1.1                          A bill for an act
  1.2             relating to health; requiring the commissioner of 
  1.3             health to study the need for an alternative licensing 
  1.4             model for rural hospitals; requiring the rural health 
  1.5             advisory committee to study regulatory barriers to 
  1.6             health care access and the provision of efficient care.
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  [ALTERNATIVE LICENSING MODEL FOR RURAL 
  1.9   HOSPITALS.] 
  1.10     The commissioner of health, through the office of rural 
  1.11  health and primary care, shall conduct a study of rural health 
  1.12  care access needs and present recommendations on the need for an 
  1.13  alternative licensing model for rural hospitals.  In conducting 
  1.14  this study, the commissioner shall consult regularly with the 
  1.15  rural health advisory committee and the regional coordinating 
  1.16  boards. 
  1.17     The study must first examine: 
  1.18     (1) the projected demographics of rural populations; 
  1.19     (2) access to emergency care, obstetrics, and other 
  1.20  traditional hospital-based services; 
  1.21     (3) access issues related to transportation; 
  1.22     (4) health care needs of different regions of the state, 
  1.23  including those areas where access to care may be threatened by 
  1.24  the financial instability of local hospitals; and 
  1.25     (5) other factors related to access to rural health care 
  1.26  and hospital-based services. 
  2.1      Based upon this examination of access to health care in 
  2.2   rural areas, the commissioner shall evaluate the need for and 
  2.3   the feasibility of implementing an alternative licensing model 
  2.4   for rural hospitals.  This evaluation must consider: 
  2.5      (1) the goals of an alternative licensing model; 
  2.6      (2) federal and state regulatory barriers and options for 
  2.7   reconfiguring traditional hospital-based health care services; 
  2.8   and 
  2.9      (3) the feasibility of implementing an alternative 
  2.10  licensing model, including the potential for integration with 
  2.11  integrated networks and likelihood of obtaining a Medicare 
  2.12  waiver and other necessary federal law changes. 
  2.13     If the commissioner determines that a need for an 
  2.14  alternative licensing model exists and implementation is 
  2.15  feasible, the commissioner shall identify changes needed in 
  2.16  federal and state law, and develop draft legislation for a 
  2.17  Minnesota-specific alternative licensing model. 
  2.18     The commissioner shall present a preliminary report to the 
  2.19  legislature by February 1, 1996.  This preliminary report must 
  2.20  summarize rural access needs and present initial recommendations 
  2.21  on the need for an alternative licensing model for rural 
  2.22  hospitals.  The commissioner shall present a final report to the 
  2.23  legislature by December 15, 1996.  This final report must 
  2.24  include detailed recommendations related to a Minnesota-specific 
  2.25  alternative model, and draft legislation necessary to implement 
  2.26  these recommendations. 
  2.27     Sec. 2.  [STUDY OF REGULATORY BARRIERS.] 
  2.28     The rural health advisory committee, in consultation with 
  2.29  the regional coordination boards, shall examine federal and 
  2.30  state regulatory barriers that limit rural access to care or 
  2.31  limit the ability of rural health care providers to provide care 
  2.32  efficiently, without improving the quality of care.  The 
  2.33  commissioner of health shall provide staff and technical 
  2.34  assistance to the advisory committee and the regional 
  2.35  coordinating boards.  The barriers to be studied must include, 
  2.36  but are not limited to: 
  3.1      (1) requirements for emergency room staffing that increase 
  3.2   hospital costs and limit access to care; 
  3.3      (2) limits on the ability of nurses to prescribe and 
  3.4   administer prescription drugs under a physician's supervision in 
  3.5   emergency situations; 
  3.6      (3) state and federal inspection and regulatory 
  3.7   requirements that are duplicative and increase administrative 
  3.8   costs; 
  3.9      (4) physician supervision requirements that limit the use 
  3.10  of physician assistants; and 
  3.11     (5) the requirement that a hospital and its attached 
  3.12  nursing home have separate directors of nursing. 
  3.13     The advisory committee shall present recommendations for 
  3.14  eliminating these and other regulatory barriers to the 
  3.15  commissioner of health by December 1, 1995.  The commissioner of 
  3.16  health shall consider these recommendations, and shall present 
  3.17  recommendations and draft legislation to the legislature on any 
  3.18  needed changes in state and federal regulatory requirements, by 
  3.19  February 1, 1996.