HF 802

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:42am

A bill for an act
relating to health and human services; clarifying hospital root cause analysis
requirements; clarifying Minnesota Board of Nursing investigations; prohibiting
hospital payment for certain hospital-acquired conditions and treatments;
requiring a report; amending Minnesota Statutes 2008, sections 144.7065,
subdivisions 8, 10; 256.969, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2008, section 144.7065, subdivision 8, is amended to
read:

Subd. 8.

Root cause analysis; corrective action plan.

new text begin (a) new text end Following the occurrence
of an adverse health care event, the facility must conduct a root cause analysis of the
event. Following the analysis, the facility must: (1) implement a corrective action plan
to implement the findings of the analysis or (2) report to the commissioner any reasons
for not taking corrective action. If the root cause analysis and the implementation of a
corrective action plan are complete at the time an event must be reported, the findings of
the analysis and the corrective action plan must be included in the report of the event. The
findings of the root cause analysis and a copy of the corrective action plan must otherwise
be filed with the commissioner within 60 days of the event.

new text begin (b) In conducting the root cause analysis of the event, the facility must consider as
a factor the staffing levels and the impact of those staffing levels on the event. Factors
that must be examined when considering staffing levels include, but are not limited to,
the following:
new text end

new text begin (1) number of patients assigned to each registered nurse in the unit or department
where the patient was receiving care at the time of the event;
new text end

new text begin (2) skill mix and the level of experience of the nursing staff, including registered
nurses, licensed practical nurses, nursing assistants, and the temporary or pool staff
available at the time the event occurred;
new text end

new text begin (3) acuity of patients in the unit or department where the event occurred; and
new text end

new text begin (4) nursing intensity as a measure of nursing care resources needed in the unit or
department where the event occurred. For purposes of this subdivision, "nursing intensity"
means a patient-specific, not diagnosis-specific, measurement of nursing care resources
expended during a patient's hospitalization. A measurement of nursing intensity includes
the complexity of care required for a patient and the knowledge and skill needed by
a nurse for surveillance of patients in order to make continuous, appropriate clinical
decisions in the care of the patients.
new text end

Sec. 2.

Minnesota Statutes 2008, section 144.7065, subdivision 10, is amended to read:

Subd. 10.

Relation to other law; data classification.

(a) Adverse health events
described in subdivisions 2 to 6 do not constitute "maltreatment," "neglect," or "a physical
injury that is not reasonably explained" under section 626.556 or 626.557 and are excluded
from the reporting requirements of sections 626.556 and 626.557, provided the facility
makes a determination within 24 hours of the discovery of the event that this section is
applicable and the facility files the reports required under this section in a timely fashion.

(b) A facility that has determined that an event described in subdivisions 2 to 6
has occurred must inform persons who are mandated reporters under section 626.556,
subdivision 3, or 626.5572, subdivision 16, of that determination. A mandated reporter
otherwise required to report under section 626.556, subdivision 3, or 626.557, subdivision
3, paragraph (e), is relieved of the duty to report an event that the facility determines under
paragraph (a) to be reportable under subdivisions 2 to 6.

(c) The protections and immunities applicable to voluntary reports under sections
626.556 and 626.557 are not affected by this section.

(d) Notwithstanding section 626.556, 626.557, or any other provision of Minnesota
statute or rule to the contrary, neither a lead agency under section 626.556, subdivision 3c,
or 626.5572, subdivision 13, the commissioner of health, nor the director of the Office of
Health Facility Complaints is required to conduct an investigation of or obtain or create
investigative data or reports regarding an event described in subdivisions 2 to 6. If the
facility satisfies the requirements described in paragraph (a), the review or investigation
shall be conducted and data or reports shall be obtained or created only under sections
144.706 to 144.7069, except as permitted or required under sections 144.50 to 144.564,
or as necessary to carry out the state's certification responsibility under the provisions of
sections 1864 and 1867 of the Social Security Act. new text begin If, acting in good faith, a registered
nurse reports an event required to be reported under subdivisions 2 to 6, in a timely
manner, the Minnesota Board of Nursing is not required to conduct an investigation of
or obtain or create investigative data or reports regarding the individual reporting of the
events described in subdivisions 2 to 6. new text end

(e) Data contained in the following records are nonpublic and, to the extent they
contain data on individuals, confidential data on individuals, as defined in section 13.02:

(1) reports provided to the commissioner under sections 147.155, 147A.155,
148.267, 151.301, and 153.255;

(2) event reports, findings of root cause analyses, and corrective action plans filed by
a facility under this section; and

(3) records created or obtained by the commissioner in reviewing or investigating
the reports, findings, and plans described in clause (2).

