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MN Medical Cannabis Program Expands Qualifying Condition List

The Minnesota Department of Health (MDH) will add irritable bowel syndrome (IBS) and obsessive-compulsive disorder (OCD) to the list of qualifying medical conditions for participation in Minnesota’s medical cannabis program. Under state law, the new qualifying conditions will take effect Aug. 1, 2023. “We are adding the new qualifying conditions to allow patients more therapy options for conditions that can be debilitating,” said Minnesota Commissioner of Health Jan Malcolm. IBS is a disorder characterized by abdominal pain or discomfort, and irregular bowel movements that can result in diarrhea, constipation, both diarrhea and constipation, or bloating. OCD is characterized by recurring, intrusive thoughts that often cause significant emotional distress and anxiety. This can lead to behaviors that the affected person feels compelled to perform to reduce that distress. Research has shown that people who suffer from these conditions can see benefits from using medical cannabis to treat their symptoms. As in past years, MDH conducted a formal petition process to solicit public input on potential qualifying medical conditions and delivery methods for medical cannabis. Minnesotans submitted petitions in June and July. Following that, the process moved into a public comment period and a review panel. No petitions for new delivery methods were submitted this year. Petitions for gastroparesis and opioid use disorder were not approved. Gastroparesis, or delayed gastric emptying, was not approved as a qualifying medical because research indicates that cannabis can make the condition worse. As for opioid use disorder, MDH heard from medical and mental health providers who recommended against approving opioid use disorder as a qualifying medical condition due to lack of evidence for its effectiveness and the availability of FDA-approved medications for treatment. As with other qualifying conditions, patients need advance certification from a participating Minnesota health care provider. When the Minnesota Legislature authorized the creation of the state’s medical cannabis program, the law included nine conditions that qualified a patient to receive medical cannabis. With the new additions, the list of qualifying conditions will be 19. Under state rules, the commissioner of health each year considers whether to add qualifying conditions and delivery methods. For a list of qualifying medical conditions, go to Medical Cannabis Qualifying Medical Conditions.

Minneapolis Executive Order Provides Safe Haven for Gender Affirming Health Care

Minneapolis Mayor Jacob Frey recently issued an executive order to ensure transgender and gender-diverse youth will continue to have access to life-saving health care. Executive Order 2022-04 prohibits all City departments and City staff from taking any enforcement action against providers or individuals exercising their right to gender-affirming health care in Minneapolis. It also affirms the rights of minors living apart from their parents to make their own medical decision regarding gender-affirming care, in accordance with Minnesota law. Angela Kade Goepferd, MD, chief education officer and medical director of the Gender Health program at Children’s Minnesota, was among those at the order signing. She commented on the importance of transgender and gender-diverse youth having access to gender-affirming care. “When transgender and gender diverse kids are seen, heard and believed, they do better. When we support kids to be who they are, we know they can grow up to be happy, healthy, safe and strong. However, too often when I’m in our Gender Health Clinic, I hear from our patients, the kids and young adults of our community, that they’re experiencing harassment and discrimination based on their gender identities and expressions.” Children’s Minnesota, and other pediatric hospitals nationwide, have experienced threats and harassment for providing health care to children and teenagers in their gender health programs. Some of the states bordering Minnesota have proposed bills restricting or criminalizing access to gender-affirming healthcare, and passed other legislation limiting the rights of trans youth. These bills could expand laws that purport to impose criminal punishment, civil liability, administrative penalties, or professional sanctions, on health care professionals who provide gender-affirming healthcare and on persons who seek, receive, or assist another in receiving gender-affirming healthcare. Under the new Executive Order “Gender-affirming healthcare” means all services, supplies, drug therapies, and other care that an individual may receive to support and affirm the individual’s gender identity, that are legal under the laws of the State of Minnesota as of the date of this Executive Order or any time thereafter. Gender-affirming healthcare has been proven to be evidence-based, medically necessary, and lifesaving by the American Medical Association, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatricians, the Endocrine Society, the American Psychiatric Association, and the World Professional Association for Transgender Health, amongst other institutions.   

DHS Declines Multimillions in Federal Mental Health Funding

The Minnesota Department of Human Sevices (DHS) made a unilateral decision to withdraw, effective 12/31/22, from a federal program that could provide up to $30 million annually to support statewide mental health services. When asked for its rationale, DHS would not answer or offer any memos, documentation, cost benefit analysis or data they used in making this decision. Mental and chemical health care providers are deeply concerned the decision to end Minnesota’s involvement in the innovative Certified Community Behavioral Health Clinic (CCBHC) National Demonstration which has provided coordinated and accessible care to thousands of Minnesotans and increased access across the state. Minnesota was selected as one of the nation’s original eight CCBHC Demonstration states. Most recently, in the passage of the Bipartisan Safer Communities Act, Congress offered all states the opportunity to participate and extended funding through September 2025. In August 2022, the Federal Department of Health Human Services (HHS) announced it will allow current or original CCBHC Demo states to add even more CCBHC clinics. In a time when Minnesota calls mental and chemical health a top priority to respond to the increasing teen suicide rate, opioid epidemic, children boarding in emergency departments, vulnerable residents – veterans, the poor, individuals suffering drug addiction, elderly, kids in school, diverse and communities of color- lacking access to mental and chemical health care, this decision poses difficult questions. In choosing to remove Minnesota from the Demo, the state’s national reputation is impacted, going from one of the pioneering states in transforming mental health care in the U.S. to dropping behind. Further, Minnesota cannot rejoin the Demo under the new pathways now open to the remaining 40 states seeking federal planning grants. Sue Abderholden, executive director of NAMI Minnesota (National Alliance on Mental Illness) expressed her frustration with the DHS’ decision. “At a time when so many Minnesotans are struggling with their mental health it simply doesn’t make sense to end a program that has actually increased access to treatment and provided holistic care to children and adults with mental illnesses. DHS is making decisions that impact the mental health community unilaterally without engaging the mental health community.”

