA DO IS DO THIS. I BELIEVE I AM GOING TO IT’S DEBATABLE SO WE ARE GOING TO [INAUDIBLE] TO TO THE MOTION BEFORE WE TAKE A VOTE COULD YOU GUYS; GO FIRST. I’M GOING TO TIME ON THIS CONVERSATION. ON THIS MOTION. I AM GOING TO MA KE A STATEMENT AND THEN WE WILL GO TO THE VOTE. REPRESENTATIVE TRAN ROBBINS>>REPRESENTATIVE ROBBINS: THANK YOU; MME. CHAIR. I’LL KEEP MY REMARKS? I JUST WANT TO [INAUDIBLE] I TEND TO THE PRESS CONFERENCE THE OTHER DAY ABOUT THE OLA REPORT AND I THINK IT WOULD BE VERY HELPFUL FOR THE COMMITTEE TO HEAR FROM SO WE CAN ASK HER QUESTIONS ABOUT THE TRANSPARENCY AND THE INVESTIGATION. SO I SUPPORT THE MOTION AND I’LL DEFER TO MY COLLEAGUE>>CHAI R MORAN: REPRESENTATIVE NEU TO BE NEWS I ALSO SUPPORT THE MOTION SHOULD THE BIGGEST PROBLEM THAT WE SAW IN THAT OLA REPORT IS A LACK OF ACCOUNTABILITY BY MS. PAM AND I THINK THAT WE DO THERE’S A REASON WE HAVE SUBPOENA POWER IN THIS BODY AND I THINK THIS IS SOMETHING THAT WE VERY RARELY EXERCISE AND I THINK THIS IS AN INSTANT AND IS VERY SPECIFICALLY IN THE PURVIEW OF THIS COMMITTEE. I THINK THIS IS AN INSTANT WHERE WE GOT A PRETTY [INAUDIBLE] CIRCUMSTANCE THERE AND I THINK WOULD BE WISE OF US AS A BODY TO EXERCISE THAT AUTHOR ITY TO GET TO THE BOTTOM OF THIS. THERE ARE CLEARLY A LOT OF UNANSWERED QUESTIONS PARTICULARLY ON ACCOUNTABILITY. I THINK WOULD BE VERY APPROPRIATE FOR US TO DO THAT.>>CHAIR MORAN: CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. FIRST OF ALL YOU MENTION YOU’RE GOING TO SET A TIME UP YOU ONE OF THE CHAIR COULD FIRST TELL US HOW LONG EACH SIDE WILL HAVE TWO I WOULD SUGGEST FIVE MINUTES AND FIVE MINUTES; NO MORE.>>CHAIR MORAN: [INAUDIBLE]>>>>[MULTIPLE VOICES.]>>CHAIR MORAN: [INAUDIBLE]>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I WOULD JUST LIKE TO SAY; FIRST OF ALL; THIS IS AN ISSUE THAT DOES NOT BELONG TODAY AND YOU KNOW; VERY SERIOUS ALLEGATIONS REMAIN AGAINST THE SOMALI COMMUNITY. PEOPLE THROUGH AROUND BULLETS LIKE TERRORISM AND MADE REALLY VERY INFLAMMATORY ALLEGATIONS WHICH THE OLA FOUND WAS NO EVIDENCE TO SUPPORT NOW YESTERDAY AS YOU MAY KNOW IN CHRISTCHURCH NEW ZEALAND 49 MUSLIMS WERE GUNNED DOWN INTO MOSQUES I BELIEVE IT WAS. SO WHEN YOU MAKE ALLEGATIONS LIKE THAT; IT IS VERY VERY SERIOUS . THIS IS THIS GOES FAR BEYOND POLITICS. BECAUSE PEOPLE LISTEN TO WHAT WE SAY. SOMETIMES THEY TAKE IT BEYOND WHERE THEY SHOULD I JUST WANT TO GET THAT OUT THERE AND IF WE ARE TALKING ABOUT THIS OLA REPORT AND THE ALLEGATIONS THAT WERE MADE. NOW; THERE IS A TIME FOR US TO EXAMINE HOW FUNDS ARE USED. THERE CERTAINLY IS. THERE’S A TIME FOR OVERSIGHT. AS PART OF THE GOVERNOR’S BUDGET THAT I TRUST THE CCAP PROGRAM THAT ATTEMPT TO GET BETTER CONTROL OVER TH AT PROGRAM COULD LET ME JUST SAY THERE ARE MANY AREAS OF OUR BUDGET THAT WE NEED TO BETTER ON . FOR EXAMPLE; THE NURSING HOME INDUSTRY THAT GOT A LOT OF MONEY FROM A FEW YEARS AGO THERE WERE PIECES THAT WE NEED TO RE-RRE-LOOK AT. THERE’S PIECES IN THE DWRS SYSTEM. THERE’S [INAUDIBLE] THERE’S A LOT OF THINGS WE NEED TO LOOK AT AND DO OVERSIGHT ON. BUT THISIS THE DAY WHEN WE HAVE THE DEADLINE FOR POLICY BILLS TO GET THROUGH THIS COMMITTEE AND BRING ING THIS UP TODAY AND TRYING TO USE A LOT OF TIME ON IT; I BELIEVE IS A STUNTAND TRYING TO PULL THE COMMITTEE OFF ITS BUSINESS OF TODAY’S. SO MME. CHAIR COME I BELIEVE WE SHOULD VOTE DOWN THIS MOTION AND GET ON WITH THE BUSINESS OF THIS COMMITTEE AND THESE ISSUES WILL BE THERE FOR ANOTHER DAY. I ALSO WANT TO SAY THAT MS. HAMM; I’MM PERFECTLY F INE WITH QUESTIONING HER AND THERE’S NO NEED FOR A SUBPOENA . I’VE BEEN TO LD SHE WILL COME BEFORE THE COMMITTEE ANYTIME THE COMMITTEE WANTS TO HEAR FROM HER BUT THAT IS NOTTHE BUSINESS FOR TODAY.>>CHAIR MORAN: WE HAVE ABOUT FOUR MORE MINUTES LEFT IF THE REPUBLICANS I WOULD LIKE TO SPEAK TO THE REPRESENTATIVE ALBRIGHT>>REPRESENTATIVE ALBRIGHT: MME. CHAIR I WOULD SPEAK IN FAVOR OF MY MOTION AND TO SOME OF THE COMMENTS THAT ALREADY BEEN HEARD; THE OLA REPORT; AS WELL AS THE REPORT THAT PFM REPO AS I WOULD READ IT; MAKES NO REFERENCE TO ETHNICITY. WHAT IT DOES DO IS REFER TO FRAUD. IT IS BLIND TO ETHNICITY.. THE CIRCUMSTANCES SURROUNDING THE INVESTIGATIONS AND PROSECUTIONS THAT TOOK PLACE SOME MIGHT INFER BUT THERE IS NO REFERENCE IN THE BODY OF THE OLA REPORT THAT WOULD IMPUGN ANY CULTURAL SENSITIVITY. THE PURPOSE OF THIS SUBPOENA PURELY AND SIMPLY; IS TO DRAW THE WEIGHT OF THE IMPORTANCE OF THE INVESTIGATION WAS CONDUCTED BY THE OLA AS WEELL AS THE INDEPENDENT AUDIT THAT WAS REQUESTED BY DHS AND THE OIG. TO THE EXTENT THAT IT DELAYS WHAT WE ARE IN THIS COMMITTEE ABOUT THEM I THINK SERVES UP THE IMPORTANCE OF TAKING UP THIS CONVERSATION AND TO THE POINT THAT WE WANT TO MAKE SURE THAT IT IS IN A TIMELY FASHION. THERE IS ANOTHER REPORT THAT IS OF COMING IN APRILTHAT THE OLA IS ALREADY ANNOUNCED AND IN LIGHT OF THAT; AND IN LIGHT OF THE SEVERITY AND THE SIGNIFICANCE OF THE FINDINGS BY BOTH REPORTSS; I THINK IT IS IMPERATIVE THAT WE BRING THIS FORWARD AND I’M HAPPY TO TAKE A VOTE AS SOON AS MY FOUR MINUTES ARE UP. I THINK IT’S IMPORTANT THAT WE PUT IT ON THE RECORD IN TERMS OF THE IMPORTANCE THAT EACH ONE OF US WAY ON THE IMPORTANCE OF THIS. SO I AM WITHOUT A DOUBT ASSURED THAT BY THAT THAT WE WILL ALL AGREE THAT WE WANT TO SEE MS. HAMM IN FRONT OF THIS COMMITTEE FOR THE PURPOSE OF HEARING HER SI DE OF THE INVESTIGATION AND HOW SHE INTENDS TO MOVE FORWARD ALONG WITH THE COMMISSIONER OF DHS. WHY THINK ALSO SHOULD BE INVITED AS WELL. THEY BOTH HAVE A PARTY TO THE JUSTICE THAT SHOULD BE SERVED ON BEHAL F OF THE TAX PAYING MEMBERS OF THE STATE TO USE THAT PROGRAM AS WELL AS THE PEOPLE THAT ARE BEEN HARMED BY THE FRAUD THAT IS BEING PERPETRATED UPON CCAP. THANK YOU.>>CHAIR MORAN: THANK YOU. I THINK WE MAYBE HAVE TWO MINUTES FOR OUR SIDE. REPRESENTATIVE WE HAVE TWO MINUTES. REPRESENTATIVE PIERSON. ON THE REPUBLICAN SIDE.>>REPRESENTATIVE PIERSON: THANK YOU; MME. CHAIR. I APPRECIATE YOU ALLOWING US TO COME TO A VOTE. MINORS IN ANOTHER COMMITTEE THIS MOTION HAD BEEN MADE AND THAT THE MOTION HA D BEEN RULED OUT OF ORDER SO I WANT TO THANK YOU FOR ALLOWING US TO VOTE ON THIS I THINK IT’S A BUDGET I THINK TIMELY.. HERE WE ARE IN A RELIES WE ARE ON FIRST DEADLINE BUT AGAIN; IF WE PUSH THIS OFF ALL OF A SUDDEN THIS COMMITTEE DOESN’T MEET QUITE AS FREQUENTLY AND IF WE DON’T GET THE SUBPOENA REQUEST IN NOW WE MAY NOT HEAR FROM M S. HAMM UNTIL LONG BEYOND THAT. SO I DO THINK IT’S A GREAT MOTION. I THINK THE TESTIMONY BELONGS IN THIS COMMITTEE MORE THAN VIRTUALLY ANY OTHER AND I REALLY RESPECT AND APPRECIATE THE FACT THAT YOU ALLOWING US TO VOTE ON THIS MOTION.>>CHAIR MORAN: WE ARE GONNA CLOSE WITH REPRESENTATIVE PINTO>>REPRESENTATIVE PINTO: THANK YOU; MME. CHAIR. SO I THINK THAT; I HOPE WE ALL UNDERSTAND THE IMPORTANCE OF THE PROGRAM THE CHILDCARE ASSISTANCE PR OGRAM FOR FAMILIES AND FOR KIDS AND FOR ALL OF US AND FOR THAT REASON I THINK FOR SO MANY OF US IT IS CRITICAL THAT FUNDS DEDICATED TO THE PROGRAM GO TO THE PEOPLE ACTUALLY ELIGIBLE TO RECEIVE THOSE FUNDS. AS A PROSECUTOR AS I WORK AT THE CAPITAL; I’M APPALLED BY [INAUDIBLE] SOLELY BY THE THOUGHT FUNDS ARE NOT BEEN USING THE APPROPRIATE WAY AND ESPECIALLY WHEN THOSE FUNDS ARE GOING TO BE AIMED AT FAMILIES AND KIDS GLADLY NEED THEM. AND ; AND; LET’S REMEMBER; MEMBERS; THAT THERE IS AS I SAID IN REFERENCE; THERE IS IN FACT A SECOND REPORT THAT IS BEEN DECLARED PREPARED RIGHT NOW BY OUR LEGISLATIVE AUDITOR THAT IS MAKING LOOKING INTO THE CONTROL WITHIN THE DEPARTMENT OF HUMAN SERVICES. WE HAD TO REDO WAS AS AWAITING THIS REPORT AS I IDENTIFY THE CHAIR LIEBLING; ; THE ALLEGATION THE PART TO THAT REPORT BEEN FOUND TO BE UNSUBSTANTIATED; NOT TO BE SUPPORTED ALL BY THE EVIDENCE. HOWEVER; THERE’S AN [INAUDIBLE] IN THE OLA HAS [INAUDIBLE] AS REPRESENTATIVE TRAN YOU SAID THE STUFF IS A VERY ROBUST WHAT SO I THINK FOR A NUMBER OF US WE DO NOT REALIZE THIS WAS SOME OF THE THINGS THAT WERE GONNA HAPPEN. SO; MEMBERS; I WOULD URGE OPPOSING TAKING THIS EXTREMELY RARE AND I THINK PRETTY CLOSE TO UNPRECEDENTED STEP AND WE HAVE OUR LEGISLATIVE AUDITOR IS LOOKING FOR PRICING INFORMATION CAN LET’S GET THAT REPORT AND LET’S GET THAT INFORMATION IN THE RIGHT WAY AND IN THE MEANTIME LET’S KEEP ON MOVING TO A PROSECUTOR THANK YOU; MME. CHAIR.>>CHAIR MORAN: THANK YOU. I AM GOING TO MAYBE JUST REPEAT SOME OF THE THINGS THAT I’VE HEARD. THAT THIS REALLY REALLY IMPORTANT THE OVERSIGHT OF THIS PROGRAM THAT IS ESSENTIAL TO MANY FAMILIES TO LOW INCOME FAMILIES.. THAT WE ARE WORKING TO ENSURE THAT THE LLIMITED RESOURCE WE HA VE OUR [INAUDIBLE] SO FRAUD AND OVERSIGHT IS IMPORTANT TO US. I THINK IT’S IMPORTANT TO THIS COMMITTEE. WE DO KNOW THAT THERE IS AND WILL BE ANOTHER OLA REPORT THAT’S COMING OUT SHORTLY. WHAT I KNOW FROM DEPARTME NT ALL WE HAVE TO DO IS REQUEST THE COMING BEFORE THE BODY AND THEY WILL BE HERE. I PERSONALLY DON’T SEE I SEE MANY OF OUR MEMBERS DON’T SEE A REASON TO HAVE A SUBPOENA FOR THE DEPARTMENT TO HAVE TO COME BEFORE THE COMMITTEE. WE CAN REQUESTED. BUT BEFORE US WE HAVE A MOTION. WE ARE GOING TO TAKE A VOTE ON THE MOTION. SO CLERK; PLEASE TAKE THE ROLL. THE>>STAFF:>>CHAIR MORAN: JUST FOR CLARITY MS. PANELLA CAN GIVE US WHAT THE VOTE WILL MEAN. CAN YOU JUST WALK US THROUGH THE [INAUDIBLE] RELATED TO THE VOTE OF THIS NATURE SO WE ARE ALL CLEAR ON THE RULES.>>STAFF: MME. CHAIR AND MEMBERS; MINNESOTA STATUTES SECTION 3.153 GOVERNS LEGISLATIVE SUBPOENAS AND THE REQUIREMENTS IN THE STATUTE IS THAT IN ORDER FOR THE SUBPOENA TO BE ISSUED THE COMMITTEE HAS TO AFFIRMATIVELY VOTE BY TWO THIRDS VOTE OF ITS MEMBERS .>>CHAIR MORAN: THANK YOU. THE CLERK WILL TAKE THE ROLL. THE>>STAFF: MORAN NAY; MORRISON NAY;KIEL AYE; ALBRIGHT AYE; BAKKER BAHNER NAY; EDELSON FISCHER NAY; FREIBERG NAY; LIEBLING NAY; LOEFFLER NAY;MANN ; [INAUDIBLE]; PIERSON AYE; PINTONAY; ROBBINS AYE; BACKER AYE; SCHOMACKER AYE; SCHULTZ NAY;>>CHAIR MORAN: THERE BEEN SIX AYE AN D NINE NAYS THE MOTION DOES NOT PREVAIL. WE WILL TAKE UP HOUSE FILE 46 NEXT REPRESENTATIVE SCHULTZ; PLEASE THEM TO THE TESTIFYING TABLE. REPRESENTATIVE NEU>>REPRESENTATIVE NEU: FIRST ALL REPRESENTATIVE WHILE REPRESENTATIVE SCHULTZ IS PREPARING; CAN I JUST ASK THERE’S LOTS OF GOOD COMMENTS AND MAKING REQUEST FOR HER TO COME BEFORE THE COMMITTEE.. CAN I ASK MME. CHAIR IF YOU CAN CONNECT TO HOLDING A HEARING AT A LATER DATE ON THIS OLA REPORT AND REQUESTING MS. HAMM TO COME TO SPEAK BEFORE THE COMMITTEE SO WE REALLY CAN DO A THOROUGH ; HAVE A THOROUGH DISCUSSION OF THIS AND MOVE BILLS THAT ACTUALLY WILL HELP TO FIX THIS PROBLEM?>>CHAIR MORAN: REPRESENTATIVE NEU; I I CAN TAKE THAT UNDER CONSIDERATION BUT I WOULD LIKE TO POINT OUT WE DO HAVE A SUBCOMMITTEE ON EARLY CHILDHOOD EDUCATION AND I REALLY BELIEVE THAT IF WE HAD HAVE A HEARING IT SHOULD GO BE HEARD WITHIN THE COMMITTEE. REPRESENTATIVE [INAUDIBLE] TO I WAS WAVING AT REPRESENTATIVE NEU MAYBE TOSSING THE QUESTION OF TO ME BUT I GUESS I WILL I SHOULD NOT [INAUDIBLE] FIRST TRYING TO [INAUDIBLE] I WILL LET HER DO THAT.>>CHAIR MORAN: ALL RIGHT. REPRESENTATIVE SCHULTZ WOULD YOU LIKE TO MOVE YOUR BILL?>>REPRESENTATIVE SCHULTZ: THANK YOU; MME. CHAIR. I MOVE HOUSE FILE 40 6B RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.>>CHAIR MORAN: WE HAVE THE BILL BEFORE THE COMMITTEE. REPRESENTATIVE SCHULTZ PLEASE PRESENT YOUR BILL>>REPRESENTATIVE SCHULTZ: THANK YOU; MME. CHAIR. HOUSE FILE 46 REQUIRES [INAUDIBLE] COVER HEARING AIDS OF PERSONS OF ALL AGES. I HAVE A CONSTITUENT IN MY DISTRICT THAT HAS CHILDREN THAT NEED HEARING AIDS AND CURRENTLY UNDER THEIR COVERAGE THEY CANNOT GET THEM AS FREQUENTLY AS I NEED THEM TO SO THIS WOULD ALSO ENSURE THAT CHILDREN ARE GETTING THEM MORE FREQUENTLY AS A GROW OUT OF OLD HEARING AIDS AND [INAUDIBBLE] BASED ON NEW PRESCRIPTIONS FOR HEARING AIDS A ND I’VE TESTIFIERS HERE MME. CHAIR.>>CHAIR MORAN: THANK YOU. PLEASE PLEASE INTRODUCE YOURSELF THE RECORD AND TELLS ABOUT WHO YOU ARE AND PROCEED WITH YOUR TESTIMONY.>>TESTIFIER: MME. CHAIR; MEMBERS OF THE COMMITTEE; THANK YOU FOR HAVING ME HERE TODAY. MY NAME IS PATTY MOREL I’M THE MOTHER OF TWO ADULT CHILDREN. MY YOUNGEST SON HAS BILATERAL HEARING LOSS. 16 YEARS AGO WHEN MY SON WAS FOUR YEARS OLD OPEN MY DOOR 20 COME IN CANDIDATEWHO IS DOORKNOCKING. YES FOR MY BOAT AND ASKED IF I HAD ANY CONCERNS. I INVITED HIM IN. WE TALKED FOR TWO HOURS AND IN TEARS EXPECTING HOW MY HUSBAND AN D I WERE STRUGGLING FINANCIALLY TO PAY THE $4000 FOR HEARING AIDS THAT ARE SO NEEDED. WE WERE TOLD THAT IS HEARING LOSS WOULD FLUCTUATE THAT WE WOULD HAVE TO PURCHASE A NEW HEARING AIDS EVERY TWO TO THREE YEARS. WE HAVE D TWO YOUNG CHILDREN WITH MORE MONEY TO COVER THE COST WE DID I KNOW HOW WE WOULD JUGGLE THE COST OF HEARING AIDS OR HOUSEHOLD EXPENSES. OUR HEALTH INSURANCE TOLD US THAT HEARING AIDS WITH COSMETIC AND THEY WOULD NOT PROVIDE COVERAGE. THERE WAS NO INSURANCE MANDATE IN THE STATE AT THE TIME. SOON AFTER THA T SOME SENATOR WEAKER INTRODUCED A BILL THAT WOULD BECOME MS-6.2 700 I DON’T EXPERIENCE ADVOCATING AT THE CAPITAL DID I FOUND ANOTHER MOM WHEN TWIN BOYS NEEDED HEARING AIDS. SHE AND I STOPPED WORKING FROM JANUARY THROUGH MAY 2003 AND BEGIN CITIZEN ADVOCATES TO GET THE BILL PASSED. WE WORKED CLOSELY WITH THE COMMISSION OF DEAF; DEAF BLIND AND HARD OF HEARING. WE WORKED WITH OTHER MOMS WHOSE CHILDREN HAD A HEARING LOSS AND WE GOT THE BILL PASSED. WE WERE ABLE TO SUCCESSFULLY ARGUE THAT HEARING AIDS ARE NOT COSMETIC. THAT THERE ESSENTIAL TO THERE ESSENTIAL MEDICAL DEVICE NEEDED TO PREVENT SERIOUS PERMANENT CONSEQUENCES OF UNTREATED HEARING LOSS. THE COST TO COMPANY RATE IS LESS THAN THE COST TO SOCIETY FOR SOCIAL EMOTIONAL AND EDUCATIONAL DELAYS THAT ARE CAUSED BY THE LACK OF COVERAGE RESULTING IN CHILDREN GOING ON NEEDED. HERE I AM 15 YEARS LATER . THAT BILL WAS A SUCCESS. REPRESENTATIVE SCHULTZ WAS APPROACHED BY HER CONSTITUENTS AND SHE RESPONDED TO THEM WITH THIS BILL. MY SON HAS BEEN ABLE TO BENEFIT FROM THE COVERAGE IS ELEMENTARY AND SECONDARY EDUCATION. HE HAS A FULL SOCIALIZE AND DOING WELL IN SCHOOL. HE IS NOW AN ADULT IS AT THE UNIVERSITY OF MINNESOTA AND DOES NOT HAVE INSURANCE COVERAGE FOR HEARING AIDS. HE NEEDS HEARING AIDS JUST AS MUCH NOW AS HE DID WHEN HE WAS A CHILD. I AM HERE TO ARGUE THAT FOR THE MAJORITY OF PEOPLE WITH PERMANENT HEARING LOSS THE ONLY APPROPRIATE TREATMENT OF HEARING AIDS . HOWEVER; HEALTH INSURANCE WILL PAY FOR HEARING AIDS UNLESS YOU’RE LUCKY ENOUGH TO BE A STATE EMPLOYEE YOU QUALIFY FOR MEDICAL ASSISTANCE; OR YOU’RE IN A SMALL MINORITY WHO HAVE HEARING AID COVERAGE IN A COMMERCIAL HEALTH PLAN. THIS IS NOT A RESPONSIBLE OR FAIR POLICY. PLEASE; SUPPORT HOUSE FILE 486. THANK YOU.