SF 2070

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 11:33pm

A bill for an act
relating to human services; requiring the issuance of certain federal incentive
payments; providing a temporary rate increase for certain hospitals; authorizing
certain voluntary intergovernmental transfer payments; authorizing additional
medical assistance payments under certain circumstances; requiring reporting
of additional certified public expenditures; amending Minnesota Statutes 2008,
sections 256.01, by adding a subdivision; 256.969, by adding a subdivision;
256B.199; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2008, section 256.01, is amended by adding a
subdivision to read:

new text begin Subd. 29. new text end

new text begin Electronic health records federal incentive payments. new text end

new text begin (a) The
commissioner shall issue electronic health records federal incentive payments available
under the American Recovery and Reinvestment Act of 2009 to qualifying hospitals
as soon as the Center for Medicare and Medicaid Services makes the federal money
available. The commissioner shall pay to each hospital that demonstrates it is engaged
in efforts to adopt, implement, or upgrade certified electronic health records technology
during the first year federal incentive payments are available an amount equal to 50
percent of the total incentive payments available for that hospital. Of the hospitals that
qualify for 50 percent incentive payments in the first year, those that demonstrate in
the second year meaningful use of certified electronic health records shall receive an
additional 40 percent of the total incentives available to that hospital. These hospitals shall
receive their final ten percent allotment in the third year.
new text end

new text begin (b) The commissioner shall develop a payment schedule and process for hospitals
that do not demonstrate in the first year that they are engaged in efforts to adopt,
implement, or upgrade certified health records technology.
new text end

Sec. 2.

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

new text begin Subd. 28. new text end

new text begin Temporary rate increase for qualifying hospitals. new text end

new text begin For the period from
October 1, 2008, to September 30, 2010, for each hospital with a medical assistance
utilization rate equal to or greater than 25 percent during the base year, the commissioner
shall provide an equal percentage rate increase for each medical assistance admission. The
commissioner shall estimate the percentage rate increase using as the state share of the
increase the amount available under section 256B.199, paragraph (d). The commissioner
shall settle up payments to qualifying hospitals based on actual payments under that
section and actual hospital admissions.
new text end

Sec. 3.

new text begin [256B.196] VOLUNTARY INTERGOVERNMENTAL TRANSFERS;
HOSPITAL PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Federal approval required. new text end

new text begin This section is contingent on federal
approval of the voluntary intergovernmental transfers and payments authorized under this
section. This section is also contingent on current payment by the government entities of
the voluntary intergovernmental transfers under this section.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin (a) For the purposes of this subdivision and
subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
services upper payment limit for nonstate government hospitals. The commissioner shall
then determine the amount of a supplemental payment to Hennepin County Medical
Center and Regions Hospital for these services that would increase medical assistance
spending in this category to the aggregate upper payment limit for all nonstate government
hospitals in Minnesota. In making this determination, the commissioner shall allot the
available increases between Hennepin County Medical Center and Regions Hospital
based on the ratio of medical assistance fee-for-service outpatient hospital payments to
the two facilities. The commissioner shall adjust this allotment as necessary based on
federal approvals, the amount of voluntary intergovernmental transfers received from each
institution, and other factors, in order to maximize the additional total payments. The
commissioner shall inform Hennepin County Medical Center and Regions Hospital of
the periodic voluntary intergovernmental transfers necessary to match federal Medicaid
payments available under this subdivision in order to make supplementary medical
assistance payments to the medical center and the hospital equal to an amount that when
combined with existing medical assistance payments to nonstate governmental hospitals
would increase total payments to hospitals in this category for outpatient services to
the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
receipt of these periodic voluntary transfers, the commissioner shall make supplementary
payments to Hennepin County Medical Center and Regions Hospital.
new text end

new text begin (b) For the purposes of this subdivision and subdivision 3, the commissioner
shall determine an upper payment limit for physicians affiliated with Hennepin County
Medical Center and with Regions Hospital. The upper payment limit shall be the average
commercial rate, based on physician rates paid to each facility by the five commercial
payers with the greatest volume of physician payments in Minnesota and based on source
documents from each eligible facility's accounts receivable systems. The commissioner
shall inform Hennepin County Medical Center and Regions Hospital of the periodic
voluntary intergovernmental transfers necessary to match the federal Medicaid payments
available under this subdivision in order to make supplementary payments to physicians
affiliated with the medical center and the hospital equal to the difference between the
established medical assistance payment for physician services and the upper payment
limit. Upon receipt of these periodic voluntary transfers, the commissioner shall make
supplementary payments to the Hennepin County Medical Center and Regions Hospital.
new text end

