SF 1640

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

A bill for an act
relating to health; modifying certain provider, hospital, and outpatient surgical
center reporting requirements; modifying requirements for health board
directories of licensees; providing for a price disclosure reminder; amending
Minnesota Statutes 2004, sections 144.698, by adding a subdivision; 144.99,
subdivision 1; Minnesota Statutes 2005 Supplement, section 214.071; proposing
coding for new law in Minnesota Statutes, chapters 62J; 214.

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

Section 1.

new text begin [62J.18] PROVIDER REPORTING IN EXCESS OF $5,000,000.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability; definitions. new text end

new text begin (a) For purposes of this section, the
terms used have the meanings given in section 62J.17, subdivision 2, except that "major
spending commitment" means an expenditure in excess of $5,000,000.
new text end

new text begin (b) This section applies to providers and to persons who would become providers
after making the expenditures described in subdivision 2. This section does not apply
to hospital construction projects subject to the hospital construction moratorium under
section 144.551 or to the public interest review under section 144.552.
new text end

new text begin Subd. 2. new text end

new text begin Reporting requirement. new text end

new text begin (a) A provider that intends to make a major
spending commitment in excess of $5,000,000 for an acquisition, by purchase or lease,
of a unit of medical equipment or in excess of $5,000,000 for a single capital project for
the purposes of providing health care services must file a report with the commissioner at
least 60 days before committing to make the expenditure. The report must contain the
information described in section 62J.17, subdivision 4a, paragraphs (b) and (c).
new text end

new text begin (b) The commissioner shall maintain a database to track expenditures reported
under this subdivision.
new text end

new text begin (c) The commissioner shall maintain a list of all persons who have registered with
the commissioner for the purpose of receiving notice by electronic mail of a report
filed under this subdivision. The commissioner shall, within 15 days of receiving an
expenditure report, provide notice of such report by electronic mail to all persons on its
list, and by publication in the State Register. The notice must include either a copy of the
report or an easily understandable description of the proposed expenditure in the report.
The notice in the State Register must include a copy of the report, along with an easily
understandable description of the proposed expenditure in the report. In addition, the
commissioner shall make reasonable efforts to notify persons or classes of persons who
may be significantly affected by the proposed expenditure in the report. The commissioner
may recover the reasonable costs incurred in providing notice as required in this paragraph
through costs paid by third parties involved in proceedings described in this section.
new text end

new text begin (d) No provider may commit to making the expenditure until the procedures
described in this section are completed.
new text end

new text begin Subd. 3. new text end

new text begin Exceptions. new text end

new text begin (a) This section does not apply to an expenditure:
new text end

new text begin (1) to replace existing equipment with comparable equipment used for direct patient
care. Upgrades of equipment beyond the current model or comparable model are subject
to this section;
new text end

new text begin (2) made by a research and teaching institution for purposes of conducting medical
education, medical research supported or sponsored by a medical school or by a federal or
foundation grant, or clinical trials;
new text end

new text begin (3) to repair, remodel, or replace existing buildings or fixtures if, in the judgment
of the commissioner, the project does not involve a substantial expansion of the service
capacity or a substantial change in the nature of health care services provided;
new text end

new text begin (4) for building maintenance, including heating, water, electricity, and other
maintenance-related expenditures;
new text end

new text begin (5) for activities not directly related to the delivery of patient care services, including
food service, laundry, housekeeping, and other service-related activities; or
new text end

new text begin (6) for computer equipment or data systems not directly related to the delivery of
patient care services, including computer equipment or data systems related to medical
record automation.
new text end

new text begin (b) In addition to the exceptions listed in paragraph (a), this section does not apply to
mergers, acquisitions, and other changes in ownership or control that, in the judgment
of the commissioner, do not involve a substantial expansion of service capacity or a
substantial change in the nature of health care services provided.
new text end

new text begin Subd. 4. new text end

new text begin Public meeting. new text end

new text begin (a) Within 30 days from the date the notice requirements
of subdivision 2, paragraph (c), are satisfied, a third party may request a public meeting on
expenditures that exceed $5,000,000. The public meeting shall serve as an informational
forum for the provider to answer inquiries of interested third parties.
new text end

