Office of the Revisor of Statutes
Minnesota Session Laws - 2002, Regular Session
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.
Official Publication of the State of Minnesota
Revisor of Statutes