Bill Text: MN SF1281 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Hospital, nursing home, intermediate care facility for the developmentally disabled (ICF/DD), and health maintenance organization (HMO) provider surcharges; medical assistance (MA) rate increase
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-03-11 - Referred to Finance [SF1281 Detail]
Download: Minnesota-2013-SF1281-Introduced.html
1.2relating to human services; modifying hospital, nursing home, ICF/DD, and
1.3health maintenance organization provider surcharges; providing a medical
1.4assistance rate increase;amending Minnesota Statutes 2012, sections 256.9657,
1.5subdivisions 1, 2, 3, 3a; 256.9685, subdivision 2; 256.969, subdivisions 3a, 21,
1.630, by adding subdivisions; 256B.441, subdivision 53; 256B.5012, by adding a
1.7subdivision; 256B.69, by adding a subdivision.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2012, section 256.9657, subdivision 1, is amended to read:
1.10 Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993,
1.11each non-state-operated nursing home licensed under chapter 144A shall pay to the
1.12commissioner an annual surcharge according to the schedule in subdivision 4. The
1.13surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds is
1.14reduced changed, the surcharge shall be based on the number of remaining licensed beds
1.15the second month following the receipt of timely notice by the commissioner of human
1.16services that the number of bedshave been delicensed has been changed. The nursing home
1.17must notify the commissioner of health in writing when the number of bedsare delicensed
1.18 is changed. The commissioner of health must notify the commissioner of human services
1.19within ten working days after receiving written notification. If the notification is received
1.20by the commissioner of human services by the15th third of the month, the invoice for the
1.21second following month must bereduced changed to recognize the delicensing change
1.22in the number of beds.Beds on layaway status continue to be subject to the surcharge.
1.23 The commissioner of human services must acknowledge a medical care surcharge appeal
1.24within 30 days of receipt of the written appeal from the provider.
1.25(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
2.1(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
2.2to $990.
2.3(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
2.4to $2,815.
2.5(e) Effective July 15, 2013, the surcharge under paragraph (d) shall be increased
2.6to $........
2.7(f) The commissioner may reduce, and may subsequently restore, the surcharge under
2.8paragraph(d) (e) based on the commissioner's determination of a permissible surcharge.
2.9(f) (g) Between April 1, 2002, and August 15, 2004 July 1, 2013, and June 30, 2014,
2.10a facility governed by this subdivision may elect to assume full participation in the medical
2.11assistance program by agreeing to comply with all of the requirements of the medical
2.12assistance program, including the rate equalization law in section256B.48, subdivision 1 ,
2.13paragraph (a), and all other requirements established in law or rule, and to begin intake
2.14of new medical assistance recipients. Rates will be determined under Minnesota Rules,
2.15parts 9549.0010 to 9549.0080. Rate calculations will be subject to limits as prescribed
2.16in rule and law. Other than the adjustments in sections256B.431 , subdivisions 30 and
2.1732;256B.437, subdivision 3 , paragraph (b), Minnesota Rules, part 9549.0057, and any
2.18other applicable legislation enacted prior to the finalization of rates, facilities assuming
2.19full participation in medical assistance under this paragraph are not eligible for any rate
2.20adjustments until the July 1 following their settle-up period.
2.21EFFECTIVE DATE.This section is effective July 1, 2013.
2.22 Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:
2.23 Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota
2.24hospital except facilities of the federal Indian Health Service and regional treatment
2.25centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
2.26patient revenues excluding net Medicare revenues reported by that provider to the health
2.27care cost information system according to the schedule in subdivision 4.
2.28(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
2.29percent.
2.30(c) Effective July 1, 2013, the surcharge under paragraph (b) is increased to ...
2.31percent for all nongovernment-owned hospitals.
2.32(d) Notwithstanding the Medicare cost finding and allowable cost principles, the
2.33hospital surcharge is not an allowable cost for purposes of rate setting under sections
2.34256.9685
to
256.9695 .
3.1EFFECTIVE DATE.This section is effective July 1, 2013.
3.2 Sec. 3. Minnesota Statutes 2012, section 256.9657, subdivision 3, is amended to read:
3.3 Subd. 3. Surcharge on HMOs and community integrated service networks. (a)
3.4Effective October 1, 1992, each health maintenance organization with a certificate of
3.5authority issued by the commissioner of health under chapter 62D and each community
3.6integrated service network licensed by the commissioner under chapter 62N shall pay to
3.7the commissioner of human services a surcharge equal to six-tenths of one percent of the
3.8total premium revenues of the health maintenance organization or community integrated
3.9service network as reported to the commissioner of health according to the schedule in
3.10subdivision 4.
3.11(b) Effective July 1, 2013:
3.12(1) the surcharge under paragraph (a) is increased to ... percent; and
3.13(2) each county-based purchasing plan authorized under section 256B.692 shall pay
3.14to the commissioner a surcharge equal to ... percent of the total premium revenues of the
3.15plan, as reported to the commissioner of health, according to the payment schedule in
3.16subdivision 4.
3.17(c) For purposes of this subdivision, total premium revenue means:
3.18(1) premium revenue recognized on a prepaid basis from individuals and groups
3.19for provision of a specified range of health services over a defined period of time which
3.20is normally one month, excluding premiums paid to a health maintenance organization
3.21or community integrated service network from the Federal Employees Health Benefit
3.22Program;
3.23(2) premiums from Medicare wraparound subscribers for health benefits which
3.24supplement Medicare coverage;
3.25(3) Medicare revenue, as a result of an arrangement between a health maintenance
3.26organization or a community integrated service network and the Centers for Medicare
3.27and Medicaid Services of the federal Department of Health and Human Services, for
3.28services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
3.29from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
3.30Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
3.311395w-24, respectively, as they may be amended from time to time; and
3.32(4) medical assistance revenue, as a result of an arrangement between a health
3.33maintenance organization or community integrated service network and a Medicaid state
3.34agency, for services to a medical assistance beneficiary.
4.1If advance payments are made under clause (1) or (2) to the health maintenance
4.2organization or community integrated service network for more than one reporting period,
4.3the portion of the payment that has not yet been earned must be treated as a liability.
