SF 2218

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; providing a
disproportionate population adjustment for certain
hospitals; providing a hospital payment adjustment for
certain hospitals under certain circumstances;
changing hospital payment adjustment provisions for
diagnostic-related group payments; increasing the
surcharge on criminal and traffic offenders;
appropriating money; amending Minnesota Statutes 2004,
sections 256.969, subdivisions 9, 23, 26; 256B.195,
subdivision 3; 357.021, subdivisions 6, 7.

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

Section 1.

Minnesota Statutes 2004, section 256.969,
subdivision 9, is amended to read:

Subd. 9.

Disproportionate numbers of low-income patients
served.

(a) For admissions occurring on or after October 1,
1992, through December 31, 1992, the medical assistance
disproportionate population adjustment shall comply with federal
law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health
Service, with a medical assistance inpatient utilization rate in
excess of the arithmetic mean. The adjustment must be
determined as follows:

(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be
determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the
arithmetic mean for all hospitals excluding regional treatment
centers and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by
1.1. If federal matching funds are not available for all
adjustments under this subdivision, the commissioner shall
reduce payments on a pro rata basis so that all adjustments
qualify for federal match. The commissioner may establish a
separate disproportionate population operating payment rate
adjustment under the general assistance medical care program.
For purposes of this subdivision medical assistance does not
include general assistance medical care. The commissioner shall
report annually on the number of hospitals likely to receive the
adjustment authorized by this paragraph. The commissioner shall
specifically report on the adjustments received by public
hospitals and public hospital corporations located in cities of
the first class.

(b) For admissions occurring on or after July 1, 1993, the
medical assistance disproportionate population adjustment shall
comply with federal law and shall be paid to a hospital,
excluding regional treatment centers and facilities of the
federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean.
The adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be
determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the
arithmetic mean for all hospitals excluding regional treatment
centers and facilities of the federal Indian Health Service;

(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by
1.1. The commissioner may establish a separate disproportionate
population operating payment rate adjustment under the general
assistance medical care program. For purposes of this
subdivision, medical assistance does not include general
assistance medical care. The commissioner shall report annually
on the number of hospitals likely to receive the adjustment
authorized by this paragraph. The commissioner shall
specifically report on the adjustments received by public
hospitals and public hospital corporations located in cities of
the first class; deleted text begin and
deleted text end

(3) for a hospital that had medical assistance
fee-for-service payment volume during calendar year 1991 in
excess of 13 percent of total medical assistance fee-for-service
payment volume, a medical assistance disproportionate population
adjustment shall be paid in addition to any other
disproportionate payment due under this subdivision as follows:
$1,515,000 due on the 15th of each month after noon, beginning
July 15, 1995. For a hospital that had medical assistance
fee-for-service payment volume during calendar year 1991 in
excess of eight percent of total medical assistance
fee-for-service payment volume and was the primary hospital
affiliated with the University of Minnesota, a medical
assistance disproportionate population adjustment shall be paid
in addition to any other disproportionate payment due under this
subdivision as follows: $505,000 due on the 15th of each month
after noon, beginning July 15, 1995 new text begin ;
new text end

new text begin (4) for a hospital not eligible under clause (5) with
medical assistance patient days greater than three percent of
total patient days during the base year, a medical assistance
disproportionate population adjustment shall be paid in addition
to any other disproportionate payments due under this
subdivision equal to 3.6 percent of the total of the operating
and payment rates, effective for admissions occurring on or
after July 1, 2005, and on or before June 30, 2006, and equal to
2.8 percent of the total of the operating and payment rates
effective for admissions occurring on or after July 1, 2006; and
new text end

new text begin (5) for a hospital with medical assistance patient days
greater than 24 percent of total patient days during the base
year that provides obstetrical services as defined in United
States Code, title 42, section 1396r-4(d)(1), a medical
assistance disproportionate population adjustment shall be paid
in addition to any other disproportionate payment due under this
subdivision equal to 10.3 percent of the total of the operating
and property payment rates, effective for admissions occurring
on or after July 1, 2005, and on or before June 30, 2005, and
equal to 8.1 percent of the total of the operating and payment
rates effective for admissions occurring on or after July 1,
2006 new text end .

