2006 Minnesota Statutes

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 (10), 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, 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 2003 legislature to define and implement this provision.
(d) For fee-for-service services provided on or after July 1, 2002, the total payment, before
third-party liability and spenddown, made to hospitals for outpatient hospital facility services is
reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service services
provided on or after July 1, 2003, made to hospitals for outpatient hospital facility services before
third-party liability and spenddown, is reduced five percent from the current statutory rates.
Facilities defined under section 256.969, subdivision 16, are excluded from this paragraph.
History: 1992 c 513 art 7 s 130; 1999 c 245 art 4 s 77; 1Sp2001 c 9 art 2 s 53; 2002 c 220
art 15 s 20; 2002 c 275 s 6; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 12 s 66; 2005 c 98 art 2 s 13