new text begin (b) The commissioner shall arrange for and coordinate the meeting on an expedited
basis. The party requesting the meeting shall pay the commissioner for the commissioner's
cost of the meeting, as determined by the commissioner. Money received by the
commissioner for reimbursement under this section is appropriated to the commissioner
for the purpose of administering this section.
new text end

new text begin Subd. 5. new text end

new text begin Information required. new text end

new text begin If a public meeting is requested, the provider shall
provide the following information to be presented at the meeting:
new text end

new text begin (1) need and access, including, but not limited to:
new text end

new text begin (i) the need of the population served or to be served by the proposed health services
for those services;
new text end

new text begin (ii) the project's contribution to meeting the needs of the medically underserved,
including persons in rural areas, low-income persons, racial and ethnic minorities, persons
with disabilities, and the elderly, as well as the extent to which medically underserved
residents in the provider's service area are likely to have access to the proposed health
service; and
new text end

new text begin (iii) the distance, convenience, cost of transportation, and accessibility to health
services for those to be served by the proposed health services;
new text end

new text begin (2) quality of health care, including, but not limited to:
new text end

new text begin (i) the impact of the proposed service on the quality of health services available to
those proposed to be served by the project; and
new text end

new text begin (ii) the impact of the proposed service on the quality of health services offered
by other providers;
new text end

new text begin (3) cost of health care, including, but not limited to:
new text end

new text begin (i) the financial feasibility of the proposal;
new text end

new text begin (ii) probable impact of the proposal on the costs of and charges for providing health
services by the person proposing the service;
new text end

new text begin (iii) probable impact of the proposal on the costs of and charges for health services
provided by other providers;
new text end

new text begin (iv) probable impact of the proposal on reimbursement for the proposed services; and
new text end

new text begin (v) the relationship, including the organizational relationship, of the proposed health
services to ancillary or support services;
new text end

new text begin (4) alternatives available to the provider, including, but not limited to:
new text end

new text begin (i) the availability of alternative, less costly, or more effective methods of providing
the proposed health services;
new text end

new text begin (ii) the relationship of the proposed project to the long-range development plan, if
any, of the person or entity providing or proposing the services; and
new text end

new text begin (iii) possible sharing or cooperative arrangements among existing facilities and
providers; and
new text end

new text begin (5) other considerations requested by the commissioner, including, but not limited to:
new text end

new text begin (i) the best interests of the patients, including conflicts of interest that may be
present in influencing the utilization of the services, facility, or equipment relating to the
expenditures;
new text end

new text begin (ii) special needs and circumstances of those entities that provide a substantial
portion of their services or resources, or both, to individuals not residing in the immediate
geographic area in which the entities are located, which entities may include, but are
not limited to, medical and other health professional schools, multidisciplinary clinics,
and specialty centers;
new text end

new text begin (iii) the special needs and circumstances of biomedical and behavioral research
projects designed to meet a national need and for which local conditions offer special
advantages; and
new text end

new text begin (iv) the impact of the proposed project on fostering competition between providers.
new text end

new text begin Subd. 6. new text end

new text begin Enforcement. new text end

new text begin The commissioner may enforce this section by denying or
refusing to reissue the permit, license, registration, or certificate of a provider that does not
comply with this section, according to section 144.99, subdivision 8.
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 2004, section 144.698, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Reporting on uncompensated care. new text end

new text begin (a) A report on the services provided
to benefit the community, as required under subdivision 1, clause (5), must report charity
care in compliance with the following requirements:
new text end

new text begin (1) For a facility to report amounts as charity care adjustments, the facility must:
new text end

new text begin (i) generate and record a charge;
new text end

new text begin (ii) have a policy on the provision of charity care that contains specific eligibility
criteria and is communicated or made available to patients;
new text end

