1.1 	A bill for an act
1.2 	relating to health; establishing the Health
1.3 	Information Technology and Infrastructure Advisory
1.4 	Committee; modifying hospital and clinic grant
1.5 	programs; eliminating community health center program;
1.6 	amending Minnesota Statutes 2004, sections 144.147,
1.7 	subdivision 2; 144.148, subdivision 1; 144.1483;
1.8 	145.9268; proposing coding for new law in Minnesota
1.9 	Statutes, chapter 62J; repealing Minnesota Statutes
1.10 	2004, section 144.1486.
1.11 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.12 	Section 1. [62J.495] HEALTH INFORMATION TECHNOLOGY AND
1.13 	INFRASTRUCTURE ADVISORY COMMITTEE.
1.14 		Subdivision 1.Establishment; members; duties. (a) The
1.15 	commissioner shall establish a Health Information Technology and
1.16 	Infrastructure Advisory Committee governed by section 15.059 to
1.17 	advise the commissioner on the following matters:
1.18 	(1) assessment of the use of health information technology
1.19 	by the state, licensed health care providers and facilities, and
1.20 	local public health agencies;
1.21 	(2) recommendations for implementing a statewide
1.22 	interoperable health information infrastructure, to include
1.23 	estimates of necessary resources, and for determining standards
1.24 	for administrative data exchange, clinical support programs, and
1.25 	maintenance of the security and confidentiality of individual
1.26 	patient data; and 
1.27 	(3) other related issues as requested by the commissioner.
1.28 	(b) The members of the Health Information Technology and
2.1 	Infrastructure Advisory Committee shall include the
2.2 	commissioners, or commissioners' designees, of health, human
2.3 	services, and commerce and additional members to be appointed by
2.4 	the commissioner to include persons representing Minnesota's
2.5 	local public health agencies, licensed hospitals and other
2.6 	licensed facilities and providers, the medical and nursing
2.7 	professions, health insurers and health plans, the state quality
2.8 	improvement organization, academic and research institutions,
2.9 	consumer advisory organizations with an interest and expertise
2.10 	in health information technology, and other stakeholders as
2.11 	identified by the Health Information Technology and
2.12 	Infrastructure Advisory Committee.
2.13 		Subd. 2.Annual report. The commissioner shall prepare
2.14 	and issue an annual report not later than January 30 of each
2.15 	year outlining progress to date in implementing a statewide
2.16 	health information infrastructure and recommending future
2.17 	projects.
2.18 		Subd. 3.Expiration. Notwithstanding section 15.059,
2.19 	this section expires June 30, 2009.

2.20 	Sec. 2. Minnesota Statutes 2004, section 144.147,
2.21 	subdivision 2, is amended to read:
2.22 		Subd. 2.Grants authorized.  The commissioner shall
2.23 	establish a program of grants to assist eligible rural
2.24 	hospitals.  The commissioner shall award grants to hospitals and
2.25 	communities for the purposes set forth in paragraphs (a) and (b).
2.26 	(a) Grants may be used by hospitals and their communities
2.27 	to develop strategic plans for preserving or enhancing access to
2.28 	health services.  At a minimum, a strategic plan must consist of:
2.29 	(1) a needs assessment to determine what health services
2.30 	are needed and desired by the community.  The assessment must
2.31 	include interviews with or surveys of area health professionals,
2.32 	local community leaders, and public hearings;
2.33 	(2) an assessment of the feasibility of providing needed
2.34 	health services that identifies priorities and timeliness for
2.35 	potential changes; and
2.36 	(3) an implementation plan.
3.1 	The strategic plan must be developed by a committee that
3.2 	includes representatives from the hospital, local public health
3.3 	agencies, other health providers, and consumers from the
3.4 	community.
