HF 3046

1st Committee Engrossment - 86th Legislature (2009 - 2010)

Posted on 03/19/2013 07:29 p.m.

1.1A bill for an act 1.2relating to health; requiring licensure for birth centers; establishing license 1.3fees; requiring a report;amending Minnesota Statutes 2008, sections 62Q.19, 1.4subdivision 1; 144.651, subdivision 2; 144A.51, subdivision 5; 256B.0625, by 1.5adding a subdivision; proposing coding for new law in Minnesota Statutes, 1.6chapter 144. 1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.8    Section 1. Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read: 1.9    Subdivision 1. Designation. (a) The commissioner shall designate essential 1.10community providers. The criteria for essential community provider designation shall be 1.11the following: 1.12(1) a demonstrated ability to integrate applicable supportive and stabilizing services 1.13with medical care for uninsured persons and high-risk and special needs populations, 1.14underserved, and other special needs populations; and 1.15(2) a commitment to serve low-income and underserved populations by meeting the 1.16following requirements: 1.17(i) has nonprofit status in accordance with chapter 317A; 1.18(ii) has tax exempt status in accordance with the Internal Revenue Service Code, 1.19section 501(c)(3); 1.20(iii) charges for services on a sliding fee schedule based on current poverty income 1.21guidelines; and 1.22(iv) does not restrict access or services because of a client's financial limitation; 1.23(3) status as a local government unit as defined in section 62D.02, subdivision 11, a 1.24hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal 2.1government, an Indian health service unit, or a community health board as defined in 2.2chapter 145A; 2.3(4) a former state hospital that specializes in the treatment of cerebral palsy, spina 2.4bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling 2.5conditions; or 2.6(5) a sole community hospital. For these rural hospitals, the essential community 2.7provider designation applies to all health services provided, including both inpatient and 2.8outpatient services. For purposes of this section, "sole community hospital" means a 2.9rural hospital that: 2.10(i) is eligible to be classified as a sole community hospital according to Code 2.11of Federal Regulations, title 42, section 412.92, or is located in a community with a 2.12population of less than 5,000 and located more than 25 miles from a like hospital currently 2.13providing acute short-term services; 2.14(ii) has experienced net operating income losses in two of the previous three 2.15most recent consecutive hospital fiscal years for which audited financial information is 2.16available; and 2.17(iii) consists of 40 or fewer licensed beds new text begin ; or new text end 2.18 new text begin (6) a birth center licensed under section 144.615 new text end . 2.19(b) Prior to designation, the commissioner shall publish the names of all applicants 2.20in the State Register. The public shall have 30 days from the date of publication to submit 2.21written comments to the commissioner on the application. No designation shall be made 2.22by the commissioner until the 30-day period has expired. 2.23(c) The commissioner may designate an eligible provider as an essential community 2.24provider for all the services offered by that provider or for specific services designated by 2.25the commissioner. 2.26(d) For the purpose of this subdivision, supportive and stabilizing services include at 2.27a minimum, transportation, child care, cultural, and linguistic services where appropriate. 2.28    Sec. 2. new text begin [144.615] BIRTH CENTERS. new text end 2.29     new text begin Subdivision 1. new text end new text begin Definitions. new text end new text begin (a) For purposes of this section, the following definitions new text end 2.30 new text begin have the meanings given to them. new text end 2.31 new text begin (b) "Birth center" means a facility licensed for the primary purpose of performing new text end 2.32 new text begin low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are new text end 2.33 new text begin planned to occur away from the mother's usual residence following a low-risk pregnancy. new text end 2.34 new text begin (c) "CABC" means the Commission for the Accreditation of Birth Centers. new text end 3.1 new text begin (d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as new text end 3.2 new text begin determined by documentation of adequate prenatal care and the anticipation of a normal new text end 3.3 new text begin uncomplicated labor and birth, as defined by reasonable and generally accepted criteria new text end 3.4 new text begin adopted by professional groups for maternal, fetal, and neonatal health care. new text end 3.5     new text begin Subd. 2. new text end new text begin License required. new text end new text begin (a) Beginning January 1, 2011, no birth center shall be new text end 3.6 new text begin established, operated, or maintained in the state without first obtaining a license from the new text end 3.7 new text begin commissioner of health according to this section. new text end 3.8 new text begin (b) A license issued under this section is not transferable or assignable and is subject new text end 3.9 new text begin to suspension or revocation at any time for failure to comply with this section. new text end 3.10 new text begin (c) A birth center licensed under this section shall not assert, represent, offer, new text end 3.11 new text begin provide, or imply that the center is or may render care or services other than the services it new text end 3.12 new text begin is permitted to render within the scope of the license or the accreditation issued. new text end 3.13 