For purposes of the nonpublic data classification contained in this paragraph, the
reporting facility shall be deemed the subject of the data.

Sec. 3.

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

new text begin Subd. 3b. new text end

new text begin Nonpayment for hospital-acquired conditions. new text end

new text begin (a) The commissioner
must not make medical assistance payments to a hospital for any costs of care that result
from a condition listed in paragraph (c), if the condition was hospital-acquired.
new text end

new text begin (b) For purposes of this subdivision, a condition is hospital-acquired if it is not
identified by the hospital as present on admission. For purposes of this subdivision,
medical assistance includes general assistance medical care and MinnesotaCare.
new text end

new text begin (c) The prohibition in paragraph (a) applies to payment for:
new text end

new text begin (1) any hospital-acquired condition listed in this clause that is represented by an
ICD-9-CM diagnosis code and is designated as a complicating condition or a major
complicating condition:
new text end

new text begin (i) foreign object retained after surgery (ICD-9-CM code 998.4 or 998.7);
new text end

new text begin (ii) air embolism (ICD-9-CM code 999.1);
new text end

new text begin (iii) blood incompatibility (ICD-9-CM code 999.6);
new text end

new text begin (iv) pressure ulcers stage III or IV (ICD-9-CM code 707.23 or 707.24);
new text end

new text begin (v) falls and trauma, including fracture, dislocation, intracranial injury, crushing
injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating
condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
940-949; and 991-994);
new text end

new text begin (vi) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
new text end

new text begin (vii) vascular catheter-associated infection (ICD-9-CM code 999.31);
new text end

new text begin (viii) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11;
249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
251.0);
new text end

new text begin (ix) surgical site infection (ICD-9-CM code 996.67 or 998.59) following certain
orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
81.85);
new text end

new text begin (x) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery
(procedure code 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity
(ICD-9-CM code 278.01);
new text end

new text begin (xi) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
artery bypass graft (procedure codes 36.10 to 36.19); and
new text end

new text begin (xii) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary
embolism (ICD-9-CM code 415.11 or 415.91) following total knee replacement (procedure
code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51 to 81.52); and
new text end

new text begin (2) any hospital-acquired condition identified as nonpayable by the Medicare
program including, but not limited to, conditions identified in current and future rules
adopted by the Centers for Medicare and Medicaid Services in compliance with section
5001(c) of the Deficit Reduction Act of 2005.
new text end

new text begin (d) The prohibition in paragraph (a) applies to any additional payments that result
from a hospital-acquired condition listed in paragraph (c) including, but not limited to,
additional treatment or procedures, readmission to the facility after discharge, increased
length of stay, change to a higher diagnostic category, or transfer to another hospital. In
the event of a transfer to another hospital, the hospital where the condition listed under
paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
the patient is transferred.
new text end

new text begin (e) A hospital shall not bill a recipient of services for any payment disallowed under
this subdivision.
new text end

Sec. 4. new text begin IMPACT OF ECONOMIC ENVIRONMENT ON STAFFING LEVELS.
new text end

new text begin In the event that state funding to hospitals is reduced for the biennium beginning
July 1, 2009, hospitals, licensed under Minnesota Statutes, sections 144.50 to 144.56,
must submit to the legislature a report on the number of direct care employees, including
registered nurses, licensed practical nurses, and nursing assistants, who were laid off by
the hospital and the number of direct care positions that were cut or left unfilled as a result
of the reduction in state funding. Hospitals must report these numbers to the legislature by
December 31, 2009, and by December 31, 2010.
new text end