Conceptual Models Dissertation
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Conceptual models dissertation

Conceptual models dissertation what is the definition of a corner lot audio editor software download free >> [GAVEL] >> [GAVEL] >> HOUSE SPEAKER: THE HOUSE WILL COME TO ORDER. CALENDAR FOR THE DAY. THE FIRST BILL ON THE CALENDAR FOR THE DAY IS SENATE FILE 800. THE CLERK WILL REPORT THE BILL. SPEAKER SENATE FILE NUMBER 800 NUMBER ONE ON THE CALENDAR FOR THE DAY AND ACT RELATING TO HUMAN SERVICES FINANCE AND POLICY AND THE BILL HAS BEEN UNOFFICIALLY ENGROSSED AND PRINTED FOR THE HOUSE TO INCLUDE COMMITTEE AMENDMENTS. >> HOUSE SPEAKER: I RECOGNIZE THE BILL AUTHOR; REPRESENTATIVE DEAN TO INTRODUCE YOUR BILL >> REPRESENTATIVE DEAN: MEMBERS; THIS IS THE HEALTH AND HUMAN SERVICES ALMOND OF THIS BILL. I WANT TO THANK OUR HOUSE HEALTH AND HUMAN SERVICES STAFF HOUSE RESEARCH RANDY CHUNG; DANIEL PANELLA; ELIZABETH CLARK; SARAH SENTIMENT OUR FISCAL ANALYST DOUG BYRD. THE REVISER'S OFFICE; SANDY GLASS; AMY BOX; LAUREN BECKY; ADAM GUZMAN; DFL RESEARCH SONDRA MOORE; GOP RESEARCH BETHANY -HAVING AND CHELSEA WHITMAN. CLA IS SHILOH LARSON; CA LAURA LARSON AND HOLLY IVERSEN. WE HAVE A GREAT BILL BEFORE YOU MEMBERS. IT'S COMPRISED OF ABOUT 129 BILLS FROM BOTH REPUBLICANS AND DEMOCRATS THE DEAL WITH PROVIDING CARE FOR MINNESOTA'S MOST VULNERABLE AND OVER 1 MILLION PEOPLE ON MEDICAID IN OUR NURSING HOMES AND OUR HOSPITALS ONLY COMMITTEE-BASED SERVICES TOUCHES MANY MANY LIVES EVERY SINGLE ONE OF YOUR CONSTITUENTS. I REALLY WANT TO THANK THE WORK OF THE COMMITTEE. BOTH REPUBLICAN MEMBERS AS WELL AS THE DEMOCRAT NUMBERS. WE LOOK FORWARD TO THE DEBATE I HAD THE BILL SPENDS ABOUT $14.32 BILLION ON STATE FUNDS. ABOUT 19.7 ON STATE FUNDS. ABOUT $19.7 BILLION IN FEDERAL FUNDS. WE HAVE LOOKED FOR SIGNIFICANT SAVINGS IN REFORMS WE WILL TALK ABOUT A LITTLE BIT THROUGH THE DEBATE TODAY. WE LOOK FORWARD TO THAT. BUT I WANT TO HIGHLIGHT SOME SPECIFIC AREAS OF THE BILL AND I WOULD LIKE TO SEND IT OVER TO THE POLICY COMMITTEE CHAIRMAN; JOE SCHOMACKER >> HOUSE SPEAKER: REPRESENTATIVE SCHOMACKER >> REPRESENTATIVE SCHOMACKER: MEMBERS I JUST WANT TO TOUCH ON A COUPLE OF POINTS TODAY. T HAT WE HAD IN THE HEALTH AND HUMAN SERVICES ALMOND OF THIS WE CONTINUE TO PRIORITIZE SENIORS AND THE DISABLED IN THIS BILL TODAY. WE WILL LOOK AT THE VALUE-BASED REIMBURSEMENT SYSTEM THAT WE IMPLEMENT IT IN 2015; WHAT WE WERE ABLE TO DO IS REFORM THE ENTIRE SYSTEM THAT WE HAD THE WAY WE FUNDED OUR NURSING HOMES SO WE WERE ABLE TO REFORM IT BUILD UP THE WORKFORCE; AND BRING SOMETHING FORWARD INTO THE FUTURE THAT WOULD CONTINUE WITH THE REFORMS THAT WE HAVE. W HAT WE LEARN; THOUGH IN THE PROCESS HAVING MAJOR REFORMS IS THAT WE HAVE TO POLISH THAT LANGUAGE AS WE MOVE FORWARD. THE MORE WE LEARN ABOUT IT THE MORE WE CAN IMPROVE UPON IT AND THAT'S WHAT WERE DOING WITH THIS BILL TODAY. SO FOR OUR NURSING HOMES AND FOR THE VALUE-BASED REIMBURSEMENT SYSTEM THAT WE HAVE YOUR PRESERVING ACCESS TO HIGH-QUALITY NURSING FACILITY SERVICES THROUGHOUT THE STATE BY PROVIDING GREATER WORKFORCE GROWTH. I BELIEVE CHAIRMAN KIEL WILL TALK MORE ABOUT THE WORK OF THE AGING AND LONG-TERM CARE COMMITTEE; ESPECIALLY IN THE WORKFORCE AREA FOR EXTENDING SCHOLARSHIPS TO HELP MORE NURSES GET INTO THE LOAN FORGIVENESS PROGRAM AND PROVIDING MORE ACCESS TO THOSE DOLLARS SO THE PEOPLE HAVE A CHANCE TO EXPAND THEIR CAREER THERE. IMPROVING TRANSPARENCY TO THE RATE SYSTEMS WE HAVE WITH OUR NURSING HOMES. SO THAT CONSUMERS ONLY HAVE TWO TIMES A YEAR WHERE THEY SEE THEIR RATES FLUCTUATE INSTEAD OF THE MONTH BY MONTH SYSTEM WE HAVE NOW. WE ALSO ENHANCE ACCOUNTABILITY IN THE SYSTEM OVERALL. THE INTEGRITY OF THE PROGRAM REQUIRING AN ONGOING REPORT FROM DHS FOR THE VALUE-BASED REIMBURSEMENT SYSTEM. MOST OF THAT IS FOUND IN ARTICLE 2 THAT WE HAVE TODAY. WE ALSO ARTICLE 9 OF THE BILL THAT ALSO CONTINUES TO POLISH SOME OF THE CODIFICATION THINGS WE WORKED ON LAST YEAR. THAT ONE IS ENTIRELY TECHNICAL IN NATURE. IT CAME FROM OUR NONPARTISAN RESEARCH STAFF. IT CLEANS UP TECHNICAL CORRECTIONS AND CROSS-REFERENCES. THE OTHER POINT I WANT TO TO TOUCH HIM BRIEFLY TODAY IS THE DISABILITY WAIVER RATE SYSTEM BECAUSE WE ARE ABLE TO FIND A MAJOR REFORMS WITHOUT. YOU KNOW THAT WE HAVE OVER THE YEARS BEEN MOVING AWAY FROM THE COUNTY-BASED RATESETTING SYSTEM FOR DISABILITY WAIVER RATES AND MOVING TO A STATEWIDE SYSTEM. WITHIN THAT IT TAKE SOME TIME TO GET THAT WORKING THE WAY WE WANT. WE HAVE BEEN INTRODUCING AND TRANSITIONING TO THAT THE LAST COUPLE OF YEARS. WE ARE FINDING WAYS THAT WE CAN IMPROVE ON THE SYSTEM THAT WE HAVE AN POLISH TH AT UP AS WERE DOING THAT IN THIS BILL WERE DOING CHANGES IN RATES FOR THE OVERNIGHT SLEEP STAFF; FOR THE HOUSING ACCESS COORDINATION. THE LICENSE PRACTICAL NURSE. THE DEFINITION OF A DAY;; NURSING ASSISTANT WE ARE REFORMING WITH NEW EMPLOYMENT SERVICES WITH THE ABSENT STUDIES ON WHAT A DAY IS FOR ABSENCE AND UTILIZATION AND WE ARE ALSO WORKING ON THE TRANSPORTATION ISSUE THAT WE HAVE WITHIN THE DISABILITY WAIVER RATE SYSTEM SETTING AND MAKING SURE THAT WE ARE DOING IT IN A FAIR WAY THAT IS ALSO EASIER FOR PROVIDERS OF DISABILITY SERVICES TO PROVIDE THE TRANSPORTATION THAT THEY NEED WITH THAT. ALSO; WITHIN WHAT WERE DOING WITH DISABILITY WAIVER RATE SYSTEM IS WE ARE ALLOWING FOR A 7% RATE INCREASE TO MOVE FORWARD IN THE BILL FROM WHAT WE HAD THIS LAST YEAR. THAT'S AN INFLATIONARY INCREASE THAT WE HAVE CHOSEN TO RECOGNIZE IN THIS BILL AND NOT PUSH OFF BACK ONTO THE RATES THAT WERE INCREASED A FEW YEARS AGO. SO; WITHOUT MEMBERS; I WILL YIELD TO THE SUBCOMMITTEE CHAIRMAN'S WE HAVE HERE THIS YEAR REPRESENTATIVE DEBBIE PUGH WITH THE AGING AND LONG-TERM CARE COMMUNITY. >> HOUSE SPEAKER: MEMBERS; IT'S TOO LOUD IN THE CHAMBER NEIGHBORS ARE HAVING TROUBLE HINDERED PLEASE; TAKE YOUR CONVERSATIONS AND APPARENTLY NOW YOUR PHONE CALLS INTO THE RETIRING ROOM 120 ALCOVES. PLEASE; BE RESPECTFUL FOR THOSE TRYING TO LISTEN TO THE DEBATE YOUR PLEASE TAKE YOUR CONVERSATIONS OFF THE HOUSE FLOOR. THE NEXT MORNING WON'T BE AS NICE. REPRESENTATIVE KIEL >> REPRESENTATIVE KIEL: THE SUBCOMMITTEE OF AGING AND LONG-TERM CARE WORKED ONCE AGAIN; ON AGING. AS WE ALL KNOW THAT IS BECOMING A LARGE DEMOGRAPHIC IN MINNESOTA . THE THINGS WE DID IN AGING AND LONG-TERM CARE WERE TO DEVELOP A NURSING -EXPAND THE NURSING FACILITY EDUCATION SCHOLARSHIPS THIS WILL HELP ADDRESS OUR WORKFORCE SHORTAGES ALONG WITH NURSING FACILITY STAFF TO EXPAND THE NURSE ELIGIBILITY TO RECEIVE SCHOLARSHIPS REIMBURSING STUDENT LOAN EXPENSES AND TRAIN EXPENSES. LAST SESSION; I DON'T KNOW IF YOU REMEMBER WE FUNDED SCHOLARSHIPS FOR RECENTLY HIRED OR GRADUATED RNS AND LPNS. WORKING WITHIN AT LEAST 10 HOURS IN NURSING HOMES AND WE ARE EXPANDING THAT TO MEET THE REQUIRED -MEETING THE WORK REQUIREMENTS. ADDITIONALLY; WERE INCLUDING NURSES AGREEING TO HEALTHY [INAUDIBLE] AGREEING TO PRACTICE IN HOUSING AND WITH SERVICES FOR-FOR HOME CARE PROVIDERS. ONE THING THAT I WORKED ON IN THE PAST; AND WE HAVE BROUGHT BACK WAS THE ALZHEIMER'S DISEASE WORKING GROUP. THE WORKING GROUP SUNSETS IN 2011 AND WE'VE DONE SOME RESEARCH ON THAT; AND WANT TO KEEP LOOKING AT THAT AS WE KNOW THAT IS A VERY COSTLY AND THERE'S NO RESPONSE-NO WAY TO HALT ALZHEIMER'S SO THERE'S SOME GREAT RESEARCH GOING ON AT MAYO BUT THERE'S A LOT OF COSTUME FAMILIES AND THE RESIDENCES WERE MANY OF OUR FAMILIES HAVE TO LIVE EVENTUALLY FOR THEIR SAFETY. SO WE ARE WORKING-WE WILL EXPAND THAT WORKING GROUP AND WORK ON THINGS LIKE; FINANCING LONG-TERM CARE; MAKING PUBLIC AWARE; RISK REDUCTION; AND DEMENTIA SPECIFIC TRAINING FOR CAREGIVERS. WE ALSO ADDED THE SENIOR CARE WORKFORCE INNOVATION GRANT PROGRAM WHERE WE WILL ESTABLISH A SENIOR CARE WORKFORCE INNOVATION GRANT PROGRAM; WHICH IS AIMED IN INCREASING THE POOL OF CAREGIVERS WORKING IN THE SENIOR CARE SERVICES. THE GRANTS MUST BE USED TO FUND PILOTS PROJECT PROGRAMS TO EXPAND EXISTING PROGRAMS; TO RECRUIT AND TRAIN INDIVIDUALS TO WORK IN THOSE 65; PLUS; AND RECEIVING SERVICES THROUGH THE HOME AND THREE BASED SETTING. ADULT DAY CARE; HOME CARE SERVICES; OR IN A NURSING HOME. THEN; FINALLY; HE BUILT ON THE SUCCESSES OF LAST SESSION IN 2015 WHEN WE PASS THE MOST COMPREHENSIVE NURSING HOME REFORM IN 30 YEARS. RESULTING IN BETTER QUALITY CARE FOR NURSING HOME RESIDENTS ; HIGHER WAGES FOR OUR VALUE CAREGIVERS; . THIS YEAR WE BUILT UPON THIS THROUGH FOLLOWING UP REFORMS AIMED AT PRESERVING ACCESS TO HIGH-QUALITY NURSING FACILITY SERVICES. THROUGHOUT THE STATE; PROVIDING FUNDING NECESSARY TO MEET THE WORKFORCE CHANGES. AND CHALLENGES. W E HAVE STRENGTHENED KEY AREAS IN EXISTING LAW TO PROVIDE THE APPROPRIATE FUNDING FOR NURSING HOME FACILITY COSTS. WITH THAT; MR. SPEAKER; I WILL-I BELIEVE THE SUBCOMMITTEE ON CHILDCARE; REPRESENTATIVE FRANSON >> HOUSE SPEAKER: REPRESENTATIVE FRANSON >> REPRESENTATIVE FRANSON: MEMBERS I'M VERY EXCITED TO BE SPEAKING IN FRONT OF YOU ON HOUSE FLOOR TODAY ABOUT OUR UPDATE ON CHILDCARE AND WHAT IS ACTUALLY IN THE BILL. IT WAS A COMPLETE HONOR TO CHAIR THE SUBCOMMITTEE ON CHILDCARE ACCESS AND AFFORDABILITY AND THERE IS NO GREATER JOY FOR ME THAN TO BE ABLE TO WORK ON THIS ISSUE; ESPECIALLY SINCE I HAVE THE BACKGROUND AS A FORMER LICENSED CHILDCARE PROVIDER MYSELF. FIRST; SOME THANK YOUSE ARE IN ORDER MR. SPEAKER AND MEMBERS. APPRECIATED THE BIPARTISAN WORK THE ENTIRE COMMITTEE DID TO ADDRESS TOGETHER. I BELIEVE THAT WHEN WE WERE TOGETHER THINGS GET DONE. THAT'S EXACTLY WHAT HAPPENED. I WANT TO THANK REPRESENTATIVE PETERSON AND DFL LEAD PEGGY FLANAGAN FOR THEIR LEADERSHIP AND THANKS TO THE STAFF MUUST LAURA LARSON AND CLA; KAREN LARSON AND PARTISAN RESEARCH BETHANY---AND DAVE SULLIVAN AND NONPARTISAN RESEARCHERS; SARAH SENTIMENT YOU WERE GUYS WERE COMPLETE ASSET TO THE COMMITTEE. THANK YOU VERY MUCH. I'M SUPER EXCITED ABOUT THE MANY BIPARTISAN SUPPORTED REFORMS WE HAVE IN CHAIRMAN DEANS. OUR POLICY WILL ADDRESS ACCESS AND AFFORDABILITY BY IMPROVING RELATIONSHIPS AND COMMUNICATIONS WITH THE COUNTY; DHS AND CHILDCARE PROVIDERS. ULTIMATELY; WE ARE WORKING TO REVERSE THE SHORTAGE OF FAMILY CHILD CARE PROVIDERS. THE SITUATION IS SO DIRE IT HAS BEEN CALLED A QUIET CRISIS. MORE FAMILIES PROVIDERS WILL MEAN MORE ACCESS TO CHILDCARE. THAT'S A GOOD THING. WE WORKED HARD WITH PROVIDERS TO CREATE A NEW FIX-IT TICKET FOR MINOR VIOLATIONS THAT GIVES PROVIDERS AN OPTION TO FIX ISSUES IN THE SHORT TERM WITHOUT FACING EXPENSIVE PENALTIES. EXIT INTERVIEWS WOULD ALSO BE CONDUCTED DURING THESE INSPECTIONS WHICH WILL HELP CREATE A MORE COLLABORATIVE RELATIONSHIP BETWEEN LICENSORS AND PROVIDERS. WE HOLD DHS ACCOUNTABLE IN MANY WAYS AS WELL. HE REQUIRED THE DEPARTMENT TO COMMUNICATE THE ELECTRONIC NEEDS WITH LICENSE HOLDING CHILDCARE PROVIDERS ABOUT CHANGES TO STATUTE FEDERAL LAW RULES; REGULATIONS AND POLICY. SO THERE AREN'T ANY SURPRISES DURING LICENSING VISITS. DHS ALSO MUST KEEP US INFORMED ABOUT THEIR EFFORTS TO REMEDY ISSUES AND WE'VE HEARD OVER THE LAST YEAR RELATED TO ENFORCEMENT TRAINING AND PAPERWORK. CHILDCARE PROVIDERS ALSO HAD CORRECTION ORDERS RETURNED BY APPEAL WOULD NOW BE ABLE TO REMOVE THE ORDER FROM PUBLIC POSTING. THESE ORDERS ARE REQUIRED TO BE POSTED FOR TWO YEARS; EVEN IF THEY ARE OVERTURNED. PROVIDERS WORK HARD TO CARE FOR CHILDREN FEEL THE POSTINGS ARE A SCARLET LETTER THAT NEGATIVELY AFFECT THEIR BUSINESSES WE FIX THAT IN THIS BILL. THAT IS AWESOME. WE CLARIFY LANGUAGE ABOUT ANNUAL TRAINING REQUIREMENTS ; PROHIBIT QUOTAS FOR CORRECTION ORDERS; REQUIRED DHS TO WORK WITH DIVIDERS ABOUT HOW THEIR INFORMATION IS POSTED ONLINE; STRENGTH AND INTEGRITY IN CCAP TO ROOT OUT FRAUD AND ABUSE SO FAMILIES THAT NEED ASSISTANCE ARE GETTING IT. AND REFORM AND INVEST IN THE CHILDCARE BASIC SLIDING FEE PROGRAM TO MAKE SURE HUNDREDS OF MORE CHILDREN STATEWIDE RECEIVE CARE JUST TO NAME A FEW ADDITIONAL PROVISIONS. MEMBERS; I LOOK FORWARD TO YOUR GREEN VOTE. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: I WOULD ASK THAT REPRESENTATIVE BAKER GO THROUGH THE OPIOID ARTICLE IN HIS BILL. >> HOUSE SPEAKER: REPRESENTATIVE BAKER >> REPRESENTATIVE BAKER: I WANT TO ALSO THANK THE COMMITTEE FOR A LOT OF HOURS; A LOT OF TIME TALK ABOUT A LOT -MANY ISSUES BUT OUR QUARTERBACK CHAIRMAN MATT DEAN; PUT IN SOME GOOD THINGS HERE IN THIS BILL TO GET OUR DISCUSSION ON OPIOIDS AND WHAT WE CAN DO LEGISLATIVELY TO GET THE CONVERSATION MOVING IN THE RIGHT DIRECTION. I WOULD JUST TALK BRIEFLY ABOUT SOME OF THESE. MEDICALLY ASSISTED TREATMENT; THINGS LIKE SUBOXONE AND METHADONE ARE THINGS YOU MIGHT'VE HEARD OF CURRENTLY BEING USED. WE EXTEND THAT A BIT TO DRUG CALLED THE TRAWL THAT THEY ONCE A MONTH INJECTION FROM YOUR DOCTOR THAT PLACES A RECEPTOR ON YOUR BRAIN THE KIND OF BLOCKS THAT FEELING OF EUPHORIA WHEN FOLKS ARE STRUGGLING WITH ADDICTION AND I THINK THAT'S CAN BE A GREAT EXPANSION OF OUR USE FOR HELPING FOLKS GET SOBER. WE ALSO TALKED ABOUT CHANGING THE COMPONENT OF HOW DO WE ASSESS PAIN. DRS.; YOU MIGHT HAVE HEARD; GET PAID BETTER IF THEY TAKE AWAY PAIN AND I THINK THAT'S A PROBLEM; MEMBERS; WHEN WE ARE ENCOURAGING THEM IN A WAY THAT MIGHT BE A LITTLE BIT OVERREACHING BECAUSE WE DON'T WANT TO REWARD FOR PRESCRIBING MORE PILLS. I THINK THAT HAVING THIS ASSESSMENT OF PAIN IN A SURVEY REMOVED IS A GOOD STARTING POINT TO THE DOCTORS AND CLINICS AND FOLKS TRULY TRYING TO HELP OUR PATIENTS BY TAKING THE QUESTION OFF THERE IS A GOOD STARTING POINT I WANT TO THANK THE TEAM FOR ALLOWING US TO HAVE DENTISTS LIMIT THEIR PRESCRIPTIONS OF OPIOIDS TO FOUR DAYS. HOW MANY TIMES HAVE YOU HEARD; I'VE CARRIED 30 DAYS OR 30 PILLS; PLUS; OUT OF A DENTIST OFFICE WHEN I GOT A WISDOM TEETH PULLED. THAT HAPPENS ALL THE TIME. THE MINNESOTA DENTAL ASSOCIATION SUPPORTS THIS FOUR-DAY LIMIT BECAUSE THEY KNOW THAT LAST YEAR ALONE IN 2016 OVER LAST YEAR ALONE IN 2000 16/100;000;000 PRESCRIPTION PILLS WERE NEVER EVEN USED AFTER A TOOTH EXTRACTION. SO ARE FILLING UP OUR MEDICINE CABINETS; FOLKS; WITH TOO MANY PILLS. WE ALSO HAVE A STICKER WE WANT TO PUT ON YOUR BOTTLE OF AN OPIOID; WHEN YOU GO TO THE PHARMACY YOU OPEN IT UP WE WENT TO A RED STICKER ON THEIR JUST REMIND YOU EVERY SINGLE TIME SOMEBODY OPENS IT UP; HEY; THIS IS VERY ADDICTIVE. VERY SIMPLE; WHO WANT TO REMIND PEOPLE BECAUSE EDUCATION IS WHERE THIS IS GOING TO GET HANDLED PROPERLY I ALSO WANT TO THANK DHS WORKING WITH US ON CHANGING THE WAY WE LOOK AT CHEMICAL DEPENDENCY AND OUR WAY WERE GOING TO REFORM HOW WE PAY FOLKS IN THE FUTURE I'M VERY VERY GRATEFUL WE GOT SOME DOLLARS IN HERE TO HELP OUR TREATMENT FACILITIES PAY THE BILLS. BECAUSE OUR ROOMS AND OUR WALLS ARE BUSTLING AT THE SEAMS AND TREATMENT CENTERS. THEY NEED THE RESOURCES; AND THIS INCREASE WILL HELP THEM DRAMATICALLY. SO FINALLY I WANT TO SAY REPRESENTATIVE KRESHA HAS A VERY GOOD BILL THAT I WHOLEHEARTEDLY SUPPORTED WITH A GRANT OPPORTUNITY FOR FOLKS LIKE IN HIS COUNTY; MORRISON COUNTY; LITTLE FALLS; TERRIFIC WORK ON EDUCATING CLINICS AROUND MINNESOTA AND THEY HAVE A PROGRAM OF TAPERING FOLKS IN FULL-BLOWN ADDICTION; BACK OFF SO THEY CAN ACTUALLY HAVE A MUCH BETTER LIFE AND QUALITY THEREFORE AFTER SO WE WILL TALK SOME MORE . WE'VE GOT SOME AMENDMENTS AS WELL BUT I WANT TO THANK THE COMMITTEE GOOD IT'S BEEN AN HONOR TO SERVE ON HHS REFORM COMMITTEE AND WITH THAT; MEMBERS I WILL PASS IT BACK TO OUR QUARTERBACK. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: I WAS WONDERING IF REPRESENTATIVE BACKER MIGHT YIELD AND DISCUSS A LITTLE BIT ABOUT EMERGENCY RESPONDERS AND TRANSPORTATION >> HOUSE SPEAKER: REPRESENTATIVE BACKER >> REPRESENTATIVE BACKER: SPEAKERS AND MEMBERS THIS BILL HAS A LOT OF GOOD THINGS HELPING WITH EMS NOT JUST IN RURAL MINNESOTA WHERE I'M FROM BUT IN THE METRO AREA. FIRST OF ALL; WE PUT TOGETHER $200;000FOR THE COWS PROGRAM WHICH PROVIDES TRAUMA SKILLS; TRAINING FOR PARAMEDICS EMT AND FIRST RESPONDERS. SO ACROSS THE STATE. WE FULLY FUND THE COOPER SAMS AMBULANCE VOLUNTEER WORDS AND RETENTION PROGRAM TO A TUNEUP $2.6 MILLION WHAT THAT MEANS FOR US HERE IN THE HOUSE IS THAT WHEN ONE OF YOUR CONSTITUENTS DIALED 911 IT HELPS US GET IT OUT OF THE GARAGE BECAUSE WE HAVE THE STAFF; VOLUNTEERS AND SO FORTH. WE ALSO HAD NEW FUNDING FOR NEARLY $220;000 TO THE VOLUNTEER AMBULANCE TRAINING FUNDING IN RURAL MINNESOTA AS MANY OF YOU KNOW I AM AN EMT BUT I VOLUNTEER AND ACTUALLY WHEN I GET BACK LATE TONIGHT OR TOMORROW MORNING; I TAKE CALL AND I'M ON CALL NEXT WEEK BECAUSE M Y OTHER MEMBERS OF MY SERVICE HELP ME OUT LIKE TODAY WHEN I'M NORMALLY ON CALL ON FRIDAYS. SO VERY IMPORTANT FOR OUR SMALL SERVICES. WE ALSO INCREASE REGIONAL FUNDING FOR ALL REGION EMS PROGRAMS TO THE TUNE OF $50;000 FOR MEMBERS WHO ARE NOT FAMILIAR WE HAVE EIGHT REGIONAL PROGRAMS IN THE STATE GEOGRAPHICALLY SO THAT'S $400;000. WE ALSO INCREASE FUNDING TO THE STATE EMS BOARD IT REQUEST FOR $212;000 WHY IS THAT IMPORTANT? WE HAVE TO GET EVERY TWO YEARS TRAINING. WE HAVE 24 HOURS OF REGULAR TRAINING AND THEN ADDITIONAL 20 HOURS. AS WE HAVE 44 HOURS EVERY TWO YEARS TO KEEP OUR CERTIFICATES. NOW WE ARE ABLE TO DO IT ONLINE SHOULD MAKE IT EASIER SO WE CAN GET MORE VOLUNTEERS. WE FUND $800;000 TO THE STATE EMS REGULATORY BOARD TO ASSIST AMBULANCE SERVICES. WE ALSO FUND AMBULANCE INTERGOVERNMENTAL TRANSFERS OF COST AT $60;000 A YEAR TO ALL 103 GOVERNMENT OPERATED AMBULANCES TO [INAUDIBLE] MEDICAID DOLLARS COULD I SERVE ON ONE OF THOSE GOVERNMENT RUN FOR THE CITY OF BROWN'S ALLEY IN WHICH WE SERVICE TO STATES; THREE COUNTIES; AND ANOTHER NATION WE SERVE A TRIBAL NATION WHERE I AM AT. THEN; FINALLY; WE SUPPORT TO FIX-SUPPORT TO FIX THE COMMUNITY EMT LEGISLATIVE PART TO ALLOW THAT GOOD PROGRAM TO FOLLOW. THAT'S REALLY USE MORE SO IN THE METRO AND SUBURBAN AREA. I WILL YIELD IT BACK TO THE REPRESENTATIVE FROM WASHINGTON. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: JUST BEFORE WE GO TO THE AMENDMENTS; I WANT TO THANK PARTICULARLY; THE DEMOCRATS ON THE COMMITTEE ; PARTICULARLY; REPRESENTATIVE ERIN MURPHY. AND FOR ALL THE WORK ON THE COMMITTEE AND FOR HELPING WITH THE BILL TOGETHER FOR OVER THE COURSE OF THE LAST COUPLE OF MONTHS AND IN THE WEEKS AHEAD. WE LOOK FORWARD TO IT COULD ALSO LOOK FORWARD TO CONTINUING TO WORK WITH DHS AND HEALTH AND ALL THE GREAT STAFF THEY HAVE THERE. IN WORKING TOGETHER WITH THE GOVERNOR'S OFFICE TO TRY TO GET A BILL HE CAN SIGN. LASTLY; JUST WANT TO SAY THANK YOU TO ALL THE DIRECT CARE WORKERS IN THE STATE WHO HANG IN THERE YEAR AFTER YEAR AND WORK TO PROVIDE CARE ; THE BEST CARE IN THE WORLD TO THE MINNESOTANS IN THE MOST NEED TO WITH THAT ; MR. SPEAKER I THINK WILL MOVE TO AMENDMENTS. >> HOUSE SPEAKER: REPRESENTATIVE GRUENHAGEN OFFERS THE FOLLOWING MMM. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: TRENT HAGAN MOVES TO AMEND THE BILL AND THE AMENDMENT IS CODED A- 10 >> HOUSE SPEAKER: REPRESENTATIVE TRENT HAGAN >> REPRESENTATIVE TRENT HAGAN; THIS AMENDMENT DOES IT ADDRESSES A SPECIAL ENROLLMENT PERIOD ON A LAW CALLED THE 21ST CENTURY CURES ACCURATE WAS SIGNED INTO LAW BY PRES. OBAMA IN IN DECEMBER 2016. WHAT THE ACT DOES; IT ALLOWS SMALL EMPLOYERS; 50 EMPLOYEES OR LESS TO SET UP A HEALTH REIMBURSEMENT ACCOUNT ON A TAX-DEDUCTIBLE BASIS WHERE SMALL EMPLOYER THAT DOES NOT OFFER GROUP INSURANCE TO THEIR EMPLOYEES CAN CONTRIBUTE UP TO $4950 PER YEAR TAX-DEDUCTIBLE FOR AN INDIVIDUAL OR $10;000 FOR A FAMILY. INDIVIDUALS AND FAMILIES CAN USE THAT MONEY TO HELP THEM PURCHASE INDIVIDUAL HEALTH INSURANCE EITHER THROUGH MNSURE OR OUTSIDE THE MNSURE. ALSO; IN THE FEDERAL ACT WAS A PROVISION THAT STATES COULD CREATE A SPECIAL ENROLLMENT PERIOD BECAUSE THE ENROLLMENT PERIOD TO DO THIS FOR A SMALL GROUP WAS ONLY FOR ABOUT 2-3 MONTHS AND STATES COULD EXPAND THAT TO YEAR-ROUND SO SMALL EMPLOYERS COULD ACTUALLY PROVIDE A BENEFIT TO HELP PEOPLE OBTAIN HEALTH INSURANCE. AND PAY FOR OUT-OF-POCKET MEDICAL EXPENSES. SO WITH THIS AMENDMENT DOES; IT ALLOWS THAT SPECIAL ENROLLMENT PERIOD FOR THIS PROVISION TO BE ENACTED BY SMALLER EMPLOYER AND WE ALREADY HAVE A NUMBER OF SPECIAL ENROLLMENT PERIOD EVENTS SUCH AS WHERE YOU CAN ENROLL IN HEALTH INSURANCE FOR HAVING A BABY; GETTING MARRIED; LOSING HER JOB; MOVING INTO A DIFFERENT AREA. SO THIS WOULD SIMPLY ADD THIS ADDITIONAL SPECIAL ENROLLMENT PERIOD TO THE ONES WE CURRENTLY HAVE IN THE STATE. WITH THAT-THIS SHOULD HELP PEOPLE AFFORD INDIVIDUAL HEALTH INSURANCE AND WE KNOW THAT THE INDIVIDUAL HEALTH INSURANCE MARKET IS IN TROUBLE IN TERMS OF PARTICIPATION. THIS WOULD BE A SMALL STEP IN THAT DIRECTION MEMBERS; URGE YOUR SUPPORT. THANK YOU. >> HOUSE SPEAKER: DISCUSSION ON THE A- 10 AMENDMENT? REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: THANK YOU REPRESENTATIVE TRENT HAGAN FOR YOUR AMENDMENT AS I DID A LITTLE CHECKING I WANT TO LET THE MEMBERS KNOW I DON'T KNOW WE HAVE THE AUTHORITY TO DO THIS I THINK THE HEALTH PLAN IS A RAISED A NUMBER OF QUESTIONS. I THINK THE ISSUE NEED SOME WORK BETTING AND WOULD ASK MEMBERS TO VOTE; NO. >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: I AGREE WITH REPRESENTATIVE MURPHY BUT I RISE TO JUST POINT OUT ONE THING. THAT IS; THAT IF WE GO TO THE FEDERAL EXCHANGE; AS THE BILL BEFORE YOU; MEMBERS; GETS RID OF MNSURE AND SENDS IT MINNESOTANS TO THE FEDERAL EXCHANGE INSTEAD AND WE WERE WE TO DO THAT WE WOULD NOT BE ABLE TO DO SOMETHING LIKE WHAT REPRESENTATIVE GRUENHAGEN IS TRYING TO HAVE DONE HERE. SO WE COULD ONLY POSSIBLY DO THIS BECAUSE WE HAVE OUR OWN MINNESOTA BASED HEALTH INSURANCE EXCHANGE. SO I ECHO REPRESENTATIVE MURPHY SAYING THERE'S A LOT OF PROBLEMS. IT'S NOT A BAD IDEA. THERE'S A LOT OF PROBLEMS WITH THE LANGUAGE ; BUT I WOULD URGE MEMBERS TO VOTE NO. >> HOUSE SPEAKER: ANY FURTHER DISCUSSION? REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: REPRESENTATIVE DEBBIE THANK YOU FOR REMINDING ME WE ARE GOING TO KILL THE MNSURE IN THE BILL TO I FORGOT. I APPRECIATE THAT. ALSO REPRESENTATIVE GRUENHAGEN'S BILL WOULD BE ABLE TO IN FACT WOULD BE ABLE TO -WOULD BE ABLE TO YOU REALIZE AND AUTHORIZE BEYOND THAT. SO I WOULD SUPPORT REPRESENTATIVE GRUENHAGEN'S AMENDMENT AND ASK FOR A ROLL CALL >> HOUSE SPEAKER: ROLL CALL HAVING BEEN REQUESTED; SEEING FIFTEEN HANDS THERE WILL BE A ROLL CALL. FURTHER DISCUSSION ON THE A- 10 AMENDMENT? REPRESENTATIVE GRUENHAGEN TO YOUR AMENDMENT >> REPRESENTATIVE GRUENHAGEN JUST A QUICK RESPONSE. THE ACA DELL ALLOW FOR EXCEPTIONAL CIRCUMSTANCES PROVISION TO BE ENACTED BY STATES. AGAIN; MEMBERS AT THIS WOULD APPLY TO INDIVIDUAL HEALTH INSURANCE INSIDE OR OUTSIDE OF MNSURE BUT I DO BELIEVE IT WOULD WORK EVEN IF WE MOVED TO THE FEDERAL EXCHANGE; AND AGAIN; THE BILL SIGNED BY PRES. OBAMA ALLOWS STATES TO SET THAT SPECIAL ENROLLMENT PERIOD. THANK YOU. >> HOUSE SPEAKER: ANY FURTHER DISCUSSION? REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: WOULD REPRESENTATIVE GRUENHAGEN YIELD TO A QUESTION? REPRESENTATIVE GRUENHAGEN; AS I WAS READING THE AMENDMENT; I THOUGHT THIS WAS KILLING THE MNSURE BOARD TO EXTEND OPEN ENROLLMENTS. IS THAT; IN FACT WITH THE AMENDMENT IS DOING? >> REPRESENTATIVE GRUENHAGEN: YES; THAT'S WHAT IT'S DOING TO DURING THE EXCEPTIONAL CIRCUMSTANCES THAT THE FEDERAL CODE ALLOWS US TO MAKE THIS CHANGE. THE BOARD OF MNSURE. WHICH; AGAIN; IS WHAT WE HAVE IN PLACE RIGHT NOW. >> REPRESENTATIVE LIEBLING: THANK YOU REPRESENTATIVE GRUENHAGEN. THEN IT DOESN'T WORK BECAUSE THE BOARD OF MNSURE CAN'T EXTEND OPEN ENROLLMENT . SORRY; I KNOW YOU WERE DISTRACTED THERE BUT IT DOESN'T WORK BECAUSE THE BOARD OF MNSURE DOESN'T HAVE AUTHORITY TO EXTEND OPEN ENROLLMENT OUTSIDE OF ITS OWN -JUST ON THE EXCHANGE. SO THAT DOESN'T WORK. I SEE REPRESENTATIVE TRENT HAGAN IS GONNA WANT THE FLOOR AGAIN TO EXPLAIN SOMETHING; BUT MEMBERS; I THINK SINCE WE GOT A ROLL CALL ON THIS I WAS A MEMBERS CAN COMFORTABLY VOTE YES ON THIS BECAUSE THIS IS EVEN THOUGH THE LANGUAGE IS NOT REALLY WORKABLE I SUPPOSE IT CAN BE FIXED IN CONFERENCE ; BUT THIS IS SOMETHING THAT RECOGNIZES HOW IMPORTANT IT IS WE HAVE OUR OWN STATE-BASED EXCHANGE; AND SO; I WOULD THEN SAY MEMBERS SHOULD VOTE YES ON THE AMENDMENT. VOTE; GREEN. >> HOUSE SPEAKER: REPRESENTATIVE GRUENHAGEN >> REPRESENTATIVE GRUENHAGEN: JUST ONE MORE CLARIFICATION YES; THIS DOESN'T EXPAND OPEN ENROLLMENTS CAN IT SIMPLY CREATES A SPECIAL ENROLLMENT PERIOD WHERE THE EMPLOYER CAN SET UP THESE TYPES OF PLANS. THESE HRA'S; SO THE EMPLOYEES CAN BENEFIT DURING THE OPEN ENROLLMENT PERIOD FROM TAX-DEDUCTIBLE MONEY CONTRIBUTIVE BY THE EMPLOYER TO HELP THEM AFFORD THE HEALTH INSURANCE PREMIUMS AND OUT-OF-POCKET MEDICAL EXPENSES. WITH THAT; MEMBERS I APPRECIATE A YES VOTE. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: I WILL WITHDRAW THE ROLL CALL >> HOUSE SPEAKER: REPRESENTATIVE DEAN WITHDRAWS THE REQUEST FOR A ROLL CALL. ANY DISCUSSION? SEEING NONE; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: REPRESENTATIVE MURPHY'S OFFERS THE FOLLOWING AMENDMENT. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: MURPHY MOVED TO AMEND SENATE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENDMENT IS CODED A- 11 >> HOUSE SPEAKER: REPRESENTATIVE MURPHY TO INTRODUCE YOUR AMENDMENT >> REPRESENTATIVE MURPHY: I WANT TO THANK REPRESENTATIVE DEAN; AND THE MEMBERS OF THE COMMITTEE BOTH POLICY AND FINANCE. DEMOCRATS AND REPUBLICANS. IT'S BEEN A NICE TERM TOGETHER DOING SOME REALLY GOOD WORK. BEFORE I GO TO THE AMENDMENT; I DO WANT TO SAY THAT THE BILL TODAY ABSOLUTELY REPRESENTS CHOICES FOR THE STATE OF MINNESOTA. GRATEFULLY; WE HAVE A STABLE BALANCED BUDGET WE TALK A LOT ABOUT THAT SURPLUS BUT WERE GOING TO NEED THOSE SURPLUSES STABLY BALANCE BUDGET AND THAT'S A REAL GIFT THAT'S THE RESULT OF A LOT OF HARD WORK BY A LOT OF PEOPLE AND IT GIVES US AN OPPORTUNITY TO LOOK AHEAD AND I THINK UNFORTUNATELY; THIS BUDGET DOESN'T DO MUCH OF THAT LOOKING AT A BARELY TAKES A GLANCE AT THE FUTURE. THAT'S UNFORTUNATE. WE ARE MAKING CHOICES IN THIS LEGISLATURE. A COU PLE OF THEM. ONE; WE TALKED A LOT ABOUT A LOT WHICH IS $1.3 BILLION IN TAX CUTS WE ALREADY MOVED THAT BILL OFF THE FLOOR. AND WE'VE ALREADY SPENT $800 MILLION IN REINSURANCE ON THE INSURANCE SUBSIDIES BECAUSE OF THAT SPEAKER DOUDT HAS GIVEN OUR COMMITTEE A $600 MILLION CUT TARGET. PEOPLE ARE GETTING [INAUDIBLE] ESPECIALLY PEOPLE WHO DO THE WORK ACROSS THE STATE OF MINNESOTA CARING FOR PEOPLE WHO ARE VULNERABLE I WILL MAKE SURE TALK ABOUT THAT TODAY. SO REPRESENTATIVE DEAN; I THINK YOU DID A DECENT JOB WITH A STINKY TARGET AND I'M GRATEFUL ABOUT THAT THI S AMENDMENT HAS TO DO WITH MAKING SURE THAT WE ARE LOOKING AT ALL SORTS OF FACTORS IF ORGAN A LOOK AT QUALITY AND QUALITY MEASUREMENT AND COMMENDING THE ALBRIGHT BUILT IN A WAY TO MAKE SURE IF WE TALK ABOUT MEASURING OUTCOMES AND SELECTING DATA WERE ALSO LOOKING AT NURSES; BOTH REGISTERED NURSES AND LICENSED PRACTICAL NURSES. AS A PART OF THE TEAM OF CAREGIVERS IN A PART OF THE OUTCOMES OF QUALITY; AND THAT AMENDMENT . MR. SPEAKER I'M WONDERING THEN IF WE COULD MOVE TO MY SECOND AMENDMENT THE A- 14? >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: ECHLIN MOVES TO AMEND THE MURPHY AMENDMENT THE UNOFFICIAL ENGROSSMENT AND THE AMENDMENT TO THE MM IT IS CODED A- 39. >> HOUSE SPEAKER: I RECOGNIZE REPRESENTATIVE ECHLIN; TO INTRODUCE YOUR AMENDMENT >> REPRESENTATIVE ECHLIN: THIS IS A SIMPLE CHANGE TO OUT HELP OUT COOK HOSPITAL IN GREATER MINNESOTA. CURRENTLY; THEIR LEVEE DOLLARS CAN ONLY GO TOWARDS EQUIPMENT AND SO THEY'RE ASKING THE CHANGE TO BE ABLE TO USE A LOT A LITTLE BIT OF THEIR LEVEE DOLLARS TO TRAIN PARAMEDICS. THEY COULD HAVE QUITE A DISTANCE TO GO TO GO TO THE COMMUNITY COLLEGES TO GET PARAMEDIC TRAINING SO THAT'S WHY I'M ASKING FOR THIS MR. SPEAKER. >> HOUSE SPEAKER: DISCUSSION ON THE A- 39 EKLUND AMENDMENT? SEEING NONE; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT TO THE AMENDMENT IS ADOPTED >> [GAVEL] >> HOUSE SPEAKER: ZERWAS OFFERS THE FOLLOWING AMENDMENT TO THE AMENDMENT. >> CHIEF CLERK: ALBRIGHT MOVED TO AMEND THE MURPHY AMENDMENT TO SENATE FILE 800 ; UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENDMENT TO THE AMENDMENT IS CODED A- 38 >> HOUSE SPEAKER: I RECOGNIZE BE ONE ALBRIGHT; TO YOUR AMENDMENT >> REPRESENTATIVE ALL BREAK ON GOOD MORNING AGAIN MEMBERS OR THE AMENDMENT BEFORE YOU GOE S A LITTLE BIT FURTHER IN TERMS OF DATA COLLECTION IF WERE GOING TO MAKE GOOD DECISIONS ABOUT THE DATA IN FRONT OF US I THINK IT'S INCUMBENT UPON US TO HAVE AS MUCH INFORMATION AS POSSIBLE. SO THIS AMENDMENT SIMPLY EXTENDS THE REACH IN OR THE NET IF YOU WILL; IN TERMS OF THE COLLECTION OF DATA THAT WE CAN PROVIDE OURSELVES WITH IN ORDER TO MAKE THE BEST DECISIONS POSSIBLE AS WE MOVE FORWARD. WITH THAT I THINK YOU MR. SPEAKER. >> HOUSE SPEAKER: DISCUSSION ON THE A- 38 AMENDMENT? REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: THANK YOU REPRESENTATIVE ALBRIGHT I KNOW WERE AMENDING PART OF THE BILL THAT IS YOURS. I WILL TELL YOU THAT THE THING I DON'T LIKE ABOUT YOUR AMENDMENT IS THAT IT NARROWS A LITTLE BIT THE MM AND I'M OFFERING. I WILL ALSO TELL YOU; THAT NURSES ACROSS THE STATE OF MINNESOTA ARE VERY CONCERNED ABOUT WHAT HAPPENS TO THE STAFFING IN THE HOSPITAL WHEN I GO ON STRIKE WHEN REPLACEMENT NURSES COME FROM OTHER PARTS OF THE COUNTRY TO STAFF OUR HOSPITALS. THE NURSES ON THE PICKET LINE WILL TELL YOU THEY'RE VERY CONCERNED ABOUT THE OUTCOMES FOR THE PATIENTS. INSIDE THE HOSPITAL DURING THAT TIME. SO FOR THAT REASON I WILL SUPPORT YOUR AMENDMENT. I THINK IT'S IMPORTANT TO HAVE THIS INFORMATION. I THINK IT'S IMPORTANT TO COLLECT THE INFORMATION AND TO UNDERSTAND WHAT HAPPENS WHEN WE IMPORT NURSES FROM OTHER PARTS OF THE COUNTRY TO CARE FOR MINNESOTANS DURING A LABOR DISPUTE >> HOUSE SPEAKER: ANY FURTHER DISCUSSION ON THE A- 38 AMENDMENT? SEEING NONE; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: REPRESENTATIVE MURPHY OFFERS THE FOLLOWING AMENDMENT. >> CHIEF CLERK: MURPHY MOVES TO AMEND HER AMENDMENT SENATE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENDMENT TO THE AMENDMENT IS CODED A- 14 >> HOUSE SPEAKER: I RECOGNIZE BE ONE MURPHY; TO YOUR AMENDMENT >> REPRESENTATIVE MURPHY: THIS AMENDMENT HAS TO DO WITH THE PROFESSIONAL WORK OF REGISTERED NURSES AND THEIR ABILITY AND AUTHORITY TO MAKE SURE THAT THE PATIENTS IN THEIR CARE ARE GETTING ADEQUATE AND SAFE CARE IN A HOSPITAL. WE HAVE HAD AN UNFULFILLING DEBATE OVER THE LAST NUMBER OF YEARS HERE IN THE LEGISLATURE ABOUT HOW WE PROPERLY STAFF OUR HOSPITALS. THE NURSES CONTINUE TO EXPRESS THEIR CONCERN THAT THERE'S AN INADEQUATE STUFFING THAT ARE OFTEN FACING INADEQUATE STAFFING AND WHILE WE'VE HAD HEARINGS ABOUT THAT; THEY'VE ALWAYS BEEN INFORMATIONAL; AND WE HAVE NOT REALLY DONE THE WORK OF RESPONDING TO THEIR CONTINUED CONCERNS IN OUR HOSPITALS WILL ALSO SAY THAT IS A CHIEF CONCERN OF THEIRS TO MAKE SURE THAT THE PATIENTS INSIDE THE WALLS OF THEIR HOSPITAL ARE GETTING ADEQUATE AND EXCELLENT CARE. IN THIS CASE; AND THE NURSES IN THE HOSPITAL SEEM SOMETIMES TO BE OPPOSING ONE ANOTHER IN THE SOLUTION. WHEN WE TALK ABOUT STAFFING RATIOS. BACK IN 2001; THERE WAS A LABOR DISPUTE HERE IN MINNESOTA AND THE RESULT OF THAT WAS GIVING THE NURSES INSERT HOSPITALS THE AUTHORITY TO TEMPORARILY CLOSE A UNIT WHEN THEY BELIEVE THERE ARE TOO MANY PATIENTS IN THEIR CARE TO DO THE WORK SAFELY. THIS IS NOW DONE IN AT LEAST 11 HOSPITALS IN THE STATE OF MINNESOTA. IT'S RARELY USED; BUT IT'S A STOPGAP IT'S A WAY FOR THE NURSES TO SAY; PAUSE IT'S A WAY FOR THE NURSES TO ARTICULATE THEIR PROFESSIONAL AUTHORITY THAT IN THEIR JUDGMENT; THERE ARE TOO MANY PATIENTS BEING CARED FOR AND THE RESULT IS A LACK OF SAFETY. IT PUTS THE DECISION I N THE HANDS OF THE PROFESSIONALS DOING THE WORK. I WANT TO TELL YOU JUST A VERY BRIEF STORY ABOUT MY EARLY PRACTICE AND EXAMPLE ; WHERE THIS POLICY WOULD HAVE BEEN HELPFUL. MY FIRST JOB WAS IN MARSHFIELD WISCONSIN. IT'S A BIG HOSPITAL IN A VERY RURAL COMMUNITY. I WORKED OVERNIGHT LIKE LOTS OF NURSES DO? I TOOK CARE OF PATIENTS AT A 50 BED UNIT PATIENTS WITH MEDICAL CONDITIONS LIKE DIABETES AND HEART FAILURE AND KIDNEY FAILURE AND LIVER FAILURE AND I WAS ASSIGNED ONE NIGHT WITH ONE OF THE REGISTERED NURSE ON AT 50 BED UNIT IN A COUPLE OF NURSING ASSISTANT WE STARTED THE NIGHT UNDERSTAFFED. ON THAT NIGHT; I HAD A PATIENT HAVE A CARDIAC ARREST. IT WAS THE FIRST TIME THAT HAPPENED TO ME IT WAS A MEMORABLE EXPERIENCE BECAUSE I WAS IN THE ROOM WITH A GENTLEMAN WHEN HE ARRESTED AND I WAS THE ONE WHO IS FIRST THERE TO RESUSCITATE HIM. WHEN YOU CALL A CODE IN A HOSPITAL A TEAM COMES TO CARE FOR THAT PATIENT BUT YOU HAVE TO STAY WITH THE PATIENT AS WHAT THEY ARE YOUR OBLIGATION THEY ARE YOUR ASSIGNMENT; YOUR RESPONSIBILITY ON THAT NIGHT; I ALSO HAD A PERSON OBLIQUELY BEEN DISCHARGED FROM THE INTENSIVE CARE UNIT HE WAS NEWLY EXCAVAT ED HE HAD A TUBE BREATHING TUBE IN HIS THROAT AND HE HAD THAT FOR SOME TIME THEY JUST REMOVE THAT BREATHING TUBE. THEY DISCHARGE HIM FROM THE INTENSIVE CARE UNIT RATE YOU USUALLY HAVE ONE; OR TO PATIENT SO WHEN YOU'RE IN THE INTENSIVE CARE YOU'RE GETTING A LOT OF ATTENTION FROM YOUR NURSE BECAUSE THERE'S ONLY JUST A COUPLE OF PEOPLE THAT YOU'RE CARING FOR. HE WAS TRANSFERRED FROM THERE TO A UNIT WHERE HE HAD ME AND ONE OTHER REGISTERED NURSE WE HAD LOTS AND LOTS OF PATIENTS. HE WAS AFRAID HE WAS AFRAID BECAUSE IT WAS THE FIRST TIME THAT HE WAS ON HIS OWN OVERNIGHT AND HE WAS AFRAID HE COULD NOT BREATHE. AND I HAD A PATIENT THAT NIGHT WHO HAD A G.I. BLEED. WHICH MEANS HE WAS BLEEDING FROM HER BOTTOM. WE NEEDED TO GET HER INTO SURGERY AND WE NEED TO GET THE SURGEONS TO COME. TO DO THAT WORK. I HAD THOSE THREE PATIENTS ALONG WITH OTHER PATIENTS IN ONE NIGHT. I WORKED IN A RURAL COMMUNITY WE COULD NOT GET EXTRAS STAFFING TO COME IN. IT TOOK HOURS FOR US TO GET EXTRA STAFFING TO COME IN. WE WERE BEYOND OUR LIMIT AT THAT POINT AND IF WE HAD TO OF HAD-IF WE HAD HAD TO ACCEPT ADMISSION THAT NIGHT; IT WOULD NOT HAVE BEEN SAFE. I WOULD HAVE LIKED TO BE AUTHORITY; TO SAY; NO. I DON'T HAVE THAT AUTHORITY WORKED OUR TAILS OFF THAT I WAS A PRETTY NEW NURSE IT WAS PRETTY SCARY AND IF WE LISTEN TO NURSES AND THOSE OF US WHO ARE SERVING ON THE HEALTH AND HUMAN SERVICES COMMITTEE HAVE HEARD THE STORIES. WE ALL KNOW THAT WE HAVE OUR DAYS AT WORK THAT WE DO ; TOO; HERE. WHEN THE NURSES ARE SAYING; THERE ARE TOO MANY EXAMPLES IN WHICH THE STAFFING IS SUCH THAT WE ARE NOT CARING FOR MINNESOTANS WE NEED TO LISTEN TO THAT. WE HAVE NOT BEEN ABLE TO COME TOGETHER AROUND THE IDEA OF A RATIO. WE HAVE NOT BEEN ABLE TO COME TO A CONSENSUS ABOUT THAT. HERE IN THE LEGISLATURE OUTSIDE OF MINNESOTA. THIS IS ANOTHER WAY TO TACKLE THE PROBLEM AND IT'S ALREADY PROVEN IT'S ALREADY WORKING IN A NUMBER OF OUR HOSPITALS . IT DOESN'T MEAN WE CLOSE THE EMERGENCY DEPARTMENT. IT DOESN'T MEAN WE CLOSE LABOR AND DELIVERY; BUT IT DOES GIVE THE PROFESSIONAL REGISTERED NURSES THE AUTHORITY TO SAY; HOLD ON. PAUSE. LET'S RETHINK THIS. LET'S STRATEGIZED TO MAKE SURE THAT THE PATIENTS COMING TO THIS UNIT ARE GETTING EXCELLENT CARE. IF WE AGREE WE WANT MINNESOTANS TO GET GREAT CARE AND OUR HOSPITALS; AS THE NURSES ARE SAYING THEY DO; AND AS THE HOSPITALS ARE SAYING THEY DO; THEN THIS IS A REMEDY THAT BRINGS US TO THAT POINT. UNIT BY UNIT. I HOPE THAT YOU WILL SUPPORT ME. AND I WOULD ASK FOR ROLL CALL. YOU VERY MUCH >> HOUSE SPEAKER: ROLL CALL HAVING BEEN REQUESTED; SEEING FIFTEEN HANDS THERE WILL BE A ROLL CALL. DISCUSSION ON THE A- 14 AMENDMENT? REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: MEMBERS; I WOULD SPEAK AGAINST THE MURPHY AMENDMENT UNDERSTAFFED RATION I DO UNDERSTAND THIS IS A TOP PRIORITY FOR THE MINNESOTA NURSES UNION AND HAS BEEN IN THE PAST; AND IT IS VERY CONTROVERSIAL IT'S VERY DIFFICULT TO IMPLEMENT IN MINNESOTA BECAUSE IF YOU GO HOME AND TALK TO YOUR NURSES; YOUR HOSPITALS; AND SAY; WHAT YOU THINK ABOUT THIS; WHAT THEY WILL LIKELY SAY IS THAT WE ARE HAVING GREAT DIFFICULTY PAYING OUR BILLS AND STAFFING OUR HOSPITAL CURRENTLY. WITHIN WHAT THEY HAVE FOR BUDGET. THEY WILL ALSO SAY THAT THEY NEED THE FLEXIBILITY TO BE ABLE TO MOVE PEOPLE THROUGHOUT THE BUILDING IN THE HOSPITAL AS SITUATIONS CHANGE SO THEY CAN RESPOND TO EMERGENT SITUATIONS; WHETHER THAT BE A GREAT BIG HOSPITAL; OR A SMALL CRITICAL-CARE HOSPITAL SO THAT'S REALLY THE DISCUSSION AROUND THAT. EVERYBODY IS FOR SAFETY FOR PATIENTS; BUT ALSO SAFETY FOR NURSES AND CAREGIVERS. THAT BALANCE IS SOMETHING NOT YET ACHIEVED IN THIS BILL IS BEEN INTRODUCED IN THE PAST REPRESENTATIVE ATKINS CARRIED IT HAD HEARINGS MOVING FORWARD. IT SIMPLY ONE THAT IS REALLY-THERE'S NO RESOLUTION ABOUT THAT BALANCE YET IF YOU LOOK AT OTHER STATES OF LEAVE CALIFORNIA HAS THIS I'M NOT SURE IF THERE ARE OTHER STATES THAT DO; BUT IT'S ONE THAT'S GETTING LOOKED AT; CHEWED ON; AND BALANCED BUT THAT'S REALLY THE DISCUSSION POINT IS ABOUT SAFETY FOR PATIENTS; SAFETY FOR STAFF; BUT ALSO THE ABILITY TO BALANCE AND RESPOND TO SITUATIONS AND BE ABLE TO KEEP OUR DOORS ARE GREAT HOSPITALS OPEN SO; FOR THAT I WOULD RESPECTFULLY ASK THAT MEMBERS OPPOSE THE MURPHY AMENDMENT. >> HOUSE SPEAKER: REPRESENTATIVE BECKER-FINN >> REPRESENTATIVE BECKER-FINN: MEMBERS I WRITE TO SUPPORT THE MURPHY AMENDMENT. I WILL NOTE THIS IS NOT JUST A PRIORITY OF THE MINNESOTA NURSES ASSOCIATION. THIS IS ADDRESSING SAVE STAFFING IS A TOP PRIORITY FOR INDIVIDUAL NURSES. I WANT TO SHARE A STORY WITH YOU ABOUT ONE OF MY CONSTITUENTS I WILL CALL HER STACY SHE IS A NURSE AND SHE WORKS AT ONE OF THE HOSPITALS HERE IN THE TWIN CITIES. SHE WORKS THE OVERNIGHT SHIFT. LIKE MOST NURSES STACY IS SMART; DETERMINE AND CARES PASSIONATELY ABOUT THE CARE THAT SHE PROVIDES FOR HER PATIENTS. THE SO THEY GET THE CARE THEY DO I TALK TO STACY RECENTLY AND I TOLD HER WE WOULD BE HEARING THIS BILL AND DEALING WITH DIFFERENT HEALTHCARE ISSUES AND I ASKED HER ABOUT HER JOB WAS GOING. SHE TOLD ME ABOUT A RECENT NIGHT AT THE HOSPITAL. ONE OF THE AIDES ON HER FLOOR WAS PULLED OFF TO TAKE CARE TO PATIENTS ELSEWHERE AND SHE HAD FOR HIGH NEED PATIENTS THAT SHE HAD TO TAKE CARE OF ALL ON HER OWN. SHE WAS FORCED TO GIVE ONE OF HER PATIENTS AND ANTIPSYCHOTIC INJECTION. BECAUSE THEY WERE SHORT STAFFED AND SHE REALLY DID NOT HAVE A CHOICE. BUT TO DO THAT HAD YOU NOT GIVING THAT PATIENT THE INJECTION HE MIGHT HAVE PULLED OUT HIS ID OR HIS CATHETER OR SUFFERED A FALL ; AND HAD THEY HAD MORE STAFF SHE COULD HAVE DONE OTHER THINGS TO PROVIDE CARE BEFORE JUMPING TO THE HIGHER LEVEL OF NEEDING TO GIVE HIM AN INJECTION. SHE WAS REALLY UPSET ABOUT THIS AND SHE SAID TO ME; SHE SAID; I HAVE TO MAKE-THIS IS A QUOTE FROM HER; HAVE TO MAKE DECISIONS LIKE THIS EVERY DAY AND IT MAKES ME FEEL THE FAILURE . IT MAKES HER FEEL LIKE A FAILURE BECAUSE SHE WANTS TO PROVIDE THE BEST CARE THAT SHE CAN FOR HER PATIENTS. SO I ASKED FOR A GREEN BOAT HERE. WE NEED TO LISTEN TO OUR NURSE APPEARED THEY ARE THE ONES THAT DO THIS WORK AND THEY'RE ASKING US TO ADDRESS THIS ISSUE. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: MEMBERS; I JUST WANT TO CLARIFY A POINT FOLLOWING REPRESENTATIVE DEAN. THIS IS NOT A STAFFING RATIO AMENDMENTS. INSTEAD; THIS IS ALLOWING NURSES; STAFFING A UNIT TO SAY; WE'VE GOT TOO MANY PATIENTS SO FOR A MOMENT WE WILL CLOSE THE UNIT TO A NEW ADMISSION. IT'S DIFFERENT THAN A RATIO. IT IS IN THE MOMENT DECISION MAKING GIVING THE NURSES AUTHORITY IN THAT THEY ARE THE ONES RESPONSIBLE FOR THE CARE OF THE PATIENT. NOT THE PEOPLE IN ADMINISTRATION; NOT THE NURSING MANAGERS; NOT THE DOCTORS; IT'S THE NURSES THAT ARE RESPONSIBLE FOR THE CARE OF THE PATIENTS. WE ARE GIVING THEM THE PROFESSIONAL AUTHORITY TO SAY; HOLD ON. HOLD YOUR HORSES. IT'S TOO MANY. IF WE BELIEVE THAT REGISTERED NURSES HAVE -AND THEY HAVE IT-THEIR LICENSE. THEY HAVE THE PROFESSIONAL RESPONSIBILITY TO CARE FOR PATIENT WE ENTRUST THEM WITHOUT WORK. THEN WE SHOULD ALSO GIVE THEM THE TOOLS TO SAY; ENOUGH. THEY SHOULD HAVE THAT MUCH POWER AS THE HOSPITAL BUDGET. WHEN THE DECISIONS ARE BEING MADE BECAUSE OF BUDGET AND WE'VE GOT TOO MANY NURSES TO MEET OUR BUDGET QUOTA; AND NOT ENOUGH NURSES TO CARE FOR PATIENTS; THE PATIENTS ARE GOING TO PAY THE PRICE. THE NURSES HAVE BEEN COMING TO THIS BODY SAYING; WE ARE CHRONICALLY UNDERSTAFFED. THEY ARE NOT SOLVING THE PROBLEM IN THEIR USUAL FASHION AND WE ARE NOT RESPONDING. TOO STUFFY RATIO. OKAY IF YOU DON'T WANT TO DO STAFFING RATIOS; HERE IS ANOTHER WAY. LET'S GIVE THEM THE ABILITY TO SAY; WHERE PROFESSIONAL CREDENTIAL; I HAVE ENOUGH. YOU NEED TO TAKE A BREAK. AND WHEN WE HAVE THE RIGHT STAFF IN PLACE WE WILL OPEN THE UNIT UP AGAIN. IT'S HOW WE MAKE SURE MINNESOTANS ARE SAFE. I ALSO WANT TO SAY; THIS SPEAKS TO WHAT IS ABSENT IN THIS BILL I HEARD REPRESENTATIVE DEAN SAY; VOTE; NO. I CAN UNDERSTAND WHERE THIS IS GOING TO GO. WE ARE GOING TO LEAVE THE NURSES BEHIND. WE ARE GONNA LEAVE THE CHILDCARE PROVIDERS BEHIND. WE ARE GOING TO LEAVE THOSE PEOPLE STAFFING OUR SECURITY HOSPITAL BEHIND. WE ARE GOING TO LEAVE HOME CARE WORKERS BEHIND. THE PEOPLE WE ENTRUST THE CARE OF THE PEOPLE WITH MENTAL ILLNESS; THE PEOPLE WHO ARE DISABLED; PEOPLE WHO ARE AGING; IN PLACE; PEOPLE IN OUR HOSPITALS; IN THIS BUDGET; WE ARE LEAVING THEM BEHIND BECAUSE OF THE CHOICE THAT WE ARE MAKING. TAX CUTS; REINSURANCE; AND A STINKY TARGET OF $600 MILLION OF A CUT WE ARE LEAVING PEOPLE BEHIND. HERE IS A CHOICE YOU COULD SAY; OKAY; SPEAKER DOUDT SAID 600 AND CUT TARGETS BUT I COULD PASS THIS POLICY AND HELP THE NURSES MAKING SURE WERE TAKING CARE OF THE HOSPITAL PATIENTS AS WELL. S O YOU SHOULD VOTE GREEN. VOTE WITH ME TO VOTE WITH A WORK WHEN YOU VOTE FOR THE WORKER YOU VOTE FOR THE PATIENTS. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE FABIAN >> REPRESENTATIVE FABIAN: WELL I WAS NOT GOING TO SPEAK UNTIL I HEARD REPRESENTATIVE MURPHY TAKE A SHOT AT THE NURSING MANAGERS. FOR ME THAT IS PERSONAL. REPRESENTATIVE MURPHY; IN YOUR BILL WERE IN YOUR AMENDMENT - EXCUSE ME - THAT YOU PUT TOGETHER HERE; I'M CURIOUS TO KNOW WHERE IN THE UNITED STATES THIS TYPE OF PROGRAM MIGHT BE CURRENTLY BEING USED? >> REPRESENTATIVE MURPHY: REPRESENTATIVE FABIAN IN MINNESOTA HOSPITALS ; RIGHT NOW; AND FOR A DECADE AND IT WORKS. >> REPRESENTATIVE FABIAN ARE THERE ANY EXCEPTIONS IN THIS FOR SMALL CRITICAL ACCESS HOSPITALS IN RURAL MINNESOTA? >> REPRESENTATIVE MURPHY: I WOULD EXPECT THAT THE PATIENTS BEING CARED FOR IN RURAL CRITICAL ACCESS HOSPITALS DESERVE THE SAME HIGH QUALITY CARE AS YOU MIGHT GET AT ABBOTT NORTHWESTERN OR ABBOTTS HOSPITAL RIGHT HERE IN ST. PAUL. >> REPRESENTATIVE FABIAN: THAT'S NOT WHAT MY QUESTION WAS DID MY QUESTION WAS; WITH AN EXCEPTION FOR CRITICAL ACCESS HOSPITALS IN RURAL HOSPITALS IN YOUR AMENDMENT? >> REPRESENTATIVE MURPHY: I'M ASKING YOU WHY YOU WOULD WANT THAT EXCEPTION FOR RURAL HOSPITALS? WITH THIS AMENDMENT DOES IS GIVE THE AUTHORITY TO THE PROFESSIONAL NURSES WORKING WITH THE PEOPLE IN THEIR HOSPITAL AND THE NURSES ; AND I'VE WORKED WITH A LOT OF NURSES ALL OVER THE STATE OF MINNESOTA-IF YOU KNOW [INAUDIBLE] LIKE I KNOW [INAUDIBLE] SHE'S GONNA FIGHT LIKE HELL FOR HER PATIENTS. SHE IS NOT FROM THE METRO AREA AND SHE'S FROM GREATER MINNESOTA AND SHE'S BEEN PRACTICING NURSING OUT THERE FOR LIKE 50 YEARS. SHE WANTS THE SAME PROFESSIONAL ABILITY TO CARE FOR PATIENTS AS I DO HERE . THAT IS RIGHT. THAT'S EXACTLY RIGHT. SO I WOULD SAY TO YOU; LET'S LET THE NURSES ALL ACROSS THE STATE OF MINNESOTA MAKE THAT DECISION. >> REPRESENTATIVE FABIAN: WELL REPRESENTATIVE MURPHY; YOU STILL HAVE NOT ANSWERED MY QUESTION. I OBVIOUSLY ASSUME YOU'RE NOT GOING TO. YOU SAY THIS BEING DONE IN MINNESOTA HOSPITALS RIGHT NOW. HOW IS IT COMING TO BE A PRACTICE IN THOSE HOSPITALS? >> REPRESENTATIVE MURPHY: REPRESENTATIVE FABIAN; THE NURSES AND THE MANAGERS IN THOSE HOSPITALS AGREE. THAT WOULD BE-THEY WOULD TACKLE THAT AND IT'S A DECENT POLICY AND IT'S WORKING. >> REPRESENTATIVE FABIAN: WELL THANK YOU REPRESENTATIVE MURPHY WHAT A NOVEL IDEA PEOPLE WORKING TOGETHER TO GET THINGS DONE. RATHER THAN HAVING THE STATE COME IN WITH A CLUB AND TELL THEM WHAT THEY HAVE TO DO. YOU KNOW; IN ROSEVILLE IN THE HOSPITALS I REPRESENT PEOPLE TO WORK TOGETHER AND THEY WERE TOGETHER EXTREMELY WELL. I DON'T SEE MEMBERS ANY REASON IN THE WORLD WHY WE WOULD MANDATE WHERE CRITICAL ACCESS HOSPITALS MUST DO WITH NO EXCEPTIONS TO CREATE AN ENVIRONMENT THAT MAY NOT BE BENEFICIAL FOR THAT FACILITY. I WOULD ENCOURAGE A RED VOTE ON THE RESPECTIVELY REPRESENTATIVE MURPHY; A RED VOTE ON YO UR AMENDMENT AND THE NEXT TIME YOU'RE IN ROSEVILLE I'LL BE HAPPY TO TAKE YOU UP TO THE HOSPITAL AND SHOW YOU WHAT A GREAT JOB THE NURSES AND THE NURSING MANAGER DOES AT OUR HOSPITAL. THANK YOU. >> HOUSE SPEAKER: FURTHER DISCUSSION ON THE A- 14 AMENDMENT? SEEING NONE; THE CLERK WILL TAKE THE ROLL. >> [ROLL CALL VOTE] >> HOUSE SPEAKER: THE CLERK WILL CLOSE THE ROLL. THERE BEING 52 AYE AND 73 NAY THE MOTION DOES NOT PREVAIL AND THE MM AND IS NOT ADOPTED BECAUSE OF >> HOUSE SPEAKER: I RECOGNIZED REPRESENTATIVE GAROFALO FOR WHAT PURPOSE THE RISE? >> REPRESENTATIVE GAROFALO I RISE JUST TO FOR A POINT OF PERSONAL PRIVILEGE. I WOULD LIKE TO DRAW YOUR ATTENTION TO THE BALCONY OF THEIR. TAKE THIS OPPORTUNITY TO RECOGNIZE SOME OF THE MINNESOTA'S FUTURE FINEST. AN INSTRUCTOR AND HIS WIFE STEVE AND KIM. SEVERAL CADET STUDENTS FROM HIBBING COMMUNITY COLLEGE TO BE COMMITTEE CALLED LAW-ENFORCEMENT CADETS PLAY RECEIVE WERE MY LAW-ENFORCEMENT TRAINING AND SKILLS IN CLASSROOMS THAT I WOULD LIKE TO PLEASE GIVE THEM A WARM WELCOME BECAUSE THEY'LL BE THE ONE STANDING IN LINE TO PROTECT YOUR FAMILIES SO THAT WE CAN ALL SLEEP AT NIGHT. [APPLAUSE] I WOULD LIKE TO JUST ADD ONE MORE THING TO THAT MR. SPEAKER. FOR MATTHEW 5-9 BLESSED ARE THE PEACEMAKERS FOR THEY WILL BE CALLED SONS AND DAUGHTERS OF GOD. >> HOUSE SPEAKER: MEMBERS WE ARE NOW ON THE JIMENEZ LEVIN AMENDMENT AS AMENDED. DISCUSSION TO THE A- 11 AMENDMENT AS AMENDED? REPRESENTATIVE DEAN >> REPRESENTATIVEDEAN: I RECOMMEND SUPPORT FOR THE AMENDMENT. >> HOUSE SPEAKER: SEEING NONE; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: HANSEN MOVES TO AMEND HOUSE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED IN THE AMENDMENT IS CODED A- 13 >> HOUSE SPEAKER: REPRESENTATIVE HANSEN TO INTRODUCE YOUR AMEND >> REPRESENTATIVE HANSEN: MEMBERS; YOU MAY REMEMBER DURING THE SUNDAY SALES DEBATE REPRESENTATIVE LOONAN AND I WERE WORKING ON TRYING TO CAPTURE THE REVENUE THAT WOULD BE GENERATED FROM SUNDAY SALES; THE EXTRA REVENUE TA X REVENUE THAT WILL BE GENERATED AND DEDICATE THAT TWO RECOVERY PROGRAMS AND I WANT TO NOTE THAT WE DID HAVE A HEARING AND REPRESENTATIVE SCHOMACKER'S COMMITTEE I'VE BEEN WORKING WITH REPRESENTATIVE LOON TO TRY TO CONTINUE PROGRESS ON THIS ISSUE IN THE A- 13 AMENDMENT WAS AN EFFORT AT THAT. I DO BELIEVE THERE'S A SECOND AMENDMENT >> HOUSE SPEAKER: THERE IS A AMENDMENT TO THE AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT . >> CHIEF CL ERK: HANSEN MOVED TO AMEND HIS AMENDMENT TO SEND ABOUT 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENDMENT TO THE AMENDMENT IS CODED A- 42 >> HOUSE SPEAKER: REPRESENTATIVE HANSEN TO INTRODUCE YOUR AMENDMENT >> REPRESENTATIVE HANSEN: MEMBERS AS I MENTIONED THIS IS CONTINUING TO BE A WORK IN PROGRESS. REPRESENTATIVE LOON AND I WERE TRYING TO MAKE SURE THIS AMENDMENT WOULD NOT BE RULED OUT OF ORDER. I DO WANT TO NOTE; SINCE WE DID PASS SUNDAY SALES THIS PARTICULAR ISSUE IS SOMETHING THAT I PROBABLY HAVE HAD MORE CONCERN OR INTEREST ABOUT FROM JUST REGULAR FOLKS ASKING ME; WHAT HAPPENED TO THAT RECOVERY THING. I WAS IN THE COFFEE SHOP AND I'D SEVERAL PEOPLE ASK ME; WHAT HAPPENED TO THAT RECOVERY AMENDMENT THAT YOU HAVE. SO I THINK IF YOU TALK TO FOLKS IN YOUR DISTRICT WHEREVER THEY ARE YOUR TO FIND SOME INTEREST IN THIS BECAUSE A LOT OF PEOPLE ARE CONCERNED ABOUT RECOVERY. I WOULD ASK MR. SPEAKER IF REPRESENTATIVE LOON WOULD YIELD? REPRESENTATIVE TRENTON; YOU AND I'VE BEEN WORKING ON THIS. I JUST WOULD LIKE TO HEAR YOUR INTEREST AND CONCERN AS WE CONTINUE ON THIS JOURNEY? >> HOUSE SPEAKER: REPRESENTATIVE LOON >> REPRESENTATIVE LOON: YES; IT'S A PLEASURE TO WORK WITH YOU ON IT BUT I THINK IT'S A FINE IDEA OBVIOUSLY; THE SUNDAY SALES LOT HAS NOT GONE INTO EFFECT YET GOT A LITTLE WAYS TO GO IN TERMS OF MEASURING THE REVENUE AND SEEING HOW THAT'S COMING IN BUT ONE IS THAT IN PLACE; AND WE HAVE SOME IDEA WHAT KIND OF REVENUES ARE THERE I DO HOPE THAT WE CAN DEDICATE IT FOR THESE PURPOSES. I THINK IT MAKES SENSE AND I THINK IT WOULD BE SOMETHING THAT MOST PEOPLE COULD GET BEHIND. >> HOUSE SPEAKER: REPRESENTATIVE HANSEN >> REPRESENTATIVE HANSEN: MEMBERS AS WERE NOT QUITE THERE YET AND I DON'T WANT THE AMENDMENT TO BE RULED OUT OF ORDER; MR. SPEAKER; AND HER ANY CHANCES OF WORKING ON THIS; I WILL WITHDRAW THIS SECONDARY IN THE PRIMARY AMENDMENT; BUT ANYONE ELSE WOULD LIKE TO CONTINUE TO WORK ON THIS ISSUE I WOULD INVITE THEM TO MEET WITH REPRESENTATIVE LOON AND I COULD I THINK THERE'S AN OPPORTUNITY HERE TO DO SOMETHING GOOD IN THIS ISSUE THAT WE HAVE NOT TRIED BEFORE. SO THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE HANSEN WITHDRAWS THE A- 13 AMENDMENT AND THE A- 42 AMENDMENT TO THE AMENDMENT. THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: HILSTROM MOVES TO AMEND SENT A FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED; AND THE AMENDMENT IS CODED A- 16. >> HOUSE SPEAKER: REPRESENTATIVE HILSTROM; TO INTRODUCE YOUR AMENDMENT >> REPRESENTATIVE HILLS: MEMBERS; THERE'S BEEN A BIPARTISAN GROUP OF LEGISLATORS AS WELL AS OUR CURRENT ATTORNEY GENERAL AND GOVERNOR WHO HAVE PRIORITIZED THE OPIOID CRISIS THAT WE'RE HAVING HERE IN MINNESOTA. WE HAVE SEEN A NUMBER PROPOSALS THAT COME FORWARD THERE'S A FEW PROPOSALS THAT ARE IN THIS OMNIBUS BILL. MEMBERS; THERE IS MUCH MUCH MORE WE NEED TO DO. MEMBERS QUITE THERE HAS BEEN A CONSTANT RISE IN OPIOID OVERDOSES AND IN 2016 MINNESOTA HAD APPROXIMATELY 20% INCREASE IN OPIOID -RELATED DEATHS. COMPARED TO 2015. MOST PEOPLE THINK THE OPIOID EPIDEMIC IS RELATED TO JUST HEROIN BUT MEMBERS WE NOW HAVE MORE PEOPLE OVERDOSING FROM PRESCRIPTION MEDICATION THAN WE DO FROM ILLEGAL DRUGS. ILLEGAL HEROIN. SO MEMBERS; THIS IS NOW REACHING EPIDEMIC MEMBERS; THIS AMENDMENT; THE A- 16 AMENDMENT; WOULD REQUIRE TWO HOURS OF CONTINUING EDUCATION RELATED TO FOLKS WHO PRESCRIBE PRESCRIBED OPIOIDS. THIS WILL BE A PROPOSAL THAT WILL CONTINUE TO WORK BIPARTISAN LEE . I WILL BE WITHDRAWING THIS AMENDMENT I JUST WANT TO MAKE CERTAIN THAT MEMBERS CONTINUE TO BE PERSISTENT ON WHAT WE CAN DO TO DEAL WITH THE OPIOID CRISIS THAT WE HAVE HERE IN MINNESOTA. THAT MR. SPEAKER I WOULD MOVE WITHDRAW THE A- 16 AMENDMENT >> HOUSE SPEAKER: HILSTROM WITHDRAWS THE A- 16 AMENDMENT. THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: HILSTROM MOVES TO AMEND SENT A FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED IN THE MM IT IS CODED A- 17 >> HOUSE SPEAKER: REPRESENTATIVE HILSTROM TO INTRODUCE YOUR AMENDMENT >> REPRESENTATIVE HILSTROM THE A- 17 AMENDMENT AGAIN IS ABOUT THE OPIOID ECHOED EPIDEMIC HERE AND SPOUT THE PRESCRIPTION MONITORING PROGRAM. MEMBERS; ONE OF THE THINGS WE CAN DO IS HAVE DOCTORS CHECK WHETHER OR NOT PEOPLE ALREADY HAVE PRESCRIPTIONS WHEN THEY'RE GETTING READY TO PRESCRIBE ADDITIONAL OPIOIDS. WE KNOW THAT IN MANY CASES PEOPLE USUALLY NEED ABOUT 10 PILLS AND AFTER THAT WHEN THEY START TO TAKE THE MEDICATION FOR LONGER PERIODS OF TIME IT ACTUALLY CHANGES THE CHEMICALS IN THEIR BRAIN AND MAKES THEM MORE SUSCEPTIBLE TO ADDICTION. AND OPIOIDS MEMBERS; THIS WOULD SIMPLY SAY THAT PRIOR TO THE PRESCRIBING THAT THEY SHOULD LOOK ABOUT THEIR PRESCRIPTION HISTORY. NOW; REPRESENTATIVE BAKER HAS BEEN WORKING ON THIS PROPOSAL HE IS THE AUTHOR OF THIS. THE A- 17 AMENDMENT WHICH I AM A CO-AUTHOR AND THERE BEEN SOME CHANGES THAT HAVE BEEN MADE. SO MR. SPEAKER IF REPRESENTATIVE BAKER WOULD YIELD TO A QUESTION? REPRESENTATIVE BAKER; AGAIN; THIS WAS THE LANGUAGE OF YOUR BILL AS IT WAS INTRODUCED AND I NOTE IT DID NOT RECEIVE A HEARING IN THE CIVIL LAW COMMITTEE; AND THIS DOES RELATE TO DATA REPRESENTATIVE AKER; CAN YOU TELL ME THE STATUS OF THE BILL CURRENTLY AND WHAT FORM YOU WILL CURRENT BILL IS IN? >> REPRESENTATIVE BAKER: REPRESENTATIVE HILSTROM; THANK YOU FOR BRINGING UP THIS REALLY IMPORTANT TOOL. WHERE IT'S CURRENTLY SITTING IS CURRENTLY SITTING IN FRONT OF CIVIL LAW. I'M STILL DETERMINED TO WORK WITH CHAIRMAN SCOTT AND OTHER MEMBERS OF OUR TEAM TO MAKE SURE THEY UNDERSTAND THE IMPORTANCE OF THIS TOOL. THE LATEST VERSION OF MY BILL IS A LITTLE DIFFERENT THAN ON ONE YOU'RE PROPOSING TODAY BECAUSE THE ONE I'M WORKING ON ACTUALLY HAS THE MINNESOTA MEDICAL ASSOCIATION SUPPORTING MY WORK WITH PROVIDING A MANDATORY USE OF THE PDM P; PRESCRIPTION DRUG MONITORING PROGRAM. ANYTIME A PATIENT ENTERS A EMERGENCY ROOM OR URGENT CARE AND THAT IS THE TIME MOST OFTEN MEMBERS WHEN THERE'S NOT A DOCTOR-PATIENT RELATIONSHIP. SO I WANT TO CONTINUE TO WORK ON THIS THIS IS A VERY IMPORTANT ITEM FOR OUR OPIOID REFORM ACT AND I THINK THIS IS SOMETHING I LOOK FORWARD TO MORE CONVERSATIONS WITH YOU IN THE FEUD THANK YOU FOR BRINGING THIS VERSION 4. >> REPRESENTATIVE HILSTROM: REPRESENTATIVE BAKER; DO YOU ANTICIPATE THAT WE WILL SEE YOUR OTHER VERSION OF THIS PRESCRIPTION MONITORING PROGRAM YET THIS SESSION? >> REPRESENTATIVE BAKER: YES; I DO. >> REPRESENTATIVE HILSTROM: WITH THAT I WOULD WITHDRAW THE A- 17 AMENDMENT >> HOUSE SPEAKER: REPRESENTATIVE HILSTROM WITHDRAWS THE MONEY 17 AMENDMENT. THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: ZERWAS MOVES TO AMEND SENT A FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED; AND THE AMENDMENT IS CODED A- 22 >> HOUSE SPEAKER: REPRESENTATIVE ZERWAS >> REPRESENTATIVE ZERWAS THE A- 22 AMENDMENT IS A VERSION OF A BILL INTRODUCED SEVERAL WEEKS BACK THAT HAS A FULL SLATE OF BILL AUTHORS FROM REPUBLICANS AND DEMOCRATS THAT WORKS TO REACT TO A SCENARIO THAT WE'VE SEEN IN MINNESOTA WHERE LEADERS -PART OF THE LEADERSHIP TEAM FOR ONE OF MINNESOTA'S MINNESOTA'S MEDICAL DISPENSARY COMEDIES APPEAR TO VIOLATE STATE AND FEDERAL LAW MOVING MEDICAL CANNABIS OIL ACROSS STATE LINES FROM THEIR FACILITY TO A FACILITY THEY WERE TRYING TO START IN NEW YORK. THIS BILL REQUIRES SOME ENFORCEMENT ACTIONS BY THE DEPARTMENT OF HEALTH IF THOSE INDIVIDUALS ARE FOUND GUILTY. I ASK FOR YOUR SUPPORT. >> HOUSE SPEAKER: DISCUSSION ON THE A- 22 AMENDMENT? REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: THANK YOU; MEMBERS. I THINK MEMBERS WILL CHOOSE TO VOTE ON THIS HOW THEY WISH . I DO HAVE A LITTLE BIT OF A CONCERN WITH THIS REMEDY . IT'S CART BEFORE THE HORSE. WHEN I THINK ABOUT A B AR SERVING LIQUOR; WHEN I THINK ABOUT A LICENSED PROFESSIONAL PROVIDING CARE; INDIVIDUALS; BREAKING THE LAW; THE INDIVIDUALS WHO BROKEN THE