4.4(c) (d) When a health maintenance organization or community integrated service
4.5network merges or consolidates with or is acquired by another health maintenance
4.6organization or community integrated service network, the surviving corporation or the
4.7new corporation shall be responsible for the annual surcharge originally imposed on
4.8each of the entities or corporations subject to the merger, consolidation, or acquisition,
4.9regardless of whether one of the entities or corporations does not retain a certificate of
4.10authority under chapter 62D or a license under chapter 62N.
4.11(d) (e) Effective July 1 of each year, the surviving corporation's or the new
4.12corporation's surcharge shall be based on the revenues earned in the second previous
4.13calendar year by all of the entities or corporations subject to the merger, consolidation,
4.14or acquisition regardless of whether one of the entities or corporations does not retain a
4.15certificate of authority under chapter 62D or a license under chapter 62N until the total
4.16premium revenues of the surviving corporation include the total premium revenues of all
4.17the merged entities as reported to the commissioner of health.
4.18(e) (f) When a health maintenance organization or community integrated service
4.19network, which is subject to liability for the surcharge under this chapter, transfers,
4.20assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
4.21for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
4.22of the health maintenance organization or community integrated service network.
4.23(f) (g) In the event a health maintenance organization or community integrated
4.24service network converts its licensure to a different type of entity subject to liability
4.25for the surcharge under this chapter, but survives in the same or substantially similar
4.26form, the surviving entity remains liable for the surcharge regardless of whether one of
4.27the entities or corporations does not retain a certificate of authority under chapter 62D
4.28or a license under chapter 62N.
4.29(g) (h) The surcharge assessed to a health maintenance organization or community
4.30integrated service network ends when the entity ceases providing services for premiums
4.31and the cessation is not connected with a merger, consolidation, acquisition, or conversion.
4.32EFFECTIVE DATE.This section is effective July 1, 2013.
4.33 Sec. 4. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
4.34 Subd. 3a.ICF/MR ICF/DD license surcharge. (a) Effective July 1, 2003, each
4.35non-state-operated facility as defined under section256B.501, subdivision 1 , shall pay
5.1to the commissioner an annual surcharge according to the schedule in subdivision 4,
5.2paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
5.3licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
5.4beds the second month following the receipt of timely notice by the commissioner of
5.5human services that beds have been delicensed. The facility must notify the commissioner
5.6of health in writing when beds are delicensed. The commissioner of health must notify
5.7the commissioner of human services within ten working days after receiving written
5.8notification. If the notification is received by the commissioner of human services by
5.9the 15th of the month, the invoice for the second following month must be reduced to
5.10recognize the delicensing of beds. The commissioner may reduce, and may subsequently
5.11restore, the surcharge under this subdivision based on the commissioner's determination of
5.12a permissible surcharge.
5.13(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to $.......
5.14per licensed bed.
5.15EFFECTIVE DATE.This section is effective July 1, 2013.
5.16 Sec. 5. Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:
5.17 Subd. 2. Federal requirements. (a) If it is determined that a provision of this
5.18section or section256.9686 ,
256.969 , or
256.9695 conflicts with existing or future
5.19requirements of the United States government with respect to federal financial participation
5.20in medical assistance, the federal requirements prevail. The commissioner may,in the
5.21aggregate, prospectively and retrospectively, reduce payment rates and payments to avoid
5.22reduced federal financial participation resulting from rates and payments determined by
5.23the commissioner that are in excess of the Medicare upper payment limitations.
5.24(b) For rates and payments determined by the commissioner to be in excess of the
5.25Medicare upper payment limits for the nongovernment-owned limit category, rates and
5.26payments shall be reduced to the limits according to clauses (1) to (4):
5.27(1) rates and payments under section 256.969, subdivisions 3a, paragraph (j); 21,
5.28paragraph (b); 30, paragraph (e); 31; and 32, shall be reduced proportionately;
5.29(2) if rates and payments remain above the limit, medical education payments under
5.30section 62J.692, subdivision 8, shall be the first reduction for the government-owned
5.31limit category;
5.32(3) if rates and payments remain above the limit, rates and payments not included
5.33under clause (1) shall be reduced in total; and
5.34(4) the state share of payments under clauses (1) and (2) shall be returned to the
5.35hospital.
6.1 Sec. 6. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
6.2 Subd. 3a. Payments. (a) Acute care hospital billings under the medical
6.3assistance program must not be submitted until the recipient is discharged. However,
6.4the commissioner shall establish monthly interim payments for inpatient hospitals that
6.5have individual patient lengths of stay over 30 days regardless of diagnostic category.
6.6Except as provided in section256.9693 , medical assistance reimbursement for treatment
6.7of mental illness shall be reimbursed based on diagnostic classifications. Individual
6.8hospital payments established under this section and sections256.9685 ,
256.9686 , and
6.9256.9695
, in addition to third-party and recipient liability, for discharges occurring during
6.10the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
6.11inpatient services paid for the same period of time to the hospital.This payment limitation
6.12shall be calculated separately for medical assistance and general assistance medical
6.13care services. The limitation on general assistance medical care shall be effective for
6.14admissions occurring on or after July 1, 1991. Services that have rates established under
6.15subdivision 11 or 12, must be limited separately from other services. After consulting with
6.16the affected hospitals, the commissioner may consider related hospitals one entity and
6.17may merge the payment rates while maintaining separate provider numbers. The operating
6.18and property base rates per admission or per day shall be derived from the best Medicare
6.19and claims data available when rates are established. The commissioner shall determine
6.20the best Medicare and claims data, taking into consideration variables of recency of the
6.21data, audit disposition, settlement status, and the ability to set rates in a timely manner.
6.22The commissioner shall notify hospitals of payment rates by December 1 of the year
6.23preceding the rate year. The rate setting data must reflect the admissions data used to
6.24establish relative values. Base year changes from 1981 to the base year established for the
6.25rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
6.26to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
6.271. The commissioner may adjust base year cost, relative value, and case mix index data
6.28to exclude the costs of services that have been discontinued by the October 1 of the year
6.29preceding the rate year or that are paid separately from inpatient services. Inpatient stays
6.30that encompass portions of two or more rate years shall have payments established based
6.31on payment rates in effect at the time of admission unless the date of admission preceded
6.32the rate year in effect by six months or more. In this case, operating payment rates for
6.33services rendered during the rate year in effect and established based on the date of
6.34admission shall be adjusted to the rate year in effect by the hospital cost index.
