HF 2128

5th Engrossment - 92nd Legislature (2021 - 2022) Posted on 05/25/2021 11:50am

A bill for an act
relating to state government; modifying policy provisions governing health, health
care, human services, human services licensing and background studies,
health-related licensing boards, prescription drugs, health insurance, telehealth,
children and family services, behavioral health, disability services and continuing
care for older adults, community supports, and chemical and mental health services;
implementing mental health uniform service standards; making forecast
adjustments; making technical and conforming changes; requiring reports;
modifying appropriations; amending Minnesota Statutes 2020, sections 62A.152,
subdivision 3; 62A.3094, subdivision 1; 62J.495, subdivision 3; 62J.498; 62J.4981;
62J.4982; 62J.84, subdivisions 3, 4, 5, 6, 9; 62Q.096; 62W.11; 144.05, by adding
a subdivision; 144.1205, subdivisions 2, 4, 8, 9, by adding a subdivision; 144.1481,
subdivision 1; 144.1911, subdivision 6; 144.223; 144.225, subdivision 7; 144.651,
subdivision 2; 144D.01, subdivision 4; 144G.08, subdivision 7, as amended;
144G.84; 145.893, subdivision 1; 145.894; 145.897; 145.899; 148B.5301,
subdivision 2; 148E.120, subdivision 2; 148F.11, subdivision 1; 151.01, subdivision
29, by adding subdivisions; 151.555, subdivisions 1, 7, 11, by adding a subdivision;
151.72, subdivision 5; 152.22, subdivisions 6, 11, by adding a subdivision; 152.23;
152.26; 152.27, subdivisions 2, 3, 4; 152.28, subdivision 1; 152.29, subdivisions
1, 3, by adding subdivisions; 152.31; 157.22; 245.462, subdivisions 1, 6, 8, 9, 14,
16, 17, 18, 21, 23, by adding a subdivision; 245.4661, subdivision 5; 245.4662,
subdivision 1; 245.467, subdivisions 2, 3; 245.469, subdivisions 1, 2; 245.470,
subdivision 1; 245.4712, subdivision 2; 245.472, subdivision 2; 245.4863;
245.4871, subdivisions 9a, 10, 11a, 17, 21, 26, 27, 29, 31, 32, 34, by adding a
subdivision; 245.4874, subdivision 1; 245.4876, subdivisions 2, 3; 245.4879,
subdivision 1; 245.488, subdivision 1; 245.4885, subdivision 1; 245.4901,
subdivision 2; 245.62, subdivision 2; 245.697, subdivision 1; 245.735, subdivisions
3, 5, by adding a subdivision; 245A.02, by adding subdivisions; 245A.04,
subdivision 5; 245A.041, by adding a subdivision; 245A.043, subdivision 3;
245A.10, subdivision 4; 245A.65, subdivision 2; 245D.02, subdivision 20; 245F.04,
subdivision 2; 245G.03, subdivision 2; 252.43; 252A.01, subdivision 1; 252A.02,
subdivisions 2, 9, 11, 12, by adding subdivisions; 252A.03, subdivisions 3, 4;
252A.04, subdivisions 1, 2, 4; 252A.05; 252A.06, subdivisions 1, 2; 252A.07,
subdivisions 1, 2, 3; 252A.081, subdivisions 2, 3, 5; 252A.09, subdivisions 1, 2;
252A.101, subdivisions 2, 3, 5, 6, 7, 8; 252A.111, subdivisions 2, 4, 6; 252A.12;
252A.16; 252A.17; 252A.19, subdivisions 2, 4, 5, 7, 8; 252A.20; 252A.21,
subdivisions 2, 4; 254B.03, subdivision 2; 256.01, subdivision 14b, by adding a
subdivision; 256.0112, subdivision 6; 256.741, by adding subdivisions; 256.969,
subdivisions 2b, 9, by adding a subdivision; 256.9695, subdivision 1; 256.9741,
subdivision 1; 256.98, subdivision 1; 256.983; 256B.051, subdivisions 1, 3, 5, 6,
7, by adding a subdivision; 256B.057, subdivision 3; 256B.0615, subdivisions 1,
5; 256B.0616, subdivisions 1, 3, 5; 256B.0622, subdivisions 1, 2, 3a, 4, 7, 7a, 7b,
7d; 256B.0623, subdivisions 1, 2, 3, 4, 5, 6, 9, 12; 256B.0624; 256B.0625,
subdivisions 3b, 3c, 3d, 3e, 5, 5m, 19c, 28a, 30, 42, 48, 49, 56a; 256B.0638,
subdivisions 3, 5, 6; 256B.0659, subdivision 13; 256B.0757, subdivision 4c;
256B.0911, subdivision 3a; 256B.0941, subdivision 1; 256B.0943, subdivisions
1, 2, 3, 4, 5, 5a, 6, 7, 9, 11; 256B.0946, subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947,
subdivisions 1, 2, 3, 3a, 5, 6, 7; 256B.0949, subdivisions 2, 4, 5a; 256B.196,
subdivision 2; 256B.25, subdivision 3; 256B.4912, subdivision 13; 256B.69,
subdivision 5a; 256B.6928, subdivision 5; 256B.761; 256B.763; 256B.85,
subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 11b, 12, 12b, 13, 13a, 15, 17a, 18a,
20b, 23, 23a, by adding subdivisions; 256E.34, subdivision 1; 256I.05, subdivisions
1a, 11; 256J.08, subdivision 21; 256J.09, subdivision 3; 256J.30, subdivision 8;
256J.45, subdivision 1; 256J.626, subdivision 1; 256J.95, subdivision 5; 256L.01,
subdivision 5; 256L.03, subdivision 1; 256L.04, subdivision 7b; 256L.05,
subdivision 3a; 256N.02, subdivisions 16, 17; 256N.22, subdivision 1; 256N.23,
subdivisions 2, 6; 256N.24, subdivisions 1, 8, 11, 12, 14; 256N.25, subdivision 1,
by adding a subdivision; 256P.01, subdivision 6a; 259.22, subdivision 4; 259.241;
259.35, subdivision 1; 259.53, subdivision 4; 259.73; 259.75, subdivisions 5, 6,
9; 259.83, subdivision 1a; 259A.75, subdivisions 1, 2, 3, 4; 260C.007, subdivisions
22a, 26c, 31; 260C.157, subdivision 3; 260C.212, subdivisions 1, 1a, 2, 13, by
adding a subdivision; 260C.219, subdivision 5; 260C.4412; 260C.452; 260C.503,
subdivision 2; 260C.515, subdivision 3; 260C.605, subdivision 1; 260C.607,
subdivision 6; 260C.609; 260C.615; 260C.704; 260C.706; 260C.708; 260C.71;
260C.712; 260C.714; 260D.01; 260D.05; 260D.06, subdivision 2; 260D.07;
260D.08; 260D.14; 260E.20, subdivision 2; 260E.31, subdivision 1; 260E.33, by
adding a subdivision; 260E.36, by adding a subdivision; 295.50, subdivision 9b;
295.53, subdivision 1; 297E.02, subdivision 3; 325F.721, subdivision 1; 326.71,
subdivision 4; 326.75, subdivisions 1, 2, 3; 518.157, subdivisions 1, 3; 518.68,
subdivision 2; 518A.29; 518A.33; 518A.35, subdivisions 1, 2; 518A.39, subdivision
7; 518A.40, subdivision 4, by adding a subdivision; 518A.42; 518A.43, by adding
a subdivision; 518A.685; 548.091, subdivisions 1a, 2a, 3b, 9, 10; 549.09,
subdivision 1; Laws 2008, chapter 364, section 17; Laws 2019, First Special Session
chapter 9, article 14, section 3, as amended; Laws 2020, Seventh Special Session
chapter 1, article 6, section 12, subdivision 4; proposing coding for new law in
Minnesota Statutes, chapters 62A; 62Q; 145; 145A; 151; 245A; 256B; 363A;
518A; proposing coding for new law as Minnesota Statutes, chapter 245I; repealing
Minnesota Statutes 2020, sections 151.19, subdivision 3; 245.462, subdivision 4a;
245.4879, subdivision 2; 245.62, subdivisions 3, 4; 245.69, subdivision 2; 245.735,
subdivisions 1, 2, 4; 252.28, subdivisions 1, 5; 252A.02, subdivisions 8, 10;
252A.21, subdivision 3; 256B.0615, subdivision 2; 256B.0616, subdivision 2;
256B.0622, subdivisions 3, 5a; 256B.0623, subdivisions 7, 8, 10, 11; 256B.0625,
subdivisions 5l, 35a, 35b, 61, 62, 65; 256B.0943, subdivisions 8, 10; 256B.0944;
256B.0946, subdivision 5; Minnesota Rules, parts 9505.0370; 9505.0371;
9505.0372; 9520.0010; 9520.0020; 9520.0030; 9520.0040; 9520.0050; 9520.0060;
9520.0070; 9520.0080; 9520.0090; 9520.0100; 9520.0110; 9520.0120; 9520.0130;
9520.0140; 9520.0150; 9520.0160; 9520.0170; 9520.0180; 9520.0190; 9520.0200;
9520.0210; 9520.0230; 9520.0750; 9520.0760; 9520.0770; 9520.0780; 9520.0790;
9520.0800; 9520.0810; 9520.0820; 9520.0830; 9520.0840; 9520.0850; 9520.0860;
9520.0870; 9530.6800; 9530.6810.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

DEPARTMENT OF HUMAN SERVICES HEALTH CARE PROGRAMS

Section 1.

Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 42. new text end

new text begin Expiration of report mandates. new text end

new text begin (a) If the submission of a report by the
commissioner of human services to the legislature is mandated by statute and the enabling
legislation does not include a date for the submission of a final report, the mandate to submit
the report shall expire in accordance with this section.
new text end

new text begin (b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1, 2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end

new text begin (c) Any reporting mandate enacted on or after January 1, 2021, shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report unless the enacting legislation provides for a different
expiration date.
new text end

new text begin (d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over human services by February 15 of each
year, beginning February 15, 2022, of all reports set to expire during the following calendar
year in accordance with this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2020, section 256.969, subdivision 2b, is amended to read:

Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year new text begin or years new text end for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year new text begin or years new text end and the next base year new text begin or years new text end . new text begin In
any year that inpatient claims volume falls below the threshold required to ensure a statically
valid sample of claims, the commissioner may combine claims data from two consecutive
years to serve as the base year. Years in which inpatient claims volume is reduced or altered
due to a pandemic or other public health emergency shall not be used as a base year or part
of a base year if the base year includes more than one year. new text end Changes in costs between base
years shall be measured using the lower of the hospital cost index defined in subdivision 1,
paragraph (a), or the percentage change in the case mix adjusted cost per claim. The
commissioner shall establish the base year for each rebasing period considering the most
recent year new text begin or years new text end for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and

(6) geographic location.