(c) The commissioner shall adjust rates paid to a health
maintenance organization under contract with the commissioner to
reflect rate increases provided in paragraph (b), clauses (1)
and (2), on a nondiscounted hospital-specific basis but shall
not adjust those rates to reflect payments provided in deleted text begin clause
deleted text end new text begin clauses new text end (3) new text begin , (4), and (5) new text end .

(d) If federal matching funds are not available for all
adjustments under paragraph (b), the commissioner shall reduce
payments under paragraph (b), clauses (1) and (2), on a pro rata
basis so that all adjustments under paragraph (b) qualify for
federal match.

(e) For purposes of this subdivision, medical assistance
does not include general assistance medical care.

Sec. 2.

Minnesota Statutes 2004, section 256.969,
subdivision 23, is amended to read:

Subd. 23.

Hospital payment adjustment after june 30,
1993.

(a) For admissions occurring after June 30, 1993, the
commissioner shall adjust the medical assistance payment paid to
a hospital, excluding regional treatment centers and facilities
of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean.
The adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient
utilization rate above the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the
federal Indian Health Service, the adjustment must be determined
by multiplying the total of the operating and property payment
rates by the difference between the hospital's actual medical
assistance inpatient utilization rate and the arithmetic mean
for all hospitals excluding regional treatment centers and
facilities of the federal Indian Health Service; deleted text begin and
deleted text end

(2) for a hospital with a medical assistance inpatient
utilization rate above one standard deviation above the mean,
the adjustment must be determined by multiplying the adjustment
under clause (1) for that hospital by 1.1 new text begin ;
new text end

new text begin (3) for a hospital not eligible under clause (4) with
medical assistance patient days greater than three percent of
total patient days during the base year, a medical assistance
disproportionate population adjustment shall be paid in addition
to any other disproportionate payments due under this
subdivision equal to 3.6 percent of the total of the operating
and payment rates, effective for admissions occurring on or
after July 1, 2005, and on or before June 30, 2006, and equal to
2.8 percent of the total of the operating and payment rates
effective for admissions occurring on or after July 1, 2006; and
new text end

new text begin (4) for a hospital with medical assistance patient days
greater than 24 percent of total patient days during the base
year that provides obstetrical services as defined in United
States Code, title 42, section 1396r-4(d)(1), a medical
assistance disproportionate population adjustment shall be paid
in addition to any other disproportionate payment due under this
subdivision equal to 10.3 percent of the total of the operating
and property payment rates, effective for admissions occurring
on or after July 1, 2005, and on or before June 30, 2005, and
equal to 8.1 percent of the total of the operating and payment
rates effective for admissions occurring on or after July 1,
2006 new text end .

(b) Any payment under this subdivision must be reduced by
the amount of any payment received under subdivision 9,
paragraph (b), clause (1) deleted text begin or deleted text end new text begin , new text end (2) new text begin , (4), or (5) new text end . For purposes of
this subdivision, medical assistance does not include general
assistance medical care.

(c) The commissioner shall adjust rates paid to a health
maintenance organization under contract with the commissioner to
reflect rate increases provided in this section new text begin , excluding
payments under paragraph (a), clauses (3) and (4) new text end . The
adjustment must be made on a nondiscounted hospital-specific
basis.

Sec. 3.

Minnesota Statutes 2004, section 256.969,
subdivision 26, is amended to read:

Subd. 26.

Greater minnesota payment adjustment after june
30, 2001.

(a) For admissions occurring after June 30, 2001, the
commissioner shall pay fee-for-service inpatient admissions for
the diagnosis-related groups specified in paragraph (b) at
hospitals located outside of the seven-county metropolitan area
at the higher of:

(1) the hospital's current payment rate for the diagnostic
category to which the diagnosis-related group belongs, exclusive
of disproportionate population adjustments received under
subdivision 9 and hospital payment adjustments received under
subdivision 23; or

(2) 90 percent of the average payment rate for that
diagnostic category for hospitals located within the
seven-county metropolitan area, exclusive of disproportionate
population adjustments received under subdivision 9 and hospital
payment adjustments received under subdivisions 20 and 23. deleted text begin The
commissioner may adjust this percentage each year so that the
estimated payment increases under this paragraph are equal to
the funding provided under section 256B.195 for this purpose.
deleted text end