LAW ARE THE ONES WHO PAY THAT PENALTY AND OF COURSE; THIS QUESTION IS FACING -IT'S IN THE LEGAL SYSTEM. WE KNOW THAT PART OF IT WHEN I TALK WITH YOU REPRESENTATIVE ZERWAS; I APPRECIATE THE ARGUMENT THAT WE DECIDED AS A STATE TO GO DOWN THIS PATH. I BELIEVE; FEBRUARY THERE ARE MINNESOTANS WHO HAVE REALLY GOT RELIEF FROM MEDICAL CANNABIS AND I'M WORRIED THAT THIS REMEDY IS SO SIGNIFICANT THAT IT WILL KNOCK ONE OF THOSE PROVIDERS OUT. HE WILL KNOCK THEM OUT OF BUSINESS AND BRING HARM; THEN; TO THOSE INDIVIDUALS. I UNDERSTAND THE WAY YOU'VE GOT THIS DRAFTED; THAT YOU DON'T THINK THAT WILL HAPPEN; BUT I AM CONCERNED THAT WE ARE CHARGING GUILTY BEFORE THE COURT AND HARMING WHAT IS; FROM MY PERSPECTIVE; A NEED TO PROVIDE MEDICAL RELIEF TO MINNESOTANS WHO HAVE SIGNIFICANT MEDICAL ISSUES. SO I'M JUST RISING TO SPEAK TO THAT. TO THINK ABOUT THAT. I DON'T WANT TO BRING HARM TO THE PEOPLE WERE GETTING RELIEF WITH THIS MEDICATION. >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: MEMBERS; PART OF THIS AMENDMENT I THINK TRACKS WITH THE DEPARTMENT OF HEALTH WAS ASKING FOR IN TERMS OF ADDITIONAL AUTHORITY. THEY KNOW THAT WELL OFTEN WHEN WE PASS A BILL AND A BIG NEW PROGRAM; WE NEED TO COME BACK AND TWEAK IT AND THAT IS CERTAINLY TRUE HERE. SO SOME OF THIS LANGUAGE I THINK IS REALLY IMPORTANT LANGUAGE THAT SHOULD BE ENACTED. HOWEVER; I THINK SP1 MURPHY WAS TALK ABOUT THE LAST SECTION IS KIND OF PROBLEMATIC. SO MR. SPEAKER I'M GONNA MOVE TO DIVIDE THE AMENDMENTS. I WOULD LIKE TO DIVIDE IT AFTER LINE 2.17. >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING WE ARE JUST CONFIRMING TO SEE IF IT IS DIVISIBLE AT THAT POINT. SO; JUST STANDBY. REPRESENTATIVE LIEBLING AT FIRST GLANCE WE THOUGHT IT MAY BE DIVISIBLE-IT APPEARS IN ALL DIRECT YOU TO LINE 2.23 THE SECOND PORTION OF WHAT YOU'RE TRYING TO DIVIDE--PUT MY GLASSES ON-REFERS TO SECTION 152.25 SUBDIVISION ONE-A. AS WE KNOW; ACCORDING TO MASONS BOTH OF THE AMENDMENTS ONCE DIVIDED WOULD HAVE TO BE STAND ON THEIR OWN IN THE SECOND PORTION OF WHAT YOU'RE TRYING TO DIVIDE REFERS TO THE FIRST PORTION AND THEREFORE IF THE FIRST PORTION WAS NOT ADOPTED THE SECOND PORTION WOULD NOT BE ABLE TO STAND ON ITS OWN. SO IT'S NOT DIVISIBLE AT THAT POINT. REPRESENTATIVE LIBBY >> REPRESENTATIVE DETTMER Q MR. SPEAKER >> HOUSE SPEAKER: FURTHER DISCUSSION ON THE -22 AMENDMENT? REPRESENTATIVE ZERWAS >> REPRESENTATIVE ZERWAS THANK YOU; MEMBERS. NOTE; YES. >> HOUSE SPEAKER: SEEING NONE; ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: LIEBLING MOVES TO AMEND SENATE F ILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED IN THE AMENDMENT IS CODED A- 25 >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING TO THE A- 25 AMENDMENT >> REPRESENTATIVE LIEBLING: THIS IS SOMETHING THAT SHOULD BE FAMILIAR TO YOU. AS YOU KNOW; WE HAVE DEALT WITH THE PROBLEM OF RISING INSURANCE PREMIUMS TWICE THIS YEAR RISING INSURANCE PREMIUMS IN THE INDIVIDUAL MARKET. ONE OF THE FIRST THINGS WE DID WHEN WE CAME INTO SESSION; I THINK WAS HOUSE BY ONE; WAS A BILL THAT FOR 2017 INSTITUTED PROGRAMS WITH AROUND $300 MILLION THAT WE USED TO PASS THROUGH TO CONSUMERS TO BUY DOWN THEIR INSURANCE PREMIUMS. S O THIS IS A DISCOUNT PROGRAM AND IT SHOULD BE ROLLING OUT RIGHT ABOUT NOW WE ARE CONSUMERS WHO ARE NOT GETTING PREMIUM SUBSIDIES; THOSE WERE NOT GETTING THE AFFORDABLE CARE ACT OR OBAMA CARE; ASSISTANCE WITH THEIR PREMIUMS; ARE ELIGIBLE TO GET A DISCOUNT FROM INSURERS. THIS IS MONEY WE ALLOCATED THAT IS PASSED THROUGH TO CONSUMERS TO HELP THEM WITH A HIGH COST. SO FAST-FORWARD AND RECENTLY; ANOTHER BILL WAS PASSED TTO DEAL WITH THE NEXT TWO YEARS THAT ARE COMING; 2018-2019. BUT; INSTEAD OF PASSING THE MONEY THROUGH TO THE CUSTOMER WHAT THE LEGISLATURE DID; AND THIS JUST BECAME LAW WITHOUT THE GOVERNOR'S SIGNATURE; WITH THE LEGISLATURE DID WAS JUST HAND THE MONEY TO THE INSURANCE COMPANY. SO FOR 2017 THE CONSUMER GETS A DISCOUNT. BUT FOR 2018 AND 2019 WERE HANDING THE MONEY TO THE INSURANCE COMPANIES WITH NO GUARANTEE THAT THEY WILL REDUCE PREMIUMS AT ALL. NOT ONLY THAT; BUT THE LATEST BILL; THE ONE THAT'S JUST A SUBSIDY BILL FOR THE INSURERS; REQUIRES A WAIVER FROM THE FEDERAL GOVERNMENT; WHICH WE DON'T KNOW WHETHER WE WILL RECEIVE AND IF WE DON'T THERE WILL BE NO HELP FOR THE CONSUMER IN 2018 AND 2019. SO; WHAT THIS BILL DOES IT GIVES US AN OPPORTUNITY TO MAKE A CHANGE SO THAT WE CAN ACTUALLY EXTEND THE PROGRAM WE HAVE THIS YEAR USING MONEY THAT WE ALLOCATED ; PULLING IT BACK AND GETTING INSTEAD OF THE INSURANCE COMMITTEE; GIVING IT TO THE CONSUMER IN THE FORM OF A DISCOUNT. SO THAT WE WILL NO THAT THE PERSON WHO IS BUYING THE INSURANCE IS ACTUALLY GOING TO GET A REDUCTION IN THEIR COST. THIS IS SOMETHING THAT WE COULD NO WOULD ACTUALLY HELP OUR CONSTITUENTS WITH THESE VERY HIGH COSTS COMING DOWN. NOW THIS IS ESPECIALLY IMPORTANT RIGHT NOW; BECAUSE WE KNOW REPUBLICANS IN CONGRESS ARE STILL READY TO DO SOMETHING TO HEALTHCARE AND WE DON'T KNOW WHAT THE SOMETHING IS. WE KNOW THERE WAS A LOT OF DISAGREEMENT OVER THE ATTEMPT TO REPEAL THE AFFORDABLE CARE ACT. WE KNOW THE ATTEMPT FAILED THAT IT WAS NOT AGREEMENT AMONG REPUBLICANS IN CONGRESS AND THE PRESIDENT ABOUT WHAT TO DO AND HOW TO DO IT ; AND WE KNOW THAT WEIGHT IS STILL BEING DISCUSSED IS PULLING BACK THE MONEY THAT GIVES SOME OF THE CONSUMERS A DISCOUNT ON THEIR PREMIUMS. SO THIS IS SOMETHING THAT IS AVAILABLE TO US. IT WON'T COST ANY ADDITIONAL MONEY BECAUSE THE MONEY IS ALREADY ALLOCATED IT SIMPLY PULLS BACK THE NEW PROGRAM AND DOES WHAT WE SHOULD HAVE DONE; WHICH IS JUST REFINANCE THE 2017 PROGRAM FOR 2018 AND 19 SO WE KNOW OUR CONSTITUENTS; THE CONSUMERS; ACTUALLY GET THE RELIEF AND NOT THE INSURANCE COMPANIES. SO MEMBERS; I WOULD REQUEST A ROLL CALL ON THE AMENDMENT >> HOUSE SPEAKER: ROLL CALL HAVING BEEN REQUESTED; SEEING FIFTEEN HANDS THERE WILL BE A ROLL CAL L. REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: I WOULD HOPE YOU CAN SUPPORT THIS BECAUSE IT'S THE ONE THING THAT WE KNOW WILL GIVE RELIEF TO OUR CONSTITUENTS FOR 2018 AND 2019 NO MATTER WHAT HAPPENS IN WASHINGTON. NOT ONLY THAT; MEMBERS; THERE'S OTHER REASONS WHICH ARE NOT TO GO INTO NOW WHY THIS IS ACTUALLY BETTER FOR OUR FINANCES HERE IN MINNESOTA BECAUSE THE WAY THAT OTHER BILL WAS DONE IT HAS THE POTENTIAL TO ACTUALLY CUT FEDERAL FUNDING AND [INAUDIBLE] REPLACE THAT FUNDING WITH STATE FUNDING I DON'T WANT TO GO TOO FAR IN THE WEEDS ON THAT BUT THIS IS A MUCH BETTER APPROACH WE AGREED ON IT FOR THIS YEAR AND WE SHOULD SIMPLY GO FORWARD WITH IT TO MAKE SURE MINNESOTA CONSUMERS GET A BREAK ON THEIR INSURANCE PREMIUMS. >> HOUSE SPEAKER: REPRESENTATIVE HOPPE >> REPRESENTATIVE HOPPE I RISE TO A POINT OF ORDER. 3.21 MOTIONS SHOULD BE GERMANE. >> HOUSE SPEAKER: REPRESENTATIVE HOPPE HAS RISEN TO A POINT OF ORDER UNDER 3.21. GERMANENESS THIS ADVICE? >> REPRESENTATIVE HOPPE: REPRESENTATIVE TEND TO BE YOU AND I HAVE TALKED A LOT THIS YEAR ABOUT THESE ISSUES; HEALTHCARE INSURANCE. HEALTH INSURANCE REFORM ALL OF THESE THINGS. WE HAD A GOOD DISCUSSION NOTHING M ORE PROPERLY THESE WERE DISCUSSIONS FOR BOTH HO USE FILE ONE AND HOUSE FILE FIVE AND MR. SPEAKER MY ADVICE TO YOU IS REPRESENTATIVE LIEBLING'SAMENDMENT IS WELL-INTENTIONED AS IT IS; IT DOES EXPAND THIS BILL FOR AMENDMENT REFERENCE CHAPTER 2 AND CHAPTER 13 AND I LOOKED THROUGH THE BILL AND DIDN'T FIND ANYTHING ELSE IN THE BILL THAT'S EITHER CHAPTER 2 OR CHAPTER 13. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: OBVIOUSLY; THIS IS THE ALMOND ABYSS HEALTH AND HUMAN SERVICES BILL. GERMANE THIS SPIRIT YOUR MENACES COME EXTREMELY FLUID CONCEPT AROUND THIS PLACE. EXTREMELY FLUID. THERE'S ALWAYS SOMETHING YOU CAN SAY ABOUT WHY SOMETHING IS NOT GERMANE AND HONESTLY; ALTHOUGH I VERY MUCH RESPECT THE SPEAKER PRO TEM WHO'S IN THE CHAIR RIGHT NOW; I DON'T KNOW IF IT'S WORTH THE BREATH TO TRY TO ARGUE GERMANENESS THIS WHEN THE MAJORITY DECIDES THAT SOMETHING IS NOT GERMANE BECAUSE YOU DON'T WANT TO TAKE A BOAT WITH ON IT. I'M NOT REALLY GOING TO DO THAT BUT IF HE ALTH INSURANCE AND THE COST OF IT IS NOT GERMANE TO HEALTH AND HUMAN SERVICES BILL; REALLY? REALLY? YOU KNOW; SOMEONE SOMETIMES I WONDER WHAT WERE ALL DOING HERE BECAUSE OBVIOUSLY; WERE NOT HERE TO TAKE A FISCAL ISSUES AND VOTE ON THEM. SOMETIMES IT SEEMS TO ME LIKE WERE NOT REALLY EVEN HEAR TO HELP OUR CONSTITUENTS ALL THAT MUCH BECAUSE THIS IS SOMETHING THAT AS I SAID; WILL HELP.. THE ONLY THING THAT WE HAVE NO WILL HELP YOUR SO THANK YOU MR. SPEAKER. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE PINTO >> REPRESENTATIVE PINTO WERE BACK AT THIS AGAIN MEMBERS. SP1 LIEBLING SAID; THIS IS THE ALMOND ABYSS HEALTH AND HUMAN SERVICES BILL. WE ALL KNOW THERE'S ALMOST NOTHING THAT IS NOT IN THIS BUILT IN SOME WAY. THIS IS A MASSIVE AREA BUT THERE'S ALL SORTS OF ISSUES CONNECTED TO THIS BILL CLEARLY; CLEARLY; THE ISSUE OF HEALTH INSURANCE AND THE ISSUES TAKEN UP IN THIS AMENDMENT ARE GERMANE THEY ARE RELATED TO IF THERE IS A SECTION OR TWO THAT ARE NOT IN THE UNDERLYING BILL; DOES THAT SUBSTANTIALLY CHANGE THE SCOPE OF THIS BILL? THIS IS A MASSIVE SCOPE OF COURSE; THIS MOMENT IS CONNECTED I WILL SAY MAYBE I HAVE MORE FAITH IN THE INSTITUTION AND REPRESENTATIVE LIEBLING BUT I WOULD LIKE TO APPEAL TO THE SPEAKER AND TO HIS RESPECT FOR THE INSTITUTION LOOK; IT SHOULD NOT MATTER IF IT'S A MAJORITY AMENDMENT OR MINORITY AMENDMENT WHEN WERE INTERPRETING THE RULES TO LET THE WHOLE POINT OF A RULE. WE CAN WRITE THE RULES IN AN UNFAIR WAY. WHATEVER THE RULES ARE BUT ONCE YOU HAVE THOSE RULES WE SHOULD APPLY THOSE RULES IN A FAIR WAY. IT SHOULD NOT MATTER SO I WILL APPEAL TO THE SPEAKER AS SOMEONE WHO AND I HOPE DEEPLY ABOUT THE INSTITUTION TO APPLY THE SAME STANDARDS TO AN AMENDMENT ADVANCED BY THE MINORITY AS BY THE MAJORITY MR. SPEAKER MY ADVICE TO YOU IS WOULD FIND THE POINT OF ORDER NOT WELL TAKEN AND CERTAINLY; FIND A PROPOSAL THAT RELATES TO HEALTH INSURANCE IS IN FACT GERMANE TO HEALTH AND HUMAN SERVICES OMNIBUS BILL. THANK YOU. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? FURTHER ADVICE? REPRESENTATIVE HOPPE >> REPRESENTATIVE HOPPE: ONE MORE PIECE OF ADVICE. THIS DOES EXPAND THE BILL BECAUSE IT IS EITHER CHAPTER 2 OR 13 IN THE AMENDMENT OR CHAPTER 62 -E WHICH IS WHAT REPRESENTATIVE THAT HE WANTS TO AMEND. THERE'S NOTHING IN THE ALMOND ABYSS BILL AS BIG AS IT IS THERE'S NOTHING THERE THAT REFERENCES THOSE SECTIONS I THINK ANYONE HERE IS AFRAID TO VOTE ON THIS. WE ALL VOTED ON IT IT WAS HOUSE FILE FIVE. WE'VE ALREADY MADE THAT DECISION. WE DON'T NEED TO FURTHER EXPAND THIS BILL. ESTHER SPEAKER I WOULD MOVE THE POINT OF ORDER BE WELL TAKEN. >> HOUSE SPEAKER: FURTHER ADVICE? REPRESENTATIVE FREIBERG >> REPRESENTATIVE FREIBERG I BELIEVE REPRESENTATIVE DETTMER IS REFERRING TO CHAPTER 2 OF THE SESSION THOSE AND NOTCH UP TO DO THE MINNESOTA STATUTES. WHEN WE DO REFER TO CHAPTER SECTIONS FOR SPEAR JANE GERMANE US GERMANENESS IS WOULD TALK ABOUT MINNESOTA STATUTES. I HAVE NOT IN THE SHORT AMOUNT OF TIME BEEN ABLE TO CHECK EXACTLY WHICH SECTION IN THE STATUTE IS AMENDED BY THIS CHAPTER 2 OF THE SESSION LAW BUT I SUSPECT IT'S THE SAME ONES WE ARE TALKING ABOUT HERE WHICH WOULD BE WELL WITHIN THE GERMANENESS THIS RULES THAT ARE GENERALLY BEEN HANDED DOWN BY SPEAKERS IN THIS AUGUSTINE BODY ALTHOUGH NOT SO MUCH THIS YEAR BUT JUST FOR THE BENNETT BENEFIT OF THOSE MEMBERS WHO NOW MAY NOT BE FAMILIAR WITH THE DISC DISTINCTION DISTINCTION THE SESSION LAWS ARE THE LAWS WE PASS THIS YEAR TYPICALLY THEY DO AMEND SPECIFIC SECTIONS OF THE STATUTES. SO; WE HAVE NEVER-WE HAVE NEVER LOOKED TO WHETHER OR NOT THINGS ARE IN THE SESSION LAWS FOR WHETHER OR NOT IT'S GERMANE. I AM SURE IF YOU GIVE ME A LITTLE BIT LONGER I CAN FIND MANY SECTIONS OF THE STATUTES THAT ARE AMENDED BY THIS LAW. CLEARLY SP1 PINTO MENTIONED IT IS DOING WITH THE SAME TOPIC AND THIS IS A ALMOND ABYSS. I'M SURE THERE SECTIONS OF STATUTE THAT ARE BEING AMENDED HERE THAT ARE THE SAME ONES. WE SHOULD NOT BE LOOKING TO WHETHER A SPECIFIC SECTION OF THE SESSION LAWS HAVE BEEN AMENDED. THAT'S NOT SOMETHING WE TYPICALLY WENT ON AND ENCOURAGE THE SPEAKER TO FIND THE POINT OF ORDER NOT WELL TAKEN >> HOUSE SPEAKER: FURTHER ADVICE? REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: I JUST WANT TO REMIND YOU THAT EARLIER TODAY WE ADOPTED ANOTHER AMENDMENT TRAN HAGAN AMENDED THE A- AND THAT DEALS WITH INSURANCE.AND BY REPRESENTATIVE TRAN HAGAN SAID; DEALS WITH INSURANCE. IT SAYS IT APPLIES TO INDIVIDUAL HEALTH PLANS SO INS IDE OF MNSURE OUTSIDE OF MNSURE. SO WE HAVE-THERE ISN'T HEALTH INSURANCE IS IN THIS BILL. SO; ONCE AGAIN; THIS IS NOT GERMANE TO THE BILL TO A ALMOND ABYSS BILL THAT HAS AN INSURANCE PROVISION IN IT; I DON'T KNOW WHEN THINGS ARE EVER GERMANE. IN AN OMNIBUS BILL THIS ISS WHERE SP1 PINTO WAS IN; IT BRINGS TOGETHER A LOT OF DIFFERENT KINDS OF PROVISIONS AND CERTAINLY; I THINK THIS IS IF THIS IS NOT GERMANE IT SETS A BAD PRECEDENT FOR THIS BODY. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE PINTO >> REPRESENTATIVE PINTO I WANT TO RESPOND TO THE POINT REPRESENTATIVE HOPPE WE KEEP ON TOSSING OUT THESE SMALL OBJECTIVE TESTS OF SAYING WELCOME AND WE SEE THE SECTION IS IT INCREASED NUMBER OF PAGES? THERE'S TWO PROBLEMS WITH ANY OF THOSE TESTS MR. SPEAKER. ONE PROBLEM IS WHEN WE APPLY THOSE TESTS TO ANY AMENDMENT PROPOSED BY THE MAJORITY SOMETIMES THOSE TEST DISAPPEAR. WE DON'T USE THOSE TEST THEM THAT'S CLEARLY UNFAIR AND DOES NOT WORK UNDER THE RULES. THE SECOND IT IGNORES THE FUNDAMENTAL ISSUE OF GERMANENESS IS DOES IT SUBSTANTIALLY CHANGE THE UNDERLYING BILL OR AMENDMENT IN THIS CASE THERE CERTAINLY HEALTH INSURANCE CONTAINED IN IT AS THE MEMBERS [INAUDIBLE] THIS COULD MEET CERTAINLY IS WELL OF THE AMENDMENTS PROPOSED BY THE MAJORITY. IF MEMBERS IF THE SPEAKER WOULD LIKE OF THE SAME RULES APPLY BOTH DIRECTIONS THE MATTER WHICH PARTY IS IN THE MAJORITY I THINK THAT ABSOLUTELY; NOW IS THE TIME TO HAVE THE RULES APPLY IN A FAIR AND BALANCED WAY AND MR. SPEAKER DEFINED THE POINT OF ORDER NOT WELL TAKEN. >> HOUSE SPEAKER: FURTHER ADVICE? THANK YOU; MEMBERS. FOR THE PURPOSE OF THE GENTLEMAN RISE? >> REPRESENTATIVE HOPPE I WILL WITHDRAW THE POINT OF ORDER >> HOUSE SPEAKER: THE POINT OF ORDER HAS BEEN WITHDRAWN FROM TO THE AMENDMENT CHAIRMAN KNOBLACH>> REPRESENTATIVE KNOBLACH I RISE TO A POINT OF ORDER UNDER RULE [INAUDIBLE] 4.0 THE MR. SPEAKER IF YOU LOOK UNDER PAGE 5 OF THE AMENDMENT YOU WILL SEE THEIR TAKING $200 MILLION FROM THE HEALTH CARE ACCESS FUND THAT RIGHT NOW; IS GOING INTO THE REINSURANCE PROGRAM AND INSTEAD PUTTING INTO THIS PROGRAM. THE $200 MILLION IN THE HEALTHCARE AXIS FUND AS PART OF THE REINSURANCE PROGRAM IS NOT PART OF THE HEALTH AND HUMAN SERVICES TARGET. WE HAVE SET A TARGET FOR THE HEALTH CARE ACCESS FUND FOR THE HEALTH AND HUMAN SERVICES BUDGET; BUT IT DID NOT INCLUDE THIS NUMBER THIS IS OUTSIDE IS CLEARLY BREAKS THE BUDGET RESOLUTION. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: THIS IS A BUDGET NEUTRAL AMENDMENT. IT'S ABSOLUTELY BUDGET NEUTRAL IN THAT IT JUST TAKES MONEY THAT IT IS FUNDED BY MONEY THAT'S ALREADY SPEND IT JUST TAKES IT AND RE-PURPOSES MONEY THAT'S ALREADY BEEN PURPOSED. YOU KNOW; ONCE AGAIN; YOU KNOW THERE'S ALWAYS A REASON TO THERE'S ALWAYS GOING TO BE LOTS OF REASONS THIS IS AN OPPORTUNITY FOR MEMBERS TO BE ABLE TO FIX WHAT SHOULD HAVE BEEN FIXED THE FIRST TIME AND THAT IS TO MAKE SURE THAT PEOPLE HAVE ARE ABLE TO AFFORD HEALTH INSURANCE FOR THE NEXT COUPLE YEARS NO MATTER WHAT REPUBLICANS IN CONGRESS DO TO US. SO; MEMBERS; MR. SPEAKER; IT IS NOT USING ANY NEW MONEY BUT IT'S NOT ADDING ANY NEW MONEY; SPENDING ANY MONEY WITHIN THE TARGET IT'S USING FUNDS OUTSIDE THE TARGET AND IT'S JUST REPURPOSE SEEN THOSE FUNDS PRETTY MUCH FOR THE SAME PURPOSE BUT INSTEAD OF GIVING IT TO INSURANCE COMPANIES IT JUST ERECTS IT RIGHT TO THE CONSUMER. >> HOUSE SPEAKER: ADVICE? REPRESENTATIVE KNOBLACH >> REPRESENTATIVE KNOBLACH ON FURTHER ADVISED YOU TO SORT REPRESENTATIVE LIEBLING MAKE THE ARGUMENT HERSELF SHE SAID THIS IS MONEY OUTSIDE THE TARGET. YES; ON A NET BASIS WERE NOT SPENDING ANY MORE MONEY BUT THIS IS NO DIFFERENT THAN IF WE TOOK MONEY OUT OF THE EDUCATION BUDGET ; AND SAID WERE GONNA TAKE $100 MILLION OUT OF THE EDUCATION TARGET ; BUDGET AND SPEND IT IN HEALTH AND HUMAN SERVICES. THIS $200 MILLION OF HEALTHCARE AXIS FUND BEING PROPOSED TO BE SPENT IS NOT PART OF THE HEALTH AND HUMAN SERVICES TARGET NOW SHE'S PROPOSING TO TAKE IT FROM ELSEWHERE AND SPEND IT HERE. IF MR. SPEAKER; IF YOU WOULD GO AHEAD AND RULE AGAINST MY POINT OF ORDER YOU WOULD DESTROY THE WHOLE 4.03 RULE BECAUSE PEOPLE TAKE MONEY FROM ANY AIR EDUCATION ENVIRONMENT; WHATEVER SPEND IT IN A DIFFERENT AREA AND AS LONG AS THEY WERE TAKING THE SAME AMOUNT FROM ONE AREA AND SPENDING IT IN A DIFFERENT AREA WOULD NOT MATTER BUT CLEARLY IT WOULD MATTER BECAUSE WE SET TARGETS FOR THESE INDIVIDUAL COMMITTEES. PLEASE; RULE AGAINST THE LIEBLING AMENDMENT >> HOUSE SPEAKER: FOR THEIR ADVICE? FURTHER ADVICE? AFTER LISTENING TO ADVICE FROM REPRESENTATIVE LIEBLING; TRAN KNOBLOCH KNOBLACH; I FIND THE POINT OF ORDER UNDER 4.03 IS WELL TAKEN. >> [GAVEL] >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: PEARSON MOVED TO AMEND SENATE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENDMENT IS CODED A- 24 >> HOUSE SPEAKER: REPRESENTATIVE PIERSON BTV PIERSON: HOUSE FILE >> REPRESENTATIVE PIERSON THE AMENDMENT A- 24 WAS SOMETHING I HAVE TO SOMETHING I TO WANT TO AVOID THIS IS THE OMBUDSMAN BILL TO THE OMNIBUS BILL. THE OMBUDSMAN AMENDMENT IS BASICALLY HAD BEEN TRAVELING THROUGH EARLIER AS HOUSE FILE 1229 AND HOUSE FILE 1229 DID JUST--DID I SAY IT WRONG? I PRACTICED SAYING IT WRONG SO I GET A GOOD LAUGH AT YOU GUYS BUT THIS DID TRAVEL ACTUALLY WAS REFERRED TO THE FLOOR AND APPARENTLY DID NOT GET THROUGH EVERYTHING IN THE SENATE SIDE WERE PUTTING IT IN HERE ON THE OMNIBUS BILL SO THE OMBUDSMAN BILL CAN TRAVEL. THANK YOU. >> HOUSE SPEAKER: DISCUSSION TO THE A- 24 AMENDMENT? DISCUSSION? REPRESENTATIVE LOEFFLER >> REPRESENTATIVE LOEFFLER: THE OMBUDSMAN PERSON OFFICE HAS DONE A VALUABLE JOB BOTH IN TERMS OF RESPONDING TO INDIVIDUAL COMPLAINTS BUT ALSO HELPING IT SHAPE OUR HOMESTEAD PLAN AND RESPOND TO A VARIETY OF KEY ISSUES AND I SUPPORT THE AMENDMENTS. >> HOUSE SPEAKER: FURTHER DISCUSSION TO THE A- 24 AMENDMENT ? ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: BAKER MOVED TO AMEND SENATE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE MM AND IS CODED A- FOUR >> HOUSE SPEAKER: REPRESENTATIVE BAKER. >> REPRESENTATIVE BAKER: AS MENTIONED THIS EARLIER IN MY OPENING REMARKS REGARDING OPIOIDS BUT WITH THIS IS DOING IS JUST SORT OF CLARIFYING FOR OUR PHARMACIST THAT WILL BE DISPENSING BETTER INFORMATION TO PEOPLE THAT ARE GOING TO BE DISPENSING A SCHEDULE TO DRUG; OPIOIDS; TO MAKE SURE WE GET A STICKER INSTEAD OF A PIECE OF PAPER CLARIFYING THE RISKS IN A VERY SIMPLE LARGER FONT SO THAT EVERYBODY KNOWS HOW CLEARLY THIS-THESE DRUGS ARE AND HOW ADDICTIVE THEY CAN ALSO; HOW DO YOU DISPOSE OF EXTRA DRUGS AS WELL THIS IS ACTUALLY HOPEFULLY A STICKER ON TOP OF THAT. THIS IS WHAT THIS BILL DOES GOOD IT'S VERY SIMPLE. WE'LL GET ALL THE LANGUAGE PERFECT IN THE CONFERENCE COMMITTEE I APPRECIATE YOUR SUPPORT. >> HOUSE SPEAKER: DISCUSSION TO THE A- FOUR AMENDMENT? ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. THE AMENDMENT IS ADOPTED. >> [GAVEL] >> HOUSE SPEAKER: THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: GRUENHAGEN MOVED TO MEN SENATE FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED AND THE AMENITIES CODED A- FIVE >> HOUSE SPEAKER: REPRESENTATIVE GRUENHAGEN >> REPRESENTATIVE GRUENHAGEN: WHAT THIS AMENDMENT DOES IT ADDRESSES A PROBLEM IN THE SMALL GROUP AREA. THAT WOULD BE [INAUDIBLE] 15 UNDER AS FAR AS EMPLOYEES. THE CURRENT SITUATION IS THIS. I GUESS THE BEST WAY TO DO THIS IS TO JUST GIVE YOU AN EXAMPLE IF I AM AN EMPLOYER WITH 20 EMPLOYEES I HAVE TO HAVE UNDER THE ACA A 75% PARTICIPATION RATE IN ORDER TO FORM A SMALL GROUP. IF SIX OF MY EMPLOYEES ARE COVERED THROUGH MNSURE I CANNOT COUNT THEM AS AN EXCLUSION FROM THE 75% REQUIREMENT. SO THE RESULT IS ONLY OF 14 EMPLOYEES WHO WANT TO FORM A SMALL GROUP AND THAT WOULD BE LESS THAN THE 75% REQUIREMENT.. THE RESULT IS; I CAN FORM A SMALL GROUP EVEN THOUGH PEOPLE HAVE HEALTH INSURANCE THROUGH MNSURE SO WHAT MY AMENDMENT DOES;-BY THE WAY UNDER THE ACA; IT DID RECOGNIZE THIS PROBLEM FOR SMALL GROUPS AND IT DID MAKE AN EXCEPTION WHERE GROUPS THAT FELL INTO THAT CATEGORY ; WHERE THEY CANNOT REACH THE 75% PARTICIPATION; THEY COULD FORM A SMALL GROUP BUT THEY ONLY -THE ONLY LEAVE A ONE MONTH-NOVEMBER 15-DECEMBER 15 ; WINDOW TO FORM THE SMALL GROUP. SO IT MAKES IT DIFFICULT AGAIN; WERE NOT EXPANDING THE ENROLLMENT. WHAT MY AMENDMENT DOES; IS; IT ALLOWS AN EMPLOYER TO EXCLUDE PEOPLE WHO ARE INSURED THROUGH THE MNSURE WHEN SUB WEBSITE ON AN INDIVIDUAL HEALTH INSURANCE CANNOT COUNT AGAINST THE 75% PARTICIPATION. THEREFORE; THE SMALL GROUP EMPLOYER CAN FORM HIS GROUP AND PROVIDE HEALTH INSURANCE FOR HIS EMPLOYEES. WITH THAT; MEMBERS; I WILL STAND FOR ANY QUESTIONS BUT I WOULD APPRECIATE YOUR SUPPORT. THANK YOU >> HOUSE SPEAKER: DISCUSSION TO THE A- FIVE AMENDMENT? REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: I RISE TO A POINT OF ORDER UNDER RULE 4.03. THIS AMENDMENT REQUIRES A WAIVER IN ORDER TO IMPLEMENT IT. THE DEPARTMENT OF COMMERCE JUST OFFERED; OR JUST PURSUED A WAIVER COST $155;000 TO DO THAT. THEREFORE; THIS AMENDMENT EXCEEDS THE BUDGET TARGET AND IS OUT OF ORDER. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE GRUENHAGEN >> REPRESENTATIVE GRUENHAGEN: YES; MY ADVICE WOULD BE THAT YES; IT DOES REQUIRE A WAIVER .. THERE IS A COST BUT I BELIEVE THERE IS A PRECEDENT SET THAT THE DEPARTMENT AT TIMES ABSORBS THAT $155;000 COST I DO FIND THAT TO BE A LITTLE BIT HIGH TO APPLY FOR A WAIVER AND MR. SPEAKER; I WOULD URGE YOU FIND A POINT OF ORDER; NOT WELL TAKEN. >> HOUSE SPEAKER: ADVICE? REPRESENTATIVE CARLSON >> REPRESENTATIVE CARLSON: WITH A BUDGET RESOLUTION WE CAN'T JUST SIMPLY START PASSING AMENDMENTS HERE THAT VIOLATE THE RESOLUTION BY SAYING THAT THE DEPARTMENT SHOULD OR CAN ABSORB THE COST IT'S A REAL COST AS YOU JUST HEARD OF $155;000 AND THEREFORE; I WOULD ARGUE IS IN VIOLATION OF THE BUDGET RESOLUTION. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE PINTO >> REPRESENTATIVE PINTO: I POINT OUT-AS ADVICE; REPRESENTATIVE GRUENHAGEN IS CORRECT THERE'S A PRECEDENT SET. THAT PERSON IS THE LIEBLING AMENDMENT THAT WAS RULED OUT OF ORDER 4.03 UNDER SIMILAR SICKNESSES AND I WOULD URGE YOU TO FIND THE POINT OF ORDER WELL TAKEN. >> HOUSE SPEAKER: REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY FOR THEIR ADVICE. WHEN WE PASS THE REINSURANCE BILL THE FEDERAL WAIVER EMBEDDED IN A PIECE OF LEGISLATION WAS ACCOUNTED FOR. THE APPROPRIATION WAS 155;000 DOCKET IT WAS IN THE BILL AND IT WAS REAL MONEY. THIS WOULD BREAK THE BUDGET AGREEMENT THIS WOULD BREAK THE BUDGET TARGET AND THEREFORE IT'S OUT OF ORDER >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE GRUENHAGEN >> REPRESENTATIVE GRUENHAGEN: I WILL YIELD TO CHAIRMAN KNOBLACH >> HOUSE SPEAKER: I WILL RECOGNIZE CHAIRMAN KNOBLACH >> REPRESENTATIVE KNOBLACH I WOULD JUST SAY THIS IS NOT LIKE THE LIEBLING AMENDMENT THE LIEBLING AMENDMENT TOOK $200 THAT WAS IN A DIFFERENT AREA; NOT PART OF THIS BUDGET TARGET AND ESSENTIALLY TRIED TO TRANSFER IT INTO THIS BUDGET TARGET. THIS IS SIMPLY SAYING THAT THE AGENCY MUST ABSORB THIS MONEY AND IT'S A QUESTION BASICALLY AS TO WHETHER PEOPLE BELIEVE THE AGENCY HAS THE ABILITY TO DO THAT. >> HOUSE SPEAKER: ADVICE? REPRESENTATIVE CARLSON >> REPRESENTATIVE CARLSON: FURTHER ADVICE. THE ISSUE HERE IS A VERY IMPORTANT PRINCIPLE I MEAN WE JUST CAN'T START TAKING UP AMENDMENTS ON THE HOUSE FLOOR LIKE THIS AND SIMPLY SAY THAT THE DEPARTMENT; ANY DEPARTMENT FOR THAT MATTER; SHOULD SIMPLY ABSORB THE COST. I MEAN; WHERE DO YOU BEGIN?OTH CHAIRMAN KNOBLACH AND MYSELF [INAUDIBLE] IF THERE'S ANY COST ON OF ALL THAT'S GOING THROUGH I THINK WE'VE HAD DIFFERENT NUMBERS EITHER 2000 OR $3000 AND MUST GO TO WAYS AND MEANS. THAT'S HOW TIGHTLY WE WATCH THE BUDGET OVER IN WAYS AND MEANS UNDER BOTH DEMOCRATIC AND REPUBLICAN LEADERSHIP. SO ANY PROPOSAL THAT IS AT $155;000 IS A BUDGET BUSTER AND I WOULD HOPE YOU WOULD RULE ACCORDINGLY. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN FOR ADVICE I WILL WOULD SAY WE ASKED THE DEPARTMENT TO DO THESE THINGS ALL THE TIME. THEY HAVE A VARIETY OF COSTS AND I WOULD QUESTION THE $155;000 OF WHETHER OR NOT THAT WOULD REQUIRE $155;000 OF ACTUARIAL WORK WITHIN THE DEPARTMENT.. MY GUESS IS IT WOULD NOT AND THAT WE COULD DO THIS WITHOUT THAT MUCH WORK; AND REALLY WOULD QUESTION WHY IT WOULD BE THAT EXPENSIVE TO FILL OUT A WAIVER WITHOUT THE ACTUARIAL DATA THAT HAS BEEN REQUIRED THE PREVIOUS COST ESTIMATE FROM MMB. >> HOUSE SPEAKER: ADVICE TO THE SPEAKER? REPRESENTATIVE GRUENHAGEN >> REPRESENTATIVE GRUENHAGEN: AFTER HEARING THE ADVICE PRO; AND GONE ON A BIPARTISAN BASIS I'LL DECIDE TO WITHDRAW THE AMENDMENT >> HOUSE SPEAKER: THE AMENDMENT HAS BEEN WITHDRAWN. THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: LIEBLING MOVED TO MINUTE CENTER FILE 800 UNOFFICIAL ENGROSSMENT AS AMENDED; AND THE AMENDMENT IS CODED A- 56 >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: THIS AMENDMENT IS THE PRIOR AUTHORIZATION BILL; PRIOR AUTHORIZATION HAVING TO DO WITH GETTING HER MEDICATIONS WHEN YOU'RE COVERED BY INSURANCE. THIS AMENDMENT BEFORE YOU HAS BEEN CHANGED SLIGHTLY FROM THE ORIGINAL BILL IN ORDER TO FIRST OF ALL; NOT HAVE A FISCAL NOTE. SO IT EXCLUDES STATE PROGRAMS. IT ONLY APPLIES IN THE PRIVATE AREA AND IT ALSO PASSED THE OTHER BODY WITH VERY OVERWHELMING SUPPORT. THIS; AS YOU KNOW; IS AN ISSUE REPRESENTATIVE HAMILTON CARES ABOUT VERY DEEPLY. WE'VE HAD A CONVERSATION ABOUT IT AND I KNOW HE WILL WANT TO SPEAK TO IT. I SEE HE IS RISEN THEREFORE RECOGNITION; BUT WHAT I WANT TO SAY ABOUT THIS; MEMBERS; THIS IS REALLY ANOTHER ISSUE ABOUT WHICH SIDE YOU ARE ON TO ARGUE ON THE SIDE OF INSURANCE COMPANIES; OR ARE YOU ON THE SIDE OF PATIENTS? CONSUMERS? THIS; THE LANGUAGE IN THIS AMENDMENT;; IS VERY COMMON SENSE STUFF. WE ARE NOT ASKING FOR THE MOON HERE. ALL WE ARE ASKING FOR IS A LITTLE BIT OF CONSISTENCY SO THAT WHEN YOU GET YOUR INSURANCE AND YOUR TOLD YOU GET CERTAIN DRUG COVERAGE UNDER THAT INSURANCE THAT THEY DON'T CHANGE IT ON YOU WITHOUT A GOOD REASON TO THAT SEEMS PRETTY COMMON SENSE TO ME. THE OTHER PIECE OF THIS IS THAT THERE'S SOME TRANSPARENCY ABOUT WHAT'S GOING TO BE INCLUDED WHEN YOU BUY THAT INSURANCE. WHAT IS GOING TO BE COVERED. SO INSURANCE COMPANIES HAVE WHAT IS CALLED A DRUG FORMULARY THAT TELLS YOU WHAT IS CAN BE COVERED AND IT SEEMS LIKE THAT SOMETHING WHEN YOU BUY YOUR INSURANCE YOU OUGHT TO BE ABLE TO KNOW WHAT THAT IS. SO I THINK IT'S A PRETTY COMMON SENSE OF BILL. I DON'T KNOW WHY IT'S BEEN SO DIFFICULT TO GET THIS HEARD IN THE HOUSE OF REPRESENTATIVES. CURRENTLY; THE OTHER PARTY HAS NO TROUBLE WITH IT AT ALL. I REALLY APPRECIATE THAT REPRESENTATIVE HAMILTON HAS BEEN WORKING ON THIS SO HARD AND PUTTING SO MUCH HEART AND SOUL INTO IT AND I'M SURE WE WILL HEAR FROM HI M ABOUT WHY THIS IS SO IMPORTANT. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE HAMILTON >> REPRESENTATIVE HAMILTON: THANK YOU REPRESENTATIVE LIEBLING FOR BRINGING THIS UP. YOU KNOW; WE HAVE RECEIVED SOME MEDIA ATTENTION ALONG THE WAY AND THE OUTPOURING OF SUPPORT HAS BEEN ABSOLUTELY OVERWHELMING IN A GOOD WAY. I HAVE RECEIVED EMAILS AND PHONE CALLS; LETTERS OF SUPPORT INDIVIDUALS NOT ONLY FROM MINNESOTA BUT IOWA; NORTH DAKOTA; SOUTH DAKOTA; KENTUCKY; TEXAS; BEEN CONTACTED BY PEOPLE ALL OVER THE NATION. YOU KNOW; AS FAR AS THE MEMBERS HERE; I WAS GOING TO SHARE WITH EVERYBODY AND EMAILS I'VE BEEN RECEIVING FROM ANY OF YOUR DISTRICTS BUT I WILL SIMPLY SAY THIS. THE NUMBER OF STORIES THAT ARE INCLUDED IN HERE AS FAR AS PEOPLE THAT HAVE BEEN IN MY OPINION; WRONGED; BY THIS VERY ISSUE -AGAIN IT'S ABSOLUTELY OVERWHELMING AND I BELIEVE IT IS WRONG. I'LL HOPE LIKE BLUE CROSS BLUE SHIELD ON THE CALL YOU OUT JUST FOR A MOMENT BECAUSE I DO HAVE INSURANCE WITH YOU AND I WANT YOU TO CONSIDER SOMETHING. I WAS DENIED A PRESCRIPTION DRUG THAT I PAID OUT-OF-POCKET THAT COST $37.07 TO BUY. NEXT WEEK WHEN WE ARE ON BREAK AND EVERYBODY'S HOME WITH THEIR FAMILIES I'M GOING TO BE AT THE MAYO CLINIC FOR TWO DAYS I'M GOING TO BE MEETING WITH A THERAPIST OCCUPATIONAL THERAPIST. I'M GOING TO BE MEETING WITH THE PHYSICAL THERAPIST I'M GOING TO A CITY CLINIC FOR NEW WHEELCHAIR. NOW SOMEONE PLEASE ASK WAYNE TO ME HOW THAT IS SAVING MONEY IN HEALTHCARE INDUSTRY.. IT'S ABSOLUTELY RUN FOR IT IS SHAMEFUL. NOW; I BELIEVE THAT WHEN THE PHARMACY BENEFITS MANAGER I BELIEVE WHEN I WAS FIRST PUT TOGETHER W ERE BROUGHT FORWARD; I BELIEVE THE PURPOSE WAS A VALID ONE TO TRY TO SAVE COSTS FOR THE CONSUMER. BUT I BELIEVE THERE PURPOSE TODAY -AND THIS IS WHAT I STRUGGLE WITH-THERE PURPOSE TODAY IS ABOUT PROFIT FOR SHAREHOLDERS. NOW; I BELIEVE IN CAPITALISM MY FRIENDS AND THIS IS-I HOPE YOU ARE LISTENING- I BELIEVE IN CAPITALISM; BUT CAPITALISM WITHOUT A CONSCIENCE IS PURE EVIL. PEOPLE ARE BEING HURT THEY'RE ABSOLUTELY BEING HURT. NOW REPRESENTATIVE LIEBLING; I SPOKE TO MY DEAR FRIEND CHAIRMAN OF HEALTH AND HUMAN SERVICES FINANCE COMMITTEE AND I'VE BEEN PROMISED A HEARING ON THIS. LIKE YOU SAID WE HAVE OVERWHELMING SUPPORT IN THE SENATE AND IT'S IN THE SENATE BILL. SO I WOULD ASK AT THIS TIME; AT THIS TIME; LET'S WORK THROUGH THE PROCESS. IF I COULD ASK YOU TO WITHDRAW YOUR AMENDMENT TODAY AND CHAIRMAN MATT DEAN DID SAY HE WOULD GIVE US A HEARING AND I'M FIRED UP I'M READY TO GO. I'M GOING TO HAVE OUR DAY IN A HEARING SHARE OUR STORIES AND MANY MANY OTHERS. WITHOUT MR. SPEAKER; I THINK YOU FOR YOUR TIME. >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: THANK YOU REPRESENTATIVE HAMILTON. WE WERE IN THE SAME CLASS. WE WERE ELECTED THE SAME YEAR AND I VALUED YOUR FRIENDSHIP AND YOU BRING SO MUCH TO THIS BODY. THE ONLY THING I WANT TO SAY IN ADDITION IS THAT WHAT WE'RE REALLY TALKING ABOUT HERE IS THAT HEALTHCARE OUGHT TO BE A RIGHT TO HEALTHCARE IS A HUMAN RIGHT AND INSURANCE COMPANIES ARE NOT ABOUT GIVING YOU HEALTHCARE; EVEN THE ONES THAT ARE NONPROFIT; THEY ARE REALLY ABOUT THE BOTTOM LINE. WE CAN DO BETTER THAN THAT. WE COULD DO BETTER FOR MINNESOTANS. WE HAVE TO. BECAUSE FOR EVERY ROD HAMILTON THAT ALL OF US LOVE; THERE'S LOTS OF OTHER PEOPLE EVEN IN OUR OWN FAMILY OUR OWN COMMUNITY WANT TO BE ABLE TO GET THE HEALTHCARE THEY NEED AND WHEN WE DENY THEM THAT HEALTHCARE IT DOESN'T SAVE MONEY. IT JUST KEEPS PEOPLE FROM LIVING FULL PRODUCTIVE LIVES THAT THEY COULD OTHERWISE BE LIVING AND IN A LOT OF CASES IT ENDS UP COSTING MORE MONEY. THANK YOU REPRESENTATIVE HAMILTON I APPRECIATE THE OPPORTUNITY TO HAVE THE DISCUSSION. MR. SPEAKER I WITHDRAW THE AMENDMENT >> HOUSE SPEAKER: THE A- 56 AMENDMENT HAS BEEN WITHDRAWN. THERE IS AN AMENDMENT AT THE DESK. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: ALBRIGHT MOVED TO MINUTES AND A FILE 800 UNOFFICIAL ENGROSSMENT IS AMENDED AND THE AMENDMENT IS CODED A- EIGHT >> HOUSE SPEAKER: REPRESENTATIVE ALBRIGHT >> REPRESENTATIVE ALBRIGHT MEMBERS; THIS IS AN AMENDMENT THAT REMOVES DUPLICATE OF LANGUAGE IN THE BILL AND I WOULD URGE A GREEN VOTE. THANK YOU >> HOUSE SPEAKER: DISCUSSION? ON THE A- EIGHT AMENDMENT; DISCUSSION? ALL THOSE IN FAVOR SAY; AYE. [CHORUS OF AYES.] OPPOSED; NAY. THE MOTION PREVAILS. >> [GAVEL] >> HOUSE SPEAKER: THERE'S NO FURTHER MOMENTS AT THE DESPERATE THE COURT WILL GIVE THE BILLET START READING >> CHIEF CLERK: THIRD READING CENTER FILE 800 AS AMENDED >> HOUSE SPEAKER: THIRD READING >> [GAVEL] >> HOUSE SPEAKER: DISCUSSION TO THE BILL? REPRESENTATIVE CONSIDINE >> REPRESENTATIVE CONSIDINE: >> HOUSE SPEAKER: MEMBERS; IT'S GETTING A LITTLE NOISY IN THE CHAMBER. REPRESENTATIVE CONSIDINE >> REPRESENTATIVE CONSIDINE: THE PRIORITIES OF THIS BILL ARE TERRIBLE. THE THINGS THAT ARE LEFT OUT ARE ABOMINABLE. WE HAVE PEOPLE IN ST. PETER THAT ARE GETTING INJURED. WE ARE VULNERABLE ADULTS IN ST. PETER THAT ARE AT RISK. IT HAS BEEN WELL DOCUMENTED. WE HAVE HAD MEETINGS. WE HAVE HAD NE WS COVERAGE; AND THERE IS NOT A DIME IN HERE FOR THE STAFF AT THE MINNESOTA SECURITY HOSPITAL. ORIGINALLY I HAD AN AMENDMENT TO TRY TO ADDRESS THAT THE SECONDARY AMENDMENT M ADE A FARCE OUT OF IT; SO I PULLED IT. I DON'T KNOW HOW YOU CAN LOOK PEOPLE IN THE FACE SOMETIMES WHEN YOU ARE BETRAYING THEM. THESE FOLKS PROVIDE A SERVICE TO THE STATE TAKING CARE OF THE MOST DIFFICULT PEOPLE IN THE STATE. SOME OF THE MOST DANGEROUS PEOPLE IN THE STATE AND NOT A DIME TO TRY TO IMPROVE IT. I AM SORRY. THAT IS JUST AMAZING AND I'M ASHAMED OF IT. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE JOHNSON >> REPRESENTATIVE JOHNSON: I HAVE RISEN ON THIS ISSUE OF STAFFING AT THE SECURITY HOSPITAL LAST YEAR AND I'M PROUD TO DO IT AGAIN. THE MINNESOTA SECURITY HOSPITAL COULD BE IN ANY OF OUR DISTRICTS . IT HAPPENS TO BE IN MINE. I'M REALLY PROUD THAT IT IS THERE. AS IS THE COMMUNITY THAT HOSTED; OUR REGION; IT'S A REMARKABLE INSTITUTION. IT'S BEEN THERE A LONG TIME IT'S CENTRAL TO THE FABRIC OF OUR COMMUNITY. BUT IT IS REALLY A STATEWIDE INSTITUTION. MY GUESS IS ALMOST ALL OF YOU HAVE A CONSTITUENT WHO IS OR HAS BEEN SERVED AND TREATED AND RECEIVED TREATMENT AT THE MINNESOTA SECURITY HOSPITAL. OF COURSE; IT'S NOT ONLY THAT INDIVIDUAL. IT'S ALSO THE FAMILIES THAT DELETE LOVE THOSE PEOPLE AND CARE FOR THEM AND ARE ALSO PART OF THEIR PROGRESS ; PART OF THEIR RECOVERY. SO THIS IS IN ONLY A ST. PETER ISSUE THIS IS IN ONLY A DISTRICT 19 OR MANKATO AREA ISSUE. THIS IS A STATEWIDE ISSUE. WE KNOW THAT THE SECURITY HOSPITAL IS SEVERELY UNDERSTAFFED AND I'LL TALK A LITTLE BIT ABOUT THAT. WE ALSO NEED WE ALSO KNOW THEY NEED A NEW FACILITY MANY OF YOU HAVE TOWARD THAT FACILITY YOU KNOW WHAT I'M TALKING ABOUT AND OBVIOUSLY; WERE HOPING FOR A BONDING BILL LATER ON FOR THE FINAL REPAIRS OF THAT FACILITY BUT THAT'S NOT WHAT WE'RE TALKING ABOUT TODAY TO TALK ABOUT A GAPING HOLE IN THIS OMNIBUS BILL I THINK IT HAD SO MANY PAGES BUT THERE'S NOT A NICKEL FOR ONE MORE STAFF PERSON AT THE SECURITY HOSPITAL. I HEAR REFERENCE MADE MANY TIMES TO HARD-WORKING MINNESOTANS AND I HEAR REFERENCE TO FAMILIES ON THIS FLOOR. I THINK THAT'S APPROPRIATE TALK; BUT I FEEL LIKE I'VE GOT A LOT OF AGENCY TODAY TO TALK TO THIS BODY AND TALK TO MINNESOTA ABOUT SOME OF MINNESOTANS HARDEST WORKING MINNESOTANS. THESE ARE SPECIAL PEOPLE WHO WORK AT THE SECURITY HOSPITAL MANY DIFFERENT TYPES OF JOBS . BUT I ALSO WANT TO REFERENCE THEIR FAMILIES. IT STARTED WHEN I FIRST RAN TO MY RAN ON A SPECIAL ELECTION IN THE WINTER SO IN THE WINTER YOU DON'T DO A LOT OF DOORKNOCKING; I DID DO A LITTLE DOORKNOCKING IN DOWNTOWN ST. PETER I CAME TO A VERY MODEST HOME. IT WAS A HOME THAT HAD SEVERAL KIDS RUNNING AROUND I GOT TO TALK TO THE FATHER AND THE FAMILY. WHO EXPLAINED TO ME THAT HE MADE A CHOICE THAT WAS REALLY HARD ON HIS FAMILY BUT HE FELT HE HAD TO MAKE IT. HE CHOSE TO WORK THE NIGHT SHIFT EVEN THOUGH HE HAS A THREE LITTLE KIDS; I BELIEVE ; HE CHOSE TO WORK THE NIGHT SHIFT AT THE SECURITY HOSPITAL BECAUSE HE FELT SAFER. AFTER THAT; I KNOCKED MY DOORS I GO DOOR TO DOOR A LOT AND I PROBABLY MOST EVERY DOOR IN ST. PETER AT LEAST TWICE. YOU DON'T ONLY MEET THE KIDS IN THESE FAMILIES BEGIN EAT THE PARENTS; THE COUSINS THE BROTHERS IT'S KIND OF A FAMILY AFFAIR. THERE ARE FAMILIES WHO SUPPORT THE INDIVIDUALS WHO WORK AT THE ST. PETER SECURITY HOSPITAL AND BELIEVE ME; THEY ARE ALL CONCERNED ABOUT IT. THEY ARE ALL PROUD AND THE STAFF REMAINS A STRONG SPIRITED CORE TO REMAIN FOCUSED ON CARING FOR PEOPLE WHO NEED A GREAT DEAL OF CARE; BUT THEY'RE ALSO CONCERNED. AS THEIR FATHER; THEIR MOTHER; THEIR BROTHER; THEIR SISTER GOES OFF TO WORK AT THE SECURITY HOSPITAL KNOWING THAT DUE TO THE NATURE OF THAT WORK SOME ROUGH STUFF CAN HAPPEN TO THEM AND THEY COULD BE A VICTIM TO VIOLENCE. IT'S A VERY TOUGH SITUATION FOR THOSE FAMILIES FOR A COMMUNITY TO INDORE. I HOPE YOU TAKE A LOOK AT THE LETTER THAT'S BEEN DISTRIBUTED THIS IS SIGNED BY THE VARIOUS LEADERS OF THE BARGAINING UNITS AND MANAGEMENT AT THE SECURITY HOSPITAL. ABOUT A YEAR AND HALF AGO AT THE INSISTENCE OF THE GOVERNOR-AND THIS IS A GOOD MOVE- THE BUREAU OF MEDIATION SERVICES CAME TO ST. PETER AND DID A SERIES OF CONVERSATIONS WITH THE PEOPLE WHO WORK THERE. I FIND IT IRONIC THAT YESTERDAY W E SEVERELY CUT FUNDING FOR THE BUREAU OF MEDIATION SERVICES. THE PEOPLE INVOLVED IN THAT DISCUSSION IN ST. PETER WILL SAY TO VERY CLEARLY; THAT MADE A DIFFERENCE IN THE WORKPLACE THE CULTURE OF THIS WORKPLACE. THEY AS A RESULT OF THOSE CONVERSATIONS HAVE WORKED TOGETHER TO ADDRESS A NUMBER OF THINGS. A NUMBER OF CHALLENGES THAT THIS HOSPITAL HAS BEEN VERY PROUD INSTITUTION CONDITIONAL LICENSE. ACTUALLY; TWO CONDITIONAL LICENSES. OSHA REPRIMANDS. SAFETY ISSUES. QUALITY OF CARE FOR THE PATIENTS. THEY CAME TOGETHER AND THEY LISTEN TO EACH OTHER AND THEY TALKED WITH EACH OTHER AND THEY ARE DEVELOPING A MUCH STRONGER CULTURE OF CARE AND AN ABILITY TO WORK TOGETHER TO SERVE YOUR NEIGHBORS WHOSE FAMILY WHO HAVE PATIENTS IN THAT HOSPITAL. THEY ARE DETERMINED TO DO IT WELL. THAT SORT OF LISTENING; THAT SORT OF PROGRESS; ABSOLUTELY NEEDS TO CONTINUE. ONE OF THEIR PRIMARY CONCLUSIONS WAS THAT THE HOSPITAL THAT'S VERY IMPORTANT INSTITUTION TO THE STATE; THAT AGAIN BENEFITS PEOPLE FROM ACROSS THE STATE OF MINNESOTA; SOME OF THE MOST CHALLENGING MENTAL HEALTH CASES THAT WE HAVE; THEY DETERMINED THEY ABSOLUTELY NEED TO HAVE MORE STAFFING. THEY ARE RIGHT. I THINK THE MOST POIGNANT WAY TO DEMONSTRATE TO YOU AND TO OTHERS IN MINNESOTA IS BY COMPARING THEIR STAFFING LEVELS TO SIMILAR INSTITUTIONS TO OTHER STATE INSTITUTIONS WHETHER BE HOSPITALS TREATMENT FACILITIES; OR HIGHER EDUCATION INSTITUTIONS COMPARE THEMSELVES TO PEER INSTITUTIONS. HERE THE ST. PETER SECURED A HOSPITAL IN ST. PETER HAS COMPARED ITSELF TO A SIMILAR FACILITY IN FULTON MISSOURI IN THE STATE HOSPITAL IN THE STATE OF OREGON. THE STAFF RATIOS AT THOSE TWO FACILITIES ARE 3.3 STAFF PER PATIENT. IT TAKES A LOT OF PEOPLE TO STAFF A FACILITY 24-7 EVERY DAY YOUR THIS GOES ON ALL THE TIME AND TAKES A LOT OF PEOPLE TO STAFF THOSE FACILITIES AND IN OREGON IN MISSOURI THERE BY 3.3 STAFF FOR EVERY PATIENT. WHAT IS IT IN ST. PETER? 