1.1 	A bill for an act
1.2 	relating to health care providers; regulating the purchase and lease of new 
1.3 	ambulances; establishing a manufacturer's duty to repair, refund, or replace; 
1.4 	authorizing construction of certain hospitals; changing public interest review 
1.5 	requirements for entities seeking hospital license; providing an alternative 
1.6 	approval process for new hospital construction; requiring a study of medical 
1.7 	facility construction;amending Minnesota Statutes 2004, sections 144.552; 
1.8 	325F.665, subdivision 1; Minnesota Statutes 2005 Supplement, section 144.551, 
1.9 	subdivision 1, as amended; proposing coding for new law in Minnesota Statutes, 
1.10 	chapter 144.
1.11 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.12 	Section 1. Minnesota Statutes 2005 Supplement, section 144.551, subdivision 1, as 
1.13 	amended by Laws 2006, chapter 172, section 1, is amended to read:
1.14 		Subdivision 1.Restricted construction or modification. (a) The following 
1.15 	construction or modification may not be commenced:
1.16 	(1) any erection, building, alteration, reconstruction, modernization, improvement, 
1.17 	extension, lease, or other acquisition by or on behalf of a hospital that increases the bed 
1.18 	capacity of a hospital, relocates hospital beds from one physical facility, complex, or site 
1.19 	to another, or otherwise results in an increase or redistribution of hospital beds within 
1.20 	the state; and
1.21 	(2) the establishment of a new hospital.
1.22 	(b) This section does not apply to:
1.23 	(1) construction or relocation within a county by a hospital, clinic, or other health 
1.24 	care facility that is a national referral center engaged in substantial programs of patient 
1.25 	care, medical research, and medical education meeting state and national needs that 
1.26 	receives more than 40 percent of its patients from outside the state of Minnesota;
2.1 	(2) a project for construction or modification for which a health care facility held 
2.2 	an approved certificate of need on May 1, 1984, regardless of the date of expiration of 
2.3 	the certificate;
2.4 	(3) a project for which a certificate of need was denied before July 1, 1990, if a 
2.5 	timely appeal results in an order reversing the denial;
2.6 	(4) a project exempted from certificate of need requirements by Laws 1981, chapter 
2.7 	200, section 2;
2.8 	(5) a project involving consolidation of pediatric specialty hospital services within 
2.9 	the Minneapolis-St. Paul metropolitan area that would not result in a net increase in the 
2.10 	number of pediatric specialty hospital beds among the hospitals being consolidated;
2.11 	(6) a project involving the temporary relocation of pediatric-orthopedic hospital 
2.12 	beds to an existing licensed hospital that will allow for the reconstruction of a new 
2.13 	philanthropic, pediatric-orthopedic hospital on an existing site and that will not result in a 
2.14 	net increase in the number of hospital beds. Upon completion of the reconstruction, 
2.15 	the licenses of both hospitals must be reinstated at the capacity that existed on each site 
2.16 	before the relocation;
2.17 	(7) the relocation or redistribution of hospital beds within a hospital building or 
2.18 	identifiable complex of buildings provided the relocation or redistribution does not result 
2.19 	in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds 
2.20 	from one physical site or complex to another; or (iii) redistribution of hospital beds within 
2.21 	the state or a region of the state;
2.22 	(8) relocation or redistribution of hospital beds within a hospital corporate system 
2.23 	that involves the transfer of beds from a closed facility site or complex to an existing site 
2.24 	or complex provided that: (i) no more than 50 percent of the capacity of the closed facility 
2.25 	is transferred; (ii) the capacity of the site or complex to which the beds are transferred 
2.26 	does not increase by more than 50 percent; (iii) the beds are not transferred outside of a 
2.27 	federal health systems agency boundary in place on July 1, 1983; and (iv) the relocation or 
2.28 	redistribution does not involve the construction of a new hospital building;
2.29 	(9) a construction project involving up to 35 new beds in a psychiatric hospital in 
2.30 	Rice County that primarily serves adolescents and that receives more than 70 percent of its 
2.31 	patients from outside the state of Minnesota;
2.32 	(10) a project to replace a hospital or hospitals with a combined licensed capacity 
2.33 	of 130 beds or less if: (i) the new hospital site is located within five miles of the current 
