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HF 643

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/28/2024 05:47pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; establishing an ambulance provider assessment program;
providing supplemental medical assistance payments for ambulance services;
exempting certain ambulance services from the MinnesotaCare provider tax;
amending Minnesota Statutes 2022, section 295.52, subdivision 5; proposing
coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.1951] AMBULANCE ASSESSMENT AND PAYMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
apply.
new text end

new text begin (b) "Ambulance provider" means an ambulance service licensed under chapter 144E,
with the exception of:
new text end

new text begin (1) ambulance services operated by a public or governmental entity, including but not
limited to a municipal fire department or police department; and
new text end

new text begin (2) ambulance services that exclusively provide air ambulance services.
new text end

new text begin (c) "Emergency ambulance services" means any services delivered by an ambulance
provider other than air ambulance services.
new text end

new text begin (d) "Fee" means the ambulance service assessment fee authorized by this section.
new text end

new text begin (e) "Gross revenues" has the meaning provided in section 295.50, subdivision 3.
new text end

new text begin Subd. 2. new text end

new text begin Ambulance provider assessment fee. new text end

new text begin (a) The commissioner, on a quarterly
basis, shall charge every ambulance provider an ambulance service assessment fee. The
commissioner shall implement the fee as a health care related tax as defined under United
States Code, title 42, section 1396b(w)(3)(A), and the commissioner shall collect the fee
only to the extent and for the periods that the commissioner determines that revenues
generated by the fee qualify as the state share of medical assistance expenditures eligible
for federal financial participation. The commissioner shall assess the fee on each ambulance
provider's gross revenues at a rate determined annually by the commissioner. The
commissioner shall calculate the rate such that the assessment generates the state share
necessary to fund the expenditures described in subdivision 4, provided that the fee must
not exceed the maximum percentage specified under Code of Federal Regulations, title 42,
section 433.68(f)(3)(i)(A). The commissioner shall establish each provider's fee amount
using the best data available, as determined by the commissioner in consultation with the
Minnesota Ambulance Association, and shall update each ambulance provider's fee at least
annually.
new text end

new text begin (b) All gross revenues received for emergency ambulance services, regardless of payer,
are subject to the fee, including but not limited to gross revenues received for emergency
ambulance services from commercial insurance and public health care programs under
fee-for-service and managed care arrangements. In the case of a transfer of ownership, an
ambulance provider's liability for the fee must be assumed by the successor in interest to
the ambulance provider.
new text end

new text begin (c) The commissioner of human services shall consult with the commissioner of revenue
when administering this subdivision.
new text end

new text begin Subd. 3. new text end

new text begin Ambulance fee fund. new text end

new text begin (a) The ambulance fee fund is established in the state
treasury. The commissioner of management and budget shall deposit the following revenues
into the fund:
new text end

new text begin (1) all revenues generated from the fee collected under subdivision 2;
new text end

new text begin (2) an amount equal to any federal financial participation revenues received by the state
for eligible expenditures made from the fund;
new text end

new text begin (3) any other appropriations to the fund authorized by law; and
new text end

new text begin (4) interest earned on any money in the fund.
new text end

new text begin (b) Money in the fund must be used only for the purposes specified in subdivision 4.
new text end

new text begin Subd. 4. new text end

new text begin Expenditures from the ambulance fee fund. new text end

new text begin (a) The commissioner shall use
money in the ambulance fee fund only to provide supplemental payments to ambulance
providers, in order to increase medical assistance payments to ambulance providers to a
level that does not exceed the average commercial insurance rate. The commissioner may
expend money in the fund for this purpose without further legislative authorization. The
commissioner shall not use money in the fund to supplant or replace existing general fund
appropriations and payment commitments.
new text end

new text begin (b) The commissioner shall make expenditures from the fund in a manner consistent
with the requirements and conditions of federal financial participation under United States
Code, title 42, section 1396b(w), and Code of Federal Regulations, title 42, section 433.68,
and consistent with federal payment requirements and payment limits as determined by the
secretary of the United States Department of Health and Human Services. The commissioner
shall expend money in the fund in a manner that maximizes federal financial participation.
new text end

new text begin (c) The commissioner shall make supplemental payments to ambulance providers on a
quarterly basis. The commissioner shall consult with the Minnesota Ambulance Association
in the development and implementation of the payments.
new text end

new text begin (d) Beginning January 1, 2025, and each January 1 thereafter, the commissioner shall
report annually to the chairs and ranking minority members of the legislative committees
with jurisdiction over health care spending and policy on expenditures from the ambulance
fee fund.
new text end

new text begin Subd. 5. new text end

new text begin Federal approval required. new text end

new text begin (a) The implementation of subdivisions 1 to 4 is
contingent on federal approval. If the Centers for Medicare and Medicaid Services does not
approve of, or withdraws approval of, the payments made to ambulance providers under
this section, all money remaining in the fund must be returned to ambulance providers. If
the commissioner no longer collects the fee, the commissioner shall return all money
remaining in the fund to ambulance providers.
new text end

new text begin (b) The commissioner shall submit to the Centers for Medicare and Medicaid Services
all Medicaid state plan amendments, waiver requests, and other documents required to
implement this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 to 4 are effective January 1, 2024, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained. Subdivision 5 is effective the day following
final enactment.
new text end

Sec. 2.

Minnesota Statutes 2022, section 295.52, subdivision 5, is amended to read:


Subd. 5.

deleted text begin Volunteerdeleted text end Ambulance services.

deleted text begin Volunteerdeleted text end new text begin (a) Except as provided in paragraph
(b), an
new text end ambulance deleted text begin services aredeleted text end new text begin service isnew text end not subject to the tax under this section. deleted text begin For purposes
of this requirement, "volunteer ambulance service" means an ambulance service in which
all of the individuals whose primary responsibility is direct patient care meet the definition
of volunteer under section 144E.001, subdivision 15. The ambulance service may employ
administrative and support staff, and remain eligible for this exemption, if the primary
responsibility of these staff is not direct patient care.
deleted text end

new text begin (b) An ambulance service operated by a hospital is subject to the tax under this section.
new text end

new text begin (c) An ambulance service operated by a hospital must pay the tax directly to the
commissioner as provided under section 295.55. Gross revenues from an ambulance service
operated by a hospital must not be included in hospital gross revenues for purposes of
payment of the tax.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for gross revenues received on or after
January 1, 2024.
new text end