>>CHAIR MORAN: THANK YOU FOR YOUR TESTIMONY. TO THE TESTIFIER; PLEASE BE INTO [INAUDIBLE]>>TESTIFIER: MME. CHAIR; MEMBERS OF THE COMMITTEE [INAUDIBLE] MISSION OF THE DEAF; DEAF BLIND AND HARD OF HEARING. MINNESOTA COMMISSION OF THE DEAF DEAF BLIND AND HARD OF HEARING HOSE A PROX AGENCY CROSS SECTOR TEST FORCE THAT FOLKS ON AGE-RELATED HEARING LOSS. THIS COMMISSION COMMISSION IS ON A TEST SECOND TEST WAS A WAS ON PROPOSAL THAT GOT US IN THE WORKFORCE BACK SEVERAL YEARS TO THIS ISSUE THE COST OF HEARING AIDS IS; HAS BEEN A PRIMARY ISSUE OR TAX COURT [INAUDIBLE] HEARS ABOUT EVERY TIME WE COLLECT STAKEHOLDER COMMUNITY FEEDBACK. THE COMMISSION IS COMMIITTED TO IMPROVING PEOPLE OF MINNESOTA’S ACCESS TO AFFORDABLE HEARING HEALTHCARE. NEARLY 20% OF ALL MINNESOTANS HAVE A CLINICALLY SIGNIFICANT LEVEL OF HEARING LOSS. HEARING AIDS ARE NEEDED FOR DEAF; DEAF BLIND; HARD OF HEARING PEOPLE BUT ALSO PEOPLE ARE HEARING AND THEN BEGIN TO LOSE THEIR HEARING AS THEY AGE. WHETHER TH AT IS [INAUDIBLE] AGE OR MEDICAL CONDITIONS. DESPITE [INAUDIBLE] TWO TO $4000 ON AVERAGE AND OFTEN TIMES [INAUDIBLE] THEY NEED TO BE REPLACED EVERY THREE TO FIVE YEARS IF NOT SOONER PARTICULARLY AS THEY GROW UP THE VAST MAJORITY OF MINNESOTANS HAVE NO HEALTH INSURANCE COVERAGE TO HELP WITH THE SIGNIFICANT OUT-OF-POCKET COSTS. THIS MEANS MANY PEOPLE WHO NEED HEARING AIDS ARE NOT GETTING THE HELP THEY NEED FOR WHEN THEY’RE IN COLLEGE; TO DO BE USEFUL BUT [INAUDIBLE] TO CONNECT WITH FAMILIES AND BUILD RELATIONSHIPS AND TO AGE IN A HEALTHY WAY. PEOPLE DESPERATELY LOOK TO GRANTS; CHARITIES; COMMUNITY ORGANIZATIONS OR FAMILY MEMBERS TO HAVE THEM PAY FOR THESE EXPENSIVE COST OUT-OF-POCKET. SOME LIKE MY MOTHER WHO IS ALSO DEAF AND HARD OF HEARING; USE OF RECYCLED HEARING IS BECAUSE YOU CAN AFFORD TO BUY HER OWN. WE KNOW THAT PEOPLE WHO LOSE THEIR HEARING AS THEY AGE ARE TO TO FIVE TIMES MORE LIKELY TO DEVELOP COGNITIVE DECLINE OR DEMENTIA CAN ALSO A SIGNIFICANT RISK FOR INCREASED RATES ARE FALLING; DEPRESSION AND OTHER SERIOUS CO-OCCURRING ISSUES. IF THEY’RE NOT ABLE TO GET HEARING AIDS COCHLEAR IMPLANTS ARE [INAUDIBLE] OF COMPLICATED TYPICALLY COVERED BY HEALTH INSURANCE PLANS AT THE COST OF COVERED BY HEALTH INSURANCE PLANS AT THE COST OF BETWEEN $40-$80;000. OUR INSURANCE SYSTEM PUSHES MINNESOTANS TOWARDS THIS EXPENSIVE OPTION. ACCESS TO FAMILY RELATIONSHIPS WORK EDUCATION AND EMPLOYMENT ALL BEGIN WITH PEOPLE’S ABILITY AND ACCESS TO COMMUNICATION. THANK YOU.>>CHAIR MORAN: THANK YOU SO MUCH. IS THERE ANYONE ELSE WOULD LIKE TO TESTIFY ON HOUSE FILE 46? MEMBERS; ANY QUESTIONS? SEEING NO FURTHER DISCUSSION REPRESENTATIVE SCHULTZ IT RENEWS HER MOTION TO HOUSE FILE 40 6B RECOMMENDED FOR REAR FALL TO THE COMMITTEE ON WAYS AND MEANS. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. HOUSE FILE 486 IS REC OMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN: THANK YOU SO MUCH. THE NEXT BILL UP IS HOUSE FILE 2009 REPRESENTATIVE PERSELL. CANTRELL. THE CHAIR MOVES HOUSE FILE 2009 TO BE RECOMMENDED FOR THE REFERRAL TO THE COMMITTEE ON WAYS AND MEANS. WE HAVE THE BILL BEFORE THE COMMITTEE REPRESENTATIVE CANTRELL I UNDERSTA ND YOU HAVE AN AUTHOR AMENDMENT AND THE CHAIR WOULD LIKE TO ENTER THE MOTION FOR THE A1. SO MOOVED. THAT IS REPRESENTATIVE ALBRIGHT. SO REPRESENTATIVE ALBRIGHT MOVES THE AUTHORS AMENDMENT. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] THOSE OPPOSED SAY; NAY. QUIT THE MOTION PREVAILS. AMENDMENT IS ADOPTED>>[GAVEL]>>CHAIR MORAN: REPRESENTATIVE CANTRELL>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. IT’S A PLEASURE TO JOIN YOU TODAY AND PRESENT HOUSE FILE 2009. WHAT IT DOES IS [INAUDIBLE] IN FROM ACQUIRING [INAUDIBLE] WERE BATTLING STAGE IV METASTATIC CANCER FROM PROGRESSING HAVING TO PROGRESS THROUGH A STANDARD STEP THERAPY PROTOCOL IN ORDER TO ACCESS OR HAVE THE MEDICATIONS COVERED THAT THEY ARE PHYSICIANS BELIEVES THAT THEY NEED TO BE ON. THIS IS A PRETTY; I WOULD SAY;GOOD STEP IN THE RIGHT DIRECTION. ITAT BIPARTISAN SUPPORT IN BOTH THE HOUSE AND SENATE. THIS BILL ALSO HAS SUPPORT FROM THE SUSAN G COLEMAN FOUNDATION. AS FAR AS MAKING SURE THAT CANCER PATIENTS ESPECIALLY CANCER PATIENTS WERE IN A FAIRLY LATE STAGE OF CANCER; ARE ABLE TO GET THE MEDICATIONS THEY NEED AND THAT IT’S AFFORDABLE. I THINK THIS BILL IS A SMALL STEP TO WHERE WE NEED TO BE WITH THAT.; MEMBERS I WILL YIELD FOR QUESTIONS BUT I ASK FOR YOUR SUPPORT.>>CHAIR MORAN: ALL RIGHT; THANK YOU. IS THERE ANYONE ELSE WOULD LIKE TO TESTIFY ON HOUSE FILE 2009? ANY DISCUSSION; MEMBERS? THERE BEING NO FURTHER REPRESENTATIVE ALBRIGHT>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL THANK YOU FOR BRINGING THE BILL FORWARD. I’M A CO-AUTHOR ON THE BILL. I JUST HAVE ONE QUESTION FOR YOU; SIR. IT HAS TO DO WITH THE EFFECTIVE DATE OF THE BILL. I’M WONDERING WHY WE WOULD WANT TO DELAY PEOPLE HAVE AN OPPORTUNITY TO BE PROVIDED WITH THESE TYPE OF THERAPIES ANY LONGER THAN I NEED TO SO IF BEFORE IT PASSES INTO LAW; HOPEFULLY; YOU WOULD CONSIDER FRIENDLY AMENDMENT TO DATE IT’S FOR THE DAY AFTER ENACTMENT>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT COULD I’M ABSOLUTELY AMENABLE TO THAT AND I’M DEFINITELY HAPPY FOR THIS BILL IS ENACTED IN FINAL VERSION TO WORK WITH YOU ON THE ENACTED DATE. WERE EFFECTIVE DATE; EXCUSE ME.>>CHAIR MORAN: SOUNDS LIKE HE’S GOING TO OFFER A AMENDMENT TO RICHARD ARE YOU GOING AS ACCEPTED>>REPRESENTATIVE ALBRIGHT: MME. CHAIR IF YOU’RE WILLING TO SUSPEND THE RULES I’M OFFERING THE AMENDMENT.>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT>>REPRESENTATIVE ALBRIGHT: MME. CHAIR SOMETIMES INTENTIONS EVEN WHILE GOOD CERTAINLY YOU CAN GET OUT IN FRONT OF YOUR SPEECH OR SOMETHING. SO OUR INTENTIONS ARE PURE BUT I AM ADVISED BY MR. THERE IS SOME OOF TIME NECESSARY FOR THE HEALTH PLANS TO GET UP TO SPEED WITH THIS PROVISION SO IT CAN HAPPEN SOON ENOUGH BUT SOON ENOUGH WOULD PROBABLY HAVE TO BE JANUARY 1.>>CHAIR MORAN: ALL RIGHT. SO SEEING NO FURTHER DISCUSSION THE CHAIR RENEWS HER MOTION HOUSE FILE 2009 AS AMENDED BE RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. HOUSE FILE 2009 AS AMENDED IS RECOMMENDED FOR RE-REFERRED TO THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN: THANK YOU SO MUCH OF FOR THE RECORD. STAY PUT. WE HAVE HOUSE FILE 47. THE CHAIR MOVES HOUSE FILE 1257 TO BE RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS. WE HAVE THE BILL BEFORE US MEMBERS. REPRESENTATIVE CANTRELL; PLEASE PRESENT YOUR BILL>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. MEMBERS; IT’S A PLEASURE TO JOIN YOU AGAIN. HOUSE FILE 1257 IS A BILL THAT I BELIEVE WILL HELP TO ALLEVIATE THE UNCERTAINTY AND THE FEAR OF AN GET TO SEE IN THE FIRST COMPUTER COVERAGE OF MANY MINNESOTANS WITH A SERIOUS AND CHRONIC HEALTH CONDITIONS HAVE TO LIVE WITH. THIS BILL PROHIBITS A HEALTH PLAN PROBABLY CHANGING ITS FORMULA DURING THE CONTRACT YEAR FOR PATIENTS ALREADY ENROLLED IN DRUG THERAPIES. THE REASON FOR THIS BILL IS THAT THIS PRACTICE OFTEN LEAVES PATIENTS; MANY OF WHOM ENROLLED IN A SPECIFIC HEALTH PLAN; BECAUSE THAT HEALTH PLAN WILL COVER THE SPECIFIC MEDICATIONS NECESSARY TO TREAT CHRONIC AND OFTEN COMPLEX HEALTH CONDITIONS; AND AND OFTENTIMES THESE PEOPLE IN A SITUATION WHERE THEY THEY CAN CONTRACTUALLY ENGAGE IN A SERVICE BUT [INAUDIBLE] THAT THE SERVICE MET THEIR NEEDS ONLY TO FIND THAT NO; WE ARE GOING TO TAKE AWAY THE DRUG THAT POTENTIALLY THE EPILEPSY THE MS DRUG THE SUPPRESSION DRUG; THAT [INAUDIBLE] WILL SWITCH OUT WITH SOMETHING ELSE. THE ISSUE THAT IS THE PATIENT SO [INAUDIBLE] FOR THE DURATION OF THE CONTRACT YEAR. SO IN ADDITION TO HAVING TO PAY ALREADY OUT-OF-POCKET HEALTHCARE COSTS IN RE: COST OF PREMIUMS; PATIENTS ARE LEFT NOW HAVING TO SUBSIDIZE OUT-OF-POCKET THE COST OF THE PRESCRIPTION DRUGS. WHICH FOR THESE CONDITIONS ARE OFTEN NOT ONLY A VERY COMPLEX REGIMEN; BUT USUALLY TAKE QUITE A BIT OF TRIAL AND ERROR TO ARRIVE TWO. AND LET’S SEE. SO UNDER THIS BILL; [INAUDIBLE] CAN EXPAND IT TO INCLUDE MORE PRESCRIPTION DRUGS MUCH REDUCE COPAYMENTS OR TO MOVE PRESCRIPTION DRUGS TO A DIFFERENT BENEFIT CATEGORY THAT REDUCES A PATIENT’S CAUSE. THAT’S [INAUDIBLE] HOWEVER; THE HEALTH PLAN WISHES TO REMOVE OR INCREASE THE PRICE OF A NAMEBRAND DRUG.. IT MUST INCLUDED IN [INAUDIBLE]THE BRAND-NAME DRUG AND IDENTIFIED IS THERAPEUTICALLY EQUIVALENT BY THE US PHARMACOPEIA. ADDITIONALLY HEALTH PLAN [INAUDIBLE] UTILIZATION REVIEW RECORDS AND MOVE THE DRUG TO MORE EXPENSIVE BENEFIT CATEGORY WITH WITH THE REQUIREMENT OF AN ISSUANCE 60 DAY NOTICE TO PRESCRIBERS PROMISES AND INFECTED ENROLLEES. BUT ONLY IF THE CHANGES DO NOT AFFECT ENROLLEES CURRENTLY TAKING THE MEDICATION OR MEDICATIONS AFFECTED BY THE CHANGES. THIS REALLY IS A BILL MEANT TO PREVENT FOLKS FROM GETTING THE RUG PULLED OUT FROM OF NOVEMBER AND AFTER THEY SIGN UP FOR A SERVICE THAT THEY INITIALLY THOUGHT WOULD COVER THEIR NEEDSONLY TO HAVE THAT SECURITY TAKEN AWAY. SO WITH THAT MEMBERS I WHEELED FOR QUESTIONS AND GREATLY APPRECIATE YOUR SUPPORT ON THIS BILL.>>CHAIR MORAN: I BELIEVE WE ARE ONE TESTIFIER. MS. . PLEASE PLEASE INTRODUCE YOURSELF AND WHO YOU’RE WITH AND PROCEED.>>TESTIFIER: THANK YOU MME. CHAIR. MEMBERS THE COMMITTEE MY NAME IS CATHERINESCHMIDT HERE FOR THE MINNESOTA COUNCIL HEALTH PLANS. WANT MAKE A FEW QUICK COMMENTS ABOUT HOUSE FILE 1257. THIS BILL WILL INCREASE THE COST OF HEALTH INSURANCE FOR PEOPLE WHO PAY HEALTH INSURANCE PREMIUMS WHICH INCLUDES EMPLOYERS; EMPLOYEES AND WITH PEOPLE WHO BUY COVERAGE ON THEIR OWN AND POTENTIALLY SENIOR CITIZENS. THIS BILL PRIVATE HEALTH PLANS FOR BEING ABLE TO MAKE CHANGES IN THE DRUG FORMULARY SO THAT HEALTH PLANS CAN ENSURE THE MOST COST EFFECTIVE USE SO THAT HEALTH PLANS CAN ENSURE THAT THEY ARE PROVIDING THE MOST COST EFFECTIVE USE OF PRESCRIPTION DRUGS. THIS BILL REMOVES ONE OF MANY TOOLS WE HAVE IN OUR TOOLBOX TO MANAGE THE COST OF DRUGS. DRUG PRICES CAN INCREASE AT ANY TIME OF THE YEAR AND WWE ALL KNOW DRUG PRICES FOR TRANAND GENERIC DRUGS ARE RAPIDLY INCREASING. THIS HEALTH PLAN IS PROHIBITED FROM MAKING FORMULARY ADJUSTMENTS DURING THE YEAR THAT WE ARE RIDE A BIG OPPORTUNITY FOR DRUG COMMITTEE TO INCREASE DRUG PRICES ON JANUARY 2. THIS IS NOT HYPERBOLE. THIS ACTUALLY HAPPENS THIS PAST JANUARY THAT A NUMBER OF DRUG COMEDIES RAISE THEIR PRICES CONSIDERABLY ON ALL THEIR DRUGS. THIS BILL ALSO APPLIES TO PEOPLE COVERED THROUGH STATE PUBLIC PROGRAMS AND DURING THE 2015; 26 BY ANIMUS SIMILAR BILL WAS PROPOSED IN THE RESULTING FISCAL NOTE WAS ABOUT OR 99 DOLLARS AND THAT WAS JUST THE COST OF PEOPLE COVERED THROUGH STATE PROGRAMS. WE DON’T KNOW HOW MUCH THE ADDITIONAL COST WOULD’VE BEEN FOR THE REST OF THE COMMERCIAL MARKET OR FOR SENIORS COVERED THROUGH MEDICARE SUPPLEMENT PRODUCT. DRUG PRICES ARE INCREASING AT A RAPID RATE. IN FACT THE COST OF PRESCRIPTION DRUGS NOW EXCEED THE COST OF INPATIENT HOSPITALIZATION. HEALTH INSURANCE PREMIUMS ARE SO EXTENSIVE BECAUSE THE COST OF CARE IS SO EXPENSIVE. WE URGE THE COMMITTEE TO CAREFULLY CONSIDER THE TRADE-OFFS ASSOCIATED WITH THIS PROPOSAL REMOVING THIS TOOL THESE HEALTH PLANS WILL BE LIMITED IN HOW THEY INSURE THE MOST COST EFFECTIVE USE OF DRUGS. AND HIGHER COST WILL BE PASSED ALONG TO PEOPLE THROUGH HIGHER PREMIUMS. THANK YOU; MME. CHAI R.>>CHAIR MORAN: THANK YOU. IS THERE ANYONE ELSE WOULD LIKE TO TESTIFY ON HOUSE FILE 1257? MEMBERS; ANY QUESTIONS? CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I LIKE MS. SCHMIDT TO COME BACK TO THE TABLE IF SHE WOULD. SO MS. SCHMIDT; YOU ARE TALKING ABOUT TO YOU ARE CLAIMING THIS BILL WOULD MAKE HEALTHCARE MORE EXPENSIVE. I AM WONDERING; WE HAVE HEARD A LOT THE SESSION ABOUT THE PHARMACY BENEFIT MANAGERS AND WE UNDERSTAND THAT ALL OF THE HEALTH PLANS USED PHARMACY BENEFIT MANAGERS WHEN WE TALK TO THE PHARMACY BENEFIT MANAGERS THEY SAY THAT THEY ARE GREAT BECAUSE THEY GET DISCOUNTS FROM THE MANUFACTURERS . THE MANUFACTURERS SAY THAT WE DID A DISCOUNT AND WHAT I WOULD LIKE TO KNOW IS TO THE HEALTH PLANS GET DISCOUNTS AND DO THEY PASS THEM ALONG TO THE ENROLLEES WHEN THEY GET THOSE DISCOUNTS?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE LIEBLING; THE ANSWER IS; YES. THOSE REBATES AND THE VALUE OF THOSE REBATES GET PASSED ALONG IN THE FORM OF LOWER PREMIUMS TO ALL THE PEOPLE WERE BUYING PRODUCTS IN THE FROM A PARTICULAR HEALTH PLAN.>>REPRESENTATIVE LIEBLING: MME. CHAIR; MS. SCHMIDT; I BELIEVE YOU ARE TELLING US IS THERE A WAY FOR THE PUBLIC TO CONFIRM THAT IS THE CASE ? IS THERE ANY PUBLIC REPORTING THAT YOU ARE AWARE OF THAT WOULD BE ABLE TO TELL US; EVEN WITHIN OUR PUBLIC PROGRAMS OR FOR PEOPLE WHO ARE BUYING A PRIVATE HEALTH INSURANCE PRODUCT.. IS THERE ANY WAY FOR MEMBERS TO KNOW THAT THOSE REBATES ARE BEING PASSED ALONG?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE LIEBLING; I’M SURE I CAN GET SOME INFORMATION FOR YOU AND FOR MEMBERS OF THE COMMITTEE BECAUSE THE HEALTH PLANS TO ADVOCATE KEEP TRACK OF HOW MUCH SPEND IS ATTRIBUTABLE TO THE PRESCRIPTION DRUGS; PRESCRIPTION DRUG COST; SO I THINK IF THIS BILL WERE TO BE ENACTED THE SPEND IT WOULD BE HIGHER AND THEN THE PREMIUMS WOULD BE HIRED COMMENSURATELY. I CAN ALSO WILL CHECK ON SPECIFICALLY YOUR QUESTION ABOUT HOW THE REBATES AND THEN THE OTHER DISCOUNTS ARE REFLECTED IN THE PREMIUMS.>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. YOU KNOW; THE OTHER PIECE OF THIS EVEN IF WE JUST ACCEPT IT WHAT YOU JUST SAID AT FACE VALUE TO A PART OF THE PROBLEM WITH THIS IS THAT WE HEARD A LOT OF TESTIMONY THIS SESSION AND I THIN K IN PREVIOUS SESSIONS; ABOUT WHAT HAPPENS TO PEOPLE WHEN THEY’RE FORCED OFF OF DRUGS THAT WORK FOR THEM ARBITRARILY FROM THEIR POINT OF VIEW OR BECAUSE THE PRICE WENT UP . WHEREVER THE FAULT LIES AND I HAVE TO SAY MORE I LEARN ABOUT THIS THE MORE CONFUSING A GUESS BECAUSE EVERYBODY POINTS FINGERS AT EVERYBODY ELSE IN THE SYSTEM. BUT WE KNOW THIS HAS IMPACT ON PEOPLE’S HEALTH. AND IF SOMEBODY IS ON A DRUG AND THEY GET ARBITRARILY SWITCH TO ANOTHER DRUG IT CAN HURT THEIR HEALTH. SO I WONDER WHEN YOU ARE SAYING HOW THIS CAN RAISE THE COST OF HEALTHCARE; WELL MAYBE JUST LET ME JUST MAKE A STATEMENT. I DON’T KNOW HOW THE HOW THE PLANTS ACCOUNT FOR THE FACT THAT SOMEBODY’S HEALTH MAY SUFFER. WE KNOW THAT THE DOWNSTREAM COSTS;; WHEN PART OF THE REASON THAT SO MUCH HAS SHIFTED TO PHARMACEUTICALS THAT PHARMACEUTICALS OFTEN HAVE ARE VERY EFFECTIVE AT KEEPING PEOPLE HEALTHY CONTROLLING CHRONIC DISEASES AND SO ON. SO FOR EXAMPLE; IF A PERSON IS ON INSULIN ONE TYPE AND THAT INSULIN IS THEN TAKEN TAKEN OFF THE FORMULA. THEM AFTER SWITCH BUT IT MAY NOT BE AS EFFECTIVE FOR THEM AND THEY MAY END UP IN THE HOSPITAL. THEY MAY END UP IN THE EMERGENCY ROOM. SO I DON’T KNOW HOW WE ACCOUNT FOR ALL THESE COSTS I THINK WHEN SOMEBODY BUYS A HEALTH INSURANCE PRODUCT THAT THEY OUGHT TO BE ABLE TO KNOW THAT THE DRUG THAT THEY HAVE THAT ARE LOOKING FOR THAT THEY ARE ON AND GO PICK ENSURE THAT INSURANCE PRODUCT BECAUSE OF BETTER; THEY SHOULD BE ABLE TO KNOW THEY ARE GOING TO BE WILL STAY ON A DRUG DURING THE COURSE OF THE TREATMENT. I THINK THAT’S WHAT REPRESENTATIVE CANTRELL’S BILL IS TRYING TO GET AT. SO I DO SUPPORT THE BILL. THANK YOU; MME. CHAIR.