2.2. 2.2. COMPARED TO WHAT THEY'RE DOING AND OR GONE IN MISSOURI JUST RADICALLY LOWER. ARE WE SURPRISED THERE'S A PROBLEM WITH CARE AND TREATMENT AT THE ST. PETER STATE HOSPITAL; MINNESOTA'S SECURITY HOSPITAL IN ST. PETER? I AM NOT. THAT'S SO OBVIOUS THAT WE NEED MORE STAFF. THE GOVERNOR BACK THAT UP AND ASKED FOR 90 MORE STAFF I BELIEVE IN THIS YEAR AND WRAP IT UP TOWARDS 150 ADDITIONAL STAFF IN THE NEXT COUPLE OF YEARS. THEY ABSOLUTELY NEED THE ADDITIONAL STAFF. IT'S TO BACK THEM UP. IT'S TO MAKE SURE THEY CAN HAVE THE PEOPLE THEY NEED TO APPROPRIATELY CARE FOR THESE FOLKS. TO DEAL WITH CRISIS SITUATIONS WHICH DO ARISE. I WILL TELL YOU; I HAD AN OPPORTUNITY A COUPLE OF SUMMERS AGO TO WATCH -I WAS ON A TOUR. AT A PERSONAL TOUR OF THE FACILITY BECAUSE THE SAFETY ISSUES WERE BIG AT THAT POINT I WAS GIVEN A PRIVATE TOUR. AT ONE OF THE UNITS; A SITUATION ESCALATED IT IMMEDIATELY GOT ME INTO A SAFE SPOT TO SPOT WHERE I COULD OBSERVE. I CAN'T -IT'S HARD FOR ME TO DESCRIBE THE PROFESSIONALS AM I OBSERVED THE STAFF RESPONDED TO THAT IN SUCH A MATURE WAY; IN SUCH A-JUST A PROFESSIONAL WAY; THAT THEY CAREFULLY AND CALMLY WORKED THIS RISING ESCALATING SITUATION DOWN SO IT WAS SOLVED AND SOLVED RIGHT THERE. THEY DON'T-AREN'T ALWAYS ABLE TO DO THAT AND REALLY REQUIRES AN AMAZING AMOUNT OF PROFESSIONAL JUDGMENT RIGHT AT THE MOMENT AND REALLY; ASKS A LOT OF PEOPLE OF THE WORKDAY. IT'S HARD TO DESCRIBE THAT YOUR NOW WHEN WE DON'T STAFF THE SECURITY HOSPITAL WHAT HAPPENS IS THERE'S A LOT OF OVERTIME. THERE'S A WHOLE LOT WHICH TO ME IS A KIND OF A WASTE OF OUR MONEY BUT IF IF THERE'S NOT ENOUGH STUFF WE HAVE TO KEEP ALL ON BOARD BECAUSE IT'S NOT A PLACE WHERE YOU JUST KIND OF SHUT DOWN FOR THE EVENING. NO. YOU CAN NEVER SHUT DOWN FOR THE EVENING. AGAIN; REMEMBER; THIS A PLACE WE NEED REMARKABLY GOOD JUDGMENT AT THE MOMENT AND JUST CHALLENGES MY MIND HOW CAN YOU EXPECT OUR TEAM THAT'S WORKING AT THE SECURITY HOSPITAL TO EXERCISE GOOD JUDGMENT WITH ON THE 14TH; OR 15TH HOUR OF A 16 HOUR SHIFT AND THAT'S WHAT WERE ASKING THEM TO DO WITH THIS BILL. NOT ONLY DOES IT NOT GET ANY ADDITIONAL STAFF BECAUSE OF THE FLATLINING FOR DIRECT CARE AND TREATMENT . THEY EXPECT TO NOT HAVE TO FILL 44 POSITIONS OVER THE NEXT COUPLE OF YEARS. NOT ONLY ARE WE NOT GAINING THE STAFF WE NEED; HE WILL BE LOSING WHAT DOES THAT SAY TO OUR HARD-WORKING MINNESOTANS? WHO CARE FOR OUR NEIGHBORS IN THE MINNESOTA STATE SECURITY HOSPITAL? IS FRANKLY AN INSULT TO THEM IT'S AN INSULT TO THOSE PATIENTS. JUST WRONGHEADED. LAST YEAR I TALKED A LOT ABOUT THIS ON THE FLOOR. I ASKED A BUNCH OF QUESTIONS THAT WILL TELL YOU THE INTERESTING I GOT FROM THAT WAS FROM THE CHAIRMAN OF THE COMMITTEE THAT THEY UNDERSTOOD THE CHALLENGE. OKAY. LAST YEAR THE LEADERSHIP FROM THE HOUSE OF REPRESENTATIVES WAS INVITED DOWN TO VISIT THE FACILITY IN ST. PETER. ANY EXPRESSIONS WERE MADE; WE UNDERSTAND WHAT'S GOING ON CAN WE UNDERSTAND THE CHALLENGES. IT JUST ABSOLUTELY BEGS THE QUESTION; WHY ISN'T THEIR RESPONSE IN THIS BILL? WHY IS THERE NOT A RESPONSE IN THIS BILL TO MEET THESE NEEDS FOR OUR HARD-WORKING MINNESOTANS WHO CARE FOR SOME OF OUR MOST VULNERABLE ADULTS IN THIS STATE? IT'S AN ABSOLUTE TRAVESTY; AND I CAN'T AND I CAN ACCESS MY DISAPPOINTMENT FOR MY ANGER OR FRUSTRATION ITCHES FUNDAMENTALLY WRONG . TO BE HONEST MY THINK WE JUST HAVE A MORAL IMPERATIVE HERE. SO IT'S A MORAL IMPERATIVE WE ARE NOT MEETING. OUR MINNESOTA STATE SECURITY HOSPITAL TEAM; THE PATIENTS IN THAT HOSPITAL; THE FAMILIES THAT CARE AND LOVE THOSE PATIENTS; ABSOLUTELY NEED OUR HELP. THIS BILL IS JUST DROPPING IT; DROPPING THE BALL COMPLETELY. IT IS WRONG. I AM VOTING; NO; AND I WILL PLEAD AS YOU GO TO CONFERENCE; AS THIS BILL PROCEEDS; REPRESENTATIVE DEAN; AS THIS BILL PROCEEDS; REPRESENTATIVE DEAN; AS THIS BILL PROCEEDS CAN I ASK THAT YOU FIND A WAY TO FUND THE STAFFING THAT THEY NEED IN ST. PETER AT THE SECURITY HOSPITAL. IS A MORAL IMPERATIVE WERE DOING WRONG AT THIS POINT PLEASE; VOTE NO AND JOIN ME IN VOTING DOWN THIS BILL. >> HOUSE SPEAKER: REPRESENTATIVE LOEFFLER >> REPRESENTATIVE LOEFFLER: THOSE OF US WHO OBSERVED YEARS ON HEALTH AND HUMAN SERVICES ARE USED TO ALWAYS FACING UNDERFUNDING . YEARS LONG WAITING LIST OF PEOPLE QUALIFY FOR SERVICES AND NEED THEM AND LISTENING TO TESTIFIER'S TRY; AS THEY SHARE THEIR LIVES LIVES IN DESPERATION AND THEIR DESPERATE HOPE WILL STEP UP AND HELP MAKE THINGS BETTER FOR THEM AND THEIR LOVED ONES AND THE PEOPLE WHO CARE FOR THEM . BUT THIS YEAR WE'VE HIT A NEW LOW. ALL OF US ARE JUST A CAR ACCIDENT OR A FALL OR AN UNEXPECTED MEDICAL DIAGNOSIS AWAY FROM NEEDING THE CARE AND HELP OF OTHERS TO LIVE OUR LIVES. WE WORKED A LONG DAY YESTERDAY BUT MOST OF US WERE ABLE TO GET OUT OF BED ON OUR OWN. WE DO NOT HAVE TO WAIT FOR SOMEONE TO SHOW UP YOU DO NOT HAVE TO HAVE SOMEONE TO LIFT US OUT OF BED HELP US BATHE YOUR HOPE THEY SHOWED UP ON TIME AND SO WE WOULD BE ON TIME FOR OUR JOB. BUT THAT IS THE LIFE OF A LOT OF PEOPLE. OTHER PEOPLE NEED OTHERS TO HELP FIND EMPLOYMENT; KEEP EMPLOYMENT; HAVE SOMETHING CONSTRUCTIVE AND WONDERFUL HAPPENING IN THEIR LIVES. HAVE THE ABILITY TO CONTINUE TO LIVE IN THEIR COMMUNITY WITH A HAVE FRIENDS AND NEIGHBORS AND ACTIVITIES THAT THEY ENJOY. BUT THEY CAN'T DO IT ALL ON THEIR OWN. THIS BILL DOES NOT INCLUDE ANY WAGE INCREASES FOR THE HOME AND COMMUNITY BASED WORKERS WHO WORK WITH THE DISABLED; THE FRAIL ELDERLY; THE PEOPLE WITH INTELLECTUAL DISABILITY FOR ALL OF YOU BEEN TALKED TO BY THE BEST LOTS ALIGNS USED TO BE KNOWN AS THE 5% CAMPAIGN AND THEY SHARE THEIR STORIES OF CONSTANT TURNOVER HOW WOULD YOU LIKE TO HAVE A DIFFERENT PERSON SHOP EVERY SINGLE DAY THAT YOU'VE NEVER MET BEFORE TO DO THE MOST PERSONAL CARE AND GROOMING ITEMS FOR YOU? THAT'S WHAT SOME PEOPLE HAVE TO WORRY ABOUT. THESE ARE THE PEOPLE WHO STEP UP TO THESE JOBS ARE SOME OF THOSE CARING PEOPLE AROUND. BUT THEY AVERAGE; ON AVERAGE; $12 TO $.32 AN HOUR. WHILE THEY LOVE THE PEOPLE THAT THEY WORK WITH AND THEY LOVE HELPING SEE THEM PROGRESS IN THEIR LIVES AND HAVE INDEPENDENCE CONTRIBUTE TO THE QUALITY OF THEIR LIFE; I KNOW ONE WOMAN WHO FIGURED OUT THAT ONE OF HER CHARGES HAD A HARD TIME GETTING UP IN THE MORNING. A LITTLE GRUMPY. SHE FOUND OUT SHE LOVED MUSIC SHE STARTS THINKING; YOU ARE MY SUNSHINE ARE SOME OF THE OTHER FAVORITE SONS AND A PERSON WOULD PERK UP AND EVERYTHING WENT GREAT THAT MORNING TO IF THAT PERSON QUIT; WHO KNOWS IF THE NEXT PERSON WOULD FIGURE OUT OR HOW LONG IT WOULD TAKE. THEY HAVE THE QUALITY OF LIFE THEY SAVE LIVES BY MANAGING SOME OF THE MOST MEDICALLY COMPLEX PEOPLE WE HAVE. PEOPLE IF THEY DID NOT HAVE THESE PEOPLE 24-7 INVOLVED IN THEIR LIVES WOULD BE LIVING IN A HOSPITAL AND SOME OF THEM ARE IN A HOSPITAL WE HEARD ABOUT KIDS IN THE HOSPITAL. LIVING MONTHS; SOMETIMES EVEN OVER YEARS IN THE HOSPITAL WAITING FOR THAT PERSON TO STEP UP AND WORK AS A HOME CARE NURSE FOR LESS THAN HALF OF WHAT A HOSPITAL NURSE WOULD BE PAID. THESE ARE PEOPLE WHOSE LIVES AND QUALITY-OF-LIFE ARE TOTALLY DEPENDENT UPON IT. OVER THE LAST FEW YEARS WE HEARD A GROWING CALL ABOUT THE WORKFORCE CRISIS. I PAID ATTENTION TO IT I KNOW A LOT OF YOU HAVE. THIS YEAR IT BECAME A CRISIS. I AM NOT THE ONE WHO USUALLY GET SURPRISED BY THE DATA AND THE STORIES AND HEALTH AND HUMAN SERVICES; BUT THIS ONE TOTALLY CAUGHT ME OFF GUARD COULD NOT ONLY OTHER 9000 AGENCIES STATEWIDE THAT EVERY DAY ARE CAUSING A PANIC IN SOME PROVIDER OR SOME PERSON'S LIFE; BUT THE NUMBER OF COMPLAINTS TO OUR DEPARTMENT OF HEALTH FOR THE QUALITY OF CARE; THE LACK OF QUALITY OF CARE; THE UNEXPECTED PROBLEMS THAT HAVE ARISEN; THE ABUSE AND MALTREATMENT HAVE MORE THAN DOUBLED. NOW OUR DEPARTMENT OF HEALTH CAN ONLY RESPOND TO 10% OF THE COMPLAINTS THAT COME FROM THE PUBLIC. 1% OF THOSE THAT ARE SELF-REPORTED FROM PROVIDERS. SO OUR SAFETY NET TO PROTECT THESE PEOPLE; BACKSTOP TO FIND OUT WHEN THINGS ARE FALLING APART; IS FALLING APART IT'S OKAY I WILL GIVE YOU JUST ONE EXAMPLE. EVERY DAY; EVERY DAY; IN A LICENSED HEALTHCARE FACILITY WERE AGENCY OR SERVICE THERE IS A MEDICATION ERROR MADE . WITH THE KINDS OF POWERFUL DRUGS PEOPLE ARE ON RIGHT NOW THAT'S LIFE-THREATENING THAT'S HAPPENING EVERY SINGLE DAY IN THE REPORT TO THE DEPARTMENT OF HOUSTON THIS IS NOT BEING DONE BY MEAN PEOPLE. THIS IS DONE BY CARING PEOPLE BUT BECAUSE OF THE WORKFORCE SHORTAGE MANY THEM ARE WORKING DOUBLE SHIFTS. SOMETIMES THE SHIFTS ARE FILLED BY ADMINISTRATORS OR BOOKKEEPER FOR THE AGENCY; ANYBODY ; ANYBODY CAN WE FIND SOMEONE; PLEASE. SO WHAT HAPPENS IS MISTAKES ARE MADE. I CAN'T IMAGINE WHAT IT IS LIKE -WE HAD A 16 HOUR DAY YESTERDAY-IF I HAD FOR MEDICALLY COMPLEX PEOPLE AND I MADE A MISTAKE IN ONE OF THEM I THOUGHT HAD GIVEN THEM THEIR MEDICATION I GAVE THEM A DOUBLE DOSE; I WOULD FEEL TERRIBLE IN THAT IS THE RISK THAT EVERY SINGLE ONE OF THESE PEOPLE WERE ROUTINELY WORKING MORE HOURS THAN THEY SHOULD ARE RUNNING INTO. SO IT'S ALSO THREATENING OUR ABILITY TO CONFORM WITH THE FEDERAL COURT ORDERS RIGHT NOW WE ARE IN NONCOMPLIANCE WITH THE OLMSTED THE REQUIREMENTS OF THE U.S. CONSTITUTION THAT PEOPLE HAVE TO LIVE IN THE MOST INDEPENDENT AND INTEGRATED SETTING OF THEIR CHOICE AND WE HAVE AN OLMSTED PLAN THAT WE'VE COMMITTED TO THE COURSE AND WE HAVE TO COMPLY WITH THAT WHICH IS WE ARE ONE OF THE STATES THAT DOES NOT HAVE A GOOD TRACK RECORD GETTING PEOPLE TO LIVE INDEPENDENTLY AND IN THE MOST INTEGRATED SETTING POSSIBLE. WE WILL NOT BE ABLE TO COMPLY WITH OUR WORKERS TO HELP THOSE PEOPLE MOVE ON TO BETTER SITUATIONS; MORE INDEPENDENT; TO CONTINUE TO LIVE IN THE COMMUNITY. SOME PEOPLE ARE SERIOUSLY THINKING THEY'RE GOING TO HAVE TO GO LIVE IN A NURSING ON THE IF YOUR VENTILATOR DEPENDENT YOUR SEMISERIOUS PHYSICAL DISABILITIES; YOUR ONLY ALTERNATIVE IS TO GO TO A HOSPITAL BECAUSE THERE ISN'T ANOTHER PLACE IN YOUR COMMUNITY THAT CAN HANDLE THOSE KINDS OF MEDICAL CARE. WITH A MODEST BUDGET SURPLUS; THERE'S NO EXCUSE FOR US NOT STEPPING UP TO THIS EVEN WITH THE BASIC 4% INCREASE THAT THE BASIC LIFE LINES ASKED FOR THE INSTEAD THE REPUBLICAN MAJORITY HAS PRIORITIZED OVER $1 BILLION IN TAX CUTS AND PROVIDED $800 MILLION TO THE INSURANCE INDUSTRY AND LESS THESE PEOPLE LEFT THESE PEOPLE BACK IN THE COLD FOR ANOTHER TWO YEARS. THESE PEOPLE DESERVE BETTER THESE WORKERS ARE REALLY DEDICATED. THEY DO MIRACULOUS THINGS IN THE LABS THE PEOPLE THEY WORK WITH THEY DESERVE TO BE PAID MORE THAN THE RETAIL STORE DOWN THE ROAD. WE HEARD FROM PEOPLE THROUGHOUT THE STATE REPRESENTATIVE CONSIDINE; HAS DONE A GREAT JOB OF SENDING OUT STORIES FROM EVERY CORNER OF THE STATE. THIS IS NOT JUST IN THE METRO OR JUST IN THE REGIONAL CENTERS. IT IS EVERYWHERE. IT IS OUR MORAL IMPERATIVE TO STEP UP TO EMERGENCIES AND TO CHRIST BUT WE'VE DONE THAT 8080 AND FLEW IT WE'VE DONE IT WITH TORNADOES. DONE IT WITH FLOODS. WE'VE DONE IT WITH THE FIRES; BUT THIS KIND OF EMERGENCY THAT HAPPENS IN THE LIVES OF THOUSANDS OF PEOPLE ON A DAILY AND MONTHLY BASIS NEEDS TO BE ADDRESSED AND I'M SO DISAPPOINTED IT IS AND I URGE A NO VOTE. >> HOUSE SPEAKER: REPRESENTATIVE MAYE-QUADE >> REPRESENTATIVE MAYE-QUADE: I WILL TRY TO BE SHORT BECAUSE MY COLLEAGUES ARTIE SAID A LOT OF THE THINGS I FEEL AND HAVE A FEELING MY COLLEAGUES WILL SAY SOME MORE. I DON'T KNOW IF IT'S BECAUSE I'M TIRED OR IF IT'S BECAUSE BEEN A HARD WEEK BUT THIS IS A HARD BILL I CAME HERE TO BE A VOICE FOR PEOPLE IN MY COMMUNITY. MOST IMPORTANTLY PEOPLE FEEL LIKE THEY DON'T HAVE A VOICE. TIME AND TIME AGAIN THIS SESSION WE'VE HAD FAMILIES WITH KIDS WITH DISABILITIES; AND SAY PRIVATE SCHOOLS WON'T TAKE MY KID. WE GIVE TAX CREDITS FOR PRIVATE SCHOOL VOUCHERS OF PEOPLE WITH DISABILITY COME AND SAY WE NEED TO ADJUST THE MA SPEND DOWN WE DON'T INCLUDED IN THIS BILL. YOUR FAMILIES WITH KIDS WERE ON MA AND [INAUDIBLE] ARE GETTING SQUEEZED AND SCAN WORK BECAUSE THEY CAN MAKE ANY MORE MONEY. THE MAXING OUT THEIR CREDIT CARDS TO PAY THE FEES AND WE PUT IT IN BY HALF. I DON'T KNOW WHAT THE PRIORITIES OF THIS BILL ARE BUT THESE ARE NOT MY PRIORITIES. THIS WORLD IS ALREADY VERY TOUGH FOR PEOPLE WITH DISABILITIES IT'S NOT AN ACCEPTABLE [INAUDIBLE] WE CAN CALL PLACE PUBLIC PLACES IF THE PUBLIC CAN'T GO THERE; EVERYBODY. SO IN THIS BODY WE HAD AN OPPORTUNITY TO USE OUR SURPLUS TO HEAR THOSE VOICES; TO RESPOND TO THE CALL. WE LITERALLY DID NOT DO THAT. FOR THE 1100 WEALTHIEST FAMILIES IN MINNESOTA; WE BENT OVER BACKWARDS FOR TAX CUTS BUT FOR THE 3500 FAMILIES WHO SHORT YEAR AFTER YEAR AFTER YEAR PLEADING AND BEGGING WITH HER KIDS IN TOW; LITERALLY REARRANGING THEIR SCHEDULE THAT'S ALREADY CRAZY AND HECTIC TO BE HERE TO HAVE OUR YEAR . WE COULD NOT HEAR THEM WE CAN UPRIGHT TORI'S THEM WE CANNOT PUT THEM IN THIS BILL. I'VE SUCH A NO COME ON THIS I DON'T KNOW HOW TO SAY IT ANYMORE WE HAVE GOT TO DO BETTER FOR THE PEOPLE MINNESOTA. WE'VE GOT TO PRIORITIZE VOICES THAT WE ARE CLEARLY NOT LISTENING TO IMA; NO COME ON THIS BILL FOR MY COMMUNITY I MAY; NO; ON THIS BILL THE VOICE IS NOT REPRESENTED I AM A; NO; ON THIS BILL AND WE NEED TO DO BETTER. >> HOUSE SPEAKER: REPRESENTATIVE OLSON >> REPRESENTATIVE OLSON: THE SAME MOMENT OF WHEN WE COME IN THE FRONT STEPS HERE AND WE HAVE THAT MOMENT OF ALL AND THAT SORT OF -IT'S SUCH A PRIVILEGE AND HONOR TO SERVE IN THIS BODY AND WE FEEL THAT ESPECIALLY WHEN WE WALK IN THOSE FRONT STEPS. I ALSO TOLD MYSELF WHEN I CAME ON THE FIRST DAY AND GOT SWORN IN IF I WAS NOT AFFECTED BY THE WORK WE DO HERE THAT IS PROBABLY TIME TO STEP ASIDE YOUR SURE YOU'LL BE HAPPY TO KNOW I'M STILL AFFECTED BY WHAT WE DO. IN PARTICULAR; THIS HHS BILL REALLY GETS ME. I'VE BEEN THINKING A LOT ABOUT THE COMMITTEE HEARING THAT WE HAD FOR THOSE OF US ON THE HHS REFORM COMMITTEE THE COMMITTEE HEARING WE HAD ON THE MA SPEND DOWN. FOR THOSE OF YOU ON THAT COMMITTEE YOU PROBABLY REMEMBER THAT IT WAS PRETTY IMPACTFUL. WE HAD FOLKS IN WHEELCHAIRS COME AND TALK TO US. PEOPLE THAT TALKED ABOUT HOW HARD IT WAS OF THE CARE THEY NEEDED TO GET OUT OF BED EVEN GET HERE TO TESTIFY. WE HAD FOLKS TALK ABOUT-WE ONE MAN IN PARTICULAR SHARE HIS STORY ABOUT HOW HE RECEIVED A TRAUMATIC BRAIN INJURY WHICH WAS SAVING A 19-YEAR-OLD WOMAN AFTER CAR ACCIDENT. HE HAD WORKED 25 YEARS IN THE TRADES HAD PUT MONEY INTO HIS PENSION; INTO HIS RETIREMENT AND SOCIAL SECURITY; AND HE WORKED HARD AND ALL OF A SUDDEN I WAS TAKEN AWAY FROM HIM. HE BECAME DISABLED AND HAD TO RELY ON A DIFFERENT WAY OF LIVING. THESE STORIES REALLY -THEY REALLY GOT ME IN THE GUT AND THE HEART AND IN THE MIND. I'VE BEEN THINKING A LOT ABOUT THAT. I'VE BEEN THINKING A LOT ABOUT WHAT HAPPENED THAT DAY AND A COMMITTEE HEARING; AND ONE OF THE THINGS I OFTEN ASKED MY COLLEAGUES I N THE COMMITTEE THAT CARRY BILLS THAT I REALLY LIKE I ASKED; WILL YOU FIGHT FOR THIS. OFTENTIMES; THEY SAY I WILL FIGHT FOR THIS I BELIEVE IN THAT SO I WAS SO DISAPPOINTED WHEN I SAW THIS OMNIBUS BILL. I WONDER WHERE THE FIGHT STOPPED . WHERE DID THE FIRE GO OUT? WE ARE DID WE GIVE UP ON THE PEOPLE WE SAID WE WERE GOING TO FIGHT FOR? IN PARTICULAR; THE MA SPEND DOWN; I FEEL; AND A BEEN THINKING A LOT ABOUT WHEN I CAME IN THE FRONT STEPS TODAY; I DON'T KNOW IF ANY OF YOU DID BUT I DO N'T KNOW IF YOU NOTICE WHO WE WALKED BY? WE WALKED BY THE PEOPLE HOLDING THE SIGNS THAT SAID; FIX THE MA SPEND DOWN. ONE OF THE PEOPLE WE WALK BY IS DON BANYAN WHO WHEN I TALK TO HIM TODAY SAID IS IT OKAY IF I TALK ABOUT YOU ON THE HOUSE FLOOR AND HE SAID; YES; PLEASE; DO. HE WAS ONE THAT CAME INTO COMMITTEE THAT STANDING OUTSIDE; SITTING OUTSIDE; BECAUSE HE'S IN A WHEELCHAIR LIES ON A LOT OF CARE JUST TO GET HERE TODAY -AND HE IS SITTING OUTSIDE THE CHAMBER DOORS LISTENING TO WHAT WE ARE DECIDING TODAY. I DO NOT THINK THIS IS ACTUALLY ABOUT FIGHTING FOR THINGS. IT SHOULD BE THE OPPOSITE . THIS SHOULD BE OUR COME TOGETHER BILL IT SHOULD NOT BE COMING TOGETHER AROUND GIANT TAX CUTS . IT SHOULD BE COMING TOGETHER AROUND WHAT WE DO FOR DON BANYAN OUT THERE. SOMEONE WHO IS WORKED HARD HIS LIFE; NEEDS THIS AND HE GETS BY ON $792 A MONTH. HE IS ASKING FOR 200 MORE DOLLARS . HOW DO WE NOT COME TOGETHER AROUND THAT? I AM A NO; VOTE. >> HOUSE SPEAKER: REPRESENTATIVE BLY >> REPRESENTATIVE BLY: SO I'M GOING TO CONTINUE ON THIS THEME; I GUESS. I VISIT MY MOM IS GOING