1.1 	 A bill for an act
1.2 	relating to health; modifying certain provider, hospital, and outpatient surgical 
1.3 	center reporting requirements; modifying requirements for health board 
1.4 	directories of licensees; providing for a price disclosure reminder; amending 
1.5 	Minnesota Statutes 2004, sections 144.698, by adding a subdivision; 144.99, 
1.6 	subdivision 1; Minnesota Statutes 2005 Supplement, section 214.071; proposing 
1.7 	coding for new law in Minnesota Statutes, chapters 62J; 214.
1.8 	 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. [62J.18] PROVIDER REPORTING IN EXCESS OF $5,000,000.
1.10 		Subdivision 1.Applicability; definitions. (a) For purposes of this section, the 
1.11 	terms used have the meanings given in section 62J.17, subdivision 2, except that "major 
1.12 	spending commitment" means an expenditure in excess of $5,000,000.
1.13 	(b) This section applies to providers and to persons who would become providers 
1.14 	after making the expenditures described in subdivision 2.  This section does not apply 
1.15 	to hospital construction projects subject to the hospital construction moratorium under 
1.16 	section 144.551 or to the public interest review under section 144.552.
1.17 		Subd. 2.Reporting requirement. (a) A provider that intends to make a major 
1.18 	spending commitment in excess of $5,000,000 for an acquisition, by purchase or lease, 
1.19 	of a unit of medical equipment or in excess of $5,000,000 for a single capital project for 
1.20 	the purposes of providing health care services must file a report with the commissioner at 
1.21 	least 60 days before committing to make the expenditure.  The report must contain the 
1.22 	information described in section 62J.17, subdivision 4a, paragraphs (b) and (c).
1.23 	(b) The commissioner shall maintain a database to track expenditures reported 
1.24 	under this subdivision.
2.1 	(c) The commissioner shall maintain a list of all persons who have registered with 
2.2 	the commissioner for the purpose of receiving notice by electronic mail of a report 
2.3 	filed under this subdivision.  The commissioner shall, within 15 days of receiving an 
2.4 	expenditure report, provide notice of such report by electronic mail to all persons on its 
2.5 	list, and by publication in the State Register.  The notice must include either a copy of the 
2.6 	report or an easily understandable description of the proposed expenditure in the report. 
2.7 	The notice in the State Register must include a copy of the report, along with an easily 
2.8 	understandable description of the proposed expenditure in the report.  In addition, the 
2.9 	commissioner shall make reasonable efforts to notify persons or classes of persons who 
2.10 	may be significantly affected by the proposed expenditure in the report.  The commissioner 
2.11 	may recover the reasonable costs incurred in providing notice as required in this paragraph 
2.12 	through costs paid by third parties involved in proceedings described in this section.
2.13 	(d) No provider may commit to making the expenditure until the procedures 
2.14 	described in this section are completed.
2.15 		Subd. 3.Exceptions. (a) This section does not apply to an expenditure:
2.16 	(1) to replace existing equipment with comparable equipment used for direct patient 
2.17 	care.  Upgrades of equipment beyond the current model or comparable model are subject 
2.18 	to this section;
2.19 	(2) made by a research and teaching institution for purposes of conducting medical 
2.20 	education, medical research supported or sponsored by a medical school or by a federal or 
2.21 	foundation grant, or clinical trials;
2.22 	(3) to repair, remodel, or replace existing buildings or fixtures if, in the judgment 
2.23 	of the commissioner, the project does not involve a substantial expansion of the service 
2.24 	capacity or a substantial change in the nature of health care services provided;
2.25 	(4) for building maintenance, including heating, water, electricity, and other 
2.26 	maintenance-related expenditures;
2.27 	(5) for activities not directly related to the delivery of patient care services, including 
2.28 	food service, laundry, housekeeping, and other service-related activities; or 
2.29 	(6) for computer equipment or data systems not directly related to the delivery of 
2.30 	patient care services, including computer equipment or data systems related to medical 
2.31 	record automation.
2.32 	(b) In addition to the exceptions listed in paragraph (a), this section does not apply to 