>>CHAIR MORAN: THANK YOU. REPRESENTATIVE TRENCH WANTS TO WHAT THANK YOU; MME. CHAIR. LIKE WHAT QUESTION WAS SOMEWHAT RELATED TO WHAT REPRESENTATIVE LIEBLING BROUGHT UP IN THAT WE AS A STATE AND EMPLOYERS HIRE HEALTH PLANS TO INTEGRATE AND MANAGE CARE. AND COURT NADER ACROSS [INAUDIBLE]AND BY DELEGATING THE DECISIONS ON A FORMULARY TO A PBM YOU ARE SEPARATING THAT FROM ALL YOUR OTHER KNOWLEDGE ABOUT THAT PATIENT EXPERIENCE AND WHETHER OR NOT THAT LEADS TO POST HOSPITALIZATION; ADDITIONAL LAB TESTS ; TRIED; SEE IF YOU LIKE IT. I MEAN IT’S ALWAYS KIND OF WEIRD WHEN IT’S JUST LIKE TRY IT; SEE HOW IT WORKS. AND COME BACK IF IT DOESN’T. THAT DURING THE PERIOD UNTIL YOU COME BACK AND BE REALLY DISABLING FOR SOME PEOPLE. TO WHAT DEGREE ARE YOU AWARE WITH HEALTH PLANS OVERSEE THAT IN THEIR ANALYSIS OF RECOMMENDATIONS FROM A PBM?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE LOEFFLER; I’M NOT FAMILIAR . I DON’T WORK FOR A HEALTH PLAN PER SE. SO I WOULD HAVE TO GET THAT INFORMATION FOR YOU. I WILL GET THAT INFORMATION FOR YOU. I JUST WANT TO SAY THAT YOU KNOW; IT’S NOT THAT THIS IS FIRST OF ALL THE HELP ANSWER NOT INTEND TO HARM ANY PATIENTS BUT WE ARE SIMPLY TRYING TO STRIKE A BALANCE BETWEEN PROVIDING COVERAGE; CONFERENCE OF COVERAGE; BUT AT THE SAME TIME DOING THAT AN AFFORDABLE AND ACCESSIBLE PREMIUM. IF IT’S THE WILL OF THE LEGISLATURE TO PASS THESE BILLS AND TO REMOVE SOME OF THE TOOLS THAT ALLOW US TO BE ABLE TO MANAGE OF THE CARE TO SWITCH TO OTHER DRUGS THAT ARE LOWER COST; THAT’S OKAY. IF YOU WANT TO PASS IT TO; WE CAN PRICE IT BUT I WOULD ALSO SAY THAT THERE ARE OPPORTUNITIES FOR PATIENTS TO APPEAL THESE DECISIONS IF THEY DON’T LIKE THAT THAT SORT OF THING. I RECOGNIZE THAT NOT EVERYBODY ENGAGES IN THE PROCESS; BUT AGAIN; THIS IS IT’S VERY CHALLENGING TO BE ABLE TO TRY TO PROVIDE A PREMIUM FOR A PRODUCT WHILE AT THE SAME TIME THERE IS NO RESTRICTION ON THE DRUG COMPANY IN THE DRUG COMPANY CAN SIMPLY INCREASE THE PRICE OF THE PRODUCT MIDYEAR OR SEVERAL TIMES OF THE YEAR AND THERE’S NO WAY TO ADJUST FOR THAT ACCORDINGLY.>>REPRESENTATIVE LOEFFLER: MME. CHAIR I WOULD JUST SAY THERE’S NO BUSINESS THAT IS IN A RISK OF MARKET CHANGES AND THE PRICES OF THE BUSINESS SERVICES THEY NEED TO DELIVER AND I SEE THIS AS A BASIC CONTRACTING OBLIGATION TO SOMEONE SELECTS A HEALTH PLAN BECAUSE IT HAS THE DOCTORS; THE HOSPITAL AND FOR SOME PEOPLE; MOST IMPORTANTLY; THE DRUGS THAT THEY PREFER AND ARE DEPENDENT UPON AND CAN TRUST. SO; TO ME WHEN YOU ARE ANSWER ENTER INTO A CONTRACT A PREMIUM; WHEN YOU OFFER PREMIUM FOR YEARS; TO THE PREMIUM SAYS THESE ARE ALL THE THINGS WE’RE GOING TO COVER FOR YOU INCLUDING THE SPECIFIC DRUGS FOR THE NEXT YEAR. AND THE NE XT YEAR COMES ALONG YOU CAN ADJUST THIS AND YOU MIGHT LOSE THE PATIENT. HE WILL GO SOMEWHERE ELSE; BUT AT LEAST IT’S A PATIENT CHOICE ABOUT WHO TO PURCHASE THE SERVICES FROM AND WHERE. I THINK IT’S EVERY BUSINESS IS SUBJECT TO MARKET CHANGE AND YOU HAVE TO ANTICIPATE THAT IN YOUR PRICING BUT TO READ THIS BUSINESS IS NOT DIFFERENT FROM THAN ANY OTHER IN TERMS OF SAYING; THE PURCHASER SHALL HAVE NO SAY IN THE TERMS OF THE CONTRACT AND THE DELIVERABLES WILL CHANGE THROUGHOUT THE YEAR BUT THEY ARE BOUND BY A PREMIUM AND I’VE NEVER HEARD OF ANYONE WHO GOT THAT HAPPY F THAT SAYS; YOUR PREMIUM IS GOING DOWN $50 THIS MONTH BECAUSE WE FOUND A BETTER CHEAPER DRUG FOR MANY OF OUR PATIENTS. THAT’S NEVER DONE. YOU HANG ON TO IT EVEN WHEN YOU HAVE SAVINGS. TH AT’S IS AN UP-AND-DOWN SORT OF GAME AND SEND IT TO A PRICE NO MATTER WHAT YOUR PRODUCT IS AND I THINK FOR PEOPLE WHO ACTUALLY ACTIVELY SEARCH FOR A PARTICULAR DRUG AND SELECT A HEALTH PLAN BASED ON THAT; I THINK THE TO LOOK [INAUDIBLE] DELIVERABLE OF A YEAR IS REASONABLE.>>CHAIR MORAN: REPRESENTATIVE JABBAR>>REPRESENTATIVE BAHNER: THANK YOU; MME. CHAIR. THANK YOU REPPRESENTATIVE CANTRELL FOR BRINGING THIS FORWARD. I WILL TRY TO KEEP IT SOMEWHAT BRIEF HERE BUT AS YOU KNOW; I MENTIONED THE OTHER DAY MY SISTER IS TYPE I DIABETES AND [INAUDIBLE] SO THIS IS IT I CAN TELL YOU WE’VE LIVED THROUGH THIS IN MY FAMILY WHEN MY SISTER WAS FORCED TO CHANGE IT INSOLENCE MIDSTREAM FOR SOMETHING THAT WAS WORKING WITH HER WHICH; IN FACT; THAT TO FRUSTRATE FLUCTUATION THE BLOOD SUGARS AND FOR THOSE OF YOU THAT DON’T KNOW; THEY’RE QU ITE SEVERE CONSEQUENCES TO THAT INCLUDING INSULIN REACTION WHICH PEOPLE COULD SLIP INTO A; . THERE ARE OTHER HEALTH ANCILLARY BENEFITS AROUND THAT AND IN SOME CASES; CAN LEAD TO THEM HAVING A HOSPITAL STAY AND I’M JUST CURIOUS IF YOU COULD TELL US THE AVERAGE HOSPITAL STAY; THE COST FOR THAT . YOU KNOW THE AVERAGE COST IS FOR HOSPITAL STAYS?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE CONSIDINE; I DO NOT.>>REPRESENTATIVE BAHNER: WELL I WILL TELL THE COMMITTEE I JUST LOOK THAT UP. IT’S AROUND $10;000 DEPENDING ON THE CONDITION. NOW IF WE ARE TALK ABOUT THIS POLICY AND TRYING TO SAVE MONEY HAVE TO BE HONEST WITH YOU. IT’S PENNY WISE POUND FOOLISH BECAUSE LET’S SAY WE SAVE $1000 BY SWITCHING SO MUCH WITH DIFFERENT INSULIN. BUT WE SPEND $10;000 ON A HOSPITAL STAY. THAT IS A PROBLEM. I CAN TELL YOU IS SOMEONE WHO DID FORMALLY WORK FOR HEALTHCARE COMPANY WHO ACTUALLY HAD AN ENTIRE PROGRAM DESIGNED AROUND PREVENTING HOSPITAL READMISSIONS; BECAUSE THEY ARE EXTREMELY COSTLY AND THEY DRIVE UP THE COST OF HEALTHCARE. THAT IS WHAT IS DRIVING UP THE COST OF HEALTHCARE. SO TO BE REALLY BLUNT; I HAVE TO BE HONEST WITH YOU; I’M NOT BUYING YOUR ARGUMENT BECAUSE IT MAKES NO SENSE. IT’S PENNY WISE AND POUND FOOLISH. IF WE REALLY WANT TO ENSURE THAT WERE KEEPING COSTS DOWN WE NEED TO MAKE SURE THAT WE ARE ENSURING GOOD PATIENT CARE; THAT WE ARE KEEPING CHRONIC CONDITIONS STABLE ; SO THAT WE KEEP THOSE COSTS DOWN AND WE KEEP OUR PATIENTS HEALTHIER. I THINK THAT IS THE TAKE AWAY HERE TODAY. SO I THINK YOU REPRESENTATIVE CANTRELL FOR BRINGING THIS FORWARD I THINK WE NEED TO DO SOMETHING TO [INAUDIBLE ] KEEP HEALTHCARE COST SAMPLE WE NEED TO DO IT IN A SMART WAY. THANK YOU.>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT YOU HAVE A QUESTION FOR THE>>REPRESENTATIVE ALBRIGHT: NO; I THINK IT’S TO THE AUTHOR.>>CHAIR MORAN: OKAY. REPRESENTATIVE ALBRIGHT.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL; ON PAGE 2 LINE 7 OR JUST IN SUUBDIVISION TWO; IS A DECLARATION THAT SPECIFIES THAT THE FORMULARY CAN BE REQUESTED EITHER BY ELECTRONIC MEANS OR UPON REQUEST PLEASE 30 DAYS PRIOR TO THE ANNUAL REVIEW DATE. IS THAT AVAILABLE TO ANYONE? AND WHAT TYPE OF MECHANISM TO THE USE IN ORDER TO MAKE A REQUEST?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT COULD I THINK IT SHOULD BE AVAILABLE TO ANYONE. AND; LET’S SEE IF YOU’RE JUST LOOKING AT THE LANGUAGE; BY ELECTRONIC MEANS UPON REQUEST IN WRITING . SO I THINK INDIVIDUALS CAN PURSUE AND WORK WITH WHATEVER THEIR HEALTH PLAN HAS AVAILABLE IN TERMS OF COMMUNICATION AND CONTACT IN THE ELECTRONIC MEANS TO REQUEST THAT INFORMATION.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME . CHAIR. REPRESENTATIVE CANTRELL; I UNDERSTAND WHAT IT SAYS HERE BUT IN TERMS OF THE– I GUESS I WAS GETTING MORE THAT IN TERMS OF HOW DID THE REQUESTED IS COMING BACK TO THEM EITHER IN ELECTRONIC FORM OR BY WRITING OR MAYBE LET’S JUST LEAVE IT AT THAT. DOWN FURTHER ON THE SAME PAGE; LINE 28 THROUGH 32; THEY MAY CHANGE OR REMOVE DRUGS FROM THE FORMULARY DEEMED UNSAFE EITHER FROM THE FDA; BUT THEN FURTHER DOWN IT GOES TO SO FDA TYPICALLY IS A PERSON WHO WOULD DEEM A FORMULARY UNSAFE. BUT YOU ALSO IN HERE IDENTIFY AN INDEPENDENT SOURCE OF RESEARCH; CLINICAL GUIDELINES OR WHATNOT . SO ARE THERE SPECIFIC SOURCES THAT ARE DEEMED CREDIBLE THEY WOULD WANT TO CITE HERE OR IS IT JUST ANYBODY THAT WOULD DEEM A DRUG UNSAFE?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. IS ANY SCIENCE-BASED PRACTICING PHYSICIAN WOULD KNOW; THAT THERE ARE CREDIBLE BODIES OF RESEARCH AND EVIDENCE IN LITERATURE ARE CONSTANTLY EVOLVING AND CHANGING IN TERMS OF BEST PRACTICES NEIGHBORS GIVES CERTAIN TREATMENTS FOR CERTAIN CONDITIONS. SO AS THOSE CHANGE IN THE HEALTH PLAN THE HEALTH PLAN EVALUATES THE MOST CONTEMPORARY RESEARCH PERTAINING TO THE EFFICACY OF CERTAIN DRUGS FOR CERTAIN CONDITIONS; IF A HEALTH PLAN OBSERVES THAT AND REFLECT UPON IT AND THEN REEVALUATES IT’S A FORMULARY COMPOSITION BASED ON THAT; I THINK THAT’S A REASONABLE WINDOW OF FLEXIBILITY TO ALLOW THEM.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. SO IF I DID MY OWN RESEARCH AND POSTED IT; DEEMED IT CREDIBLE; COULD I AFFECT THE FORMULARY?>>REPRESENTATIVE CANTRELL:>>REPRESENTATIVE ALBRIGHT: UNDER YOUR RESPONSE; MY A CREDIBLE SOURCE?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. A THANK YOU REPRESENTATIVE ALBRIGHT. I DON’T THINK YOU’LL BE AN INDEPENDENT SOURCE OF RESEARCH IF YOU PUBLISH YOUR OWN RESEARCH AND DEEM IT CREDIBLE.>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE CANTRELL COME I THINK THE POINT BEING IS THAT YOU ARE NOT DEFINED WHAT AN INDEPENDENT SOURCE OF RESEARCH IS HERE. YOU DON’T HAVE YOUR NO BASIS HERE TO SAY WHAT IS CREDIBLE OR NOT. JUST SPECIFIES INDEPENDENT SOURCE OF RESEARCH. SO AT YOUR OWN PERIL I THINK YOU GO FORWARD WITH THAT LANGUAGE FINAL QUESTION MME. CHAIR. IN YOUR HOUSE FILE 1257; AS IT IS WRITTEN; WHAT AFFECT YOUR LEGISLATION HAVE ON PRIVATE CONTRACTS?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. YOU KNOW I MIGHT HAVE TO DEFER TO RESEARCH ON THAT.>>>>CHAIR MORAN: MR.>>STAFF: MME. CHAIR REPRESENTATIVE ALBRIGHT; IF BY PRIVATE CONTRACTS DEEMING CONTRACTS BETWEEN THEIR PLAN OF HEALTH COVERAGE>>REPRESENTATIVE ALBRIGHT: YES>>STAFF: WELL I THINK THIS BILL WOULD FUNCTION AS I GUESS MANY OTHER PROPOSALS; TO CHANGE WAS COVERED OR HOW SOMETHING IS COVERED.. I THINK THAT WHEN [INAUDIBLE] P LANS PUT TOGETHER THEIR FORMULAS OR WHEN PLANS PUT TOGETHER YOUR DOCUMENTS HOW FORMULARY CHANGES ARE MADE DURING THE YEAR I THINK THESE TYPES OF THINGS WOULD BE INCORPORATED INTO THOSE CONTRACTS>>REPRESENTATIVE ALBRIGHT: MME. CHAIR IF I COULD ASK A FOLLOW-UP TO MR. CHUNG. THANK YOU; MME. CHAIR. MR. CHUNG WITH THAT ALSO AFFECT PRIVATE CONTRACTS BETWEEN HMOS; PMS; INSURANCE COMPANIES AND HMOS OR THE TRIANGULATION OF THOSE THREE ENTITIES?>>STAFF: MME. CHAIR REPRESENTATIVE ALBRIGHT; I GUESS THE DUTIES FOR COMPLIANCE HERE ARE BASED ON THE [INAUDIBLE] COMPANY. SO I GUESS THE HEALTH PLAN COMPANY; WHAT IT DOES TO USE THE SERVICES OF A PBM COME I THINK IT WOULD HAVE TO ENSURE THAT THE PBM WAS FOLLOWING PROVISIONS SUCH AS THESE BECAUSE IT WOULD BE THE HEALTH PLAN THAT IS ULTIMATE RESPONSIBILITY FOR ITS CLIENTS.>>REPRESENTATIVE ALBRIGHT: MME. CHAIR; THANK YOU. FINAL QUESTION OF REPRESENTATIVE CANTRELL; WE ARE IN THE MIDST OF TALK ABOUT CHANGING POLICY FOR THE BENEFIT OF ENROLLEES TO FORMULARIES EXTREME TO GET IN YOUR EFFECTIVE DATE OR DATE OF ENACTMENT ON HERE. IT WOULD SEEM YOU ARE CHANGING COURSE WITH REGARD TO ENROLLEES REGISTERING BECAUSE THERE IS NO EFFECTIVE DATE HERE AS WELL. IT WOULD BE EFFECTIVE THE DATE OF ENACTMENT BY DEFAULT OR JULY 1; AUGUST 1?>>STAFF: MME . CHAIR REPRESENTATIVE ALBRIGHT THE DEFECTIVE OF ALTERNATE ISN’T SPECIFIED IN THE BILL. IT’S EITHER AUGUST 1 IN CASE OF A BILL THAT DOESN’T HAVE A COST OR JULY 1 TO THE BILL HAS A COST.>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE CANTRELL I WOULD COORDINATE THAT ENACTMENT SO YOU ARE CONSISTENT WITH THE LANGUAGE IN THE BILL.>>CHAIR MORAN: REPRESENTATIVE PIERSON.>>REPRESENTATIVE PIERSON: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL; THANKS FOR BRINGING THE BILL. AGAIN I UNDERSTAND THE INTENTION AND ACTUALLY REPRESENTATIVE BAHNER’S LINE OF THOUGHT KIND OF JUST FIGURED IN MY HEAD THAT AGAIN; WE HAVE A LOT OF TESTIFIERS WERE NEGATIVELY IMPACTED AND AGAIN; MAYBE SOMEONE ELSE WANTS TO SPEAK TO THIS BUT WHEN WE HAVE THOSE INDIVIDUALS THAT ARE NEGATIVELY IMPACTED;; I JUST WONDER IF THERE IS THE POTENTIAL THERE THAT THOUSANDS OF OTHER PEOPLE ACTUALLY BENEFITING FROM THESE CHANGES THAT ARE OCCURRING. WHETHER THAT IS IN THE PRICE OF THE PRESCRIPTION DRUG IT’S BEEN GIVEN AT THAT POINT OR AGAIN; THERE’S EBBERS REACTIONS TO MEDICATIONS BUT THAT HAPPENS; WRITES. WHILE THE CHANGE IN THE FORMULARY FOR THE PBM MIGHT BE NEGATIVE IMPACT IN ONE PERSON AND COSTING $10;000 TO THE HOSPITAL VISIT AND ONLY SAVING THOUSAND DOLLARS; THAT’S GOING ON FOR 1000 PEOPLE WORE 10;000 PEOPLE AND THE REST OF THEM ARE HAVING POSITIVE OUTCOMES AND WE ARE LOWERING THE COST OF THAT TOTAL COST OF THE DELIVERY OF HEALTHCARE.. WITHIN THE EXCEPTIONS THAT YOU’VE GIVEN THEM A DO WE STILL HAVE THAT FLEXIBILITY FOR THE CHANGES?>>REPRESENTATIVE CANTRELL: THANK YOU CHAIR MORAN AND THANK YOU REPRESENTATIVE PIERSON FOR EXTREMELY THOUGHTFUL QUESTIONS BUT I BELIEVE THIS DOES STILL PROVIDE A GREAT DEAL OF FLEXIBILITY AND CONTRARY TO SOME OF THE TESTIMONY THAT WAS HEARD IN THIS COMMITTEE HEARING; FOR THIS BILL; THIS DOESN’T RESTRICT OFFENSE FROM CHANGING THEIR FORMULARIES COULD STILL ALLOWS FOR THAT AND IT HAS SEVERAL ENUMERATED CONDITIONS UNDER WHICH HEALTH PLANS ARE ABLE TO ALTER THEIR FORMULARIES. SO I THINK IT STILL ALLOWS FOR HEALTH PLAN TO PARTICIPATE IN THE HOUSE ECONOMY WITHOUT HAVING TO SERVE AT THE DETRIMENT OF PATIENTS AND I THINK EFFECTIVELY IT SEEKS TO AND WILL BE SUCCESSFUL IN REMEDYING THIS CURRENT ONGOING PUMP THAT WE HEARD FROM A LOT OF ADVOCATES FROM ACROSS THE BOARD ABOUT WHETHER THEY ARE STRUGGLING WITH DIABETES OR EPILEPSY OR ANY OTHER TYPE OF CHRONIC HEALTH CONDITION THAT REQUIRES CONTINUAL AND VERY SPECIFIC HEART CARE MAINTENANCE. SO I ABSOLUTELY APPRECIATE YOUR QUESTION AND MAKING SURE THAT SOMEHOW THE LANGUAGE IN THIS BILL DOESN’T DISADVANTAGE SOME PEOPLE AT THE BENEFIT OF OTHERS AND I THINK THAT WE HAVE AVOIDED UP WITH THE LANGUAGE IN THIS BILL AS IS CURRENTLY WRITTEN.>>REPRESENTATIVE PIERSON: MME. CHAIR; TO THE AUTHOR JUST POINT ME TO WHERE THOSE EXCEPTIONS ARE ACTUALLY PROVIDED ? BECAUSE I’M JUST SEEN IN SUBSECTION3 OF I GUESS THIS WOULD BE I’M LOOKING AT SECTION 1; SUBSECTION 3. IS THAT WHAT I’M LOOKING AT?>>REPRESENTATIVE CANTRELL: OF DIVISION III? MME. CHAIR REPRESENTATIVE PIERSON; SO IN SUBDIVISION THREE; LET ME JUST TAKE A LOOK AT THIS REAL QUICK. SUBDIVISION THREE OUTLINES FORMULARY CHANGES SO IT IS PRETTY MUCH FROM LINE 2 AND 12 TO 2.32; WE ARE OUTLINING A LOT OF THE THOSE DIFFERENT COMPONENTS THAT I EXPRESSED IN MY STATEMENT.>>REPRESENTATIVE PIERSON: WELL I SEE WHERE D IS OBVIOUSLY; TO READ THAT’S A NO-BRAINER. IF THE FDA HAS DEEMED IT UNSAFE WERE GOING TO LET THEM DROP THAT DRUG; RIGHT BUT SECTIONS B AND C ARE GONNA COVER THE TYPE OF FORMULAIC YOU ARE SAYING THAT LANGUAGE IS GOING TO COVER US THE TYPE OF CIRCUMSTANCES I WAS HIS CABIN EARLIER . I GUESS I DON’T KNOW IF SOMEONE ELSE CAN COMMENT ON THAT BECAUSE I JUST DON’T KNOW THAT IS GIVEN IS QUITE ENOUGH LATITUDE FOR THOSE ENTITIES.