SF 4948

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/14/2024 10:00am

A bill for an act
relating to health; requiring nonprofit hospitals to make certain information
available to the public and report certain information to the commissioner of health;
amending Minnesota Statutes 2022, sections 144.698, subdivision 1; 144.699,
subdivision 5; proposing coding for new law in Minnesota Statutes, chapter 144.

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

Section 1. new text begin ACT TITLE.
new text end

new text begin This act shall be known as the "Tax-Exempt Accountability Law (TEAL)."
new text end

Sec. 2.

Minnesota Statutes 2022, section 144.698, subdivision 1, is amended to read:

Subdivision 1.

Yearly reports.

Each hospital and each outpatient surgical center, which
has not filed the financial information required by this section with a voluntary, nonprofit
reporting organization pursuant to section 144.702, shall file annually with the commissioner
of health after the close of the fiscal year:

(1) a balance sheet detailing the assets, liabilities, and net worth of the hospital or
outpatient surgical center;

(2) a detailed statement of income and expenses;

(3) a copy of its most recent cost report, if any, filed pursuant to requirements of Title
XVIII of the United States Social Security Act;

(4) a copy of all changes to articles of incorporation or bylaws;

(5) information on services provided to benefit the community, including services
provided at no cost or for a reduced fee to patients unable to pay, teaching and research
activities, or other community or charitable activities;

(6) information required on the revenue and expense report form set in effect on July 1,
1989, or as amended by the commissioner in rule;

(7) information on changes in ownership or control;

(8) other information required by the commissioner in rule;

(9) information on the number of available hospital beds that are dedicated to certain
specialized services, as designated by the commissioner, and annual occupancy rates for
those beds, separately for adult and pediatric care;

(10) from outpatient surgical centers, the total number of surgeries; deleted text begin and
deleted text end

(11) a report on health care capital expenditures during the previous year, as required
by section 62J.17 deleted text begin . deleted text end new text begin ;
new text end

new text begin (12) for hospitals, data on hospital expenses and the number of full-time equivalents for
the following employees and contract staff:
new text end

new text begin (i) full-time registered nurses and licensed practical nurses whose primary duties are to
provide direct patient care;
new text end

new text begin (ii) full-time registered nurses and licensed practical nurses whose primary duties are
administrative or managerial;
new text end

new text begin (iii) registered nurses whose primary duties are to provide direct patient care and who
are working on a temporary basis or on a short-term contract through a third-party staffing
agency, including but not limited to per diem nurses, travel nurses, and nurses on assignment
for a few months at a time;
new text end

new text begin (iv) registered nurses whose primary duties are administrative or managerial and who
are working on a temporary basis or on a short-term contract through a third-party staffing
agency, including but not limited to per diem nurses, travel nurses, and nurses on assignment
for a few months at a time; and
new text end

new text begin (v) temporary physicians and hospitalists, including physicians working on a temporary
basis and paid as independent contractors either according to a contract or through a
third-party agency.
new text end

new text begin For purposes of this clause, an individual's primary duties are to provide direct patient care
if the individual's work assignment typically includes working at the patient bedside or
providing other direct patient care; and
new text end

new text begin (13) for hospitals, data on:
new text end

new text begin (i) expenditures for billboards, radio and television advertisements, online and other
digital advertisements, flyers, posters, or marketing materials featuring the name, branding,
or logo of the hospital;
new text end

new text begin (ii) consulting fees and other payments made to third-party entities for strategic,
organizational, or day-to-day management services of the hospital; and
new text end

new text begin (iii) costs incurred by the hospital to plan or carry out activities or strategies to prevent
or discourage workers from communicating with, organizing, or otherwise coordinating
with labor organizations.
new text end

Sec. 3.

new text begin [144.6985] COMMUNITY HEALTH NEEDS ASSESSMENT; COMMUNITY
HEALTH IMPROVEMENT SERVICES; IMPLEMENTATION.
new text end

new text begin Subdivision 1. new text end

new text begin Community health needs assessment. new text end

new text begin A nonprofit hospital that is exempt
from taxation under section 501(c)(3) of the Internal Revenue Code must make available
to the public and submit to the commissioner of health, by January 15, 2025, the most recent
community health needs assessment submitted by the hospital to the Internal Revenue
Service. Each time the hospital conducts a subsequent community health needs assessment,
the hospital must, within 15 business days after submitting the subsequent community health
needs assessment to the Internal Revenue Service, make the subsequent assessment available
to the public and submit the subsequent assessment to the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Description of community. new text end

