HF 570

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; adjusting payment rates for a long-term hospital;
appropriating money; amending Minnesota Statutes 2006, section 256.969,
subdivision 3a, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2006, section 256.969, subdivision 3a, is amended to
read:

Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, deleted text begin and deleted text end
facilities defined under subdivision 16 new text begin , and, effective for admissions occurring on or after
July 1, 2007, a long-term hospital as designated by the Medicare program that is located in
a city of the first class as defined in section 410.01, new text end are excluded from this paragraph.

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
the current statutory rates. Mental health services within diagnosis related groups 424 to
432 deleted text begin and deleted text end new text begin , new text end facilities defined under subdivision 16 new text begin , and, effective for admissions occurring
on or after July 1, 2007, a long-term hospital as designated by the Medicare program
that is located in a city of the first class as defined in section 410.01, new text end are excluded from
this paragraph. Notwithstanding section 256.9686, subdivision 7, for purposes of this
paragraph, medical assistance does not include general assistance medical care. Payments
made to managed care plans shall be reduced for services provided on or after January
1, 2006, to reflect this reduction.

Sec. 2.

Minnesota Statutes 2006, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 28. new text end

new text begin Long-term hospital payment adjustment. new text end

new text begin For admissions occurring on
or after July 1, 2007, the commissioner shall increase the medical assistance payments
to a long-term hospital with a medical assistance inpatient utilization rate of 17.95
percent of total patient days as of the base year in effect on July 1, 2005, by an amount
equal to 13 percent of the total of the operating and property payment rates. Payments
made to managed care plans shall not reflect this payment increase. For purposes of
this subdivision, medical assistance does not include general assistance medical care.
Payments to a hospital under this subdivision shall be reduced by the amount of any
payments made under subdivision 27.
new text end

Sec. 3. new text begin APPROPRIATION.
new text end

new text begin $....... is appropriated from the general fund to the commissioner of human services
for the biennium beginning July 1, 2007, for the purposes of sections 1 and 2.
new text end