>>CHAIR MORAN: THANK YOU. PLEASE PLEASE INTRODUCE YOURSELF AND PROCEED WITH YOUR TESTIMONY. THE AFTERNOON MEMBERS THE COMMITTEE ERIC WITHIN MINNESOTA MEDICAL ASSOCIATION DID THINK OF YOURS QUESTION REPRESENTATIVE PIERSON I WOULD POINT TO THE LIMITS THAT IN PARAGRAPH CBEGINNING AT LINE 2.23 SPECIFICALLY THE LANGUAGE FOLLOWING THE LAST; ON LINE 2.25 PROVIDED THESE CHANGES DO NOT APPLY TO ENROLLEES WERE CURRENTLY TAKING THE DRUG AFFECTED BY THE CHANGES. THIS IS LANGUAGE THAT WE HAD THE MEDICAL ASSOCIATION FOR [INAUDIBLE] REPRESENTATIVE CANTRELL BECAUSE THEY ALLOW LPNS MAXIMUM LATITUDE TO CHANGE FORMULARIES SAY FOR THOSE INSTANCES WHEN A PATIENT IS CURRENTLY TAKING A DRUG THAT DRUG THERAPY IS WORKING. UNDER THIS BILL HEALTH PLANS WOULD BE ALLOWED TO CHANGE FORM THERE IS AS THEY SEE FIT. SAVE FOR THOSE DATES WHO ARE CURRENTLY TAKING A THERAPY THAT’S WORKING FOR THEM.>>CHAIR MORAN: QUESTION?>>REPRESENTATIVE PIERSON: I DON’T KNOW. TO ME THAT JUST GOES TO I MEAN IT OPPOSED THE ENTIRE CONCEPT OF YES; THERE ARE ADVERSE REACTIONS TO DRUGS AND CHANGES BUT SOMETIMES PEOPLE ARE JUST TAKING THE MEDICATION PER WHAT THEIR DOCTORS ARE ORDERING AND IS FORMULAIC TO CHANGE AND ACTUALLY IMPROVE THEIR LIVES AND HERE; YOU ARE BASICALLY MAKING THE STATEMENT THAT THAT CAN ONLY HAPPEN AT THE ANNIVERSARY; ON JANUARY 1 WHEN A NEW PLAN COMES OUT ; AND I DON’T KNOW. AGAIN; A DOCTOR IS GOING TO BE MAKING THE CHANGES ALONG THE WAY IF SOMEONE IS HAVING A NEGATIVE REACTION TO THEIR CURRENT PRESCRIPTION. ONE WOULD HOPE AND ASSUME.. BUT HERE WE ARE JUST SO NARROWLY GIVING ANYONE THE OPPORTUNITY TO MAKE THOSE CHANGES AND AGAIN; I KIND OF ASKED THE QUESTION ; IF WE ANTICIPATE THE COSTS ARE GOING TO GO DOWN BY THOUSANDS OF DOLLARS FOR THOUSANDS OF PATIENTS; AND YET THERE MIGHT BE A COUPLE OF ADVERSE REACTIONS NOT TO BE CRUEL ABOUT IT; BECAUSE OF COURSE WE WANT TO MAKE SURE THE PATIENTS ARE SAFE . WE ARE NOT TRYING TO PRESCRIBE ANYTHING THAT’S UNSAFE FOR THEM;; BUT THIS CONCEPT OF PENNY WISE AND POUND FOOLISH; THERE IS A WHOLE CALCULATION TO THAT THAT IF THERE’S ENOUGH PENNIES ADDING UP THERE; IT MAY NOT HOLD TRUE THAT’S THE RIGHT DECISION AND THIS GIVES VERY LITTLE LATITUDE AS I READ IT BECAUSE WE ARE SAYING YOU’RE ON A DRUG AND THINGS ARE GOOD . THERE’S NO WAY THEY CAN CHANGE IT. AGAIN; THAT’S MAYBE WHAT WE ALL FEEL THE DOCTOR’S JOB IS BUT HERE WE’VE GOT THIS MANAGEMENT COMPANY THAT HAS THE RESPONSIBILITY ; AND WE ARE REALLY TYING THEIR HANDS AS I READ THE LANGUAGE.. BECAUSE IT’S GIVING VERY LITTLE NARROW EXCEPTIONS FOR THAT.>>CHAIR MORAN: REPRESENTATIVE BAHNER>>REPRESENTATIVE BAHNER: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL. SO WE TALKED A LOT TODAY ABOUT DO NO HARM. I THINK OUR FIRST TESTIFIER CAME UP AND SAID WELL THE INTENT OF THE HOUSE PLANS IS TO DO NO HARM. WELL I HAVE TO BE HONEST WITH YOU SWITCHING DRUGS MIDSTREAM TO HAVE SOMEONE END UP IN THE HOSPITAL IS CERTAINLY DOING HARM. NOT TO MENTION; JUST TO BE CLEAR; WHEN I MENTIONED EARLIER THE AVERAGE HOSPITAL STAY IS $10;000; THAT’S AN AVERAGE. THAT’S AN AVERAGE. THAT DOESN’T MEAN IT’S NOT MORE. AN D IF LET’S SAY YOU SWITCH A PATIENT TO ANOTHER DRUG OR ANOTHER INSULIN FOR EXAMPLE THAT DOES NOT WORK; AND THEY ARE IN THE HOSPITAL BECAUSE THE OTHER DRUG BEEN TAKEN BEFORE IS STILL NOT ON THE FORMULARY THEY ARE GONNA TRY YET A THIRD DRUG AND WHAT HAPPENS WHEN THAT DRUG FAILS? WHICH; BY THE WAY; HAPPENS AND HAS HAPPENED THEN THEY END UP IN THE HOSPITAL AGAIN. NOW WE’RE AT $20;000 TO SAVE A FEW PENNIES. THAT MATH DOES NOT AT ALL. IT MAKES NO SENSE. QUITE FRANKLY; AM REALLY DISAPPOINTED WE ARE NOT HAVING A ON A DATE DR. MANN IS HERE BECAUSE I TELL YOU SHE WILL BE THE FIRST ONE TO STAND UP AND RAISE HER HAND AND SAY THAT DOCTORS – SORRY – I’M SORRY WE HAVE A DOCTOR IN THE CORNER BUT THE POINT HERE IS THAT WE HAVE TO DO IT RIGHT FOR OUR PATIENTS . THAT MEANS ON EVERY LEVEL AND EVERY DOCTOR WILL TELL YOU T HAT MOST PATIENTS IN MANY CASES HAVE TRIED AND FAILED AND WE WILL LET THE DOCTOR TO THIS; BUT HAVE TRIED MULTIPLE MEDICATIONS . AND WHEN YOU FIND SOMETHING THAT WORKS YOU WANT TO KEEP YOUR PATIENT ON IT. YOU WANT THEM TO HAVE THE BEST POSSIBLE HEALTH OUTCOMES. SO ARBITRARILY SWITCHING THINGSWILL WILLY-NILLY MAKES NO SENSE AND I WOULD THINK THAT THE DOCTORS WOULD TAKE CERTAIN EXCEPTION TO THE IDEA THAT THEY ARE SIMPLY PRESCRIBING A DRUG JUST BECAUSE THAT’S WHAT THEY’RE PRESCRIBING AND THAT THEY COULD JUST GO AHEAD AND SWITCH THINGS WILLY-NILLY BASED ON CHANGES . I DON’T THINK MOST PHYSICIANS WOULD BE OKAY WITH THAT CONCEPT. WHICH IS SORT OF WHAT WAS IMPLIED HERE. I REALLY THINK TO BE A REAL EXCEPTION TO THAT AND NOT ONLY THAT; YOU KNOW JUST TO BRING THIS BACK TO THE WHOLE POINT WE’VE HEARD TODAY. THIS IS ABOUT MAKING SURE CONSUMERS HAVE TRANSPARENCY THEY SIGN UP BECAUSE THEY’RE USING A DRUG THAT WORKS FOR THEM. IT IS CONSISTENT. IT HELPS ENSURE THEIR HEALTH. THEY HAVE WORKED WITH THEIR PHYSICIAN; HAND IN HAND; TO FIND THAT DRUG THAT WORKS FOR THEM. AND WHEN THEY ARE USING THAT AS A BASIS OF THEIR DECISION TO ENTER INTO A CONTRACTTHEY HAVE A REASONABLE EXPECTATION THAT THE OTHER END OF THE CONTRACT WILL BE FILLED. PLAIN AND SIMPLE. THANK YOU.>>CHAIR MORAN: CHAIR LIEBLING.>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. SORRY. I JUST WOULD LIKE TO RESPOND TO A COUPLE THINGS THAT ARE BEEN SAID HERE. YOU KNOW MS. SMIT I THINK SAID TO US THAT PHARMACEUTICAL COSTS ARE BEING PART OF WHAT STRIVING INCREASES IN HEALTHCARE. THEY’RE VERY IMPORTANT DRUGS ARE VERY EXPENSIVE. AND THAT THIS TOOL THAT THEY USE IN THE PBM’S TO KEEP COSTS THIS IS A COST SAVINGS THINK IT REPRESENTATIVE PIERSON WAS I THINK I THINK QUITE RIGHTLY THINK ABOUT WITH THE OVERALL IMPACT ON PATIENTS BUT I JUST WANT TO BRING IN AND REMIND FOLKS ABOUT SOMETHING ELSE. THAT WE HAVE BEEN TOLD THAT IF WE STOP SUBSIDIZING HEALTH INSURANCE COMPANIES TO THE TUNE OF HUNDREDS OF MILLIONS OF STATE DOLLARS THAT THEY WILL INCREASE RATES; I THINK BY 54%. BEST RATES WILL JUST SHOOT UP. SO MY QUESTION IS; WHERE IS THE BIG COST SAVINGS HERE? IF THIS IS; INDEED; THEIR BALANCING THINGS OUT AND THEY AS REPRESENTATIVE PIERSON TO HE LEFT THE ROOM; BUT AS THINGS ARE BEING BALANCED OUT AS HE SUSPECTED THEY MIGHT BE WHY THE WORLD WOULD THEY BE SAYING TO AND FRANKLY I DON’T BELIEVE THEM FOR A MOMENT THAT’S WHAT WILL HAPPEN; BUT THAT IS WHAT THEY WERE CLAIMING. THAT RATES WILL JUST SHOOT UP . SO THAT WOULD TELL ME THAT THE STRATEGIES ARE USING A FAILING MISERABLY IF THAT IS WHAT INDEED WOULD HAPPEN. IF WE START GIVING THEM HUNDREDS OF MILLIONS OF STATE DOLLARS TO KEEP THEIR RATES DOWN. SO THAT IS ONE THING THE OTHER THING I WANT TO POINT OUT TO HIM NOT TO ASK IT AS A QUESTION. IF SHE WANTS TO RESPOND WHAT THE CHAIR MIGHT ALLOW HER TO BUT IN ANOTHER COMMITTEE ; AS MEMBERS KNOW; THERE’S ANOTHER PROPOSAL THERE’S OTHER PROPOSALS MOVING THROUGH. ONE OF THEM FROM THE GOVERNOR TO HAVE A SEPARATE PRESCRIPTION AND IF IT. AND STOP IN OTHER WORDS; RIGHT NOW; IN OUR PUBLIC PROGRAMS WHERE WE ARE DOING FEE FOR SERVICE; THE INCREASES ARE MUCH LOWER THAN THEY ARE IN THE PRESCRIPTION BENEFITS UNDER THE AGE OF MOST THEY’RE USING PBM’S. SO SOMEHOW WHATEVER THEY’RE DOING WITH THE PBM’S IS NOT WORKING TO KEEP COSTS DOWN. I BELIEVE MS. SCHMIDT MADE THE COMMENT THAT SHE WAS OPPOSED TO THE THE ORGANIZATION WAS OPPOSED TO THE BENEFIT AND DOING IT SEPARATELY BECAUSE IT WOULD REALLY IMPACT THE ABILITY OF THE HMOS TO MANAGE CARE; TO COORDINATE CARE. BUT WE ALSO JUST HEARD HER SAY IN RESPONSE TO SOME QUESTIONS FROM REPRESENTATIVE LOEFFLER;; SHE DOESN’T EVEN KNOW HOW THE PBM COORDINATESWITH THE HEALTHCARE SIDE; THE OTHER KINDS OF HEALTHCARE THAT THESE PLANS ARE MANAGING .. SO I WOULD JUST SUBMIT TO MEMBERS; I’VE COME TO UNDERSTAND OVER THE YEARS AND WHAT THE HMOS ARE REALLY MANAGING HIS MONEY; NOT CARE. I’M HIGHLY SKEPTICAL OF THE CLAIM THAT THIS IS THAT DOING THIS AND BEING ABLE TO SWITCH PATIENTS AROUND WILLY-NILLY’S OFFER AND OFFER OFFER MEDICATIONS ARE PROMISED WHEN THEY SIGN UP FOR THE PLAN BUT THIS IS A COST SAVINGS TO THE CONSUMER. THAT IT GETS PASSED THROUGH TO THE CONSUMER IN ANY RESPECT; BECAUSE ANYW AY I WILL LEAVE IT THERE. I THINK IT’S BEEN A VERY INTERESTING CONVERSATION AND I’M HIGHLY SKEPTICAL OF THE EXCUSES THAT ARE BEING GIVEN TO US AND I SUPPORT THE BILL.>>CHAIR MORAN: OKAY. THE NEXT PERSON WILL BE REPRESENTATIVE NEU AND THEN WILL DO CLOSING STATEMENT.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. BE REP HE CAN SHOW I WANT TO FOCUS ON SUBDIVISION TWO ON PAGE 2. THE PRESCRIPTION DRUG BENEFIT DISCLOSURE. I’M WONDERING IF YOU CAN JUST BRIEFLY EXPLAIN THE SECTION AND HOW IT MIGHT DIFFER FROM CURRENT DISCLOSURE?>>REPRESENTATIVE CANTRELL: I THINK IT’S A GOOD SECTION TO HAVE IN THE BILL.>>REPRESENTATIVE NEU: THANK YOU. DO YOU KNOW HOW IT DIFFERS; DO YOU KNOW KIND OF DISCLOSURE IS AND HOW THIS MIGHT DIFFER?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE NEU. I’ VE GOT TO SAY; I JUST THINK THIS A GOOD SECTION TO INCLUDE IN THE BILL TO MAKE SURE THAT IT’S LINKEDIN WITH A LANGUAGE WITH THIS PIECE OF LEGISLATION.>>REPRESENTATIVE NEU: SO WE DON’T KNOW HOW THIS WILL CHANGE THINGS. THEN MY NEXT QUESTION I WILL FOLLOW UP; UNDER C HUNDRED .10 AND 2.11; IS A COUPLE OF THINGS I’M WONDERING ABOUT. FOR EACH ITEM OR CATEGORY IN A FORMULA SAYS THE BENEFIT TERMS MUST BE IDENTIFIED.. I ACTUALLY ASSUMED I COULD BE WRONG BUT I WOULD THINK THAT’S ALREADY HAPPENING. THE NEXT ITEM SAYS INCLUDING ENROLLEE COST SHARING. I’M WONDERING I LOOK THROUGH THE DEFINITIONS IN THE BILL AND IT DOES NOT DEFINE THE ENROLLEE COST SHARING. SOME JUST WONDERING WHAT SPECIFICALLY THAT IS REFERRING TO?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE NEU. SO IT IS REFERRING TO THE ALTERATIONS THAT MAY OCCUR IN THE SHARE OF ESSENTIALLY THE COST SHARING [INAUDIBLE] AND EXPECTED OUT OF POCKET COST WITH ANY TYPE OF PERCEPTION DUG IN THE FORM THERE WERE ANY ANTICIPATED CHANGES.>>REPRESENTATIVE NEU: THANK YOU MME. CHAIR. SO THIS IS SPECIFICALLY REFERENCING THE FORMULARY AT THE BEGINNING OF THE YEAR IS MY UNDERSTANDING. IS IT NOT? IS THIS REFERENCING FORMULARY CHANGES ? BECAUSE MY UNDERSTANDING IS THAT WOULD NOT BE ALLOWED TO CHANGE BASED ON THIS BILL. SO YOU ARE TALKING ABOUT FLUCTUATION COULD I’M JUST WONDERING ; TO I’M NOT SURE THAT DEFINITION IS CLEAR ON COST-SHARING AND WHAT YOU’RE EXPLAINING I GUESS IS NOT SORT OF WHAT I ASSUMED IT WOULD BE SO DO YOU HAVE PREPS IS A GOOD BETTER QUESTION FOR NONPARTISAN COULD>>REPRESENTATIVE CANTRELL: ACTUALLY MME. CHAIR I CAN ANSWER THAT QUESTION DID YOU CAN CHANGE THE FORM OF A REPRESENTATIVE NEU IN THIS BILL. THIS BILL LANGUAGE INCLUDES SEVERAL SECTIONS THAT ALLOWS A HEALTH PLAN TO CHANGE HIS FORMULARY DURING THE CONTRACT YEAR. FOR SEVERAL EXCEPTIONS IN THIS BILL THAT PERMIT THE WHOLE PLAN TO CHANGE HIS FORMULARY INCLUDING EXPANDING FROM THAT BY ADDING DRUGS TO THE FORMER SHIFTING THE DRUGS TO A DIFFERENT COST-BENEFIT TEAR. AS LONG AS A DECREASE OF THE DRUG. SO; IN THE BILL; THERE IS LANGUAGE THAT SAYS YOU CAN CHANGE THE FORMULARY. THERE ARE SEVERAL CONDITIONS IN WHICH THAT CAN TAKE PLACE.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. I DO UNDERSTAND THAT. I GUESS WHAT I’M GETTING AT HERE IS THAT THIS ENROLLEE COST-SHARING IS NOT DEFINED AND IT DOESN’T SAY HERE THAT THE FLUUCTUATIONS THAT MAY BE HAPPENING. SIBLEY SAYS THE ENROLLEE COST-SHARING. I’LL BE HONEST I ASSUMED WITH THAT MEANT WAS THAT THEY HAD CLEARLY DEFINED CO-PAYS; COINSURANCE; THIS KIND OF THING BUT PERHAPS THAT’S NOT CORRECT. IT IS BASED ON SOMETHING ELSE?>>REPRESENTATIVE CANTRELL: THANK YOU;>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. NO REPRESENTATIVE NEU; THAT IS CORRECT.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. THEN THE NEXT QUESTION; THE VERY NEXT PIECE THERE;; WE EXPECTED OUT OF POCKET COST;; I AM WONDERING HOW THAT WOULD BE DEFINED EXPECTED OUT-OF-POCKET COSTS? THAT BASED ON CURRENT PRESCRIPTION? IS THAT SOMEHOW FORECASTING YOUR HEALTH INTO THE FUTURE? HOW WOULD; EXPECTED OUT-OF-POCKET COSTS CALCULATED?>>REPRESENTATIVE CANTRELL: THANK YOU REPRESENTATIVE JANELLE. THE EXPECTED COST BE CALCULATED JUST AS ANY OTHER TYPE OF IN ANY OTHER CIRCUMSTANCE IN WHICH YOU ANTICIPATED THAT THERE MIGHT BE COST X OUT-OF-POCKET FOR DRUG Y LET’S SAY. THAT’S PRETTY MUCH WHAT THAT IS REFERRING TO.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. SO THAT WOULD BE BASED ON EACH INDIVIDUAL DRUG IN THE FORMULARY THAT IS EXPECTED TO THAT EXPECTED OUT-OF-POCKET COST WOULD BE DEFINED FOR EACH INDIVIDUAL. IT’S NOT MEANING IS NOT BASED ON THE PATIENT THAT IS BASED ON THE DRUG IN THE FORM THAT?>>REPRESENTATIVE CANTRELL:>>CHAIR MORAN: WAS OR SOMEONE FROM THE DEPARTMENT AND THE RESPONSE OF THIS? PLEASE INTRODUCE YOURSELF>>TESTIFIER: MME. CHAIR; REPRESENTATIVE; [INAUDIBLE] MINNESOTA MEDICAL ASSOCIATES. AM SORRY REPRESENTATIVE NEU CAN YOU REPEAT YOUR QUESTION>>REPRESENTATIVE NEU: ABSOLUTELY THANK YOU MME. CHAIR. MY QUESTION IS HOW ARE THE EXPECTED OUT-OF-POCKET COSTS CALCULATED? IS THAT CALCULATED FOR EACH ITEM IN THE FORMULARY ? MEANING; IS IT ITEM-BASED OR IS IT PATIENT BASED?>>TESTIFIER: THE INTENT MME. CHAIR EXCUSE ME IS TO MAKE IT ITEM-BASED. SO EACH DRUG INCLUDED IN THE FORM OF THE EXPECTED OUT OF POCKET COST WILL BE CALCULATED.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. AND YOU HAVE AN IDEA OF HOW MANY ITEMS WERE CATEGORIES ARE CURRENTLY ON A TYPICAL ON A FORMULARY AND IS THAT INFORMATION CURRENTLY AVAILABLE OR WOULD THAT BE A CHANGE REALLY?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE NEU; I BELIEVE FORMULARIES ARE FAIRLY READILY AVAILABLE PRESENTLY . IF THE MMA WAS DONE A LOT OF RESEARCH INTO FORMULAS AND WHERE THEIR PART ON DIFFERENT WEBSITES . SOME HEALTH PLANS MAKE IT VERY EASY TO FIND A FORMULARY. SOME DON’T. SOME TAKE QUITE A BIT OF SEARCHING. SO TO YOUR EARLIER QUESTION; THE TRANSPARENCY PIECE INCLUDED IN SUBDIVISION TWO ; LINE 2.4; IS REALLY IMPORTANT. I WILL PLEAD A LITTLE BIT OF IGNORANCE AND WHAT CURRENT LAW REQUIRES AS A TRANSPARENT IS MATTER OF TRANSPARENCY FOR FORMULAS. SO WE BELIEVE THIS LANGUAGE CERTAINLY MAKES CLEAR THAT HEALTH PLANS CANNOT BE BE HIDING HER FORMULARIES THEY NEED TO BE READILY ACCESSIBLE FOR CONSUMERS.>>REPRESENTATIVE NEU: THANK YOU>>CHAIR MORAN: THANK YOU. SO I’D SAY THAT WE CAN GO TO CLOSING STATEMENTS FROM THE AUTHOR BUT I THINK THAT REPRESENTATIVE ALBRIGHT NEEDS TO MAKE A STATEMENT.>>REPRESENTATIVE ALBRIGHT: MME. CHAIR; MAYBE NOT A CLOSING STATEMENT BUT I SOON WITH GREAT INTENT TO REPRESENTATIVE LIEBLING’S STATEMENT AND I THINK WITH SOME PRETTY PROVOCATIVE COMMENTS MADE IN HER DISSERTATION AND I’M JUST WONDERING IF I COULD REQUEST [INAUDIBLE] BACK TO THE TESTIFIERS TABLE. I WOULD LIKE TO HEAR HER RESPONSE.>>CHAIR MORAN: MS. SCHMIDT. MS. SCHMIDT YOU REMEMBER THE QUESTION? THAT REPRESENTATIVE ALBRIGHT IS REFERRING TO? REPRESENTATIVE ALBRIGHT WOULD YOU LIKE TO ENLIGHTEN US AS TO WHAT THE QUESTION WAS.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. MS. SCHMIDT; IN THE COMMITTEE PROVIDED SEVEN BY REPRESENTATIVE LIEBLING MADE SOME NOT ASSERTIONS BUT MADE SOME SIMS CERTAINLY I THINK COMPEL RESPONSE . NOT THAT I AGREE OR DISAGREE BUT I THINK IT’S IN FAIRNESS SHOULD BE PROVIDE AN OPPORTUNITY TO RESPOND.