new text begin (c) For purposes of this subdivision and subdivision 3, the commissioner shall
determine the highest payment rates for Metropolitan Health Plan and HealthPartners that
would be actuarially sound. For purposes of this paragraph, "actuarially sound" means
rates that:
new text end

new text begin (1) have been developed in accordance with generally accepted accounting
principals and practices;
new text end

new text begin (2) are appropriate for the populations covered and services furnished under the
contract; and
new text end

new text begin (3) have been certified by a qualified actuary.
new text end

new text begin The commissioner shall inform Hennepin County Medical Center and Regions Hospital
of the periodic voluntary intergovernmental transfers necessary to match the federal
Medicaid payments available under this subdivision in order to make supplementary
payments to Metropolitan Health Plan and HealthPartners equal to the difference between
the established medical assistance payment and the actuarially sound rate determined
under this paragraph. Upon receipt of these periodic voluntary transfers, the commissioner
shall make supplementary payments to Metropolitan Health Plan and HealthPartners.
new text end

new text begin (d) The commissioner shall inform Hennepin County Medical Center and Regions
Hospital on an ongoing basis of the need for any changes needed in the voluntary
intergovernmental transfers in order to continue the supplementary payments under
paragraphs (a) to (c), at their maximum level, including increases in upper payment limits,
changes in the federal Medicaid match, and other factors.
new text end

new text begin (e) The payments in paragraphs (a) to (c) shall be implemented independently of
each other, subject to federal approval and to the receipt of voluntary transfers under
subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Voluntary intergovernmental transfers. new text end

new text begin Based on the determination by
the commissioner under subdivision 2, Hennepin County Medical Center and Regions
Hospital may make periodic voluntary intergovernmental transfers to the commissioner for
the purposes of subdivision 2, paragraphs (a) to (c). All of the voluntary intergovernmental
transfers made by Hennepin County Medical Center shall be used to match federal
payments to Hennepin County Medical Center under subdivision 2, paragraph (a);
to physicians affiliated with Hennepin County Medical Center under subdivision 2,
paragraph (b); and to Metropolitan Health Plan under subdivision 2, paragraph (c). All
of the voluntary intergovernmental transfers made by Regions Hospital shall be used
to match federal payments to Regions Hospital under subdivision 2, paragraph (a); to
physicians affiliated with Regions Hospital under subdivision 2, paragraph (b); and to
HealthPartners under subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Adjustments permitted. new text end

new text begin (a) The commissioner may adjust the
intergovernmental transfers under subdivision 3 and the payments under subdivision
2 based on the commissioner's determination of Medicare upper payment limits,
hospital-specific charge limits, and hospital-specific limitations on disproportionate share
payments. Any adjustments must be made on a proportional basis. The commissioner
may make adjustments under this subdivision only after consultation with the affected
counties and hospitals.
new text end

new text begin (b) The ratio of medical assistance payments specified in subdivision 2 to the
voluntary intergovernmental transfers specified in subdivision 3 shall not be reduced
except as provided under paragraph (a).
new text end

Sec. 4.

Minnesota Statutes 2008, section 256B.199, is amended to read:

256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.

(a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
for the expenditures in paragraphs (b) and (c).

(b) The commissioner shall apply for federal matching funds for certified public
expenditures as follows:

(1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report quarterly to the commissioner beginning June 1, 2007, payments made during the
second previous quarter that may qualify for reimbursement under federal law;

(2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and

(3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.

(c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:

(1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:

(i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and

(ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and

(2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.

new text begin (d) For the period from October 1, 2008, to September 30, 2009, the commissioner
shall apply for additional federal matching funds available as disproportionate share
hospital payments under the American Recovery and Reinvestment Act of 2009. These
funds shall be made available as the state share of payments under section 256.969,
subdivision 28. The entities required to report certified public expenditures under
paragraph (b), clause (1), shall report additional certified public expenditures as necessary
under this paragraph.
new text end