1.1                          A bill for an act 
  1.2             relating to health care; modifying the major 
  1.3             commitment expenditure report requirements; amending 
  1.4             Minnesota Statutes 1998, section 62J.17, subdivisions 
  1.5             2, 5a, and 6a. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1998, section 62J.17, 
  1.8   subdivision 2, is amended to read: 
  1.9      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  1.10  terms defined in this subdivision have the meanings given. 
  1.11     (a)  [ACCESS.] "Access" means the financial, temporal, and 
  1.12  geographic availability of health care to individuals who need 
  1.13  it. 
  1.14     (b)  [CAPITAL EXPENDITURE.] "Capital expenditure" means an 
  1.15  expenditure which, under generally accepted accounting 
  1.16  principles, is not properly chargeable as an expense of 
  1.17  operation and maintenance. 
  1.18     (c)  [COST.] "Cost" means the amount paid by consumers or 
  1.19  third party payers for health care services or products. 
  1.20     (d)  [DATE OF THE MAJOR SPENDING COMMITMENT.] "Date of the 
  1.21  major spending commitment" means the date the provider formally 
  1.22  obligated itself to the major spending commitment.  The 
  1.23  obligation may be incurred by entering into a contract, making a 
  1.24  down payment, issuing bonds or entering a loan agreement to 
  1.25  provide financing for the major spending commitment, or taking 
  2.1   some other formal, tangible action evidencing the provider's 
  2.2   intention to make the major spending commitment.  
  2.3      (e)  [HEALTH CARE SERVICE.] "Health care service" means: 
  2.4      (1) a service or item that would be covered by the medical 
  2.5   assistance program under chapter 256B if provided in accordance 
  2.6   with medical assistance requirements to an eligible medical 
  2.7   assistance recipient; and 
  2.8      (2) a service or item that would be covered by medical 
  2.9   assistance except that it is characterized as experimental, 
  2.10  cosmetic, or voluntary. 
  2.11     "Health care service" does not include retail, 
  2.12  over-the-counter sales of nonprescription drugs and other retail 
  2.13  sales of health-related products that are not generally paid for 
  2.14  by medical assistance and other third-party coverage. 
  2.15     (f) [MAJOR SPENDING COMMITMENT.] "Major spending 
  2.16  commitment" means an expenditure in excess of $500,000 for: 
  2.17     (1) acquisition of a unit of medical equipment; 
  2.18     (2) a capital expenditure for a single project for the 
  2.19  purposes of providing health care services, other than for the 
  2.20  acquisition of medical equipment; 
  2.21     (3) offering a new specialized service not offered before; 
  2.22     (4) planning for an activity that would qualify as a major 
  2.23  spending commitment under this paragraph; or 
  2.24     (5) a project involving a combination of two or more of the 
  2.25  activities in clauses (1) to (4). 
  2.26     The cost of acquisition of medical equipment, and the 
  2.27  amount of a capital expenditure, is the total cost to the 
  2.28  provider regardless of whether the cost is distributed over time 
  2.29  through a lease arrangement or other financing or payment 
  2.30  mechanism.  
  2.31     (g) [MEDICAL EQUIPMENT.] "Medical equipment" means fixed 
  2.32  and movable equipment that is used by a provider in the 
  2.33  provision of a health care service.  "Medical equipment" 
  2.34  includes, but is not limited to, the following: 
  2.35     (1) an extracorporeal shock wave lithotripter; 
  2.36     (2) a computerized axial tomography (CAT) scanner; 
  3.1      (3) a magnetic resonance imaging (MRI) unit; 
  3.2      (4) a positron emission tomography (PET) scanner; and 
  3.3      (5) emergency and nonemergency medical transportation 
  3.4   equipment and vehicles. 
  3.5      (h) [NEW SPECIALIZED SERVICE.] "New specialized service" 
  3.6   means a specialized health care procedure or treatment regimen 
  3.7   offered by a provider that was not previously offered by the 
  3.8   provider, including, but not limited to:  
  3.9      (1) cardiac catheterization services involving high-risk 
  3.10  patients as defined in the Guidelines for Coronary Angiography 
  3.11  established by the American Heart Association and the American 
  3.12  College of Cardiology; 
  3.13     (2) heart, heart-lung, liver, kidney, bowel, or pancreas 
  3.14  transplantation service, or any other service for 
  3.15  transplantation of any other organ; 
  3.16     (3) megavoltage radiation therapy; 
  3.17     (4) open heart surgery; 
  3.18     (5) neonatal intensive care services; and 
  3.19     (6) any new medical technology for which premarket approval 
  3.20  has been granted by the United States Food and Drug 
  3.21  Administration, excluding implantable and wearable devices. 
  3.22     (i) [PROVIDER.] "Provider" means: 
  3.23     (1) a provider as defined in section 62J.03, subdivision 8; 
  3.24     (2) a person or organization that, upon engaging in an 
  3.25  activity related to a major spending commitment, will become a 
  3.26  provider as defined in section 62J.03, subdivision 8; 
  3.27     (3) an organization under common control with an 
  3.28  organization described in clause (1) or (2); or 
  3.29     (4) an organization that manages a person or organization 
  3.30  described in clause (1), (2), or (3).  