>>TESTIFIER: THANK YOU MME. CHAIR AND REPRESENTATIVE ALBRIGHT. CATHERINE SCHMIDT FOR MINNESOTA COUNCIL OF HEALTH PLANS. SO WHILE I WAS AWAY FROM THE TABLE I DID GET A CHANCE TO TALK TO CUT MY COLLEAGUES AND HAPPY TO SHARE WITH YOU THAT HEALTH PLANS TO GET DRUG UTILIZATION INFORMATION FROM THE PBM’S THAT THEY USE TO HELP MANAGE THE CARE FOR PATIENTS BUT ESPECIALLY FOR PEOPLE WITH COMPLICATED CONDITIONS INCLUDING PEOPLE WERE DIABETIC . I CAN ALSO TELL YOU THAT THERE IS A BENEFIT EXCEPTION PROCESS THAT IS AVAILABLE SO IF THE DRUG IS WORKING FOR A PATIENT AND THEY DON’T WANT TO CHANGE IT AND IT’S BEEN WORKED OUT BETWEEN A PHYSICIAN AND PATIENT THERE IS AN EXCEPTION PROCESS IN PLACE TO ALLOW THE PATIENT TO CONTINUE IN A PARTICULAR DRUG. THEN; WHEN MY OTHER COLLEAGUES INFORMED ME THAT ONE OF THE PLANS SAVED 59 DOLLARS ONE YEAR BY JUST CHANGING FROM ONE INSULIN TO ANOTHER ONE BECAUSE THE COST OF THE DRUG IS SO EXORBITANT .. THEY WILL ABLE TO SAY 59 DOLLARS; AND AGAIN; IF SOMEBODY IS ON A PARTICULAR MEDICATION FROM A PARTICULAR TYPE OF INSULIN THEY’RE ABLE TO STAY ON THAT WERE TO GO TO THAT EXCEPTION PROCESS ALONG WITH HER PHYSICIAN TO HELP MAKE THAT HAPPEN. THEN; I DID WANT TO JUST SAY I’M GOING TO TESTIFY ON THE NEXT BILL THAT I GUESS I’LL LEAVE MY REMARKS UNTIL THEN BUT WITH RESPECT TO CARVING OUT PRESCRIPTION DRUG COVERAGE. SO I’LL BE HAVING COMMENTS THEN; TOO.>>CHAIR MORAN: REPRESENTATIVE CANTRELL TO JOE THANK YOU; MME. CHAIR. THANK YOU MEMBERS OF THE COMMITTEE AM APPRECIATIVE YOUR SUPPORT. THANK YOU.>>CHAIR MORAN: REPRESENTATIVE FREIBERG.>>REPRESENTATIVE FREIBERG: I LIKE A ROLLCALL ON THIS; PLEASE.>>CHAIR MORAN: ROLLCALL HAS BEEN CALLED THE CLERK WILL TAKE THE ROLL. THERE BE NO FURTHER DISCUSSION THE CHAIR RENEWS HER [INAUDIBLE] TO THE COMMITTEE ON WAYS AND MEANS. THE CLERK WILL TAKE THE ROLL.>>STAFF: MORAN AYE; MORRISON AYE; KIEL NAY; ALBRIGHT NAY; BACKER BAHNER AYE; EDELSON ; FISCHER ; FREIBERG AYE; LIEBLING AYE; LOEFFLER AYE; MANN ; NEU NAY; PIERSON NAY; PINTO AYE; ROBBINS NAY; SCHOMACKER NAY; SCHULTZ AYE;..>>CHAIR MORAN: SO THERE BEING EIGHT AYE AND SIX NAYS THE MOTION PREVAILS AND HOUSE FILE 1257 IS RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN: THE NEXT BILL UP HIS REPRESENTATIVE CANTRELL 1523. THE CHAIR MOVES HOUSE FILE 1523 TO BE RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS. WE HAVE THE BILL BEFORE US COMMITTEE MEMBERS. REPRESENTATIVE CANTRELL; PLEASE TO YOUR BILL>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU MEMBERS OF THE COMMITTEE. IT’S A PLEASURE TO PRESENT TO YOU TODAY HOUSE FILE 1523 TO HOUSE FILE 1523 IS A BILL THAT WOULD ESTABLISH A UNIFIED PHARMACY BENEFIT TO USE A UNIFIED PHARMACY PROGRAM FOR PUBLIC HEALTH BENEFITS THROUGH THE NUMBER OF HUMAN SERVICES FROM MINNESOTANS ENROLLED IN MEDICAL ASSISTANCE IN MINNESOTA CARE AND FOR MINNESOTANS WHO PURCHASE HEALTHCARE COVERAGE FROM PARTICIPATING PLANS THROUGH FOUR OF MNSURE. THE PROGRAM PROPOSED IN THIS BILL THE STATE WOULD BE ABLE TO HAVE A GREATER PURCHASING AND NEGOTIATING POWER FROM PHARMACEUTICAL MANUFACTURERS WOULD YIELD [INAUDIBLE] OVER THE PAST THREE YEARS WE’VE NOT SEEN A DRAMATIC INCREASE THE COST OF COVERAGE FROM INDIVIDUALS ENROLLED IN FEE-FOR-SERVICE PUBLIC HEALTH BENEFITS WHEREAS FROM 2015 TO 2017 THE COST OF ADMINISTERING MANAGED-CARE PLANS IS INCREASED 21.5% LARGELY BECAUSE OF INCREASING PHARMACY COST. ALL OF MINNESOTA’S MANAGED CARE PLAN SUBCONTRACT WITH PHARMACY BENEFIT MANAGERS IN THIS BILL SEEKS TO EXPAND THE COST SAVINGS ALREADY BEEN EXPENSED IN THE ADMINISTRATION FOR FEE-FOR-SERVICE PUBLIC HEALTH PLANS FOR WHICH THE STATE IS ALREADY NEGOTIATED PRICES AND LEVERAGING PERSON POWER TO THE ED MINISTRATION MANAGED-CARE PLANS AS WELL. AS A RESULT OF THE PUBLIC PROCESS EMPLOYED AND FOR THE PURPOSES SPEAKERS EMPLOYED IN THE PURPOSE OF THIS PROGRAM; WILL BE EMPLOYED BY DHS; THIS PROGRAM WILL BE SIGNIFICANTLY MORE TRANSPARENT THAN THE OPAQUUE PROCESS THROUGH WHICH PHARMACY BENEFIT MANAGERS OPERATE IN PRICE OF THEIR PRODUCTS AS WELL AS IN TERMS OF HOW PHARMACY BENEFIT MANAGERS AND HEALTH PLANS CURRENTLY INTERACT WITH THE WHOLE LANDSCAPE AROUND REBATES. BOTH [INAUDIBLE] CRITERIA AND FOR DRUG EVENTS WILL BE PUBLICLY POSTED AND THE OVERALL REBATE INCENTIVE STRUCTURE INCLUDING THE BOARD OF PROFIT INCENTIVES WILL REGRADE AND READ CONSONANTS FOR PATIENT. I DO WANT TO SAY THE STATE OF WEST VIRGINIA TO IMPLEMENT A PROGRAM SIMILAR TO THIS ONE ANTICIPATES SAVING A $30 MILLION AND THEY ENDED UP SAVING A $30 MILLION. SO THIS IS NOT A NOVEL CONCEPT. WERE ALREADY DOING THIS. FOR FOLKS ON MEDICAID WITH THIS BILL REALLY DOES; IS IT EXPANDS THE AMOUNT OF POTENTIAL PUBLIC LIVES AND EXPANDS THE STATE PURCHASING POWER IN NEGOTIATING POWER.. AND DRIVING DOWN THE COST OF PHARMACEUTICALS. I’LL TURN THIS [INAUDIBLE] THE SCOPE OF THE BUILDER 1.2 MILLION MINNESOTANS RECEIVING HEALTHCARE COVERAGE THE MEDICAL ASSISTANCE IN MINNESOTA CARE COMBINED WHIC H ROUGHLY TRANSLATES TO ONE IN FIVE MINNESOTANS TOTALLY BY STREAMLINING THE ED MINISTRATION DRUG BENEFIT FOR ALL INDIVIDUALS WITH QUALIFIED [INAUDIBLE] THIS PROGRAM USES STATE WOULD NOT ONLY BE ABLE TO ENSURE MORE PEOPLE ESPECIALLY THOSE ARE THE MOST VULNERABLE AMONG US ARE ABLE TO AFFORD THEIR MEDICATIONS BUT WE WOULD ALSO LIKELY DRIVE DOWN SIGNIFICANTLY THE COST OF ADMINISTERING DRUG BENEFITS FOR PUBLIC HEALTH PROGRAMS. I WILL SAY THIS BILL IS A STARTING POINT. THIS BILL HAS HAD ONE COMMITTEE STOP SO FAR. IT STOPS IN COMMERCE PRIOR TO ARRIVING IN THIS COMMITTEE. AND THERE’S A LOT OF THINGS THAT DHS AND I REFINE CERTAIN ELEMENTS OF THIS BILL. ESPECIALLY; AS WE COMPARE IT TO GOV. WALZ IS ONE CARE PACKAGE; WE ARE LOOKING AT THE VARIOUS OPTIONS AND THAT’S WHAT THIS WHOLE LEGISLATOR PROCESSES ABOUT IT BUT HAVING VARIOUS OPTIONS OF WHAT WORKS BEST TO SERVE THE FOLKS OF MINNESOTA. SO AS WE CONTINUE WORKING TO EVOLVE A TECHNICAL FRAMEWORK I GREATLY APPRECIATE ANY FEEDBACK FROM MEMBERS OF THE COMMITTEE AND OTHER FOLKS FROM DHS IN THE ROOM TO ANSWER SOLELY TECHNICAL QUESTIONS ABOUT THIS PIECE OF LEGISLATION. AND WITH THAT; I WILL INCLUDE ALSO THAT MINNESOTA NURSES ASSOCIATION ALSO SUPPORTS THIS MEASURE AND WITH THAT; MANAGER; I YIELD TO QUESTIONS ASKED FOR FOLKS SUPPORT. SPEECH OR MORE THANK YOU REPRESENTATIVE CANTRELL. WE HAVE ONE TESTIFIER MS. SCHMIDT. WELCOME APPEARED TO COMMEND CHAIR AND MEMBERS THE COMMITTEE CATHERINE SCHMIDT MINNESOTA HEALTH AND SOME OF MY COMMENTS THAT WILL GET YOU SOME OF THE QUESTIONS THAT REPRESENTATIVE LIEBLING WAS RAISING EARLIER. HOUSE FILE 5020S GOVERNOR’S PROPOSAL TO COME OUT THAT THIS PRESCRIPTION DRUG BENEFIT I SEE REPRESENTATIVE CANTRELL IS SHAKING HIS HEAD. LET ME REPHRASE THAT IT’S A SIMILAR PROPOSAL TO THE GOVERNOR HAS RECOMMENDED TO COVER PRESCRIPTION DRUG BENEFIT FROM HEALTH PLANS F OR PEOPLE COVER THROUGH THE STATE PUBLIC PROGRAMS. WE STRONGL Y OPPOSE CARVING OUT PRESCRIPTION DRUGS BECAUSE IT WILL MAKE IT MUCH MORE DIFFICULT RECORDED CARE FOR MEMBERS FOR RELATED HEALTH CONDITIONS. DHS FOR THE CONTRACTS WITH HEALTH PLANS HAS MOVED TO ESTATE-BASED PREFERRED DRUG LIST THIS BILL GOES A STEP FURTHER BY CARVING OUT PRESCRIPTION DRUGS ALTOGETHER FROM HEALTH PLANS. CARVING OUT DRUGS SINCE THE STATE CAN ACHIEVE SOMETHING THE WHOLE PLANS CANNOT ACHIEVE . WE DON’T UNDERSTAND THAT ASSUMPTION. FROM A QUALITY STANDPOINT THE DRUG CARVEOUT WOULD [INAUDIBLE] CREATE MULTIPLE CONSUMER SPEAKERS CR EATE MULTIPLE; CUSTOMER-SERVICE POINTS FOR MEMBERS AND TAKE WITHOUT PLANS ABILITY TO TRULY MANAGE THE PATIENT HOLISTICALLY. LACK OF CARE CORONATION OF A NEGATIVE IMPACT ON PATIENTS AND THEIR HEALTH. WE ALSO NOTE PRESCRIPTION DRUG QUESTIONS THAT HOTPANTS RECEIVED GENERATE A SIGNIFICANT VOLUME OF CALLS FROM MEMBERS AND WE WOUL D QUESTION WHETHER DHS HAS THE CAPACITY TO HANDLE POTENTIALLY LARGE VOLUME OF CALLS FROM ENROLLEES IN GOVERNMENT PROGRAMS AS WAS THE INDIVIDUAL MARKET. GIVEN SOME OF THE PROPOSALS BEFORE CONGRESS IN RECENT EXECUTIVE ACTIONS PROPOSED BY THE CURRENT ADMINISTRATION; WE SEE IT’S NOT APPROPRIATE FOR THE STATE TO BE MOVING IN THIS DIRECTION AT THIS TIME. WE RESPECTFUL LY OPPOSE THIS BILL. THANK YOU.>>CHAIR MORAN: THANK YOU. IS THERE ANYONE ELSE IN THE AUDIENCE WHO WISHES TO TESTIFY ON HOUSE FILE 1523? OKAY.>>TESTIFIER: I WILL BE BRIEF MME. CHAIR MEMBERS THE COMMITTEE. MY NAME IS [INAUDIBLE] I WANT TO POINT OUT YOUR TESTIMONY IN SUPPORT OF THIS BILL WRITTEN IN FRONT OF YOU ALONG WITH A REPORT FROM [INAUDIBLE] A POLL CONDUCTED JUST LAST YEAR THAT SHOWS THE NEED FOR THIS BILL. WE ASK FOR YOUR SUPPORT.>>CHAIR MORAN: THANK YOU SO MUCH. ANY DISCUSSION? REPRESENTATIVE ALBRIGHT.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL; IN YOUR DEFINITION I SEE THAT YOU ARE IDENTIFYING PEOPLE THAT WOULD BE ELIGIBLE FOR THIS PROGRAM. COULD YOU IDENTIFY IN TERMS OF THE NUMBER OF ENROLLEES BOTH IN MEDICAL ASSISTANCE IN MINNESOTA CARE; THAT WOULD BE CONSIDERED ON YOUR PROPOSAL?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. YES MME. CHAIR AND THANK YOU REPRESENTATIVE ALBRIGHT. SO CURRENTLY I KNOW THE COMBINED NUMBER OF MA OR FOLKS ENROLLED IN MID MA MINNESOTA CARE; IS 1.2 MILLION MINNESOTANS AND I CAN ASCERTAIN THE NUMBERS IN THE FURTHER BREAKDOWN OF THAT FOR YOU. FOR FOLKS CURRENTLY ENROLLED; ENROLLED IN MNSURE WOULD BE RON I THINK 100;000 OR SO BUT OTHERWISE I CAN GET MORE SPECIFICS ON THOSE EXACT NUMBERS BUT WE KNOW THAT ONE IN FIVE MINNESOTANS ARE IN EITHER ENROLLED IN MA OR RECEIVE HEALTHCARE THROUGH MINNESOTA CARE.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL; ON PAGE 2; LINE 19 AND 20; YOU IDENTIFY THE COMMISSIONER A CONTRACT WITH ONE OR MORE [INAUDIBLE] ANY OF THE FUNCTIONS DESCRIBED IN PARAGRAPH A. SO W ITH THIS CONSTRUE THEY COULD CONTRACT WITH THE PBM FOR THE SERVICES THAT YOU ESPOUSE TO IN THE BILL?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. THE GOAL OF THE PROGRAM IS TO REDUCE THE OVERALL COST OF CARE AND SEEING AS THAT THE STATE WOULD BE UNLIKELY TO DO THAT; I DOUBT THAT THEY WOULD TAKE SUCH LATITUDE WITH THEE LANGUAGE WRITTEN IN THIS BILL. IS A CONTRACT WITH A FOUR FOR-PROFIT PHARMACY BENEFIT MANAGER.>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE CANTRELL; HOW DOES THE COMMISSIONER IN HIS DEPARTMENT ANTICIPATE GOING ABOUT DOING THIS WORK? WHAT DEPARTMENT WOULD IT UNDERTAKE AND AM WONDERING IF THEY HAVE THE CAPACITY AND HAVE YOU CONSIDERED DISCUSSED THIS MEASURE WITH THE COMMISSIONER ? WHAT ARE HIS THOUGHTS ON THIS?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. THIS BILL IS APSLEY MODELED AFTER THECOMMISSIONER INTRODUCED A FEW YEARS AGO. I ACTUALLY HAVE FROM THE VERY BEGINNING OF THIS PROCESS OF PUTTING THIS BILL TOGETHER I HAVE BEEN TALKING WITH DHS IT TO MAKE SURE THAT IT IS CONSISTENT WITH THE CAPACCITIES AND CONSISTENT WITH THEIR OPERATIONS. SO ALL OF THE INVOLVED ENTITIES HA VE BEEN CONSULTED ABOUT THIS. I EVEN ASK COMMISSIONER TRAN LORI EXACTLY WHAT HIS THOUGHTS ARE ON THIS BILL BUT SINCE IT’S MODELED AFTER BILL HE INTRODUCED I ASSUME YOU WOULD LET ME KNOW IF HE TOOK UMBRAGE WITH IT BUT PERHAPS I COULD BE INCORRECT THERE BUT HOWEVER I BEEN TALKING WITH DHS AND THEY HAVE INDICATED THAT THIS IS NOT ONLY FEASIBLE BUT IT TO YOU IT’S NOT OUTSIDE OF THEIR CAPACITIES. ESPECIALLY – SORRY – ESPECIALLY BECAUSE STATE GOVERNMENT ADMINISTERING THESE PUBLIC BENEFITS. SO THIS WOULD ESSENTIALLY BE A LATERAL EXPANSION OF THE PRACTICE BEING EMPLOYED AT THE STATE LEVEL.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE CANTRELL; UNDER LINE 25 AND 26 OF PAGE 2; YOU ALSO NOTE THAT THE FEDERAL WAIVER WILL BE NECESSARY TO MOVE FORWARD WITH THIS. I’M JUST WONDERING WHAT WAIVER YOU ARE DISCUSSING AND WHETHER OR NOT THE PROCESS HOW LONG IT WOULD TAKE AND WHAT MEASURE WOULD BE UNDERTAKEN I F THE WAIVER WAS THAT RECEIPT?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. SO IN THE LANGUAGE IN PARTICULAR THE COMMISSIONER SO SEEK ANY NECESSARY FEDERAL APPROVAL TO IMPLEMENT THE SECTION. THE POINT AT WHICH WE ARE CURRENTLY ; WE DON’T KNOW IF ANY WAIVER WOULD BE NECESSARY BUT SHOULD ONE BE NECESSARY WE MIGHT ASSESSMENT THAT I 1332 WAIVER MAY NEED TO BE PURSUED BUT WE ARE A LITTLE BIT OUT FROM EVALUATING WHETHER OR NOT THE FEDERAL GOVERNMENT WOULD REQUIRE US TO SUBMIT ANY TITLE WAIVER OR REQUEST FOR FEDERAL APPROVAL. THERE ARE SOME COMPONENTS THAT MAY REQUIRE APPROVAL BUT WE ARE CURRENTLY WORKING ON WHAT THAT MIGHT LOOK LIKE AND IF THAT IS ACTUALLY THE CASE.>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE CANTRELL I THINK MASSACHUSETTS DID REQUIRE IT AND DID UNDERSTAND THROUGH CMS DOES 1332 WAIVER WAS REQUIRED. SO BEST PREPARED FOR THAT. MME. CHAIR; REPRESENTATIVE CANTRELL; HAVE ANY HOPE AS EXPRESSED INTEREST IN PARTICIPATING IN THIS PROGRAM?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. THERE’S ONLY BEEN ONE HEALTH PLAN LOBBYIST WHO HAS APPROACHED ME ABOUT THIS WHO HAS EXPRESSED DISINTEREST ABOUT THIS BUT HOWEVER; I THINK THAT CONVERSATIONS PERTAINING TO THE POSSIBILITY OF THIS PROGRAM CONTINUE I THINK THAT HEALTH PLANS WOULD REALLY DO WELL TO TAKE A LOOK AT IN THE INTEREST OF COMPETITION IN THE FREE MARKET TO TAKE A LOOK AT WELL; IF WE CAN REDUCE PERCEPTION DRUG COSTS MS. [INAUDIBLE] IF WE CAN REDUCE PERCEPTION DRUG COST BY PURSUING THIS PROGRAM THAN THAT MIGHT BE AN AVENUE WORTHWHILE PURSUING.>>REPRESENTATIVE ALBRIGHT: ANOTHER QUESTION MME. CHAIR. REPRESENTATIVE CANTRELL; OBVIOUSLY; THIS IS GOING TO REQUIRE FUNDING MAYBE TO COUNTER YOUR ASSERTION THAT DHS MAY BE ABLE TO TAKE CARE OF THIS WITHIN OUR BUDGET BUT T O THE GOVERNOR IN HIS BUDGET PROPOSAL CONSIDEER OR PUT FORTH ANY TYPE OF APPROPRIATION FOR THIS TYPE OF LANGUAGE?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. A THANK YOU REPRESENTATIVE ALBRIGHT. YES. THEN THERE’S ALSO IN HIS BILL THE COST SAVING GOING BACK TO THOSE FIGURES THAT I CITED IN MY OPENING REMARKS ABOUT HOW FOR THE FEE-FOR-SERVICE PUBLIC PHARMACY BENEFIT COSTS HAVE REMAINED FAIRLY STAGNANT RELATED TO PHARMACEUTICAL COSTS WHEREAS FOR MANAGED CARE ORGANIZATION CAUSE; WE’VE SEEN A 21.5% PRICE INCREASE. SO WE ARE ALSO INTO SPINNING WELL THERE IS A PORTION IN HIS BUDGET THAT PERTAINS TO AN IDEA LIKE THIS AND WHILE THERE IS GOING TO BE SOME TRANSITION COSTS AND THERE’S ALWAYS SOME COSTS WITH GETTING THINGS RUNNING; WE ARE ALSO ANTICIPATING A GREATER PROPORTIONAL SAVINGS AS A RESULT OF JUST THAT DISCREPANCY IN THOSE TWO FIGURES I JUST MENTIONED.>>REPRESENTATIVE ALBRIGHT: MME. CHAIR; SO ARE YOU ASSERTING THIS CAN BE SOME TYPE OF ENTERPRISE FUND NECESSARY FOR YOUR RESERVES TO BE HELD IN WHILE THIS PLAN IS PUT TOGETHER?>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE ALBRIGHT. YOU KNOW; I’M NOT CERTAIN YET. I’M NOT CERTAIN YET WHETHER OR NOT AN ENTERPRISE FUND WOULD BE NECESSARY.