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SF 2702

3rd Engrossment - 86th Legislature (2009 - 2010) Posted on 05/03/2010 06:29pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 02/17/2010
1st Engrossment Posted on 03/04/2010
2nd Engrossment Posted on 04/13/2010
3rd Engrossment Posted on 05/03/2010
Conference Committee Reports
CCR-SF2702 Posted on 05/16/2010

Current Version - 3rd Engrossment

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A bill for an act
relating to health; establishing licensure for birth centers; appropriating money;
amending Minnesota Statutes 2008, sections 62Q.19, subdivision 1; 144.651,
subdivision 2; 144A.51, subdivision 5; 256B.0625, by adding a subdivision;
proposing coding for new law in Minnesota Statutes, chapter 144.

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 beginor
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 bedsnew text begin; or
new text end

new text begin (6) a birth center licensed under section 144.615new 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 [144.615] BIRTH 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) "Birth center" means a facility licensed for the primary purpose of performing
low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are
planned to occur away from the mother's usual residence following a low-risk pregnancy.
new text end

new text begin (c) "CABC" means the Commission for the Accreditation of Birth Centers.
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.
new text end

new text begin Subd. 2. new text end

new text begin License required. new text end

new text begin (a) Beginning January 1, 2011, no birth center shall be
established, operated, or maintained in the state without first obtaining a license from the
commissioner of health according to this section.
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 birth 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 or the accreditation 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 Temporary license. new text end

new text begin For new birth centers planning to begin operations
after January 1, 2011, the commissioner may issue a temporary license to the birth center
that is valid for a period of six months from the date of issuance. The birth center must
submit to the commissioner an application and applicable fee for licensure as required
under subdivision 4. The application must include the information required in subdivision
4, clauses (1) to (3) and (5) to (7), and documentation that the birth center has submitted
an application for accreditation to the CABC. Upon receipt of accreditation from the
CABC, the birth center must submit to the commissioner the information required in
subdivision 4, clause (4), and the applicable fee under subdivision 8. The commissioner
shall issue a new license.
new text end

new text begin Subd. 4. new text end

new text begin Application. new text end

new text begin An application for a licensure to operate a birth center and
the applicable fee under subdivision 8 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 site location of the birth 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 accreditation described under subdivision 6 has been
issued, including the effective date and the expiration date of the accreditation, and the
date of the last site visit by the CABC;
new text end

new text begin (5) the number of patients the birth center is capable of serving at a given time;
new text end

new text begin (6) the names and license numbers, if applicable, of the health care professionals
on staff at the birth center; and
new text end

new text begin (7) any other information the commissioner deems necessary.
new text end

new text begin Subd. 5. 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, paragraph (a), clause (2), (3), or (4), or
upon the loss of accreditation by the CABC. The applicant or licensee is entitled to notice
and a hearing as described under section 144.55, subdivision 7, and a new license may be
issued after proper inspection of the birth center has been conducted.
new text end

new text begin Subd. 6. 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 birth center must be accredited by the CABC or must obtain accreditation
within six months of the date of the application for licensure. If the birth center loses its
accreditation, the birth center must immediately notify the commissioner.
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.
new text end

new text begin (c) The birth center shall provide the commissioner of health, upon request, with any
material submitted by the birth center to the CABC as part of the accreditation process,
including the accreditation application, the self-evaluation report, the accreditation
decision letter from the CABC, and any reports from the CABC following a site visit.
new text end

new text begin Subd. 7. new text end

new text begin Limitations of services. new text end

new text begin (a) The following limitations apply to the services
performed at a birth 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 administered; and
new text end

new text begin (3) no general or regional anesthesia may be administered.
new text end

new text begin (b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth
center if the administration of the anesthetic is performed within the scope of practice of a
health care professional.
new text end

new text begin Subd. 8. new text end

new text begin Fees. new text end

new text begin (a) The biennial license fee for a birth center is $365.
new text end

new text begin (b) The temporary license fee is $365.
new text end

new text begin (c) Fees shall be collected and deposited according to section 144.122.
new text end

new text begin Subd. 9. new text end

new text begin Renewal. new text end

new text begin (a) Except as provided in paragraph (b), a license issued under
this section expires two years from the date of issue.
new text end

new text begin (b) A temporary license issued under subdivision 3 expires six months from the date
of issue, and may be renewed for one additional six-month period.
new text end

new text begin (c) An application for renewal shall be submitted at least 60 days prior to expiration
of the license on forms prescribed by the commissioner of health.
new text end

new text begin Subd. 10. new text end

new text begin Records. new text end

new text begin All health records maintained on each client by a birth center
are subject to sections 144.292 to 144.298.
new text end

