State of Minnesota Medical Services Review Board July 21, 2005 443 Lafayette Road N. St.

Paul, MN MSRB members present: Philip Bachman, M.D. Barbara Baum, P.T. Charles J. Hipp, M.D. Margaret Kasting Reed Pollack Andrew Schmidt Jon Talsness Andrea Trimble Hart Lynn Ayers Beth Baker, M.D., MSRB chairperson Jeffrey Bonsell, D.C. Sharon Ellis, R.N. Michael Goertz, M.D. Ronald Groat, M.D. Gregory J. Hynan, D.C. William Martin, Esq. Robin Peterson, P.T. Kate Berger Rosaland Hoffman William Lohman, M.D. Julie Marquardt Brian Hicks, MAPS 1. Call to order, introductions, announcements Chairperson Baker and Vice Chairperson Jeffrey Bonsell were not in attendance, so Dr. Lohman acted as temporary chairperson and began the meeting at 4:20 p.m. He noted the meeting would be for presenting facts and there could be no decisions or votes made, since there was not a quorum. Reed Pollack asked Lohman how the MSRB interfaced with the Workers’ Compensation Advisory Council about the workers’ compensation medical costs, in general, and Lohman gave a brief explanation of the process.

MSRB members excused:

Staff members present:

Others present:


2. Legislative update The department’s bill passed. There wasn’t much in the bill that impacts the MSRB other than a provision that allowed for insurers to set up pharmacy networks and constrain the employee to get their medication from the designated pharmacy network, as long as there was an outlet within 15 miles of the employee’s residence or place of employment. Insurers are allowed to bargain price with the pharmacies in their network. The department doesn’t have any type of regulatory role in the process, so they don’t know how many (if any) employers or insurers have done this. Kasting said she has one. Lohman asked if they got a reasonable price from the pharmacist on the drugs and Kasting said it was better than what you get otherwise. Regarding other legislative issues, Barbara Baum asked if there was language around conversion factors. Lohman discussed what was in the omnibus reconciliation bill, which included an amendment sponsored by the Minnesota Chiropractic Association, that raises maximum chiropractic fees. The department is instructed to create a conversion factor for each of the provider types currently identified in the fee schedule. The conversion factor for chiropractors will then be increased over two years and the annual adjustments to the other conversion factors will be reduced as much as needed to offset the costs of increasing the chiropractor’s conversion factor. 3. Pharmacy rules update Lohman distributed a copy of the most recent draft of the pharmacy rules. Lohman said there have been some changes, which are in italics. There has been some new language added to define what is a usual and customary pharmacy charge. This is the definition used in Medicare. Lohman noted the department has met extensively with the various interest groups and they have tried to understand their issues and address them. Lohman asked if there were any other questions about the pharmacy rules. He noted the legislation set up the networks. These rules set up new maximum fees for those people getting medications outside of the network. None of the rules apply to networks. If a pharmacy enters into a network arrangement with the insurer, that is their business and whatever they have agreed to by contract with the insurer is fine with the department. The rules allow for electronic submission of the bill and they create a two-tiered maximum fee. The maximum fee is lower if the pharmacist is able to electronically submit their bill. 4. Task force report about NSAIDs Lohman distributed a copy of the final report from the task force about nonsteroidal anti-inflammatory drugs. Lohman gave an overview of the report. A copy of this report is also available on the Web site at: Lohman noted the task force made a number of recommendations. Lohman discussed the recommendations. Lohman noted that if the board accepts the report and recommendations without any need for change, then the department would start writing proposed treatment parameter rules to

3 encompass these recommendations. Lohman noted he would be sending an e-mail message with the report to each member, asking them to say whether they accept it or reject it. If a majority accepts the report, the department can start writing the rules. Lohman asked if anyone had an objection to this process. Kasting asked Lohman and Berger if after the report gets approved, do they see doing the rules in pieces and trying to put them through the whole rulemaking process or waiting until they do all of them. Lohman said the department anticipates doing all of the medication rules together. 5. New and old business Lohman asked members if there was any new business to discuss. Someone asked about reimbursement for new orthopedic implants and locking plates that are much more expensive than those previously used. He asked if the DRG is the same and would the hospital have to take on that cost. Lohman said the equipment is charged separately to workers’ compensation. 6. Adjourn Meeting adjourned at 5 p.m. Respectfully submitted, Rosaland Hoffman