>>CHAIR MORAN: ALL RIGHT IT’S WE HAVE A AMENDMENT BEFORE THE BODY. SO REPRESENTATIVE LIEBLING MOVES THE A1>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I WOULD LLIKE TO MOVE THE A1 AMENDMENT . MEMBERS; THIS IS SOMETHING THAT [INAUDIBLE] I’M DOING ON BEHALF OF REPRESENTATIVE MANN AND SHE IS INTRODUCED A BILL TO THIS EFFECT BUT FRANKLY; WE WANTED US TO MEET DEADLINE AND IT’S REALLY JUST A CLARIFICATION IN CURRENT LAW AND THIS RELATES TO THE FACT THAT AS YOU WELL KNOW; SOME PHARMACEUTICAL MANUFACTURERS HAVE THESE SPECIAL PROGRAMS TO ASSIST SOME CONSUMERS. OF COURSE; WE COULD PROBABLY DEBATE WHETHER THE OVERALL EFFECT OF THOSE PLANS IS HOW BENEFICIAL THAT IS ON DRUG PRICES; BUT THE BOTTOM LINE ON THIS IS THAT THERE ARE SOME CONSTITUENTS AROUND THE STATE SEVERAL MEMBERS DISTRICTS AS A MATTER FACT OR BENEFITING FROM THESE PROGRAMS BUT THERE’S A CLARIFICATION NEEDED BECAUSE SOME OF THE DRUGS THAT ARE BEING PROVIDED NEED TO BE ADMINISTERED BY CERTAIN VERY EXPENSIVE SUPPLIES. SO ALL THIS DOES IS CLARIFY LANGUAGE THAT WOULD ALLOW THOSE SUPPLIES TO BE PROVIDED IN ADDITION TO THE DRUG ITSELF. SO REALLY IS JUST A CLARIFICATION TO CURRENT LAW THAT’S BEEN REQUESTED BY CERTAIN MANUFACTURERS WHO FEEL THAT THEY WOULD PROVIDE THIS BUT ARE NOT ABLE TO BECAUSE THEY ARE JUST DON’T WANT TO RUN AFOUL OF OUR LAW IN DOING SO. SO WE WOULD APPRECIATE YOUR SUPPORT IN ATTACHING THIS TO THE BILL AND LETTING IT GET A HEARING SO WE CAN MOVE IT ALONG.>>CHAIR MORAN: REPRESENTATIVE CANTRELL TO HAVE ANY COMMENTS TO THE AMENDMENT>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE LIEBLING. THIS A FRIENDLY AMENDMENTS AND I URGE BETTER SUPPORT. SPEECH OR MORE REPRESENTATIVE ALBRIGHT>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. YOU DOME A BIT IN A QUANDARY BECAUSE OF LOOKING AT THE SECTIONOF STATUTE THAT THE BILL PRETENDS 250 6B DOT 86. BUT YET IN THE AMENDMENT [INAUDIBLE] 60 2J .23. THE MORNING WONDERING WHAT RELEVANCE THE AMENDMENT HAS TO THE UNDERLYING BILL?>>CHA IR MORAN: REPRESENTATIVE LIEBLING>>REPRESENTATIVE LIEBLING: WELL REPRESENTATIVE ALBRIGHT THERE’S NO GERMANENESS RULE IN COMMITTEE SO BOTH THIS BILL AND REPRESENTATIVE CANTRELL’S BILL IS BEEN RECOMMENDED TO BE REFERRED TO WAYS AND MEANS .. FROM THERE; THE EXPECTATION IS IT WOULD BE REFERRED TO HEALTH AND HUMAN SERVICES FINANCE COMMITTEE WILL BE LAID OVER FOR POSSIBLE INCLUSION. SO WHATEVER IS ATTACHED TO IT; WHATEVER BARNACLES IT HAS ON IT; THEY’RE GOING TO COME OFF AT SOME POINT SO THE GERMANENESS IN COMMITTEE THERE’S NO GERMANENESS RULE IN COMMITTEE AND OVER THE YEARS I’VE WATCHED MANY MANY MEMBERS ON DEADLINES WHICH ON ITS WAY SO THAT IS FRANKLY; WHAT WERE DOING IT WE ARE NOT THE MINUTES REMAIN TO THIS BILL OTHER THAN HAVING TO DO WITH THE BILL WENT TO PHARMACEUTICALS>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE LIEBLING I MEAN NO DISRESPECT ON THE ISSUES OF GERMANENESS. I JUST NOTICED THAT FOR PURPOSES OF CLARITY; WE ARE DOING WITH TWO DIFFERENT SECTIONS OF STATUTE AND TO THE EXTENT THAT WE BOTH WERE COMMITTEES HAVE CERTAINLY PARTICIPATED OVER THE YEARS THAT I’VE BEEN HERE IN USING CAREERS OR CARRIERS; OR CHASSIS TO BRING ABOUT OTHER PIECE OF LEGISLATION WE KNOW HOW THIS ESTABLISHMENT WORKS. SO JUST A POINT OF CLARIFICATION JUST TO MAKE SURE WERE ALL AWARE OF WHAT’S GOING ON HERE. THANK YOU.>>CHAIR MORAN: ALL RIGHT. ANY FURTHER DISCUSSION ON THE AMENDMENT? SEEING NO FURTHER DISCUSSION; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS.>>[GAVEL]>>CHAIR MORAN: OKAY. SO SEEING NO FURTHER AMENDMENTS REPRESENTATIVE SEEING NO FURTHER DISCUSSION THE CHAIR RENEWS HER MOTION THAT HOUSE FILE 1523 1520 3B REFER TO WAYS AND MEANS. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. HOUSE FILE 1523 AS AMENDED IS RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN:>>REPRESENTATIVE CANTRELL: THANK YOU; MME. CHAIR. AND THANK YOU MEMBERS THE LIVELY DISCUSSION IN>>CHAIR MORAN: NEXT UP IS HOUSE FILE 1719; REPRESENTATIVE NOOR. THE CHAIR MOVES HOUSE FILE 1719 B RECOMMENDED FOR REFERRAL TO THE COMMITTEE ON WAYS AND MEANS. WE HAVE THE BILL BEFORE THE COMMITTEE. REPRESENTATIVE NOOR I UNDERSTAND YOU OF AN AUTHOR AMENDMENT AND THE CHAIR WOULD LIKE TO ENTERTAIN A MOTION OF THE A1 AUTHOR AMENDMENT. SO MOVED. CHAIR LIEBLING MOVE THE A1 AUTHOR AMENDMENT. ALL THHOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. REPRESENTATIVE NOOR PLEASE; PRESENT YOUR BILL>>REPRESENTATIVE NOOR: THANK YOU; MME. CHAIR. MEMBERS; HOUSE FILE 1719 REMOVED SOME PARTICIPANTS WILL A PARTICIPANT ARE RECEIVING AND TO MINNESOTA FAMILY INVESTMENT PROGRAM AND GEN. ASSISTANCE. THE REQUIREMENTS FOR DRUG TESTING AND ALSO THE EXCLUSION FOR INDIVIDUALS WHO SUBSEQUENTLY FOUND THAT THEY HAVE [INAUDIBLE]. SO THIS BILL ESTABLISHES A PROCESS BY WHERE THE COUNTY WOULD BE REQUIRED TO DO A REFERRAL AND ALLOW THEM THE INDIVIDUAL TO GET THE HELP THEY NEED. I UNDERSTAND THE CHALLENGES WE ARE FACING THE OPIOID CRISIS AND WE WANT TO MAKE SURE THAT WE ARE ALLOWING INDIVIDUALS TO HAVE SERVICES THEY NEED.. ESSENTIALLY; THIS PROVIDES A PROCESS FOR THE INDIVIDUAL WHO IS A PARTICIPANT TO GET WHAT IS REQUIRED. ALSO; IT REMOVES THE SANCTION WHICH IS ALMOST 30% FOR INDIVIDUALS WHO ARE RECEIVING AMPHIBIAN. I HAVE A TESTIFIER WHO CAN WALK US THROUGH THE BILL.>>CHAIR MORAN: THANK YOU REPRESENTATIVE GENERATIVE PLEASE INTRODUCE YOURSELF AND PROCEED WITH THE TEST WAY.>>TESTIFIER: THANK YOU MME. CHAIR MANAGEMENT MY NAME IS JESSICA WEBSTER DEAF ATTORNEY WITH LEGAL AID. WE ARE HERE IN SUPPORT OF THIS BILL. WE THANK REPRESENTATIVE NOOR FOR CARRYING IT. WITH THIS BILL DOES IT DOES NOT REPEAL DRUG TESTING AND DOES NOT REMOVE DRUG TESTING. IT DOES RESTORE DISCUSSION TO COUNTIES ON DOING DRUG TESTING IN A PUBLIC BENEFITS PROGRAM AND AS REPRESENTATIVE NOOR SAID; HE REMOVES THE SANCTIONS THAT CAN HAPPEN IF SOMEONE SHOWED SIGNS OF CHEMICAL DEPENDENCY OR SUBSTANCE ABUSE DISORDER THE SESSION LEGAL AID HAS BEEN TESTIFYING IN SUPPORT OF ALL THE OPIOID LEGISLATION THAT’S BEEN MOVING FORWARD AND WE BEEN DOING UP BECAUSE WE BELIEVVE THAT THE STATE IS NOW IN A DIFFERENT PLACE IN THE CONVERSATION ABOUT SUBSTANCE ABUSE — AND CHEMICAL DEMENTIA BUT OUR TESTIMONY WE BEEN NOTED THAT THERE IS THIS AREA OF LAW THAT SECTION OF LAW WHERE A HANDFUL OF YEARS AGO THE LEGISLATOR DECIDED TO GET TOUGHER ON PEOPLE WHO HAD THE COLDEST PENDENCY ISSUES AND WERE AXIS IN PUBLIC BENEFITS PROGRAMS. SO WE WANT TO MAKE SURE THAT EXISTING LAW FOR FAMILIES WITH CHILDREN AND FOR VULNERABLE ADULTS WERE AXIS IN VERY SMALL AMOUNTS OF THE ASSISTANCE IN MINNESOTA WE WANTED TO MAKE SURE THEY ARE TREATED IN THE SAME COMPASSIONATE WAY THAT WE ARE NOW LOOKING AT TREATING OTHER POPULATIONS THAT ARE DOING WITH THESE CRISES. SO WHAT IS SANCTION LOOKS LIKE; FOR INSTANCE IN THE MINNESOTA FAMILY INVESTMENT PROGRAM; IF YOU ME THAT’S RECEIVING A $348 MONTH GRANT COULD HAVE A $300 SANCTION DID SO THE GRANT WOULD BE CUT BY $300 IF THEY SHOWED SIGNS OF ILLNESS. AND THIS IS NOT A HUGE NUMBER OF PEOPLE THAT WAS A VERY SMALL NUMBER OF PEOPLE THAT WE ARE SEEN THAT HAVE TESTED POSITIVE IN THESE PROGRAMS BUT THIS WOULD BE A W AY TO MAKE SURE THAT WE HAVE A COMPASSIONATE RESPONSE. IT DOESN’T REQUIRE THE COUNTY TO PAY FOR TREATMENT. IT DOESN’T REQUIRE THE COUNTY TO DO ANYTHING EXTRAORDINARY OTHER THAN PROVIDE RESOURCES AND REFERRALS TO FOLKS SHOWED NO SIGNS OF ILLNESS. THANK YOU FOR YOUR SUPPORT. SPEECH OR MORE THANK YOU SO MUCH FOR YOUR TESTIMONY. REPRESENTATIVE ROBIN>>REPRESENTATIVE ROBBINS: OF THANK YOU; MME. CHAIR. THANK YOU REPRESENTATIVE NOOR. I JUST A COUPLE QUESTIONS. SO YOU MENTIONED CURRENTLY THIS APPLIES TO JUST A SMALL NUMBER OF PEOPLE WHO ARE FILLING THE DRUG TEST THAT DO CURRENTLY TRACK THOSE NUMBERS AND ARE THEY REPORTED TO THE LEGISLATURE?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE I DO HAVE SEEN THOSE NUMBERS BUT DHS DOES KEEP THAT DATA THAT WE SAW THEM RECENTLY IT WAS I BELIEVE IT WAS LESS THAN ; FEWER THAN 100 INDIVIDUALS BUT I WOULD DEFER TO THEM ON HOW MANY PEOPLE THAT WOULD BE 30;000 FAMILIES IN THE MINNESOTA FAMILY INVESTMENT PROGRAM AND PROBABLY I WON’T SAY SOME THOUSAND SUMMERS OF GEN. ASSISTANCE.>>REPRESENTATIVE ROBBINS: THANK YOU; MME. CHAIR. DO YOU THINK THAT ONE OF THE REASONS FOR THE LOW NUMBER IS PEOPLE KNOWING THEY WOULD LOSE THEIR BENEFITS?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE; I DON’T QUITE UNDERSTAND YOUR QUESTION.>>REPRESENTATIVE ROBBINS:>>CHAIR MORAN: REPRESENTATIVE NOOR>>REPRESENTATIVE NOOR: I’VE BEEN WORKING AT THE COUNTY FOR A LONG TIME AND I’VE [INAUDIBLE] MFIP PROGRAMS AND QUITE FRANKLY WHAT I’VE SEEN THAT NUMBERS ALWAYS BEEN LOW NO MATTER WHETHER WE HAD THE DRUG TESTING OR NOT BU T DHS; INDIVIDUALS CAN GUIDE US IN THE PROCESS. BECAUSE THIS ALLOWS THE INDIVIDUALS WHO HAVE BEEN CONVICTED TO STILL RECEIVE THE BENEFITS WITH CONDITION IT DOES NOT REMOVE THAT BUT IT ALSO ALLOWS THE COUNTY TO ALSO COLLECT DATA FROM THE TREATMENT COURT SO THEY CAN IF AN INDIVIDUAL IS RECEIVING BENEFITS AND THERE IS USING SOME JUDGMENTS OF THE SYSTEM IS ALREADY WORKING; BUT THE ISSUE RIGHT NOW IS IF SOMEBODY FALLS THROUGH THE CRACK ORGAN OF FINE WE WILL BE PUNISHING THEM BECAUSE THEY DO NOT GET THE RIGHT [INAUDIBLE] SO ESSENTIALLY THIS BILL ALLOWS INDIVIDUALS TO GET THE SERVICES NEEDED FOR TREATMENT AND MAKING SURE WE ARE TAKING CARE OF THOSE CHILDREN AND FAMILIES AT THE SAME TIME.>>CHAIR MORAN: REPRESENTATIVE ROBINSON>>REPRESENTATIVE ROBBINS: I APPRECIATE THAT AND SUPPORT THAT INTENTION BUT I’M JUST CONCERNED THAT THE COUNTIES NOT PAYING FOR TREATMENT THERE JUST REFERRING PEOPLE .. PERHAPS THEY WILL BE GETTING TREATMENT THEY NEED AND SO HOW WOULD LIKE WE TRACK THAT I WITH A GET THE TREATMENT AND THEN ALSO; IF THERE IS NO TREATMENT AND THEY CONTINUE TO RECEIVE THE BENEFITS I JUST WANT TO [INAUDIBLE] TRACKING THOSE NUMBERS IF THERE’S ANY CHANGE IN HOW MANY PEOPLE FOLLOWING THIS POPULATION AND WE COULD SEE IF THERE’S ANY EFFECT OF THIS BILL ON THAT NUMBER.. THANK YOU.>>CHAIR MORAN: MS. WEBSTER>>TESTIFIER: MME. CHAIR; AND REPRESENTATIVE; I THINK THAT’S A GOOD STEP AND I THINK THAT IF THERE WERE THE POLITICAL WILL TO PROVIDE INVESTMENT FOR MORE TREATMENT BEDS AND MORE TREATMENT AND RESOURCES ACROSS ESPECIALLY GREATER MINNESOTA WE WOULD WELCOME THAT.>>REPRESENTATIVE ROBBINS: SO BUT AS IT STANDS; THIS IS SAYING THEY CONTINUE TO RECEIVE THE BENEFITS AND [INAUDIBLE] BUT THERE’S NO REQUIREMENT THE TREATMENT IS TAKEN AS A CONDITION OF CONTINUING TO RECEIVE THE BENEFITS AND THERE’S NO FURTHER EXEMPTION .. IS THAT ACCURATE?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE; THAT IS ACCURATE. I THINK WHAT YOU ARE SEEING HERE; TO READ THIS THE FIRST STEP IN TERMS OF MAKING SURE THAT FOLKS HAVE HOUSING AND FOOD AND SOME VERY RUDIMENTARY BASIC NEEDS. ONE OF THE FOLKS THAT WE WORKED WITH THIS SUMMER WAS A GENTLEMAN FROM MINNESOTA WHO’S BEEN WORKING AS A HANDYMAN AND HAD LOST WORK AND HAD BEEN CLEAN FOR SEVERAL YEARS AND RELAPSED AND HE RECEIVED A $203 GEN. ASSISTANCE GRANT MONEY RELAPSED HE FAILED TO TEST AND WAS THE $203 GRANT AND HE WAS RENTING A ROOM IN MINNESOTA FOR $200 A MONTH. SO ALL OF A SUDDEN HE WAS HOMELESS AND LEGAL AID HAS BEEN LOOKING FOR FRANK; MORE EXTENSIVE OPTIONS BECAUSE FOR RESIDENTIAL HOUSING OR OTHER ALTERNATIVES FOR HIM EITHER RATHER THAN LETTING THEM RENT THAT ROOM AND HOPEFULLY; ONLY GET TREATMENT BUT AT LEAST BE STABLY HOUSED AND HAVE FOOD IN THE MEANTIME.>>CHAIR MORAN: THANK YOU. ANY OTHER REPRESENTATIVE NEU>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. MEMBERS; REPRESENTATIVE NOOR YOU MENTIONED THAT THE NUMBER OF PRESUMABLY I GUESS I SHOULD ASK; HE SAID THAT NUMBER IS ALWAYS BEEN LOW WITH OR WITHOUT THE REQUIREMENT FOR DRUG TESTING ARE YOU SAYING THE NUMBER OF DRUG USERS HAS ALWAYS BEEN LOW?>>REPRESENTATIVE NOOR: THANK YOU; MME. CHAIR. REPRESENTATIVE NEU; THE NUMBER OF PEOPLE WERE PARTICIPATING IN THE PROGRAM HAVE BEEN CONVICTED OF A CRIME BUT I WILL DEFER THAT TO DHS IF THEY HAVE THE EXACT NUMBERS.>>CHAIR MORAN: WELL WELCOME TO THE COMMITTEE. PLEASE INTRODUCE YOURSELF AND PROCEED WITH YOUR TESTIMONY.>>TESTIFIER: THANK YOU MME. CHAIR BUT MY NAME IS RON JOHNSON MINNESOTA DEPARTMENT OF HUMAN SERVICES. REPRESENTATIVE; TO ANSWER YOUR QUESTION; COUNTER YOUR 2016 THE MINNESOTA FAMILY INVESTMENT PROGRAM; THERE WERE A TOTAL OF 42 PEOPLE THAT WERE SUBJECT TO DRUG TESTING AND 11 OF THOSE PEOPLE TESTED POSITIVE.>>REPREESENTATIVE NEU: THANK YOU; MME. CHAIR. HOW OFTEN IS THE DRUG TESTING TAKEN PLACE WITH THOSE 42 PEOPLE ? YOU SAID 11 TESTED POSITIVE. IS THIS HAPPENING PERIODICALLY? DO THEY KNOW WHEN THEY ARE GOING TO BE TESTED ? WHAT IS THE PROCEDURE ON THAT?>>TESTIFIER: I DON’T HAVE THAT IN FRONT INFORMATION IN FRONT OF ME – SORRY – MME. CHAIR REPRESENTATIVE; I DON’T HAVE THE PROCEDURAL INFORMATION ON RIGHT KNEE. THAT IS THE STATUS FOR THE FULL CALENDAR YEAR THOUGH; THAT THOSE 42 INDIVIDUALS THAT ONLY 11 OF THOSE THAT WERE SUBJECT TO THE TEST ACTUALLY TESTED POSITIVE IN THE FULL YEAR.>>REPRESENTATIVE NOOR: MME. CHAIR; REPRESENTATIVE NEU; WHAT I’VE FOUND FROM SOME OF THE COUNTIES THEY USE THE DRUG TREATMENT INFORMATION SO THEY CAN UNDERSTAND [INAUDIBLE] ACTUALLY USING DRUGS AND THE SECOND PIECE IS; SOME OF THEM REQUIRE THEM TO DO THE DRUG TESTING BASED ON THIS LOT RIGHT NOW BUT EVERY TIME THEY COME FOR RECERTIFICATION AMOUNT BY THE END OF THE EVERY 12 MONTH I DO HAVE A RECERTIFICATION. THERE’S A PROCESS AND PROCEDURE THAT ARE IN PLACE TO MAKE SURE THE DRUG TESTING IS DONE.>>REPRESENTATIVE NEU: THANK YOU; MME. CHAIR. SO ARE HEARING A LOT OF NUMBERS THROWN UP YET SO I JUST WANT TO BE REALLY CLEAR WHAT’S HAPPENING. ONE MEMBER TOLD US THERE’S 30;000 PEOPLE WHO ARE RECEIVING THE BENEFITS AND THAT 100 OF THE PEOPLE TESTED POSITIVE SO I’M JUST WONDERING; WHERE ALL THESE DIFFERENT NUMBERS ARE COMING FROM. OF THE 30;000 PEOPLE RECEIVING BENEFITS; ARE WE SAYING THAT ONLY 42 PEOPLE HAVE BEEN CONVICTED OF A DRUG-RELATED CRIME?>>TESTIFIER: MME. CHAIR; REPRESENTATIVE; IN CALENDAR YEAR 2015 THAT IS CORRECT.