SF 1266

1st Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; modifying certain critical access
hospital provisions; requiring a report; amending
Minnesota Statutes 2004, sections 144.147, subdivision
1; 144.148, subdivision 1; 144.551, subdivision 1;
144.562, subdivision 2.

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

Section 1.

Minnesota Statutes 2004, section 144.147,
subdivision 1, is amended to read:

Subdivision 1.

Definition.

"Eligible rural hospital"
means any nonfederal, general acute care hospital that:

(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than deleted text begin 10,000 deleted text end new text begin 15,000 new text end , according to United
States Census Bureau statistics, outside the seven-county
metropolitan area;

(2) has 50 or fewer beds; and

(3) is not for profit.

Sec. 2.

Minnesota Statutes 2004, section 144.148,
subdivision 1, is amended to read:

Subdivision 1.

Definition.

(a) For purposes of this
section, the following definitions apply.

(b) "Eligible rural hospital" means any nonfederal, general
acute care hospital that:

(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than deleted text begin 10,000 deleted text end new text begin 15,000 new text end , according to United
States Census Bureau statistics, outside the seven-county
metropolitan area;

(2) has 50 or fewer beds; and

(3) is not for profit.

(c) "Eligible project" means a modernization project to
update, remodel, or replace aging hospital facilities and
equipment necessary to maintain the operations of a hospital.

Sec. 3.

Minnesota Statutes 2004, section 144.551,
subdivision 1, is amended to read:

Subdivision 1.

Restricted construction or modification.

(a) The following construction or modification may not be
commenced:

(1) any erection, building, alteration, reconstruction,
modernization, improvement, extension, lease, or other
acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one
physical facility, complex, or site to another, or otherwise
results in an increase or redistribution of hospital beds within
the state; and

(2) the establishment of a new hospital.

(b) This section does not apply to:

(1) construction or relocation within a county by a
hospital, clinic, or other health care facility that is a
national referral center engaged in substantial programs of
patient care, medical research, and medical education meeting
state and national needs that receives more than 40 percent of
its patients from outside the state of Minnesota;

(2) a project for construction or modification for which a
health care facility held an approved certificate of need on May
1, 1984, regardless of the date of expiration of the
certificate;

(3) a project for which a certificate of need was denied
before July 1, 1990, if a timely appeal results in an order
reversing the denial;

(4) a project exempted from certificate of need
requirements by Laws 1981, chapter 200, section 2;

(5) a project involving consolidation of pediatric
specialty hospital services within the Minneapolis-St. Paul
metropolitan area that would not result in a net increase in the
number of pediatric specialty hospital beds among the hospitals
being consolidated;

(6) a project involving the temporary relocation of
pediatric-orthopedic hospital beds to an existing licensed
hospital that will allow for the reconstruction of a new
philanthropic, pediatric-orthopedic hospital on an existing site
and that will not result in a net increase in the number of
hospital beds. Upon completion of the reconstruction, the
licenses of both hospitals must be reinstated at the capacity
that existed on each site before the relocation;

(7) the relocation or redistribution of hospital beds
within a hospital building or identifiable complex of buildings
provided the relocation or redistribution does not result in:
(i) an increase in the overall bed capacity at that site; (ii)
relocation of hospital beds from one physical site or complex to
another; or (iii) redistribution of hospital beds within the
state or a region of the state;

(8) relocation or redistribution of hospital beds within a
hospital corporate system that involves the transfer of beds
from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the
capacity of the closed facility is transferred; (ii) the
capacity of the site or complex to which the beds are
transferred does not increase by more than 50 percent; (iii) the
beds are not transferred outside of a federal health systems
agency boundary in place on July 1, 1983; and (iv) the
relocation or redistribution does not involve the construction
of a new hospital building;

(9) a construction project involving up to 35 new beds in a
psychiatric hospital in Rice County that primarily serves
adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;

(10) a project to replace a hospital or hospitals with a
combined licensed capacity of 130 beds or less if: (i) the new
hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement
hospital, either at the time of construction of the initial
building or as the result of future expansion, will not exceed
70 licensed hospital beds, or the combined licensed capacity of
the hospitals, whichever is less;

(11) the relocation of licensed hospital beds from an
existing state facility operated by the commissioner of human
services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one
regional treatment center site to another; or from one building
or site to a new or existing building or site on the same
campus;

(12) the construction or relocation of hospital beds
operated by a hospital having a statutory obligation to provide
hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds;

(13) a construction project involving the addition of up to
31 new beds in an existing nonfederal hospital in Beltrami
County;

(14) a construction project involving the addition of up to
eight new beds in an existing nonfederal hospital in Otter Tail
County with 100 licensed acute care beds;