new text begin Subd. 11. new text end

new text begin Report. new text end

new text begin (a) The commissioner of health, in consultation with the
commissioner of human services and representatives of the licensed birth centers,
the American College of Obstetricians and Gynecologists, the American Academy
of Pediatrics, the Minnesota Hospital Association, and the Minnesota Ambulance
Association, shall evaluate the quality of care and outcomes for services provided in
licensed birth centers, including, but not limited to, the utilization of services provided at a
birth center, the outcomes of care provided to both mothers and newborns, and the numbers
of transfers to other health care facilities that are required and the reasons for the transfers.
The commissioner shall work with the birth centers to establish a process to gather and
analyze the data within protocols that protect the confidentiality of patient identification.
new text end

new text begin (b) The commissioner of health shall report the findings of the evaluation to the
chairs and ranking minority members of the senate Health and Human Services Budget
Division and the house of representatives Health Care and Human Services Finance
Division by January 15, 2014.
new text end

Sec. 3.

Minnesota Statutes 2008, section 144.651, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For the purposes of this section, "patient" means a person
who is admitted to an acute care inpatient facility for a continuous period longer than
24 hours, for the purpose of diagnosis or treatment bearing on the physical or mental
health of that person. For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20,
"patient" also means a person who receives health care services at an outpatient surgical
centernew text begin or at a birth center licensed under section 144.615new text end. "Patient" also means a minor
who is admitted to a residential program as defined in section 253C.01. For purposes of
subdivisions 1, 3 to 16, 18, 20 and 30, "patient" also means any person who is receiving
mental health treatment on an outpatient basis or in a community support program or other
community-based program. "Resident" means a person who is admitted to a nonacute care
facility including extended care facilities, nursing homes, and boarding care homes for
care required because of prolonged mental or physical illness or disability, recovery from
injury or disease, or advancing age. For purposes of all subdivisions except subdivisions
28 and 29, "resident" also means a person who is admitted to a facility licensed as a board
and lodging facility under Minnesota Rules, parts 4625.0100 to 4625.2355, or a supervised
living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which operates
a rehabilitation program licensed under Minnesota Rules, parts 9530.4100 to 9530.4450.

Sec. 4.

Minnesota Statutes 2008, section 144A.51, subdivision 5, is amended to read:


Subd. 5.

Health facility.

"Health facility" means a facility or that part of a facility
which is required to be licensed pursuant to sections 144.50 to 144.58, new text begin144.615, new text endand a
facility or that part of a facility which is required to be licensed under any law of this state
which provides for the licensure of nursing homes.

Sec. 5.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 54. new text end

new text begin Services provided in birth centers. new text end

new text begin (a) Medical assistance covers
services provided in a birth center licensed under section 144.615 by a licensed health
professional if the service would otherwise be covered if provided in a hospital.
new text end

new text begin (b) Facility services provided by a birth center shall be paid at the lower of billed
charges or 70 percent of the statewide average for a facility payment rate made to a
hospital for an uncomplicated vaginal birth as determined using the most recent calendar
year for which complete claims data is available. If a recipient is transported from a birth
center to a hospital prior to the delivery, the payment for facility services to the birth center
shall be the lower of billed charges or 15 percent of the average facility payment made to a
hospital for the services provided for an uncomplicated vaginal delivery as determined
using the most recent calendar year for which complete claims data is available.
new text end

new text begin (c) Nursery care services provided by a birth center shall be paid the lower of billed
charges or 70 percent of the statewide average for a payment rate paid to a hospital for
nursery care as determined by using the most recent calendar year for which complete
claims data is available.
new text end

new text begin (d) Professional services provided by traditional midwives licensed under chapter
147D shall be paid at the lower of billed charges or 100 percent of the rate paid to a
physician performing the same services. If a recipient is transported from a birth center to
a hospital prior to the delivery, a licensed traditional midwife who does not perform the
delivery may not bill for any delivery services. Services are not covered if provided by an
unlicensed traditional midwife.
new text end

new text begin (e) The commissioner shall apply for any necessary waivers from the Centers for
Medicare and Medicaid Services to allow birth centers and birth center providers to be
reimbursed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 6. new text beginPREPAID HEALTH PLAN RATES.
new text end

new text begin In negotiating the managed care contract rates for services rendered on or after
January 1, 2011, the commissioner of human services shall take into consideration and
the rates shall reflect the anticipated savings in the medical assistance program due to
extending medical assistance coverage to services provided in licensed birth centers,
the anticipated use of these services within the medical assistance population, and the
reduced medical assistance costs associated with the use of birth centers for normal,
low-risk deliveries.
new text end

Sec. 7. new text beginAPPROPRIATION.
new text end

new text begin $9,000 is appropriated in fiscal year 2011 from the state government special revenue
fund to the commissioner of health to implement Minnesota Statutes, section 144.615.
Base funding shall be $7,000 in fiscal year 2012 and $7,000 in fiscal year 2013.
new text end