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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                            CHAPTER 275-S.F.No. 3100 
                  An act relating to human services; establishing 
                  approved tribal health professionals as medical 
                  assistance providers; reimbursement for certain health 
                  services; American Indian contracting provisions; 
                  requiring an evaluation of managed care regional rate 
                  differences; authorizing new rate regions; amending 
                  Minnesota Statutes 2000, sections 254B.09, subdivision 
                  2; 256B.02, subdivision 7; 256B.32; Minnesota Statutes 
                  2001 Supplement, sections 256B.0644; 256B.69, 
                  subdivision 5b; 256B.75; 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 2000, section 254B.09, 
        subdivision 2, is amended to read: 
           Subd. 2.  [AMERICAN INDIAN AGREEMENTS.] The commissioner 
        may enter into agreements with federally recognized tribal units 
        to pay for chemical dependency treatment services provided under 
        Laws 1986, chapter 394, sections 8 to 20.  The agreements 
        must require clarify how the governing body of the tribal 
        unit to fulfill all county fulfill local agency responsibilities 
        regarding: 
           (1) selection of eligible vendors under section 254B.03, 
        subdivision 1; 
           (2) negotiation of agreements that establish vendor 
        services and rates for programs located on the tribal governing 
        body's reservation; 
           (3) the form and manner of invoicing,; and 
           (4) provide that only invoices for eligible vendors 
        according to section 254B.05 will be included in invoices sent 
        to the commissioner for payment, to the extent that money 
        allocated under subdivisions 3, 4, and 5 is used. 
           Sec. 2.  Minnesota Statutes 2000, section 256B.02, 
        subdivision 7, is amended to read: 
           Subd. 7.  [VENDOR OF MEDICAL CARE.] (a) "Vendor of medical 
        care" means any person or persons furnishing, within the scope 
        of the vendor's respective license, any or all of the following 
        goods or services:  medical, surgical, hospital, optical, 
        visual, dental and nursing services; drugs and medical supplies; 
        appliances; laboratory, diagnostic, and therapeutic services; 
        nursing home and convalescent care; screening and health 
        assessment services provided by public health nurses as defined 
        in section 145A.02, subdivision 18; health care services 
        provided at the residence of the patient if the services are 
        performed by a public health nurse and the nurse indicates in a 
        statement submitted under oath that the services were actually 
        provided; and such other medical services or supplies provided 
        or prescribed by persons authorized by state law to give such 
        services and supplies.  The term includes, but is not limited 
        to, directors and officers of corporations or members of 
        partnerships who, either individually or jointly with another or 
        others, have the legal control, supervision, or responsibility 
        of submitting claims for reimbursement to the medical assistance 
        program.  The term only includes directors and officers of 
        corporations who personally receive a portion of the distributed 
        assets upon liquidation or dissolution, and their liability is 
        limited to the portion of the claim that bears the same 
        proportion to the total claim as their share of the distributed 
        assets bears to the total distributed assets.  
           (b) "Vendor of medical care" also includes any person who 
        is credentialed as a health professional under standards set by 
        the governing body of a federally recognized Indian tribe 
        authorized under an agreement with the federal government 
        according to United States Code, title 25, section 450f, to 
        provide health services to its members, and who through a tribal 
        facility provides covered services to American Indian people 
        within a contract health service delivery area of a Minnesota 
        reservation, as defined under Code of Federal Regulations, title 
        42, section 36.22. 
           (c) A federally recognized Indian tribe that intends to 
        implement standards for credentialing health professionals must 
        submit the standards to the commissioner of human services, 
        along with evidence of meeting, exceeding, or being exempt from 
        corresponding state standards.  The commissioner shall maintain 
        a copy of the standards and supporting evidence, and shall use 
        those standards to enroll tribal-approved health professionals 
        as medical assistance providers.  For purposes of this section, 
        "Indian" and "Indian tribe" mean persons or entities that meet 
        the definition in United States Code, title 25, section 450b. 
           Sec. 3.  Minnesota Statutes 2001 Supplement, section 
        256B.0644, is amended to read: 
           256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
        OTHER STATE HEALTH CARE PROGRAMS.] 
           A vendor of medical care, as defined in section 256B.02, 
        subdivision 7, and a health maintenance organization, as defined 
        in chapter 62D, must participate as a provider or contractor in 
        the medical assistance program, general assistance medical care 
        program, and MinnesotaCare as a condition of participating as a 
        provider in health insurance plans and programs or contractor 
        for state employees established under section 43A.18, the public 
        employees insurance program under section 43A.316, for health 
        insurance plans offered to local statutory or home rule charter 
        city, county, and school district employees, the workers' 
        compensation system under section 176.135, and insurance plans 
        provided through the Minnesota comprehensive health association 
        under sections 62E.01 to 62E.19.  The limitations on insurance 
        plans offered to local government employees shall not be 
        applicable in geographic areas where provider participation is 
        limited by managed care contracts with the department of human 
        services.  For providers other than health maintenance 
        organizations, participation in the medical assistance program 
        means that (1) the provider accepts new medical assistance, 
        general assistance medical care, and MinnesotaCare patients or 
        (2) for providers other than dental service providers, at least 
        20 percent of the provider's patients are covered by medical 
        assistance, general assistance medical care, and MinnesotaCare 
        as their primary source of coverage, or (3) for dental service 
        providers, at least ten percent of the provider's patients are 
        covered by medical assistance, general assistance medical care, 
        and MinnesotaCare as their primary source of coverage.  Patients 
        seen on a volunteer basis by the provider at a location other 
        than the provider's usual place of practice may be considered in 
        meeting this participation requirement.  The commissioner shall 
        establish participation requirements for health maintenance 
        organizations.  The commissioner shall provide lists of 
        participating medical assistance providers on a quarterly basis 
        to the commissioner of employee relations, the commissioner of 
        labor and industry, and the commissioner of commerce.  Each of 
        the commissioners shall develop and implement procedures to 
        exclude as participating providers in the program or programs 
        under their jurisdiction those providers who do not participate 
        in the medical assistance program.  The commissioner of employee 
        relations shall implement this section through contracts with 
        participating health and dental carriers. 
