<a id="pl.1.3"></a><var>1.3</var>fees; requiring a report;amending Minnesota Statutes 2008, sections 62Q.19, <br/>
<a id="pl.1.4"></a><var>1.4</var>subdivision 1; 144.651, subdivision 2; 144A.51, subdivision 5; 256B.0625, by <br/>
<a id="pl.1.5"></a><var>1.5</var>adding a subdivision; proposing coding for new law in Minnesota Statutes, <br/>
<a id="pl.1.6"></a><var>1.6</var>chapter 144.<br/>
<a id="pl.1.7"></a><var>1.7</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.8"></a><var>1.8</var>    Section 1. Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:<br/>
<a id="pl.1.9"></a><var>1.9</var>    Subdivision 1. <b>Designation.</b> (a) The commissioner shall designate essential <br/>
<a id="pl.1.10"></a><var>1.10</var>community providers. The criteria for essential community provider designation shall be <br/>
<a id="pl.1.11"></a><var>1.11</var>the following:<br/>
<a id="pl.1.12"></a><var>1.12</var>(1) a demonstrated ability to integrate applicable supportive and stabilizing services <br/>
<a id="pl.1.13"></a><var>1.13</var>with medical care for uninsured persons and high-risk and special needs populations, <br/>
<a id="pl.1.14"></a><var>1.14</var>underserved, and other special needs populations; and<br/>
<a id="pl.1.15"></a><var>1.15</var>(2) a commitment to serve low-income and underserved populations by meeting the <br/>
<a id="pl.1.16"></a><var>1.16</var>following requirements:<br/>
<a id="pl.1.17"></a><var>1.17</var>(i) has nonprofit status in accordance with chapter 317A;<br/>
<a id="pl.1.18"></a><var>1.18</var>(ii) has tax exempt status in accordance with the Internal Revenue Service Code, <br/>
<a id="pl.1.19"></a><var>1.19</var>section 501(c)(3);<br/>
<a id="pl.1.20"></a><var>1.20</var>(iii) charges for services on a sliding fee schedule based on current poverty income <br/>
<a id="pl.1.21"></a><var>1.21</var>guidelines; and<br/>
<a id="pl.1.22"></a><var>1.22</var>(iv) does not restrict access or services because of a client's financial limitation;<br/>
<a id="pl.1.23"></a><var>1.23</var>(3) status as a local government unit as defined in section 
         <statute_ref>62D.02, subdivision 11</statute_ref>, a <br/>
<a id="pl.1.24"></a><var>1.24</var>hospital district created or reorganized under sections 
         <statute_ref>447.31</statute_ref> to 
         <statute_ref>447.37</statute_ref>, an Indian tribal <br/>
<a id="pl.2.1"></a><var>2.1</var>government, an Indian health service unit, or a community health board as defined in <br/>
<a id="pl.2.2"></a><var>2.2</var>chapter 145A;  <br/>
<a id="pl.2.3"></a><var>2.3</var>(4) a former state hospital that specializes in the treatment of cerebral palsy, spina <br/>
<a id="pl.2.4"></a><var>2.4</var>bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling <br/>
<a id="pl.2.5"></a><var>2.5</var>conditions; or<br/>
<a id="pl.2.6"></a><var>2.6</var>(5) a sole community hospital. For these rural hospitals, the essential community <br/>
<a id="pl.2.7"></a><var>2.7</var>provider designation applies to all health services provided, including both inpatient and <br/>
<a id="pl.2.8"></a><var>2.8</var>outpatient services. For purposes of this section, "sole community hospital" means a <br/>
<a id="pl.2.9"></a><var>2.9</var>rural hospital that:<br/>
<a id="pl.2.10"></a><var>2.10</var>(i) is eligible to be classified as a sole community hospital according to Code <br/>
<a id="pl.2.11"></a><var>2.11</var>of Federal Regulations, title 42, section 
         <statute_ref>412.92</statute_ref>, or is located in a community with a <br/>
<a id="pl.2.12"></a><var>2.12</var>population of less than 5,000 and located more than 25 miles from a like hospital currently <br/>
<a id="pl.2.13"></a><var>2.13</var>providing acute short-term services;  <br/>
<a id="pl.2.14"></a><var>2.14</var>(ii) has experienced net operating income losses in two of the previous three <br/>
<a id="pl.2.15"></a><var>2.15</var>most recent consecutive hospital fiscal years for which audited financial information is <br/>
<a id="pl.2.16"></a><var>2.16</var>available; and<br/>