Sec. 3.

Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision to
read:

new text begin Subd. 2f. new text end

new text begin Alternate inpatient payment rate. new text end

new text begin Effective January 1, 2022, for a hospital
eligible to receive disproportionate share hospital payments under subdivision 9, paragraph
(d), clause (6), the commissioner shall reduce the amount calculated under subdivision 9,
paragraph (d), clause (6), by 99 percent and compute an alternate inpatient payment rate.
The alternate payment rate shall be structured to target a total aggregate reimbursement
amount equal to what the hospital would have received for providing fee-for-service inpatient
services under this section to patients enrolled in medical assistance had the hospital received
the entire amount calculated under subdivision 9, paragraph (d), clause (6).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end

Sec. 4.

Minnesota Statutes 2020, section 256.969, subdivision 9, is amended to read:

Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.

(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.

(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:

(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;

(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;

(3) a hospital that has received new text begin medical assistance new text end payment deleted text begin from the fee-for-service
program deleted text end for at least 20 transplant services in the base year shall receive a factor of 0.0435;

(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;

(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than two and
one-half standard deviations above the mean shall receive a factor of 0.2300; and

(6) a hospital new text begin that is a level one trauma center and new text end that has a medical assistance utilization
rate in the base year that is at least two and one-half standard deviations above the statewide
mean utilization rate shall receive a factor of 0.3711.

new text begin (e) For the purposes of determining eligibility for the disproportionate share hospital
factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and
discharge thresholds shall be measured using only one year when a two-year base period
is used.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end Any payments or portion of payments made to a hospital under this subdivision
that are subsequently returned to the commissioner because the payments are found to
exceed the hospital-specific DSH limit for that hospital shall be redistributed, proportionate
to the number of fee-for-service discharges, to other DSH-eligible non-children's hospitals
that have a medical assistance utilization rate that is at least one standard deviation above
the mean.

deleted text begin (f) deleted text end new text begin (g) new text end An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed $1,500,000.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2021.
new text end

Sec. 5.

Minnesota Statutes 2020, section 256.9695, subdivision 1, is amended to read:

Subdivision 1.

Appeals.

A hospital may appeal a decision arising from the application
of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would
result in a change to the hospital's payment rate or payments. Both overpayments and
underpayments that result from the submission of appeals shall be implemented. Regardless
of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge
ratios, and policy adjusters shall not be changed. The appeal shall be heard by an
administrative law judge according to sections 14.57 to 14.62, or upon agreement by both
parties, according to a modified appeals procedure established by the commissioner and the
Office of Administrative Hearings. In any proceeding under this section, the appealing party
must demonstrate by a preponderance of the evidence that the commissioner's determination
is incorrect or not according to law.

To appeal a payment rate or payment determination or a determination made from base
year information, the hospital shall file a written appeal request to the commissioner within
60 days of the date the preliminary payment rate determination was mailed. The appeal
request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or
rule upon which the hospital relies for each disputed item; and (iii) the name and address
of the person to contact regarding the appeal. Facts to be considered in any appeal of base
year information are limited to those in existence deleted text begin 12 deleted text end new text begin 18 new text end months after the last day of the
calendar year that is the base year for the payment rates in dispute.

Sec. 6.

Minnesota Statutes 2020, section 256.983, is amended to read:

256.983 FRAUD PREVENTION INVESTIGATIONS.

Subdivision 1.

Programs established.

Within the limits of available appropriations, the
commissioner of human services shall require the maintenance of budget neutral fraud
prevention investigation programs in the counties new text begin or tribal agencies new text end participating in the
fraud prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other counties
new text begin or tribal agencies new text end provided the expansion is budget neutral to the state. Under any expansion,
the commissioner has the final authority in decisions regarding the creation and realignment
of individual county new text begin , tribal agency, new text end or regional operations.

Subd. 2.

County new text begin and tribal agency new text end proposals.

Each participating county new text begin and tribal
new text end agency shall develop and submit an annual staffing and funding proposal to the commissioner
no later than April 30 of each year. Each proposal shall include, but not be limited to, the
staffing and funding of the fraud prevention investigation program, a job description for
investigators involved in the fraud prevention investigation program, and the organizational
structure of the county new text begin or tribal new text end agency unit, training programs for case workers, and the
operational requirements which may be directed by the commissioner. The proposal shall
be approved, to include any changes directed or negotiated by the commissioner, no later
than June 30 of each year.

Subd. 3.

Department responsibilities.

The commissioner shall establish training
programs which shall be attended by all investigative and supervisory staff of the involved
county new text begin and tribal new text end agencies. The commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms, which shall be used by the involved county new text begin
or tribal new text end agencies. An individual's application or redetermination form for public assistance
benefits, including child care assistance programs and medical care programs, must include
an authorization for release by the individual to obtain documentation for any information
on that form which is involved in a fraud prevention investigation. The authorization for
release is effective for six months after public assistance benefits have ceased.

Subd. 4.

Funding.

(a) County new text begin and tribal new text end agency reimbursement shall be made through
the settlement provisions applicable to the Supplemental Nutrition Assistance Program
(SNAP), MFIP, child care assistance programs, the medical assistance program, and other
federal and state-funded programs.

(b) The commissioner will maintain program compliance if for any three consecutive
month period, a county new text begin or tribal new text end agency fails to comply with fraud prevention investigation
program guidelines, or fails to meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county new text begin or tribal new text end agency shall be required to submit a corrective
action plan to the commissioner within 30 days of receipt of a notice of noncompliance.
Failure to submit a corrective action plan or, continued deviation from standards of more
than ten percent after submission of a corrective action plan, will result in denial of funding
for each subsequent month, or billing the county new text begin or tribal new text end agency for fraud prevention
investigation (FPI) service provided by the commissioner, or reallocation of program grant
funds, or investigative resources, or both, to other counties new text begin or tribal agencies new text end . The denial of
funding shall apply to the general settlement received by the county new text begin or tribal new text end agency on a
quarterly basis and shall not reduce the grant amount applicable to the FPI project.

Subd. 5.

Child care providers; financial misconduct.

(a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.

(b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The county new text begin or tribe new text end must send notice in accordance with the requirements of section
119B.161, subdivision 2. If a provider's payment is suspended under this section, the payment
suspension shall remain in effect until: (1) the commissioner, county, new text begin tribe, new text end or a law
enforcement authority determines that there is insufficient evidence warranting the action
and a county, tribe, or the commissioner does not pursue an additional administrative remedy
under chapter 119B or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and
administrative proceedings related to the provider's alleged misconduct conclude and any
appeal rights are exhausted.

(c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.

(d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).

Sec. 7.

Minnesota Statutes 2020, section 256B.057, subdivision 3, is amended to read:

Subd. 3.

Qualified Medicare beneficiaries.

new text begin (a) new text end A person deleted text begin who is entitled to Part A
Medicare benefits, whose income is equal to or less than 100 percent of the federal poverty
guidelines, and whose assets are no more than $10,000 for a single individual and $18,000
for a married couple or family of two or more, deleted text end is eligible for medical assistance
reimbursement of new text begin Medicare new text end Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Act deleted text begin . deleted text end new text begin
if:
new text end

new text begin (1) the person is entitled to Medicare Part A benefits;
new text end

new text begin (2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
new text end

new text begin (3) the person's assets are no more than (i) $10,000 for a single individual, or (ii) $18,000
for a married couple or family of two or more; or, when the resource limits for eligibility
for the Medicare Part D extra help low income subsidy (LIS) exceed either amount in item
(i) or (ii), the person's assets are no more than the LIS resource limit in United States Code,
title 42, section 1396d, subsection (p).
new text end

new text begin (b) new text end Reimbursement of the Medicare coinsurance and deductibles, when added to the
amount paid by Medicare, must not exceed the total rate the provider would have received
for the same service or services if the person were a medical assistance recipient with
Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until July 1 of each year.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 8.

Minnesota Statutes 2020, section 256B.0625, subdivision 3c, is amended to read:

Subd. 3c.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end .

(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-member deleted text end new text begin 14-member new text end Health Services deleted text begin Policy Committee deleted text end new text begin Advisory
Council new text end , which consists of deleted text begin 12 deleted text end new text begin 13 new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall advise the commissioner regarding new text begin (1) new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programs deleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision-making and health care benefit and coverage policies for
MHCP. The Health Services Advisory Council shall consider available evidence regarding
quality, safety, and cost-effectiveness when advising the commissioner new text end . The Health Services
deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committee deleted text end new text begin Advisory Council new text end shall annually deleted text begin elect deleted text end new text begin select new text end a deleted text begin physician deleted text end chair from among its
members deleted text begin , deleted text end who shall work directly with the commissioner's medical director deleted text begin , deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall also deleted text end new text begin Advisory
Council may new text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.

(b) The commissioner shall establish a dental deleted text begin subcommittee deleted text end new text begin subcouncil new text end to operate under
the Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end . The dental deleted text begin subcommittee deleted text end new text begin
subcouncil new text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommittee deleted text end new text begin subcouncil new text end shall advise the commissioner regarding:

(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;

(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;

(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;

(4) the development of dental delivery models; and

(5) dental services to be added or eliminated from subdivision 9, paragraph (b).

deleted text begin (c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end

deleted text begin (d) deleted text end new text begin (c) new text end The Health Services deleted text begin Policy Committee shall deleted text end new text begin Advisory Council may new text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrollees deleted text end new text begin health care providers who serve MHCP recipients new text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committee deleted text end new text begin monitoring
and tracking new text end shall focus on services or specialties for which there is a high variation in
utilization new text begin or quality new text end across deleted text begin physicians deleted text end new text begin providers new text end , or which are associated with high medical
costs. The commissioner, based upon the findings of the deleted text begin committee deleted text end new text begin Health Services Advisory
Council new text end , deleted text begin shall regularly deleted text end new text begin may new text end notify deleted text begin physicians deleted text end new text begin providers new text end whose practice patterns indicate
new text begin below average quality or new text end higher than average utilization or costs. Managed care and
county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make deleted text begin this deleted text end new text begin these new text end
data available to the deleted text begin committee deleted text end new text begin Health Services Advisory Council new text end .

deleted text begin (e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end

Sec. 9.

Minnesota Statutes 2020, section 256B.0625, subdivision 3d, is amended to read:

Subd. 3d.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end members.

(a) The
Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end consists of:

(1) deleted text begin seven deleted text end new text begin six new text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, and deleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistance deleted text end new text begin MHCP new text end recipients;

(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;

(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;

new text begin (4) one voting member who is a health care or mental health professional licensed or
registered in the member's profession, actively engaged in the practice of the member's
profession in Minnesota, and actively engaged in the treatment of persons with mental
illness;
new text end

deleted text begin (4) one consumer deleted text end new text begin (5) two consumers new text end who shall serve as deleted text begin a deleted text end voting deleted text begin member deleted text end new text begin members new text end ; and

deleted text begin (5) deleted text end new text begin (6) new text end the commissioner's medical director who shall serve as a nonvoting member.