7.1 (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
7.2payment, before third-party liability and spenddown, made to hospitals for inpatient
7.3services is reduced by .5 percent from the current statutory rates.
7.4 (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
7.5admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
7.6before third-party liability and spenddown, is reduced five percent from the current
7.7statutory rates. Mental health services within diagnosis related groups 424 to 432, and
7.8facilities defined under subdivision 16 are excluded from this paragraph.
7.9 (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
7.10fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
7.11inpatient services before third-party liability and spenddown, is reduced 6.0 percent
7.12from the current statutory rates. Mental health services within diagnosis related groups
7.13424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
7.14Notwithstanding section
256.9686, subdivision 7, for purposes of this paragraph, medical
7.15assistance does not include general assistance medical care. Payments made to managed
7.16care plans shall be reduced for services provided on or after January 1, 2006, to reflect
7.17this reduction.
7.18 (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.19fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
7.20to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.213.46 percent from the current statutory rates. Mental health services with diagnosis related
7.22groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
7.23paragraph. Payments made to managed care plans shall be reduced for services provided
7.24on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
7.25 (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.26fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
7.27to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.281.9 percent from the current statutory rates. Mental health services with diagnosis related
7.29groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
7.30paragraph. Payments made to managed care plans shall be reduced for services provided
7.31on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
7.32 (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
7.33for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
7.34inpatient services before third-party liability and spenddown, is reduced 1.79 percent
7.35from the current statutory rates. Mental health services with diagnosis related groups
7.36424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
8.1Payments made to managed care plans shall be reduced for services provided on or after
8.2July 1, 2011, to reflect this reduction.
8.3(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
8.4payment for fee-for-service admissions occurring on or after July 1, 2009, made to
8.5hospitals for inpatient services before third-party liability and spenddown, is reduced
8.6one percent from the current statutory rates. Facilities defined under subdivision 16 are
8.7excluded from this paragraph. Payments made to managed care plans shall be reduced for
8.8services provided on or after October 1, 2009, to reflect this reduction.
8.9(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
8.10payment for fee-for-service admissions occurring on or after July 1, 2011, made to
8.11hospitals for inpatient services before third-party liability and spenddown, is reduced
8.121.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
8.13excluded from this paragraph. Payments made to managed care plans shall be reduced for
8.14services provided on or after January 1, 2011, to reflect this reduction.
8.15(j) In order to offset the rateable reductions provided for in this subdivision, the total
8.16payment rate for medical assistance admissions for nongovernment-owned hospitals
8.17occurring on or after July 1, 2013, made to Minnesota hospitals for inpatient services
8.18before third-party liability and spenddown, shall be increased by ... percent from the
8.19current statutory rates. The commissioner shall not adjust rates paid to a prepaid health
8.20plan under contract with the commissioner to reflect payments provided in this paragraph.
8.21The commissioner shall adjust rates and payments in excess of the Medicare upper limits
8.22on payments according to section 256.9685, subdivision 2.
8.23EFFECTIVE DATE.This section is effective July 1, 2013.
8.24 Sec. 7. Minnesota Statutes 2012, section 256.969, subdivision 21, is amended to read:
8.25 Subd. 21. Mental health or chemical dependency admissions; rates. (a)
8.26Admissions underthe general assistance medical care program occurring on or after
8.27July 1, 1990, and admissions under medical assistance, excluding general assistance
8.28medical care, occurring on or after July 1, 1990, and on or before September 30, 1992,
8.29that are classified to a diagnostic category of mental health or chemical dependency
8.30shall have rates established according to the methods of subdivision 14, except the per
8.31day rate shall be multiplied by a factor of 2, provided that the total of the per day rates
8.32shall not exceed the per admission rate. This methodology shall also apply when a hold
8.33or commitment is ordered by the court for the days that inpatient hospital services are
8.34medically necessary. Stays which are medically necessary for inpatient hospital services
8.35and covered by medical assistance shall not be billable to any other governmental entity.
9.1Medical necessity shall be determined under criteria established to meet the requirements
9.2of section256B.04, subdivision 15 , or
256D.03, subdivision 7 , paragraph (b).
9.3(b) In order to ensure adequate access for the provision of mental health services
9.4and to encourage broader delivery of these services outside the nonstate governmental
9.5hospital setting, payment rates for medical assistance admissions occurring on or after
9.6July 1, 2013, at a Minnesota nongovernment-owned hospital above the 75th percentile
9.7of all Minnesota private, nonprofit hospitals for diagnosis-related groups 424 to 432 and
9.8521 to 523 admissions paid by medical assistance for admissions occurring in calendar
9.9year 2010, shall be increased for these diagnosis-related groups at a percentage calculated
9.10to cost an average of not more than $....... each year after rateable reductions under
9.11subdivision 3a, including state and federal shares. The commissioner shall not adjust rates
9.12paid to a prepaid health plan under contract with the commissioner to reflect payments
9.13provided in this paragraph. The commissioner shall adjust rates and payments in excess of
9.14the Medicare upper limits on payments according to section 256.9685, subdivision 2.
9.15EFFECTIVE DATE.This section is effective July 1, 2013.
9.16 Sec. 8. Minnesota Statutes 2012, section 256.969, subdivision 30, is amended to read:
9.17 Subd. 30. Payment rates for births. (a) For admissions occurring on or after
9.18October 1, 2009, the total operating and property payment rate, excluding disproportionate
9.19population adjustment, for the following diagnosis-related groups, as they fall within
9.20the diagnostic categories: (1) 371 cesarean section without complicating diagnosis; (2)
9.21372 vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without
9.22complicating diagnosis, shall be no greater than $3,528.
9.23(b) The rates described in this subdivision do not include newborn care.
9.24(c) Payments to managed care and county-based purchasing plans under section
9.25256B.69
,
256B.692 , or
256L.12 shall be reduced for services provided on or after October
9.261, 2009, to reflect the adjustments in paragraph (a).
9.27(d) Prior authorization shall not be required before reimbursement is paid for a
9.28cesarean section delivery.
