1.1A bill for an act1.2relating 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; and1.15(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; and1.22(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; or2.6(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; and2.17(iii) consists of 40 or fewer licensed beds; or2.18(6) a birth center licensed under section 144.615.2.19(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. [144.615] BIRTH CENTERS.2.29    Subdivision 1.Definitions.(a) For purposes of this section, the following definitions 2.30have the meanings given to them.2.31(b) "Birth center" means a facility licensed for the primary purpose of performing 2.32low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are 2.33planned to occur away from the mother's usual residence following a low-risk pregnancy.2.34(c) "CABC" means the Commission for the Accreditation of Birth Centers.3.1(d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as 3.2determined by documentation of adequate prenatal care and the anticipation of a normal 3.3uncomplicated labor and birth, as defined by reasonable and generally accepted criteria 3.4adopted by professional groups for maternal, fetal, and neonatal health care.3.5    Subd. 2.License required.(a) Beginning January 1, 2011, no birth center shall be 3.6established, operated, or maintained in the state without first obtaining a license from the 3.7commissioner of health according to this section.3.8(b) A license issued under this section is not transferable or assignable and is subject 3.9to suspension or revocation at any time for failure to comply with this section.3.10(c) A birth center licensed under this section shall not assert, represent, offer, 3.11provide, or imply that the center is or may render care or services other than the services it 3.12is permitted to render within the scope of the license or the accreditation issued.3.13(d) The license must be conspicuously posted in an area where patients are admitted.3.14    Subd. 3.Temporary license.For new birth centers planning to begin operations 3.15after January 1, 2011, the commissioner may issue a temporary license to the birth center 3.16that is valid for a period of six months from the date of issuance. The birth center must 3.17submit to the commissioner an application and applicable fee for licensure as required 3.18under subdivision 4. The application must include the information required in subdivision 3.194, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted 3.20an application for accreditation to the CABC. Upon receipt of accreditation from the 3.21CABC, the birth center must submit to the commissioner the information required in 3.22subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner 3.23shall issue a new license.3.24    Subd. 4.Application.An application for a license to operate a birth center and the 3.25applicable fee under subdivision 8 must be submitted to the commissioner on a form 3.26provided by the commissioner and must contain:3.27(1) the name of the applicant;3.28(2) the site location of the birth center;3.29(3) the name of the person in charge of the center;3.30(4) documentation that the accreditation described under subdivision 6 has been 3.31issued, including the effective date and the expiration date of the accreditation, and the 3.32date of the last site visit by the CABC;3.33(5) the number of patients the birth center is capable of serving at a given time;3.34(6) the names and license numbers, if applicable, of the health care professionals 3.35on staff at the birth center; and3.36(7) any other information the commissioner deems necessary.4.1    Subd. 5.Suspension, revocation, and refusal to renew.The commissioner may 4.2refuse to grant or renew, or may suspend or revoke, a license on any of the grounds 4.3described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or 4.4upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice 4.5and a hearing as described under section 144.55, subdivision 7, and a new license may be 4.6issued after proper inspection of the birth center has been conducted.4.7    Subd. 6.Standards for licensure.(a) To be eligible for licensure under this 4.8section, a birth center must be accredited by the CABC or must obtain accreditation 4.9within six months of the date of the application for licensure. If the birth center loses its 4.10accreditation, the birth center must immediately notify the commissioner.4.11(b) The center must have procedures in place specifying criteria by which risk status 4.12will be established and applied to each woman at admission and during labor.4.13(c) The birth center shall provide the commissioner of health, upon request, with any 4.14material submitted by the birth center to the CABC as part of the accreditation process, 4.15including the accreditation application, the self-evaluation report, the accreditation 4.16decision letter from the CABC, and any reports from the CABC following a site visit.4.17    Subd. 7.Limitations of services.(a) The following limitations apply to the services 4.18performed at a birth center:4.19(1) surgical procedures must be limited to those normally accomplished during an 4.20uncomplicated birth, including episiotomy and repair;4.21(2) no abortions may be administered; and4.22(3) no general or regional anesthesia may be administered.4.23(b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth 4.24center if the administration of the anesthetic is performed within the scope of practice of a 4.25health care professional.4.26    Subd. 8.Fees.(a) The biennial license fee for a birth center is $365.4.27(b) The temporary license fee is $365.4.28(c) Fees shall be collected and deposited according to section 144.122.4.29    Subd. 9.Renewal.(a) Except as provided in paragraph (b), a license issued under 4.30this section expires two years from the date of issue.4.31(b) A temporary license issued under subdivision 3 expires six months from the date 4.32of issue, and may be renewed for one additional six-month period.4.33(c) An application for renewal shall be submitted at least 60 days prior to expiration 4.34of the license on forms prescribed by the commissioner of health.4.35    Subd. 10.Records.All health records maintained on each client by a birth center 4.36are subject to sections 144.292 to 144.298.5.1    Subd. 11.Report.(a) The commissioner of health, in consultation with the 5.2commissioner of human services and representatives of the licensed birth centers, shall 5.3evaluate the quality of care and outcomes for services provided in licensed birth centers, 5.4including, but not limited to, the utilization of services provided at a birth center, the 5.5outcomes of care provided to both mothers and newborns, and the numbers of transfers 5.6to other health care facilities that are required and the reasons for the transfers. The 5.7commissioner shall work with the birth centers to establish a process to gather and analyze 5.8the data within protocols that protect the confidentiality of patient identification.5.9(b) The commissioner of health shall report the findings of the evaluation to the 5.10legislature by January 15, 2014.5.11    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 or at a birth center licensed under section 144.615. "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, 144.615, 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    Subd. 54.Services provided in birth centers.(a) Medical assistance covers 6.4services provided in a birth center licensed under section 144.615 by a licensed health 6.5professional if the service would otherwise be covered if provided in a hospital.6.6(b) The commissioner shall apply for any necessary waivers from the Centers for 6.7Medicare and Medicaid Services to allow birth centers and birth center providers to be 6.8reimbursed.6.9    Sec. 6. PREPAID HEALTH PLAN RATES.6.10In negotiating the managed care contract rates for services rendered on or after 6.11January 1, 2011, the commissioner of human services shall take into consideration and 6.12the rates shall reflect the anticipated savings in the medical assistance program due to 6.13extending medical assistance coverage to services provided in licensed birth centers, 6.14the anticipated use of these services within the medical assistance population, and the 6.15reduced medical assistance costs associated with the use of birth centers for normal, 6.16low-risk deliveries.