(b) Members of the Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end shall not be
employed by the deleted text begin Department of Human Services deleted text end new text begin state of Minnesota new text end , except for the medical
director. new text begin A quorum shall comprise a simple majority of the voting members. Vacant seats
shall not count toward a quorum.
new text end

Sec. 10.

Minnesota Statutes 2020, section 256B.0625, subdivision 3e, is amended to read:

Subd. 3e.

Health Services deleted text begin Policy Committee deleted text end new text begin Advisory Council new text end terms and
compensation.

deleted text begin Committee deleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committee deleted text end new text begin Advisory Council new text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committee deleted text end new text begin council new text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committee deleted text end new text begin Advisory
Council new text end does not expire as provided in section 15.059, subdivision 6.

Sec. 11.

Minnesota Statutes 2020, section 256B.0625, subdivision 30, is amended to read:

Subd. 30.

Other clinic services.

(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.

(b) A federally qualified health center (FQHC) that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. An FQHC that is already in operation shall submit
an initial report using actual costs and visits for the initial reporting period. Within 90 days
of the end of its reporting period, an FQHC shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred for
the period and the actual number of visits for services furnished during the period, and other
information required by the commissioner. FQHCs that file Medicare cost reports shall
provide the commissioner with a copy of the most recent Medicare cost report filed with
the Medicare program intermediary for the reporting year which support the costs claimed
on their cost report to the state.

(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation
as an essential community provider within six months of final adoption of rules by the
Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and
rural health clinics that have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will continue to be made according
to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural
health clinics that either do not apply within the time specified above or who have had
essential community provider status for three years, medical assistance payments for health
services provided by these entities shall be according to the same rates and conditions
applicable to the same service provided by health care providers that are not FQHCs or rural
health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural
health clinic to make application for an essential community provider designation in order
to have cost-based payments made according to paragraphs (a) and (b) no longer apply.

(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.

(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.

(g) Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).

(h) For purposes of this section, "nonprofit community clinic" is a clinic that:

(1) has nonprofit status as specified in chapter 317A;

(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);

(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;

(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;

(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and

(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.

(i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner. the commissioner shall determine the most feasible method for paying claims
from the following options:

(1) FQHCs and rural health clinics submit claims directly to the commissioner for
payment, and the commissioner provides claims information for recipients enrolled in a
managed care or county-based purchasing plan to the plan, on a regular basis; or

(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed
care or county-based purchasing plan to the plan, and those claims are submitted by the
plan to the commissioner for payment to the clinic.

(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.

(k) The commissioner shall seek a federal waiver, authorized under section 1115 of the
Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.

(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:

(1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;

(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;

(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:

(i) general social services and administrative costs;

(ii) retail pharmacy;

(iii) patient incentives, food, housing assistance, and utility assistance;

(iv) external lab and x-ray;

(v) navigation services;

(vi) health care taxes;

(vii) advertising, public relations, and marketing;

(viii) office entertainment costs, food, alcohol, and gifts;

(ix) contributions and donations;

(x) bad debts or losses on awards or contracts;

(xi) fines, penalties, damages, or other settlements;

(xii) fund-raising, investment management, and associated administrative costs;

(xiii) research and associated administrative costs;

(xiv) nonpaid workers;

(xv) lobbying;

(xvi) scholarships and student aid; and

(xvii) nonmedical assistance covered services;

(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;

(5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:

(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;

(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;

(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year new text begin . Years in which organizational
cost or claims volume is reduced or altered due to a pandemic, disease, or other public health
emergency shall not be used as part of a base year when the base year includes more than
one year. The commissioner may use the Medicare cost reports of a year unaffected by a
pandemic, disease, or other public health emergency, or previous two consecutive years,
inflated to the base year as established under item (iv) new text end ;

(iv) must be inflated to the base year using the inflation factor described in clause (6);
and

(v) the commissioner must provide for a 60-day appeals process under section 14.57;

(6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;

(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;

(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;

(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;

(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:

(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;

(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and

(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);

(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;

(12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rate;

(13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and

(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.

Sec. 12.

Minnesota Statutes 2020, section 256B.0638, subdivision 3, is amended to read:

Subd. 3.

Opioid prescribing work group.

(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:

(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;

(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;

(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;

(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;

(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;

(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;

(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;

(8) one member who is a medical examiner for a Minnesota county;

(9) one member of the Health Services Policy Committee established under section
256B.0625, subdivisions 3c to 3e;

(10) one member who is a medical director of a health plan company doing business in
Minnesota;

(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; deleted text begin and
deleted text end

(12) one member representing Minnesota law enforcement deleted text begin . deleted text end new text begin ; and
new text end

new text begin (13) two consumer members who are Minnesota residents and who have used or are
using opioids to manage chronic pain.
new text end

(b) In addition, the work group shall include the following nonvoting members:

(1) the medical director for the medical assistance program;

(2) a member representing the Department of Human Services pharmacy unit; deleted text begin and
deleted text end

(3) the medical director for the Department of Labor and Industry deleted text begin . deleted text end new text begin ; and
new text end

new text begin (4) a member representing the Minnesota Department of Health.
new text end

(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.

Sec. 13.

Minnesota Statutes 2020, section 256B.0638, subdivision 5, is amended to read:

Subd. 5.

Program implementation.

(a) The commissioner shall implement the programs
within the Minnesota health care program to improve the health of and quality of care
provided to Minnesota health care program enrollees. The commissioner shall annually
collect and report to new text begin provider groups the sentinel measures of data showing individual new text end opioid
deleted text begin prescribers data showing the sentinel measures of their deleted text end new text begin prescribers' new text end opioid prescribing
patterns compared to their anonymized peers. new text begin Provider groups shall distribute data to their
affiliated, contracted, or employed opioid prescribers.
new text end

(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:

(1) components of the program described in subdivision 4, paragraph (a);

(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and

(3) appropriate use of the prescription monitoring program under section 152.126.

(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall take one or more of the following steps:

(1) monitor prescribing practices more frequently than annually;

(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or

(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.

(d) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.

Sec. 14.

Minnesota Statutes 2020, section 256B.0638, subdivision 6, is amended to read:

Subd. 6.

Data practices.

(a) Reports and data identifying an opioid prescriber are private
data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber
is subject to termination as a medical assistance provider under this section. Notwithstanding
this data classification, the commissioner shall share with all of the provider groups with
which an opioid prescriber is employed new text begin , contracted, new text end or affiliated, deleted text begin a report identifying an
opioid prescriber who is subject to quality improvement activities deleted text end new text begin the data new text end under subdivision
5, paragraph new text begin (a), new text end (b) new text begin , new text end or (c).

(b) Reports and data identifying a provider group are nonpublic data as defined under
section 13.02, subdivision 9, until the provider group is subject to termination as a medical
assistance provider under this section.

(c) Upon termination under this section, reports and data identifying an opioid prescriber
or provider group are public, except that any identifying information of Minnesota health
care program enrollees must be redacted by the commissioner.

Sec. 15.

Minnesota Statutes 2020, section 256B.0659, subdivision 13, is amended to read:

Subd. 13.

Qualified professional; qualifications.

(a) The qualified professional must
work for a personal care assistance provider agency, meet the definition of qualified
professional under section 256B.0625, subdivision 19c, deleted text begin and enroll with the department as
a qualified professional after clearing deleted text end new text begin clear new text end a background study new text begin , and meet provider training
requirements new text end . Before a qualified professional provides services, the personal care assistance
provider agency must initiate a background study on the qualified professional under chapter
245C, and the personal care assistance provider agency must have received a notice from
the commissioner that the qualified professional:

(1) is not disqualified under section 245C.14; or

(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.

(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:

(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;

(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;

(3) review documentation of personal care assistance services provided;

(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and

(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.

(c) deleted text begin Effective July 1, 2011, deleted text end The qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.

Sec. 16.

Minnesota Statutes 2020, section 256B.196, subdivision 2, is amended to read:

Subd. 2.

Commissioner's duties.

(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.

(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.

(c) Beginning January 1, 2010, deleted text begin Hennepin County and deleted text end Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
deleted text begin $12,000,000 per year from Hennepin County and deleted text end $6,000,000 per year deleted text begin from Ramsey County deleted text end .
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to deleted text begin Hennepin County Medical Center or deleted text end Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to deleted text begin Hennepin County Medical Center and deleted text end
Regions Hospital by those plans. For the purposes of this paragraph, "the base amount"
means the total annual value of increased medical assistance capitation payments, including
the voluntary intergovernmental transfers, under this paragraph in calendar year 2017. For
managed care contracts beginning on or after January 1, 2018, the commissioner shall reduce
the total annual value of increased medical assistance capitation payments under this
paragraph by an amount equal to ten percent of the base amount, and by an additional ten
percent of the base amount for each subsequent contract year until December 31, 2025.
Upon the request of the commissioner, health plans shall submit individual-level cost data
for verification purposes. The commissioner may ratably reduce these payments on a pro
rata basis in order to satisfy federal requirements for actuarial soundness. If payments are
reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
increased medical assistance capitation payments under the intergovernmental transfer
described in this paragraph shall increase its medical assistance payments to deleted text begin Hennepin
County Medical Center and deleted text end Regions Hospital by the same amount as the increased payments
received in the capitation payment described in this paragraph. This paragraph expires
January 1, 2026.

(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County, the
city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center, the city of St. Paul, and other participating governmental entities equal to
the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center, the city of St.
Paul, and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.

(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.

(f) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (e), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.

(g) The payments in paragraphs (a) to (e) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under subdivision 3.

(h) All of the data and funding transactions related to the payments in paragraphs (a) to
(e) shall be between the commissioner and the governmental entities.