>>CHAIR MORAN: CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I JUST WANTED TO SAY THAT I APPRECIATE THAT REPRESENTATIVE NOOR IS BRINGING FORWARD THIS BILL. THIS COMES AT A OUT OF THE CONTEXT THAT A LOT OF DISCUSSION WE BEEN HAVING IN THIS LEGISLATURE OVER SEVERAL YEARS ABOUT HOW TO NOW UNDERSTAND SUBSTANCE ABUSE DISORDER AND WHAT WE’VE DONE IN THE PAST IS TAKE A PUNISHMENT APPROACH.. WE NOW UNDERSTAND I THINK MORE FULLY THAN BEFORE; THAT WHAT WE ARE TALK ABOUT IS A CHRONIC DISEASE. ALSO; WE HAVE TO REALLY PUT THIS IN CONTEXT OF WHAT THESE PROGRAMS ARE AND I THINK MS. WEBSTER MENTIONED IT A LITTLE BIT WHEN SHE TALKED ABOUT GEN. ASSISTANCE AND HOW MUCH THAT WAS IN THE CASE SHE TALKED ABOUT;; BUT IN THE HEALTH AND HUMAN SERVICES FINANCE COMMITTEE WE HAD AN INFORMATIONAL HEARING ABOUT THE MFIP PROGRAM AND I GUESS THE COMMITTEE [INAUDIBLE] I’M NOT SURE HOW MUCH WE TALKED ABOUT THAT IN HERE; MEMBERS BUT IT’S REALLY; REALLY QUITE SHOCKING HOW LITTLE THESE FAMILIES ARE GETTING; HOW LITTLE THEIR LIVING ON AND MOST OF THE PEOPLE IN THIS PROGRAM; I THINK IT IS ABOUT 70%; OUR CHILDREN. SO HERE’S WHAT WE ARE TALKING ABOUT. THIS PROGRAM VERY OFTEN FUNCTIONS AS UNEMPLOYMENT INSURANCE FOR PEOPLE ARE THE LOWEST WAGE WORKERS BUT FOR PEOPLE WERE WORKING RETAIL. FOR PEOPLE WHO ARE WORKING FAST FOOD WHO DON’T HAVE UNEMPLOYMENT INSURANCE AND WHEN THEY LOSE THEIR JOB THIS IS THE ONLY PLACE THEY HAVE TO LAND WITH THEIR CHILDREN. AFTER THE CHILDREN TO BE ON THE MFIP PROGRAM; RIGHT. SO WHEN PEOPLE HAVE A SUBSTANCE ABUSE DISORDER WHAT ARE WE DOING UNDER CURRENT LAW? WE ARE PUNISHING THEM AND MORE IMPORTANTLY; YOUR PUNISHING THEIR CHILDREN BY TAKING AWAY THIS EXTREMELY MINIMAL LEVEL OF FUNDING THAT THEY NOW RECEIVE. WE DO HAVE A PROPOSAL FROM THE GOVERNOR . IS A NUMBER OF PROPOSALS BEFORE US THE SESSION TO RAISE THE CASH BENEFIT FOR THESE FAMILIES BUT I AM REALLY GRATEFUL THAT WE ARE TALKING ABOUT REMOVING THIS . I AGREE WITH REPRESENTATIVE ROBBINS IS WAS TA LKING ABOUT NEEDING TO MAKE SURE THE TREATMENT IS AVAILABLE AND WE ARE TRYING TO DO THAT AS WELL ON A NUMBER OF FRONTS. BUT FOR THESE FAMILIES SO SPECIFICALLY BUT THIS IS A HUGE PROBLEM IN OUR STATE. MAKE IT YOUR PEOPLE CAN ACTUALLY ACCESS TREATMENT WHEN THEY NEEDED AND GET IN THERE AND TAKE ADVANTAGE OF THAT AND I WOULD LIKE TO SEE IF WE CAN GET TO IT A MORE SURER WAY OF KNOWING THAT THESE FAMILIES THAT IF SOMEONE HAS POSITIVE WE ARE GOING TO GET THIS SERVICE BECAUSE BUT IN THE MEANTIME WHAT WE BEEN DOING BY PUNISHING PEOPLE TO GET THEM TO STOP BEING ADDICTED TO YOU KNOW; IF SOMEBODY IS A DIABETIC WE DON’T PUNISH THEM TO GET THEM TO STOP BEING A DIABETIC. SOMEBODY HAS MULTIPLE SCLEROSIS; WE DON’T PUNISH THEM TO GET THEM TO STOP NOW I DO KNOW THAT THESE ARE DISEASES OF DENIAL SOMETIMES. THERE ARE DIFFERENT WAYS THIS NEEDS TO BE APPROACHED WITH THE IDEA THAT WE ARE PUNISHING FAMILIES BY TAKING AWAY VERY VERY LOW SUBSISTENCE LEVEL OF HEALTH THAT WE ARE GIVING THEM; IT’S JUST IT JUST BOTH INHUMANE AND RIDICULOUSLY OUT OF STEP WITH OUR UNDERSTANDING OF SUBSTANCE ABUSE DISORDER OR SUBSTANCE ABUSE DISORDER. SO I APPLAUD YOU REPRESENTATIVE NOOR FOR PAYING ATTENTION TO THESE ISSUES AND MS. WEBSTER WORK ON THIS TIRELESSLY AND I CERTAINLY HOPE WE CAN DO THIS THIS SESSION. THANK YOU.>>CHAIR MORAN: THANK YOU. REPRESENTATIVE LOEFFLER.>>REPRESENTATIVE LOEFFLER: THANK YOU; MME. CHAIR. REPRESENTATIVE NOOR I APPRECIATE YOU BRINGING THIS FORWARD AND BRINGING US TO THE [INAUDIBLE] SUPPORTING FAMILIES WHO NEED HELP IN TOUGH TIMES. WE KNOW THERE ARE ENOUGH TREATMENT FACILITIES PARTICULARLY THOSE WHO TAKE WOMEN WITH THEIR CHILDREN. SO THE FAMILY CAN STAY TOGETHER. THERE’S OFTEN A WAY TIME TO SAY DURING THAT WAY TIME THAT THERE IS FOOD SUPPORT FOR THE FAMILY; THE FOOD IS USED TO FEED THOSE CHILDREN TO BE CUT ; TO SAY THAT THE GRANT SHOULD BE CUT SO THEY CAN POTENTIALLY END UP IN A SHELTER THAT CAN COST AS MUCH AS $2000 A MONTH BUT MORE IMPORTANTLY IS JUST TOTALLY DEVASTATING TO THOSE CHILDREN STUDIES HAVE SHOWN WHEN THEY GET INTO THAT SITUATION THEY JUST ARE SO OVERWHELMED AND TRAUMATIZED THAT THEIR EDUCATIONAL PROGRESS STOPS INTO THAT FAMILY IS RE-STABILIZED. THAT IS JUST TOO HEAVY A BURDEN FOR SOMEONE IS TRYING TO STABILIZE THEIR LIFE; MAYBE WAITING FOR TREATMENT AND IS DOING THE BEST THEY CAN . AND THE ROLE OF THE COUNTIES IN THE ROLE OF OUR SERVICE SYSTEM SHOULD BE TO HELP PEOPLE LIFT PEOPLE UP WHATEVER THE HEALTH [INAUDIBLE] WE DON’T DO THIS TO THE SENIOR WHO SAYS I CAN’T AFFORD THE CO-PAYS AND CUTS THEIR PILLS AND HAPPY THAT WE ALL SAY WE ARE GOING TO CUT YOU OFF OF SOME OF THE BASIC SUPPORTS YOU NEED I THINK WE SHOULD NOT DO THAT WITH FAMILIES AND OTHER PEOPLE WHO ARE IN THE SYSTEM BECAUSE THEY KNOW THEY NEED HELP AND SUPPORT.>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE NOOR THANK YOU FOR BRINGING THIS FORWARD. I THINK THE STRIKES A GOOD BALANCE BETWEEN;; AS REPRESENTATIVE LIEBLING AND OTHERS HAVE SAID IN TERMS OF PROVIDING TREATMENT BUT ALSO MAKING SURE THE PEOPLE ARE DILIGENT ABOUT PERSONAL RESPONSIBILITY. I UNDERSTAND THAT THE RULE HAS BEEN SUSPENDED FOR AMENDMENTS MME. CHAIR AND SO I’D LIKE TO OFFER A ORAL AMENDMENT AT THIS TIME.>>CHAIR MORAN: OKAY. A AMENDMENT HAS BEEN OFFERED THAT YOU WANTED TO IT?>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. I WILL DELINEATE IT’S JUST A CHANGE OF ONE WORD FOR ANOTHER. SO ON LINE 1.15 THE PLACE THE WORD; MAY WITH MUST. LINE 2.11; REPLACE THE WORD; MAY; WITH;; MUST. LINE 4.10 REPLACE THE WORD; MAY; WITH; MUST AND ON LINE 4.22; REPLAY THE WORD; MAY; WITH THE WORK; MUST. MY STRONG RECOMMENDATION FOR ACCEPTANCE OF THAT IS TO THE VERY POINT THAT I DON’T THINK IT’S VOLUNTARY FOR PEOPLE TO FALL INTO A CORROSIVE DISEASE SUCH AS IS WHAT REPRESENTATIVE NOOR HAS ARTICULATED. I THINK IT IS INCUMBENT UPON US TO SEND A STRONG STATEMENT IN TERMS OF OUR DESIRE TO GET THEM INTO TREATMENT AND PROVIDE THE TYPES OF SERVICES THAT EITHER THE STATE OR THE COUNTY CAN OFFER TO THOSE INDIVIDUALS. SO I WOULD HOPE THE AUTHOR OF THE BILL WOULD ACCEPT THIS AS A FRIENDLY AMENDMENT.>>CHAIR MORAN: REPRESENTATIVE NOOR>>REPRESENTATIVE NOOR: MME. CHAIR; I WILL ACCEPT THAT AS A FRIENDLY AMENDMENT DID I JUST WANT TO GET CLARITY FROM HOUSE RESEARCH. IS IT SHALL; OR MUST? WHICH ONE DO WE GO WITH?>>CHAIR MORAN: NELLY.>>STAFF: MME. CHAIR AND MEMBERS I BELIEVE THE REVISOR’S OFFICE TYPICALLY DOES PREFER; MUST; OVERSELL.>>REPRESENTATIVE NOOR: I ACCEPT THE AMENDMENT FROM REPRESENTATIVE ALBRIGHT MME. CHAIR>>CHAIR MORAN: THANK YOU. CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I APPRECIATE THE SENTIMENT HERE THOUGH. I HAVE TO SAY THOUGH; THIS I THINK THIS IS IMPOSE A UNFUNDED MANDATE ON COUNTIES AND LOOKS LIKE A PRETTY BIG ONE I MEAN THAT WOULD BE GREAT IF WE COULD FIND THIS AND ALL THAT BUT JUST CHANGING THE LINE WAS RIGHT HERE AND NOW I ONE OF THOSE A COUNTY REPRESENTED HERE OR SOMEONE FROM DHS WOULD WANT TO ADDRESS THAT BUT IT LOOKS TO ME LIKE AN UNFUNDED MANDATE ON COUNTIES.. NOW; THE BILL IS GOING TO MOVE ON AND GO TO HHS FINANCE AND I SUPPOSE WE CAN GET A FISCAL NOTE ON THAT BUT I THINK THAT TO JUST TO EAT WELL MAYBE WE SHOULD HEAR FROM THE TESTIFIER ABOUT THAT BEFORE WE JUST GO MANDATING THINGS BECAUSE I DON’T KNOW ABOUT YOU BUT I KNOW I HEAR FROM MY COUNTY ALL THE TIME; DON’T PUT STUFF ON US BECAUSE IF YOU ARE GOING TO TELL SOMEBODY TO DO SOMETHING YOU BETTER FIND OUT WHO’S GOING TO HAVE TO DO THE WORK AND WHERE THE MONEY IS COMING FROM AND I WOULD BE SEVERELY CHASTISED IF I DO NOT PAY ATTENTION TO THAT.>>REPRESENTATIVE ALBRIGHT: MME. CHAIR I WOULD ARTICULATE TO ADD ON TO WHAT REPRESENTATIVE LIEBLING JUST SAID THAT THIS IS A POLICY COMMITTEE NOT A FINANCE COMMITTEE AND I’M CERTAIN THAT IT WOULD OBLIGATE A FISCAL NOTE AND I’LL BE TAKING UP IN HER COMMITTEE AS WELL AS OTHERS GOING FORWARD BUT I THINK THE SENTIMENT OR THE INTENT OF THE BILL IS GOOD . WE ARE STRENGTHENING LANGUAGE SO THE PEOPLE THAT ARE MOST IN NEED OF IT WILL GET IT.>>CHAIR MORAN: WOULD YOU LIKE TO TO THE AMENDMENT? PLEASE INTRODUCE YOURSELF>>TESTIFIER: THANK YOU MME. CHAIR MY NAME IS ELIZABETH AS PRESIDENT FOR GOVERNMENT RELATIONS AND I’M HERE REPRESENTING MINNESOTA [INAUDIBLE ] ADMINISTRATORS TO THE POLICY QUESTION I THINK WE WOULD ECHO SOME OF THE FACT THAT REPRESENTATIVE LIEBLING SHARED TO THE POLICY OF A; JUST KIND OF READING THIS I THINK EVEN IN ORDER TO DETERMINE WITH THE FISCAL IMPACT OF COUNTIES WOULD BE WE WOULD NEED DEFINITION AROUND WITH THE TERM RESOURCES MEANS AND KIND OF WHAT THE SCOPE OF THAT MEANS BUT DOES THAT MEAN THE COUNTY IS ACTUALLY MINISTERING THOSE SERVICES OR AS A REFERRAL SUGGEST YOU REFERRING TO OUTSIDE PROVIDERS. SO IN ORDER TO EVEN DETERMINE THE FISCAL IMPACT WE WOULD NEED A POLICY DEFINITION AROUND SOURCES.>>CHAIR MORAN: THANK YOU SO MUCH. BE REP HE MORRISON>>REPRESENTATIVE MORRISON: THANK YOU; MME. CHAIR. I WAS JUST USING WHICH THAT THE COUNTY MUST PROVIDE REFERRALS AND THEN WE CAN RE-EXAMINE THE MUST PROVIDE RESOURCES IS A SEPARATE ISSUE.>>CHAIR MORAN: WOULD YOU LIKE TO SPEAK TO THAT REPRESENTATIVE NOOR?>>REPRESENTATIVE NOOR: MME. CHAIR; I THINK THE REQUIREMENT FOR THE COUNTIES [INAUDIBLE] MUST PROVIDE THE RESOURCES. WE MUST TALKED ABOUT THE UNFUNDED MANDATES WILL DEFER THAT TO THE FINANCE COMMITTEE SO WE CAN REALLY EVALUATE AND I WILL [INAUDIBLE] THE COUNTIES WORK WITH COUNTIES>>CHAIR MORAN: CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. AT THE TESTIFIER NOTED THAT WOULD BE A GOOD STRATEGY TO JUST WHO THE BILL ON WITH THIS AND SEND IT AND GET A FISCAL NOTE. I ACTUALLY WOULD LIKE TO SEE WITH A FISCAL NOTE WOULD BE BUT THE TESTIFIER TOLD US THAT BECAUSE THE POLICY IS SO UNDEFINED THAT WE WOULD NOT BE ABLE TO DO THAT. SO I GUESS I WOULD ASK THE MAKER OF THE MOTION JUST LET ME SAY; EVEN THOUGH I THINK IT’S GREAT FOR MEMBERS TO BE ABLE TO WORK ON BILLS ON THE FLY; AND MY COMMITTEE I DON’T HAVE A 24 HOUR RULE FOR AMENDMENTS BECAUSE I THINK IT’S GREAT TO WORK ON THEM .. WHEN WE KIND OF DO THINGS ON THE FLY; WE ALSO SOMETIMES DON’T THINK THROUGH FULLY WHAT IT IS WE ARE DOING AND THAT MIGHT BE THE PROBLEM RIGHT HERE. SO I WOULD LIKE TO ASK REPRESENTATIVE ALBRIGHT TO HAVE A BETTER DEFINITION OR WITHDRAW THE AMENDMENT SO WE CAN ACTUALLY CONTINUE TO WORK ON IT.. I BET REPRESENTATIVE NOOR WILL WE COULD ASK HIM IF HE’S WILLING TO WORK MAYBE WAS REPRESENTATIVE ALBRIGHT TO DEFINE THE TERM A LITTLE BETTER SO WE REALLY COULD GET A FISCAL NOTE. I WOULD LIKE TO DO THAT.>>CHAIR MORAN: REPRESENTATIVE NEU>>REPRESENTATIVE NEU: IT’S A LITTLE FRUSTRATING TO ME. WE ARE VERY [INAUDIBLE] CASH ASSISTANCE HERE. WE ARE LITERALLY PUTTING MONEY IN PEOPLE’S POCKETS AND THIS IS A REALLY CRITICAL PROGRAM FOR SO MANY PEOPLE. I MEAN WE ARE HEARING THIS NUMBER; 30;000 PEOPLE. THIS IS REALLY REALLY IMPORTANT AND WE ARE TALK ABOUT HOW IMPORTANT IT IS FOR PEOPLE WHO HAVE SUBSTANCE ABUSE DISORDERS TO RECEIVE THE HELP THEY NEED AND YET WE HAVE THIS [INAUDIBLE] TO MAKE THAT HAPPEN AND WE ARE SAYING; BUT; WE DON’T REALLY WANT TO DO THAT. THIS IS I DO SEE A LOT OF THE HYPOCRISY HERE RIGHT NOW. THIS INCREDIBLY FRUSTRATING TO ME. YOU KNOW; I ASSUME WWE TALK ABOUT THE OPIOID EPIDEMIC AND CERTAINLY; THERE ARE PEOPLE OF THE FOUR AFFECTED BY THE OPIOID ACADEMIC BUT I WOULD ACTUALLY TALK ABOUT THE ADDICTION EPIDEMIC BECAUSE I BET EVERY SINGLE PERSON AROUND THIS TABLE HAS BEEN AFFECTED BY THE ADDICTION EPIDEMIC. THAT’S REALLY WHAT WE’RE TALKING ABOUT HERE. WE ARE TALKING ABOUT THIS EPIDEMIC OF ADDICTION AND I DON’T KNOW ABOUT ALL OF YOU BUT I CERTAINLY HAVE DEALT WITH PEOPLE VERY CLOSE TO ME IN MY LIFE OF DEALT WITH ADDICTION FOR OVER 30 YEARS. YOU KNOW WHAT WE KNOW IN MY FAMILY ;; THAT THE WORST THING TO DO IS PUT CASH IN THEIR POCKET. THAT IS THE WORST THING WE CAN DO FOR THEM. THAT DOES NOT HELP THEM TO PUT CASH IN THEIR POCKET . WHAT HELPS THEM IS TO SUPPORT THEM;; GET OUT THE HELP THEY NEED TO MOVE FORWARD. I UNDERSTAND THE INTENT OF THIS ;; THAT WE DON’T WANT TO DENY THOSE BENEFITS BUT IF WERE NOT TO DENY THOSE BENEFITS THEN WE GUARANTEE GET THEM THE HELP THEY NEED.>>CHAIR MORAN: SO IT LOOKS LIKE WE HAVE SOMEONE ELSE WOULD LIKE TO TESTIFY. MS. WEBSTER. I THINK ONE OF THE THINGS WE SHOULD THINK ABOUT DOING BECAUSE THE FACT IS; WE PUT A HUGE AMOUNT OF RESPONSIBILITY ONTO OUR COUNTIES WERE REALLY STRUGGLING AND THAT’S AROUND THE STATE. THE MORE [INAUDIBLE] THE LESS RESOURCES THEY HAVE. AND WE DO WANT TO SUPPORT INDIVIDUAL FAMILIES WITH THE RESOURCES THEY WANT; BUT I THINK THAT WHAT WERE LOOKING AT IS THE UNFUNDED MANDATE ON THOSSE COUNTIES. SO MAYBE THE AUTHOR OF THE BILL AND REPRESENTATIVE ALBRIGHT CAN WORK TOGETHER TO [INAUDIBLE] TO THE NEXT COMMITTEE TO SEE WHAT IS RESOURCE. WHAT ARE THE COSTS ASSOCIATED WITH THE MEANING OF RESOURCES. I’M GOING TO STOP THERE AND LET MS. WEBSTER SPEA K.>>TESTIFIER: THANK YOU MME. CHAIR AND REPRESENTATIVE NEU YOU JUST MENTIONED PUTTING CASH IN PEOPLE’S HANDS AND ACTUALLY; IF YOU LOOK AT LINE 2.3; WE ACTUALLY DON’T PUT CASH IN PEOPLE’S HANDS WHEN THEY ARE CONVICTED OF A DRUG OFFENSE. THE ASSISTANCE IS VENDOR PAID. SO THEY GOES DIRECTLY TO THEIR LANDLORD WERE TO THEIR UTILITIES; WHICH ENSURES THAT IT’S ACTUALLY VERY BURDENSOME PROCESS FOR THE COUNTY GETS ONE MOST BURDENSOME THINGS WE DO IN THIS PROGRAM BUT IT GETS AT THAT CONCERN YOU HAVE THAT CASH WOULD NOT BE SPENT ON BASIC NEEDS SUCH AS SHELTER.>>CHAIR MORAN: SO WE HAVE REPRESENTATIVE NOOR WHAT WOULD BE YOUR PREFERENCE; PLEASE>>REPRESENTATIVE NOOR: MME. CHAIR I’M WILLING TO WORK WITH REPRESENTATIVE ALBRIGHT TO MAKE SURE WE DO HAVE THAT LANGUAGE IN AND ENSURING THAT THE COUNTIES HAVE THE RIGHT SUPPORT SERVICES SO THEY CAN ADMINISTER THIS PROGRAM. IF YOU ARE WILLING TO WITHDRAW THE MOTION OUT I’LL BE MORE THAN WILLING BEFORE IT COMES TO HHS FINANCE TO WORK THROUGH THE PROCESS AND COME UP WITH THE LANGUAGE IN THAT COMMITTEE.>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT ARE YOU WILLING TO CONTINUE WORK WITH REPRESENTATIVE NOOR AND WITHDRAW THE AMENDMENT OR WOULD YOU LIKE TO MOVE FORWARD?>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE NOOR WHILE APPRECIATE THE SENTIMENTS OF WORKING WITH YOU ON THIS AND I THINK THAT IN CONCURRENCE WITH THE AMENDMENT THAT I’VE OFFERED ORALLY; I DON’T SEE ANY REASON WHY WE CAN’T WORK ON THE LANGUAGE WHILE STILL PUTTING MY ORAL AMENDMENT ON.. I THINK IT HAS REPRESENTATIVE NEU SAID I WOULD LIKE TO FIND OUT WITH THE FISCAL NOTE LOOKS LIKE ON THISS. WITH THAT CHANGE ABOUT ONE WORD BECAUSE I THINK IT DOES BRING INTO BETTER CLARITY WHERE OUR PRIORITIES ARE AS A STATE IN TERMS OF ARE WE WILLING TO PROVIDE IF IN FACT THE FISCAL NOTE COMES BACK THAT THERE IS A NEED FOR ADDITIONAL SUPPORT TO THE COUNTIES. I LIKE TO KNOW WHAT THAT AMOUNT IS . BECAUSE AS REPRESENTATIVE NEU SAID AND I WHOLEHEARTEDLY AGREE WITH HER; THIS IS ABOUT ADDICTION ON A WHOLE MYRIAD OF FRONTS. SO WHILE I APPRECIATE THE SENTIMENTS OF THE NEXT BEST BY A NUMBER OF THE MEMBERS OF THIS COMMITTEE I AM UNWILLING TO WITHDRAW MY ORAL AMENDMENT AT THIS TIME AND I’M ALSO ASKING ON A ROLLCALL ON THE AMENDMENT.>>CHAIR MORAN: ROLLCALL HAS BEEN CALLED FOR ON THE AMENDMENT. CHAIR LIEBLING>>REPRESENTATIVE LIEBLING: THANK YOU; MME. CHAIR. I’M GLAD YOU DID THAT REPRESENTATIVE ALBRIGHT BECAUSE I WAS JUST GOING TO SAY COME I THINK I THINK WE COULD PUT THIS ON AND SO I ENCOURAGE OTHER MEMBERS TO VOTE FOR IT. I HOPE THAT YOU WE CAN GET A FISCAL NOTE UNTIL YOU REPRESENTATIVE NOOR COME UP IN LANGUAGE AND WHEN YOU GET A AMENDMENT TOGETHER AND WE WILL GIVE A FISCAL NOTE SO MENTORSHIP SHOULD VOTE FOR THE AMENDMENT AND MME. CHAIRMAN UP ASK FOR A ROLLCALL ON THE BILL BECAUSE IF WERE NOT BEING HYPOCRITES. ALL OF US SHOULD THEN BE VOTING FOR THIS BILL. SOSINCE REPRESENTATIVE NEU PART OF BEING A HYPOCRITE; IF YOU ARE SERIOUS ABOUT WORKING ON THIS PROBLEM AND SERIOUS ABOUT THE ISSUE OF ADDICTION THEN EVERYONE SHOULD BE VOTING FOR THE BILL.