new text begin (iii) have made a reasonable effort to identify a third-party payer, encourage the
patient to enroll in public programs, and, to the extent possible, aid the patient in the
enrollment process; and
new text end

new text begin (iv) ensure that the patient meets the charity care criteria of this subdivision.
new text end

new text begin (2) In determining whether to classify care as charity care, the facility must consider
the following:
new text end

new text begin (i) charity care may include services that the provider is obligated to render
independently of the ability to collect;
new text end

new text begin (ii) charity care may include care provided to patients who meet the facility's charity
care guidelines and have partial coverage, but who are unable to pay the remainder of their
medical bills, but this does not apply to that portion of the bill that has been determined to
be the patient's responsibility after a partial charity care classification by the facility;
new text end

new text begin (iii) charity care may include care provided to low-income patients who may qualify
for a public health insurance program and meet the facility's eligibility criteria for charity
care, but who do not complete the application process for public insurance despite the
facility's reasonable efforts;
new text end

new text begin (iv) charity care may include care to individuals whose eligibility for charity care
was determined through third-party services for information gathering purposes only;
new text end

new text begin (v) charity care does not include contractual allowances, which is the difference
between gross charges and payments received under contractual arrangements with
insurance companies and payers;
new text end

new text begin (vi) charity care does not include bad debt;
new text end

new text begin (vii) charity care does not include what may be perceived as underpayments for
operating public programs;
new text end

new text begin (viii) charity care does not include unreimbursed costs of basic or clinical research
or professional education and training;
new text end

new text begin (ix) charity care does not include professional courtesy discounts;
new text end

new text begin (x) charity care does not include community service or outreach activities; and
new text end

new text begin (xi) charity care does not include services for patients against whom collection
actions were taken that resulted in a financial obligation documented on a patient's credit
report with credit bureaus.
new text end

new text begin (3) When reporting charity care adjustments, the facility must report total dollar
amounts and the number of contacts between a patient and a health care provider during
which a service is provided for the following categories:
new text end

new text begin (i) care to patients with family incomes at or below 275 percent of the federal
poverty guideline;
new text end

new text begin (ii) care to patients with family incomes above 275 percent of the federal poverty
guideline; and
new text end

new text begin (iii) care to patients when the facility, with reasonable effort, is unable to determine
family incomes.
new text end

new text begin (b) For the report required under subdivision 1, clause (5), the facility must, in
determining whether to classify care as a bad debt expense:
new text end

new text begin (1) presume that a patient is able and willing to pay until and unless the facility has
reason to consider the care as a charity care case under its charity care policy and the
facility classifies the care as a charity care case; and
new text end

new text begin (2) include as a bad debt expense any unpaid deductibles, coinsurance, co-payments,
noncovered services, and other unpaid patient responsibilities.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for facility fiscal years ending on or
after December 31, 2006.
new text end

Sec. 3.

Minnesota Statutes 2004, section 144.99, subdivision 1, is amended to read:

Subdivision 1.

Remedies available.

The provisions of chapters 103I and 157 and
sections new text begin 62J.18; new text end 115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10),
(12), (13), (14), and (15); 144.1201 to 144.1204; 144.121; 144.1222; 144.35; 144.381 to
144.385; 144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9509; 144.992;
326.37 to 326.45; 326.57 to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all
rules, orders, stipulation agreements, settlements, compliance agreements, licenses,
registrations, certificates, and permits adopted or issued by the department or under any
other law now in force or later enacted for the preservation of public health may, in
addition to provisions in other statutes, be enforced under this section.

Sec. 4.

Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:

214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.

Each deleted text begin health deleted text end new text begin health-related licensing new text end board deleted text begin under chapters 147, 148, 148B, and 150A deleted text end new text begin ,
as defined in section 214.01, subdivision 2 new text end , shall establish a directory of licensees that
includes biographical data for each licensee.

Sec. 5.

new text begin [214.121] PRICE DISCLOSURE REMINDER.
new text end

new text begin Each health-related licensing board shall at least annually inform and remind its
licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable,
through the board's regular means of communicating with its licensees.
new text end