(i) For purposes of this subdivision, billing professionals are limited to physicians, nurse
practitioners, nurse midwives, clinical nurse specialists, physician assistants,
anesthesiologists, certified registered nurse anesthetists, dentists, dental hygienists, and
dental therapists.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval
of both this section and Minnesota Statutes, section 256B.1973, whichever is later. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 17.

new text begin [256B.1973] DIRECTED PAYMENT ARRANGEMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (b) "Billing professionals" means physicians, nurse practitioners, nurse midwives, clinical
nurse specialists, physician assistants, anesthesiologists, and certified registered anesthetists,
and may include dentists, individually enrolled dental hygienists, and dental therapists.
new text end

new text begin (c) "Health plan" means a managed care or county-based purchasing plan that is under
contract with the commissioner to deliver services to medical assistance enrollees under
section 256B.69.
new text end

new text begin (d) "High medical assistance utilization" means a medical assistance utilization rate
equal to the standard established in section 256.969, subdivision 9, paragraph (d), clause
(6).
new text end

new text begin Subd. 2. new text end

new text begin Federal approval required. new text end

new text begin Each directed payment arrangement under this
section is contingent on federal approval and must conform with the requirements for
permissible directed managed care organization expenditures under section 256B.6928,
subdivision 5.
new text end

new text begin Subd. 3. new text end

new text begin Eligible providers. new text end

new text begin Eligible providers under this section are nonstate government
teaching hospitals with high medical assistance utilization and a level 1 trauma center and
all of the hospital's owned or affiliated billing professionals, ambulance services, sites, and
clinics.
new text end

new text begin Subd. 4. new text end

new text begin Voluntary intergovernmental transfers. new text end

new text begin A nonstate governmental entity that
is eligible to perform intergovernmental transfers may make voluntary intergovernmental
transfers to the commissioner. The commissioner shall inform the nonstate governmental
entity of the intergovernmental transfers necessary to maximize the allowable directed
payments.
new text end

new text begin Subd. 5. new text end

new text begin Commissioner's duties; state-directed fee schedule requirement. new text end

new text begin (a) For
each federally approved directed payment arrangement that is a state-directed fee schedule
requirement, the commissioner shall determine a uniform adjustment factor to be applied
to each claim submitted by an eligible provider to a health plan. The uniform adjustment
factor shall be determined using the average commercial payer rate or using another method
acceptable to the Centers for Medicare and Medicaid Services if the average commercial
payer rate is not approved, minus the amount necessary for the plan to satisfy tax liabilities
under sections 256.9657 and 297I.05 attributable to the directed payment arrangement. The
commissioner shall ensure that the application of the uniform adjustment factor maximizes
the allowable directed payments and does not result in payments exceeding federal limits,
and may use an annual settle-up process. The directed payment shall be specific to each
health plan and prospectively incorporated into capitation payments for that plan.
new text end

new text begin (b) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner shall develop a plan for the initial
implementation of the state-directed fee schedule requirement to ensure that the eligible
provider receives the entire permissible value of the federally approved directed payment
arrangement. If federal approval of a directed payment arrangement under this subdivision
is retroactive, the commissioner shall make a onetime pro rata increase to the uniform
adjustment factor and the initial payments in order to include claims submitted between the
retroactive federal approval date and the period captured by the initial payments.
new text end

new text begin Subd. 6. new text end

new text begin Health plan duties; submission of claims. new text end

new text begin In accordance with its contract,
each health plan shall submit to the commissioner payment information for each claim paid
to an eligible provider for services provided to a medical assistance enrollee.
new text end

new text begin Subd. 7. new text end

new text begin Health plan duties; directed payments. new text end

new text begin In accordance with its contract, each
health plan shall make directed payments to the eligible provider in an amount equal to the
payment amounts the plan received from the commissioner.
new text end

new text begin Subd. 8. new text end

new text begin State quality goals. new text end

new text begin The directed payment arrangement and state-directed fee
schedule requirement must align the state quality goals to Hennepin Healthcare medical
assistance patients, including unstably housed individuals, those with higher levels of social
and clinical risk, limited English proficiency (LEP) patients, adults with serious chronic
conditions, and individuals of color. The directed payment arrangement must maintain
quality and access to a full range of health care delivery mechanisms for these patients that
may include behavioral health, emergent care, preventive care, hospitalization, transportation,
interpreter services, and pharmaceutical services. The commissioner, in consultation with
Hennepin Healthcare, shall submit to the Centers for Medicare and Medicaid Services a
methodology to measure access to care and the achievement of state quality goals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, or upon federal approval,
whichever is later, unless the federal approval provides for an effective date after July 1,
2021, but before the date of federal approval, in which case the federally approved effective
date applies.
new text end

Sec. 18.

Minnesota Statutes 2020, section 256B.6928, subdivision 5, is amended to read:

Subd. 5.

Direction of managed care organization expenditures.

(a) The commissioner
shall not direct managed care organizations expenditures under the managed care contract,
except deleted text begin in deleted text end new text begin as permitted under Code of Federal Regulations, part 42, section 438.6(c). The
exception under this paragraph includes new text end the following situations:

(1) implementation of a value-based purchasing model for provider reimbursement,
including pay-for-performance arrangements, bundled payments, or other service payments
intended to recognize value or outcomes over volume of services;

(2) participation in a multipayer or medical assistance-specific delivery system reform
or performance improvement initiative; or

(3) implementation of a minimum or maximum fee schedule, or a uniform dollar or
percentage increase for network providers that provide a particular service. The maximum
fee schedule must allow the managed care organization the ability to reasonably manage
risk and provide discretion in accomplishing the goals of the contract.

(b) Any managed care contract that directs managed care organization expenditures as
permitted under paragraph (a), clauses (1) to (3), must be developed in accordance with
Code of Federal Regulations, part 42, sections 438.4 and 438.5; comply with actuarial
soundness and generally accepted actuarial principles and practices; and have written
approval from the Centers for Medicare and Medicaid Services before implementation. To
obtain approval, the commissioner shall demonstrate in writing that the contract arrangement:

(1) is based on the utilization and delivery of services;

(2) directs expenditures equally, using the same terms of performance for a class of
providers providing service under the contract;

(3) is intended to advance at least one of the goals and objectives in the commissioner's
quality strategy;

(4) has an evaluation plan that measures the degree to which the arrangement advances
at least one of the goals in the commissioner's quality strategy;

(5) does not condition network provider participation on the network provider entering
into or adhering to an intergovernmental transfer agreement; and

(6) is not renewed automatically.

(c) For contract arrangements identified in paragraph (a), clauses (1) and (2), the
commissioner shall:

(1) make participation in the value-based purchasing model, special delivery system
reform, or performance improvement initiative available, using the same terms of
performance, to a class of providers providing services under the contract related to the
model, reform, or initiative; and

(2) use a common set of performance measures across all payers and providers.

(d) The commissioner shall not set the amount or frequency of the expenditures or recoup
from the managed care organization any unspent funds allocated for these arrangements.

Sec. 19.

Minnesota Statutes 2020, section 256L.01, subdivision 5, is amended to read:

Subd. 5.

Income.

"Income" has the meaning given for modified adjusted gross income,
as defined in Code of Federal Regulations, title 26, section 1.36B-1, and means a household's
deleted text begin current income, or if income fluctuates month to month, the income for the 12-month
eligibility period deleted text end new text begin projected annual income for the applicable tax year new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 20.

Minnesota Statutes 2020, section 256L.04, subdivision 7b, is amended to read:

Subd. 7b.

Annual income limits adjustment.

The commissioner shall adjust the income
limits under this section annually deleted text begin each July 1 deleted text end new text begin on January 1 new text end as deleted text begin described in section 256B.056,
subdivision 1c deleted text end new text begin provided in Code of Federal Regulations, title 26, section 1.36B-1(h) new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 21.

Minnesota Statutes 2020, section 256L.05, subdivision 3a, is amended to read:

Subd. 3a.

Redetermination of eligibility.

(a) An enrollee's eligibility must be
redetermined on an annual basis deleted text begin , in accordance with Code of Federal Regulations, title 42,
section 435.916 (a). The 12-month eligibility period begins the month of application.
Beginning July 1, 2017, the commissioner shall adjust the eligibility period for enrollees to
implement renewals throughout the year according to guidance from the Centers for Medicare
and Medicaid Services deleted text end . new text begin The period of eligibility is the entire calendar year following the
year in which eligibility is redetermined. Eligibility redeterminations shall occur during the
open enrollment period for qualified health plans as specified in Code of Federal Regulations,
title 45, section 155.410(e)(3).
new text end

(b) Each new period of eligibility must take into account any changes in circumstances
that impact eligibility and premium amount. Coverage begins as provided in section 256L.06.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 22.

Minnesota Statutes 2020, section 295.53, subdivision 1, is amended to read:

Subdivision 1.

Exclusions and exemptions.

(a) The following payments are excluded
from the gross revenues subject to the hospital, surgical center, or health care provider taxes
under sections 295.50 to 295.59:

(1) payments received by a health care provider or the wholly owned subsidiary of a
health care provider for care provided outside Minnesota;

(2) government payments received by the commissioner of human services for
state-operated services;

(3) payments received by a health care provider for hearing aids and related equipment
or prescription eyewear delivered outside of Minnesota; and

(4) payments received by an educational institution from student tuition, student activity
fees, health care service fees, government appropriations, donations, or grants, and for
services identified in and provided under an individualized education program as defined
in section 256B.0625 or Code of Federal Regulations, chapter 34, section 300.340(a). Fee
for service payments and payments for extended coverage are taxable.

(b) The following payments are exempted from the gross revenues subject to hospital,
surgical center, or health care provider taxes under sections 295.50 to 295.59:

(1) payments received for services provided under the Medicare program, including
payments received from the government and organizations governed by sections 1833,
1853, and 1876 of title XVIII of the federal Social Security Act, United States Code, title
42, section 1395; and enrollee deductibles, co-insurance, and co-payments, whether paid
by the Medicare enrollee, by Medicare supplemental coverage as described in section
62A.011, subdivision 3, clause (10), or by Medicaid payments under title XIX of the federal
Social Security Act. Payments for services not covered by Medicare are taxable;

(2) payments received for home health care services;

(3) payments received from hospitals or surgical centers for goods and services on which
liability for tax is imposed under section 295.52 or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);

(4) payments received from the health care providers for goods and services on which
liability for tax is imposed under this chapter or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);

(5) amounts paid for legend drugs to a wholesale drug distributor who is subject to tax
under section 295.52, subdivision 3, reduced by reimbursement received for legend drugs
otherwise exempt under this chapter;

(6) payments received from the chemical dependency fund under chapter 254B;

(7) payments received in the nature of charitable donations that are not designated for
providing patient services to a specific individual or group;

(8) payments received for providing patient services incurred through a formal program
of health care research conducted in conformity with federal regulations governing research
on human subjects. Payments received from patients or from other persons paying on behalf
of the patients are subject to tax;

(9) payments received from any governmental agency for services benefiting the public,
not including payments made by the government in its capacity as an employer or insurer
or payments made by the government for services provided under the MinnesotaCare
program or the medical assistance program governed by title XIX of the federal Social
Security Act, United States Code, title 42, sections 1396 to 1396v;

(10) payments received under the federal Employees Health Benefits Act, United States
Code, title 5, section 8909(f), as amended by the Omnibus Reconciliation Act of 1990.
Enrollee deductibles, co-insurance, and co-payments are subject to tax;

(11) payments received under the federal Tricare program, Code of Federal Regulations,
title 32, section 199.17(a)(7). Enrollee deductibles, co-insurance, and co-payments are
subject to tax; and

(12) supplemental deleted text begin or deleted text end new text begin , new text end enhanced new text begin , or uniform adjustment factor new text end payments authorized under
section 256B.196 deleted text begin or deleted text end new text begin , new text end 256B.197 new text begin , or 256B.1973 new text end .