  3.31     Sec. 2.  Minnesota Statutes 1998, section 62J.17, 
  3.32  subdivision 5a, is amended to read: 
  3.33     Subd. 5a.  [RETROSPECTIVE REVIEW.] (a) The commissioner 
  3.34  shall retrospectively review each major spending commitment and 
  3.35  notify the provider of the results of the review.  The 
  3.36  commissioner shall determine whether the major spending 
  4.1   commitment was appropriate.  In making the determination, the 
  4.2   commissioner may shall consider the following criteria: 
  4.3      (1) the major spending commitment's impact on the cost, 
  4.4   access, and quality of health care; 
  4.5      (2) the clinical effectiveness and cost-effectiveness of 
  4.6   the major spending commitment; and 
  4.7      (3) the alternatives available to the provider; 
  4.8      (4) the alternatives available to patients in terms of 
  4.9   avoiding an unwarranted duplication of services, facilities, or 
  4.10  equipment in and around the location of the major spending 
  4.11  commitment; and 
  4.12     (5) the best interests of the patients, including conflicts 
  4.13  of interest that may be present in influencing the utilization 
  4.14  of the services, facility, or equipment relating to the major 
  4.15  spending commitment. 
  4.16     (b) The commissioner may not prevent or prohibit a major 
  4.17  spending commitment subject to retrospective review.  However, 
  4.18  if the provider fails the retrospective review, any major 
  4.19  spending commitments by that provider for the five-year period 
  4.20  following the commissioner's decision are subject to prospective 
  4.21  review under subdivision 6a.  
  4.22     Sec. 3.  Minnesota Statutes 1998, section 62J.17, 
  4.23  subdivision 6a, is amended to read: 
  4.24     Subd. 6a.  [PROSPECTIVE REVIEW AND APPROVAL.] (a)  
  4.25  [REQUIREMENT.] No health care provider subject to prospective 
  4.26  review under this subdivision shall make a major spending 
  4.27  commitment unless:  
  4.28     (1) the provider has filed an application with the 
  4.29  commissioner to proceed with the major spending commitment and 
  4.30  has provided all supporting documentation and evidence requested 
  4.31  by the commissioner; and 
  4.32     (2) the commissioner determines, based upon this 
  4.33  documentation and evidence, that the major spending commitment 
  4.34  is appropriate under the criteria provided in subdivision 5a in 
  4.35  light of the alternatives available to the provider.  
  4.36     (b)  [APPLICATION.] A provider subject to prospective 
  5.1   review and approval shall submit an application to the 
  5.2   commissioner before proceeding with any major spending 
  5.3   commitment.  The application must address each item listed in 
  5.4   subdivision 4a, paragraph (a), and must also include 
  5.5   documentation to support the response to each item.  The 
  5.6   provider may submit information, with supporting documentation, 
  5.7   regarding why the major spending commitment should be excepted 
  5.8   from prospective review under subdivision 7.  The submission may 
  5.9   be made either in addition to or instead of the submission of 
  5.10  information relating to the items listed in subdivision 4a, 
  5.11  paragraph (a).  
  5.12     (c)  [REVIEW.] The commissioner shall determine, based upon 
  5.13  the information submitted, whether the major spending commitment 
  5.14  is appropriate under the criteria provided in subdivision 5a, or 
  5.15  whether it should be excepted from prospective review under 
  5.16  subdivision 7.  In making this determination, the commissioner 
  5.17  may also consider relevant information from other sources.  At 
  5.18  the request of the commissioner, the health technology advisory 
  5.19  committee shall convene an expert review panel made up of 
  5.20  persons with knowledge and expertise regarding medical 
  5.21  equipment, specialized services, health care expenditures, and 
  5.22  capital expenditures to review applications and make 
  5.23  recommendations to the commissioner.  The commissioner shall 
  5.24  make a decision on the application within 60 days after an 
  5.25  application is received. 
  5.26     (d)  [PENALTIES AND REMEDIES.] The commissioner of health 
  5.27  has the authority to issue fines, seek injunctions, and pursue 
  5.28  other remedies as provided by law, including, but not limited 
  5.29  to, the following: 
  5.30     (1) assessing fines against providers violating paragraph 
  5.31  (a), of up to triple the amount of the major spending 
  5.32  commitment; 
  5.33     (2) securing a permanent injunction against providers 
  5.34  violating paragraph (a), halting the construction, preventing 
  5.35  the acquisition and operation of equipment, or prohibiting the 
  5.36  operation of a facility or provision of a service related to the 
  6.1   major spending commitment; 
  6.2      (3) obtaining a court order to invalidate any purchase 
  6.3   agreement, management agreement, lease, or other contract 
  6.4   relating to the major spending commitment; and 
  6.5      (4) obtaining a court order requiring the property owner to 
  6.6   forfeit the property subject to the major spending commitment.