2.34 	site; and (ii) the total licensed capacity of the replacement hospital, either at the time of 
2.35 	construction of the initial building or as the result of future expansion, will not exceed 70 
3.1 	licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is 
3.2 	less;
3.3 	(11) the relocation of licensed hospital beds from an existing state facility operated 
3.4 	by the commissioner of human services to a new or existing facility, building, or complex 
3.5 	operated by the commissioner of human services; from one regional treatment center 
3.6 	site to another; or from one building or site to a new or existing building or site on the 
3.7 	same campus;
3.8 	(12) the construction or relocation of hospital beds operated by a hospital having a 
3.9 	statutory obligation to provide hospital and medical services for the indigent that does not 
3.10 	result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27 
3.11 	beds, of which 12 serve mental health needs, may be transferred from Hennepin County 
3.12 	Medical Center to Regions Hospital under this clause;
3.13 	(13) a construction project involving the addition of up to 31 new beds in an existing 
3.14 	nonfederal hospital in Beltrami County;
3.15 	(14) a construction project involving the addition of up to eight new beds in an 
3.16 	existing nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
3.17 	(15) a construction project involving the addition of 20 new hospital beds 
3.18 	used for rehabilitation services in an existing hospital in Carver County serving the 
3.19 	southwest suburban metropolitan area. Beds constructed under this clause shall not be 
3.20 	eligible for reimbursement under medical assistance, general assistance medical care, 
3.21 	or MinnesotaCare;
3.22 	(16) a project for the construction or relocation of up to 20 hospital beds for the 
3.23 	operation of up to two psychiatric facilities or units for children provided that the operation 
3.24 	of the facilities or units have received the approval of the commissioner of human services;
3.25 	(17) a project involving the addition of 14 new hospital beds to be used for 
3.26 	rehabilitation services in an existing hospital in Itasca County;
3.27 	(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin 
3.28 	County that closed 20 rehabilitation beds in 2002, provided that the beds are used only 
3.29 	for rehabilitation in the hospital's current rehabilitation building. If the beds are used for 
3.30 	another purpose or moved to another location, the hospital's licensed capacity is reduced 
3.31 	by 20 beds; 
3.32 	(19) a critical access hospital established under section 144.1483, clause (9), and 
3.33 	section 1820 of the federal Social Security Act, United States Code, title 42, section 
3.34 	1395i-4, that delicensed beds since enactment of the Balanced Budget Act of 1997, Public 
3.35 	Law 105-33, to the extent that the critical access hospital does not seek to exceed the 
3.36 	maximum number of beds permitted such hospital under federal law; or
4.1 	(20) notwithstanding section 144.552, a project for the construction of a new hospital 
4.2 	in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
4.3 	(i) the project, including each hospital or health system that will own or control the 
4.4 	entity that will hold the new hospital license, is approved by a resolution of the Maple 
4.5 	Grove City Council as of March 1, 2006;
4.6 	(ii) the entity that will hold the new hospital license will be owned or controlled by 
4.7 	one or more not-for-profit hospitals or health systems that have previously submitted a 
4.8 	plan or plans for a project in Maple Grove as required under section 144.552, and the 
4.9 	plan or plans have been found to be in the public interest by the commissioner of health 
4.10 	as of April 1, 2005;
4.11 	(iii) the new hospital's initial inpatient services must include, but are not limited 
4.12 	to, medical and surgical services, obstetrical and gynecological services, intensive 
4.13 	care services, orthopedic services, pediatric services, noninvasive cardiac diagnostics, 
4.14 	behavioral health services, and emergency room services; 
4.15 	(iv) the new hospital:
4.16 	(A) will have the ability to provide and staff sufficient new beds to meet the growing 
4.17 	needs of the Maple Grove service area and the surrounding communities currently being 
4.18 	served by the hospital or health system that will own or control the entity that will hold 
4.19 	the new hospital license;
4.20 	(B) will provide uncompensated care;
