SF 460

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:13am

A bill for an act
relating to human services; prohibiting hospital payment for certain
hospital-acquired conditions and certain treatments; amending Minnesota
Statutes 2008, section 256.969, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2008, section 256.969, is amended by adding a
subdivision to read:

new text begin Subd. 3b. new text end

new text begin Nonpayment for hospital-acquired conditions. new text end

new text begin (a) The commissioner
must not make medical assistance payments to a hospital:
new text end

new text begin (1) at a higher rate for the increased costs of care that result when a patient is harmed
by a condition listed in paragraph (c), if the condition was hospital-acquired; or
new text end

new text begin (2) for a treatment described in paragraph (d).
new text end

new text begin (b) For purposes of this subdivision, a condition is hospital-acquired if it is not
identified by the hospital as present on admission. For purposes of this subdivision,
medical assistance includes general assistance medical care and MinnesotaCare.
new text end

new text begin (c) The prohibition in paragraph (a) applies to payment for:
new text end

new text begin (1) any hospital-acquired condition resulting from an adverse health care event
reportable under section 144.7065, subdivision 2, clauses (1), (2), (3), and (5); subdivision
3, clauses (1) and (2); subdivision 4; subdivision 5, clauses (1), (3), (5), (7), and (8);
subdivision 6, clauses (2) and (5); and subdivision 7; and
new text end

new text begin (2) any hospital-acquired condition listed in this clause that is represented by an
ICD-9-CM diagnosis code and is designated as a complicating condition or a major
complicating condition:
new text end

new text begin (i) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
new text end

new text begin (ii) air embolism (ICD-9-CM code 999.1);
new text end

new text begin (iii) blood incompatibility (ICD-9-CM code 999.6);
new text end

new text begin (iv) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
new text end

new text begin (v) falls and trauma, including fracture, dislocation, intracranial injury, crushing
injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating
condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
940-949; and 991-994);
new text end

new text begin (vi) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
new text end

new text begin (vii) vascular catheter-associated infection (ICD-9-CM code 999.31);
new text end

new text begin (viii) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11;
249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
251.0);
new text end

new text begin (ix) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain
orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
81.85);
new text end

new text begin (x) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery
(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity
(ICD-9-CM code 278.01);
new text end

new text begin (xi) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
artery bypass graft (procedure codes 36.10 to 36.19);
new text end

new text begin (xii) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary
embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement
(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51
to 81.52); and
new text end

new text begin (xiii) ventilator-associated pneumonia (ICD-9-CM code 997.31).
new text end

new text begin (d) The prohibition in paragraph (a) applies to payment for the following treatments:
new text end

new text begin (1) venous thromboembolism prophylaxis ordered for surgery patients;
new text end

new text begin (2) venous thromboembolism prophylaxis within 24 hours prior to or following
surgery; and
new text end

new text begin (3) prophylactic antibiotic selection for surgical patients.
new text end

new text begin (e) The payment prohibitions in this subdivision do not apply to critical access
hospitals, long-term care hospitals, cancer hospitals, children's inpatient hospitals,
inpatient rehabilitation facilities, inpatient psychiatric facilities, and facilities of the Indian
health service.
new text end

new text begin (f) The payment prohibitions in this subdivision do not apply to payment for
physician services and other covered items or services that are needed to treat the
hospital-acquired condition, including the costs of postacute care that would not have
been needed for the patient's initial medical problem but are needed because of the
hospital-acquired condition.
new text end

new text begin (g) A hospital shall not bill a recipient of services for any payment disallowed
under this subdivision.
new text end