(b) The payment increases provided in paragraph (a) apply
to the following diagnosis-related groups, as they fall within
the diagnostic categories:

(1) 370 cesarean section with complicating diagnosis;

(2) 371 cesarean section without complicating diagnosis;

(3) 372 vaginal delivery with complicating diagnosis;

(4) 373 vaginal delivery without complicating diagnosis;

(5) 386 extreme immaturity and respiratory distress
syndrome, neonate;

(6) 388 full-term neonates with other problems;

(7) 390 prematurity without major problems;

(8) 391 normal newborn;

(9) 385 neonate, died or transferred to another acute care
facility;

(10) 425 acute adjustment reaction and psychosocial
dysfunction;

(11) 430 psychoses;

(12) 431 childhood mental disorders; and

(13) 164-167 appendectomy.

Sec. 4.

Minnesota Statutes 2004, section 256B.195,
subdivision 3, is amended to read:

Subd. 3.

Payments to certain safety net providers.

(a)
Effective July 15, 2001, the commissioner shall make the
following payments to the hospitals indicated after noon on the
15th of each month:

(1) to Hennepin County Medical Center, any federal matching
funds available to match the payments received by the medical
center under subdivision 2, to increase payments for medical
assistance admissions and to recognize higher medical assistance
costs in institutions that provide high levels of charity care;
and

(2) to Regions Hospital, any federal matching funds
available to match the payments received by the hospital under
subdivision 2, to increase payments for medical assistance
admissions and to recognize higher medical assistance costs in
institutions that provide high levels of charity care.

(b) Effective July 15, 2001, the following percentages of
the transfers under subdivision 2 shall be retained by the
commissioner for deposit each month into the general fund:

(1) 18 percent, plus any federal matching funds, shall be
allocated for the following purposes:

(i) during the fiscal year beginning July 1, 2001, of the
amount available under this clause, 39.7 percent shall be
allocated to make increased hospital payments under section
256.969, subdivision 26; 34.2 percent shall be allocated to fund
the amounts due from small rural hospitals, as defined in
section 144.148, for overpayments under section 256.969,
subdivision 5a, resulting from a determination that medical
assistance and general assistance payments exceeded the charge
limit during the period from 1994 to 1997; and 26.1 percent
shall be allocated to the commissioner of health for rural
hospital capital improvement grants under section 144.148; and

(ii) during fiscal years beginning on or after July 1,
2002, of the amount available under this clause, 55 percent
shall be allocated to make increased hospital payments under
section 256.969, subdivision 26, and 45 percent shall be
allocated to the commissioner of health for rural hospital
capital improvement grants under section 144.148; and

(2) 11 percent shall be allocated to the commissioner of
health to fund community clinic grants under section 145.9268.

(c) This subdivision shall apply to fee-for-service
payments only and shall not increase capitation payments or
payments made based on average rates. new text begin The allocation in
paragraph (b), clause (1), item (ii), to increase hospital
payments under section 256.969, subdivision 26, shall not limit
payments under that section.
new text end

(d) Medical assistance rate or payment changes, including
those required to obtain federal financial participation under
section 62J.692, subdivision 8, shall precede the determination
of intergovernmental transfer amounts determined in this
subdivision. Participation in the intergovernmental transfer
program shall not result in the offset of any health care
provider's receipt of medical assistance payment increases other
than limits resulting from hospital-specific charge limits and
limits on disproportionate share hospital payments.

(e) Effective July 1, 2003, if the amount available for
allocation under paragraph (b) is greater than the amounts
available during March 2003, after any increase in
intergovernmental transfers and payments that result from
section 256.969, subdivision 3a, paragraph (c), are paid to the
general fund, any additional amounts available under this
subdivision after reimbursement of the transfers under
subdivision 2 shall be allocated to increase medical assistance
payments, subject to hospital-specific charge limits and limits
on disproportionate share hospital payments, as follows:

(1) if the payments under subdivision 5 are approved, the
amount shall be paid to the largest ten percent of hospitals as
measured by 2001 payments for medical assistance, general
assistance medical care, and MinnesotaCare in the nonstate
government hospital category. Payments shall be allocated
according to each hospital's proportionate share of the 2001
payments; or

(2) if the payments under subdivision 5 are not approved,
the amount shall be paid to the largest ten percent of hospitals
as measured by 2001 payments for medical assistance, general
assistance medical care, and MinnesotaCare in the nonstate
government category and to the largest ten percent of hospitals
as measured by payments for medical assistance, general
assistance medical care, and MinnesotaCare in the nongovernment
hospital category. Payments shall be allocated according to
each hospital's proportionate share of the 2001 payments in
their respective category of nonstate government and
nongovernment. The commissioner shall determine which hospitals
are in the nonstate government and nongovernment hospital
categories.