4.21 	(C) will provide mental health services, including inpatient beds;
4.22 	(D) will be a site for workforce development for a broad spectrum of 
4.23 	health-care-related occupations and have a commitment to providing clinical training 
4.24 	programs for physicians and other health care providers;
4.25 	(E) will demonstrate a commitment to quality care and patient safety;
4.26 	(F) will have an electronic medical records system, including physician order entry;
4.27 	(G) will provide a broad range of senior services;
4.28 	(H) will provide emergency medical services that will coordinate care with regional 
4.29 	providers of trauma services and licensed emergency ambulance services in order to 
4.30 	enhance the continuity of care for emergency medical patients; and
4.31 	(I) will be completed by December 31, 2009, unless delayed by circumstances 
4.32 	beyond the control of the entity holding the new hospital license; and
4.33 	(v) as of 30 days following submission of a written plan, the commissioner of health 
4.34 	has not determined that the hospitals or health systems that will own or control the entity 
4.35 	that will hold the new hospital license are unable to meet the criteria of this clause.;
4.36 	(21) a project approved under section 144.553; 
5.1 	(22) a project for the construction of a hospital with up to 25 beds in Cass County 
5.2 	within a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's 
5.3 	license holder is approved by the Cass County Board; or 
5.4 	(23) a project for an acute care hospital in Fergus Falls that will increase the bed 
5.5 	capacity from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 
5.6 	and closing a separately licensed 13-bed skilled nursing facility.

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

5.8 	Sec. 2. Minnesota Statutes 2004, section 144.552, is amended to read:
5.9 	144.552 PUBLIC INTEREST REVIEW.
5.10 	(a) The following entities must submit a plan to the commissioner:
5.11 	(1) a hospital seeking to increase its number of licensed beds; or
5.12 	(2) an organization seeking to obtain a hospital license must submit a plan to 
5.13 	the commissioner of health and notified by the commissioner under section 144.553, 
5.14 	subdivision 1, paragraph (c), that it is subject to this section. 
5.15 	The plan must include information that includes an explanation of how the expansion will 
5.16 	meet the public's interest. When submitting a plan to the commissioner, an applicant shall 
5.17 	pay the commissioner for the commissioner's cost of reviewing the plan, as determined 
5.18 	by the commissioner and notwithstanding section  16A.1283. Money received by the 
5.19 	commissioner under this section is appropriated to the commissioner for the purpose of 
5.20 	administering this section. 
5.21 	(b) Plans submitted under this section shall include detailed information necessary 
5.22 	for the commissioner to review the plan and reach a finding. The commissioner may 
5.23 	request additional information from the hospital submitting a plan under this section and 
5.24 	from others affected by the plan that the commissioner deems necessary to review the 
5.25 	plan and make a finding.
5.26 	(c) The commissioner shall review the plan and, within 90 days, but no more than 
5.27 	six months if extenuating circumstances apply, issue a finding on whether the plan is in 
5.28 	the public interest. In making the recommendation, the commissioner shall consider 
5.29 	issues including but not limited to:
5.30 	(1) whether the new hospital or hospital beds are needed to provide timely access to 
5.31 	care or access to new or improved services;
5.32 	(2) the financial impact of the new hospital or hospital beds on existing acute-care 
5.33 	hospitals that have emergency departments in the region;
6.1 	(3) how the new hospital or hospital beds will affect the ability of existing hospitals 
6.2 	in the region to maintain existing staff;
6.3 	(4) the extent to which the new hospital or hospital beds will provide services to 
6.4 	nonpaying or low-income patients relative to the level of services provided to these groups 
6.5 	by existing hospitals in the region; and
6.6 	(5) the views of affected parties.
6.7 	Prior to making a recommendation, the commissioner shall conduct a public hearing in the 
6.8 	affected hospital service area to take testimony from interested persons.
6.9 	(d) Upon making a recommendation under paragraph (c), the commissioner shall 
6.10 	provide a copy of the recommendation to the chairs of the house and senate committees 
6.11 	having jurisdiction over health and human services policy and finance.

