SF 4946

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/26/2024 09:49am

A bill for an act
relating to health insurance; establishing supplemental payments to eligible hospitals
for graduate medical education costs; amending Minnesota Statutes 2022, section
256.969, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 2g. new text end

new text begin Supplemental payments; direct and indirect graduate medical
education. new text end

new text begin (a) Notwithstanding subdivision 2b, paragraph (k), for discharges occurring on
or after January 1, 2025, the commissioner shall determine and pay annual supplemental
payments to all eligible hospitals for direct and indirect graduate medical education cost
reimbursement.
new text end

new text begin (b) Eligible hospitals for the supplemental payments under this subdivision are those
hospitals participating in Minnesota's medical assistance program that are:
new text end

new text begin (1) eligible to receive graduate medical education payments from the Medicare program
under Code of Federal Regulations, title 42, section 413.75; or
new text end

new text begin (2) a children's hospital.
new text end

new text begin (c) When determining the amount of supplemental payments under this subdivision, the
commissioner shall collect the following from eligible hospitals to calculate the total cost
of graduate medical education incurred by each eligible hospital:
new text end

new text begin (1) the total allowable direct graduate medical education cost, as calculated by adding
form CMS-2552-10, worksheet B, part 1, columns 21 and 22, line 202; and
new text end

new text begin (2) the Medicaid share of total allowable direct graduate medical education cost
percentage, representing the allocation of total graduate medical education costs to Medicaid
based on the share of all Medicaid inpatient days, as reported on form CMS-2552-10,
worksheets S-2 and S-3, divided by the hospital's total inpatient days, as reported on
worksheet S-3.
new text end

new text begin (d) The commissioner shall determine each hospital's total allowable indirect graduate
medical education amount using the following:
new text end

new text begin (1) for eligible hospitals that are not children's hospitals, the indirect graduate medical
education amount attributable to Medicaid, calculated based on form CMS-2552-10,
worksheet E, part A, including:
new text end

new text begin (i) the Medicare indirect medical education formula, using Medicaid variables;
new text end

new text begin (ii) Medicaid payments for inpatient services under fee-for-service and managed care,
as reported by hospitals in the Medicaid disproportionate share hospital survey, or if not
available, a proxy filing to the commissioner;
new text end

new text begin (iii) total inpatient beds available, as reported on form CMS-2552-10, worksheet E, part
A, line 4; and
new text end

new text begin (iv) full-time employees, as determined by adding form CMS-2552-10, worksheet E,
part A, lines 10 and 11; and
new text end

new text begin (2) for eligible hospitals that are children's hospitals:
new text end

new text begin (i) the Medicare indirect medical education formula, using Medicaid variables;
new text end

new text begin (ii) Medicaid payments for inpatient services under fee-for-service and managed care,
as reported by hospitals in the Medicaid disproportionate share hospital survey, or if not
available, a proxy filing to the commissioner;
new text end

new text begin (iii) total inpatient beds available, as reported on form CMS-2552-10, worksheet S-3,
part 1; and
new text end

new text begin (iv) full-time equivalent interns and residents, as determined by adding form
CMS-2552-10, worksheet E-4, lines 6, 10.01, and 15.01.
new text end

new text begin (e) The commissioner shall determine each eligible hospital's maximum allowable
Medicaid direct graduate medical education supplemental payment amount by calculating
the sum of:
new text end

new text begin (1) the total allowable direct graduate medical education costs multiplied by the Medicaid
share of total allowable direct graduate medical education cost percentage; and
new text end

new text begin (2) the total allowable direct graduate medical education costs multiplied by the Medicaid
utilization percentage that is updated annually using data from the most recently available
Medicare hospital cost report from form CMS-2552, submitted to Medicare by each eligible
hospital.
new text end

new text begin (f) The commissioner shall determine each eligible hospital's indirect graduate medical
education supplemental payment amount by multiplying the total allowable indirect medical
education amount calculated in paragraph (d) by:
new text end

new text begin (1) ..... for prospective payment system, for hospitals that are not children's hospitals
and have fewer than 50 full-time equivalent trainees;
new text end

new text begin (2) ..... for prospective payment system, for hospitals that are not children's hospitals
and have equal to or greater than 50 full-time equivalent trainees; and
new text end

new text begin (3) ..... for children's hospitals.
new text end

new text begin (g) The commissioner shall determine the amount of supplemental payment for an
eligible hospital for its graduate medical education program by calculating the sum of the
amount calculated for the hospital under paragraph (e) and the amount calculated for the
hospital under paragraph (f).
new text end

new text begin (h) The supplemental payments under this subdivision are contingent upon federal
approval and must conform with the requirements for permissible supplemental payments
for direct and indirect graduate medical education under all applicable federal laws.
new text end

new text begin (i) For purposes of this subdivision, "children's hospital" means a hospital whose
inpatients are predominantly individuals under 18 years of age, as described under United
States Code, title 42, section 1395ww, subsection (d), paragraph 1, subparagraph (B).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end