Sec. 5.

Minnesota Statutes 2004, section 357.021,
subdivision 6, is amended to read:

Subd. 6.

Surcharges on criminal and traffic offenders.

(a) The court shall impose and the court administrator shall
collect a deleted text begin $60 deleted text end new text begin $70 new text end surcharge on every person convicted of any
felony, gross misdemeanor, misdemeanor, or petty misdemeanor
offense, other than a violation of a law or ordinance relating
to vehicle parking, for which there shall be a $3 surcharge. In
the Second Judicial District, the court shall impose, and the
court administrator shall collect, an additional $1 surcharge on
every person convicted of any felony, gross misdemeanor, or
petty misdemeanor offense, other than a violation of a law or
ordinance relating to vehicle parking, if the Ramsey County
Board of Commissioners authorizes the $1 surcharge. The
surcharge shall be imposed whether or not the person is
sentenced to imprisonment or the sentence is stayed.

(b) If the court fails to impose a surcharge as required by
this subdivision, the court administrator shall show the
imposition of the surcharge, collect the surcharge and correct
the record.

(c) The court may not waive payment of the surcharge
required under this subdivision. Upon a showing of indigency or
undue hardship upon the convicted person or the convicted
person's immediate family, the sentencing court may authorize
payment of the surcharge in installments.

(d) The court administrator or other entity collecting a
surcharge shall forward it to the commissioner of finance.

(e) If the convicted person is sentenced to imprisonment
and has not paid the surcharge before the term of imprisonment
begins, the chief executive officer of the correctional facility
in which the convicted person is incarcerated shall collect the
surcharge from any earnings the inmate accrues from work
performed in the facility or while on conditional release. The
chief executive officer shall forward the amount collected to
the commissioner of finance.

new text begin (f) The $10 surcharge increase in paragraph (a) is in
addition to any other increase in this surcharge enacted by the
2005 legislature.
new text end

Sec. 6.

Minnesota Statutes 2004, section 357.021,
subdivision 7, is amended to read:

Subd. 7.

Disbursement of surcharges by commissioner of
finance.

(a) Except as provided in paragraphs (b), (c), and
(d), the commissioner of finance shall disburse surcharges
received under subdivision 6 and section 97A.065, subdivision 2,
as follows:

(1) one percent shall be credited to the game and fish fund
to provide peace officer training for employees of the
Department of Natural Resources who are licensed under sections
626.84 to 626.863, and who possess peace officer authority for
the purpose of enforcing game and fish laws;

(2) 39 percent shall be credited to the peace officers
training account in the special revenue fund; and

(3) 60 percent shall be credited to the general fund.

(b) The commissioner of finance shall credit $3 of each
surcharge received under subdivision 6 and section 97A.065,
subdivision 2, to the general fund.

(c) In addition to any amounts credited under paragraph
(a), the commissioner of finance shall credit deleted text begin $32 deleted text end new text begin $42 new text end of each
surcharge received under subdivision 6 and section 97A.065,
subdivision 2, and the $3 parking surcharge, to the general fund.

(d) If the Ramsey County Board of Commissioners authorizes
imposition of the additional $1 surcharge provided for in
subdivision 6, paragraph (a), the court administrator in the
Second Judicial District shall withhold $1 from each surcharge
collected under subdivision 6. The court administrator must use
the withheld funds solely to fund the petty misdemeanor
diversion program administered by the Ramsey County Violations
Bureau. The court administrator must transfer any unencumbered
portion of the funds received under this subdivision to the
commissioner of finance for distribution according to paragraphs
(a) to (c).

Sec. 7. new text begin APPROPRIATION.
new text end

new text begin $4,900,000 in fiscal year 2006 and $6,500,000 in fiscal
year 2007 is appropriated from the general fund to the
commissioner of human services for the purposes of sections 1 to
3.
new text end