TO TURN 90 THIS YEAR AT THE MEMORY UNIT IN NORTHFIELD. IT'S NOT ALWAYS AN EASY VISIT; BUT MY SISTER WAS IN TOWN THIS LAST SUNDAY AND SHE BROUGHT WITH HER A FAMILY FRIEND WHO I HAD NOT SEEN FOR A WHILE BUT I KNEW OF AND HAV E HAD DISCUSSIONS WITH HER SHE WORKS AT THE LOWER BAKER INSTITUTION; WHICH IS A PLACE WHERE PEOPLE WERE MENTALLY HANDICAPPED LIVE AND I ASKED HER HOW SHE WAS DOING KIND OF KNOWING THE SITUATION AND SHE SAID; WELL THIS IS SUPPOSED TO BE MY THREE DAY WEEKEND AND I'VE BEEN CALLED INTO WORK TWO OF THOSE THREE DAYS. SHE SAID; WE JUST CAN'T HOLD ON TO EMPLOYEES BECAUSE THEY CAN MAKE MORE MONEY IF THEY GO WORK AT MCDONALD'S OR SOMEWHERE ELSE THAT BUT I REALLY LIKE WORKING WITH THE FOLKS I WORK WITH AND I REALLY LIKE MY JOB. BUT WE CAN CONTINUE THIS. HER JOB AND HER EMPLOYER IS FUNDED BY THE SAME KIND OF FUNDS THAT THE BEST LIFE ALLIANCE MONEY GOES TO. I RUN INTO PEOPLE LIKE JANE ALL THE TIME AT THE GROCERY STORE IN OTHER PLACES BECAUSE THEY KNOW ME. HE RECOGNIZED ME AND I TALK WITH THEM THERE IS ANOTHER PLACE CALLED EPIC ENTERPRISE IN MY COMMUNITY ; TOO; WHERE THEY WORK WITH THE DISABLED TO GO OUT AND BE EMPLOYED THE BEST WAY THEY CAN IN MY COMMUNITY AND I'LL SEE THEM AT THE GROCERY STORE. T HEY GET HIRED TO DO THE CLEANING AND THEY WILL STOP AND TALK TO ME ABOUT THINGS. JUST COME UP HERE ON THE VISIT THERE COMING UP TO ASK FOR MORE FUNDING AND AGAIN; THEY KNOW ME AND I PROMISED I'M GOING TO WORK HARD TO HELP THEM DO THAT. HELP THEM HELP THEIR STAFF GET MORE FUNDING SO THEY CAN HAVE STABILITY IN THE STAFF THE PEOPLE THAT CARE FOR THEM AND HELP THEM. REPRESENTATIVE HAMILTON SPEAKING EARLIER REMINDED ME OF AN EARLIER DAY SEVERAL YEARS AGO I WAS RELATIVELY A NEW LEGISLATURE AND DIFFERENT GOVERNOR; I THINK OUR SIDE WAS IN CHARGE-AND WE WERE CUTTING NURSING HOMES AND MAYBE NOT CUTTING THE NURSING HOMES; BUT WE DIDN'T RETRIEVE THE FUNDING FOR THE FOLKS WHO WORKED WITH THE DISABLED THE PEOPLE THAT WERE TALKING ABOUT. I SAID THIS CAN'T BE. WE CAN'T DO THIS. I WAS REMINDED OF A STORY ABOUT MY FATHER; WHICH I TOLD ON THAT DAY; AND MY FATHER SPENT THE FIRST YEARS OF HIS CHILDHOOD IN INSTITUTIONS BECAUSE HE HAD A VERY SEVERE DISEASE. WHEN HE GREW UP HE NEVER LOST THAT EXPERIENCE; WHAT THAT WAS LIKE TO LIVE IN THAT ENVIRONMENT. SO; AS AN ADULT HE- HE WAS A BOY SCOUT LEADER. HE DECIDED TO MAKE A -OR DEVELOP A BOY SCOUT TROOP AT THE STATE INSTITUTION IN FARIBAULT FOR THE DISABLED PEOPLE THERE. HE WOULD TAKE SAYING ALL OF STUDENTS DOWN THERE AND MAKE THIS TROOP. I WAS A BOY SCOUT IN HIS TROOP AND WE WENT DOWN TO VISIT THE INMATES THERE; OR THE PEOPLE WHO LIVE THERE; AND HE SAID THIS IS GOING TO BE UNCOMFORTABLE FOR YOU. YOU WILL FIND IT HARD TO VISIT WITH THESE FOLKS. IT'S NOT GOING TO BE EASY; BUT REMEMBER; THEIR LIVES MATTER; TOO. THEIR IMPORTANCE. YOU CAN MAKE A DIFFERENCE IN THEIR LIVES. SO YOU KNOW; DO THIS FOR THEM. I DID AND IT WAS HARD. BUT IT WAS IMPORTANT LESSON FOR ME THAT WE NEED TO CARE FOR THEM; AND WE NEED TO MAKE SURE THE PEOPLE WHO CARE FOR THEM AND LIKE THAT WORK ARE COMPENSATED PROPERLY. ANYWAY; I WITHDREW MY AMENDMENT BECAUSE IT WAS GOING TO UPSET- THE THINGS WE HEARD TODAY-BLOW UP THE BUDGET AND ALL OF THAT BUT REPRESENTATIVE HAMILTON; HE WASN'T FROM OUR SIDE; SO HE KEPT THE AMENDMENT I WAS WITHDRAWING AND HE CARRIED IT TO THE FINISH LINE. HE GOT CREDIT FOR THAT. SO IT'S NOT A REPUBLICAN OR DEMOCRAT ISSUE IT'S NOT AN ISSUE THAT WE SHOULD BE DIVIDED BY ABOUT. IT'S IMPORTANT WE NOT FORGET THEM. IT'S IMPORTANT. I WAS READING AN ARTICLE THE OTHER DAY THAT SAID HOW IS WEALTH CREATED. DIMENSION IS BECAUSE I THINK IT FITS. SOME OF THE MENTALITY ABOUT HOW WE ALLOW OURSELVES TO IGNORE THE PEOPLE WHO CARE FOR THE FOLKS WERE KIND OF AT THE BOTTOM. THAT WE JUST IGNORE THAT MAKE US UNCOMFORTABLE THAT WE JUST NOT ASSUME BE AROUND. WHAT IT SAID WAS; WE OFTEN THINK- WEALTH IS CREATED BY THE PEOPLE WHO HAVE WEALTH DISTRIBUTING AROUND TO THE REST OF US. WHATEVER. THIS ARTICLE SAID; NO; WEALTH IS CREATED BY THE PEOPLE WHO DO THE REALLY HARD WORK AND WE JUST DON'T PAY THEM ENOUGH. WE LET THEM WORK DAY AND NIGHT TO THE DIRTIEST MOST DISGUSTING WORK; AND WE DON'T PAY THEM WHAT THEY ARE WORTH. THAT IS HOW WE GET WEALTHY. THAT IS HOW WE SAVE MONEY. BY NOT LOOKING AT WHAT THEY DO TO BENEFIT US. IT HAPPENS ALL ACROSS OUR CAMP ECONOMY AND I THINK IT SHOWN I THINK; IF YOU LOOK AT THE NUMBERS OF THE ELITE WERE THE ONES WHO DO REALLY WELL IN OUR ECONOMY THEY HAVE DONE VERY WELL THEIR INCOME HAS GONE WAY UP IF YOU LOOK AT THE CHARTS ; BUT THE WORKING PEOPLE IT JUST KIND OF GOES ALONG AT THE BOTTOM LINE AND DOESN'T IMPROVE. SOMEHOW WE HAVE TO CHANGE THAT. SOMEHOW; WE HAVE TO RECOGNIZE THAT THE PEOPLE WHO DO THE REALLY HARD WORK THAT WE DON'T WANT TO DO ; THE WAY JUST ASSUMED NOT TO; LET SOMEBODY ELSE DO; WE NEED TO MAKE SURE THAT THEY GET COMPENSATED. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE TRAN CAGLE >> REPRESENTATIVE TRAN CAGLE MEMBERS I RISE TODAY TO SPEAK IN SUPPORT OF THE PEOPLE THIS BILL IGNORES. I LIKE TO SHARE A COUPLE STORIES WITH YOU. [INAUDIBLE] LIVES IN ROBBINSDALE AND WORKS AS A DIRECT SERVICE PROFESSIONAL AT [INAUDIBLE]. SHE'S A SINGLE MOTHER OF ONE HIGH SCHOOL AGE SON WHO SHE SAYS HE'S EATS LIKE A HORSE. THIS JOB IS HER PASSION HER CALLING. THE SAME THING SHE FEELS SHE WAS MEANT TO DO IN LIFE. SHE WORKS FULL-TIME AS A PART-TIME JOB CARING FOR ANOTHER WOMAN WITH MULTIPLE SCLEROSIS AND SHE IS AN ON-CALL PERSONAL CARE ATTENDANT FURTHER COMPANY WHERE SHE FILLS IN AS AS NEEDED BASIS AND SHE'S FREQUENTLY NEEDED. AT A MINIMUM BETWEEN ALL HER JOBS SHE WORKS 50 HOURS PER WEEK AND TYPICALLY MUCH MORE. OFTEN; IT'S 14 HOURS IN A SINGLE DAY. EVEN THOUGH SHE LOVES HER WORK; IT IS HARD AND EXHAUSTING. FROM THE BEGINNING OF THE DAY UNTIL THE END; SHE SPORTING THE NEEDS AND GOALS OF OTHERS. HER WORK INCLUDES TASK LIKE COMPLETING PAPERWORK; PROVIDING LIFE-SAVING CPR AND FIRST AID; HELPING PEOPLE IN THE BATHROOM; PREPARING MEALS; TRAINING PEOPLE ON WORK TASKS; WORKING WITH FAMILIES TO FIGURE OUT CHALLENGES; AND HELPING PEOPLE BATHE IN ANY MANY OTHER THINGS THAT HELP THE PERSON BE HAPPY; SAFE AND WELL. IT IS RARE THAT JENNY GOES A DAY W HERE SHE DOESN'T HAVE TO WORK AT ONE OF HER JOBS. THIS HAPPENS ONCE OR TWICE A MONTH. IN SPITE OF ALL THIS; JAKE LOVES HER JOB SHE'S MAKING A DIFFERENCE IN PEOPLE'S LIVES. HOWEVER; THE WAGES AR E CHALLENGING. SHE IS FORCED TO MAKE HARD DECISIONS BECOME BETWEEN GOING TO WORK AND SUPPORTING HER FAMILY. WITH HER SON'S GRADUATION APPROACHING SHE DOESN'T KNOW IF SHE'LL BE ABLE TO AFFORD ANNOUNCEMENTS FOR -OR A PARTY ON HER BUDGET THIS IS SOMETHING MANY FAMILIES TAKE FOR GRANTED. HE'S GONE WITHOUT MANY THINGS AND SHE WOU LD LOVE TO BE ABLE TO DO THIS FOR HIM. SHE IS ALSO THING THAT YOU MAY HAVE TO MOVE BACK IN WITH HER PARENTS AT AGE 46 SO SHE CAN FINALLY GET AHEAD AND SAVE SOME MONEY FOR RETIREMENT OR EMERGENCIES. WHAT DOES THIS PAY BILL SAY TO G&A ? WE ARE ALMOST 20 BILLS RELATING TO SUPPORTING PEOPLE WITH DISABILITIES AND THEIR CAREGIVERS. I'M SURE WE WERE ALL TALK TO PEOPLE BY THE BEST LIFELINES IMPLORING US TO HELP ADDRESS THE WORKER SHORTAGE AND LOW WAGES. WE HAVE A $1.6 BILLION BUDGET SURPLUS . YET; WE DO NOTHING TO LET G&A KNOW WE VALUE HER HARD WORK AT HIS BILL TELLS HER; YOUR WORK DOES NOT MATTER TO US. OVER THE PAST FEW MONTHS OF GOT TO KNOW WHAT MY CONSTITUENTS; ERIC FEELINGS. ERIC IS A 24 HE'S VERY FRIENDLY HAS A GREAT SENSE OF HUMOR. THOSE BEING AROUND OTHER PEOPLE. HE ENJOYS SPENDING TIME PLAYING [INAUDIBLE] AND CHOOSES TO LIVE WITH HIS MOM AND STEPDAD INCLUDE RAPIDS. DURING THE DAY HE GOES TO LIFEWORK AND ENJOY SEEING HIS FRIENDS AND BE VERY SAD IF HE CANNOT SEE THEM ANYMORE. HE GETS TO GO INTO THE COMMUNITY AND VOLUNTEER PLACE LIKE GLOBAL HEALTH RE-HELPS PEOPLE ALL THE WAY IN AFRICA. YOU PROBABLY HAVE SEEN ERIC AROUND HERE. AS PART OF THE SELF ADVOCACY GROUP. HE'S ACTUALLY HERE IN A GALLERY TODAY AS WELL. EVERY WEEK HE LOBBIES WITH OTHERS ON ISSUES THAT ARE IMPORTANT TO HIM AND OTHERS WITH DISABILITIES. WHICH HE REALLY ENJOYS DOING. ERICA SHARED WITH ME WAYS HE BELIEVED THAT THIS BILL WILL IMPACT -THAT HE BELIEVES HE WILL BE IMPACTED WHEN THE REPUBLICAN CUTS TAKE A FACT. HE SAYS IF HE LOSES HIS PCA SERVICES THAT MOM WOULD HAVE TO QUIT HER JOB AND STAY HOME TO CARE FOR HIM. THEIR HOUSEHOLD INCOME WOULD DROP IMMENSELY. HIS DAY PROGRAM AT LIFEWORK'S HAS CUTS THAT WILL AFFECT THE COMMUNITY INVOLVEMENT MEANINGFUL PROGRAMMING; AND QUALITY CONSISTENT STAFF. IF YOU HAD TO STAY ON IT WOULD AFFECT HIS MENTAL AND EMOTIONAL WELL-BEING. HE SAYS; I'M A VERY SOCIAL PERSON LOVE BEING AROUND OTHER PEOPLE. HE'S ON VERY EXPENSIVE MEDICATION FOR HIS HEMOPHILIA AND NEEDS ADAPTIVE EQUIPMENT LIKE A WHEELCHAIR OR WALKER TO ASSIST HIM IN GETTING AROUND IS UNABLE TO AFFORD HIS THIS MEDICATION ON HIS OWN OR BE ABLE TO AFFORD THE EQUIPMENT HE NEEDS TO HELP HIM BE INDEPENDENT. ERIC'S MOM SAYS; OVERALL ERIC WOULD NOT GROW AND IS ALWAYS FRIENDLY AND SMILING HE WOULD LOSE THAT FUN-LOVING PERSONALITY WITH NO SOCIAL INTERACTION. YESTERDAY ERIC TOLD ME I DO NOT HAVE TO HAVE THESE AS TO HAVE THESE ABILITIES. NEITHER DID AND WHAT YOU SAY THESE COMPANIES RECEIVE SERVICES FROM NEED TO BE PERSON CENTERED SO THAT WE CAN HAVE THE BEST QUALITY OF LIFE. DESPITE OUR DISABILITIES. I'M ASKING YOU TO BE PERSON CENTERED SO THAT THE COMPANIES THAT SERVICE CAN BE PERSON CENTERED. WHAT DOES THIS BILL SAY TO ERIC ? AGAIN; WE ARE 20 BILLS RELATED TO SUPPORTING ERIC AND HIS CAREGIVERS. THE PEOPLE CARING FOR ERIC AND OTHERS WITH DISPOSER BEGGING US FOR HELP. A1 $.6 BILLION BUDGET SURPLUS YET THIS BILL DOES NOTHING TO ENSURE ERIC WILL HAVE THE PERSON TO HELP THEM TO THE THINGS HE LOVES. THIS BILL TELLS HIM YOU INDEPENDENCE DOES NOT MATTER TO US. I REFUSE TO TELL G&A HER HARD WORK IS A MATTER TO ME I WILL NOT SEE TO ERIC THAT I VALUE TAX CUTS TO THE WEALTHY OVERS MENTAL AND EMOTIONAL WELL-BEING. WE CAN DO BETTER FOR THIS. I AM A NO; VOTE. >> HOUSE SPEAKER: REPRESENTATIVE HALVERSON >> REPRESENTATIVE HALVERSON: I'VE GOT TO SERVE ON THE HEALTH AND SERVICES FINANCE COMMITTEE SINCE IT WAS FOR SELECTED SO THIS MY THIRD TERM ON HHS FINANCE AND IT'S A PRIVILEGE TO SERVE ON A COMMITTEE THAT WE HAVE A RESPONSIBILITY TO THE LARGEST PART OF THE STATE BUDGET BUT MORE IMPORTANTLY; WE HAVE THE ABILITY TO REALLY IMPACT THE LIVES OF THE PEOPLE WHO COME TO US AND THIS YEAR IN PARTICULAR WE HEARD WELL OVER $2 BILLION IN SPENDING BILLS IN HHS FINANCE. THESE WERE NOT NICE TO HAVE PROPOSALS. THESE WERE PEOPLE COMING TO US BECAUSE THEY ARE IN CRISIS AND CHUM WAY SHAPE OR FORM AND THEY COME TO US AND THEIR BILLS ARE OFFERED AND IT GIVES THEM HOPE THAT SOMEBODY IS LISTENING. THEY SIT IN OUR COMMITTEE AND SHARE THE MOST PAINFUL AND INTIMATE PARTS OF THEIR LIVES; AND ANYONE WHO SITS ON THE COMMITTEE KNOWS THAT I AM THE CRIER IN COMMITTEE. THEY ALWAYS GET ME. PEOPLE WILL SIT AT THE TEST FIND SAY I'M SORRY FOR CRYING AND I SAY; IT'S OKAY WE CRYING HERE ALL THE TIME BECAUSE IT HURTS SO MUCH TO KNOW HO W MUCH THESE FOLKS ARE COUNTING ON US AND TO KNOW THAT WE ARE GOING TO LET THEM DOWN BECAUSE WE HAVE BEEN ASKED TO CUT $6 MILLION FROM THE HEALTH AND HUMAN SERVICES BUDGET. AT A TIME WHEN WE ARE NOT IN A BUDGET CRISIS IN THE STATE OF MINNESOTA. BUT; 600 MILLION-SORRY. [INAUDIBILE / OFF MIC] THAT'S OKAY. WE ARE NOT IN A BUDGET CRISIS IN THE STATE OF MINNESOTA. $600 MILLION CUT ISN'T NECESSARY WE DO NOT HAVE TO BE THAT DRACONIAN. WE DO NOT HAVE TO TAKE THESE PEOPLE'S NEEDS AND HOPES AND DREAMS AND CRUSH THEM. AND SAY THEY DON'T MATTER. MOMS COME TO US A LOT. THE CARING FOR THEIR CHILDREN MOTHERS WHO HAVE BE SEPARATED FROM THEIR CHILDREN BECAUSE THEY CAN'T GET MENTAL HEALTH SERVICES IN THE STATE OF MINNESOTA IN THEIR COMMUNITY WHERE THEY LIVE. I HAVE A CHILD WHO WAS HOSPITALIZED FOR A WEEK AND IT WAS HARD TO BE ACROSS THE ROOM FROM HIM. IT WAS HARD TO LET GO OF HIM WHEN THE DOCTORS NEEDED TO CARE FOR HIM. I CAN'T IMAGINE HAVING TO BE 100 MILES AWAY FROM M Y CHILD IF HE WAS HOSPITALIZED. BUT; BECAUSE WE HAVE SUCH A BOTTLENECK IN OUR MENTAL HEALTH SYSTEM THAT WE ARE NOT ADDRESSING IN THIS BILL WE ARE ASKING MOTHERS TO HAVE TO SEND THEIR CHILDREN AWAY FROM THEM WHEN THEY NEED THEIR MOTHERS THE MOST. YOU DO WANT TO BE BY YOUR KIDS SIDE BUT THESE MOTHERS HAVE TESTIFIED THEY HAVE TO WORK . THEY HAVE TO MAKE SURE THEY KEEP THEIR INSURANCE. THEY HAVE TO MAKE SURE THEY CAN PAY FOR THESE MEDICAL BILLS SO THEY CARE FOR THEIR CHILDREN. SO THEY TAKE WHAT THEY CAN GET WHEN THEY CAN GET IT. BY THE TIME A LOT OF PEOPLE GETTING CARE IN A MENTAL HEALTH SYSTEM THEY ARE GETTING CRISIS CARE. IT'S SO SAD FOR ME TO TALK TO MENTAL HEALTH PROFESSIONALS AND HEAR HOW HELPLESS THEY FEEL. THEY DON'T GET TO DO THE IMPORTANT WORK OF PREVENTING MENTAL HEALTH CRISIS BECAUSE THEY'RE SUCH A BOTTLENECK IN >> >> >> MINNESOTA STATE GOVERNMENT; HOUSE OF REPRESENTATIVES FLOOR SESSION FOR FRIDAY; FOR FRIDAY; APRIL 7; 2017 WILL RECONVENE SHORTLY. >> >> [GAVEL] >> [GAVEL] >> HOUSE SPEAKER: THE HOUSE WILL COME TO ORDER. CALENDAR FOR THE DAY. THE FIRST BILL ON THE CALENDAR FOR THE DAY IS SENATE FILE 800. THE CLERK WILL REPORT THE BILL. SPEAKER SENATE FILE NUMBER 800 NUMBER ONE ON THE CALENDAR FOR THE DAY AND ACT RELATING TO HUMAN SERVICES FINANCE AND POLICY AND THE BILL HAS BEEN UNOFFICIALLY ENGROSSED AND PRINTED FOR THE HOUSE TO INCLUDE COMMITTEE AMENDMENTS. >> HOUSE SPEAKER: I RECOGNIZE THE BILL AUTHOR; REPRESENTATIVE DEAN TO INTRODUCE YOUR BILL >> REPRESENTATIVE DEAN: MEMBERS; THIS IS THE HEALTH AND HUMAN SERVICES ALMOND OF THIS BILL. I WANT TO THANK OUR HOUSE HEALTH AND HUMAN SERVICES STAFF HOUSE RESEARCH RANDY CHUNG; DANIEL PANELLA; ELIZABETH CLARK; SARAH SENTIMENT OUR FISCAL ANALYST DOUG BYRD. THE REVISER'S OFFICE; SANDY GLASS; AMY BOX; LAUREN BECKY; ADAM GUZMAN; DFL RESEARCH SONDRA MOORE; GOP RESEARCH BETHANY -HAVING AND CHELSEA WHITMAN. CLA IS SHILOH LARSON; CA LAURA LARSON AND HOLLY IVERSEN. WE HAVE A GREAT BILL BEFORE YOU MEMBERS. IT'S COMPRISED OF ABOUT 129 BILLS FROM BOTH REPUBLICANS AND DEMOCRATS THE DEAL WITH PROVIDING CARE FOR MINNESOTA'S MOST VULNERABLE AND OVER 1 MILLION PEOPLE ON MEDICAID IN OUR NURSING HOMES AND OUR HOSPITALS ONLY COMMITTEE-BASED SERVICES TOUCHES MANY MANY LIVES EVERY SINGLE ONE OF YOUR CONSTITUENTS. I REALLY WANT TO THANK THE WORK OF THE COMMITTEE. BOTH REPUBLICAN MEMBERS AS WELL AS THE DEMOCRAT NUMBERS. WE LOOK FORWARD TO THE DEBATE I HAD THE BILL SPENDS ABOUT $14.32 BILLION ON STATE FUNDS. ABOUT 19.7 ON STATE FUNDS. ABOUT $19.7 BILLION IN FEDERAL FUNDS. WE HAVE LOOKED FOR SIGNIFICANT SAVINGS IN REFORMS WE WILL TALK ABOUT A LITTLE BIT THROUGH THE DEBATE TODAY. WE LOOK FORWARD TO THAT. BUT I WANT TO HIGHLIGHT SOME SPECIFIC AREAS OF THE BILL AND I WOULD LIKE TO SEND IT OVER TO THE POLICY COMMITTEE CHAIRMAN; JOE SCHOMACKER >> HOUSE SPEAKER: REPRESENTATIVE SCHOMACKER >> REPRESENTATIVE SCHOMACKER: MEMBERS I JUST WANT TO TOUCH ON A COUPLE OF POINTS TODAY. T HAT WE HAD IN THE HEALTH AND HUMAN SERVICES ALMOND OF THIS WE CONTINUE TO PRIORITIZE SENIORS AND THE DISABLED IN THIS BILL TODAY. WE WILL LOOK AT THE VALUE-BASED REIMBURSEMENT SYSTEM THAT WE IMPLEMENT IT IN 2015; WHAT WE WERE ABLE TO DO IS REFORM THE ENTIRE SYSTEM THAT WE HAD THE WAY WE FUNDED OUR NURSING HOMES SO WE WERE ABLE TO REFORM IT BUILD UP THE WORKFORCE; AND BRING SOMETHING FORWARD INTO THE FUTURE THAT WOULD CONTINUE WITH THE REFORMS THAT WE HAVE. W HAT WE LEARN; THOUGH IN THE PROCESS HAVING MAJOR REFORMS IS THAT WE HAVE TO POLISH THAT LANGUAGE AS WE MOVE FORWARD. THE MORE WE LEARN ABOUT IT THE MORE WE CAN IMPROVE UPON IT AND THAT'S WHAT WERE DOING WITH THIS BILL TODAY. SO FOR OUR NURSING HOMES AND FOR THE VALUE-BASED REIMBURSEMENT SYSTEM THAT WE HAVE YOUR PRESERVING ACCESS TO HIGH-QUALITY NURSING FACILITY SERVICES THROUGHOUT THE STATE BY PROVIDING GREATER WORKFORCE GROWTH. I BELIEVE CHAIRMAN KIEL WILL TALK MORE ABOUT THE WORK OF THE AGING AND LONG-TERM CARE COMMITTEE; ESPECIALLY IN THE WORKFORCE AREA FOR EXTENDING SCHOLARSHIPS TO HELP MORE NURSES GET INTO THE LOAN FORGIVENESS PROGRAM AND PROVIDING MORE ACCESS TO THOSE DOLLARS SO THE PEOPLE HAVE A CHANCE TO EXPAND THEIR CAREER THERE. IMPROVING TRANSPARENCY TO THE RATE SYSTEMS WE HAVE WITH OUR NURSING HOMES. SO THAT CONSUMERS ONLY HAVE TWO TIMES A YEAR WHERE THEY SEE THEIR RATES FLUCTUATE INSTEAD OF THE MONTH BY MONTH SYSTEM WE HAVE NOW. WE ALSO ENHANCE ACCOUNTABILITY IN THE SYSTEM OVERALL. THE INTEGRITY OF THE PROGRAM REQUIRING AN ONGOING REPORT FROM DHS FOR THE VALUE-BASED REIMBURSEMENT SYSTEM. MOST OF THAT IS FOUND IN ARTICLE 2 THAT WE HAVE TODAY. WE ALSO ARTICLE 9 OF THE BILL THAT ALSO CONTINUES TO POLISH SOME OF THE CODIFICATION THINGS WE WORKED ON LAST YEAR. THAT ONE IS ENTIRELY TECHNICAL IN NATURE. IT CAME FROM OUR NONPARTISAN RESEARCH STAFF. IT CLEANS UP TECHNICAL CORRECTIONS AND CROSS-REFERENCES. THE OTHER POINT I WANT TO TO TOUCH HIM BRIEFLY TODAY IS THE DISABILITY WAIVER RATE SYSTEM BECAUSE WE ARE ABLE TO FIND A MAJOR REFORMS WITHOUT. YOU KNOW THAT WE HAVE OVER THE YEARS BEEN MOVING AWAY FROM THE COUNTY-BASED RATESETTING SYSTEM FOR DISABILITY WAIVER RATES AND MOVING TO A STATEWIDE SYSTEM. WITHIN THAT IT TAKE SOME TIME TO GET THAT WORKING THE WAY WE WANT. WE HAVE BEEN INTRODUCING AND TRANSITIONING TO THAT THE LAST COUPLE OF YEARS. WE ARE FINDING WAYS THAT WE CAN IMPROVE ON THE SYSTEM THAT WE HAVE AN POLISH TH AT UP AS WERE DOING THAT IN THIS BILL WERE DOING CHANGES IN RATES FOR THE OVERNIGHT SLEEP STAFF; FOR THE HOUSING ACCESS COORDINATION. THE LICENSE PRACTICAL NURSE. THE DEFINITION OF A DAY;; NURSING ASSISTANT WE ARE REFORMING WITH NEW EMPLOYMENT SERVICES WITH THE ABSENT STUDIES ON WHAT A DAY IS FOR ABSENCE AND UTILIZATION AND WE ARE ALSO WORKING ON THE TRANSPORTATION ISSUE THAT WE HAVE WITHIN THE DISABILITY WAIVER RATE SYSTEM SETTING AND MAKING SURE THAT WE ARE DOING IT IN A FAIR WAY THAT IS ALSO EASIER FOR PROVIDERS OF DISABILITY SERVICES TO PROVIDE THE TRANSPORTATION THAT THEY NEED WITH THAT. ALSO; WITHIN WHAT WERE DOING WITH DISABILITY WAIVER RATE SYSTEM IS WE ARE ALLOWING FOR A 7% RATE INCREASE TO MOVE FORWARD IN THE BILL FROM WHAT WE HAD THIS LAST YEAR. THAT'S AN INFLATIONARY INCREASE THAT WE