3.5 	(b) The grants may also be used by eligible rural hospitals
3.6 	that have developed strategic plans to implement transition
3.7 	projects to modify the type and extent of services provided, in
3.8 	order to reflect the needs of that plan.  Grants may be used by
3.9 	hospitals under this paragraph to develop hospital-based
3.10 	physician practices that integrate hospital and existing medical
3.11 	practice facilities that agree to transfer their practices,
3.12 	equipment, staffing, and administration to the hospital.  The
3.13 	grants may also be used by the hospital to establish a health
3.14 	provider cooperative, a telemedicine system, an electronic
3.15 	health records system,or a rural health care system or to cover
3.16 	expenses associated with being designated as a critical access
3.17 	hospital for the Medicare rural hospital flexibility program.
3.18 	Not more than one-third of any grant shall be used to offset
3.19 	losses incurred by physicians agreeing to transfer their
3.20 	practices to hospitals. The commissioner shall give priority to
3.21 	grant applications for projects involving electronic health
3.22 	records systems.

3.23 	Sec. 3. Minnesota Statutes 2004, section 144.148,
3.24 	subdivision 1, is amended to read:
3.25 		Subdivision 1.Definition.  (a) For purposes of this
3.26 	section, the following definitions apply.
3.27 	(b) "Eligible rural hospital" means any nonfederal, general
3.28 	acute care hospital that:
3.29 	(1) is either located in a rural area, as defined in the
3.30 	federal Medicare regulations, Code of Federal Regulations, title
3.31 	42, section 405.1041, or located in a community with a
3.32 	population of less than 10,000, according to United States
3.33 	Census Bureau statistics, outside the seven-county metropolitan
3.34 	area;
3.35 	(2) has 50 or fewer beds; and
3.36 	(3) is not for profit.
4.1 	(c) "Eligible project" means a modernization project to
4.2 	update, remodel, or replace aging hospital facilities and
4.3 	equipment necessary to maintain the operations of a hospital,
4.4 	including establishing an electronic health records system. The
4.5 	commissioner shall give priority to grant applications for
4.6 	projects involving electronic health records systems.

4.7 	Sec. 4. Minnesota Statutes 2004, section 144.1483, is
4.8 	amended to read:
4.9 	144.1483 RURAL HEALTH INITIATIVES.
4.10 	The commissioner of health, through the Office of Rural
4.11 	Health, and consulting as necessary with the commissioner of
4.12 	human services, the commissioner of commerce, the Higher
4.13 	Education Services Office, and other state agencies, shall:
4.14 	(1) develop a detailed plan regarding the feasibility of
4.15 	coordinating rural health care services by organizing individual
4.16 	medical providers and smaller hospitals and clinics into
4.17 	referral networks with larger rural hospitals and clinics that
4.18 	provide a broader array of services;
4.19 	(2) develop and implement a program to assist rural
4.20 	communities in establishing community health centers, as
4.21 	required by section 144.1486;
4.22 	(3) develop recommendations regarding health education and
4.23 	training programs in rural areas, including but not limited to a
4.24 	physician assistants' training program, continuing education
4.25 	programs for rural health care providers, and rural outreach
4.26 	programs for nurse practitioners within existing training
4.27 	programs;
4.28 	(4) (3) develop a statewide, coordinated recruitment
4.29 	strategy for health care personnel and maintain a database on
4.30 	health care personnel as required under section 144.1485;
4.31 	(5) (4) develop and administer technical assistance
4.32 	programs to assist rural communities in:  (i) planning and
4.33 	coordinating the delivery of local health care services; and
4.34 	(ii) hiring physicians, nurse practitioners, public health
4.35 	nurses, physician assistants, and other health personnel;
4.36 	(6) (5) study and recommend changes in the regulation of
5.1 	health care personnel, such as nurse practitioners and physician
5.2 	assistants, related to scope of practice, the amount of on-site
5.3 	physician supervision, and dispensing of medication, to address
5.4 	rural health personnel shortages;
5.5 	(7) (6) support efforts to ensure continued funding for
5.6 	medical and nursing education programs that will increase the