2.33 	mergers, acquisitions, and other changes in ownership or control that, in the judgment 
2.34 	of the commissioner, do not involve a substantial expansion of service capacity or a 
2.35 	substantial change in the nature of health care services provided.
3.1 		Subd. 4.Public meeting. (a) Within 30 days from the date the notice requirements 
3.2 	of subdivision 2, paragraph (c), are satisfied, a third party may request a public meeting on 
3.3 	expenditures that exceed $5,000,000.  The public meeting shall serve as an informational 
3.4 	forum for the provider to answer inquiries of interested third parties.
3.5 	(b) The commissioner shall arrange for and coordinate the meeting on an expedited 
3.6 	basis.  The party requesting the meeting shall pay the commissioner for the commissioner's 
3.7 	cost of the meeting, as determined by the commissioner.  Money received by the 
3.8 	commissioner for reimbursement under this section is appropriated to the commissioner 
3.9 	for the purpose of administering this section.
3.10 		Subd. 5.Information required. If a public meeting is requested, the provider shall 
3.11 	provide the following information to be presented at the meeting:
3.12 	(1) need and access, including, but not limited to:
3.13 	(i) the need of the population served or to be served by the proposed health services 
3.14 	for those services;
3.15 	(ii) the project's contribution to meeting the needs of the medically underserved, 
3.16 	including persons in rural areas, low-income persons, racial and ethnic minorities, persons 
3.17 	with disabilities, and the elderly, as well as the extent to which medically underserved 
3.18 	residents in the provider's service area are likely to have access to the proposed health 
3.19 	service; and 
3.20 	(iii) the distance, convenience, cost of transportation, and accessibility to health 
3.21 	services for those to be served by the proposed health services;
3.22 	(2) quality of health care, including, but not limited to:
3.23 	(i) the impact of the proposed service on the quality of health services available to 
3.24 	those proposed to be served by the project; and 
3.25 	(ii) the impact of the proposed service on the quality of health services offered 
3.26 	by other providers;
3.27 	(3) cost of health care, including, but not limited to:
3.28 	(i) the financial feasibility of the proposal;
3.29 	(ii) probable impact of the proposal on the costs of and charges for providing health 
3.30 	services by the person proposing the service;
3.31 	(iii) probable impact of the proposal on the costs of and charges for health services 
3.32 	provided by other providers;
3.33 	(iv) probable impact of the proposal on reimbursement for the proposed services; and 
3.34 	(v) the relationship, including the organizational relationship, of the proposed health 
3.35 	services to ancillary or support services;
3.36 	(4) alternatives available to the provider, including, but not limited to:
4.1 	(i) the availability of alternative, less costly, or more effective methods of providing 
4.2 	the proposed health services;
4.3 	(ii) the relationship of the proposed project to the long-range development plan, if 
4.4 	any, of the person or entity providing or proposing the services; and 
4.5 	(iii) possible sharing or cooperative arrangements among existing facilities and 
4.6 	providers; and 
4.7 	(5) other considerations requested by the commissioner, including, but not limited to:
4.8 	(i) the best interests of the patients, including conflicts of interest that may be 
4.9 	present in influencing the utilization of the services, facility, or equipment relating to the 
4.10 	expenditures;
4.11 	(ii) special needs and circumstances of those entities that provide a substantial 
4.12 	portion of their services or resources, or both, to individuals not residing in the immediate 
4.13 	geographic area in which the entities are located, which entities may include, but are 
4.14 	not limited to, medical and other health professional schools, multidisciplinary clinics, 
4.15 	and specialty centers;
4.16 	(iii) the special needs and circumstances of biomedical and behavioral research 
4.17 	projects designed to meet a national need and for which local conditions offer special 
4.18 	advantages; and 
4.19 	(iv) the impact of the proposed project on fostering competition between providers.
4.20 		Subd. 6.Enforcement. The commissioner may enforce this section by denying or 
4.21 	refusing to reissue the permit, license, registration, or certificate of a provider that does not 
4.22 	comply with this section, according to section 144.99, subdivision 8. 