new text begin (d) The license must be conspicuously posted in an area where patients are admitted. new text end 3.14     new text begin Subd. 3. new text end new text begin Temporary license. new text end new text begin For new birth centers planning to begin operations new text end 3.15 new text begin after January 1, 2011, the commissioner may issue a temporary license to the birth center new text end 3.16 new text begin that is valid for a period of six months from the date of issuance. The birth center must new text end 3.17 new text begin submit to the commissioner an application and applicable fee for licensure as required new text end 3.18 new text begin under subdivision 4. The application must include the information required in subdivision new text end 3.19 new text begin 4, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted new text end 3.20 new text begin an application for accreditation to the CABC. Upon receipt of accreditation from the new text end 3.21 new text begin CABC, the birth center must submit to the commissioner the information required in new text end 3.22 new text begin subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner new text end 3.23 new text begin shall issue a new license. new text end 3.24     new text begin Subd. 4. new text end new text begin Application. new text end new text begin An application for a license to operate a birth center and the new text end 3.25 new text begin applicable fee under subdivision 8 must be submitted to the commissioner on a form new text end 3.26 new text begin provided by the commissioner and must contain: new text end 3.27 new text begin (1) the name of the applicant; new text end 3.28 new text begin (2) the site location of the birth center; new text end 3.29 new text begin (3) the name of the person in charge of the center; new text end 3.30 new text begin (4) documentation that the accreditation described under subdivision 6 has been new text end 3.31 new text begin issued, including the effective date and the expiration date of the accreditation, and the new text end 3.32 new text begin date of the last site visit by the CABC; new text end 3.33 new text begin (5) the number of patients the birth center is capable of serving at a given time; new text end 3.34 new text begin (6) the names and license numbers, if applicable, of the health care professionals new text end 3.35 new text begin on staff at the birth center; and new text end 3.36 new text begin (7) any other information the commissioner deems necessary. new text end 4.1     new text begin Subd. 5. new text end new text begin Suspension, revocation, and refusal to renew. new text end new text begin The commissioner may new text end 4.2 new text begin refuse to grant or renew, or may suspend or revoke, a license on any of the grounds new text end 4.3 new text begin described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or new text end 4.4 new text begin upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice new text end 4.5 new text begin and a hearing as described under section 144.55, subdivision 7, and a new license may be new text end 4.6 new text begin issued after proper inspection of the birth center has been conducted. new text end 4.7     new text begin Subd. 6. new text end new text begin Standards for licensure. new text end new text begin (a) To be eligible for licensure under this new text end 4.8 new text begin section, a birth center must be accredited by the CABC or must obtain accreditation new text end 4.9 new text begin within six months of the date of the application for licensure. If the birth center loses its new text end 4.10 new text begin accreditation, the birth center must immediately notify the commissioner. new text end 4.11 new text begin (b) The center must have procedures in place specifying criteria by which risk status new text end 4.12 new text begin will be established and applied to each woman at admission and during labor. new text end 4.13 new text begin (c) The birth center shall provide the commissioner of health, upon request, with any new text end 4.14 new text begin material submitted by the birth center to the CABC as part of the accreditation process, new text end 4.15 new text begin including the accreditation application, the self-evaluation report, the accreditation new text end 4.16 new text begin decision letter from the CABC, and any reports from the CABC following a site visit. new text end 4.17     new text begin Subd. 7. new text end new text begin Limitations of services. new text end new text begin (a) The following limitations apply to the services new text end 4.18 new text begin performed at a birth center: new text end 4.19 new text begin (1) surgical procedures must be limited to those normally accomplished during an new text end 4.20 new text begin uncomplicated birth, including episiotomy and repair; new text end 4.21 new text begin (2) no abortions may be administered; and new text end 4.22 new text begin (3) no general or regional anesthesia may be administered. new text end 4.23 new text begin (b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth new text end 4.24 new text begin center if the administration of the anesthetic is performed within the scope of practice of a new text end 4.25 new text begin health care professional. new text end 4.26     new text begin Subd. 8. new text end new text begin Fees. new text end new text begin (a) The biennial license fee for a birth center is $365. new text end 4.27 new text begin (b) The temporary license fee is $365. new text end 4.28 new text begin (c) Fees shall be collected and deposited according to section 144.122. new text end 4.29     new text begin Subd. 9. new text end new text begin Renewal. new text end new