6.12 	Sec. 3. [144.553] ALTERNATIVE APPROVAL PROCESS FOR NEW 
6.13 	HOSPITAL CONSTRUCTION.
6.14 		Subdivision 1.Letter of intent; publication; acceptance of additional proposals.
 6.15 	(a) An organization seeking to obtain a hospital license must submit a letter of intent to the 
6.16 	commissioner, specifying the community in which the proposed hospital would be located 
6.17 	and the number of beds proposed for the new hospital. When multiple letters of intent are 
6.18 	received, the commissioner shall determine whether they constitute requests for separate 
6.19 	projects or are competing proposals to serve the same or a similar service area.
6.20 	(b) Upon receipt of a letter under paragraph (a), the commissioner shall publish a 
6.21 	notice in the State Register that includes the information received from the organization 
6.22 	under paragraph (a). The notice must state that another organization interested in seeking 
6.23 	a hospital license to serve the same or a similar service area must notify the commissioner 
6.24 	within 30 days.
6.25 	(c) If no responses are received from additional organizations under paragraph (b), 
6.26 	the commissioner shall notify the entity seeking a license that it is required to submit a 
6.27 	plan under section 144.552 and shall notify the chairs of the house of representatives and 
6.28 	senate committees having jurisdiction over health and human services policy and finance 
6.29 	that the project is subject to sections 144.551 and 144.552.
6.30 		Subd. 2.Needs assessment. (a) If one or more responses are received by the 
6.31 	commissioner under subdivision 1, paragraph (b), the commissioner shall complete within 
6.32 	90 days a needs assessment to determine if a new hospital is needed in the proposed 
6.33 	service area.
6.34 	(b) The organizations that have filed or responded to a letter of intent under 
6.35 	subdivision 1 shall provide to the commissioner within 30 days of a request from the 
7.1 	commissioner a statement justifying the need for a new hospital in the service area and 
7.2 	sufficient information, as determined by the commissioner, to allow the commissioner to 
7.3 	determine the need for a new hospital. The information may include, but is not limited 
7.4 	to, a demographic analysis of the proposed service area, the number of proposed beds, 
7.5 	the types of hospital services to be provided, and distances and travel times to existing 
7.6 	hospitals currently providing services in the service area.
7.7 	(c) The commissioner shall make a determination of need for the new hospital. If 
7.8 	the commissioner determines that a new hospital in the service area is not justified, the 
7.9 	commissioner shall notify the applicants in writing, stating the reasons for the decision.
7.10 		Subd. 3.Process when hospital need is determined. (a) If the commissioner 
7.11 	determines that a new hospital is needed in the proposed service area, the commissioner 
7.12 	shall notify the applicants of that finding and shall select the applicant determined under 
7.13 	the process established in this subdivision to be best able to provide services consistent 
7.14 	with the review criteria established in this subdivision.
7.15 	(b) The commissioner shall:
7.16 	(1) determine market-specific criteria that shall be used to evaluate all proposals. 
7.17 	The criteria must include standards regarding:
7.18 	(i) access to care;
7.19 	(ii) quality of care;
7.20 	(iii) cost of care; and
7.21 	(iv) overall project feasibility;
7.22 	(2) establish additional criteria at the commissioner's discretion. In establishing the 
7.23 	criteria, the commissioner shall consider the need for:
7.24 	(i) mental health services in the service area, including both inpatient and outpatient 
7.25 	services for adults, adolescents, and children; 
7.26 	(ii) a significant commitment to providing uncompensated care, including discounts 
7.27 	for uninsured patients and coordination with other providers of care to low-income 
7.28 	uninsured persons; and 
7.29 	(iii) coordination with other hospitals so that specialized services are not 
7.30 	unnecessarily duplicated and are provided in sufficient volume to ensure the maintenance 
7.31 	of high-quality care; and
7.32 	(3) define a service area for the proposed hospital. The service area shall consist of:
7.33 	(i) in the 11-county metropolitan area, in St. Cloud, and in Duluth, the zip codes 
7.34 	located within a 20-mile radius of the proposed new hospital location; and 
7.35 	(ii) in the remainder of the state, the zip codes within a 30-mile radius of the 
7.36 	proposed new hospital location.