9.29(e) Notwithstanding paragraph (a), for medical assistance admissions occurring on
9.30or after July 1, 2013, the commissioner shall increase rates for inpatient hospital services
9.31at Minnesota nongovernment-owned hospitals by a dollar amount for each admission
9.32calculated not to exceed an average of $....... each year, after rateable reductions under
9.33subdivision 3a, including state and federal shares. The commissioner shall not adjust rates
9.34paid to a prepaid health plan under contract with the commissioner to reflect payments
10.1provided in this subdivision. The commissioner shall adjust rates and payments in excess
10.2of the Medicare upper limits on payments according to section 256.9685, subdivision 2.
10.3EFFECTIVE DATE.This section is effective July 1, 2013.
10.4 Sec. 9. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.5to read:
10.6 Subd. 31. Critical access hospitals. As designated under section 144.1483, clause
10.7(9), for medical assistance admissions to critical access hospitals occurring on or after July
10.81, 2013, the commissioner shall increase rates for inpatient hospital services at Minnesota
10.9nongovernment-owned hospitals by a dollar amount for each admission calculated not
10.10to exceed an average of $....... each year, after rateable reductions under subdivision 3a,
10.11including state and federal shares.
10.12The commissioner shall not adjust rates paid to a prepaid health plan under contract
10.13with the commissioner to reflect payments provided in this subdivision. The commissioner
10.14shall adjust rates and payments in excess of the Medicare upper limits on payments
10.15according to section 256.9685, subdivision 2.
10.16EFFECTIVE DATE.This section is effective July 1, 2013.
10.17 Sec. 10. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.18to read:
10.19 Subd. 32. Pediatric care. For medical assistance admissions occurring on or after
10.20July 1, 2013, the commissioner shall increase rates at Minnesota nongovernment-owned
10.21hospitals above the 85th percentile for patient days for patients under 18 years of age in
10.22calendar year 2012 of all Minnesota private, nonprofit hospitals. The increase shall be a
10.23percentage calculated to cost an average of not more than $....... each year.
10.24 The commissioner shall not adjust rates paid to a prepaid health plan under contract
10.25with the commissioner to reflect payments provided in this subdivision. The commissioner
10.26shall adjust rates and payments in excess of the Medicare upper limits on payments
10.27according to section 256.9685, subdivision 2.
10.28EFFECTIVE DATE.This section is effective July 1, 2013.
10.29 Sec. 11. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.30to read:
10.31 Subd. 33. Pediatric orthopedic care. For medical assistance admissions
10.32occurring on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.1nongovernment-owned hospitals above the 90th percentile for patient days for patients
11.2under 18 years of age in calendar year 2011 of all Minnesota private, nonprofit hospitals
11.3for diagnosis-related groups 453 to 517, 533 to 541, 906, and 956. The increase shall be a
11.4percentage calculated to cost an average of not more than $....... each year.
11.5The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.6with the commissioner to reflect payments provided in this subdivision. The commissioner
11.7shall adjust rates and payments in excess of the Medicare upper limits on payments
11.8according to section 256.9685, subdivision 2.
11.9EFFECTIVE DATE.This section is effective July 1, 2013.
11.10 Sec. 12. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
11.11to read:
11.12 Subd. 34. Trauma-designated hospitals. For medical assistance admissions
11.13occurring on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.14nongovernment-owned hospitals verified by the American College of Surgeons as a Level
11.15I trauma center. The increase shall be $....... each year for each nongovernment-owned
11.16hospital with the Level I trauma center designation.
11.17The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.18with the commissioner to reflect payments provided in this subdivision. The commissioner
11.19shall adjust rates and payments in excess of the Medicare upper limits on payments
11.20according to section 256.9685, subdivision 2.
11.21EFFECTIVE DATE.This section is effective July 1, 2013.
11.22 Sec. 13. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
11.23to read:
11.24 Subd. 35. Medicare volume. For medical assistance admissions occurring
11.25on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.26nongovernment-owned hospitals that serve large Medicare populations. The increase shall
11.27be based on the percentage-to-total of Medicare admissions for all Minnesota private,
11.28nonprofit hospitals, calculated to cost an average of not more than $....... each year.
11.29The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.30with the commissioner to reflect payments provided in this subdivision. The commissioner
11.31shall adjust rates and payments in excess of the Medicare upper limits on payments
11.32according to section 256.9685, subdivision 2.
11.33EFFECTIVE DATE.This section is effective July 1, 2013.
12.1 Sec. 14. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
12.2 Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
12.3shall calculate a payment rate for external fixed costs.
12.4 (a) For a facility licensed as a nursing home, the portion related to section256.9657
12.5shall be equal to $8.86 $........ For a facility licensed as both a nursing home and a
12.6boarding care home, the portion related to section256.9657 shall be equal to $8.86 $.......
12.7 multiplied by the result of its number of nursing home beds divided by its total number of
12.8licensed beds.
12.9 (b) The portion related to the licensure fee under section144.122 , paragraph (d),
12.10shall be the amount of the fee divided by actual resident days.
12.11 (c) The portion related to scholarships shall be determined under section256B.431 ,
12.12subdivision 36.
12.13 (d) The portion related to long-term care consultation shall be determined according
12.14to section256B.0911, subdivision 6 .
12.15 (e) The portion related to development and education of resident and family advisory
12.16councils under section144A.33 shall be $5 divided by 365.
12.17 (f) The portion related to planned closure rate adjustments shall be as determined
12.18under section256B.437, subdivision 6 , and Minnesota Statutes 2010, section
256B.436 .
12.19Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
12.20be included in the payment rate for external fixed costs beginning October 1, 2016.
12.21Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
12.22longer be included in the payment rate for external fixed costs beginning on October 1 of
12.23the first year not less than two years after their effective date.
12.24 (g) The portions related to property insurance, real estate taxes, special assessments,
12.25and payments made in lieu of real estate taxes directly identified or allocated to the nursing
12.26facility shall be the actual amounts divided by actual resident days.
12.27 (h) The portion related to the Public Employees Retirement Association shall be
12.28actual costs divided by resident days.
