HF 102

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 01/30/2017 03:42pm

A bill for an act
relating to human services; modifying an intergovernmental transfer related to
ambulance services; amending Minnesota Statutes 2016, section 256B.196,
subdivision 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2016, section 256B.196, subdivision 2, is amended to read:

Subd. 2.

Commissioner's duties.

(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.

(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.

(c) Beginning January 1, 2010, Hennepin County and Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
$12,000,000 per year from Hennepin County and $6,000,000 per year from Ramsey County.
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to Hennepin County Medical Center or Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to Hennepin County Medical Center and
Regions Hospital by those plans. Upon the request of the commissioner, health plans shall
submit individual-level cost data for verification purposes. The commissioner may ratably
reduce these payments on a pro rata basis in order to satisfy federal requirements for actuarial
soundness. If payments are reduced, transfers shall be reduced accordingly. Any licensed
health plan that receives increased medical assistance capitation payments under the
intergovernmental transfer described in this paragraph shall increase its medical assistance
payments to Hennepin County Medical Center and Regions Hospital by the same amount
as the increased payments received in the capitation payment described in this paragraph.

(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul new text begin , and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit new text end . The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County deleted text begin and deleted text end new text begin , new text end
the city of St. Paul new text begin , and other participating governmental entities new text end of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center deleted text begin and deleted text end new text begin , new text end the city of St. Paul new text begin , and other participating governmental entities new text end equal
to the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center deleted text begin and deleted text end new text begin , new text end the city of
St. Paul new text begin , and other participating governmental entities new text end . new text begin A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.
new text end

(e) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (d), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.

(f) The payments in paragraphs (a) to (d) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under new text begin this subdivision and
new text end subdivision 3.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2017, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is received.
new text end