<a id="pl.2.17"></a><var>2.17</var>(iii) consists of 40 or fewer licensed beds; or<br/>
<a id="pl.2.18"></a><var>2.18</var>(6) a birth center licensed under section 144.615.<br/>
<a id="pl.2.19"></a><var>2.19</var>(b) Prior to designation, the commissioner shall publish the names of all applicants <br/>
<a id="pl.2.20"></a><var>2.20</var>in the State Register. The public shall have 30 days from the date of publication to submit <br/>
<a id="pl.2.21"></a><var>2.21</var>written comments to the commissioner on the application. No designation shall be made <br/>
<a id="pl.2.22"></a><var>2.22</var>by the commissioner until the 30-day period has expired.<br/>
<a id="pl.2.23"></a><var>2.23</var>(c) The commissioner may designate an eligible provider as an essential community <br/>
<a id="pl.2.24"></a><var>2.24</var>provider for all the services offered by that provider or for specific services designated by <br/>
<a id="pl.2.25"></a><var>2.25</var>the commissioner.<br/>
<a id="pl.2.26"></a><var>2.26</var>(d) For the purpose of this subdivision, supportive and stabilizing services include at <br/>
<a id="pl.2.27"></a><var>2.27</var>a minimum, transportation, child care, cultural, and linguistic services where appropriate.<br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.2.28"></a><var>2.28</var>    Sec. 2. <b>[144.615] BIRTH CENTERS.</b><br/>
<a id="pl.2.29"></a><var>2.29</var>    Subdivision 1. <b>Definitions.</b> (a) For purposes of this section, the following definitions <br/>
<a id="pl.2.30"></a><var>2.30</var>have the meanings given to them.<br/>
<a id="pl.2.31"></a><var>2.31</var>(b) "Birth center" means a facility licensed for the primary purpose of performing <br/>
<a id="pl.2.32"></a><var>2.32</var>low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are <br/>
<a id="pl.2.33"></a><var>2.33</var>planned to occur away from the mother's usual residence following a low-risk pregnancy.<br/>
<a id="pl.2.34"></a><var>2.34</var>(c) "CABC" means the Commission for the Accreditation of Birth Centers.<br/>
<a id="pl.3.1"></a><var>3.1</var>(d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as <br/>
<a id="pl.3.2"></a><var>3.2</var>determined by documentation of adequate prenatal care and the anticipation of a normal <br/>
<a id="pl.3.3"></a><var>3.3</var>uncomplicated labor and birth, as defined by reasonable and generally accepted criteria <br/>
<a id="pl.3.4"></a><var>3.4</var>adopted by professional groups for maternal, fetal, and neonatal health care.<br/>
<a id="pl.3.5"></a><var>3.5</var>    Subd. 2. <b>License required.</b> (a) Beginning January 1, 2011, no birth center shall be <br/>
<a id="pl.3.6"></a><var>3.6</var>established, operated, or maintained in the state without first obtaining a license from the <br/>
<a id="pl.3.7"></a><var>3.7</var>commissioner of health according to this section.<br/>
<a id="pl.3.8"></a><var>3.8</var>(b) A license issued under this section is not transferable or assignable and is subject <br/>
<a id="pl.3.9"></a><var>3.9</var>to suspension or revocation at any time for failure to comply with this section.<br/>
<a id="pl.3.10"></a><var>3.10</var>(c) A birth center licensed under this section shall not assert, represent, offer, <br/>
<a id="pl.3.11"></a><var>3.11</var>provide, or imply that the center is or may render care or services other than the services it <br/>
<a id="pl.3.12"></a><var>3.12</var>is permitted to render within the scope of the license or the accreditation issued.<br/>
<a id="pl.3.13"></a><var>3.13</var>(d) The license must be conspicuously posted in an area where patients are admitted.<br/>
<a id="pl.3.14"></a><var>3.14</var>    Subd. 3. <b>Temporary license.</b> For new birth centers planning to begin operations <br/>
<a id="pl.3.15"></a><var>3.15</var>after January 1, 2011, the commissioner may issue a temporary license to the birth center <br/>
<a id="pl.3.16"></a><var>3.16</var>that is valid for a period of six months from the date of issuance. The birth center must <br/>
<a id="pl.3.17"></a><var>3.17</var>submit to the commissioner an application and applicable fee for licensure as required <br/>