>>CHAIR MORAN: ANY FURTHER DISCUSSION ON THE ORAL AMENDMENTS? SO WHY DO WE TAKE THE ROLL ON THE AMENDMENT FIRST.>>STAFF: MORAN AYE; MORRISON AYE; KIEL AYE; ALBRIGHT AYE; BACKER BAHNER AYE; EDELSON ; FISCHER AYE;FREIBERG AYE; LIEBLING AYE; LOEFFLER AYE; MANN ; NEU AYE; PIERSON AYE; PINTO AYE; ROBBINS ; SCHOMACKER AYE; SCHULTZ AYE; ..>>CHAIR MORAN: THERE BEING 14 AYE AND ZERO NAYS THE ORAL AMENDMENT IS ADOPTED>>[GAVEL]>>CHAIR MORAN: IS THERE ANY FURTHER DISCUSSION ON THE BILL AS AMENDED? THERE BEING NO FURTHER DISCUSSION ON THE BILL AS AMENDED; WE WILL GO TO THE ROLLCALL.>>STAFF: MORAN AYE; MORRISON AYE; KIEL AYE; ALBRIGHT AYE; BACKER ; BAHNER AYE; EDELSON ; FISCHER AYE; FREIBERG AYE; LIEBLING AYE; LOEFFLER AYE; MANN ; NEU AYE; PIERSON AYE; PINTO AYE; ROBBINS ; SCHOMACKER AYE; SCHULTZ AYE .>>CHAIR MORAN: THERE BEEN 14 AYE AND ZERO NAYS MOTION PREVAILS. HOUSE FILE 1719 AS AMENDED IS RECOMMENDED FOR RE-REFERRAL TO THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN: OKAY; THE NEXT BILL IS HOUSE FILE 1892 REPRESENTATIVE MORRISON. REPRESENTATIVE MORRISON WOULD YOU LIKE TO MOVE YOUR BILL?>>REPRESENTATIVE MORRISON: MME. CHAIR I MOVE THAT HOUSE I MOVE THAT HOUSE FILE 1890 2B REFER TO THE GENERAL REGISTER BE>>CHAIR MORAN: WE HAVE THE BILL BEFORE THE COMMITTEE. REPRESENTATIVE MORRISON PLEASE PRESENT YOUR BILL>>REPRESENTATIVE MORRISON:>>HOUSE SPEAKER HORTMAN: MEMBERS THE COMMITTEE; THANK YOU FOR LONNIE TO PRESENT HOUSE FILE 1892. WHICH ISSS A BILL THAT IT’S VERY IMPORTANT IN ENSURING PREGNANT WOMEN CONTINUE PRENATAL CARE AND THEY AND THEIR BABIES HAVE GOOD HEALTH OUTCOMES. I ALSO THINK MY CO-AUTHOR REPRESENTATIVE MANN; BAKER PINTO AND AVENUE. CURREENTLY HEALTHCARE PROFESSIONALS IN SOCIAL SERVICE PROFESSIONALS ARE MANDATED TO REPORT A PREGNANT WOMEN TO A LOCAL WELFARE [INAUDIBLE] IF SHE TESTS POSITIVE OR ANY CONTROLLED SUBSTANCE FOR OTHER THAN ALCOHOL OR CANNABIS AND 40 MINUTES ARE REPORTING CONTROLLED SUBSTANCE ABUSE AFTER PRENATAL SCREENING THESE TWO DISTRUST OF PROVIDERS AND OF WHAT IT’S A PRENATAL CARE DURING PREGNANCY. HOUSE FILE 1890 WOULD AMEND THOSE REQUIREMENTS TO ELIMINATE BARRIERS TO ACCEPTING PRENATAL CARE IMPROVE ACCESS TO ADDICTION SERVICES. PREGNANT WOMAN WHO HAVE SUBSTANCE ABUSE DISORDERS SHOULD HAVE ACCESS TO CONFERENCE OF SERVICES INCLUDING PRENATAL CARE AND DRUG TREATMENT AND SOCIAL SUPPORT SERVICES. TH ESE WOMEN OFTEN OF OTHER PSYCHOSOCIAL RISK FACTORS AND PROGRAM COMORBIDITIES THAT NEED TO BE ADDRESSED IN ORDER TO ENSURE THEIR SUCCESSFULLY THAT THERE SUBSTANCE ABUSERS SUCCESSFULLY TREATED. THESE WOMEN OFTEN DO NOT SEEK PRENATAL CAREE INTO LATE PREGNANCY OR NOT AT ALL BECAUSE THEY’RE WORRIED THAT WE STIGMATIZED WITH A NEWBORN WE TAKEN AWAY. I BELIEVE THAT TARGETING WOMEN WHO USE DRUGS DURING PREGNANCY FOR CRIMINAL PROSECUTION DRIVE WOMEN AWAY FOR TREATMENT VITAL FOR BOTH THE MOMMY AND THE BABY. AS A PRACTICING OB/GYN; I CAN TELL YOU FIRSTHAND HOW IMPORTANT TRUST IS IN THE DOCTOR-PATIENT RELATIONSHIP. LIVING WITH A SUBSTANCE ABUSE DISORDER NEEDS HEALTHCARE NOT CONDEMNATION. FOR THAT TO OCCUR WOMEN MUST BELIEVE AND KNOW THAT THE PROVIDER IS ON THEIR TEAM. WORD WAS POSSIBLE THING FOR THEM AND THEIR BABY IS TO AVOID PRENATAL CARE BUT THIS BILL PROVIDES STEPS IN THAT DIRECTION. I HAVE A COLLEAGUE FROM THE AMERICAN COLLEGE OF OB/GYN HERE TO TESTIFY AS WELL.>>CHAIR MORAN: WELCOME TO THE COMMITTEE. PLEASE PLEASE INTRODUCE YOURSELF AND TELL US WHO YOU WITH AND PROCEED>>TESTIFIER: MME. CHAIR; COMMITTEE MEMBERS; I AM DR. [INAUDIBLE] LEGISLATIVE CHAIR OF THE MINNESOTA SECTION OF THE AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY BUT WE REPRESENT OVER 1000 HEALTHCARE PROVIDERS HERE IN THE STATE OF MINNESOTA. WE ARE HERE IN SUPPORT OF HOUSE FILE 1892. I LIKE TO EXPLAIN WHAT WE FEEL THE SUCH AN IMPORTANT STEP MATERNAL WHAT WADDELL MORTALITY RATE . MINNESOTA’S 14 PER 1000 NO DOUBT THAT’S LOWER THAN THE US AVERAGE OF 24 PER 100;000 AND IT IS STILL UNACCEPTABLY HIGHER THAN ANY OTHER DEVELOPED COUNTRY. IT’S TWICE THAT OF CANADA [INAUDIBLE] IT’S MORE DANGEROUS TO BE PREGNANT AND GIVE BIRTH NOW IN THE UNITED STATES AND WAS A GENERATION AGO. DATA FROM OUR INFANT MORTALITY COMMITTEE HERE IN MINNESOTA SHOWS THAT MENTAL HEALTH AND SUBSTANCE ABUSE DISORDER ARE AMONG THE MOST COMMON CAUSES OF MATERNAL DEATH HERE IN MINNESOTA. WE KNOW THAT ADEQUATE CARE IS ESSENTIAL TO OPTIMIZING THE OUTCOME OF ANY PREGNANCY AND ESPECIALLY IMPORTANT FOR THOSE THAT ARE COMPLICATED BY MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS. HOWEVER; ACCORDING TO A 2015 SURVEY OF THE MINNESOTA DHS MOTHERS OF BABIES WITH NEONATAL SYNDROME WITH 12 TIMES LESS LIKELY TO SEEK PRENATAL CARE. AND 20% OF MOTHERS USING OPIOIDS ARE NOT DIAGNOSED UNTIL EITHER DELIVERY OR AFTER HERE IN MINNESOTA. MARCH OF DIMES STUDIES HAVE SHOWN WOMEN AVOID OR DELAY PRENATAL CARE BECAUSE THEY FEAR A PUNITIVE RESPONSE. THE CURRENT LAW REQUIRES THAT WE HELP HEALTHCARE PROVIDERS REPORT POSITIVE SCREENS FOR ANY SUBSTANCE OTHER THAN ALCOHOL OR THC. REMOVING THIS LANGUAGE WOULD REEMOVE A REAL BARRIER TO PATIENT FOCUSED CARE . WHEN THE PATIENT CAN TRUST AND SHARE HER HISTORY WITH HER HEALTH CARE TEAM SHE HAS A PIVOTAL OPPORTUNITY TO GET THE CARE SHE NEEDS IN THE NEWBORN MAY NEED TO ADEQUATELY ADDRESS HER CHRONIC RELAPSE DISORDER SO THAT SHE AND HER FAMILY NOT JUST SURVIVE BUT GO ON TO THRIVE. THANK YOU.>>CHAIR MORAN: THANK YOU FOR YOUR TESTIMONY. IS THERE ANYONE ELSE IN THE AUDIENCE WHO WISHES TO TESTIFY ON HOUSE FILE 1892? REPRESENTATIVE ALBRIGHT.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE MORRISON I KNOW THERE’S A PROBABLY A TECHNICAL QUESTION BUT YOU STRIKE LINE 1.14;; WHICH TALKS TO THE USE OF THC; WHICH IS ONE OF THE AGENTS IN CANNABIS BUT THERE IS ANOTHER ONE; ANOTHER ELEMENT IN CANNABIS THAT ALSO IS CONSIDERED . I’M WONDERING; PART ONE; WHY THAT MAYBE IT’S ARTY STRICKEN AND ARE CONSIDERED AND SO IT’S NOT NECESSARY; BUT I’M ALSO WONDERING IF THIS WOULD INCLUDE WORDS ALREADY BEEN STRICKEN IN TERMS OF CBD AND THOSE TYPES OF ELEMENTS FROM HEMP WHICH IS A CLOSE COUSIN TO MARIJUANA?>>REPRESENTATIVE MORRISON: MME. CHAIR REPRESENTATIVE ALBRIGHT I APOLOGIZE BUT I DON’T HAVE THE BILL LANGUAGE IN FRONT OF ME BUT IS NOT MANDATORY REPORTINGFOR THC OR CBD.>>REPRESENTATIVE ALBRIGHT: OKAY. SO THEN MY QUESTION IS; I THINK REPRESENTATIVE CONSIDINE JUST PROVIDED YOU WITH THE LANGUAGE ; BUT YOU MIGHT WANT TO AMEND YOUR ANSWER GIVEN THE FACT THAT TETRAHYDRO CAN OF ALL IS IDENTIFIED THERE.>>CHAIR MORAN: REPRESENTATIVE MORRISON>>REPRESENTATIVE MORRISON: MME. CHAIR REPRESENTATIVE ALBRIGHT; THE INTENT IS TO REMOVE REPORTING OF ALL SUBSTANCES .>>REPRESENTATIVE ALBRIGHT: REPRESENTATIVE MORRISON; SO LET ME BE CLEAR THAN. ALL SUBSTANCES REPORTABLE UNDER WHAT DEFINITION?>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT I’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’M JUST WONDERING ON THE DEFINITION . IT SAYS SPECIFICALLY; IF THE PROFESSIONALS PROVIDING THE WOMAN WITH PRENATAL CARE OR OTHER HEALTH CARE SERVICES . MY QUESTION IS THAT PRENATAL CARE ; IS IT POSSIBLE THAT IS A ONE-TIME EVENT; THE PRENATAL CARE? IS THAT DEFINED? I ASK THIS BECAUSE MY CONCERN IS THAT IF THERE IS A SINGLE EVENT; IF THERE’S A SINGLE VISIT IN PROVIDING THE PRENATAL CARE I WOULD BE CONCERNED THAT THERE IS NOT A FOLLOW-UP AND MONITORING. SO I CERTAINLY AGREE WITH THE INTENT OF THE BILL BUT IF THERE IS ONGOING PRENATAL CARE CLEARLY WE WANT TO CARE FOR THAT WOMAN AND THAT BABY . SO I’M JUST WONDERING IF YOU HAVE ANY INSIGHT OR CLARIFICATION ON THAT?>>REPRESENTATIVE MORRISON: MME. CHAIR REPRESENTATIVE NEU; IT CERTAINLY COULD REFER TO A SINGLE VISIT. BOY WHAT AN OPPORTUNITY THAT SINGLE VISIT COULD BE IF YOU COULD GAIN THAT WOMAN’S TRUST AND GET HER INTO THE HEALTHCARE SYSTEM. THANK YOU FOR YOUR QUESTION.>>CHAIR MORAN: REPRESENTATIVE ALBRIGHT>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. CHAIR. REPRESENTATIVE MORRISON; IS A MEDICAL PROFESSIONAL THEN; TO FALL ONTO WHAT REPRESENTATIVE NEU SAID;; IF SOMEONE PRESENTS THEMSELVES WITH A SUBSTANCE DISORDER BY PRESUMPTION IS THAT IS A MEDICAL PROFESSIONAL; YOU WOULD SEEK OUT THE PROPER TREATMENT WERE INTRODUCTION TO TREATMENT FOR THAT SUBSTANCE ABUSE? AM I CORRECT? CORRECT?>>REPRESENTATIVE MORRISON: MME. CHAIR REPRESENTATIVE ALBRIGHT; YOU CAN’T ALWAYS DIAGNOSE A SUBSTANCE ABUSE DISORDER IN A SINGLE VISIT BUT. BUT CERTAINLY IF THAT BECAME APPARENT IN THE COURSE OF A VISIT THAT WOULD BE PART OF THE TREATMENT PLAN.>>REPRESENTATIVE ALBRIGHT: THANK YOU.>>CHAIR MORAN: ANY FURTHER QUESTIONS? SO THERE BE NO FURTHER DISCUSSION REPRESENTATIVE MORRISON RENEWS HER MOTION HOUSE FILE 1892 BE RECOMMENDED FOR PLACEMENT ON THE GENERAL REGISTER. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. HOUSE FILE 1892 IS RECOMMENDED FOR PLACEMENT ON THE GENERAL REGISTER.>>[GAVEL]>>CHAIR MORAN: THANK YOU. OUR NEXT BILL UP IS HOUSE FILE 1535 REPRESENTATIVE MORRISON. WOULD YOU LIKE TO INTRODUCE YOUR BILL?>>REPRESENTATIVE MORRISON:>>REPRESENTATIVE MORRISON: MME. CHAIR I MOVE HOUSE FILE 1555 I MOVE HOUSE FILE 1550 5B REFER TO THE GRAND WAYS AND MEANS.>>CHAIR MORAN: SO WE HAVE THE BILL BEFORE THE COMMITTEE. REPRESENTATIVE MORRISON PLEASE; PRESENT YOUR BILL.>>REPRESENTATIVE MORRISON: CHAIR MORAN MEMBERS QUICKLY HOUSE FILE 1535 PROVIDES MEDICAID COVERAGE FOR HOME ENVIRONMENTAL ASSESSMENT AND FOR DURABLE MEDICAL EQUIPMENT TO TREAT POORLY MANAGE ASTHMA IN CHILDREN. ASTHMA IS A CRUEL DISEASE AND IT’S WORSE INVOLVING TAX OF ACUTE BREATHING DIFFICULTIES THAT OFTEN REQUIRES INTENSE RESPIRATORY TREATMENT AND ONGOING MEDICATION. ANYONE WHO IS WITNESSED OR EXPERIENCED ACUTE ASTHMA ATTACK KNOWS THE TERROR IT CAN INDUCE ESPECIALLY FOR CHILDREN AND PARENTS. WE CAN DO BETTER IN TREATING THE COMMON DISEASE. THIS BILL PROVIDES COVERAGE BEYOND THE CORE MEDICAL TREATMENT REQUIRED TO MANAGE THAT ASTHMA. IT LISTS THE KIDS HOMES [INAUDIBLE] BIMETAL TRIGGERS TO MAYBE CONTRIBUTE TO A CONDITION. IT PROVIDES PRACTICAL LOW-COST EQUIPMENT AND SUPPLIES TO PARENTS AND CAREGIVERS TO ADDRESS THE ALLERGENS IN THE CHILD’S HOME. THE TRIGGER ATTACKS OR ACTIVATES SYMPTOMS. THIS BILL HAS BEEN INTRODUCED BEFORE SEVERAL TIMES AS I ATTEMPTED IS A POSITION THAT HONESTLY CONFUSE ME WHY IT’S NOT BEEN PASSED. BESIDES ABORTING GOOD EFFECTS OF HEALTHCARE IT SAVES MONEY. IT’S TIME TO PASS THIS COMMON SENSE BILL DID EVERYONE WINS. CHILDREN WITH ASTHMA OTHER FILMS; HEALTHCARE PROVIDERS INSURERS AND TAXPAYERS. I HAVE A TESTIFIER WITH ME TODAY PLANS TO BE BRIEF IN HER COMMENTS .>>CHAIR MORAN: WELCOME TO THE COMMITTEE. PLEASE INTRODUCE YOURSELF FOR THE RECORD AND PROCEED WITH YOUR TESTIMONY>>TESTIFIER: THANK YOU MME. CHAIR AND MEMBERS OF THE COMMITTEE. MY NAME IS LISA [INAUDIBLE] ON THE MANAGER OF THE FLOOD HAZARD CONTROL AND HEALTHY OHMS UNIT IN THE MINNEAPOLIS HEALTH DEPARTMENT. THIS BILL WOULD PROVIDE MEDICAID REIMBURSEMENT FOR HOME ENVIRONMENTAL ASSESSMENT DONE BY SPECIFICALLY TRAINED PUBLIC HEALTH STAFF AND RESIDENTS OF HER MA ENROLLED CHILDREN WITH INSUFFICIENTLY MANAGED ASTHMA . UNDER THE SPELL COVERAGE FOR APPROPRIATE ALLERGEN PRODUCING DURABLE MEDICAL EQUIPMENT WOULD BE PROVIDED. WE MAY NOT THINK OF HEPA FILTER VACUUM CLEANERS AND [INAUDIBLE] AS MEDICAL EQUIPMENT BUT FOR THESE CHILDREN THEY ARE. EVEN WITH THE BEST MEDICAL CARE WHEN A CHILD IS SENT BACK TO A HOME ENVIRONMENT THAT CONTAINS ASTHMA TRIGGERING MATERIALS THINGS LIKE MILLE THE ROAD AND WASTE OR CERTAIN INSECTS; THE CONDITION DOES NOT IMPROVE AND THE [INAUDIBLE] THE MINNEAPOLIS HEALTH GOVERNMENT MISSING PAUL RAMSEY COUNTY PROGRAM AND OTHERS LIKE THEM ACROSS THE STATE OF A PROVEN TRACK RECORD FOR HELPING FAMILIES REDUCE ENVIRONMENTAL TRIGGERS TO THEIR OWN. STATEWIDE; ONE IN 14 MINNESOTA CHILDREN HAVE AN ASTHMA DIAGNOSIS. STUDIES DONE BY THE AMERICAN LUNG ASSOCIATION AND THE MINNEAPOLIS OF THE VARMINT THAT ARE PUBLIC HEALTH HOME ASSESSMENT PROGRAM SAVE $2.19 FOR EVERY DOLLAR SPENT. GRANTS WORK GREAT GREAT FOR PUB PROJECT FOR FUNDING LONG-RUNNING PROGRAMS TO PRODUCE RELIABLY POSITIVE RESULTS INSTEAD OF BEST PRACTICE BASELINE ONGOING PREDICTABLE FUNDING [INAUDIBLE] IS A NECESSITY AN AVERAGE [INAUDIBLE] IS A GREAT PLACE TO STOP IT IN SUMMARY; THE KEY TO SUCCESSFULLY MANAGING CHILD WITH ASTHMA IS HIGH QUALITY MEDICAL CARE COUPLED WITH A PUBLIC HEALTH IN-HOME SERVICES AS OUTLINED IN HOUSE FILE 1535. THIS PROP [INAUDIBLE]– WHICH BY THE WAY IS MOST COMMON REASON FOR ELEMENTARY AGED SCHOOL ABSENCES. I WOULD ALSO DO LIKE TO READ A SMALL PORTION OF DR. DORI BAKER WHO HAD TO LEAVE. SHE IS AN ASSOCIATE A CLINICAL DIRECTOR OF ASTHMA AT CHILDREN’S OF MINNESOTA. CHILDREN IS A STATE’S LARGEST PROVIDER OF PEDIATRIC HEALTHCARE. AT CHILDREN’S EACH YEAR THEY TREAT 4000 CHILDREN DIAGNOSED WITH ASTHMA. OF THOSE; IT HUNDRED PARTICIPATED IN THEIR ASTHMA CLINIC. THE ASTHMA CLINIC PATIENTS TO COMPLETE ASTHMA HISTORY WITH THE MEDICATION AND COMPLIANCE AND RESPIRATORY [INAUDIBLE] TO DETERMINE IF THEIR ASTHMA IS UNDER CONTROL. THEY ALSO DISCUSS THE PATIENT’S [INAUDIBLE] HOME ENVIRONMENT TO ASSESS POSSIBLE EXPOSURE TO ASTHMA TRIGGERS. WHEN APPROPRIATE THEY DO FOR PATIENTS TO COMMUNITY TONIGHT SOCIAL SERVICE AND HEALTHCARE LEGAL PARTNERSHIPS WITH ASSISTANCE WITH HOUSING AND FREE LEGAL SERVICE. THE COMMUNITY CONNECT PROGRAM MAY MAKE ADDITIONAL REFERRALS TO THE MINNEAPOLIS HEALTHY HOMES RAMSEY COUNTY ST. PAUL PUBLIC HEALTH HOME ASSESSMENT AND MEDIATION [INAUDIBLE] IN 2016 CHILDREN’S COMMITTEE HEALTH NEEDS ASSESSMENT IDENTIFIED ASTHMA IS A COMMUNITY HEALTH NEED. TREATMENT OF ASTHMA IS A HEALTH EQUITY ISSUE AS WELL. AND SO HIS CHILDREN LIVING IN LOW INCOME COMMUNITIES ARE MORE LIKELY THAN CHILDREN LIVING IN HIGHER INCOME COMMUNITIES WHO BEEN HOSPITALIZED FOR ASTHMA IN AMERICAN INDIAN AND AFRICAN-AMERICAN KIDS ARE MORE LIKELY THAN OTHERS TO BEEN DIAGNOSED WITH ASTHMA. WE HAVE FOUND WE CAN MOST BY THE BENEFITS OF OUR SPECIALIZED ASTHMA MEDICAL CARE BY PARTNERING THE CITY AND COUNTY PUBLIC HEALTH DEPARTMENTS TO PROVIDE HEALTHY HOME ENVIRONMENTAL ASSESSMENTS. ASTHMA IS ONE OF THE CONDITIONS BEST TREATED TO A HOLISTIC PREVENTABLE THIS BILL SUPPORTS THAT APPROACH. THANK YOU FOR YOUR TIME AND CONSIDERATION TODAY AND HAPPY TO ANSWER ANY QUESTIONS.>>CHAIR MORAN: THANK YOU BEING HERE FOR TESTIFY. IS THERE ANYONE IN THE AUDIENCE WOULD LIKE TO TESTIFY ON HOUSE FILE 1535? MEMBERS ANY FURTHER DISCUSSION? THERE BEING NO FURTHER DISCUSSION REPRESENTATIVE MORRISON RENEWS HER MOTION THAT HOUSE FILE 1530 5B RECOMMENDED FOR THE REFERRAL TO THE COMMITTEE ON WAYS AND MEANS. ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED? THE MOTION PREVAILS. HOUSE FILE 1535 IS RECOMMENDED FOR REFERRALS OF THE COMMITTEE ON WAYS AND MEANS.>>[GAVEL]>>CHAIR MORAN: WHY DON’T WE TAKE MAYBE A 10 MINUTE BREAK FOR WATER OR SOMETHING 10 TO 10 MINUTES. BE BE BACK AT 3:45 PM. WE ARE NOW RECESS.>>[GAVEL]>>[RECESS]>>>>[GAVEL]>>[RECESS]


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