(c) Payments received by wholesale drug distributors for legend drugs sold directly to
veterinarians or veterinary bulk purchasing organizations are excluded from the gross
revenues subject to the wholesale drug distributor tax under sections 295.50 to 295.59.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2021.
new text end

Sec. 23. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FUNDING FOR RECUPERATIVE CARE.
new text end

new text begin The commissioner of human services shall develop a medical assistance reimbursable
recuperative care service, not limited to a health home model, designed to serve individuals
with chronic conditions, as defined in United States Code, title 42, section 1396w-4(h), who
also lack a permanent place of residence at the time of discharge from an emergency
department or hospital in order to prevent a return to the emergency department, readmittance
to the hospital, or hospitalization. This section is contingent on the receipt of nonstate
funding to the commissioner of human services for this purpose as permitted by Minnesota
Statutes, section 256.01, subdivision 25.
new text end

Sec. 24. new text begin REVISOR INSTRUCTION.
new text end

new text begin The revisor of statutes must change the term "Health Services Policy Committee" to
"Health Services Advisory Council" wherever the term appears in Minnesota Statutes and
may make any necessary changes to grammar or sentence structure to preserve the meaning
of the text.
new text end

ARTICLE 2

DEPARTMENT OF HUMAN SERVICES
LICENSING AND BACKGROUND STUDIES

Section 1.

Minnesota Statutes 2020, section 245A.043, subdivision 3, is amended to read:

Subd. 3.

Change of ownership process.

(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.

(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of deleted text begin Minnesota Rules, part 9530.6800 deleted text end new text begin sections 245G.03,
subdivision 2, paragraph (b), and 254B.03, subdivision 2, paragraphs (d) and (e) new text end .

(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.

(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.

(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.

(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.

(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.

(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.

(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.

Sec. 2.

Minnesota Statutes 2020, section 245F.04, subdivision 2, is amended to read:

Subd. 2.

Contents of application.

Prior to the issuance of a license, an applicant must
submit, on forms provided by the commissioner, documentation demonstrating the following:

(1) compliance with this section;

(2) compliance with applicable building, fire, and safety codes; health rules; zoning
ordinances; and other applicable rules and regulations or documentation that a waiver has
been granted. The granting of a waiver does not constitute modification of any requirement
of this section; new text begin and
new text end

deleted text begin (3) completion of an assessment of need for a new or expanded program as required by
Minnesota Rules, part 9530.6800; and
deleted text end

deleted text begin (4) deleted text end new text begin (3) new text end insurance coverage, including bonding, sufficient to cover all patient funds,
property, and interests.

Sec. 3.

Minnesota Statutes 2020, section 245G.03, subdivision 2, is amended to read:

Subd. 2.

Application.

new text begin (a) new text end Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires.

new text begin (b) The applicant must submit documentation that the applicant has notified the county
as required under section 254B.03, subdivision 2.
new text end

Sec. 4.

Minnesota Statutes 2020, section 254B.03, subdivision 2, is amended to read:

Subd. 2.

Chemical dependency fund payment.

(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state that would be required to be
licensed as a chemical dependency program if the program were in the state. Out of state
vendors must also provide the commissioner with assurances that the program complies
substantially with state licensing requirements and possesses all licenses and certifications
required by the host state to provide chemical dependency treatment. Vendors receiving
payments from the chemical dependency fund must not require co-payment from a recipient
of benefits for services provided under this subdivision. The vendor is prohibited from using
the client's public benefits to offset the cost of services paid under this section. The vendor
shall not require the client to use public benefits for room or board costs. This includes but
is not limited to cash assistance benefits under chapters 119B, 256D, and 256J, or SNAP
benefits. Retention of SNAP benefits is a right of a client receiving services through the
consolidated chemical dependency treatment fund or through state contracted managed care
entities. Payment from the chemical dependency fund shall be made for necessary room
and board costs provided by vendors meeting the criteria under section 254B.05, subdivision
1a, or in a community hospital licensed by the commissioner of health according to sections
144.50 to 144.56 to a client who is:

(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and

(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.

(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.

(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.

new text begin (d) At least 60 days prior to submitting an application for new licensure under chapter
245G, the applicant must notify the county human services director in writing of the
applicant's intent to open a new treatment program. The written notification must include,
at a minimum:
new text end

new text begin (1) a description of the proposed treatment program; and
new text end

new text begin (2) a description of the target population to be served by the treatment program.
new text end

new text begin (e) The county human services director may submit a written statement to the
commissioner, within 60 days of receiving notice from the applicant, regarding the county's
support of or opposition to the opening of the new treatment program. The written statement
must include documentation of the rationale for the county's determination. The commissioner
shall consider the county's written statement when determining whether there is a need for
the treatment program as required by paragraph (c).
new text end

Sec. 5. new text begin REPEALER.
new text end

new text begin Minnesota Rules, parts 9530.6800; and 9530.6810, new text end new text begin are repealed.
new text end

ARTICLE 3

HEALTH DEPARTMENT

Section 1.

Minnesota Statutes 2020, section 62J.495, subdivision 3, is amended to read:

Subd. 3.

Interoperable electronic health record requirements.

(a) Hospitals and health
care providers must meet the following criteria when implementing an interoperable
electronic health records system within their hospital system or clinical practice setting.

(b) The electronic health record must be a qualified electronic health record.

(c) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and health
care providers if a certified electronic health record product for the provider's particular
practice setting is available. This criterion shall be considered met if a hospital or health
care provider is using an electronic health records system that has been certified within the
last three years, even if a more current version of the system has been certified within the
three-year period.

(d) The electronic health record must meet the standards established according to section
3004 of the HITECH Act as applicable.

(e) The electronic health record must have the ability to generate information on clinical
quality measures and other measures reported under sections 4101, 4102, and 4201 of the
HITECH Act.

(f) The electronic health record system must be connected to a state-certified health
information organization either directly or through a connection facilitated by a deleted text begin state-certified deleted text end
health data intermediary as defined in section 62J.498.

(g) A health care provider who is a prescriber or dispenser of legend drugs must have
an electronic health record system that meets the requirements of section 62J.497.

Sec. 2.

Minnesota Statutes 2020, section 62J.498, is amended to read:

62J.498 HEALTH INFORMATION EXCHANGE.

Subdivision 1.

Definitions.

(a) The following definitions apply to sections 62J.498 to
62J.4982:

(b) "Clinical data repository" means a real time database that consolidates data from a
variety of clinical sources to present a unified view of a single patient and is used by a
deleted text begin state-certified deleted text end health information exchange service provider to enable health information
exchange among health care providers that are not related health care entities as defined in
section 144.291, subdivision 2, paragraph (k). This does not include clinical data that are
submitted to the commissioner for public health purposes required or permitted by law,
including any rules adopted by the commissioner.

(c) "Clinical transaction" means any meaningful use transaction or other health
information exchange transaction that is not covered by section 62J.536.

(d) "Commissioner" means the commissioner of health.

(e) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.

(f) "Health data intermediary" means an entity that provides the technical capabilities
or related products and services to enable health information exchange among health care
providers that are not related health care entities as defined in section 144.291, subdivision
2, paragraph (k). This includes but is not limited to health information service providers
(HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries
as defined in section 62J.495.

(g) "Health information exchange" means the electronic transmission of health-related
information between organizations according to nationally recognized standards.

(h) "Health information exchange service provider" means a health data intermediary
or health information organization.

(i) "Health information organization" means an organization that oversees, governs, and
facilitates health information exchange among health care providers that are not related
health care entities as defined in section 144.291, subdivision 2, paragraph (k), to improve
coordination of patient care and the efficiency of health care delivery.

deleted text begin (j) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act as defined in section 62J.495.
deleted text end

deleted text begin (k) deleted text end new text begin (j) new text end "Major participating entity" means:

(1) a participating entity that receives compensation for services that is greater than 30
percent of the health information organization's gross annual revenues from the health
information exchange service provider;

(2) a participating entity providing administrative, financial, or management services to
the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and

(3) a participating entity that nominates or appoints 30 percent or more of the board of
directors or equivalent governing body of the health information organization.

deleted text begin (l) deleted text end new text begin (k) new text end "Master patient index" means an electronic database that holds unique identifiers
of patients registered at a care facility and is used by a deleted text begin state-certified deleted text end health information
exchange service provider to enable health information exchange among health care providers
that are not related health care entities as defined in section 144.291, subdivision 2, paragraph
(k). This does not include data that are submitted to the commissioner for public health
purposes required or permitted by law, including any rules adopted by the commissioner.

deleted text begin (m) "Meaningful use" means use of certified electronic health record technology to
improve quality, safety, and efficiency and reduce health disparities; engage patients and
families; improve care coordination and population and public health; and maintain privacy
and security of patient health information as established by the Centers for Medicare and
Medicaid Services and the Minnesota Department of Human Services pursuant to sections
4101, 4102, and 4201 of the HITECH Act.
deleted text end

deleted text begin (n) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
deleted text end

deleted text begin (o) deleted text end new text begin (l) new text end "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization deleted text begin or health
data intermediary deleted text end has contracts or other agreements for the provision of health information
exchange services:

(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;

(2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;

(3) a group, professional corporation, or other organization that provides the services of
individuals or entities identified in clause (2), including but not limited to a medical clinic,
a medical group, a home health care agency, an urgent care center, and an emergent care
center;

(4) a health plan as defined in section 62A.011, subdivision 3; and

(5) a state agency as defined in section 13.02, subdivision 17.

deleted text begin (p) deleted text end new text begin (m) new text end "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of clinical transactions.

deleted text begin (q) "State-certified health data intermediary" means a health data intermediary that has
been issued a certificate of authority to operate in Minnesota.
deleted text end

deleted text begin (r) deleted text end new text begin (n) new text end "State-certified health information organization" means a health information
organization that has been issued a certificate of authority to operate in Minnesota.

Subd. 2.

Health information exchange oversight.

(a) The commissioner shall protect
the public interest on matters pertaining to health information exchange. The commissioner
shall:

(1) review and act on applications from deleted text begin health data intermediaries and deleted text end health information
organizations for certificates of authority to operate in Minnesota;

new text begin (2) require information to be provided as needed from health information exchange
service providers in order to meet requirements established under sections 62J.498 to
62J.4982;
new text end

deleted text begin (2) deleted text end new text begin (3) new text end provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;

deleted text begin (3) deleted text end new text begin (4) new text end respond to public complaints related to health information exchange services;

deleted text begin (4) deleted text end new text begin (5) new text end take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;

deleted text begin (5) deleted text end new text begin (6) new text end provide a biennial report on the status of health information exchange services
that includes but is not limited to:

(i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;

(ii) recommendations on enforcement actions to ensure that health information exchange
service providers act in the public interest without causing disruption in health information
exchange services;

(iii) recommendations on updates to criteria for obtaining certificates of authority under
this section; and

(iv) recommendations on standard operating procedures for health information exchange,
including but not limited to the management of consumer preferences; and

deleted text begin (6) deleted text end new text begin (7) new text end other duties necessary to protect the public interest.