           Sec. 4.  Minnesota Statutes 2000, section 256B.32, is 
        amended to read: 
           256B.32 [FACILITY FEE FOR OUTPATIENT HOSPITAL EMERGENCY 
        ROOM AND CLINIC VISITS.] 
           Subdivision 1.  [FACILITY FEE PAYMENT.] The commissioner 
        shall establish a facility fee payment mechanism that will pay a 
        facility fee to all enrolled outpatient hospitals for each 
        emergency room or outpatient clinic visit provided on or after 
        July 1, 1989.  This payment mechanism may not result in an 
        overall increase in outpatient payment rates.  This section does 
        not apply to federally mandated maximum payment limits, 
        department approved program packages, or services billed using a 
        nonoutpatient hospital provider number. 
           Subd. 2.  [PROSPECTIVE PAYMENT SYSTEM.] Effective for 
        services provided on or after July 1, 2003, rates that are based 
        on the Medicare outpatient prospective payment system shall be 
        replaced by a budget-neutral prospective payment system that is 
        derived using medical assistance data. 
           Sec. 5.  Minnesota Statutes 2001 Supplement, section 
        256B.69, subdivision 5b, is amended to read: 
           Subd. 5b.  [PROSPECTIVE REIMBURSEMENT RATES.] (a) For 
        prepaid medical assistance and general assistance medical care 
        program contract rates set by the commissioner under subdivision 
        5 and effective on or after January 1, 1998, capitation rates 
        for nonmetropolitan counties shall on a weighted average be no 
        less than 88 percent of the capitation rates for metropolitan 
        counties, excluding Hennepin county.  The commissioner shall 
        make a pro rata adjustment in capitation rates paid to counties 
        other than nonmetropolitan counties in order to make this 
        provision budget neutral.  The commissioner, in consultation 
        with a health care actuary, shall evaluate the regional rate 
        relationships based on actual health plan costs for Minnesota 
        health care programs.  The commissioner may establish, based on 
        the actuary's recommendation, new rate regions that recognize 
        metropolitan areas outside of the seven-county metropolitan area.
           (b) For prepaid medical assistance program contract rates 
        set by the commissioner under subdivision 5 and effective on or 
        after January 1, 2001, capitation rates for nonmetropolitan 
        counties shall, on a weighted average, be no less than 89 
        percent of the capitation rates for metropolitan counties, 
        excluding Hennepin county. 
           (c) This subdivision shall not affect the nongeographically 
        based risk adjusted rates established under section 62Q.03, 
        subdivision 5a. 
           Sec. 6.  Minnesota Statutes 2001 Supplement, section 
        256B.75, is amended to read: 
           256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
           (a) For outpatient hospital facility fee payments for 
        services rendered on or after October 1, 1992, the commissioner 
        of human services shall pay the lower of (1) submitted charge, 
        or (2) 32 percent above the rate in effect on June 30, 1992, 
        except for those services for which there is a federal maximum 
        allowable payment.  Effective for services rendered on or after 
        January 1, 2000, payment rates for nonsurgical outpatient 
        hospital facility fees and emergency room facility fees shall be 
        increased by eight percent over the rates in effect on December 
        31, 1999, except for those services for which there is a federal 
        maximum allowable payment.  Services for which there is a 
        federal maximum allowable payment shall be paid at the lower of 
        (1) submitted charge, or (2) the federal maximum allowable 
        payment.  Total aggregate payment for outpatient hospital 
        facility fee services shall not exceed the Medicare upper 
        limit.  If it is determined that a provision of this section 
        conflicts with existing or future requirements of the United 
        States government with respect to federal financial 
        participation in medical assistance, the federal requirements 
        prevail.  The commissioner may, in the aggregate, prospectively 
        reduce payment rates to avoid reduced federal financial 
        participation resulting from rates that are in excess of the 
        Medicare upper limitations. 
           (b) Notwithstanding paragraph (a), payment for outpatient, 
        emergency, and ambulatory surgery hospital facility fee services 
        for critical access hospitals designated under section 144.1483, 
        clause (11), shall be paid on a cost-based payment system that 
        is based on the cost-finding methods and allowable costs of the 
        Medicare program. 
           (c) Effective for services provided on or after July 1, 
        2002 2003, rates that are based on the Medicare outpatient 
        prospective payment system shall be replaced by a budget neutral 
        prospective payment system that is derived using medical 
        assistance data.  The commissioner shall provide a proposal to 
        the 2002 legislature to define and implement this provision. 
           Sec. 7.  [256B.84] [AMERICAN INDIAN CONTRACTING 
        PROVISIONS.] 
           Notwithstanding other state laws or rules, Indian health 
        services and agencies operated by Indian tribes are not required 
        to have a county contract or county certification to enroll as 
        providers of family community support services under section 
        256B.0625, subdivision 35; therapeutic support of foster care 
        under section 256B.0625, subdivision 36; adult rehabilitative 
        mental health services under section 256B.0623; and adult mental 
        health crisis response services under section 256B.0624.  In 
        order to enroll as providers of these services, Indian health 
        services and agencies operated by Indian tribes must meet the 
        vendor of medical care requirements in section 256B.02, 
        subdivision 7. 
           Presented to the governor March 22, 2002 
           Signed by the governor March 25, 2002, 2:17 p.m.