text begin (a) Except as provided in paragraph (b), a license issued under new text end 4.30 new text begin this section expires two years from the date of issue. new text end 4.31 new text begin (b) A temporary license issued under subdivision 3 expires six months from the date new text end 4.32 new text begin of issue, and may be renewed for one additional six-month period. new text end 4.33 new text begin (c) An application for renewal shall be submitted at least 60 days prior to expiration new text end 4.34 new text begin of the license on forms prescribed by the commissioner of health. new text end 4.35     new text begin Subd. 10. new text end new text begin Records. new text end new text begin All health records maintained on each client by a birth center new text end 4.36 new text begin are subject to sections 144.292 to 144.298. new text end 5.1     new text begin Subd. 11. new text end new text begin Report. new text end new text begin (a) The commissioner of health, in consultation with the new text end 5.2 new text begin commissioner of human services and representatives of the licensed birth centers, shall new text end 5.3 new text begin evaluate the quality of care and outcomes for services provided in licensed birth centers, new text end 5.4 new text begin including, but not limited to, the utilization of services provided at a birth center, the new text end 5.5 new text begin outcomes of care provided to both mothers and newborns, and the numbers of transfers new text end 5.6 new text begin to other health care facilities that are required and the reasons for the transfers. The new text end 5.7 new text begin commissioner shall work with the birth centers to establish a process to gather and analyze new text end 5.8 new text begin the data within protocols that protect the confidentiality of patient identification. new text end 5.9 new text begin (b) The commissioner of health shall report the findings of the evaluation to the new text end 5.10 new text begin legislature by January 15, 2014. new text end 5.11    Sec. 3. Minnesota Statutes 2008, section 144.651, subdivision 2, is amended to read: 5.12    Subd. 2. Definitions. For the purposes of this section, "patient" means a person 5.13who is admitted to an acute care inpatient facility for a continuous period longer than 5.1424 hours, for the purpose of diagnosis or treatment bearing on the physical or mental 5.15health of that person. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, 5.16"patient" also means a person who receives health care services at an outpatient surgical 5.17center new text begin or at a birth center licensed under section 144.615 new text end . "Patient" also means a minor 5.18who is admitted to a residential program as defined in section 253C.01. For purposes of 5.19subdivisions 1, 3 to 16, 18, 20 and 30, "patient" also means any person who is receiving 5.20mental health treatment on an outpatient basis or in a community support program or other 5.21community-based program. "Resident" means a person who is admitted to a nonacute care 5.22facility including extended care facilities, nursing homes, and boarding care homes for 5.23care required because of prolonged mental or physical illness or disability, recovery from 5.24injury or disease, or advancing age. For purposes of all subdivisions except subdivisions 5.2528 and 29, "resident" also means a person who is admitted to a facility licensed as a board 5.26and lodging facility under Minnesota Rules, parts 4625.0100 to 4625.2355, or a supervised 5.27living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which operates 5.28a rehabilitation program licensed under Minnesota Rules, parts 9530.4100 to 9530.4450. 5.29    Sec. 4. Minnesota Statutes 2008, section 144A.51, subdivision 5, is amended to read: 5.30    Subd. 5. Health facility. "Health facility" means a facility or that part of a facility 5.31which is required to be licensed pursuant to sections 144.50 to 144.58, new text begin 144.615, new text end and a 5.32facility or that part of a facility which is required to be licensed under any law of this state 5.33which provides for the licensure of nursing homes. 6.1    Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 6.2subdivision to read: 6.3     new text begin Subd. 54. new text end new text begin Services provided in birth centers. new text end new text begin (a) Medical assistance covers new text end 6.4 new text begin services provided in a birth center licensed under section 144.615 by a licensed health new text end 6.5 new text begin professional if the service would otherwise be covered if provided in a hospital. new text end 6.6 new text begin (b) The commissioner shall apply for any necessary waivers from the Centers for new text end 6.7 new text begin Medicare and Medicaid Services to allow birth centers and birth center providers to be new text end 6.8 new text begin reimbursed. new text end 6.9    Sec. 6. new text begin PREPAID HEALTH PLAN RATES. new text end 6.10 new text begin In negotiating the managed care contract rates for services rendered on or after new text end 6.11 new text begin January 1, 2011, the commissioner of human services shall take into consideration and new text end 6.12 new text begin the rates shall reflect the anticipated savings in the medical assistance program due to new text end 6.13 new text begin extending medical assistance coverage to services provided in licensed birth centers, new text end 6.14 new text begin the anticipated use of these services within the medical assistance population, and the new text end 6.15 new text begin reduced medical assistance costs associated with the use of birth centers for normal, new text end 6.16 new text begin low-risk deliveries. new text end