(b) As part of the application review process for certification under paragraph (a), prior
to issuing a certificate of authority, the commissioner shall:

(1) make all portions of the application classified as public data available to the public
for at least ten days while an application is under consideration. At the request of the
commissioner, the applicant shall participate in a public hearing by presenting an overview
of their application and responding to questions from interested parties; and

(2) consult with hospitals, physicians, and other providers prior to issuing a certificate
of authority.

(c) When the commissioner is actively considering a suspension or revocation of a
certificate of authority as described in section 62J.4982, subdivision 3, all investigatory data
that are collected, created, or maintained related to the suspension or revocation are classified
as confidential data on individuals and as protected nonpublic data in the case of data not
on individuals.

(d) The commissioner may disclose data classified as protected nonpublic or confidential
under paragraph (c) if disclosing the data will protect the health or safety of patients.

(e) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified as
public data.

Sec. 3.

Minnesota Statutes 2020, section 62J.4981, is amended to read:

62J.4981 CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.

Subdivision 1.

Authority to require organizations to apply.

The commissioner shall
require deleted text begin a health data intermediary or deleted text end a health information organization to apply for a
certificate of authority under this section. An applicant may continue to operate until the
commissioner acts on the application. If the application is denied, the applicant is considered
a health information exchange service provider whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).

deleted text begin Subd. 2. deleted text end

deleted text begin Certificate of authority for health data intermediaries. deleted text end

deleted text begin (a) A health data
intermediary must be certified by the state and comply with requirements established in this
section.
deleted text end

deleted text begin (b) Notwithstanding any law to the contrary, any corporation organized to do so may
apply to the commissioner for a certificate of authority to establish and operate as a health
data intermediary in compliance with this section. No person shall establish or operate a
health data intermediary in this state, nor sell or offer to sell, or solicit offers to purchase
or receive advance or periodic consideration in conjunction with a health data intermediary
contract unless the organization has a certificate of authority or has an application under
active consideration under this section.
deleted text end

deleted text begin (c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
deleted text end

deleted text begin (1) hold reciprocal agreements with at least one state-certified health information
organization to access patient data, and for the transmission and receipt of clinical
transactions. Reciprocal agreements must meet the requirements established in subdivision
5; and
deleted text end

deleted text begin (2) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability between state-certified health information
organizations and state-certified health data intermediaries.
deleted text end

Subd. 3.

Certificate of authority for health information organizations.

(a) A health
information organization must obtain a certificate of authority from the commissioner and
demonstrate compliance with the criteria in paragraph (c).

(b) Notwithstanding any law to the contrary, an organization may apply for a certificate
of authority to establish and operate a health information organization under this section.
No person shall establish or operate a health information organization in this state, nor sell
or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in
conjunction with a health information organization or health information contract unless
the organization has a certificate of authority under this section.

(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:

(1) the entity is a legally established organization;

(2) appropriate insurance, including liability insurance, for the operation of the health
information organization is in place and sufficient to protect the interest of the public and
participating entities;

(3) strategic and operational plans address governance, technical infrastructure, legal
and policy issues, finance, and business operations in regard to how the organization will
expand to support providers in achieving health information exchange goals over time;

(4) the entity addresses the parameters to be used with participating entities and other
health information exchange service providers for clinical transactions, compliance with
Minnesota law, and interstate health information exchange trust agreements;

(5) the entity's board of directors or equivalent governing body is composed of members
that broadly represent the health information organization's participating entities and
consumers;

(6) the entity maintains a professional staff responsible to the board of directors or
equivalent governing body with the capacity to ensure accountability to the organization's
mission;

(7) the organization is compliant with national certification and accreditation programs
designated by the commissioner;

(8) the entity maintains the capability to query for patient information based on national
standards. The query capability may utilize a master patient index, clinical data repository,
or record locator service as defined in section 144.291, subdivision 2, paragraph (j). The
entity must be compliant with the requirements of section 144.293, subdivision 8, when
conducting clinical transactions;

(9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;

(10) the organization demonstrates compliance with all privacy and security requirements
required by state and federal law; and

(11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's financials
on an annual basis.

(d) Health information organizations that have obtained a certificate of authority must:

(1) meet the requirements established for connecting to the National eHealth Exchange;

(2) annually submit strategic and operational plans for review by the commissioner that
address:

(i) progress in achieving objectives included in previously submitted strategic and
operational plans across the following domains: business and technical operations, technical
infrastructure, legal and policy issues, finance, and organizational governance;

(ii) plans for ensuring the necessary capacity to support clinical transactions;

(iii) approach for attaining financial sustainability, including public and private financing
strategies, and rate structures;

(iv) rates of adoption, utilization, and transaction volume, and mechanisms to support
health information exchange; and

(v) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;

(3) enter into reciprocal agreements with all other state-certified health information
organizations deleted text begin and state-certified health data intermediaries deleted text end to enable access to patient data,
and for the transmission and receipt of clinical transactions. Reciprocal agreements must
meet the requirements in subdivision 5;

(4) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability deleted text begin between state-certified health information
organizations and state-certified health data intermediaries deleted text end ; and

(5) comply with additional requirements for the certification or recertification of health
information organizations that may be established by the commissioner.

Subd. 4.

Application for certificate of authority for health information deleted text begin exchange
service providers deleted text end new text begin organizations new text end .

(a) Each application for a certificate of authority shall
be in a form prescribed by the commissioner and verified by an officer or authorized
representative of the applicant. Each application shall include the following in addition to
information described in the criteria in deleted text begin subdivisions 2 and deleted text end new text begin subdivision new text end 3:

(1) deleted text begin for health information organizations only, deleted text end a copy of the basic organizational document,
if any, of the applicant and of each major participating entity, such as the articles of
incorporation, or other applicable documents, and all amendments to it;

(2) deleted text begin for health information organizations only, deleted text end a list of the names, addresses, and official
positions of the following:

(i) all members of the board of directors or equivalent governing body, and the principal
officers and, if applicable, shareholders of the applicant organization; and

(ii) all members of the board of directors or equivalent governing body, and the principal
officers of each major participating entity and, if applicable, each shareholder beneficially
owning more than ten percent of any voting stock of the major participating entity;

(3) deleted text begin for health information organizations only, deleted text end the name and address of each participating
entity and the agreed-upon duration of each contract or agreement if applicable;

(4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information deleted text begin exchange service provider deleted text end new text begin organization new text end . Contractual
provisions shall be consistent with the purposes of this section, in regard to the services to
be performed under the standard agreement or contract, the manner in which payment for
services is determined, the nature and extent of responsibilities to be retained by the health
information organization, and contractual termination provisions;

(5) a statement generally describing the health information deleted text begin exchange service provider deleted text end new text begin
organization new text end , its health information exchange contracts, facilities, and personnel, including
a statement describing the manner in which the applicant proposes to provide participants
with comprehensive health information exchange services;

(6) a statement reasonably describing the geographic area or areas to be served and the
type or types of participants to be served;

(7) a description of the complaint procedures to be used as required under this section;

(8) a description of the mechanism by which participating entities will have an opportunity
to participate in matters of policy and operation;

(9) a copy of any pertinent agreements between the health information organization and
insurers, including liability insurers, demonstrating coverage is in place;

(10) a copy of the conflict of interest policy that applies to all members of the board of
directors or equivalent governing body and the principal officers of the health information
organization; and

(11) other information as the commissioner may reasonably require to be provided.

(b) Within 45 days after the receipt of the application for a certificate of authority, the
commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.

(c) Within 90 days after the receipt of a complete application for a certificate of authority,
the commissioner shall issue a certificate of authority to the applicant if the commissioner
determines that the applicant meets the minimum criteria requirements of deleted text begin subdivision 2 for
health data intermediaries or deleted text end subdivision 3 deleted text begin for health information organizations deleted text end . If the
commissioner determines that the applicant is not qualified, the commissioner shall notify
the applicant and specify the reasons for disqualification.

(d) Upon being granted a certificate of authority to operate as a state-certified health
information organization deleted text begin or state-certified health data intermediary deleted text end , the organization must
operate in compliance with the provisions of this section. Noncompliance may result in the
imposition of a fine or the suspension or revocation of the certificate of authority according
to section 62J.4982.

Subd. 5.

Reciprocal agreements between health information deleted text begin exchange entities deleted text end new text begin
organizations new text end .

(a) Reciprocal agreements between two health information organizations
deleted text begin or between a health information organization and a health data intermediary deleted text end must include
a fair and equitable model for charges between the entities that:

(1) does not impede the secure transmission of clinical transactions;

(2) does not charge a fee for the exchange of deleted text begin meaningful use deleted text end transactions transmitted
according to nationally recognized standards where no additional value-added service is
rendered to the sending or receiving health information organization deleted text begin or health data
intermediary deleted text end either directly or on behalf of the client;

(3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and

(4) prevents health care stakeholders from being charged multiple times for the same
service.

(b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.

(c) Reciprocal agreements are subject to review and approval by the commissioner.

(d) Nothing in this section precludes a state-certified health information organization deleted text begin or
state-certified health data intermediary deleted text end from entering into contractual agreements for the
provision of value-added services deleted text begin beyond meaningful use transactions deleted text end .

Sec. 4.

Minnesota Statutes 2020, section 62J.4982, is amended to read:

62J.4982 ENFORCEMENT AUTHORITY; COMPLIANCE.

Subdivision 1.

Penalties and enforcement.

(a) The commissioner may, for any violation
of statute or rule applicable to a health information deleted text begin exchange service provider deleted text end new text begin organization new text end ,
levy an administrative penalty in an amount up to $25,000 for each violation. In determining
the level of an administrative penalty, the commissioner shall consider the following factors:

(1) the number of participating entities affected by the violation;

(2) the effect of the violation on participating entities' access to health information
exchange services;

(3) if only one participating entity is affected, the effect of the violation on the patients
of that entity;

(4) whether the violation is an isolated incident or part of a pattern of violations;

(5) the economic benefits derived by the health information organization deleted text begin or a health data
intermediary deleted text end by virtue of the violation;

(6) whether the violation hindered or facilitated an individual's ability to obtain health
care;

(7) whether the violation was intentional;

(8) whether the violation was beyond the direct control of the health information deleted text begin exchange
service provider deleted text end new text begin organization new text end ;

(9) any history of prior compliance with the provisions of this section, including
violations;

(10) whether and to what extent the health information deleted text begin exchange service provider deleted text end new text begin
organization new text end attempted to correct previous violations;

(11) how the health information deleted text begin exchange service provider deleted text end new text begin organization new text end responded to
technical assistance from the commissioner provided in the context of a compliance effort;
and

(12) the financial condition of the health information deleted text begin exchange service provider deleted text end new text begin
organization new text end including deleted text begin , deleted text end but not limited to deleted text begin , deleted text end whether the health information deleted text begin exchange service
provider deleted text end new text begin organization new text end had financial difficulties that affected its ability to comply or whether
the imposition of an administrative monetary penalty would jeopardize the ability of the
health information deleted text begin exchange service provider deleted text end new text begin organization new text end to continue to deliver health
information exchange services.