(15) a construction project involving the addition of 20
new hospital beds used for rehabilitation services in an
existing hospital in Carver County serving the southwest
suburban metropolitan area. Beds constructed under this clause
shall not be eligible for reimbursement under medical
assistance, general assistance medical care, or MinnesotaCare;

(16) a project for the construction or relocation of up to
20 hospital beds for the operation of up to two psychiatric
facilities or units for children provided that the operation of
the facilities or units have received the approval of the
commissioner of human services;

(17) a project involving the addition of 14 new hospital
beds to be used for rehabilitation services in an existing
hospital in Itasca County; deleted text begin or
deleted text end

(18) a project to add 20 licensed beds in existing space at
a hospital in Hennepin County that closed 20 rehabilitation beds
in 2002, provided that the beds are used only for rehabilitation
in the hospital's current rehabilitation building. If the beds
are used for another purpose or moved to another location, the
hospital's licensed capacity is reduced by 20 beds new text begin ; or
new text end

new text begin (19) a critical access hospital established under section
144.1483, clause (10), and section 1820 of the federal Social
Security Act, United States Code, title 42, section 1395i-4,
that delicensed beds since enactment of the Balanced Budget Act
of 1997, Public Law 105-33, to the extent that the critical
access hospital does not seek to exceed the maximum number of
beds permitted such hospital under federal law new text end .

Sec. 4.

Minnesota Statutes 2004, section 144.562,
subdivision 2, is amended to read:

Subd. 2.

Eligibility for license condition.

new text begin (a) new text end A
hospital is not eligible to receive a license condition for
swing beds unless (1) it either has a licensed bed capacity of
less than 50 beds defined in the federal Medicare regulations,
Code of Federal Regulations, title 42, section 482.66, or it has
a licensed bed capacity of 50 beds or more and has swing beds
that were approved for Medicare reimbursement before May 1,
1985, or it has a licensed bed capacity of less than 65 beds and
the available nursing homes within 50 miles have had, in the
aggregate, an average occupancy rate of 96 percent or higher in
the most recent two years as documented on the statistical
reports to the Department of Health; and (2) it is located in a
rural area as defined in the federal Medicare regulations, Code
of Federal Regulations, title 42, section 482.66.

new text begin (b) Except for those critical access hospitals established
under section 144.1483, clause (10), and section 1820 of the
federal Social Security Act, United States Code, title 42,
section 1395i-4, that have an attached nursing home, new text end eligible
hospitals are allowed a total of deleted text begin 1,460 deleted text end new text begin 2,000 new text end days of swing bed
use per year deleted text begin , provided that no more than ten hospital beds are
used as swing beds at any one time deleted text end . new text begin Critical access hospitals
that have an attached nursing home are allowed swing bed use as
provided in federal law.
new text end

new text begin (c) Except for critical access hospitals that have an
attached nursing home, new text end the commissioner of health deleted text begin must deleted text end new text begin may
new text end approve swing bed use beyond deleted text begin 1,460 deleted text end new text begin 2,000 new text end days as long as there
are no Medicare certified skilled nursing facility beds
available within 25 miles of that hospital new text begin that are willing to
admit the patient. Critical access hospitals exceeding 2,000
swing bed days must maintain documentation that they have
contacted skilled nursing facilities within 25 miles to
determine if any skilled nursing facility beds are available
that are willing to admit the patient new text end .

new text begin (d) After reaching 2,000 days of swing bed use in a year,
an eligible hospital to which this limit applies may admit six
additional patients to swing beds each year without seeking
approval from the commissioner or being in violation of this
subdivision. These six swing bed admissions are exempt from the
limit of 2,000 annual swing bed days for hospitals subject to
this limit.
new text end

new text begin (e) A health care system that is in full compliance with
this subdivision may allocate its total limit of swing bed days
among the hospitals within the system, provided that no hospital
in the system without an attached nursing home may exceed 2,000
swing bed days per year.
new text end

Sec. 5. new text begin REPORT TO THE LEGISLATURE ON SWING BED USAGE.
new text end

new text begin The commissioner of health shall review swing bed and
related data reported under Minnesota Statutes, sections
144.562, subdivision 3, paragraph (f); 144.564; and 144.698.
The commissioner shall report and make any appropriate
recommendations to the legislature by January 31, 2007, on:
new text end

new text begin (1) the use of swing bed days by all hospitals and by
critical access hospitals;
new text end

new text begin (2) occupancy rates in skilled nursing facilities within 25
miles of hospitals with swing beds; and
new text end

new text begin (3) information provided by rural providers on the use of
swing beds and the adequacy of rural services across the
continuum of care.
new text end