<a id="pl.3.18"></a><var>3.18</var>under subdivision 4. The application must include the information required in subdivision <br/>
<a id="pl.3.19"></a><var>3.19</var>4, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted <br/>
<a id="pl.3.20"></a><var>3.20</var>an application for accreditation to the CABC. Upon receipt of accreditation from the <br/>
<a id="pl.3.21"></a><var>3.21</var>CABC, the birth center must submit to the commissioner the information required in <br/>
<a id="pl.3.22"></a><var>3.22</var>subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner <br/>
<a id="pl.3.23"></a><var>3.23</var>shall issue a new license.<br/>
<a id="pl.3.24"></a><var>3.24</var>    Subd. 4. <b>Application.</b> An application for a license to operate a birth center and the <br/>
<a id="pl.3.25"></a><var>3.25</var>applicable fee under subdivision 8 must be submitted to the commissioner on a form <br/>
<a id="pl.3.26"></a><var>3.26</var>provided by the commissioner and must contain:<br/>
<a id="pl.3.27"></a><var>3.27</var>(1) the name of the applicant;<br/>
<a id="pl.3.28"></a><var>3.28</var>(2) the site location of the birth center;<br/>
<a id="pl.3.29"></a><var>3.29</var>(3) the name of the person in charge of the center;<br/>
<a id="pl.3.30"></a><var>3.30</var>(4) documentation that the accreditation described under subdivision 6 has been <br/>
<a id="pl.3.31"></a><var>3.31</var>issued, including the effective date and the expiration date of the accreditation, and the <br/>
<a id="pl.3.32"></a><var>3.32</var>date of the last site visit by the CABC;<br/>
<a id="pl.3.33"></a><var>3.33</var>(5) the number of patients the birth center is capable of serving at a given time;<br/>
<a id="pl.3.34"></a><var>3.34</var>(6) the names and license numbers, if applicable, of the health care professionals <br/>
<a id="pl.3.35"></a><var>3.35</var>on staff at the birth center; and<br/>
<a id="pl.3.36"></a><var>3.36</var>(7) any other information the commissioner deems necessary.<br/>
<a id="pl.4.1"></a><var>4.1</var>    Subd. 5. <b>Suspension, revocation, and refusal to renew.</b> The commissioner may <br/>
<a id="pl.4.2"></a><var>4.2</var>refuse to grant or renew, or may suspend or revoke, a license on any of the grounds <br/>
<a id="pl.4.3"></a><var>4.3</var>described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or <br/>
<a id="pl.4.4"></a><var>4.4</var>upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice <br/>
<a id="pl.4.5"></a><var>4.5</var>and a hearing as described under section 144.55, subdivision 7, and a new license may be <br/>
<a id="pl.4.6"></a><var>4.6</var>issued after proper inspection of the birth center has been conducted.<br/>
<a id="pl.4.7"></a><var>4.7</var>    Subd. 6. <b>Standards for licensure.</b> (a) To be eligible for licensure under this <br/>
<a id="pl.4.8"></a><var>4.8</var>section, a birth center must be accredited by the CABC or must obtain accreditation <br/>
<a id="pl.4.9"></a><var>4.9</var>within six months of the date of the application for licensure. If the birth center loses its <br/>
<a id="pl.4.10"></a><var>4.10</var>accreditation, the birth center must immediately notify the commissioner.<br/>
<a id="pl.4.11"></a><var>4.11</var>(b) The center must have procedures in place specifying criteria by which risk status <br/>
<a id="pl.4.12"></a><var>4.12</var>will be established and applied to each woman at admission and during labor.<br/>
<a id="pl.4.13"></a><var>4.13</var>(c) The birth center shall provide the commissioner of health, upon request, with any <br/>
<a id="pl.4.14"></a><var>4.14</var>material submitted by the birth center to the CABC as part of the accreditation process, <br/>
<a id="pl.4.15"></a><var>4.15</var>including the accreditation application, the self-evaluation report, the accreditation <br/>
<a id="pl.4.16"></a><var>4.16</var>decision letter from the CABC, and any reports from the CABC following a site visit.<br/>
<a id="pl.4.17"></a><var>4.17</var>    Subd. 7. <b>Limitations of services.</b> (a) The following limitations apply to the services <br/>