12.29 (i) The single bed room incentives shall be as determined under section256B.431 ,
12.30subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
12.31no longer be included in the payment rate for external fixed costs beginning October 1,
12.322016. Single bed room incentives that take effect on or after October 1, 2014, shall no
12.33longer be included in the payment rate for external fixed costs beginning on October 1 of
12.34the first year not less than two years after their effective date.
12.35 (j) The payment rate for external fixed costs shall be the sum of the amounts in
12.36paragraphs (a) to (i).
13.1EFFECTIVE DATE.This section is effective July 1, 2013.
13.2 Sec. 15. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
13.3subdivision to read:
13.4 Subd. 14. Rate increase effective July 1, 2013. For rate periods beginning on or
13.5after July 1, 2013, the commissioner shall increase the total operating payment rate for
13.6each facility reimbursed under this section by $....... per day. The increase shall not be
13.7subject to any annual percentage increase.
13.8EFFECTIVE DATE.This section is effective July 1, 2013.
13.9 Sec. 16. Minnesota Statutes 2012, section 256B.69, is amended by adding a
13.10subdivision to read:
13.11 Subd. 5l. Rate modification. For services rendered on or after July 1, 2013, to
13.12December 31, 2014, the total payment made to managed care plans under the medical
13.13assistance program and under MinnesotaCare for families with children shall be increased
13.14by ... percent.
13.15EFFECTIVE DATE.This section is effective July 1, 2013.
1.3health maintenance organization provider surcharges; providing a medical
1.4assistance rate increase;amending Minnesota Statutes 2012, sections 256.9657,
1.5subdivisions 1, 2, 3, 3a; 256.9685, subdivision 2; 256.969, subdivisions 3a, 21,
1.630, by adding subdivisions; 256B.441, subdivision 53; 256B.5012, by adding a
1.7subdivision; 256B.69, by adding a subdivision.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2012, section 256.9657, subdivision 1, is amended to read:
1.10 Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993,
1.11each non-state-operated nursing home licensed under chapter 144A shall pay to the
1.12commissioner an annual surcharge according to the schedule in subdivision 4. The
1.13surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds is
1.14
1.15the second month following the receipt of timely notice by the commissioner of human
1.16services that the number of beds
1.17must notify the commissioner of health in writing when the number of beds
1.18 is changed. The commissioner of health must notify the commissioner of human services
1.19within ten working days after receiving written notification. If the notification is received
1.20by the commissioner of human services by the
1.21second following month must be
1.22in the number of beds.
1.23 The commissioner of human services must acknowledge a medical care surcharge appeal
1.24within 30 days of receipt of the written appeal from the provider.
1.25(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
2.1(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
2.2to $990.
2.3(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
2.4to $2,815.
2.5(e) Effective July 15, 2013, the surcharge under paragraph (d) shall be increased
2.6to $........
2.7(f) The commissioner may reduce, and may subsequently restore, the surcharge under
2.8paragraph
2.9
2.10a facility governed by this subdivision may elect to assume full participation in the medical
2.11assistance program by agreeing to comply with all of the requirements of the medical
2.12assistance program, including the rate equalization law in section
2.13paragraph (a), and all other requirements established in law or rule, and to begin intake
2.14of new medical assistance recipients. Rates will be determined under Minnesota Rules,
2.15parts 9549.0010 to 9549.0080. Rate calculations will be subject to limits as prescribed
2.16in rule and law. Other than the adjustments in sections
2.1732;
2.18other applicable legislation enacted prior to the finalization of rates, facilities assuming
2.19full participation in medical assistance under this paragraph are not eligible for any rate
2.20adjustments until the July 1 following their settle-up period.
2.21EFFECTIVE DATE.This section is effective July 1, 2013.
2.22 Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:
2.23 Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota
2.24hospital except facilities of the federal Indian Health Service and regional treatment
2.25centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
2.26patient revenues excluding net Medicare revenues reported by that provider to the health
2.27care cost information system according to the schedule in subdivision 4.
2.28(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
2.29percent.
2.30(c) Effective July 1, 2013, the surcharge under paragraph (b) is increased to ...
2.31percent for all nongovernment-owned hospitals.
2.32(d) Notwithstanding the Medicare cost finding and allowable cost principles, the
2.33hospital surcharge is not an allowable cost for purposes of rate setting under sections
3.1EFFECTIVE DATE.This section is effective July 1, 2013.
3.2 Sec. 3. Minnesota Statutes 2012, section 256.9657, subdivision 3, is amended to read:
3.3 Subd. 3. Surcharge on HMOs and community integrated service networks. (a)
3.4Effective October 1, 1992, each health maintenance organization with a certificate of
3.5authority issued by the commissioner of health under chapter 62D and each community
3.6integrated service network licensed by the commissioner under chapter 62N shall pay to
3.7the commissioner of human services a surcharge equal to six-tenths of one percent of the
3.8total premium revenues of the health maintenance organization or community integrated
3.9service network as reported to the commissioner of health according to the schedule in
3.10subdivision 4.
3.11(b) Effective July 1, 2013:
3.12(1) the surcharge under paragraph (a) is increased to ... percent; and
3.13(2) each county-based purchasing plan authorized under section 256B.692 shall pay
3.14to the commissioner a surcharge equal to ... percent of the total premium revenues of the
3.15plan, as reported to the commissioner of health, according to the payment schedule in
3.16subdivision 4.
3.17(c) For purposes of this subdivision, total premium revenue means:
3.18(1) premium revenue recognized on a prepaid basis from individuals and groups
3.19for provision of a specified range of health services over a defined period of time which
3.20is normally one month, excluding premiums paid to a health maintenance organization
3.21or community integrated service network from the Federal Employees Health Benefit
3.22Program;
3.23(2) premiums from Medicare wraparound subscribers for health benefits which
3.24supplement Medicare coverage;
3.25(3) Medicare revenue, as a result of an arrangement between a health maintenance
3.26organization or a community integrated service network and the Centers for Medicare
3.27and Medicaid Services of the federal Department of Health and Human Services, for
3.28services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
3.29from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
3.30Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
3.311395w-24, respectively, as they may be amended from time to time; and
3.32(4) medical assistance revenue, as a result of an arrangement between a health
3.33maintenance organization or community integrated service network and a Medicaid state
3.34agency, for services to a medical assistance beneficiary.
