SF 780

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:15am

A bill for an act
relating to health; establishing licensure for birthing centers; limiting
reimbursement for uncomplicated births; designating licensed birthing centers
as essential community providers; amending Minnesota Statutes 2008, section
62Q.19, subdivision 1; proposing coding for new law in Minnesota Statutes,
chapters 144; 256B.

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

Section 1.

Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:

Subdivision 1.

Designation.

(a) The commissioner shall designate essential
community providers. The criteria for essential community provider designation shall be
the following:

(1) a demonstrated ability to integrate applicable supportive and stabilizing services
with medical care for uninsured persons and high-risk and special needs populations,
underserved, and other special needs populations; and

(2) a commitment to serve low-income and underserved populations by meeting the
following requirements:

(i) has nonprofit status in accordance with chapter 317A;

(ii) has tax exempt status in accordance with the Internal Revenue Service Code,
section 501(c)(3);

(iii) charges for services on a sliding fee schedule based on current poverty income
guidelines; and

(iv) does not restrict access or services because of a client's financial limitation;

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health board as defined in
chapter 145A;

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
conditions; deleted text begin or
deleted text end

(5) a sole community hospital. For these rural hospitals, the essential community
provider designation applies to all health services provided, including both inpatient and
outpatient services. For purposes of this section, "sole community hospital" means a
rural hospital that:

(i) is eligible to be classified as a sole community hospital according to Code
of Federal Regulations, title 42, section 412.92, or is located in a community with a
population of less than 5,000 and located more than 25 miles from a like hospital currently
providing acute short-term services;

(ii) has experienced net operating income losses in two of the previous three
most recent consecutive hospital fiscal years for which audited financial information is
available; and

(iii) consists of 40 or fewer licensed beds new text begin ; or
new text end

new text begin (6) a birthing center licensed under section 144.566 new text end .

(b) Prior to designation, the commissioner shall publish the names of all applicants
in the State Register. The public shall have 30 days from the date of publication to submit
written comments to the commissioner on the application. No designation shall be made
by the commissioner until the 30-day period has expired.

(c) The commissioner may designate an eligible provider as an essential community
provider for all the services offered by that provider or for specific services designated by
the commissioner.

(d) For the purpose of this subdivision, supportive and stabilizing services include at
a minimum, transportation, child care, cultural, and linguistic services where appropriate.

Sec. 2.

new text begin [144.566] BIRTHING CENTERS.
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
have the meanings given to them.
new text end

new text begin (b) "Birthing center" means a health care facility licensed for the primary purpose
of performing low-risk deliveries that is not a hospital or in a hospital and where
births are planned to occur away from the mother's usual residence following a normal
uncomplicated pregnancy.
new text end

new text begin (c) "Licensed traditional midwife" means a midwife who is licensed under chapter
147D.
new text end

new text begin (d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as
determined by documentation of adequate prenatal care and the anticipation of a normal
uncomplicated labor and birth, as defined by reasonable and generally accepted criteria
adopted by professional groups for maternal, fetal, and neonatal health care, and
generally accepted by the health care providers to whom they apply and approved by
the commissioner as reasonable.
new text end

new text begin Subd. 2. new text end

new text begin License required. new text end

new text begin (a) No birthing center shall be established, operated,
or maintained in the state without first obtaining a license from the commissioner of
health according to this section. The license is effective for one year following the date of
issuance.
new text end

new text begin (b) A license issued under this section is not transferable or assignable and is subject
to suspension or revocation at any time for failure to comply with this section.
new text end

new text begin (c) A birthing center licensed under this section shall not assert, represent, offer,
provide, or imply that the center is or may render care or services other than the services it
is permitted to render within the scope of the license issued.
new text end

new text begin (d) The license must be conspicuously posted in an area where patients are admitted.
new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin An application for a license to operate a birthing center and
the applicable fee under subdivision 7 must be submitted to the commissioner on a form
provided by the commissioner and must contain:
new text end