8.1 	(c) The commissioner shall publish the criteria determined under paragraph (b) in the 
8.2 	State Register within 60 days of the determination under subdivision 2. Once published, 
8.3 	the criteria shall not be modified with respect to the particular project and applicants 
8.4 	to which they apply. The commissioner shall publish with the criteria guidelines for a 
8.5 	proposal and submission review process.
8.6 	(d) For 60 days after the publication under paragraph (c), the commissioner shall 
8.7 	accept proposals to construct a hospital from organizations that have submitted a letter 
8.8 	of intent under subdivision 1, paragraph (a), or have notified the commissioner under 
8.9 	subdivision 1, paragraph (b). The proposal must include a plan for the new hospital and 
8.10 	evidence of compliance with the criteria specified under paragraph (b). Once submitted, 
8.11 	the proposal may not be revised except:
8.12 	(1) to submit corrections of material facts; or
8.13 	(2) in response to a request from the commissioner to provide clarification or 
8.14 	further information. 
8.15 	(e) The commissioner shall determine within 90 days of the deadline for applications 
8.16 	under paragraph (d), which applicant has demonstrated that it is best able to provide 
8.17 	services consistent with the published criteria. The commissioner shall make this 
8.18 	determination by order following a hearing according to this paragraph. The hearing 
8.19 	shall not constitute or be considered to be a contested case hearing under chapter 14 and 
8.20 	shall be conducted solely under the procedures specified in this paragraph. The hearing 
8.21 	shall commence upon at least 30 days' notice to the applicants by the commissioner. 
8.22 	The hearing may be conducted by the commissioner or by a person designated by the 
8.23 	commissioner. The designee may be an administrative law judge. The purpose of the 
8.24 	hearing shall be to receive evidence to assist the commissioner in determining which 
8.25 	applicant has demonstrated that it best meets the published criteria.
8.26 	The parties to the hearing shall consist only of those applicants who have submitted 
8.27 	a completed application. Each applicant shall have the right to be represented by 
8.28 	counsel, to present evidence deemed relevant by the commissioner, and to examine and 
8.29 	cross-examine witnesses. Persons who are not parties to the proceeding but who wish to 
8.30 	present comments or submit information may do so in the manner determined by the 
8.31 	commissioner or the commissioner's designee. Any person who is not a party shall have 
8.32 	no right to examine or cross-examine witnesses. The commissioner may participate as an 
8.33 	active finder of fact in the hearing and may ask questions to elicit information or clarify 
8.34 	answers or responses.
8.35 	(f) Prior to making a determination selecting an application, the commissioner shall 
8.36 	hold a public hearing in the proposed hospital service area to accept comments from 
9.1 	members of the public. The commissioner shall take this information into consideration 
9.2 	in making the determination. The commissioner may appoint an advisory committee, 
9.3 	including legislators and local elected officials who represent the service area and outside 
9.4 	experts to assist in the recommendation process. The commissioner shall issue an order 
9.5 	selecting an application following the closing of the record of the hearing as determined 
9.6 	by the hearing officer. The commissioner's order shall include a statement of the reasons 
9.7 	the selected application best meets the published criteria.
9.8 	(g) Within 30 days following the determination under paragraph (e), the 
9.9 	commissioner shall recommend the selected proposal to the legislature.
9.10 		Subd. 4.Payment of commissioner's expenses. Notwithstanding section 
9.11 	16A.1283, applicants who are a party at any stage of the administrative process established 
9.12 	in this section shall pay the cost of that stage of the process, as determined by the 
9.13 	commissioner. The cost of the needs assessment, criteria development, and hearing shall 
9.14 	be divided equally among the applicants. Money received by the commissioner under 
9.15 	this subdivision is appropriated to the commissioner for the purpose of administering 
9.16 	this section.

9.17 	Sec. 4. Minnesota Statutes 2004, section 325F.665, subdivision 1, is amended to read:
9.18 		Subdivision 1.Definitions. (a) For the purposes of this section, the following terms 
9.19 	in paragraphs (b) to (i) have the meanings given them:.