4.1If advance payments are made under clause (1) or (2) to the health maintenance
4.2organization or community integrated service network for more than one reporting period,
4.3the portion of the payment that has not yet been earned must be treated as a liability.
4.4
4.5network merges or consolidates with or is acquired by another health maintenance
4.6organization or community integrated service network, the surviving corporation or the
4.7new corporation shall be responsible for the annual surcharge originally imposed on
4.8each of the entities or corporations subject to the merger, consolidation, or acquisition,
4.9regardless of whether one of the entities or corporations does not retain a certificate of
4.10authority under chapter 62D or a license under chapter 62N.
4.11
4.12corporation's surcharge shall be based on the revenues earned in the second previous
4.13calendar year by all of the entities or corporations subject to the merger, consolidation,
4.14or acquisition regardless of whether one of the entities or corporations does not retain a
4.15certificate of authority under chapter 62D or a license under chapter 62N until the total
4.16premium revenues of the surviving corporation include the total premium revenues of all
4.17the merged entities as reported to the commissioner of health.
4.18
4.19network, which is subject to liability for the surcharge under this chapter, transfers,
4.20assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
4.21for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
4.22of the health maintenance organization or community integrated service network.
4.23
4.24service network converts its licensure to a different type of entity subject to liability
4.25for the surcharge under this chapter, but survives in the same or substantially similar
4.26form, the surviving entity remains liable for the surcharge regardless of whether one of
4.27the entities or corporations does not retain a certificate of authority under chapter 62D
4.28or a license under chapter 62N.
4.29
4.30integrated service network ends when the entity ceases providing services for premiums
4.31and the cessation is not connected with a merger, consolidation, acquisition, or conversion.
4.32EFFECTIVE DATE.This section is effective July 1, 2013.
4.33 Sec. 4. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
4.34 Subd. 3a.
4.35non-state-operated facility as defined under section
5.1to the commissioner an annual surcharge according to the schedule in subdivision 4,
5.2paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
5.3licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
5.4beds the second month following the receipt of timely notice by the commissioner of
5.5human services that beds have been delicensed. The facility must notify the commissioner
5.6of health in writing when beds are delicensed. The commissioner of health must notify
5.7the commissioner of human services within ten working days after receiving written
5.8notification. If the notification is received by the commissioner of human services by
5.9the 15th of the month, the invoice for the second following month must be reduced to
5.10recognize the delicensing of beds. The commissioner may reduce, and may subsequently
5.11restore, the surcharge under this subdivision based on the commissioner's determination of
5.12a permissible surcharge.
5.13(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to $.......
5.14per licensed bed.
5.15EFFECTIVE DATE.This section is effective July 1, 2013.
5.16 Sec. 5. Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:
5.17 Subd. 2. Federal requirements. (a) If it is determined that a provision of this
5.18section or section
5.19requirements of the United States government with respect to federal financial participation
5.20in medical assistance, the federal requirements prevail. The commissioner may,
5.21
5.22reduced federal financial participation resulting from rates and payments determined by
5.23the commissioner that are in excess of the Medicare upper payment limitations.
5.24(b) For rates and payments determined by the commissioner to be in excess of the
5.25Medicare upper payment limits for the nongovernment-owned limit category, rates and
5.26payments shall be reduced to the limits according to clauses (1) to (4):
5.27(1) rates and payments under section 256.969, subdivisions 3a, paragraph (j); 21,
5.28paragraph (b); 30, paragraph (e); 31; and 32, shall be reduced proportionately;
5.29(2) if rates and payments remain above the limit, medical education payments under
5.30section 62J.692, subdivision 8, shall be the first reduction for the government-owned
5.31limit category;
5.32(3) if rates and payments remain above the limit, rates and payments not included
5.33under clause (1) shall be reduced in total; and
5.34(4) the state share of payments under clauses (1) and (2) shall be returned to the
5.35hospital.
6.1 Sec. 6. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
6.2 Subd. 3a. Payments. (a) Acute care hospital billings under the medical
6.3assistance program must not be submitted until the recipient is discharged. However,
6.4the commissioner shall establish monthly interim payments for inpatient hospitals that
6.5have individual patient lengths of stay over 30 days regardless of diagnostic category.
6.6Except as provided in section
6.7of mental illness shall be reimbursed based on diagnostic classifications. Individual
6.8hospital payments established under this section and sections
6.10the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
6.11inpatient services paid for the same period of time to the hospital.
6.12
6.13
6.14
6.15subdivision 11 or 12, must be limited separately from other services. After consulting with
6.16the affected hospitals, the commissioner may consider related hospitals one entity and
6.17may merge the payment rates while maintaining separate provider numbers. The operating
6.18and property base rates per admission or per day shall be derived from the best Medicare
6.19and claims data available when rates are established. The commissioner shall determine
6.20the best Medicare and claims data, taking into consideration variables of recency of the
6.21data, audit disposition, settlement status, and the ability to set rates in a timely manner.
6.22The commissioner shall notify hospitals of payment rates by December 1 of the year
6.23preceding the rate year. The rate setting data must reflect the admissions data used to
6.24establish relative values. Base year changes from 1981 to the base year established for the
6.25rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
6.26to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
6.271. The commissioner may adjust base year cost, relative value, and case mix index data
6.28to exclude the costs of services that have been discontinued by the October 1 of the year
6.29preceding the rate year or that are paid separately from inpatient services. Inpatient stays
6.30that encompass portions of two or more rate years shall have payments established based
6.31on payment rates in effect at the time of admission unless the date of admission preceded
6.32the rate year in effect by six months or more. In this case, operating payment rates for
6.33services rendered during the rate year in effect and established based on the date of
6.34admission shall be adjusted to the rate year in effect by the hospital cost index.
7.1 (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
7.2payment, before third-party liability and spenddown, made to hospitals for inpatient
7.3services is reduced by .5 percent from the current statutory rates.
7.4 (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
7.5admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
7.6before third-party liability and spenddown, is reduced five percent from the current
7.7statutory rates. Mental health services within diagnosis related groups 424 to 432, and
7.8facilities defined under subdivision 16 are excluded from this paragraph.