The commissioner shall give reasonable notice in writing to the health information
deleted text begin exchange service provider deleted text end new text begin organization new text end of the intent to levy the penalty and the reasons for
it. A health information deleted text begin exchange service provider deleted text end new text begin organization new text end may have 15 days within
which to contest whether the facts found constitute a violation of sections 62J.4981 and
62J.4982, according to the contested case and judicial review provisions of sections 14.57
to 14.69.

(b) If the commissioner has reason to believe that a violation of section 62J.4981 or
62J.4982 has occurred or is likely, the commissioner may confer with the persons involved
before commencing action under subdivision 2. The commissioner may notify the health
information deleted text begin exchange service provider deleted text end new text begin organization new text end and the representatives, or other persons
who appear to be involved in the suspected violation, to arrange a voluntary conference
with the alleged violators or their authorized representatives. The purpose of the conference
is to attempt to learn the facts about the suspected violation and, if it appears that a violation
has occurred or is threatened, to find a way to correct or prevent it. The conference is not
governed by any formal procedural requirements, and may be conducted as the commissioner
considers appropriate.

(c) The commissioner may issue an order directing a health information deleted text begin exchange service
provider deleted text end new text begin organization new text end or a representative of a health information deleted text begin exchange service provider deleted text end new text begin
organization new text end to cease and desist from engaging in any act or practice in violation of sections
62J.4981 and 62J.4982.

(d) Within 20 days after service of the order to cease and desist, a health information
deleted text begin exchange service provider deleted text end new text begin organization new text end may contest whether the facts found constitute a
violation of sections 62J.4981 and 62J.4982 according to the contested case and judicial
review provisions of sections 14.57 to 14.69.

(e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or other
appropriate relief in Ramsey County District Court.

Subd. 2.

Suspension or revocation of certificates of authority.

(a) The commissioner
may suspend or revoke a certificate of authority issued to a deleted text begin health data intermediary or deleted text end
health information organization under section 62J.4981 if the commissioner finds that:

(1) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end is operating
significantly in contravention of its basic organizational document, or in a manner contrary
to that described in and reasonably inferred from any other information submitted under
section 62J.4981, unless amendments to the submissions have been filed with and approved
by the commissioner;

(2) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;

(3) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end is no longer financially
solvent or may not reasonably be expected to meet its obligations to participating entities;

(4) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end has failed to implement
the complaint system in a manner designed to reasonably resolve valid complaints;

(5) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end , or any person acting
with its sanction, has advertised or merchandised its services in an untrue, misleading,
deceptive, or unfair manner;

(6) the continued operation of the health information deleted text begin exchange service provider deleted text end new text begin
organization new text end would be hazardous to its participating entities or the patients served by the
participating entities; or

(7) the health information deleted text begin exchange service provider deleted text end new text begin organization new text end has otherwise failed
to substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.

(b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.

(c) If the certificate of authority of a health information deleted text begin exchange service provider deleted text end new text begin
organization new text end is suspended, the health information deleted text begin exchange service provider deleted text end new text begin organization new text end
shall not, during the period of suspension, enroll any additional participating entities, and
shall not engage in any advertising or solicitation.

(d) If the certificate of authority of a health information deleted text begin exchange service provider deleted text end new text begin
organization new text end is revoked, the organization shall proceed, immediately following the effective
date of the order of revocation, to wind up its affairs, and shall conduct no further business
except as necessary to the orderly conclusion of the affairs of the organization. The
organization shall engage in no further advertising or solicitation. The commissioner may,
by written order, permit further operation of the organization as the commissioner finds to
be in the best interest of participating entities, to the end that participating entities will be
given the greatest practical opportunity to access continuing health information exchange
services.

Subd. 3.

Denial, suspension, and revocation; administrative procedures.

(a) When
the commissioner has cause to believe that grounds for the denial, suspension, or revocation
of a certificate of authority exist, the commissioner shall notify the health information
deleted text begin exchange service provider deleted text end new text begin organization new text end in writing stating the grounds for denial, suspension,
or revocation and setting a time within 20 days for a hearing on the matter.

(b) After a hearing before the commissioner at which the health information deleted text begin exchange
service provider deleted text end new text begin organization new text end may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information deleted text begin exchange service provider deleted text end new text begin
organization new text end to appear at the hearing, the commissioner shall take action as deemed necessary
and shall issue written findings and mail them to the health information deleted text begin exchange service
provider deleted text end new text begin organization new text end .

(c) If suspension, revocation, or administrative penalty is proposed according to this
section, the commissioner must deliver, or send by certified mail with return receipt
requested, to the health information deleted text begin exchange service provider deleted text end new text begin organization new text end written notice
of the commissioner's intent to impose a penalty. This notice of proposed determination
must include:

(1) a reference to the statutory basis for the penalty;

(2) a description of the findings of fact regarding the violations with respect to which
the penalty is proposed;

(3) the nature and amount of the proposed penalty;

(4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;

(5) instructions for responding to the notice, including a statement of the health
information deleted text begin exchange service provider's deleted text end new text begin organization's new text end right to a contested case proceeding
and a statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and

(6) the address to which the contested case proceeding request must be sent.

Subd. 4.

Coordination.

The commissioner shall, to the extent possible, seek the advice
of the Minnesota e-Health Advisory Committee, in the review and update of criteria for the
certification and recertification of health information deleted text begin exchange service providers deleted text end new text begin
organizations new text end when implementing sections 62J.498 to 62J.4982.

Subd. 5.

Fees and monetary penalties.

(a) The commissioner shall assess fees on every
health information deleted text begin exchange service provider deleted text end new text begin organization new text end subject to sections 62J.4981 and
62J.4982 as follows:

(1) filing an application for certificate of authority to operate as a health information
organization, $7,000; new text begin and
new text end

(2) deleted text begin filing an application for certificate of authority to operate as a health data intermediary,
$7,000;
deleted text end

deleted text begin (3) deleted text end annual health information organization certificate fee, $7,000 deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (4) annual health data intermediary certificate fee, $7,000.
deleted text end

(b) Fees collected under this section shall be deposited in the state treasury and credited
to the state government special revenue fund.

(c) Administrative monetary penalties imposed under this subdivision shall be credited
to an account in the special revenue fund and are appropriated to the commissioner for the
purposes of sections 62J.498 to 62J.4982.

Sec. 5.

Minnesota Statutes 2020, section 62J.84, subdivision 3, is amended to read:

Subd. 3.

Prescription drug price increases reporting.

(a) Beginning deleted text begin October 1, 2021 deleted text end new text begin
January 1, 2022 new text end , a drug manufacturer must submit to the commissioner the information
described in paragraph (b) for each prescription drug for which the price was $100 or greater
for a 30-day supply or for a course of treatment lasting less than 30 days and:

(1) for brand name drugs where there is an increase of ten percent or greater in the price
over the previous 12-month period or an increase of 16 percent or greater in the price over
the previous 24-month period; and

(2) for generic drugs where there is an increase of 50 percent or greater in the price over
the previous 12-month period.

(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the price increase goes into effect, in the form
and manner prescribed by the commissioner, the following information, if applicable:

(1) the name and price of the drug and the net increase, expressed as a percentage;

(2) the factors that contributed to the price increase;

(3) the name of any generic version of the prescription drug available on the market;

(4) the introductory price of the prescription drug when it was approved for marketing
by the Food and Drug Administration and the net yearly increase, by calendar year, in the
price of the prescription drug during the previous five years;

(5) the direct costs incurred by the manufacturer that are associated with the prescription
drug, listed separately:

(i) to manufacture the prescription drug;

(ii) to market the prescription drug, including advertising costs; and

(iii) to distribute the prescription drug;

(6) the total sales revenue for the prescription drug during the previous 12-month period;

(7) the manufacturer's net profit attributable to the prescription drug during the previous
12-month period;

(8) the total amount of financial assistance the manufacturer has provided through patient
prescription assistance programs, if applicable;

(9) any agreement between a manufacturer and another entity contingent upon any delay
in offering to market a generic version of the prescription drug;

(10) the patent expiration date of the prescription drug if it is under patent;

(11) the name and location of the company that manufactured the drug; and

(12) if a brand name prescription drug, the ten highest prices paid for the prescription
drug during the previous calendar year in any country other than the United States.

(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.

Sec. 6.

Minnesota Statutes 2020, section 62J.84, subdivision 4, is amended to read:

Subd. 4.

New prescription drug price reporting.

(a) Beginning deleted text begin October 1, 2021 deleted text end new text begin January
1, 2022 new text end , no later than 60 days after a manufacturer introduces a new prescription drug for
sale in the United States that is a new brand name drug with a price that is greater than the
tier threshold established by the Centers for Medicare and Medicaid Services for specialty
drugs in the Medicare Part D program for a 30-day supply or a new generic or biosimilar
drug with a price that is greater than the tier threshold established by the Centers for Medicare
and Medicaid Services for specialty drugs in the Medicare Part D program for a 30-day
supply and is not at least 15 percent lower than the referenced brand name drug when the
generic or biosimilar drug is launched, the manufacturer must submit to the commissioner,
in the form and manner prescribed by the commissioner, the following information, if
applicable:

(1) the price of the prescription drug;

(2) whether the Food and Drug Administration granted the new prescription drug a
breakthrough therapy designation or a priority review;

(3) the direct costs incurred by the manufacturer that are associated with the prescription
drug, listed separately:

(i) to manufacture the prescription drug;

(ii) to market the prescription drug, including advertising costs; and

(iii) to distribute the prescription drug; and

(4) the patent expiration date of the drug if it is under patent.

(b) The manufacturer may submit documentation necessary to support the information
reported under this subdivision.

Sec. 7.

Minnesota Statutes 2020, section 62J.84, subdivision 5, is amended to read:

Subd. 5.

Newly acquired prescription drug price reporting.

(a) Beginning deleted text begin October
1, 2021 deleted text end new text begin January 1, 2022 new text end , the acquiring drug manufacturer must submit to the commissioner
the information described in paragraph (b) for each newly acquired prescription drug for
which the price was $100 or greater for a 30-day supply or for a course of treatment lasting
less than 30 days and:

(1) for a newly acquired brand name drug where there is an increase of ten percent or
greater in the price over the previous 12-month period or an increase of 16 percent or greater
in price over the previous 24-month period; and

(2) for a newly acquired generic drug where there is an increase of 50 percent or greater
in the price over the previous 12-month period.