5.7 	number of health professionals serving in rural areas;
5.8 	(8) (7) support efforts to secure higher reimbursement for
5.9 	rural health care providers from the Medicare and medical
5.10 	assistance programs;
5.11 	(9) (8) coordinate the development of a statewide plan for
5.12 	emergency medical services, in cooperation with the Emergency
5.13 	Medical Services Advisory Council;
5.14 	(10) (9) establish a Medicare rural hospital flexibility
5.15 	program pursuant to section 1820 of the federal Social Security
5.16 	Act, United States Code, title 42, section 1395i-4, by
5.17 	developing a state rural health plan and designating, consistent
5.18 	with the rural health plan, rural nonprofit or public hospitals
5.19 	in the state as critical access hospitals.  Critical access
5.20 	hospitals shall include facilities that are certified by the
5.21 	state as necessary providers of health care services to
5.22 	residents in the area.  Necessary providers of health care
5.23 	services are designated as critical access hospitals on the
5.24 	basis of being more than 20 miles, defined as official mileage
5.25 	as reported by the Minnesota Department of Transportation, from
5.26 	the next nearest hospital, being the sole hospital in the
5.27 	county, being a hospital located in a county with a designated
5.28 	medically underserved area or health professional shortage area,
5.29 	or being a hospital located in a county contiguous to a county
5.30 	with a medically underserved area or health professional
5.31 	shortage area.  A critical access hospital located in a county
5.32 	with a designated medically underserved area or a health
5.33 	professional shortage area or in a county contiguous to a county
5.34 	with a medically underserved area or health professional
5.35 	shortage area shall continue to be recognized as a critical
5.36 	access hospital in the event the medically underserved area or
6.1 	health professional shortage area designation is subsequently
6.2 	withdrawn; and
6.3 	(11) (10) carry out other activities necessary to address
6.4 	rural health problems.

6.5 	Sec. 5. Minnesota Statutes 2004, section 145.9268, is
6.6 	amended to read:
6.7 	145.9268 COMMUNITY CLINIC GRANTS.
6.8 		Subdivision 1.Definition. For purposes of this section,
6.9 	"eligible community clinic" means:
6.10 	(1) a nonprofit clinic that provides is established to
6.11 	provide health services under conditions as defined in Minnesota
6.12 	Rules, part 9505.0255,to low income or rural population groups;
6.13 	provides medical, preventive, dental, or mental health primary
6.14 	care services;and utilizes a sliding fee scale or other
6.15 	procedure to determine eligibility for charity care or to ensure
6.16 	that no person will be denied services because of inability to
6.17 	pay;
6.18 	(2) a governmental entity or an Indian tribal government or
6.19 	Indian health service unit that provides services and utilizes a
6.20 	sliding fee scale or other procedure as described under clause
6.21 	(1); or 
6.22 	(3) a consortium of clinics comprised of entities under
6.23 	clause (1) or (2); or 
6.24 	(4) a nonprofit, tribal, or governmental entity proposing
6.25 	the establishment of a clinic that will provide services and
6.26 	utilize a sliding fee scale or other procedure as described
6.27 	under clause (1).
6.28 		Subd. 2.Grants authorized. The commissioner of health
6.29 	shall award grants to eligible community clinics to plan,
6.30 	establish, or operate services to improve the ongoing viability
6.31 	of Minnesota's clinic-based safety net providers.  Grants shall
6.32 	be awarded to support the capacity of eligible community clinics
6.33 	to serve low-income populations, reduce current or future
6.34 	uncompensated care burdens, or provide for improved care
6.35 	delivery infrastructure.  The commissioner shall award grants to
6.36 	community clinics in metropolitan and rural areas of the state,
7.1 	and shall ensure geographic representation in grant awards among
7.2 	all regions of the state.
7.3 		Subd. 3.Allocation of grants. (a) To receive a grant
7.4 	under this section, an eligible community clinic must submit an
7.5 	application to the commissioner of health by the deadline
7.6 	established by the commissioner.  A grant may be awarded upon
7.7 	the signing of a grant contract.  Community clinics may apply
7.8 	for and the commissioner may award grants for one-year or
7.9 	two-year periods.