7.9 (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
7.10fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
7.11inpatient services before third-party liability and spenddown, is reduced 6.0 percent
7.12from the current statutory rates. Mental health services within diagnosis related groups
7.13424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
7.14
7.15
7.16care plans shall be reduced for services provided on or after January 1, 2006, to reflect
7.17this reduction.
7.18 (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.19fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
7.20to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.213.46 percent from the current statutory rates. Mental health services with diagnosis related
7.22groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
7.23paragraph. Payments made to managed care plans shall be reduced for services provided
7.24on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
7.25 (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.26fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
7.27to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.281.9 percent from the current statutory rates. Mental health services with diagnosis related
7.29groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
7.30paragraph. Payments made to managed care plans shall be reduced for services provided
7.31on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
7.32 (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
7.33for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
7.34inpatient services before third-party liability and spenddown, is reduced 1.79 percent
7.35from the current statutory rates. Mental health services with diagnosis related groups
7.36424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
8.1Payments made to managed care plans shall be reduced for services provided on or after
8.2July 1, 2011, to reflect this reduction.
8.3(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
8.4payment for fee-for-service admissions occurring on or after July 1, 2009, made to
8.5hospitals for inpatient services before third-party liability and spenddown, is reduced
8.6one percent from the current statutory rates. Facilities defined under subdivision 16 are
8.7excluded from this paragraph. Payments made to managed care plans shall be reduced for
8.8services provided on or after October 1, 2009, to reflect this reduction.
8.9(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
8.10payment for fee-for-service admissions occurring on or after July 1, 2011, made to
8.11hospitals for inpatient services before third-party liability and spenddown, is reduced
8.121.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
8.13excluded from this paragraph. Payments made to managed care plans shall be reduced for
8.14services provided on or after January 1, 2011, to reflect this reduction.
8.15(j) In order to offset the rateable reductions provided for in this subdivision, the total
8.16payment rate for medical assistance admissions for nongovernment-owned hospitals
8.17occurring on or after July 1, 2013, made to Minnesota hospitals for inpatient services
8.18before third-party liability and spenddown, shall be increased by ... percent from the
8.19current statutory rates. The commissioner shall not adjust rates paid to a prepaid health
8.20plan under contract with the commissioner to reflect payments provided in this paragraph.
8.21The commissioner shall adjust rates and payments in excess of the Medicare upper limits
8.22on payments according to section 256.9685, subdivision 2.
8.23EFFECTIVE DATE.This section is effective July 1, 2013.
8.24 Sec. 7. Minnesota Statutes 2012, section 256.969, subdivision 21, is amended to read:
8.25 Subd. 21. Mental health or chemical dependency admissions; rates. (a)
8.26Admissions under
8.27
8.28
8.29that are classified to a diagnostic category of mental health or chemical dependency
8.30shall have rates established according to the methods of subdivision 14, except the per
8.31day rate shall be multiplied by a factor of 2, provided that the total of the per day rates
8.32shall not exceed the per admission rate. This methodology shall also apply when a hold
8.33or commitment is ordered by the court for the days that inpatient hospital services are
8.34medically necessary. Stays which are medically necessary for inpatient hospital services
8.35and covered by medical assistance shall not be billable to any other governmental entity.
9.1Medical necessity shall be determined under criteria established to meet the requirements
9.2of section
9.3(b) In order to ensure adequate access for the provision of mental health services
9.4and to encourage broader delivery of these services outside the nonstate governmental
9.5hospital setting, payment rates for medical assistance admissions occurring on or after
9.6July 1, 2013, at a Minnesota nongovernment-owned hospital above the 75th percentile
9.7of all Minnesota private, nonprofit hospitals for diagnosis-related groups 424 to 432 and
9.8521 to 523 admissions paid by medical assistance for admissions occurring in calendar
9.9year 2010, shall be increased for these diagnosis-related groups at a percentage calculated
9.10to cost an average of not more than $....... each year after rateable reductions under
9.11subdivision 3a, including state and federal shares. The commissioner shall not adjust rates
9.12paid to a prepaid health plan under contract with the commissioner to reflect payments
9.13provided in this paragraph. The commissioner shall adjust rates and payments in excess of
9.14the Medicare upper limits on payments according to section 256.9685, subdivision 2.
9.15EFFECTIVE DATE.This section is effective July 1, 2013.
9.16 Sec. 8. Minnesota Statutes 2012, section 256.969, subdivision 30, is amended to read:
9.17 Subd. 30. Payment rates for births. (a) For admissions occurring on or after
9.18October 1, 2009, the total operating and property payment rate, excluding disproportionate
9.19population adjustment, for the following diagnosis-related groups, as they fall within
9.20the diagnostic categories: (1) 371 cesarean section without complicating diagnosis; (2)
9.21372 vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without
9.22complicating diagnosis, shall be no greater than $3,528.
9.23(b) The rates described in this subdivision do not include newborn care.
9.24(c) Payments to managed care and county-based purchasing plans under section
9.261, 2009, to reflect the adjustments in paragraph (a).
9.27(d) Prior authorization shall not be required before reimbursement is paid for a
9.28cesarean section delivery.
9.29(e) Notwithstanding paragraph (a), for medical assistance admissions occurring on
9.30or after July 1, 2013, the commissioner shall increase rates for inpatient hospital services
9.31at Minnesota nongovernment-owned hospitals by a dollar amount for each admission
9.32calculated not to exceed an average of $....... each year, after rateable reductions under
9.33subdivision 3a, including state and federal shares. The commissioner shall not adjust rates
9.34paid to a prepaid health plan under contract with the commissioner to reflect payments
10.1provided in this subdivision. The commissioner shall adjust rates and payments in excess
10.2of the Medicare upper limits on payments according to section 256.9685, subdivision 2.
10.3EFFECTIVE DATE.This section is effective July 1, 2013.
10.4 Sec. 9. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.5to read:
10.6 Subd. 31. Critical access hospitals. As designated under section 144.1483, clause
10.7(9), for medical assistance admissions to critical access hospitals occurring on or after July
10.81, 2013, the commissioner shall increase rates for inpatient hospital services at Minnesota
10.9nongovernment-owned hospitals by a dollar amount for each admission calculated not
10.10to exceed an average of $....... each year, after rateable reductions under subdivision 3a,
10.11including state and federal shares.