<a id="pl.4.18"></a><var>4.18</var>performed at a birth center:<br/>
<a id="pl.4.19"></a><var>4.19</var>(1) surgical procedures must be limited to those normally accomplished during an <br/>
<a id="pl.4.20"></a><var>4.20</var>uncomplicated birth, including episiotomy and repair;<br/>
<a id="pl.4.21"></a><var>4.21</var>(2) no abortions may be administered; and<br/>
<a id="pl.4.22"></a><var>4.22</var>(3) no general or regional anesthesia may be administered.<br/>
<a id="pl.4.23"></a><var>4.23</var>(b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth <br/>
<a id="pl.4.24"></a><var>4.24</var>center if the administration of the anesthetic is performed within the scope of practice of a <br/>
<a id="pl.4.25"></a><var>4.25</var>health care professional.<br/>
<a id="pl.4.26"></a><var>4.26</var>    Subd. 8. <b>Fees.</b> (a) The biennial license fee for a birth center is $365.<br/>
<a id="pl.4.27"></a><var>4.27</var>(b) The temporary license fee is $365.<br/>
<a id="pl.4.28"></a><var>4.28</var>(c) Fees shall be collected and deposited according to section 144.122.<br/>
<a id="pl.4.29"></a><var>4.29</var>    Subd. 9. <b>Renewal.</b> (a) Except as provided in paragraph (b), a license issued under <br/>
<a id="pl.4.30"></a><var>4.30</var>this section expires two years from the date of issue.<br/>
<a id="pl.4.31"></a><var>4.31</var>(b) A temporary license issued under subdivision 3 expires six months from the date <br/>
<a id="pl.4.32"></a><var>4.32</var>of issue, and may be renewed for one additional six-month period.<br/>
<a id="pl.4.33"></a><var>4.33</var>(c) An application for renewal shall be submitted at least 60 days prior to expiration <br/>
<a id="pl.4.34"></a><var>4.34</var>of the license on forms prescribed by the commissioner of health.<br/>
<a id="pl.4.35"></a><var>4.35</var>    Subd. 10. <b>Records.</b> All health records maintained on each client by a birth center <br/>
<a id="pl.4.36"></a><var>4.36</var>are subject to sections 144.292 to 144.298.<br/>
<a id="pl.5.1"></a><var>5.1</var>    Subd. 11. <b>Report.</b> (a) The commissioner of health, in consultation with the <br/>
<a id="pl.5.2"></a><var>5.2</var>commissioner of human services and representatives of the licensed birth centers, shall <br/>
<a id="pl.5.3"></a><var>5.3</var>evaluate the quality of care and outcomes for services provided in licensed birth centers, <br/>
<a id="pl.5.4"></a><var>5.4</var>including, but not limited to, the utilization of services provided at a birth center, the <br/>
<a id="pl.5.5"></a><var>5.5</var>outcomes of care provided to both mothers and newborns, and the numbers of transfers <br/>
<a id="pl.5.6"></a><var>5.6</var>to other health care facilities that are required and the reasons for the transfers. The <br/>
<a id="pl.5.7"></a><var>5.7</var>commissioner shall work with the birth centers to establish a process to gather and analyze <br/>
<a id="pl.5.8"></a><var>5.8</var>the data within protocols that protect the confidentiality of patient identification.<br/>
<a id="pl.5.9"></a><var>5.9</var>(b) The commissioner of health shall report the findings of the evaluation to the <br/>
<a id="pl.5.10"></a><var>5.10</var>legislature by January 15, 2014.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.5.11"></a><var>5.11</var>    Sec. 3. Minnesota Statutes 2008, section 144.651, subdivision 2, is amended to read:<br/>
<a id="pl.5.12"></a><var>5.12</var>    Subd. 2. <b>Definitions.</b> For the purposes of this section, "patient" means a person <br/>
<a id="pl.5.13"></a><var>5.13</var>who is admitted to an acute care inpatient facility for a continuous period longer than <br/>
<a id="pl.5.14"></a><var>5.14</var>24 hours, for the purpose of diagnosis or treatment bearing on the physical or mental <br/>
<a id="pl.5.15"></a><var>5.15</var>health of that person. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, <br/>
<a id="pl.5.16"></a><var>5.16</var>"patient" also means a person who receives health care services at an outpatient surgical <br/>