(b) For each of the drugs described in paragraph (a), the acquiring manufacturer shall
submit to the commissioner no later than 60 days after the acquiring manufacturer begins
to sell the newly acquired drug, in the form and manner prescribed by the commissioner,
the following information, if applicable:

(1) the price of the prescription drug at the time of acquisition and in the calendar year
prior to acquisition;

(2) the name of the company from which the prescription drug was acquired, the date
acquired, and the purchase price;

(3) the year the prescription drug was introduced to market and the price of the
prescription drug at the time of introduction;

(4) the price of the prescription drug for the previous five years;

(5) any agreement between a manufacturer and another entity contingent upon any delay
in offering to market a generic version of the manufacturer's drug; and

(6) the patent expiration date of the drug if it is under patent.

(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.

Sec. 8.

Minnesota Statutes 2020, section 62J.84, subdivision 6, is amended to read:

Subd. 6.

Public posting of prescription drug price information.

(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:

(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; and

(2) information reported to the commissioner under subdivisions 3, 4, and 5.

(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.

(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.

(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.

new text begin (e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
new text end

Sec. 9.

Minnesota Statutes 2020, section 62J.84, subdivision 9, is amended to read:

Subd. 9.

Legislative report.

(a) No later than deleted text begin January 15 of each year, beginning January
15, 2022 deleted text end new text begin May 15, 2022, and by January 15 of each year thereafter new text end , the commissioner shall
report to the chairs and ranking minority members of the legislative committees with
jurisdiction over commerce and health and human services policy and finance on the
implementation of this section, including but not limited to the effectiveness in addressing
the following goals:

(1) promoting transparency in pharmaceutical pricing for the state and other payers;

(2) enhancing the understanding on pharmaceutical spending trends; and

(3) assisting the state and other payers in the management of pharmaceutical costs.

(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and 5.

Sec. 10.

Minnesota Statutes 2020, section 144.05, is amended by adding a subdivision to
read:

new text begin Subd. 7. new text end

new text begin Expiration of report mandates. new text end

new text begin (a) If the submission of a report by the
commissioner of health to the legislature is mandated by statute and the enabling legislation
does not include a date for the submission of a final report, the mandate to submit the report
shall expire in accordance with this section.
new text end

new text begin (b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1,2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end

new text begin (c) Any reporting mandate enacted on or after January 1, 2021 shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report, unless the enacting legislation provides for a different
expiration date.
new text end

new text begin (d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over health by February 15 of each year, beginning
February 15, 2022, of all reports set to expire during the following calendar year in
accordance with this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 11.

Minnesota Statutes 2020, section 144.1205, subdivision 2, is amended to read:

Subd. 2.

new text begin Initial and new text end annual fee.

new text begin (a) A licensee must pay an initial fee that is equivalent
to the annual fee upon issuance of the initial license.
new text end

new text begin (b) new text end A licensee must pay an annual fee at least 60 days before the anniversary date of the
issuance of the license. The annual fee is as follows:

TYPE		deleted text begin ANNUAL deleted text end new text begin LICENSE new text end FEE
Academic broad scope - type A new text begin , B, or C new text end		deleted text begin $19,920 deleted text end new text begin $25,896 new text end
deleted text begin Academic broad scope - type B deleted text end		deleted text begin 19,920 deleted text end
deleted text begin Academic broad scope - type C deleted text end		deleted text begin 19,920 deleted text end
new text begin Academic broad scope - type A, B, or C (4-8 locations) new text end		new text begin $31,075 new text end
new text begin Academic broad scope - type A, B, or C (9 or more locations) new text end		new text begin $36,254 new text end
Medical broad scope - type A		deleted text begin 19,920 deleted text end new text begin $25,896 new text end
new text begin Medical broad scope- type A (4-8 locations) new text end		new text begin $31,075 new text end
new text begin Medical broad scope- type A (9 or more locations) new text end		new text begin $36,254 new text end
deleted text begin Medical institution - diagnostic and therapeutic deleted text end		deleted text begin 3,680 deleted text end
new text begin Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end		new text begin $4,784 new text end
new text begin Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (4-8 locations) new text end		new text begin $5,740 new text end
new text begin Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (9 or more locations) new text end		new text begin $6,697 new text end
deleted text begin Medical institution - diagnostic (no written directives) deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Medical private practice - diagnostic and therapeutic deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Medical private practice - diagnostic (no written directives) deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Eye applicators deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Nuclear medical vans deleted text end		deleted text begin 3,680 deleted text end
deleted text begin High dose rate afterloader deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Mobile high dose rate afterloader deleted text end		deleted text begin 3,680 deleted text end
deleted text begin Medical therapy - other emerging technology deleted text end		deleted text begin 3,680 deleted text end
Teletherapy		deleted text begin 8,960 deleted text end new text begin $11,648 new text end
Gamma knife		deleted text begin 8,960 deleted text end new text begin $11,648 new text end
Veterinary medicine		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
In vitro testing lab		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
Nuclear pharmacy		deleted text begin 8,800 deleted text end new text begin $11,440 new text end
new text begin Nuclear pharmacy (5 or more locations) new text end		new text begin $13,728 new text end
Radiopharmaceutical distribution (10 CFR 32.72)		deleted text begin 3,840 deleted text end new text begin $4,992 new text end
Radiopharmaceutical processing and distribution (10 CFR 32.72)		deleted text begin 8,800 deleted text end new text begin $11,440 new text end
new text begin Radiopharmaceutical processing and distribution (10 CFR 32.72) (5 or more locations) new text end		new text begin $13,728 new text end
Medical sealed sources - distribution (10 CFR 32.74)		deleted text begin 3,840 deleted text end new text begin $4,992 new text end
Medical sealed sources - processing and distribution (10 CFR 32.74)		deleted text begin 8,800 deleted text end new text begin $11,440 new text end
new text begin Medical sealed sources - processing and distribution (10 CFR 32.74) (5 or more locations) new text end		new text begin $13,728 new text end
Well logging - sealed sources		deleted text begin 3,760 deleted text end new text begin $4,888 new text end
Measuring systems - new text begin ( new text end fixed gauge new text begin , portable gauge, gas chromatograph, other) new text end		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
deleted text begin Measuring systems - portable gauge deleted text end		deleted text begin 2,000 deleted text end
new text begin Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (4-8 locations) new text end		new text begin $3,120 new text end
new text begin Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (9 or more locations) new text end		new text begin $3,640 new text end
X-ray fluorescent analyzer		deleted text begin 1,520 deleted text end new text begin $1,976 new text end
deleted text begin Measuring systems - gas chromatograph deleted text end		deleted text begin 2,000 deleted text end
deleted text begin Measuring systems - other deleted text end		deleted text begin 2,000 deleted text end
deleted text begin Broad scope deleted text end Manufacturing and distribution - type A new text begin broad scope new text end		deleted text begin 19,920 deleted text end new text begin $25,896 new text end
new text begin Manufacturing and distribution - type A broad scope (4-8 locations) new text end		new text begin $31,075 new text end
new text begin Manufacturing and distribution - type A broad scope (9 or more locations) new text end		new text begin $36,254 new text end
deleted text begin Broad scope deleted text end Manufacturing and distribution - type B new text begin or C broad scope new text end		deleted text begin 17,600 deleted text end new text begin $22,880 new text end
deleted text begin Broad scope Manufacturing and distribution - type C deleted text end		deleted text begin 17,600 deleted text end
new text begin Manufacturing and distribution - type B or C broad scope (4-8 locations) new text end		new text begin $27,456 new text end
new text begin Manufacturing and distribution - type B or C broad scope (9 or more locations) new text end		new text begin $32,032 new text end
Manufacturing and distribution - other		deleted text begin 5,280 deleted text end new text begin $6,864 new text end
new text begin Manufacturing and distribution - other (4-8 locations) new text end		new text begin $8,236 new text end
new text begin Manufacturing and distribution - other (9 or more locations) new text end		new text begin $9,609 new text end
Nuclear laundry		deleted text begin 18,640 deleted text end new text begin $24,232 new text end
Decontamination services		deleted text begin 4,960 deleted text end new text begin $6,448 new text end
Leak test services only		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
Instrument calibration service only deleted text begin , less than 100 curies deleted text end		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
deleted text begin Instrument calibration service only, 100 curies or more deleted text end		deleted text begin 2,000 deleted text end
Service, maintenance, installation, source changes, etc.		deleted text begin 4,960 deleted text end new text begin $6,448 new text end
Waste disposal service, prepackaged only		deleted text begin 6,000 deleted text end new text begin $7,800 new text end
Waste disposal		deleted text begin 8,320 deleted text end new text begin $10,816 new text end
Distribution - general licensed devices (sealed sources)		deleted text begin 1,760 deleted text end new text begin $2,288 new text end
Distribution - general licensed material (unsealed sources)		deleted text begin 1,120 deleted text end new text begin $1,456 new text end
Industrial radiography - fixed new text begin or temporary new text end location		deleted text begin 9,840 deleted text end new text begin $12,792 new text end
deleted text begin Industrial radiography - temporary job sites deleted text end		deleted text begin 9,840 deleted text end
new text begin Industrial radiography - fixed or temporary location (5 or more locations) new text end		new text begin $16,629 new text end
Irradiators, self-shielding deleted text begin , less than 10,000 curies deleted text end		deleted text begin 2,880 deleted text end new text begin $3,744 new text end
Irradiators, other, less than 10,000 curies		deleted text begin 5,360 deleted text end new text begin $6,968 new text end
deleted text begin Irradiators, self-shielding, 10,000 curies or more deleted text end		deleted text begin 2,880 deleted text end
Research and development - type A new text begin , B, or C new text end broad scope		deleted text begin 9,520 deleted text end new text begin $12,376 new text end
deleted text begin Research and development - type B broad scope deleted text end		deleted text begin 9,520 deleted text end
deleted text begin Research and development - type C broad scope deleted text end		deleted text begin 9,520 deleted text end
new text begin Research and development - type A, B, or C broad scope (4-8 locations) new text end		new text begin $14,851 new text end
new text begin Research and development - type A, B, or C broad scope (9 or more locations) new text end		new text begin $17,326 new text end
Research and development - other		deleted text begin 4,480 deleted text end new text begin $5,824 new text end
Storage - no operations		deleted text begin 2,000 deleted text end new text begin $2,600 new text end
Source material - shielding		deleted text begin 584 deleted text end new text begin $759 new text end
Special nuclear material plutonium - neutron source in device		deleted text begin 3,680 deleted text end new text begin $4,784 new text end
Pacemaker by-product and/or special nuclear material - medical (institution)		deleted text begin 3,680 deleted text end new text begin $4,784 new text end
Pacemaker by-product and/or special nuclear material - manufacturing and distribution		deleted text begin 5,280 deleted text end