7.10 	(b) An application must be on a form and contain
7.11 	information as specified by the commissioner but at a minimum
7.12 	must contain:
7.13 	(1) a description of the purpose or project for which grant
7.14 	funds will be used;
7.15 	(2) a description of the problem or problems the grant
7.16 	funds will be used to address; and 
7.17 	(3) a description of achievable objectives, a workplan, and
7.18 	a timeline for implementation and completion of processes or
7.19 	projects enabled by the grant; and 
7.20 	(4) a process for documenting and evaluating results of the
7.21 	grant.
7.22 	(c) The commissioner shall review each application to
7.23 	determine whether the application is complete and whether the
7.24 	applicant and the project are eligible for a grant.  In
7.25 	evaluating applications according to paragraph (d), the
7.26 	commissioner shall establish criteria including, but not limited
7.27 	to:  the priority level eligibility of the project; the
7.28 	applicant's thoroughness and clarity in describing the problem
7.29 	grant funds are intended to address; a description of the
7.30 	applicant's proposed project; a description of the population
7.31 	demographics and service area of the proposed project;the
7.32 	manner in which the applicant will demonstrate the effectiveness
7.33 	of any projects undertaken; and evidence of efficiencies and
7.34 	effectiveness gained through collaborative efforts.  The
7.35 	commissioner may also take into account other relevant factors,
7.36 	including, but not limited to, the percentage for which
8.1 	uninsured patients represent the applicant's patient base and
8.2 	the degree to which grant funds will be used to support services
8.3 	increasing or maintaining access to health care services.
8.4 	During application review, the commissioner may request
8.5 	additional information about a proposed project, including
8.6 	information on project cost.  Failure to provide the information
8.7 	requested disqualifies an applicant.  The commissioner has
8.8 	discretion over the number of grants awarded.
8.9 	(d) In determining which eligible community clinics will
8.10 	receive grants under this section, the commissioner shall give
8.11 	preference to those grant applications that show evidence of
8.12 	collaboration with other eligible community clinics, hospitals,
8.13 	health care providers, or community organizations. In addition,
8.14 	the commissioner shall give priority, in declining order, to
8.15 	grant applications for projects that:In addition, the
8.16 	commissioner shall give priority to grant applications for
8.17 	projects involving electronic health records systems.
8.18 		Subd. 3a.Awarding grants. (a) The commissioner may
8.19 	award grants for activities to:
8.20 	(1) provide a direct offset to expenses incurred for
8.21 	services provided to the clinic's target population;
8.22 	(2) establish, update, or improve information, data
8.23 	collection, or billing systems, including electronic health
8.24 	records systems;
8.25 	(3) procure, modernize, remodel, or replace equipment used
8.26 	in the delivery of direct patient care at a clinic;
8.27 	(4) provide improvements for care delivery, such as
8.28 	increased translation and interpretation services; or 
8.29 	(5) build a new clinic or expand an existing facility; or 
8.30 	(6) other projects determined by the commissioner to
8.31 	improve the ability of applicants to provide care to the
8.32 	vulnerable populations they serve.
8.33 	(e) (b) A grant awarded to an eligible community clinic may
8.34 	not exceed $300,000 per eligible community clinic.  For an
8.35 	applicant applying as a consortium of clinics, a grant may not
8.36 	exceed $300,000 per clinic included in the consortium.  The
9.1 	commissioner has discretion over the number of grants awarded.
9.2 		Subd. 4.Evaluation and report. The commissioner of
9.3 	health shall evaluate the overall effectiveness of the grant
9.4 	program.  The commissioner shall collect progress reports to
9.5 	evaluate the grant program from the eligible community clinics
9.6 	receiving grants.  Every two years, as part of this evaluation,
9.7 	the commissioner shall report to the legislature on priority
9.8 	areas for grants set under subdivision 3 the needs of community
9.9 	clinics and provide any recommendations for adding or
9.10 	changing priority areas eligible activities.

9.11 	Sec. 6. REPEALER.
 9.12 	Minnesota Statutes 2004, section 144.1486, is repealed.