9.20 	(a)(b) "Consumer" means the purchaser or lessee, other than for purposes of resale 
9.21 	or sublease, of a new motor vehicle used for personal, family, or household purposes at 
9.22 	least 40 percent of the time, and a person to whom the new motor vehicle is transferred 
9.23 	for the same purposes during the duration of an express warranty applicable to the motor 
9.24 	vehicle;. The term also includes an ambulance service licensed under chapter 144E that 
9.25 	has purchased or leased a new motor vehicle of the type specified in paragraph (f), and a 
9.26 	person to whom the ambulance is transferred for the same purpose during the duration of 
9.27 	any applicable express warranty.
9.28 	(b)(c) "Manufacturer" means a person engaged in the business of manufacturing, 
9.29 	assembling or distributing motor vehicles, who will, under normal business conditions 
9.30 	during the year, manufacture, assemble or distribute to dealers at least ten new motor 
9.31 	vehicles;.
9.32 	(c)(d) "Manufacturer's express warranty" and "warranty" mean the written warranty 
9.33 	of the manufacturer of a new motor vehicle of its condition and fitness for use, including 
9.34 	any terms or conditions precedent to the enforcement of obligations under that warranty;.
10.1 	(d)(e) "Lease" means a contract in the form of a lease or bailment for the use of 
10.2 	personal property by a natural person for a period of time exceeding four months, used for 
10.3 	personal, family, or household purposes at least 40 percent of the time, whether or not the 
10.4 	lessee has the option to purchase or otherwise become the owner of the property at the 
10.5 	expiration of the lease;.
10.6 	(e)(f) "Motor vehicle" means (1) a passenger automobile as defined in section  
10.7 	168.011, subdivision 7, including pickup trucks and vans, and (2) the self-propelled 
10.8 	motor vehicle chassis or van portion of recreational equipment as defined in section  
10.9 	168.011, subdivision 25, which is sold or leased to a consumer in this state;, and (3) the 
10.10 	self-propelled motor vehicle chassis or van portion of an ambulance as defined in section 
10.11 	144E.001, subdivision 2.
10.12 	(f)(g) "Informal dispute settlement mechanism" means an arbitration process 
10.13 	or procedure by which the manufacturer attempts to resolve disputes with consumers 
10.14 	regarding motor vehicle nonconformities and repairs that arise during the vehicle's 
10.15 	warranty period;.
10.16 	(g)(h) "Motor vehicle lessor" means a person who holds title to a motor vehicle 
10.17 	leased to a lessee under a written lease agreement or who holds the lessor's rights under 
10.18 	such agreement; and.
10.19 	(h)(i) "Early termination costs" means expenses and obligations incurred by a 
10.20 	motor vehicle lessor as a result of an early termination of a written lease agreement and 
10.21 	surrender of a motor vehicle to a manufacturer under subdivision 4, including penalties 
10.22 	for prepayment of finance arrangements.

10.23 	Sec. 5. STUDY OF MEDICAL FACILITY CONSTRUCTION.
 10.24 	The commissioner of health shall study and report to the legislature by February 15, 
10.25 	2007, on the need for a new process for approving the construction of medical facilities 
10.26 	or the addition of services at existing medical facilities. The report shall consider the 
10.27 	following issues:
10.28 	(1) what type of investment in medical facilities should be subject to prior approval, 
10.29 	including the types of facilities that should be included, the types of services that should 
10.30 	be included, and the threshold level of investment that would make a project subject 
10.31 	to an approval process;
10.32 	(2) what entity should be responsible for approving investments in medical facilities;
10.33 	(3) what decision-making process should be used when multiple providers propose 
10.34 	to invest in similar facilities or services within the same geographic area;
11.1 	(4) what information would be required to effectively determine the need for new 
11.2 	medical facilities or services; and 
11.3 	(5) other issues identified by the commissioner as relevant to health care delivery 
11.4 	capacity in Minnesota.
11.5 	The report shall include recommendations for legislative changes necessary to 
11.6 	implement a new process for approving the expansion or construction of medical facilities 
11.7 	or major changes in services provided at existing facilities.

11.8 	Sec. 6. SUNSET.
 11.9 	Section 3 expires on January 1, 2009.

11.10 	Sec. 7. EFFECTIVE DATE; APPLICATION.
 11.11 	Section 4 is effective August 1, 2006, and applies to new motor vehicle sales and 
11.12 	leases made on or after that date.