new text begin (1) the name of the applicant;
new text end

new text begin (2) the location of the birthing center;
new text end

new text begin (3) the name of the person in charge of the center;
new text end

new text begin (4) documentation that the standards described under subdivision 5 have been
met; and
new text end

new text begin (5) any other information the commissioner deems necessary.
new text end

new text begin Subd. 4. new text end

new text begin Suspension, revocation, and refusal to renew. new text end

new text begin The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the grounds
described under section 144.55, subdivision 6, and the applicant or licensee is entitled to
notice and a hearing as described under section 144.55, subdivision 7.
new text end

new text begin Subd. 5. new text end

new text begin Standards for licensure. new text end

new text begin (a) To be eligible for licensure under this section,
a birthing center must meet the following requirements:
new text end

new text begin (1) a governing body or person must be clearly identified as being legally responsible
for setting policies and procedures and ensuring that they are implemented;
new text end

new text begin (2) care must be provided by a physician, advanced practice registered nurse, or
licensed traditional midwife during labor, birth, and puerperium;
new text end

new text begin (3) an obstetrician and pediatrician must be on call and available to provide medical
guidance at all times;
new text end

new text begin (4) procedures must be in place to transfer a patient within 30 minutes from the time
of diagnosis of an emergency to an acute care hospital capable of providing obstetrical and
neonatal services;
new text end

new text begin (5) the birthing center must be equipped to initiate emergency procedures
in life-threatening events to the mother and baby including, but not limited to,
cardiopulmonary resuscitation (CPR) equipment, oxygen, positive pressure mask,
suction, intravenous medications, and equipment for maintaining infant temperature and
ventilation; and
new text end

new text begin (6) the birthing center must maintain a quality assurance program.
new text end

new text begin (b) The center must have procedures in place specifying criteria by which risk status
will be established and applied to each woman at admission and during labor. Before
admitting a patient, the birthing center must fully inform each woman seeking care on
the benefits and risks of the services available at the center and each woman must sign a
written informed consent indicating that she has received this information.
new text end

new text begin Subd. 6. new text end

new text begin Limitations of services. new text end

new text begin The following limitations apply to the services
performed at a birthing center:
new text end

new text begin (1) surgical procedures must be limited to those normally accomplished during an
uncomplicated birth, including episiotomy and repair;
new text end

new text begin (2) no abortions may be performed; and
new text end

new text begin (3) no general or conduction anesthesia may be performed.
new text end

new text begin Subd. 7. new text end

new text begin Fees. new text end

new text begin The annual license fee for a birthing center is $......., and shall be
collected and deposited according to section 144.122.
new text end

new text begin Subd. 8. new text end

new text begin Inspections. new text end

new text begin The commissioner shall annually conduct an inspection of
each licensed birthing center for the purpose of determining compliance with this section
and any rules promulgated under subdivision 9.
new text end

new text begin Subd. 9. new text end

new text begin Rules. new text end

new text begin The commissioner may promulgate rules necessary to implement
this section.
new text end

Sec. 3.

new text begin [256B.755] REIMBURSEMENT FOR UNCOMPLICATED VAGINAL
BIRTHS.
new text end

new text begin Notwithstanding section 256.969, effective for services provided on or after January
1, 2010, the facility payment rate for labor, birthing, and puerperium services provided
for an uncomplicated vaginal birth shall be no greater than $1,650 when the services are
provided through a managed care plan contract under section 256B.69, 256B.692, or
256L.12 or provided on a fee-for-service basis, if the date the woman was enrolled was
at least 45 days before the date the services were provided. This rate does not include
newborn care.
new text end

Sec. 4.

new text begin [256B.85] BIRTHING CENTERS.
new text end

new text begin As a condition of participating in the prepaid medical assistance or MinnesotaCare
programs under section 256B.69 or 256L.12, a health plan must either contract with or
establish a birthing center for the provision of obstetric services that are covered under
section 256B.0625 and provided by the birthing center. The birthing center must be
licensed under section 144.566.
new text end