Walz Appoints New Commissioner of Health

In filling six cabinet positions before the Christmas break; Governor Walz announced that Brooke Cunningham, MD, PhD, would succeed retiring Commissioner Jan Malcom in the vital role of leading the Minnesota Department of Health. Dr. Cunningham was appointed assistant commissioner for the Health Equity Bureau in 2022. As assistant commissioner, she was responsible for overseeing the Center for Health Equity, the Office of American Indian Health, the COVID-19 Health Equity Team, and Diversity, Equity, and Inclusion. As a general internist, a sociologist, and an assistant professor in the University of Minnesota Department of Family Medicine and Community Health she brings a wealth of experience and resources to the position. Dr. Cunningham uses mixed methods to examine factors at both the provider and organizational levels that impede or facilitate efforts to address health equity, including how health care workers make sense of race and frame the causes of and solutions to racial disparities in health and health care. She teaches a course on race to first-year medical students and has been invited to speak to students and faculty from other medical schools about race and medicine. Dr. Cunningham practiced internal medicine at the Community-University Health Care Clinic (CUHCC), a federally-qualified health clinic in Minneapolis that serves a diverse patient population, most of whom live in poverty. She also co-directed the University of Minnesota Medical School’s Diversity, Equity, and Inclusion Thread in medical education. In 2021, she was selected as one of four inaugural recipients of the University of Minnesota’s Justice, Equity, Diversity, and Inclusion (JEDI) Award. She received degrees in history and African-American studies at the University of Virginia; received her doctorates in medicine and sociology from the University of Pennsylvania; trained in internal medicine at Duke University Medical Center; and completed postdoctoral fellowships at the Johns Hopkins University School of Medicine and the Medica Research Institute (Academy Health).

BC/BS MN and MN Oncology Announce Value-based Improvements

Blue Cross and Blue Shield of Minnesota (BC/BSMN) and Minnesota Oncology, a practice in The US Oncology Network, recently announced preliminary cost and quality results stemming from a value-based contract that went into effect in the fall of 2019. The agreement shifted payment from a traditional model that incentivized volume of transactional care to a value-based approach built on the shared principle that the most effective outcomes for patients are determined by a holistic approach that includes quality, cost, trend, and patient experience. Based on an analysis of the first results of available data, the total cost of care for Minnesota Oncology patients with Blue Cross employer group coverage trended more than 10 percent below the Twin Cities oncology market. The two organizations also cited the efficacy of programs built collaboratively within the agreement, ensuring that patients would receive the most effective and efficient care at the right time for their specific health situation. A critical aspect of the five-year agreement was the creation of new care coordination initiatives designed to avoid unnecessary trips to the hospital or emergency room, help patients manage side effects of treatment, and have a proactive and defined role in their care plans. The care coordinators stayed connected with patients throughout treatment with support throughout their cancer journey. “Cancer patients face a big challenge when it comes to the cost of quality, comprehensive care,” said John Schwerkoske, MD, president and medical oncologist at Minnesota Oncology. “Under this agreement with Blue Cross, we now have encouraging evidence that our model works. It is possible to offer state-of-the-art therapies, precision medicine, genetic testing, palliative care, and access to clinical trials while lowering overall costs.” “The early successes of this agreement, along with the collaborative spirit of both organizations, is continuing to grow with a desire to evolve and further improve the model,” said Eric Hoag, vice president of provider relations at Blue Cross and Blue Shield of Minnesota. “We are pleased to be adding three new quality measures in 2023 which include social determinants.” 

U of M School of Nursing and Mayo Announce New Partnership 

The University of Minnesota School of Nursing and Mayo Clinic’s Department of Nursing have recently formed a collaboration to facilitate their academic-practice partnership to generate, disseminate and apply knowledge for the improvement of nursing practice, education and health outcomes. The partnership will engage nursing faculty, nursing staff and nursing students in the development of strategies to enhance nursing education, research and practice. Initially, the partnership will center on fostering innovative undergraduate, graduate and postgraduate education degree opportunities and experiences at Mayo Clinic and advancing nursing knowledge to improve and support the health of individuals and their families through research and evidence-based practice. The partnership also will address nursing workforce needs to support a smooth transition of graduates into practice.”The School of Nursing’s physical presence in Rochester and its history of partnering with Mayo Clinic and the University of Minnesota Rochester create a unique opportunity to foster innovation,” says Connie White Delaney, PhD, dean of the School of Nursing. “Establishing a nursing collaboration formalizes our longtime relationship and offers a framework for us to further advance nursing and nursing education.” “Mayo Clinic nurses are known for their exceptional knowledge, trusted expertise and innovative patient care,” says Ryannon Frederick, chief nursing officer, Mayo Clinic. “This collaboration will help us accelerate improvements in nursing practice, education and research to benefit patients everywhere.”The collaboration will build on the partnership that University of Minnesota School of Nursing and Mayo Clinic’s Department of Nursing have had since the school first began educating Bachelor of Science in Nursing students in Rochester in 2002. All School of Nursing students in Rochester complete their clinical education at Mayo Clinic and learn from clinical instructors and preceptors who are Mayo nurses. In 2020, the School of Nursing and Mayo Clinic collaborated to provide a first-of-its-kind clinical learning experience by creating a dedicated education unit in an ambulatory care setting