HF 2578

as introduced - 90th Legislature (2017 - 2018) Posted on 04/04/2017 08:57am

A bill for an act
relating to human services; creating an intergovernmental transfer for University
of Minnesota Physicians and dentists; amending Minnesota Statutes 2016, section
256B.196, subdivisions 2, 3, 4.

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

Section 1.

Minnesota Statutes 2016, 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, Hennepin County and Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
$12,000,000 per year from Hennepin County and $6,000,000 per year from Ramsey County.
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 Hennepin County Medical Center or 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 Hennepin County Medical Center and
Regions Hospital by those plans. 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 Hennepin County Medical Center and Regions Hospital by the same amount
as the increased payments received in the capitation payment described in this paragraph.

(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. 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
the city of St. Paul 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 and the city of St. Paul 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 and the city of St. Paul.

(e) new text begin 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 the University
of Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision to make supplementary
payments to physicians, dentists, and other billing professionals affiliated with the University
of Minnesota and 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 University of Minnesota
Physicians.
new text end

new text begin (f) Beginning January 1, 2018, the University of Minnesota Medical School and the
University of Minnesota School of Dentistry may make monthly voluntary intergovernmental
transfers to the commissioner in amounts not to exceed $20,000,000 per year from the
University of Minnesota Medical School and $6,000,000 per year from the University of
Minnesota School of Dentistry. 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 the University of Minnesota and
University of Minnesota Physicians. 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
services by physicians, dentists, and other billing professionals affiliated with the University
of Minnesota and University of Minnesota Physicians. 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 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 the University of Minnesota and University of Minnesota
Physicians by the same amount as the increased payments received in the capitation payment
described in this paragraph.
new text end

new text begin (g) new text end 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 deleted text begin (d) deleted text end new text begin (f) new text end , at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.

deleted text begin (f) deleted text end new text begin (h) new text end The payments in paragraphs (a) to deleted text begin (d) deleted text end new text begin (f) new text end shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.

Sec. 2.

Minnesota Statutes 2016, section 256B.196, subdivision 3, is amended to read:

Subd. 3.

Intergovernmental transfers.

Based on the determination by the commissioner
under subdivision 2, Hennepin County and Ramsey County shall make periodic
intergovernmental transfers to the commissioner for the purposes of subdivision 2, paragraphs
(a) and (b). All of the intergovernmental transfers made by Hennepin County shall be used
to match federal payments to Hennepin County Medical Center under subdivision 2,
paragraph (a), and to physicians and other billing professionals affiliated with Hennepin
County Medical Center under subdivision 2, paragraph (b). All of the intergovernmental
transfers made by Ramsey County shall be used to match federal payments to Regions
Hospital under subdivision 2, paragraph (a), and to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group under subdivision
2, paragraph (b). new text begin All of the intergovernmental transfer payments made by the University of
Minnesota Medical School and the University of Minnesota School of Dentistry shall be
used to match federal payments to the University of Minnesota and University of Minnesota
Physicians under subdivision 2, paragraphs (e) and (f).
new text end

Sec. 3.

Minnesota Statutes 2016, section 256B.196, subdivision 4, is amended to read:

Subd. 4.

Adjustments permitted.

(a) The commissioner may adjust the
intergovernmental transfers under subdivision 3 and the payments under subdivision 2,
based on the commissioner's determination of Medicare upper payment limits,
hospital-specific charge limits, hospital-specific limitations on disproportionate share
payments, medical inflation, actuarial certification, new text begin average commercial rates for physician
and other professional services, new text end and cost-effectiveness for purposes of federal waivers. Any
adjustments must be made on a proportional basis. The commissioner may make adjustments
under this subdivision only after consultation with the affected counties new text begin , university schools, new text end
and hospitals. All payments under subdivision 2 and all intergovernmental transfers under
subdivision 3 are limited to amounts available after all other base rates, adjustments, and
supplemental payments in chapter 256B are calculated.

(b) The ratio of medical assistance payments specified in subdivision 2 to the voluntary
intergovernmental transfers specified in subdivision 3 shall not be reduced except as provided
under paragraph (a).