10.12The commissioner shall not adjust rates paid to a prepaid health plan under contract
10.13with the commissioner to reflect payments provided in this subdivision. The commissioner
10.14shall adjust rates and payments in excess of the Medicare upper limits on payments
10.15according to section 256.9685, subdivision 2.
10.16EFFECTIVE DATE.This section is effective July 1, 2013.
10.17 Sec. 10. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.18to read:
10.19 Subd. 32. Pediatric care. For medical assistance admissions occurring on or after
10.20July 1, 2013, the commissioner shall increase rates at Minnesota nongovernment-owned
10.21hospitals above the 85th percentile for patient days for patients under 18 years of age in
10.22calendar year 2012 of all Minnesota private, nonprofit hospitals. The increase shall be a
10.23percentage calculated to cost an average of not more than $....... each year.
10.24 The commissioner shall not adjust rates paid to a prepaid health plan under contract
10.25with the commissioner to reflect payments provided in this subdivision. The commissioner
10.26shall adjust rates and payments in excess of the Medicare upper limits on payments
10.27according to section 256.9685, subdivision 2.
10.28EFFECTIVE DATE.This section is effective July 1, 2013.
10.29 Sec. 11. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
10.30to read:
10.31 Subd. 33. Pediatric orthopedic care. For medical assistance admissions
10.32occurring on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.1nongovernment-owned hospitals above the 90th percentile for patient days for patients
11.2under 18 years of age in calendar year 2011 of all Minnesota private, nonprofit hospitals
11.3for diagnosis-related groups 453 to 517, 533 to 541, 906, and 956. The increase shall be a
11.4percentage calculated to cost an average of not more than $....... each year.
11.5The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.6with the commissioner to reflect payments provided in this subdivision. The commissioner
11.7shall adjust rates and payments in excess of the Medicare upper limits on payments
11.8according to section 256.9685, subdivision 2.
11.9EFFECTIVE DATE.This section is effective July 1, 2013.
11.10 Sec. 12. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
11.11to read:
11.12 Subd. 34. Trauma-designated hospitals. For medical assistance admissions
11.13occurring on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.14nongovernment-owned hospitals verified by the American College of Surgeons as a Level
11.15I trauma center. The increase shall be $....... each year for each nongovernment-owned
11.16hospital with the Level I trauma center designation.
11.17The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.18with the commissioner to reflect payments provided in this subdivision. The commissioner
11.19shall adjust rates and payments in excess of the Medicare upper limits on payments
11.20according to section 256.9685, subdivision 2.
11.21EFFECTIVE DATE.This section is effective July 1, 2013.
11.22 Sec. 13. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
11.23to read:
11.24 Subd. 35. Medicare volume. For medical assistance admissions occurring
11.25on or after July 1, 2013, the commissioner shall increase rates at Minnesota
11.26nongovernment-owned hospitals that serve large Medicare populations. The increase shall
11.27be based on the percentage-to-total of Medicare admissions for all Minnesota private,
11.28nonprofit hospitals, calculated to cost an average of not more than $....... each year.
11.29The commissioner shall not adjust rates paid to a prepaid health plan under contract
11.30with the commissioner to reflect payments provided in this subdivision. The commissioner
11.31shall adjust rates and payments in excess of the Medicare upper limits on payments
11.32according to section 256.9685, subdivision 2.
11.33EFFECTIVE DATE.This section is effective July 1, 2013.
12.1 Sec. 14. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
12.2 Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
12.3shall calculate a payment rate for external fixed costs.
12.4 (a) For a facility licensed as a nursing home, the portion related to section
12.6boarding care home, the portion related to section
12.7 multiplied by the result of its number of nursing home beds divided by its total number of
12.8licensed beds.
12.9 (b) The portion related to the licensure fee under section
12.10shall be the amount of the fee divided by actual resident days.
12.11 (c) The portion related to scholarships shall be determined under section
12.12subdivision 36.
12.13 (d) The portion related to long-term care consultation shall be determined according
12.14to section
12.15 (e) The portion related to development and education of resident and family advisory
12.16councils under section
12.17 (f) The portion related to planned closure rate adjustments shall be as determined
12.18under section
12.19Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
12.20be included in the payment rate for external fixed costs beginning October 1, 2016.
12.21Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
12.22longer be included in the payment rate for external fixed costs beginning on October 1 of
12.23the first year not less than two years after their effective date.
12.24 (g) The portions related to property insurance, real estate taxes, special assessments,
12.25and payments made in lieu of real estate taxes directly identified or allocated to the nursing
12.26facility shall be the actual amounts divided by actual resident days.
12.27 (h) The portion related to the Public Employees Retirement Association shall be
12.28actual costs divided by resident days.
12.29 (i) The single bed room incentives shall be as determined under section
12.30subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
12.31no longer be included in the payment rate for external fixed costs beginning October 1,
12.322016. Single bed room incentives that take effect on or after October 1, 2014, shall no
12.33longer be included in the payment rate for external fixed costs beginning on October 1 of
12.34the first year not less than two years after their effective date.
12.35 (j) The payment rate for external fixed costs shall be the sum of the amounts in
12.36paragraphs (a) to (i).
13.1EFFECTIVE DATE.This section is effective July 1, 2013.
13.2 Sec. 15. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
13.3subdivision to read:
13.4 Subd. 14. Rate increase effective July 1, 2013. For rate periods beginning on or
13.5after July 1, 2013, the commissioner shall increase the total operating payment rate for
13.6each facility reimbursed under this section by $....... per day. The increase shall not be
13.7subject to any annual percentage increase.
13.8EFFECTIVE DATE.This section is effective July 1, 2013.
13.9 Sec. 16. Minnesota Statutes 2012, section 256B.69, is amended by adding a
13.10subdivision to read:
13.11 Subd. 5l. Rate modification. For services rendered on or after July 1, 2013, to
13.12December 31, 2014, the total payment made to managed care plans under the medical
13.13assistance program and under MinnesotaCare for families with children shall be increased
13.14by ... percent.
13.15EFFECTIVE DATE.This section is effective July 1, 2013.