HAVE CHOSEN TO RECOGNIZE IN THIS BILL AND NOT PUSH OFF BACK ONTO THE RATES THAT WERE INCREASED A FEW YEARS AGO. SO; WITHOUT MEMBERS; I WILL YIELD TO THE SUBCOMMITTEE CHAIRMAN'S WE HAVE HERE THIS YEAR REPRESENTATIVE DEBBIE PUGH WITH THE AGING AND LONG-TERM CARE COMMUNITY. >> HOUSE SPEAKER: MEMBERS; IT'S TOO LOUD IN THE CHAMBER NEIGHBORS ARE HAVING TROUBLE HINDERED PLEASE; TAKE YOUR CONVERSATIONS AND APPARENTLY NOW YOUR PHONE CALLS INTO THE RETIRING ROOM 120 ALCOVES. PLEASE; BE RESPECTFUL FOR THOSE TRYING TO LISTEN TO THE DEBATE YOUR PLEASE TAKE YOUR CONVERSATIONS OFF THE HOUSE FLOOR. THE NEXT MORNING WON'T BE AS NICE. REPRESENTATIVE KIEL >> REPRESENTATIVE KIEL: THE SUBCOMMITTEE OF AGING AND LONG-TERM CARE WORKED ONCE AGAIN; ON AGING. AS WE ALL KNOW THAT IS BECOMING A LARGE DEMOGRAPHIC IN MINNESOTA . THE THINGS WE DID IN AGING AND LONG-TERM CARE WERE TO DEVELOP A NURSING -EXPAND THE NURSING FACILITY EDUCATION SCHOLARSHIPS THIS WILL HELP ADDRESS OUR WORKFORCE SHORTAGES ALONG WITH NURSING FACILITY STAFF TO EXPAND THE NURSE ELIGIBILITY TO RECEIVE SCHOLARSHIPS REIMBURSING STUDENT LOAN EXPENSES AND TRAIN EXPENSES. LAST SESSION; I DON'T KNOW IF YOU REMEMBER WE FUNDED SCHOLARSHIPS FOR RECENTLY HIRED OR GRADUATED RNS AND LPNS. WORKING WITHIN AT LEAST 10 HOURS IN NURSING HOMES AND WE ARE EXPANDING THAT TO MEET THE REQUIRED -MEETING THE WORK REQUIREMENTS. ADDITIONALLY; WERE INCLUDING NURSES AGREEING TO HEALTHY [INAUDIBLE] AGREEING TO PRACTICE IN HOUSING AND WITH SERVICES FOR-FOR HOME CARE PROVIDERS. ONE THING THAT I WORKED ON IN THE PAST; AND WE HAVE BROUGHT BACK WAS THE ALZHEIMER'S DISEASE WORKING GROUP. THE WORKING GROUP SUNSETS IN 2011 AND WE'VE DONE SOME RESEARCH ON THAT; AND WANT TO KEEP LOOKING AT THAT AS WE KNOW THAT IS A VERY COSTLY AND THERE'S NO RESPONSE-NO WAY TO HALT ALZHEIMER'S SO THERE'S SOME GREAT RESEARCH GOING ON AT MAYO BUT THERE'S A LOT OF COSTUME FAMILIES AND THE RESIDENCES WERE MANY OF OUR FAMILIES HAVE TO LIVE EVENTUALLY FOR THEIR SAFETY. SO WE ARE WORKING-WE WILL EXPAND THAT WORKING GROUP AND WORK ON THINGS LIKE; FINANCING LONG-TERM CARE; MAKING PUBLIC AWARE; RISK REDUCTION; AND DEMENTIA SPECIFIC TRAINING FOR CAREGIVERS. WE ALSO ADDED THE SENIOR CARE WORKFORCE INNOVATION GRANT PROGRAM WHERE WE WILL ESTABLISH A SENIOR CARE WORKFORCE INNOVATION GRANT PROGRAM; WHICH IS AIMED IN INCREASING THE POOL OF CAREGIVERS WORKING IN THE SENIOR CARE SERVICES. THE GRANTS MUST BE USED TO FUND PILOTS PROJECT PROGRAMS TO EXPAND EXISTING PROGRAMS; TO RECRUIT AND TRAIN INDIVIDUALS TO WORK IN THOSE 65; PLUS; AND RECEIVING SERVICES THROUGH THE HOME AND THREE BASED SETTING. ADULT DAY CARE; HOME CARE SERVICES; OR IN A NURSING HOME. THEN; FINALLY; HE BUILT ON THE SUCCESSES OF LAST SESSION IN 2015 WHEN WE PASS THE MOST COMPREHENSIVE NURSING HOME REFORM IN 30 YEARS. RESULTING IN BETTER QUALITY CARE FOR NURSING HOME RESIDENTS ; HIGHER WAGES FOR OUR VALUE CAREGIVERS; . THIS YEAR WE BUILT UPON THIS THROUGH FOLLOWING UP REFORMS AIMED AT PRESERVING ACCESS TO HIGH-QUALITY NURSING FACILITY SERVICES. THROUGHOUT THE STATE; PROVIDING FUNDING NECESSARY TO MEET THE WORKFORCE CHANGES. AND CHALLENGES. W E HAVE STRENGTHENED KEY AREAS IN EXISTING LAW TO PROVIDE THE APPROPRIATE FUNDING FOR NURSING HOME FACILITY COSTS. WITH THAT; MR. SPEAKER; I WILL-I BELIEVE THE SUBCOMMITTEE ON CHILDCARE; REPRESENTATIVE FRANSON >> HOUSE SPEAKER: REPRESENTATIVE FRANSON >> REPRESENTATIVE FRANSON: MEMBERS I'M VERY EXCITED TO BE SPEAKING IN FRONT OF YOU ON HOUSE FLOOR TODAY ABOUT OUR UPDATE ON CHILDCARE AND WHAT IS ACTUALLY IN THE BILL. IT WAS A COMPLETE HONOR TO CHAIR THE SUBCOMMITTEE ON CHILDCARE ACCESS AND AFFORDABILITY AND THERE IS NO GREATER JOY FOR ME THAN TO BE ABLE TO WORK ON THIS ISSUE; ESPECIALLY SINCE I HAVE THE BACKGROUND AS A FORMER LICENSED CHILDCARE PROVIDER MYSELF. FIRST; SOME THANK YOUSE ARE IN ORDER MR. SPEAKER AND MEMBERS. APPRECIATED THE BIPARTISAN WORK THE ENTIRE COMMITTEE DID TO ADDRESS TOGETHER. I BELIEVE THAT WHEN WE WERE TOGETHER THINGS GET DONE. THAT'S EXACTLY WHAT HAPPENED. I WANT TO THANK REPRESENTATIVE PETERSON AND DFL LEAD PEGGY FLANAGAN FOR THEIR LEADERSHIP AND THANKS TO THE STAFF MUUST LAURA LARSON AND CLA; KAREN LARSON AND PARTISAN RESEARCH BETHANY---AND DAVE SULLIVAN AND NONPARTISAN RESEARCHERS; SARAH SENTIMENT YOU WERE GUYS WERE COMPLETE ASSET TO THE COMMITTEE. THANK YOU VERY MUCH. I'M SUPER EXCITED ABOUT THE MANY BIPARTISAN SUPPORTED REFORMS WE HAVE IN CHAIRMAN DEANS. OUR POLICY WILL ADDRESS ACCESS AND AFFORDABILITY BY IMPROVING RELATIONSHIPS AND COMMUNICATIONS WITH THE COUNTY; DHS AND CHILDCARE PROVIDERS. ULTIMATELY; WE ARE WORKING TO REVERSE THE SHORTAGE OF FAMILY CHILD CARE PROVIDERS. THE SITUATION IS SO DIRE IT HAS BEEN CALLED A QUIET CRISIS. MORE FAMILIES PROVIDERS WILL MEAN MORE ACCESS TO CHILDCARE. THAT'S A GOOD THING. WE WORKED HARD WITH PROVIDERS TO CREATE A NEW FIX-IT TICKET FOR MINOR VIOLATIONS THAT GIVES PROVIDERS AN OPTION TO FIX ISSUES IN THE SHORT TERM WITHOUT FACING EXPENSIVE PENALTIES. EXIT INTERVIEWS WOULD ALSO BE CONDUCTED DURING THESE INSPECTIONS WHICH WILL HELP CREATE A MORE COLLABORATIVE RELATIONSHIP BETWEEN LICENSORS AND PROVIDERS. WE HOLD DHS ACCOUNTABLE IN MANY WAYS AS WELL. HE REQUIRED THE DEPARTMENT TO COMMUNICATE THE ELECTRONIC NEEDS WITH LICENSE HOLDING CHILDCARE PROVIDERS ABOUT CHANGES TO STATUTE FEDERAL LAW RULES; REGULATIONS AND POLICY. SO THERE AREN'T ANY SURPRISES DURING LICENSING VISITS. DHS ALSO MUST KEEP US INFORMED ABOUT THEIR EFFORTS TO REMEDY ISSUES AND WE'VE HEARD OVER THE LAST YEAR RELATED TO ENFORCEMENT TRAINING AND PAPERWORK. CHILDCARE PROVIDERS ALSO HAD CORRECTION ORDERS RETURNED BY APPEAL WOULD NOW BE ABLE TO REMOVE THE ORDER FROM PUBLIC POSTING. THESE ORDERS ARE REQUIRED TO BE POSTED FOR TWO YEARS; EVEN IF THEY ARE OVERTURNED. PROVIDERS WORK HARD TO CARE FOR CHILDREN FEEL THE POSTINGS ARE A SCARLET LETTER THAT NEGATIVELY AFFECT THEIR BUSINESSES WE FIX THAT IN THIS BILL. THAT IS AWESOME. WE CLARIFY LANGUAGE ABOUT ANNUAL TRAINING REQUIREMENTS ; PROHIBIT QUOTAS FOR CORRECTION ORDERS; REQUIRED DHS TO WORK WITH DIVIDERS ABOUT HOW THEIR INFORMATION IS POSTED ONLINE; STRENGTH AND INTEGRITY IN CCAP TO ROOT OUT FRAUD AND ABUSE SO FAMILIES THAT NEED ASSISTANCE ARE GETTING IT. AND REFORM AND INVEST IN THE CHILDCARE BASIC SLIDING FEE PROGRAM TO MAKE SURE HUNDREDS OF MORE CHILDREN STATEWIDE RECEIVE CARE JUST TO NAME A FEW ADDITIONAL PROVISIONS. MEMBERS; I LOOK FORWARD TO YOUR GREEN VOTE. THANK YOU. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: I WOULD ASK THAT REPRESENTATIVE BAKER GO THROUGH THE OPIOID ARTICLE IN HIS BILL. >> HOUSE SPEAKER: REPRESENTATIVE BAKER >> REPRESENTATIVE BAKER: I WANT TO ALSO THANK THE COMMITTEE FOR A LOT OF HOURS; A LOT OF TIME TALK ABOUT A LOT -MANY ISSUES BUT OUR QUARTERBACK CHAIRMAN MATT DEAN; PUT IN SOME GOOD THINGS HERE IN THIS BILL TO GET OUR DISCUSSION ON OPIOIDS AND WHAT WE CAN DO LEGISLATIVELY TO GET THE CONVERSATION MOVING IN THE RIGHT DIRECTION. I WOULD JUST TALK BRIEFLY ABOUT SOME OF THESE. MEDICALLY ASSISTED TREATMENT; THINGS LIKE SUBOXONE AND METHADONE ARE THINGS YOU MIGHT'VE HEARD OF CURRENTLY BEING USED. WE EXTEND THAT A BIT TO DRUG CALLED THE TRAWL THAT THEY ONCE A MONTH INJECTION FROM YOUR DOCTOR THAT PLACES A RECEPTOR ON YOUR BRAIN THE KIND OF BLOCKS THAT FEELING OF EUPHORIA WHEN FOLKS ARE STRUGGLING WITH ADDICTION AND I THINK THAT'S CAN BE A GREAT EXPANSION OF OUR USE FOR HELPING FOLKS GET SOBER. WE ALSO TALKED ABOUT CHANGING THE COMPONENT OF HOW DO WE ASSESS PAIN. DRS.; YOU MIGHT HAVE HEARD; GET PAID BETTER IF THEY TAKE AWAY PAIN AND I THINK THAT'S A PROBLEM; MEMBERS; WHEN WE ARE ENCOURAGING THEM IN A WAY THAT MIGHT BE A LITTLE BIT OVERREACHING BECAUSE WE DON'T WANT TO REWARD FOR PRESCRIBING MORE PILLS. I THINK THAT HAVING THIS ASSESSMENT OF PAIN IN A SURVEY REMOVED IS A GOOD STARTING POINT TO THE DOCTORS AND CLINICS AND FOLKS TRULY TRYING TO HELP OUR PATIENTS BY TAKING THE QUESTION OFF THERE IS A GOOD STARTING POINT I WANT TO THANK THE TEAM FOR ALLOWING US TO HAVE DENTISTS LIMIT THEIR PRESCRIPTIONS OF OPIOIDS TO FOUR DAYS. HOW MANY TIMES HAVE YOU HEARD; I'VE CARRIED 30 DAYS OR 30 PILLS; PLUS; OUT OF A DENTIST OFFICE WHEN I GOT A WISDOM TEETH PULLED. THAT HAPPENS ALL THE TIME. THE MINNESOTA DENTAL ASSOCIATION SUPPORTS THIS FOUR-DAY LIMIT BECAUSE THEY KNOW THAT LAST YEAR ALONE IN 2016 OVER LAST YEAR ALONE IN 2000 16/100;000;000 PRESCRIPTION PILLS WERE NEVER EVEN USED AFTER A TOOTH EXTRACTION. SO ARE FILLING UP OUR MEDICINE CABINETS; FOLKS; WITH TOO MANY PILLS. WE ALSO HAVE A STICKER WE WANT TO PUT ON YOUR BOTTLE OF AN OPIOID; WHEN YOU GO TO THE PHARMACY YOU OPEN IT UP WE WENT TO A RED STICKER ON THEIR JUST REMIND YOU EVERY SINGLE TIME SOMEBODY OPENS IT UP; HEY; THIS IS VERY ADDICTIVE. VERY SIMPLE; WHO WANT TO REMIND PEOPLE BECAUSE EDUCATION IS WHERE THIS IS GOING TO GET HANDLED PROPERLY I ALSO WANT TO THANK DHS WORKING WITH US ON CHANGING THE WAY WE LOOK AT CHEMICAL DEPENDENCY AND OUR WAY WERE GOING TO REFORM HOW WE PAY FOLKS IN THE FUTURE I'M VERY VERY GRATEFUL WE GOT SOME DOLLARS IN HERE TO HELP OUR TREATMENT FACILITIES PAY THE BILLS. BECAUSE OUR ROOMS AND OUR WALLS ARE BUSTLING AT THE SEAMS AND TREATMENT CENTERS. THEY NEED THE RESOURCES; AND THIS INCREASE WILL HELP THEM DRAMATICALLY. SO FINALLY I WANT TO SAY REPRESENTATIVE KRESHA HAS A VERY GOOD BILL THAT I WHOLEHEARTEDLY SUPPORTED WITH A GRANT OPPORTUNITY FOR FOLKS LIKE IN HIS COUNTY; MORRISON COUNTY; LITTLE FALLS; TERRIFIC WORK ON EDUCATING CLINICS AROUND MINNESOTA AND THEY HAVE A PROGRAM OF TAPERING FOLKS IN FULL-BLOWN ADDICTION; BACK OFF SO THEY CAN ACTUALLY HAVE A MUCH BETTER LIFE AND QUALITY THEREFORE AFTER SO WE WILL TALK SOME MORE . WE'VE GOT SOME AMENDMENTS AS WELL BUT I WANT TO THANK THE COMMITTEE GOOD IT'S BEEN AN HONOR TO SERVE ON HHS REFORM COMMITTEE AND WITH THAT; MEMBERS I WILL PASS IT BACK TO OUR QUARTERBACK. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: I WAS WONDERING IF REPRESENTATIVE BACKER MIGHT YIELD AND DISCUSS A LITTLE BIT ABOUT EMERGENCY RESPONDERS AND TRANSPORTATION >> HOUSE SPEAKER: REPRESENTATIVE BACKER >> REPRESENTATIVE BACKER: SPEAKERS AND MEMBERS THIS BILL HAS A LOT OF GOOD THINGS HELPING WITH EMS NOT JUST IN RURAL MINNESOTA WHERE I'M FROM BUT IN THE METRO AREA. FIRST OF ALL; WE PUT TOGETHER $200;000FOR THE COWS PROGRAM WHICH PROVIDES TRAUMA SKILLS; TRAINING FOR PARAMEDICS EMT AND FIRST RESPONDERS. SO ACROSS THE STATE. WE FULLY FUND THE COOPER SAMS AMBULANCE VOLUNTEER WORDS AND RETENTION PROGRAM TO A TUNEUP $2.6 MILLION WHAT THAT MEANS FOR US HERE IN THE HOUSE IS THAT WHEN ONE OF YOUR CONSTITUENTS DIALED 911 IT HELPS US GET IT OUT OF THE GARAGE BECAUSE WE HAVE THE STAFF; VOLUNTEERS AND SO FORTH. WE ALSO HAD NEW FUNDING FOR NEARLY $220;000 TO THE VOLUNTEER AMBULANCE TRAINING FUNDING IN RURAL MINNESOTA AS MANY OF YOU KNOW I AM AN EMT BUT I VOLUNTEER AND ACTUALLY WHEN I GET BACK LATE TONIGHT OR TOMORROW MORNING; I TAKE CALL AND I'M ON CALL NEXT WEEK BECAUSE M Y OTHER MEMBERS OF MY SERVICE HELP ME OUT LIKE TODAY WHEN I'M NORMALLY ON CALL ON FRIDAYS. SO VERY IMPORTANT FOR OUR SMALL SERVICES. WE ALSO INCREASE REGIONAL FUNDING FOR ALL REGION EMS PROGRAMS TO THE TUNE OF $50;000 FOR MEMBERS WHO ARE NOT FAMILIAR WE HAVE EIGHT REGIONAL PROGRAMS IN THE STATE GEOGRAPHICALLY SO THAT'S $400;000. WE ALSO INCREASE FUNDING TO THE STATE EMS BOARD IT REQUEST FOR $212;000 WHY IS THAT IMPORTANT? WE HAVE TO GET EVERY TWO YEARS TRAINING. WE HAVE 24 HOURS OF REGULAR TRAINING AND THEN ADDITIONAL 20 HOURS. AS WE HAVE 44 HOURS EVERY TWO YEARS TO KEEP OUR CERTIFICATES. NOW WE ARE ABLE TO DO IT ONLINE SHOULD MAKE IT EASIER SO WE CAN GET MORE VOLUNTEERS. WE FUND $800;000 TO THE STATE EMS REGULATORY BOARD TO ASSIST AMBULANCE SERVICES. WE ALSO FUND AMBULANCE INTERGOVERNMENTAL TRANSFERS OF COST AT $60;000 A YEAR TO ALL 103 GOVERNMENT OPERATED AMBULANCES TO [INAUDIBLE] MEDICAID DOLLARS COULD I SERVE ON ONE OF THOSE GOVERNMENT RUN FOR THE CITY OF BROWN'S ALLEY IN WHICH WE SERVICE TO STATES; THREE COUNTIES; AND ANOTHER NATION WE SERVE A TRIBAL NATION WHERE I AM AT. THEN; FINALLY; WE SUPPORT TO FIX-SUPPORT TO FIX THE COMMUNITY EMT LEGISLATIVE PART TO ALLOW THAT GOOD PROGRAM TO FOLLOW. THAT'S REALLY USE MORE SO IN THE METRO AND SUBURBAN AREA. I WILL YIELD IT BACK TO THE REPRESENTATIVE FROM WASHINGTON. >> HOUSE SPEAKER: REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: JUST BEFORE WE GO TO THE AMENDMENTS; I WANT TO THANK PARTICULARLY; THE DEMOCRATS ON THE COMMITTEE ; PARTICULARLY; REPRESENTATIVE ERIN MURPHY. AND FOR ALL THE WORK ON THE COMMITTEE AND FOR HELPING WITH THE BILL TOGETHER FOR OVER THE COURSE OF THE LAST COUPLE OF MONTHS AND IN THE WEEKS AHEAD. WE LOOK FORWARD TO IT COULD ALSO LOOK FORWARD TO CONTINUING TO WORK WITH DHS AND HEALTH AND ALL THE GREAT STAFF THEY HAVE THERE. IN WORKING TOGETHER WITH THE GOVERNOR'S OFFICE TO TRY TO GET A BILL HE CAN SIGN. LASTLY; JUST WANT TO SAY THANK YOU TO ALL THE DIRECT CARE WORKERS IN THE STATE WHO HANG IN THERE YEAR AFTER YEAR AND WORK TO PROVIDE CARE ; THE BEST CARE IN THE WORLD TO THE MINNESOTANS IN THE MOST NEED TO WITH THAT ; MR. SPEAKER I THINK WILL MOVE TO AMENDMENTS. >> HOUSE SPEAKER: REPRESENTATIVE GRUENHAGEN OFFERS THE FOLLOWING MMM. THE CLERK WILL REPORT THE AMENDMENT. >> CHIEF CLERK: TRENT HAGAN MOVES TO AMEND THE BILL AND THE AMENDMENT IS CODED A- 10 >> HOUSE SPEAKER: REPRESENTATIVE TRENT HAGAN >> REPRESENTATIVE TRENT HAGAN; THIS AMENDMENT DOES IT ADDRESSES A SPECIAL ENROLLMENT PERIOD ON A LAW CALLED THE 21ST CENTURY CURES ACCURATE WAS SIGNED INTO LAW BY PRES. OBAMA IN IN DECEMBER 2016. WHAT THE ACT DOES; IT ALLOWS SMALL EMPLOYERS; 50 EMPLOYEES OR LESS TO SET UP A HEALTH REIMBURSEMENT ACCOUNT ON A TAX-DEDUCTIBLE BASIS WHERE SMALL EMPLOYER THAT DOES NOT OFFER GROUP INSURANCE TO THEIR EMPLOYEES CAN CONTRIBUTE UP TO $4950 PER YEAR TAX-DEDUCTIBLE FOR AN INDIVIDUAL OR $10;000 FOR A FAMILY. INDIVIDUALS AND FAMILIES CAN USE THAT MONEY TO HELP THEM PURCHASE INDIVIDUAL HEALTH INSURANCE EITHER THROUGH MNSURE OR OUTSIDE THE MNSURE. ALSO; IN THE FEDERAL ACT WAS A PROVISION THAT STATES COULD CREATE A SPECIAL ENROLLMENT PERIOD BECAUSE THE ENROLLMENT PERIOD TO DO THIS FOR A SMALL GROUP WAS ONLY FOR ABOUT 2-3 MONTHS AND STATES COULD EXPAND THAT TO YEAR-ROUND SO SMALL EMPLOYERS COULD ACTUALLY PROVIDE A BENEFIT TO HELP PEOPLE OBTAIN HEALTH INSURANCE. AND PAY FOR OUT-OF-POCKET MEDICAL EXPENSES. SO WITH THIS AMENDMENT DOES; IT ALLOWS THAT SPECIAL ENROLLMENT PERIOD FOR THIS PROVISION TO BE ENACTED BY SMALLER EMPLOYER AND WE ALREADY HAVE A NUMBER OF SPECIAL ENROLLMENT PERIOD EVENTS SUCH AS WHERE YOU CAN ENROLL IN HEALTH INSURANCE FOR HAVING A BABY; GETTING MARRIED; LOSING HER JOB; MOVING INTO A DIFFERENT AREA. SO THIS WOULD SIMPLY ADD THIS ADDITIONAL SPECIAL ENROLLMENT PERIOD TO THE ONES WE CURRENTLY HAVE IN THE STATE. WITH THAT-THIS SHOULD HELP PEOPLE AFFORD INDIVIDUAL HEALTH INSURANCE AND WE KNOW THAT THE INDIVIDUAL HEALTH INSURANCE MARKET IS IN TROUBLE IN TERMS OF PARTICIPATION. THIS WOULD BE A SMALL STEP IN THAT DIRECTION MEMBERS; URGE YOUR SUPPORT. THANK YOU. >> HOUSE SPEAKER: DISCUSSION ON THE A- 10 AMENDMENT? REPRESENTATIVE MURPHY >> REPRESENTATIVE MURPHY: THANK YOU REPRESENTATIVE TRENT HAGAN FOR YOUR AMENDMENT AS I DID A LITTLE CHECKING I WANT TO LET THE MEMBERS KNOW I DON'T KNOW WE HAVE THE AUTHORITY TO DO THIS I THINK THE HEALTH PLAN IS A RAISED A NUMBER OF QUESTIONS. I THINK THE ISSUE NEED SOME WORK BETTING AND WOULD ASK MEMBERS TO VOTE; NO. >> HOUSE SPEAKER: REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: I AGREE WITH REPRESENTATIVE MURPHY BUT I RISE TO JUST POINT OUT ONE THING. THAT IS; THAT IF WE GO TO THE FEDERAL EXCHANGE; AS THE BILL BEFORE YOU; MEMBERS; GETS RID OF MNSURE AND SENDS IT MINNESOTANS TO THE FEDERAL EXCHANGE INSTEAD AND WE WERE WE TO DO THAT WE WOULD NOT BE ABLE TO DO SOMETHING LIKE WHAT REPRESENTATIVE GRUENHAGEN IS TRYING TO HAVE DONE HERE. SO WE COULD ONLY POSSIBLY DO THIS BECAUSE WE HAVE OUR OWN MINNESOTA BASED HEALTH INSURANCE EXCHANGE. SO I ECHO REPRESENTATIVE MURPHY SAYING THERE'S A LOT OF PROBLEMS. IT'S NOT A BAD IDEA. THERE'S A LOT OF PROBLEMS WITH THE LANGUAGE ; BUT I WOULD URGE MEMBERS TO VOTE NO. >> HOUSE SPEAKER: ANY FURTHER DISCUSSION? REPRESENTATIVE DEAN >> REPRESENTATIVE DEAN: REPRESENTATIVE DEBBIE THANK YOU FOR REMINDING ME WE ARE GOING TO KILL THE MNSURE IN THE BILL TO I FORGOT. I APPRECIATE THAT. ALSO REPRESENTATIVE GRUENHAGEN'S BILL WOULD BE ABLE TO IN FACT WOULD BE ABLE TO -WOULD BE ABLE TO YOU REALIZE AND AUTHORIZE BEYOND THAT. SO I WOULD SUPPORT REPRESENTATIVE GRUENHAGEN'S AMENDMENT AND ASK FOR A ROLL CALL >> HOUSE SPEAKER: ROLL CALL HAVING BEEN REQUESTED; SEEING FIFTEEN HANDS THERE WILL BE A ROLL CALL. FURTHER DISCUSSION ON THE A- 10 AMENDMENT? REPRESENTATIVE GRUENHAGEN TO YOUR AMENDMENT >> REPRESENTATIVE GRUENHAGEN JUST A QUICK RESPONSE. THE ACA DELL ALLOW FOR EXCEPTIONAL CIRCUMSTANCES PROVISION TO BE ENACTED BY STATES. AGAIN; MEMBERS AT THIS WOULD APPLY TO INDIVIDUAL HEALTH INSURANCE INSIDE OR OUTSIDE OF MNSURE BUT I DO BELIEVE IT WOULD WORK EVEN IF WE MOVED TO THE FEDERAL EXCHANGE; AND AGAIN; THE BILL SIGNED BY PRES. OBAMA ALLOWS STATES TO SET THAT SPECIAL ENROLLMENT PERIOD. THANK YOU. >> HOUSE SPEAKER: ANY FURTHER DISCUSSION? REPRESENTATIVE LIEBLING >> REPRESENTATIVE LIEBLING: WOULD REPRESENTATIVE GRUENHAGEN YIELD TO A QUESTION? REPRESENTATIVE GRUENHAGEN; AS I WAS READING THE AMENDMENT; I THOUGHT THIS WAS KILLING THE MNSURE BOARD TO EXTEND OPEN ENROLLMENTS. IS THAT; IN FACT WITH THE AMENDMENT IS DOING? >> REPRESENTATIVE GRUENHAGEN: YES; THAT'S WHAT IT'S DOING TO DURING THE EXCEPTIONAL CIRCUMSTANCES THAT THE FEDERAL CODE ALLOWS US TO MAKE THIS CHANGE. THE BOARD OF MNSURE. WHICH; AGAIN; IS WHAT WE HAVE IN PLACE RIGHT NOW. >> REPRESENTATIVE LIEBLING: THANK YOU REPRESENTATIVE GRUENHAGEN. THEN IT DOESN'T WORK BECAUSE THE BOARD OF MNSURE CAN'T EXTEND OPEN ENROLLMENT . SORRY; I KNOW YOU WERE DISTRACTED THERE BUT IT DOESN'T WORK BECAUSE THE BOARD OF MNSURE DOESN'T HAVE AUTHORITY TO EXTEND OPEN ENROLLMENT OUTSIDE OF dissertation druck hamburg York College, City University of New York.

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