SF 460

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:13am

A bill for an act
relating to human services; prohibiting hospital and physician payment for
certain hospital-acquired conditions and certain treatments; amending Minnesota
Statutes 2008, sections 256.969, by adding a subdivision; 256B.0625, subdivision
3.

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 and for certain
treatments. new text end

new text begin (a) The commissioner must not make medical assistance payments to a
hospital for any costs of care that result from a condition listed in paragraph (c), if the
condition was hospital-acquired.
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 each hospital-acquired
condition listed in this paragraph 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 (1) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
new text end

new text begin (2) air embolism (ICD-9-CM code 999.1);
new text end

new text begin (3) blood incompatibility (ICD-9-CM code 999.6);
new text end

new text begin (4) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
new text end

new text begin (5) 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 (6) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
new text end

new text begin (7) vascular catheter-associated infection (ICD-9-CM code 999.31);
new text end

new text begin (8) 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 (9) 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 (10) 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 (11) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
artery bypass graft (procedure codes 36.10 to 36.19); and
new text end

new text begin (12) 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).
new text end

new text begin (d) The prohibition in paragraph (a) applies to any additional payments that result
from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
additional treatment or procedures, readmission to the facility after discharge, increased
length of stay, change to a higher diagnostic category, or transfer to another hospital. In
the event of a transfer to another hospital, the hospital where the condition listed under
paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
the patient is transferred.
new text end

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

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, subdivision 3, is amended to read:

Subd. 3.

Physicians' services.

new text begin (a) new text end Medical assistance covers physicians' services.
Rates paid for anesthesiology services provided by physicians shall be according to the
formula utilized in the Medicare program and shall use a conversion factor "at percentile
of calendar year set by legislature."

new text begin (b) Medical assistance does not cover physicians' services related to the provision of
care related to a treatment reportable under section 144.7065, subdivision 2, clauses (1),
(2), (3), and (5), and subdivision 7, clause (1).
new text end

new text begin (c) Medical assistance does not cover physicians' services related to the provision of
care (1) for which hospital reimbursement is prohibited under section 256.969, subdivision
3b, paragraph (c), or (2) reportable under section 144.7065, subdivisions 2 to 7, if the
physicians' services are billed by a physician who delivered care that contributed to or
caused the adverse health care event or hospital-acquired condition.
new text end

new text begin (d) The payment limitations in paragraphs (b) and (c) shall also apply to
MinnesotaCare and general assistance medical care.
new text end