<a id="pl.5.17"></a><var>5.17</var>center or at a birth center licensed under section 144.615. "Patient" also means a minor <br/>
<a id="pl.5.18"></a><var>5.18</var>who is admitted to a residential program as defined in section 
         <statute_ref>253C.01</statute_ref>. For purposes of <br/>
<a id="pl.5.19"></a><var>5.19</var>subdivisions 1, 3 to 16, 18, 20 and 30, "patient" also means any person who is receiving <br/>
<a id="pl.5.20"></a><var>5.20</var>mental health treatment on an outpatient basis or in a community support program or other <br/>
<a id="pl.5.21"></a><var>5.21</var>community-based program. "Resident" means a person who is admitted to a nonacute care <br/>
<a id="pl.5.22"></a><var>5.22</var>facility including extended care facilities, nursing homes, and boarding care homes for <br/>
<a id="pl.5.23"></a><var>5.23</var>care required because of prolonged mental or physical illness or disability, recovery from <br/>
<a id="pl.5.24"></a><var>5.24</var>injury or disease, or advancing age. For purposes of all subdivisions except subdivisions <br/>
<a id="pl.5.25"></a><var>5.25</var>28 and 29, "resident" also means a person who is admitted to a facility licensed as a board <br/>
<a id="pl.5.26"></a><var>5.26</var>and lodging facility under Minnesota Rules, parts 4625.0100 to 4625.2355, or a supervised <br/>
<a id="pl.5.27"></a><var>5.27</var>living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which operates <br/>
<a id="pl.5.28"></a><var>5.28</var>a rehabilitation program licensed under Minnesota Rules, parts 9530.4100 to 9530.4450. <br/>
<br/>
<a id="bill.0.4.0"></a><a id="pl.5.29"></a><var>5.29</var>    Sec. 4. Minnesota Statutes 2008, section 144A.51, subdivision 5, is amended to read:<br/>
<a id="pl.5.30"></a><var>5.30</var>    Subd. 5. <b>Health facility.</b> "Health facility" means a facility or that part of a facility <br/>
<a id="pl.5.31"></a><var>5.31</var>which is required to be licensed pursuant to sections 
         <statute_ref>144.50</statute_ref> to 
         <statute_ref>144.58</statute_ref>, 144.615, and a <br/>
<a id="pl.5.32"></a><var>5.32</var>facility or that part of a facility which is required to be licensed under any law of this state <br/>
<a id="pl.5.33"></a><var>5.33</var>which provides for the licensure of nursing homes. <br/>
<br/>
<a id="bill.0.5.0"></a><a id="pl.6.1"></a><var>6.1</var>    Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a <br/>
<a id="pl.6.2"></a><var>6.2</var>subdivision to read:<br/>
<a id="pl.6.3"></a><var>6.3</var>    Subd. 54. <b>Services provided in birth centers.</b> (a) Medical assistance covers <br/>
<a id="pl.6.4"></a><var>6.4</var>services provided in a birth center licensed under section 144.615 by a licensed health <br/>
<a id="pl.6.5"></a><var>6.5</var>professional if the service would otherwise be covered if provided in a hospital.<br/>
<a id="pl.6.6"></a><var>6.6</var>(b) The commissioner shall apply for any necessary waivers from the Centers for <br/>
<a id="pl.6.7"></a><var>6.7</var>Medicare and Medicaid Services to allow birth centers and birth center providers to be <br/>
<a id="pl.6.8"></a><var>6.8</var>reimbursed.<br/>
<br/>
<a id="bill.0.6.0"></a><a id="pl.6.9"></a><var>6.9</var>    Sec. 6. <b>PREPAID HEALTH PLAN RATES.</b><br/>
<a id="pl.6.10"></a><var>6.10</var>In negotiating the managed care contract rates for services rendered on or after <br/>
<a id="pl.6.11"></a><var>6.11</var>January 1, 2011, the commissioner of human services shall take into consideration and <br/>
<a id="pl.6.12"></a><var>6.12</var>the rates shall reflect the anticipated savings in the medical assistance program due to <br/>
<a id="pl.6.13"></a><var>6.13</var>extending medical assistance coverage to services provided in licensed birth centers, <br/>
<a id="pl.6.14"></a><var>6.14</var>the anticipated use of these services within the medical assistance population, and the <br/>
<a id="pl.6.15"></a><var>6.15</var>reduced medical assistance costs associated with the use of birth centers for normal, <br/>
<a id="pl.6.16"></a><var>6.16</var>low-risk deliveries.<br/>