4.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

4.24 	Sec. 2. Minnesota Statutes 2004, section 144.698, is amended by adding a subdivision 
4.25 	to read:
4.26 		Subd. 6.Reporting on uncompensated care. (a) A report on the services provided 
4.27 	to benefit the community, as required under subdivision 1, clause (5), must report charity 
4.28 	care in compliance with the following requirements:
4.29 	(1) For a facility to report amounts as charity care adjustments, the facility must: 
4.30 	(i) generate and record a charge; 
4.31 	(ii) have a policy on the provision of charity care that contains specific eligibility 
4.32 	criteria and is communicated or made available to patients; 
4.33 	(iii) have made a reasonable effort to identify a third-party payer, encourage the 
4.34 	patient to enroll in public programs, and, to the extent possible, aid the patient in the 
4.35 	enrollment process; and 
5.1 	(iv) ensure that the patient meets the charity care criteria of this subdivision. 
5.2 	(2) In determining whether to classify care as charity care, the facility must consider 
5.3 	the following: 
5.4 	(i) charity care may include services that the provider is obligated to render 
5.5 	independently of the ability to collect; 
5.6 	(ii) charity care may include care provided to patients who meet the facility's charity 
5.7 	care guidelines and have partial coverage, but who are unable to pay the remainder of their 
5.8 	medical bills, but this does not apply to that portion of the bill that has been determined to 
5.9 	be the patient's responsibility after a partial charity care classification by the facility; 
5.10 	(iii) charity care may include care provided to low-income patients who may qualify 
5.11 	for a public health insurance program and meet the facility's eligibility criteria for charity 
5.12 	care, but who do not complete the application process for public insurance despite the 
5.13 	facility's reasonable efforts; 
5.14 	(iv) charity care may include care to individuals whose eligibility for charity care 
5.15 	was determined through third-party services for information gathering purposes only; 
5.16 	(v) charity care does not include contractual allowances, which is the difference 
5.17 	between gross charges and payments received under contractual arrangements with 
5.18 	insurance companies and payers; 
5.19 	(vi) charity care does not include bad debt; 
5.20 	(vii) charity care does not include what may be perceived as underpayments for 
5.21 	operating public programs; 
5.22 	(viii) charity care does not include unreimbursed costs of basic or clinical research 
5.23 	or professional education and training; 
5.24 	(ix) charity care does not include professional courtesy discounts; 
5.25 	(x) charity care does not include community service or outreach activities; and 
5.26 	(xi) charity care does not include services for patients against whom collection 
5.27 	actions were taken that resulted in a financial obligation documented on a patient's credit 
5.28 	report with credit bureaus.
5.29 	(3) When reporting charity care adjustments, the facility must report total dollar 
5.30 	amounts and the number of contacts between a patient and a health care provider during 
5.31 	which a service is provided for the following categories: 
5.32 	(i) care to patients with family incomes at or below 275 percent of the federal 
5.33 	poverty guideline; 
5.34 	(ii) care to patients with family incomes above 275 percent of the federal poverty 
5.35 	guideline; and 
6.1 	(iii) care to patients when the facility, with reasonable effort, is unable to determine 
6.2 	family incomes.
6.3 	(b) For the report required under subdivision 1, clause (5), the facility must, in 
6.4 	determining whether to classify care as a bad debt expense:
6.5 	(1) presume that a patient is able and willing to pay until and unless the facility has 
6.6 	reason to consider the care as a charity care case under its charity care policy and the 
6.7 	facility classifies the care as a charity care case; and
6.8 	(2) include as a bad debt expense any unpaid deductibles, coinsurance, co-payments, 
6.9 	noncovered services, and other unpaid patient responsibilities.

6.10 	EFFECTIVE DATE. This section is effective for facility fiscal years ending on or 
6.11 	after December 31, 2006.

6.12 	 Sec. 3. Minnesota Statutes 2004, section 144.99, subdivision 1, is amended to read:
6.13 		 Subdivision 1.Remedies available.  The provisions of chapters 103I and 157 and 
6.14 	sections 62J.18; 115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), 
6.15 	(12), (13), (14), and (15); 144.1201 to 144.1204; 144.121; 144.1222; 144.35; 144.381 to 
6.16 	144.385; 144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9509; 144.992; 
6.17 	326.37 to 326.45; 326.57 to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all 
6.18 	rules, orders, stipulation agreements, settlements, compliance agreements, licenses, 
6.19 	registrations, certificates, and permits adopted or issued by the department or under any 
6.20 	other law now in force or later enacted for the preservation of public health may, in 
6.21 	addition to provisions in other statutes, be enforced under this section.

6.22 	Sec. 4. Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:
6.23 	214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.
6.24 	Each health health-related licensing board under chapters 147, 148, 148B, and 150A, 
6.25 	as defined in section 214.01, subdivision 2, shall establish a directory of licensees that 
6.26 	includes biographical data for each licensee.

6.27 	Sec. 5. [214.121] PRICE DISCLOSURE REMINDER.
6.28 	Each health-related licensing board shall at least annually inform and remind its 
6.29 	licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable, 
6.30 	through the board's regular means of communicating with its licensees.