new text begin A nonprofit hospital subject to subdivision 1 must
make available to the public and submit to the commissioner of health a description of the
community served by the hospital. The description must include a geographic description
of the area where the hospital is located, a description of the general population served by
the hospital, and demographic information about the community served by the hospital,
such as leading causes of death, levels of chronic illness, and descriptions of the medically
underserved, low-income, minority, or chronically ill populations in the community. A
hospital is not required to separately make the information available to the public or
separately submit the information to the commissioner if the information is included in the
hospital's community health needs assessment made available and submitted under
subdivision 1.
new text end

new text begin Subd. 3. new text end

new text begin Addendum; community health improvement services. new text end

new text begin (a) A nonprofit hospital
subject to subdivision 1 must annually submit to the commissioner an addendum which
details information about hospital activities identified as community health improvement
services with a cost of $5,000 or more. The addendum must include the type of activity, the
method through which the activity was delivered, how the activity relates to an identified
community need in the community health needs assessment, the target population for the
activity, strategies to reach the target population, identified outcome metrics, the cost to the
hospital to provide the activity, the methodology used to calculate the hospital's costs, and
the number of people served by the activity. If a community health improvement service is
administered by an entity other than the hospital, the administering entity must be identified
in the addendum. This paragraph does not apply to hospitals required to submit an addendum
under paragraph (b).
new text end

new text begin (b) A nonprofit hospital subject to subdivision 1 must annually submit to the
commissioner an addendum which details information about the ten highest-cost activities
of the hospital identified as community health improvement services if the nonprofit hospital:
new text end

new text begin (1) is designated as a critical access hospital under section 144.1483, clause (9), and
United States Code, title 42, section 1395i-4;
new text end

new text begin (2) meets the definition of sole community hospital in section 62Q.19, subdivision 1,
paragraph (a), clause (5); or
new text end

new text begin (3) meets the definition of rural emergency hospital in United States Code, title 42,
section 1395x(kkk)(2).
new text end

new text begin The addendum must include the type of activity, the method in which the activity was
delivered, how the activity relates to an identified community need in the community health
needs assessment, the target population for the activity, strategies to reach the target
population, identified outcome metrics, the cost to the hospital to provide the activity, the
methodology used to calculate the hospital's costs, and the number of people served by the
activity. If a community health improvement service is administered by an entity other than
the hospital, the administering entity must be identified in the addendum.
new text end

new text begin Subd. 4. new text end

new text begin Community benefit implementation strategy. new text end

new text begin A nonprofit hospital subject
to subdivision 1 must make available to the public, within one year after completing each
community health needs assessment, a community benefit implementation strategy. In
developing the community benefit implementation strategy, the hospital must consult with
community-based organizations, stakeholders, local public health organizations, and others
as determined by the hospital. The implementation strategy must include how the hospital
shall address the top three community health priorities identified in the community health
needs assessment. Implementation strategies must be evidence-based, when available, and
development and implementation of innovative programs and strategies may be supported
by evaluation measures.
new text end

new text begin Subd. 5. new text end

new text begin Information made available to the public. new text end

new text begin A nonprofit hospital required to
make information available to the public under this section may do so by posting the
information on the hospital's website in a consolidated location and with clear labeling.
new text end

Sec. 4.

Minnesota Statutes 2022, section 144.699, subdivision 5, is amended to read:

Subd. 5.

Annual reports on community benefit, community care amounts, and state
program underfunding.

(a) For each hospital reporting health care cost information under
section 144.698 or 144.702, the commissioner shall report annually on the hospital's
community benefit and community care, including detailed information on each component
of those costs as defined in this subdivision. The information shall be reported in terms of
total dollars and as a percentage of total operating costs for each hospital.

(b) For purposes of this subdivision, "community benefit" means the costs of community
care, underpayment for services provided under state health care programs, research costs,
community health services costs, financial and in-kind contributions, costs of community
building activities, costs of community benefit operations, education costs, and the cost of
operating subsidized services. The cost of bad debts and underpayment for Medicare services
are not included in the calculation of community benefit. new text begin Community benefit does not
include expenditures specified in section 144.698, subdivision 1, clause (13).
new text end

(c) For purposes of this subdivision, "community care" means the costs for medical care
that a hospital has determined is charity care as defined under Minnesota Rules, part
4650.0115, or for which the hospital determines after billing for the services that there is a
demonstrated inability to pay. Any costs forgiven under a hospital's community care plan
or under section 62J.83 may be counted in the hospital's calculation of community care.
Bad debt expenses and discounted charges available to the uninsured shall not be included
in the calculation of community care. The amount of community care is the value of costs
incurred and not the charges made for services.

(d) For purposes of this subdivision, "underpayment for services provided under state
health care programs" means the difference between hospital costs and public program
payments.